The Ethics and Politics of Small Sacrifices in Stem Cell Research Glenn McGee and Arthur Caplan

Kennedy Institute of Ethics Journal 9.2 (1999) 151-158

Abstract: Pluripotent human stem cell research may offer new treatments for hundreds of diseases, but opponents of this research argue that such therapy comes attached to a Faustian bargain: cures at the cost of the destruction of many frozen embryos. The National Bioethics Advisory Commission (NBAC), government officials, and many scholars of bioethics, including, in these pages, John Robertson, have not offered an adequate response to ethical objections to stem cell research. Instead of examining the ethical issues involved in sacrificing human embryos for the goal of curing fatal and disabling diseases, they seek to either dismiss the moral concerns of those with objections or to find an "accommodation" with those opposed to stem cell research. An ethical argument can be made that it is justifiable to modify or destroy certain human embryos in the pursuit of cures for dread and lethal diseases. Until this argument is made, the case for stem cell research will rest on political foundations rather than on the ethical foundations that the funding of stem cell research requires.

Pluripotent Human Stem CellL research may offer new treatments for hundreds of diseases (Thomson et al. 1998; Vogel 1999), but opponents of such research argue that pluripotent stem cell therapy comes attached to a Faustian bargain: the destruction of many frozen embryos for every new cure. The National Bioethics Advisory Commission (NBAC), the Geron Ethics Advisory Board (GEAB), and many scholars of bioethics, including, in these pages, John Robertson, have raised interesting ethical issues about potential stem cell research (NBAC 1999; GEAB 1999; McGee and Caplan 1999; Fletcher 1999; Robertson 1999). But nothing holds the attention of the public or lawmakers like the brewing battle between millions of ill Americans who favor stem cell research and millions who oppose the destruction of any fetus or embryo for any [End Page 151] purpose. The plan to sacrifice embryos for a revolutionary new kind of research has reawakened a long-dormant academic debate about the morality of destroying developing human life.

In these pages, Robertson (like the GEAB and NBAC) argues that one's position on whether pluripotent stem cells can be used in research depends on one's view of the intrinsic and symbolic status of the embryo (Robertson 1999). In essence, Robertson and many others argue that one's position on stem cell research pretty much boils down to one's position on abortion. But that is too simple a framework.

Robertson and NBAC make two mistakes: first, they duck the task of identifying and analysing criteria for justifying the sacrifice of human cells and human life in the name of research. All who write about pluripotent stem cells refer to respect for pro-life views about symbolic moral status, and GEAB in particular claims that symbolic status is the reason such research should be therapeutic in nature. Yet so far no one has explained what kind of destruction is appropriate and of what sort of creatures and for what specific goals and contexts.

Second, Robertson, NBAC, and GEAB take what we call an "accommodationist" posture toward political opposition to stem cell research. In their haste to avoid rehashing the abortion debate, many proponents of stem cell research, including the National Institutes of Health Counsel, Harriet Raab (1999), cede too much ground to foes of abortion procedures, allowing too many arguments to go unanswered. They thus miss critical opportunities to engage in ethical debate about what sorts of rights and duties attend the making and management of embryonic life.

Moral Sacrifice

It seems to us that the central moral issues in stem cell research have less to do with abortion than with the criteria for moral sacrifices of human life. Those who inveigh against the derivation and use of pluripotent stem cells make the assumption that an embryo has not only the moral status of human person, but also a sort of super status that outweighs the needs of others in the human community. It is wrong to abort or kill a human, they argue, and thus it is wrong to kill an embryo. But this argument, which is problematic when made about abortion more generally, is doubly so when made against the derivation of pluripotent stem cells from embryos.

Even if frozen human embryos are persons, symbolically or intrinsically, this in no way entails the right of a frozen embryo to gestation, or to [End Page 152] a risk-free pathway into maturation. Adult and child human beings' right "to life" is, considered constitutionally and as a moral problem, at best a negative right against unwarranted violence by the state or individuals. There are, sadly, few positive rights involved. Americans cannot, for example, claim a right against the state to protect them against disease, disasters, adverse weather, and other acts of nature. If a frozen human embryo is a full human person, it still has no right to life per se, but rather a negative right against unwarranted violence and a weak positive right to a set of basic social services (police protection, fire protection, and the like). The question remains as to what constitutes unwarranted violence against an embryo, and for what reasons might an embryo ethically be destroyed-e.g., in the interest of saving the community. Adults and even children are sometimes forced to give life, but only in the defense or at least interest of the community's highest ideals and most pressing interests. One would expect that the destruction of embryonic life, whatever its moral status, would also take place only under the most scrupulous conditions and for the best communal reasons. It bears noting that only those who consistently oppose all violence, destruction, or killing of any kind in the name of the state, the church, or the community can rationally oppose the destruction of an embryo solely by virtue of its status as a human person.

