This article explains several different views of tissues being used in medical research, and as property. It talks about the educational, scientifical, ethical and religious views of using human tissues for research. I think this article will be good because of the different viewpoints that it has in it about using human tissues for research. It will tie in with the subject of the tissues as property because the in order for research on the tissues today you need the consent of the patient. It also gives the moral and the religious views on the subject as a whole.
Religion and the Body in Medical Research
Courtney S. Campbell
Abstract. Religious discussion of human organs and tissues has concentrated largely on donation for therapeutic purposes. The retrieval and use of human tissue samples in diagnostic, research, and education contexts have, by contrast, received very little direct theological attention. Initially undertaken at the behest of the National Bioethics Advisory Commission, this essay seeks to explore the theological and religious questions embedded in nontherapeutic use of human tissue. It finds that the "donation paradigm" typically invoked in religious discourse to justify uses of the body for therapeutic reasons is inadequate in the context of nontherapeutic research, while the "resource paradigm" implicit in scientific discourse presumes a reductionist account of the body that runs contrary to important religious values about embodiment. The essay proposes a "contribution paradigm" that provides a religious perspective within which research on human tissue can be both justified and limited.
The retrieval and use of human tissue samples for diagnostic, therapeutic, research, and educational purposes represent further developments in scientific study of the human body as a source of medical information. Following the completion of its examination of the ethical and policy issues pertaining to human cloning in the spring of 1997, the National Bioethics Advisory Commission (NBAC) returned to the set of questions for which it had been originally constituted, including ethical issues that arise in human subjects research. One issue that proved controversial for the human genetics subcommittee of NBAC was the scientific, philosophical, and legal status of tissue and other body parts (usually surgical specimens) that had been retrieved from patients (not research subjects) who had given general consent to the use of their body materials for research and educational purposes. The subcommittee addressed questions about the adequacy of general versus specific [End Page 275] consent, the scientific merits of identifiable versus anonymous samples and claims about patient confidentiality, and the justification for patient refusals and requests that the materials be returned to the patient or discarded rather than made available for scientific research. In an effort to better understand the ramifications of research on human tissue, the subcommittee commissioned several background papers that examined these questions from ethical, legal, research, and religious perspectives. What follows is a modified version of the report on religious considerations originally presented to the genetics subcommittee of NBAC.
The central question examined in this article is whether tissue banking for purposes of research presents distinctive theological issues or prompts objections from religious communities or scholars. Religious discussion of human organs and tissues has focused largely on donation for therapeutic purposes (what I describe as the "donation paradigm"); hence, there is very little direct consideration of nontherapeutic uses of such tissue. It is possible, however, to describe implications and suggest inferences by considering (1) religious attitudes to the human body and to organs, tissues, and cells removed from the body, and (2) religious discussions of modes of transfer of body parts, such as donations, offerings, sales, and abandonment. By and large, this discussion will reflect themes that emerge from the central Western religious traditions, with some attention given to Eastern and Native perspectives.
The Body: Religious Holism, Scientific Reductionism, Private Property
The human body as an organic totality has long been the subject of theological reflection and a symbol for religious communities. However, much less attention has been devoted to the religious status of organs, tissues, cells, and DNA. The reflection of religious scholars and communities on the status of body parts has been prompted by the necessity to confront practical questions in personal and public health and in communal life, such as justifications for surgery, autopsies, organ donation, or burial. Scientific and research interest in parts of the body can sometimes conflict with religious values about bodily integrity. Indeed, E. Richard Gold cites the "disparate claims of scientific investigation and religious belief on the body" as the exemplary case of incommensurate values regarding the body. According to Gold (1996, p. 149), "The body, from a scientific viewpoint, is a source of knowledge of physical development, aging, and disease. From a religious perspective, the body is understood [End Page 276] as a sacred object, being created in the image of God. . . . The scientist values the body instrumentally, as a means to acquire knowledge; the believer values the body intrinsically, for being an image of God."
Theological holism is posed in fundamental conflict with scientific reductionism. In the Western faith traditions (primarily Judaism, Christianity, and Islam), theological holism takes as its starting point an assessment about the body in its organic totality and in its fundamental integration with the person. This assessment perhaps is characterized best as an expression of "awe" or "reverence" toward the person, who is portrayed theologically as an embodied self in the "image of God" (imago Dei). 1 This theological understanding entails that the body is intrinsic to personal identity and is invested with an aura of sacrality: the metaphors of "temple," "sacrament," "tabernacle," and "sanctuary" are prominent in religious language about the body. This profound commitment to the inherent value of the body is acknowledged even when, as upon death, the self-body interrelationship is severed. The religious traditions of the West nonetheless require respectful treatment and disposal of the corpse, which in practical terms often has meant a presumption in favor of burial following rituals of remembrance.
Body parts, organs, and tissues also can shape a sense of self. Empirical studies suggest that visible parts of the body, such as skin, genitals, fingers, hands, legs, and eyes, as well as the heart, have a strong correlation with a sense of self. With the exception of the heart, nonvisible organs and tissues are not as strongly incorporated into a sense of self. Thus, not all body parts possess equal status, or are equally important to self-identity. Moreover, men and women may value specific organs and tissues differently; males apparently value the liver as part of selfhood, while females place greater emphasis on eyes, hair, skin, and tears. It is possible, as Russell W. Belk (1990, p. 144) suggests, that the less an organ or tissue is connected with a sense of self-identity, the more willing a person will be to donate it for use by others.
By contrast, the "dis-integrating" body, or a body that is "dis-incorporated" in the sense that tissues or organs have been removed in isolation from the bodily totality may summon a sentiment not of awe, but of revulsion. The emphasis on bodily integrity in the Western religious faiths has culminated in the development of stigmas and taboos regarding certain bodily tissues when they are external rather than internal to the body. Characteristically, the dis-incorporation of bodily tissues is assessed by religious thought with reference to issues of purity and cleanliness. Very [End Page 277] prominent historical illustrations of this issue of purity, which has permeated secular culture and has not been entirely overcome in contemporary religious communities, are stigmas and taboos surrounding menstruation.
This distinction between the status of organs, tissues, and fluids when they reside in and are integrated within the body rather than exist outside and separate from the body is displayed as well in an illustration by Gordon Allport (1955, p. 43): "Think first of swallowing the saliva in your mouth, or do so. Then imagine expectorating it into a tumbler and drinking it! What seemed natural and 'mine' suddenly becomes disgusting and alien. . . . What I perceive as separate from my body becomes, in the twinkling of an eye, cold and foreign."
