Emotion in Political Discourse: Contrasting Approaches to Stem Cell Governance in the USA, UK, Israel and Germany

SPECIAL REPORT Emotion in political discourse: contrasting approaches to stem cell governance in the USA, UK, Israel and Germany

Herbert Gottweis1 & In August 2004, Stojkovic and Murdoch from the University of Newcastle upon Tyne, UK, Barbara Prainsack1,2† were granted the UK’s first license to create human embryonic stem cells (hESC) using cell †Author for correspondence nuclear replacement. While this news made headlines around the globe, a spokesman for 1University of Vienna, Department of Political the German Ministry of Research warned scientists in his country of the illegality of Science, and Life Science advising their English colleagues on hESC research. Meanwhile, US Members of Congress Governance Platform, had asked President Bush to revoke his decision to limit federal funding to research on a Universitätsstraße 7 A-1010 Wien, limited number of hESC lines created before 9 August, 2001 (a decision which he confirmed Vienna, Austria in July 2006, while non-federally funded research on hESC continues to be unrestricted). In Tel.: +43 142 774 7737; Israel, where hESC research is legal and has never been a contested political issue, a E-mail: herbert.gottweis@ univie.ac.at bioethicist argued that in light of the potential to alleviate human suffering, “banning 2E-mail: barbara.prainsack@ research is against human dignity”. How can such striking differences in the regulation of univie.ac.at hESC research be explained? Not only scientific objectives, but also history, change men as to affect their judgement’ [5]. culture, and the particular ities of different politi- Emotional response was intelligent behavior cal systems play a role in shaping the regulation of open to reasoned persuasion. medical research at national levels. Much has In Aristotle’s theory, pathos refers to the been written, for example, about the influence of importance of feelings and passions in the mobi- the traumatic experiences during the Nazi period lization of opinion – and to the conviction that on current perceptions of modern biomedicine in knowledge of other people’s emotions is vital for Germany [1,2], as well as about the traditionally political decision-making. The term ethos desig- important role of religious groups in public nates the particular credibility and character of debates in the USA [3,4]. Our analysis goes fur- the speaker (ethos does not signify any internal ther. We argue that, besides the above-mentioned attitude or system of abstract values). People or cultural, historical and political factors, emotions institutions can possess ethos, which is closely and the building of trust play a crucial role in related to high levels of public trust in these shaping differences among nations in their regu- actors. While logos (reason) in Aristotelian theory latory regimes. Our argumentation is counter- can ‘stand alone’, pathos and ethos are tied to spe- intuitive to some extent. While we certainly do cific circumstances and particular actors in a not propagate the display of emotions as a substi- social and political interaction [6]. tute for substantial political debate, neither do we hESC and cloning policies in the USA, UK, consider it an obstacle to dealing reasonably with Israel, and Germany are significantly shaped by Authornew scientific–medical developments. Rather, Proof we emotional dynamics (the mobilization of pathos) see emotions as a key element in the process of and a struggle for trust-building (related to the dealing with uncertainty in political–scientific ethos of some of the key actors in the public and decision-making processes. Giving emotions a regulatory debates). Policy-makers, scientists, place in political debates does not automatically activists, and patient groups in these countries create obstacles to building public trust either in not only appeal to ‘rational’ arguments for or scientific advances or in regulatory and research against hESC research (such as improving a Keywords: emotions and trust-building, cultural and policy structures in general. country’s competitiveness in science, or arguing historical context, human in favor of the greater potential of adult stem cell embryonic stem cell research, Role of pathos in decision making: research), they also grant significant space to peo- political strategies, public debates, regulation, rhetoric Aristotle & beyond ple’s feelings, suffering, pain, anxieties, despair, Our analysis draws upon the concepts of Aristo- hope, outrage, and compassion. Not surprisingly, tle’s ‘On Rhetoric’. Aristotle saw no fundamental the religiously motivated opponents of hESC antagonism between reason and emotion. He research in many Christian countries have understood as emotions ‘all those feelings that so referred to the derivation of stem cells from