It remains to be shown what the common good is, and what sort of sacrifice an embryo should make in its interest. It is commonly held that no human being should be allowed to lie unaided in preventable pain and suffering. The desire to ameliorate the suffering of the ill motivated Hippocrates, St. Francis of Assisi, Cicero, and Florence Nightingale. It is a central tenet of contemporary medicine that disease is almost always to be attended to and treated because it brings such pain and suffering to its victims and to their family and communities. Trade-offs are made in the treatment of disease, against cost and other competing social demands. But both the Western ethic of rescue and the practical structure of contemporary health care and other social institutions make it clear that among the deepest moral habits of human life is that of compassion for the sick and vulnerable. One of the compelling tenets of the movement to prevent abortion is the argument that a pregnancy ought not be terminated for superficial reasons, but should be viewed as a responsibility to aid the developing human life and to prevent it from needless suffering.

It is the moral imperative of compassion that compels stem cell research. Stem cell research consortium Patient's CURe estimates that as [End Page 153] many as 128 million Americans suffer from diseases that might respond to pluripotent stem cell therapies. Even if that is an optimistic number, many clinical researchers and cell biologists hold that stem cell therapies will be critical in treating cancer, heart disease, and degenerative diseases of aging such as Parkinson's disease. More than half of the world's population will suffer at some point in life with one of these three conditions, and more humans die every year from cancer than were killed in both the Kosovo and Vietnam conflicts. Stem cell research is a pursuit of known and important moral goods.

What is Destroyed?

The sacrifice of frozen embryos is a curious matter. Set aside, again, the question of whether a frozen embryo is a human life or human person. Grant for a moment that a 100-cell human blastocyst, approximately the size of the tip of an eyelash and totally lacking in cellular differentiation, is a fully human person. What does such a person's identity mean, and in what ways can it be destroyed? What would it mean for such a person to die? When could such a death be justified? These questions require a new kind of analysis.

The human embryo from which stem cells are to be taken is an undifferentiated embryo. It contains mitochondria, cytoplasm, and the DNA of mother and father within an egg wall (which also contains some RNA). None of the identity of that embryo is wrapped up in its memory of its origins: it has no brain cells to think, no muscle cells to exercise, no habits. The 100-cell embryo has one interesting and redeeming feature, which as best anyone can tell is the only thing unique about it: its recombined DNA. The DNA of the embryo contains the instructions of germ cells from father and mother, and the earliest moments of its conception determined how the DNA of mother and father would be uniquely combined into a human person. The DNA of that person will, if the embryo survives implantation, gestation, and birth, continue to direct many facets of the growth and identity of our human person. At 100 cells, nuclear DNA is the only feature of the embryo that is not replaceable by donor components without compromising the critical features of the initial recombination of maternal and paternal genetic material after sex (or, in this case, in vitro).

Opponents of stem cell research make an anti-abortion argument, namely that the harvesting of pluripotent stem cells will require the destruction of the embryo. But while the cytoplasm, egg wall, and mitochondria of the embryo are destroyed, we just noted that none of these [End Page 154] cellular components identifies the embryo at the 100- cell stage. The personifying feature of a 100-cell blastocyst is its DNA. Pluripotent stem cells from the harvested embryo are directed to form cell lines, each cell of which contains, in dormant form, the full component of embryonic DNA. The DNA in the cell lines has a much greater chance of continuing to exist through many years than does the DNA of a frozen embryo (which in most cases already will have been slated for destruction by the IVF clinic that facilitated the donation, and which would have no better than a 5 to 10 percent chance of successful implantation in any event). Although most Americans are opposed to the "cloning" of adult human beings, it might be possible to harvest DNA from any of the stem-cell-based cell lines to make a new, nuclear- transfer-derived embryo, or in fact to make five or ten embryos, each of which would possess all of the DNA of the original embryo. In this sense, the critical, identifying features of the embryo would never have been destroyed in the first place, unless what one means by "destroying" an embryo is the loss of its first egg wall, cytoplasm, and mitochondria. The transfer of the nucleus from an embryo to an enucleated egg is a bit like a transplant, though here the donor and the donation are both the DNA. In the case of embryos already slated to be discarded after IVF, the use of stem cells may actually lend permanence to the embryo. Our point here is that the sacrifice of an early embryo, whether it involves a human person or not, is not the same as the sacrifice of an adult because the life of a 100-cell embryo is contained in its cells' nuclear material.

The task of balancing sacrifice in the community is one encountered by Solomon in the Judeo-Christian religious texts. Our institutions must enable us in the community to debate and identify the ideals that merit sacrifice, and the loss must be weighed with justice in mind. An embryo cannot reason and it cannot reject a sacrifice or get up and leave the community. For those who feel special responsibility to embryos, the vulnerability of the frozen embryo may suggest special consideration of the kind given to all moral actors in society who are for one reason or another without voice. The question remains, though: what need is so great that it rises to the level where every member of the human family, even the smallest of humans might sacrifice? Already it is clear that we believe that no need is more obvious or compelling than the suffering of half the world at the hand of miserable disease. Not even the most insidious dictator could dream up a chemical war campaign as horrific as the devastation [End Page 155] wrought by Parkinson's disease, which destroys our grandparents, parents, and finally many of us.