There are then different ways of assessing the theological and moral status of the body and of body organs and tissues depending on their location. For example, organs and tissues may be (1) intrinsic to self-identity (heart) or incidental (pancreas); (2) visible (eyes, skin) or hidden (kidney); and (3) integrated (circulating blood) or dis-incorporated (bodily excretions). In general, it may be claimed that the more an organ, tissue, or fluid possesses the former of these characteristics, the more its retrieval and use for biomedical research purposes may present theological and ethical questions. Put another way, Western religious thought on the body begins with a strong presumption that the status of the body as a whole is greater than the sum of its parts. Body organs and tissues, moreover, contain potent symbolic significance when considered as part of the bodily whole (Vlahos 1979). Yet, as noted above, organs and tissues when considered in isolation from the rest of the body may be sources of revulsion and stigma. The relevant question is what religious significance should be attributed in particular to body tissue that may be stored and used for purposes of medical science.
This question is complicated because the approach of medical science to the human body begins from a different starting point, that of "reductionism." The interest of medical science in the body stems from the prospect of gaining information about human character traits and behaviors, including susceptibilities to illness and bodily responses to disease, through studying, analyzing, and understanding the basic components of life, such as genes. DNA constitutes the building blocks of life, with cells, tissues, organs, and the like viewed as more complex, functional entities of the basic genetic materials. The scientific value of the body as a totality is instrumental to the goal of deciphering the codes, messages, and functions of the fundamental components of parts of the body that contain [End Page 278] valuable information. In this respect, the whole is reduced to the sum of its parts in two respects: (1) genes are more scientifically significant than the body totality, and (2) the value of an organ, tissue, or cell resides primarily in the information it provides researchers, rather than, for example, in its significance as a symbol of life.
An illustrative example of scientific reductionism is presented in scientific discourse about the Human Genome Project. Rosner and Johnson (1995) have identified three basic metaphors of science discourse about the genome project--interpretation of a "book" or "library," repairing a flawed "machine," or the mapping of a mysterious "wilderness"--each of which places the scientist in a dominant and exploitative role. These understandings of a scientific research project involving body organisms contrast significantly with the religious metaphors of the body as "temple" or "sacrament." Thus, although the diagnostic and therapeutic prospects of the genome project are generally viewed with great promise by religious communities, issues may emerge over the reductionist account of the body embedded in genomic research. For example, to develop the wilderness metaphor along the linguistic lines common in an issue of Science or Nature, if the human body is understood as merely a "natural resource" for "gene prospectors" to "map," "mine," and make "claims" to establish property rights, patents, and commercial products, then some religious objections may emerge that focus not on the long-term social consequences of the research, but on the intrinsic value of present studies. When the human body of the late twentieth century is portrayed in terms analogous to the land of the nineteenth century--i.e., as an exploitable natural resource whose contents are of more interest than is the integrity of the whole--then the theological question to modern science is whether the body is only the sum of its constitutive biological materials without remainder.
A prominent model of the body in legal and policy discourse is compatible with the scientific account but potentially in conflict with theological holism. This is the model of the body as "property" (Scott 1981; Andrews 1986). The property understanding stems from a claim of self-ownership and gives the individual control over the use and disposition of his or her body and body parts. This view tends to treat the body as incidental rather than intrinsic to personal identity: the body as a totality is distinct from the self, and body organs and tissues can be alienated or transferred to others without compromising the nature of the self. These features make the property model conducive to scientific interest in body [End Page 279] tissue, with the proviso that informed consent is obtained from the person. However, conflict can arise when, for example, a patient and a researcher assert competing claims or "property rights" to excised body tissues. 2
These three models ask somewhat different questions about the possibility of using stored tissue samples for research purposes. The question for the scientific and property understandings of the body is what kinds of limits may be placed on tissue research and on the transfer of bodily property. That is, the scientific and property perspectives presume the legitimacy of the use of body tissue and direct attention to the avoidance of abuse. By contrast, the theological emphasis on the embodied self and bodily integrity entails the need to articulate an argument that justifies use of the body for scientific purposes. The most common justifying argument in religious thought is that the presumption in favor of bodily integrity and wholeness may be overridden for therapeutic purposes. I will refer to this justifying argument as the "donation paradigm."
The Donation Paradigm
With few exceptions, religious thought on the body and its use within medicine has presupposed a context within which organs and tissues are donated for therapeutic purposes of healing, restoring, or saving life. This moral presumption in Western religious discourse is emphasized through the language of "gift," "altruism," "sacrifice," and the like on the part of the donor and that of "benefits" for recipients. The donation paradigm seems to incorporate four principal features:
(1) Altruistic intent. The intent of the donor of an organ or tissue is structured by gift-giving to specific beneficiaries or recipients, such as persons on a waiting list for a transplant (although the identities of such persons may be veiled from the donor).
(2) Therapeutic expectation. The expectation for the gift of the body is that it will offer a pronounced therapeutic prospect for the recipient. The provision of a needed organ or tissue should offer substantial benefits to the beneficiary, whether an enhanced quality of life or the preservation of life itself. A clear articulation of this therapeutic expectation is found in Jewish thought, where a general presumption in favor of bodily integrity can be overridden by the paramount imperative of pikkuah nefesh, the saving of human life.
(3) "Re-incorporation." Body tissue that has been retrieved from the donor, or "dis-incorporated," should in most circumstances be "re-incorporated" [End Page 280] within the body of the recipient. As noted above, tissue that remains "dis-incorporated" may evoke sentiments of revulsion and practices of stigma and taboo. Some religious practices and rituals require burial--"re-incorporation" in the earth--of removed body parts. This is particularly the case with body parts that have an identifiable human form. In Jewish thought, body parts composed of "flesh, sinew, and bones," such as limbs, should under most circumstances be buried. Roman Catholic tradition distinguishes major from minor parts of the body in a manner similar to Jewish thought. Major parts of the body are those, such as a limb, that retain their "human quality" following excision and should be buried (Childress 1989, 1995). Such concerns may reflect the importance of these visible body parts for self-identity.
"Re-incorporation" of organs or tissues in a human recipient has generative power in that it offers the prospect of new or renewed life to the recipient. In general, then, the donation paradigm prioritizes practices in which tissue remains with a body (even if transferred and transplanted to that of another person) and thus symbolizes the significance of bodily integrity and theological holism.
(4) Recipient responsibilities. The gift of the body carries with it certain responsibilities on the part of the recipient, responsibilities that are embedded in everyday practices of sharing and gift giving (Camenisch 1981; Murray 1987). These include a sentiment of gratitude toward the gift giver or toward the institutional structure that mediates the gift transfer. Gratitude also should be expressed in the actions and conduct of the recipient by which he or she makes grateful use of the gift. In addition, a gift induces a responsibility of reciprocity. Reciprocity does not necessarily mean the continuation of the gift relationship between the initial giver and recipient; rather, a recipient of donated blood, for example, may become a blood donor in the future.
