Tuesday, July 20, 2004
Two of the editorials were written by members of the President's Council on Bioethics, Dr. Sandel and Dr. McHugh; the other was written by Dr. Spar, a professor at the Harvard Business School.
Embryo Ethics — The Moral Logic of Stem-Cell Research
The question is whether the destruction of human embryos in stem-cell research amounts to the killing of human beings. Professor Michael J. Sandel on the stem-cell debate.
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Zygote and "Clonote" — The Ethical Use of Embryonic Stem Cells
The concern that shadows the free use of human stem cells derives from disquiet over their origins. Dr. Paul R. McHugh on the stem-cell debate.
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The Business of Stem Cells
Professor Debora Spar argues that the commercial consequences of U.S. policy are staggering. The future of stem-cell research is likely to be driven as much by markets as by science.
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Dr. Sandel is a professor of Government. His editorial begins as follows:
Neither objection is ultimately persuasive, though each raises questions that proponents of stem-cell research should take seriously. [...]
Dr. Sandel goes on to argue against the first point:
He points out that all human reproduction involves the loss of embryos. In fact, it is estimated that half of all embryos created through traditional reproduction either fail to implant, or abort spontaneously.
Even critics of stem-cell research hesitate to embrace the full implications of the embryo objection. President George W. Bush has prohibited federal funding for research on embryonic stem-cell lines derived after August 9, 2001, but has not sought to ban such research, nor has he called on scientists to desist from it. And as the stem-cell debate heats up in Congress, even outspoken opponents of embryo research have not mounted a national campaign to ban in vitro fertilization or to prohibit fertility clinics from creating and discarding excess embryos. This does not mean that their positions are unprincipled — only that their positions cannot rest on the principle that embryos are inviolable.
What else could justify restricting federal funding for stem-cell research? It might be the worry, mentioned above, that embryo research will lead down a slippery slope of exploitation and abuse. This objection raises legitimate concerns, but curtailing stem-cell research is the wrong way to address them. Congress can stave off the slippery slope by enacting sensible regulations, beginning with a simple ban on human reproductive cloning. Following the approach adopted by the United Kingdom, Congress might also require that research embryos not be allowed to develop beyond 14 days, restrict the commodification of embryos and gametes, and establish a stem-cell bank to prevent proprietary interests from monopolizing access to stem-cell lines. Regulations such as these could save us from slouching toward a brave new world as we seek to redeem the great biomedical promise of our time.
I agree with Dr. Sandel's points. The loss of human embryos is inevitable in human reproduction, and to ban any activity that could result in such loss would be a ban on all human reproduction. The dehumanization argument is less clear-cut, since dehumanization is a subjective process: it occurs in the mind of the person who is perceiving the action under question. Dr. Sandel's argument is one of proportionality. He argues that we should respect human embryos, but not to the extent of sanctifying them.
Dr. McHugh is a Professor of Psychiatry. His editorial begins as follows:
On August 9, 2001, President George W. Bush made a thoughtful speech in which he proposed regulations permitting federal funding for research using stem-cell lines from human embryos that had been killed before that date. The National Institutes of Health, proceeding under this compromise, has since made 15 to 20 human stem-cell lines available for federally supported research.
But as might have been expected, few serious participants in the debate were satisfied by this compromise. Most stem-cell specialists reject what they see as an arbitrary limit on their resources and programs — and, among other substantive objections, note that a boundary date for production eliminates the chance of improving the quality of stem cells.1 People who recognize a gift of individual human life in every embryo — an "end" in itself, not to be treated merely as a "means" — recoil at its destruction, no matter when or why it occurs. All the members of the President's Council on Bioethics — whose formation President Bush announced during that same August speech — developed our views on federal funding as we gathered information and exercised (vigorously, I can attest) our human talent for disagreement.
The concern that shadows the free use of human stem cells derives from disquiet over their origins. If a source other than embryos can provide pluripotential stem cells — and harvesting them requires no killing — then this shadow vanishes. Thus, we all celebrate the discovery of stem cells in umbilical-cord blood, bone marrow, and other tissues. [...]
Here, Dr. McHugh is referring to the fact that embryos are not the only source of stem cells. This is a fact that often is forgotten in public debate on the stem cell issue. Stem cells from adults, or from umbilical cord blood, do have the potential to be used to create significant medical advances. However, researchers tell us that they are not the same and do not have the same potential. This illustrates one of Dr. McHugh's main points:
Reading through some of the posts on the Blogosphere, it is apparent that some persons see the term "stem cell" and automatically equate all stem cell research with embryonic stem cell research. This is an error that serious investigators and thoughtful moralists will not make.