If Parkinson's disease, or for that matter if a dictator could only be stopped through the destruction of an infant, most every human would blanch at the idea of such sacrifice. But that is not what is asked here. Even those who hold that an embryo is a person will not want to argue that the life of a 100-cell embryo is contained in its inessential components. Assuming that a developing embryo can be salvaged by transplanting its DNA, as we have described, it seems unreasonable to oppose the destruction of the embryo's external cellular material or to fear that the 100-cell embryo is killed in the transfer. The identity of the human embryo person, if it is a symbolic or intrinsic person, is tied at that stage to the DNA. That DNA is not lost or even injured by the harvesting of embryonic stem cells. This is not the sacrifice of the smallest and most vulnerable among us. We are debating the potential for temporary transplant of undifferentiated tissue and the DNA of such a "person," rather than the imminent destruction of an embryo discarded by a clinic. It is difficult to imagine those who favor just war opposing a war against such suffering given the meager loss of a few cellular components.

Political Accommodation

The road to a democratic debate about stem cell research is difficult, as Robertson acknowledges. We entirely agree with Robertson that NIH, and researchers working on stem-cell-based cell lines, need not be considered complicit in the destruction of an embryo far removed in time and space (Robertson 1999). However, complicity assumes someone has done something wrong. Critics and NBAC are thus right to call attention to the amoral nature of the Raab opinion. It could not be more plain that NIH (and some politicians who favor stem cell research) initially hoped to sidestep entirely any ethical debate over the use of cell lines derived from the destruction of embryos. As we have argued above, it hardly does justice to those who believe that embryos are human persons to sacrifice those persons in a cloud of deception and cowardice. Moral sacrifice demands the highest accountability of our social institutions and especially those entrusted with writing and litigating the theory and policy that guides bodies like NIH.

Since at least 1980, the market on "family values" has been cornered by one side of the political spectrum. Anticipating that the public prefers platitudes about abortion to complex positions, most in American political [End Page 156] office do not even discuss abortion and embryo research beyond a simple reference to their pro- or anti- abortion voting record. Meanwhile, the last 20 years have seen conservatives develop extraordinarily rigid and arcane positions on virtually every area of "family values."

Again and again, bioethicists' and politicians' policy of appeasing conservative views on family values has resulted in bad policy and balkanized public debate. Embryo research and fetal tissue are particularly instructive in this regard. Without an engagement of the moral questions involved and without an explicit moral framework to explain the decisions, the nation found itself with bans on embryo research and fetal tissue transplantation research that the majority of citizens did not support.

NIH Counsel Raab, National Institutes of Health Director Harold Varmus, NBAC, the GEAB, and in these pages Robertson each give too much moral ground by ceding the illogical (embryos are special people who can never be allowed to die) and bizzare (researchers must not be complicit in the death of an embryo) arguments made by opponents of stem cell research. The sight of scientists rushing to find a legal opinion that legitimizes their work is not a pretty one, nor is that of politicians running scared from those who threaten to shut down the National Institutes of Health in the interest of preserving frozen embryos in stasis. We must be conscious of the role of politics (McGee 1999), but the law and the facts do not help with stem cell research. The issues here are novel and they are hard, but mostly they require philosophical innovation about what an embryo is and how we are to treat embryonic material in a time of stem cell research. Our argument here is that no embryo need be sacrificed, but we must alter the terms and goals of our debate to frame an appropriate moral framework for dealing with embryos.

Glenn McGee, Ph.D., is an Associate Director at the Center for Bioethics at the University of Pennsylvania, where he is an Assistant Professor of Bioethics, Cellular and Molecular Engineering, Philosophy, and the History and Philosophy of Science.

Arthur Caplan, Ph.D., is Trustee Professor and Director of the Center for Bioethics at the University of Pennsylvania.

References

Fletcher, John. 1999. Deliberately Incrementally on Human Pluripotential Stem Cell Research. National Bioethics Advisory Commission Background Papers on Embryonic Stem Cell Research.

Geron Ethics Advisory Board. 1999. Research with Human Embryonic Stem Cells: Ethical Considerations. Hastings Center Report 29 (2): 36-38.

McGee, Glenn. 1999. Pragmatic Method in Bioethics. In Pragmatic Bioethics, ed. Glenn McGee, pp. 31-73. Nashville, TN: Vanderbilt University Press.

------, and Caplan, Arthur. 1999. What's In the Dish? [Symposium on Ethical Issues in Stem Cell Research] Hastings Center Report 29 (2): 38-41.

NBAC. National Bioethics Advisory Commission. 1999. The Ethical Use of Human Stem Cells in Research. Draft Report (15 June). Rockville, MD: NBAC.

Raab, Harriet. 1999. Memorandum to Harold Varmus, M.D., Director, NIH, Federal Funding for Research Involving Human Pluripotent Stem Cells, 15 January.

Robertson, John A. 1999. Ethics and Policy in Embryonic Stem Cell Research. Kennedy Institute of Ethics Journal 9: 109-36.

Thomson, James A.; Itskovitz-Eldor, Joseph; Shapiro, Sander; et al. 1998. Embryonic Stem Cell Lines Derived from Human Blastocysts. Science 282: 1145-47.

Vogel, Gretchen. 1999. Harnessing the Power of Stem Cells. Science 283: 1432.