The donation paradigm as delineated here provides a religious justification for medical use of human body tissue. For the most part, however, it is limited to medical practices of transplantation or transfusion, practices that promise some form of therapeutic outcome from the gift. Two questions emerge at this point: (1) To what extent is the donation paradigm compatible with the scientific or property understandings of the body? and (2) Can the donation paradigm accommodate nontherapeutic uses of body tissue, namely, uses of tissue for research purposes? I will examine these two questions in turn, using the preceding fourfold schema for comparative purposes. [End Page 281]
The Resource Paradigm
The different understandings of the body in the scientific and property perspectives carry over into perceptions of the status of body tissue. From these perspectives, body tissue is viewed as a "resource" for scientific study and exploitation; I will designate this the "resource paradigm." The altruistic intent of the "donor" is attenuated because the tissue may be acquired either through surgical procedures, in which case it assumes the status of "surplus" or of bodily "refuse" that has been discarded or abandoned, or through a transfer of "property" rights. In either case, the resource paradigm downplays or neglects the meaning of "gifts" of the body.
Body tissue is a resource because it contains information. The purpose of procuring tissues for research is to generate generalizable knowledge that advances researchers' understanding of human disease, for example, without necessarily promising therapeutic benefits to individuals, at least in the short-term. This purpose suggests two important distinctions between the resource paradigm and the donation paradigm. First, the recipient of the tissue is a member of the scientific research community rather than an ailing member of the human community. Second, research on body tissue may generate important information in the short-term, but it defers therapeutic potential to the long-term. This disparity between research that provides information that enhances diagnostic capabilities and research that generates immediate therapeutic benefits has played an important role in theological assessments of genetic research, including ethical analysis of the Human Genome Project (Bouma 1989, pp. 243-66).
Moreover, since the primary goal of the resource paradigm is the extraction of information from bodily tissue rather than its "re-incorporation" in a recipient, the tissue has no distinctive moral status and the information derived from it should be treated in the same manner as other forms of medical information. Thus, although the tissue may remain "dis-incorporated" in perpetuity, safeguards such as privacy and confidentiality are placed around the information.
The notion of recipient responsibilities also is attenuated in the resource paradigm. The researcher is not bound by responsibilities of gratitude or reciprocity because the work of the scientific community has made the retrieval of the tissue possible in the first place. There would be no gifts of the body to give were it not for the initial labor of researchers and physicians. This reiterates the paradigm's attribution of "surplus" or "property" status to human body tissue. The main responsibility of the researcher-recipient [End Page 282] appears to be ensuring that informed consent takes place. However, since the research process may lead to inadvertent and serendipitous discoveries, making it very difficult to anticipate possible research uses of tissue, disclosure of relevant information by the researcher may be very limited.
Although these contrasts between the donation and the resource paradigms may be somewhat overdrawn, such simplifications should not hide the general point that the paradigms are not easily reconciled. Indeed, if they were completely compatible, research on tissue samples would raise little in the way of distinctive ethical issues. The ethical issues emerge because of the conflict between the fundamental values embedded in each of the paradigms--e.g., a personalized gift given for the specific purpose of benefitting another versus depersonalized surplus or property retrieved in order to generate information that may not even have therapeutic value. This conflict in turn is rooted in the paradigms' differing approaches to the body: holism, which places the moral burden of proof on those who seek to justify uses of the body, and reductionism, which places the moral burden on those who seek to impose limits on uses and prevent abuses of tissue that will be used in research. The question is whether there is another paradigm that, on one hand, retains the aspects of gift, benefit, and responsibility embedded in the donation paradigm and, on the other, retains the importance of generating generalizable knowledge through biomedical research and permits research with human tissue samples, features vital to the resource paradigm.
The Contribution Paradigm
The use of human body tissue for research poses a problem for the donation paradigm, which is central to religious understandings of the body and of moral life, because such use generally does not involve personalized gifts of the body for therapeutic purposes. I want to suggest a third paradigm, which seeks to bridge the gap between the donation and resource paradigms. I will refer to this as the "offering" or "contribution" paradigm. This paradigm retains the morally valuable features of the donation paradigm while providing a justification for biomedical research undertaken without therapeutic intent. It also reflects the importance of medical research to the generation of generalizable knowledge, but imposes some limits on the scope and extent of research on human tissues. Again, the four features of the donation paradigm will be used to illuminate distinctions and comparisons. [End Page 283]
An analogy helps to illustrate the moral context of the contribution paradigm. In this analogy, following Belk's (1988, p. 152) suggestion that "the house is a symbolic body for the family," household goods take the place of human tissue samples. Household goods can be discarded in many ways, but I will focus on three. Some goods are donated, for example, clothing to a community goodwill program. This presents an example of a gift or an altruistic action designed to benefit others and to enhance a recipient's quality of life. A different set of household goods are those that have been consumed completely and whose benefits have been exhausted; such goods now are discarded through a community service agency, for example, a trash collection service. Household refuse has no personal meaning to the discarder, who is typically quite willing to pay a fee to have the material removed. This does not, of course, pre-empt the possibility that the refuse may have value to someone else. A third form of disposal involves household materials whose original use has become obsolete--e.g., plastic or cardboard food containers--but which now are "recycled" by organizations that have the knowledge and expertise to convert the materials into something beneficial for the community.
This analogy underscores the claim that not all body organs and tissues have equal status (Belk 1988, p. 157). Some body parts, such as the heart, eyes, or blood, may have such symbolic significance and connection to personal identity that their donation is the moral equivalent of a gift of self. Other body tissues, for example, urine or hair clippings, may have such minimal value to the sense of self that they are routinely discarded. Still other organs and tissues, such as the pancreas, liver, spleen, marrow, and the like, fall in between these examples; they are not as central to personal identity as the heart or eyes, but not as incidental as urine. As indicated above, the status of human tissues is shaped not only by their contribution to personal identity, but also by their visibility and location relative to the bodily totality. These considerations also suggest that human tissue samples procured for research purposes fall into the middle category, making them analogous to domestic recyclables. The features of this analogy form the basis for the contribution paradigm.
Contributor Intent
An individual who places recyclable materials at the curbside is not necessarily making a personalized gift, but rather is contributing to a cause that is larger than oneself and the benefits one might provide in a direct or [End Page 284] mediated relationship with another person in need. The cause in the domestic case may be "environmental preservation"; in the case of body tissue, it may be designated as "scientific discovery" or "medical progress." The contribution in both cases is one of nonspecific generosity, "nonspecific" in that the recipient is a "cause," rather than a specific person intended as the beneficiary and "generous" in that the contributor is participating in the advancement of the larger cause when he or she could just as easily place the recyclable material in the refuse bin without moral blame or request either disposal or return of the body tissue.