In addition to the distinction drawn between adult, umbilical, and embryonic stem cells, Dr. McHugh takes pains to draw a distinction between embryos derived from in-vitro fertilization and those developed via somatic-cell nuclear transfer (SCNT). SCNT is what is popularly called cloning. His explanation of the process follows:
Dr. McHugh is not opposed to use of SCNT for the production of cells, although he remains opposed to an attempt to clone an entire human. In contrast, he views embryos as having only one rightful purpose: to produce babies. This is a distinction that may surprise some people, since, in theory, an entity produced via SCNT has the potential to develop into a complete human. This potential does not impress him, in the sense that he does not believe that the potential for a mass of cells to produce an entire human as worthy of sanctity:
My distinction rests on the origin of cells in SCNT, not on the process's vaunted potential for producing a living replica (clone) of the donor, as with Dolly the sheep. My confidence in making origins rather than potential the crux of the argument rests first on a reductio ad absurdum: if one used the notion of "potential" to protect cells developed through SCNT because with further manipulation they might become a living clone, then every somatic cell would deserve some protection because it has the potential to follow the same path. [...]
What he means here is that all somatic cells -- all nucleated cells in the body except sperm and eggs -- could be used to grow a complete clone. In theory, that is: no one has done so with humans. Clearly, we cannot provide every cell with the same level of protection that we would a complete human. Indeed, many of our cells are made to be disposable. The lining of the digestive tract is one example. Based upon this argument, Dr. McHugh comes out in support of SCNT technology, but with limitations to ensure that it is not used to produce anything other than cells:
Thus, he does not support cloning per se, but he does support limited use of cloning technology.
Dr. Spar is a Professor of Business. He editorial begins as follows:
[...T]he Korean success was greeted with scientific delight and a flurry of accelerated research activity. In Canada, a parliamentary committee voted to legalize the use of excess embryos for stem-cell research. Sweden announced that it would support the cloning of embryos for therapeutic purposes, the United Kingdom authorized a private firm to begin deriving embryonic stem cells, and Singapore forged ahead with plans to spend $300 million on Biopolis, a cutting-edge science park focused on stem-cell technology.
In the United States, by contrast, recent policy has moved sharply in the opposite direction. Following an August 2001 announcement by President George W. Bush, federal funding for stem-cell research has been restricted to roughly 19 stem-cell lines — those created before the President's announcement from embryos donated after in vitro fertilization. No federal funds may be used to investigate other lines or to create new ones. Although federal law remains silent on the topic of therapeutic cloning, the President's Council on Bioethics has recommended a moratorium on the practice.
Dr. Spar goes on to summarize the controversy over cloning research, pointing out that while several advocacy groups clamor for greater federal support of such research, while others declare that the creation, followed by the destruction, of embryonic cells violates "the fundamental sanctity of life." She explores this controversy:
There is another lens through which to view the stem-cell controversy, however — a less obvious but also a less controversial one. And that is the lens of the market, a lens through which stem cells are seen not as life-or-death projects but rather as the basis for a set of highly promising but still unproven technologies. They are technologies that — like satellite television in the 1980s or Web browsers in the 1990s — seem to be standing on the cusp of history, eliciting a complicated mix of commercial interest and social concern. They are technologies, moreover, whose evolution will be shaped by business as well as science — by the markets they create, in other words, and the people who clamor for their goods.
Dr. Spar seems to believe that market forces will prevail, ultimately:
Based upon this line of reasoning, she concludes:
At first, it may seem that she is abandoning ethical principles in the service of pure pragmatism. As is often the case, you have to get to the end of her essay to see her point:
[...] Venture capitalists will fund research into the most acceptable offshoots of stem-cell science, driving a market that runs in accordance with the wishes of society and not against them. Firms, in other words, will cluster not at the scary edges of scientific potential but, rather, where rules are transparent, and where states are essentially accepting.
Dr. Spar's conclusion is consistent with that expressed in the editorial by Dr. Tauer in The Lancet, discussed in a previous post here. That is, governments should act quickly to establish clear, if conservative, regulations. The lack of clarity is an impediment to progress. Although there may be a temptation in government circles to wait until a comprehensive set of guidelines can be developed, that is unlikely to be feasible. As the announcement from South Korea demonstrates, science develops faster than governments can act. Therefore, if government waits until the implications of a line of research are known fully, then tries to write comprehensive guidelines, the guidelines will be outdated by the time they are enacted. The correct governmental approach, then, is to establish policies that clarify positions on the more fundamental aspects of a line of research, and allow the policies to evolve as the science progresses.
This may seem distasteful, event intolerable, to moral absolutists. But guidelines in bioethics are not fundamentally different from other areas of government regulation where human safety is involved.
For example, look at airline regulations. Not as glamorous as biotech, to be sure, but still a matter of life and death. If a new aeronautical technology is developed, it is tested. If it seems safe, the new technology is permitted. If a plane crashes and people die, that is a serious matter. Then we go back and revise the regulations. Governments deal with this level of risk all the time. Now we know that we should not route wiring through fuel tanks in airplanes. If anyone built such a plane today, that would be unethical. But no one is going out and clamoring for all airplanes to be grounded, claiming that some of them might have been built in a manner that later will be found to have been unethical.
This is not a perfect analogy, but it illustrates the point: as we strive for higher levels of achievement, we cannot allow all of our worries about possible future ethical problems to block our progress completely. Nor do we rush headlong into strange new worlds without prudence. We seek to find an appropriate balance. In doing so, we should heed Dr. McHugh's advice, and remember that we must know the technical details through and through, as we seek the appropriate balance.
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