Beneficial Expectation
Although the contribution does not bring benefits to a specific or designated individual, the contributor's expectation is that benefits will accrue over time to the whole of society, or least to those persons with a stake in the justifying cause. In most instances, the beneficiaries will be future patients, persons, or generations (although the contributor can also be a beneficiary).
One's contribution of either domestic or bodily recyclables provides the raw materials to which persons and institutions with the requisite knowledge can apply their technical skills and expertise. Unlike the resource paradigm, however, the willingness to contribute does not imply that the contribution has little or no value to the contributor. A plastic milk jug that can be recycled is equally serviceable as a water jug, and newspaper can be a fire starter. Similarly, a person may attribute value to many tissue specimens, including blood, reproductive tissues, skin, or hair, that have been retrieved or excised from the body. Rather, the difference between the resource and contribution paradigms lies in the fact that in the latter, something of value is contributed to a person or organization through whose work the society realizes a greater benefit than if the contributor had retained or discarded the material. The contribution paradigm thereby intends a benefit for the common good.
Symbolic "Re-Incorporation"
The religious understanding of the body that prevails in the West commonly requires some practices or rituals that re-incorporate tissues that are removed from the body either into another body, in the case of organ transplantation or blood transfusion, or into the earth through burial. The contribution paradigm can meet this condition through symbolic "re-incorporation." [End Page 285] Just as recycling contributes to the good of the communal body, the contribution of body tissues for research can provide information that can then be integrated within a larger, symbolic body, namely, the "body of scientific knowledge."
Recipient Responsibilities
Contributions generally are acknowledged in some way by the recipient; it therefore seems important for contributions of bodily tissue to be acknowledged with some expression of gratitude. Such acknowledgment might occur during the informed consent ritual, at which time a researcher would not presume that the contributor should simply "sign off" to any and all uses made of retrieved body tissues, but instead might directly thank the person for their contribution to the advancement of scientific research. The researcher, acting as trustee for the community, also has a responsibility to use the contributed tissue for the common good. At a minimum, this responsibility requires treating the information generated by tissue research with safeguards to ensure protection against discrimination or harm to the contributor. The appeal to the "common good" also need not preclude recourse to the private sector to carry out research; in some cases, as with domestic recyclables, the good of all can be more efficiently and effectively achieved through private sector initiatives. However, any profit interests must be subordinated to and limited by the common good and the greater cause that the contribution is designed to advance. Retrieved body tissue is a source of good, and not merely a resource for financial gain. The contribution paradigm precludes viewing body tissue as merely an economic asset.
The contribution paradigm thus provides a justification for research uses of human body tissue, a justification that was absent in the donation paradigm due to its focus on direct therapeutic prospects. It also imposes limitations on research, such as the importance of the common good, "re-incorporation," and informed consent, that are absent in the resource paradigm because of its focus on using the body merely as a means to generate generalizable information. Table 1 summarizes the overlap and differences of the three paradigms.
Despite the distinctions between the paradigms, it may be argued that the contribution paradigm is philosophically unnecessary and that the donation paradigm can be extended beyond the therapeutic setting to accommodate the issues that emerge in the nontherapeutic contexts of research and education. This extension is embedded in the common declaration: [End Page 286] "I want to donate my body to science." In this statement, the donation model is joined with the advancement of a cause--the progress of medical science through research projects or training of prospective researchers--without expectation of therapeutic benefits to an individual recipient. Thus, cadaver donation might provide an example of extension of the donation paradigm in which the major themes of the contribution paradigm are largely incorporated.
There is a certain legitimacy to the extension argument, especially as it appears embedded in common discourse about whole body donation. I am not convinced, however, that the extension can be made so readily for all religious traditions in the context of body donation, nor that it applies to all forms of nontherapeutic research using bodily tissues. I shall discuss in more detail the substantive restrictions that emerge in several traditions with respect to cadaver donation. The point is that the integrity of the body upon death and the absence of direct or immediate therapeutic benefit from research on the corpse do seem to establish important moral presumptions for some faith traditions, particularly within Jewish and Islamic thought, but also within some Christian communities and practices. [End Page 287] These presumptions restrict a broad extension or application of the donation paradigm even in the case of whole body donation.
Furthermore, the use of cadavers for research and medical training is illuminating but not necessarily prescriptive for the set of questions regarding tissues and fluids, such as surgical specimens or blood draws, that have been retrieved from the body for research projects. To treat these bodily materials as severable from the body of which they were once integral parts is to see them according to the resource or property paradigm of biomedical science. The question now is to examine the extent to which the contribution paradigm and the resource paradigm are compatible with specific religious attitudes toward the human body and body tissues.
Implications Of Embodiment
The analysis to this point has situated ethical issues in research on human tissue within the broad framework of Western religious thought. The issues and conflicts may be different when consideration is given to the pluralism present in diverse faith traditions on the status of the body, the body's relationship to self, and the status of body parts. Protestant theologian William F. May (1985) has identified a continuum of five "religious" attitudes on the status of the body and its parts that is useful to review in the context of retrieval of human tissue:
DUALISM----GNOSTICISM----EMBODIMENT----
MATERIALISM----IDEALISM
This typology relies on questions such as whether the body has a phenomenal reality, is ontologically good, and is intrinsic or incidental to personal identity.
Dualism affirms the phenomenal reality of the body but denies the body's goodness because of its association with flesh and matter. The body is portrayed as being "at war" with the self, its literal mortal enemy. Parts of the body, disposal of the body, and persons who come into contact with a corpse are denigrated, stigmatized, and considered taboo and sources of pollution or uncleanness.
At the opposite end of the continuum, idealism denies that bodily life has any ultimate significance. The body, disease, and death are constructs of the mind that can be transcended through identification with a separate realm of the spiritual. The self seeks its true home in this spiritual [End Page 288] realm, and relies on spiritual healing rather than on medical ministrations to achieve this goal. Body parts and study of the body are not denigrated as much as seen as existentially indifferent.
The gnostic attitude seeks liberation of the true self from the body, which is understood as a prison of the soul. The true self resides in a disembodied mind or consciousness. Knowledge is the means to liberation, which entails overcoming the burdens of mortality including finitude, disease, and death. Body parts have no significant value.
Hindu and Buddhist teachings about life's purpose reflect a similar appraisal of the secondary status of the body and the necessity of liberation from the bodily world. The body is incidental to personal identity--indeed, a self may be incarnated in several bodies--and the true self resides in a realm of trans-bodily consciousness.
May argues that in Western thought the gnostic attitude lives on in philosophical Cartesianism. The Cartesian separation of self (mind) and body (matter) is embedded within the ideology of biomedical research; as exemplified above, the body is perceived merely as a "resource" for obtaining raw biological materials that can, through study and application, be converted into drugs that offer mastery over nature (Campbell 1995). The Cartesian separation of self and body has a further consequence, namely, that there is no moral necessity for informed consent to the removal of bodily tissue, or to its subsequent use in research. Since a body is incidental to personal identity, the retrieval of an organ, tissue, or cell cannot be said to violate persons and their integrity, even if their bodily space is violated. In this respect, informed consent appears to be a rule without a rationale. Its use under the resource paradigm may be a signal of the general inadequacy of that paradigm with respect to human tissue research.
In contrast to an approach that seeks to master nature, the materialistic attitude to the body is shaped by an ideology that human life is at the mercy of powers in nature that are arbitrary, abusive, and destructive. This can lead to two different and conflicting perspectives both of which are present in Western cultures, avoidance/denial of aging, death, and the like, and resistance. The latter belief is enacted primarily through the practice of medicine and its war on death and human disease. In this perspective, the body assumes the role of primary "battleground." A patient may give consent to invasive procedures but is principally a passive observer to the battle plan carried out by physicians and researchers. A successful [End Page 289] waging of the war often requires excision of body parts or removal of tissue; such parts thereby assume the status of surplus.
Within this typology, the dualistic, gnostic, and materialistic perspectives can be construed as compatible with the resource paradigm of biomedical research. The idealistic attitude, by contrast, finds in medical research a misguided attempt at medicalization of the metaphysical. Research on human tissue samples raises ethical issues only in those traditions that understand embodiment--that is, the intrinsic relationship of body and self--as a fundamental given of human life. Such attitudes are embedded in the monotheistic traditions of Judaism, Christianity, and Islam. These traditions affirm the ontological reality of the body as well as its intrinsic moral goodness, in contrast to the instrumental value embedded in Cartesian and materialist thought. Moreover, the Western traditions affirm the intrinsic nature of the body to personal identity: human beings are embodied selves, not simply souls or minds housed within a corporeal prison.
These features provide religious and moral validation for medical interventions in the body. The reality and goodness of the body entail the use of medical procedures to restore and heal. The fundamental connection of body and self makes consent of the person a moral mandate with respect to invasive medical procedures and removal of bodily tissue, healthy or diseased. However, the rationale for consent does not necessarily presume personal ownership of the body. Instead, control over the body and its disposition is a responsibility often portrayed as "trusteeship" or "stewardship" from the Creator (Campbell 1992). Responsible stewardship involves accountability for uses of the body and orientation of such uses toward the common good. Ethical positions and liturgical rituals, for example, can justify sharing the body as a form of altruistic service to others. The trusteeship understanding thereby rules out viewing the body merely as property or merely as a resource for economic gain.
Within these traditions, it is clear that the donation paradigm is prominent with respect to organ transplants or transfusions of vital tissues (blood, bone marrow). Discussion of the use of body tissues for research or educational purposes is minimal. It is possible to begin such discussion, however, by considering theological perspectives on issues raised by donation of the intact body to medical schools for research or teaching purposes and by autopsy. These actions provide some examples of uses of the body in medicine without direct therapeutic benefit, and thus may illuminate important theological principles and precedents. [End Page 290]
Body Donation and Dissection
Judaism
Rabbinic writings give high esteem to the body as the "masterpiece" of creation. God is worshiped through the body: The 248 positive precepts of the Torah are said to correspond to the number of body parts and the body is compared to a Torah scroll in its sanctity (Jacobs 1997). Even though the connection between self and body may be severed (through death, for example) there remains a presumptive obligation of respectful care for the corpse (kavod ha'met). This obligation supports preserving the integrity of the corpse as a symbol of the person and as a requirement of care for God's creation, and precludes desecration of the corpse. Jewish tradition therefore presents a strong presumption in favor of respecting bodily integrity before and after death.
However, this presumption can be overridden (as can all commandments in Jewish law, save for prohibitions against murder, idolatry, and illicit sexual relations) by the requirement of pikkuah nefesh, the saving of human life. Disputes within Judaism about the moral status of donating the whole body to medical schools for the education of prospective physicians reflect differences over the priorities given to these two primary obligations in Jewish law.
Within the moral framework set by these two principles, some Orthodox rabbis object to body donation unless it has an immediate practical benefit to a needy patient. Other rabbis permit body donation in principle because it contributes to medical education and benefits future patients through the anatomical studies carried out by present researchers. The principal proviso in this understanding is that the body parts dissected for study be preserved and eventually receive a respectful burial in conformity with Jewish law (Dorff 1996a, pp. 16-18). The emphasis on burial and "re-incorporation" of the body in Judaism is also illustrated by the practices of ultra-Orthodox Jews in Israel, who, following a terrorist bombing, attempt to locate all dismembered body parts for proper burial. Although Jewish thought appears in principle to permit donation of the body to medical science, some Jewish scholars have cited a surplus of cadavers available for research and training at medical institutions and contend that there is, therefore, no practical imperative to such donation within the tradition. [End Page 291]
Roman Catholicism
Roman Catholic thought affirms the intrinsic nature of the body to both personal and religious identity. Bodily life is incarnational and "sacramental," that is, a revelation of the divine in corporeal form. The sacramental nature of the body is reaffirmed in central doctrinal teachings (the incarnation of Jesus, the resurrection of the physical body), liturgical rituals (baptism, the Eucharist), and ecclesiastical identity (the Church as corpus Christi or "body of Christ").
As in Judaism, Roman Catholic discussion about the religious status of the body and body parts often has emerged from such contexts as cadaver dissection, surgery, and organ transplants. The major theological principle invoked in moral deliberation is that of totality, which presumes a background commitment to bodily integrity and functions and a correlative prohibition against mutilation. The principle of totality historically justified the removal of a diseased part of the body, such as by amputation, for the benefit of the whole body. The interpretation of totality has been expanded subsequently to encompass psychological as well as physiological benefits to the person and to refer to natural body functions (primarily procreative) as well as to body parts. However, Pope Pius XII maintained that totality does not justify communal claims on the body through an appeal to collective or social benefits (Gallagher 1984; Curran 1995).
Although Roman Catholic teaching specifically has addressed the practice of autopsy (as discussed in the following section), there appears to be no direct comment in canon law or in catechesis on whole body donation for non-autopsy-related research or for educational purposes. Otherwise, the "bodies of the dead are to be treated with respect and charity" (Catholic Church 1994; Coriden, Green, and Heintschel 1985, p. 837).
Islam
Attitudes toward the body in Islam both perpetuate and differ from those displayed in Judaism and Christianity. The Islamic understanding of the human body stresses the importance of body wholeness at death. Islam affirms a general presumption against donation of the body for anatomical dissection that reflects the principles of the dignity of the human body and a prohibition on its mutilation (Rahman 1989, p. 106). Moreover, bodily parts possess a religious significance that parallels the [End Page 292] Jewish correspondence between body parts and God's commandments: in Qur'anic teaching, God will require each part of the human body to "account for the actions of the person whose bodily organs they formed" (Sachedina 1988).
The principal doctrine in Islamic thought that bears on uses of the body is not creation, as in many Jewish and Christian views, but rather the themes of judgment and bodily resurrection. Although Allah has the power to summon dispersed body parts into an organic whole, Islamic views of bodily resurrection typically have supported immediate burial of an intact cadaver. Dismembered remains, especially those composed of flesh, sinew, and bone, also should be buried out of respect for bodily sanctity.
Protestantism
Protestantism lacks a unifying principle, such as pikkuah nefesh or totality, to ground whole body donation or removal of body parts and tissues. Some arguments have appealed to the Protestant vocation to discern the workings of the divine order through the natural world. Critics have maintained that this view supplants the sovereignty of the Creator with the sovereignty of creation and, in the modern context, gives primacy of place to science and technology rather than to worship. The Protestant affirmation of personal autonomy confronts counterclaims that self-determination reduces the image of God to a disembodied will. Although these positions give a theological warrant for medical interventions and uses of the human body, both seem unable to set limits on scientific or personal autonomy with respect to uses of body parts.
William F. May's argument for the donation of body parts, primarily organs and tissues for transplantation, appeals to a different strand of Protestant thought, which emphasizes love of neighbor. The central Christian ritual of the Eucharist, patterned after the passion of Jesus, exemplifies love of neighbor through sharing one's body to serve others. Love of neighbor provides a profound religious motivation for organ and tissue donation that, because of its altruistic expression, is not susceptible to the criticisms directed against autonomy. Moreover, love of neighbor provides a standard against which to assess noncommunal motives for body and tissue removal, such as personal financial gain (May 1985). [End Page 293]
Autopsy
Judaism
The Jewish approach to autopsy again invokes the basic principles of nondesecration and the preservation of life. Within this moral structure, autopsies may be permitted under certain limited conditions: when they are legally required, when the cause of death cannot be determined, when an autopsy may help save the lives of persons suffering from an illness similar to the cause of death of the deceased, or when relatives might be protected by learning of hereditary illness (Jakobovits 1959, p. 150). In the rare circumstances under which an autopsy is performed, only small amounts of blood, fluid, and tissue can be removed for analysis; organs must be examined intact within the body; and the body must be buried whole (Iserson 1994, pp. 157-58).
Roman Catholicism
In the Roman Catholic tradition, Pope Pius XII declared that autopsy can be morally permitted so long as two conditions are satisfied: (1) the body must be treated with respect and not objectified or treated as a "thing," and (2) the family of the deceased person must consent to the procedure (Hamel 1996, p. 17). The Catholic Church (1994, p. 553) deems autopsies to be morally permissible for either legal inquests or scientific research; this would seem to allow for complete autopsy, so long as the provisos of consent and respect for the body are satisfied.
Islam
The strong presumption in Islamic thought on bodily wholeness at the time of death limits the scope of acceptable autopsies. Autopsy is therefore not a routine medical procedure, but the presumption can be overridden and requests for autopsies can be accommodated in cases where death occurs from suspicious causes (Sachedina 1988). The use of human tissue for research purposes is precluded, however. Instead, anatomical research in Islamic medical schools frequently is performed on animals.
Protestantism and Other Traditions
Other religious traditions that have articulated objections to autopsies include Orthodox Christianity, Hinduism, and Shintoism (the indigenous religion of Japan). It is also common for Native Americans to refuse to [End Page 294] give permission for autopsy, unless it is an absolute legal requirement (Quigley 1996, pp. 115-20). Protestant perspectives, by contrast, generally reflect deference to familial autonomy-autopsy is a permissible procedure if the family of the deceased consents.
Fetal Tissue
Fetal tissue research provides another context for religious discussions of research on bodily tissue, although this practice is not as clear an illustration as autopsy because the procurement of fetal tissue is complicated by its moral proximity to abortion. In their presentations to the Human Fetal Tissue Transplantation Research Panel of the National Institutes of Health in 1988, some rabbis invoked the Jewish principle of pikkuah nefesh, that is, therapy to a specified individual, as a justifying condition for the use of fetal tissue. Rabbi J. David Bleich, however, interpreted research on fetal tissue as "research protocols with undetermined and remote benefits for future patients, rather than therapeutic protocols with high probabilities of immediate benefits for current patients" (see Childress 1997, pp. 301-28).
Roman Catholic teaching holds that fetal remains should receive the same respect as the corpse of any human being and that obtaining fetal tissue for research purposes from direct abortion constitutes complicity in moral evil. Other religious objections have focused on the possible commercial exploitation of fetal tissue.
Tissue Research
These few examples of religious discussion regarding use of the human body and human tissue for research and education reiterate the importance that some religious traditions attach to the integrity and totality of the body. Even under the circumstances in which body donation or autopsy is deemed permissible (or legally required), researchers and educators have an obligation to maintain respect for the corpse as a symbol of the person. Beyond these rather limited examples, there seems to be minimal religious discussion of use of human tissue for research purposes when the tissue is acquired from living persons through routine medical procedures--e.g., blood draws, postpartum retrievals of placentas or umbilical cord blood, or surgical excisions. A recent study of ethical issues in the banking of umbilical cord blood, for example, recommended sensitivity to "the variety of beliefs held [by individual patients] regarding the placenta and umbilical cord," but acknowledged a general "dearth of information" [End Page 295] with respect to more general cultural attitudes (Sugarman et al. 1997). Yet, in many indigenous cultures, including Native American, the placenta, umbilical cord, and umbilical cord blood have sacred symbolic value associated with the creation of life and personal identity (Mead 1996). This disparity between the meaning of body tissue to researchers and its meaning to members of religious traditions should be a central concern of biomedical research policy and clinical ethics. Three traditions will be surveyed briefly with respect to their openness to new research proposals that use human tissues or cells.
Judaism
Based on the obligation of pikkuah nefesh, the questions with respect to human tissue banking for purposes of research and genetic analysis within Jewish thought are: (1) whether such research promises probable benefits rather than serendipitous discoveries, (2) whether it will benefit patients and not simply provide scientists with general knowledge of genetics, and (3) whether the benefits will accrue to present or to future patients. Thus, guidelines for policy on tissue research reflecting Jewish thought would limit scientific autonomy on grounds of respect for persons as embodied selves; of beneficence, especially specific benefits to patients; and of justice with respect to the distribution of benefits between present and future patients.
Retrieval of body tissue to increase general medical knowledge or to establish epidemiological data through tissue banking generally does not satisfy the criterion of providing an immediate practical benefit to another person. However, interpretative issues surround the concepts of "immediate," "probability," and "benefit." Dorff (1996b, p. 171), for example, contends that retrieval of organs for transplant is permitted if it is "known that the body part will eventually, but definitely, be used for purposes of transplantation" (emphasis added). This reasoning would also seem to validate tissue storage--e.g., blood banking--for therapeutic purposes.
Roman Catholicism
Roman Catholic thought does not require the medical use of body parts to meet conditions of immediacy and specific benefit. This tradition therefore seems more open to the possibility of human tissue banking than does Judaism, although magisterial teaching usually presumes a therapeutic [End Page 296] potential. It is possible to donate some body tissues (such as blood) either to institutions such as blood banks for storage and eventual use or to specific persons with immediate needs.
Native American Religions
The diversity of Native American religions and their practices regarding the body are just beginning to be studied by bioethicists. In the most general terms, Native traditions emphasize a holistic understanding of the relationship between the self, the body, and nature. Bodily remains are sacred for Native Americans; disturbance of a grave site is a sacrilege. Cultural sensitivity to Native values about the body and ancestral bones led to the passage in 1990 of the federal Grave Protection and Repatriation Act.
Native American practices are also oriented by the primacy of the whole over the part, and the moral priority of the community over the individual. As William Freeman argues, this emphasis has important implications for research studies, including research on human tissue. He suggests that the informed consent of individual patients may not be morally sufficient and that communal consent and perhaps communal participation in the development of a research protocol are more consonant with Native values. This argument also entails that the community can experience harm even if individual participants receive protections of confidentiality and anonymity. For example, studies that seek to determine whether a genetic predisposition to alcohol exists among Native Americans may stigmatize an entire population (Freeman n.d.).
Theology and Policy: Respect for Religious Values
These examples illustrate the importance that many religious traditions attach to the body as a whole, and to parts of the body that are excised or otherwise removed, as well as the strong presumption that removal of organs or tissues should have therapeutic potential for the recipients. Given these presumptions, I am not persuaded that the donation paradigm can be readily extended to encompass the clinical and ethical issues raised by biomedical protocols to retrieve bodily tissue for nontherapeutic purposes of research or education. I have articulated an alternative paradigm of contribution that retains the features of the donation paradigm that are important for faith traditions and also provides theological legitimacy for promising scientific research on human tissues and cells. In this way, the [End Page 297] contribution paradigm offers both justifications for such research (absent from the donation paradigm for nontherapeutic investigations) and limitations on such research (absent from the resource paradigm). With these stipulations in mind, I wish to conclude with some recommendations about how these religious values about the body can be both respected and applied within public policy and research settings.
(1) Public Education on Human Tissue Banking is Vital.
It is difficult to interpret the meaning of the silence of religious traditions on medical issues. In some cases, it may reflect a particular tradition's commitment to personal autonomy and conscience in making health care decisions. In other traditions, silence may indicate that the issue at stake is morally unproblematic and therefore left to the individual to decide. Given the strong convictions about the body present in most religious traditions, however, the absence of religious discussion on tissue banking for research purposes may also reflect widespread lack of awareness. Education of the public, including citizens who are members of religious communities, should be an essential part of concerted public and biomedical policy on use of human tissue for research. Since it is the research community that seeks access to human tissue, the moral burden should fall on researchers to elicit from prospective tissue contributors, both individual and communal, the values and meaning they attach to the requested tissue. An additional rationale for public education that provides a clear account of ongoing or proposed research on human tissue is the preemption of religious objections that are based on fuzzy understandings of science and muddled theology.
(2) The Informed Consent Process for Obtaining Authorization to Use Human Tissue for Research Should Be Specific, Substantive, and Sensitive to Religious Values about the Body, Both Personal and Communal.
"Religious" beliefs, such as belief in an afterlife or in bodily resurrection, have been commonly cited as grounds for refusal to sign organ donor cards. In the absence of general public awareness, it is likely that similar objections may surface when requests are made to use retrieved tissue for research purposes.
Informed consent is described by the Protestant ethicist Paul Ramsey (1970, p. 5) as the "cardinal canon of loyalty" between patient and medical professional, whether physician or researcher. Informed consent is the [End Page 298] tangible expression of an implicit covenantal bond between the patient (as person) and professional in a joint enterprise to develop medically useful knowledge. This influential understanding of the meaning of informed consent requires a version of "thick" or specific consent to the use of human tissue rather than a general or implicit consent to any research and educational uses. Specific consent is compatible with and extends the values underlying the contribution paradigm and makes it possible for persons to understand themselves as contributing partners in the scientific enterprise of generating important knowledge.
Roman Catholic teaching emphasizes that informed consent should protect the dignity of the human person, but it can only do so when physicians or researchers adopt a holistic rather than reductionist view of the patient as person. Pope John Paul II stated that "in the body and through the body, one touches the person himself in his concrete reality." Thus, even though physicians and researchers may have a scientific interest in specific body tissues, the informed consent process should inform and respect the embodied self rather than proceed as though the self is a disembodied will (Hamel 1996, pp. 6-7).
During the informed consent process, researchers should be cognizant of the significance of "symbolic" harms for members of some faith traditions. The language of biomedical description can hinder understanding and comprehension within some communities, as revealed in studies on information disclosure among the Navajo (Carrese and Rhodes 1995). Researchers thus need to be familiar with, and sensitive to, the communicative processes within a religious or cultural tradition.
The idea of symbolic harm is often placed at the boundaries of bioethical controversies, portrayed as a mere "sentimental" or "speculative" concern rather than as a tangible substantive harm equivalent to the direct injury of the person. Yet, religious traditions are centrally organized around symbol-systems; indeed, "symbolism is the language of religion generally; it is to religion what numbers are to science" (Smith 1991, p. 262). Issues of symbolic harm should not be dismissed in the research setting. As previously described, the body is a symbol of the divine in much religious thought. Symbolic harms inform religious restrictions on, for example, appropriate treatment of the corpse, such as the prohibition of desecration found in Judaism, thus placing off-limits body tissue that might otherwise provide important medical knowledge through dissection or autopsy. The study and subsequent disposal of body parts by means other than burial also may constitute harm of a symbolic nature. [End Page 299]
(3) The Patient Should Be Regarded as Possessing Dispositional Authority over his or her Body, and over the Specific Research Uses of Retrieved Human Tissue for which Informed Consent is Sought.
It may be argued that the general recognition by religious traditions of the liberty of persons to donate organs or tissues constitutes an implicit property right of the person to their body parts. This interpretation, however, seems to contravene the basic theological conviction of the Western traditions that any "ownership" rights to the human body reside in the Creator and that persons are trustees or stewards over their bodies rather than owners.
There are two different approaches to resolve this potential conflict. First, one might accept the validity of the ownership-property model but still seek to distinguish between God's creation (the body) and human intervention (retrieval of body parts). A second approach claims that concepts of ownership and property are misguided ways to think about the human body and its parts. Property discourse, which is shaped in large part by market values, effectively preempts other discourses of value about the human body, including religious discourse (Gold 1996, pp. 125-43, 164-77). Property discourse emphasizes a relationship with "things"; the theologies of the body addressed above consider the body so intrinsic to personal identity and invest the body with such symbolic significance, as conveyed in the rich imagery of "temple" or "sanctuary," that attribution of the status of "thing" to the body is inadequate.
This function of property discourse about the body is no different than the historical role of property discourse: "property" is the language of power. Property discourse empowers an agent with decision-making authority about use, transfer, and disposal of possessions, whether they be land or ideas ("intellectual property"). It seems possible, and from a religious understanding, desirable, to refer to the person whose body tissues might be donated or retrieved as holding dispositional authority over the body without presuming that this authority implies ownership or property rights. Since trustees and stewards can be authorized to share the goods entrusted to them for the benefit of others, this distinction between dispositional authority and property rights does not impugn the ultimate sovereignty or ownership of the Creator over the body.
(4) Contributions of Human Body Tissue for Purposes of Advancing Scientific Research and Knowledge are Ethically Preferable to Other Modes of Acquisition of Tissue, such as Sales or Abandonment. Any [End Page 300] Compensation to Individuals for their Contribution Should Not Presuppose or Encourage an Organized and Regulated Market in Human Tissue.
The donation and contribution paradigms are strongly supported in Western religious traditions by discourse on symbols of "gifts," "sacrifice," and "altruism." This emphasis raises important questions regarding the prospects of acquiring bodily tissue through commerce and sales. The latter approach seems more compatible with the resource and property understandings of the body. The Protestant ethicist William May (1985) is especially critical of proposals that commercialize the body, arguing that they reflect "no religious view but rather . . . a wholly secularized marketplace that permits one to reduce any and all things to assets for sale." The claim that the religious status of the body is incompatible with a market in body tissues and cells resonates even with nonreligious writers, who nonetheless appeal to religious language of "reverence," "awe," or "sacred" to express criticism of property and market models of the body and of human biological materials. It seems fair to state that religious thought, in addition to objecting to scientific reductionism of the body, would find economic reductionism morally problematic.
Roman Catholic teaching has expressed some openness to compensation of donors, though not to a full-scale organ or tissue market. Pius XII expressed concern about the "grave abuses" that may ensue from routine market transactions in bodily parts, but qualified his reservations by stating, "it would be going too far to declare immoral every acceptance or every demand or payment. It is commendable for the donor to refuse recompense: it is not necessarily a fault to accept it" (Childress 1989, p. 236). The donation and contribution paradigms are perhaps best embodied and facilitated by altruism, but compensation--which is morally and institutionally different than a system of commerce in body parts--may be ethically acceptable for some religious traditions, although not ethically ideal or preferable.
(5) Procedures for Retrieval, Storage, and Research Use of Human Tissue Should Incorporate Provisions for Protection of Confidentiality. Such Procedures Should also Provide Protections for Communities.
The preceding analysis has emphasized the importance in religious thought of the body as partly constitutive of personal identity. Although the retrieval of tissue from the "dis-incorporated" body may diminish the [End Page 301] intrinsic connection of self and body in many circumstances, the prospects of genetic analysis of tissue samples and research constructions of a person's genotype can reaffirm this connection in important and potentially risky ways. The concern here is not an expression of theological reductionism, that is, a view that personal identity is derived from genetic makeup. Rather, the issue is that, in a society in which genetic information may be highly valued to parties outside the contributor-researcher relationship, disclosure of this information to such parties may have a significant impact on a person's social self. The religious understandings of the body therefore establish a strong presumption in favor of protecting this information as confidential.
The justification for confidentiality is embedded in the features of the contribution paradigm. The moral intent of the contribution is to facilitate the advance of biomedical research through the generation of generalizable knowledge. Research that discovers and discloses specific, identifying information, by contrast, risks violating the moral intent of the contribution. Moreover, a contribution entails recipient responsibilities, including a responsibility to prevent harms, such as discrimination, from befalling tissue contributors. These features present presumptive arguments in favor of protecting information as confidential. Moreover, in some research studies where samples are taken from members of a larger community, it is possible for the community to experience harms and stigmas from information disclosure, even if the particular individuals from whom tissues are retrieved remain anonymous. Procedures to protect confidentiality do not preclude contributors from waiving their claims to confidentiality however.
Conclusion
This essay has sought to situate the ethical dilemmas posed by biomedical research on human tissue within a context of various religious understandings of embodiment. If there is one common theme among the theological diversity in this area, it is the affirmation of the moral significance of the body in its organic totality and a concern that biomedical research may encourage a reductionist attitude toward the body. Should this attitude prevail, the awe demanded by the presence of an embodied person will be diminished to the extent that the self is seen primarily as a disembodied will. The central theological concern is that the sacral role of the body be acknowledged in order to justify biomedical research on bodily tissue. Within the justifications and limitations delineated above, [End Page 302] it seems possible both to respect and acknowledge the sacral role of the body in religious discourse and practice and to promote promising directions in research on human tissue.
Courtney S. Campbell, Ph.D., is Associate Professor and Director of the Program for Ethics, Science, and the Environment, Department of Philosophy, Oregon State University, Corvallis.
Notes
1. Although Islamic thought clearly affirms the sacrality of the body, the tradition's proscription against images of the divine (e.g., Allah cannot be portrayed in Islamic art) does not allow for use of the language of "image of God" to describe the self.
2. The most famous dispute of this type was addressed in Moore v. Regents of the University of California (51 Cal. 3d 120 (1990)). See Gold (1996, pp. 19-39) for a thoughtful analysis.
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