embryos as ‘killing babies’, invoking the image of tific, legal, and social implications of stem cell a suffering newborn struggling for his or her life. research, the NBAC strongly endorsed the use of But also pro-hESC research legislators and public federal funds for hESC research [102]. The NIH figures, such as the late former US President Ron- final guidelines were published on 25 August ald Reagan’s wife Nancy, have appealed to human 2000, giving the green light to federal funding of compassion in light of the suffering of patients hESC research in the USA. In the middle of a for whom hESC might generate new therapies or highly emotionalized debate, an argument pre- eventually even bring a cure. In all four countries sented as an instance of logical reasoning, com- of our case study, the mobilization and language bined with effective trust-building measures, had of emotions have played a significant role in helped to overcome the ban on federal funding shaping regulatory outcomes. for embryo research of prior years. However, very soon thereafter, hESC resur- USA: the taxpayers’ stalemate faced as a contested political issue. Already during From the very beginning, hESC research has been the presidential campaign of George W. Bush, a hotly contested topic characterized by emotional aides had indicated that he would halt the NIH’s polarization in the USA [7]. Being closely linked to initiative to support hESC research. Anti-abortion embryo research in the bioethical debate both on groups had put considerable pressure on Bush to the public level and among scientists in a context reconsider the Clinton administration’s approach of increasing religious politicization, the issue of to stem cell research regulation. In a nationally- hESC research quickly became a subfield of the televised speech in August 2001, President Bush abortion wars [4]. It was precisely this instrumen- outlined his government’s new policy. Federal talization of a topic of medical research in the con- funds, he stated, would be used only for research text of the politics of religion against which on existing hESC lines that had been derived with patient advocacy groups [8] joined forces. the informed consent of the donors; from While privately- and state-funded research on embryos which had been created for reproductive hESC continues to be unrestricted, the use of purposes but were no longer so needed; and those federal funds for this contested field of research embryos which had been produced without any has been a hotly debated issue for almost a dec- financial inducements to the donors. The NIH ade. In light of earlier presidential and legislative was to examine all existing hESC lines and set up bans on embryo research, the NIH in 1999 a registry of those lines that met the criteria out- requested a legal opinion from the General lined by the President. No federal tax funds were Counsel of the Department of Health and to be spent to create additional embryos for Human Services (HHS) on whether federal research, or to study cells derived from new funds could be used to support research on embryos previously created for research purposes human stem cells derived from embryos or fetal with private funds [9]. tissue. HHS’ General Counsel Harriet Rabb This decision meant serious restrictions and concluded that then-current legal prohibitions limitations for hESC research in the USA [103]. on the use of HHS-appropriated funds for Since 2001, the debate has been characterized by human embryo research did not apply to an even stronger ideological clash than in previous research using hESC “because such cells are not a years between religiously motivated opponents of humanAuthor embryo within the statutory definition” ProofhESC research and its supporters, which include [101]. The statute defines an embryo as an ‘organ- scientists’ associations and patient advocacy ism’ which, when implanted in the uterus, is groups led by celebrities such as Michael J Fox, capable of becoming a human being – which is Nancy Reagan and Christopher Reeve. While the not possible for pluripotent stem cells. There- National Right to Life alliance presented hESC fore, HHS concluded that the NIH could fund research as a plan for ‘baby farming’ [104], Nancy research on hESC previously derived from Reagan countered with a desperate plea to focus embryos in a privately-funded setting. on curing patients: “There are so many diseases This rational argumentation was combined that can be cured or at least helped. We have lost with deliberate attempts to trust-building. In so much time already and I just really can’t bear to November 1998 President Clinton asked the lose anymore” [105]. National Bioethics Advisory Commission On 20 July 2006, however, President Bush (NBAC) for a review of the medical and ethical vetoed a bill which Senate had passed shortly issues associated with human stem cell research. before with the aim of loosening restrictions on After a thorough discussion of the ethical, scien- federal funding for hESC research. In a televised

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speech, surrounded by young children and their Social Democrats (SPD), and a broad spectrum parents, the President explained: “These boys and of nongovernmental organizations (NGOs) rang- girls are not spare parts… They remind us of ing from feminist groups to green organizations what is lost when embryos are destroyed in the conceptualized hESC research as an ‘attack on name of research. They remind us that we all life’, an unprecedented undermining of ethical begin our lives as a small collection of cells” [106]. principles, a ‘dehumanization’ of life, and even This setting can be interpreted as an attempt to ‘cannibalism’ [109]. The Nationaler Ethikrat reframe what most people see as a destruction of (National Ethics Council), set up by Chancellor cells and/or early-stage human life as an instance Schröder in May 2001 (exactly at the time when of destroying - ‘killing’ – children. At the same the legalization of importing hESC lines was time, proponents of extension of federal funding being discussed), was soon branded a puppet for hESC research engaged in another ‘reframing institution intended to generate ad hoc legitima- project’ by portraying the death of patients suffer- tion for the government’s allegedly bio-liberal ing from diseases (which hESC research promises decisions. The Council, after it issued a recom- to alleviate) as instances of hESC-opponents let- mendation in favor of allowing the import of ting them die [107]. This sort of emotional polari- hESC lines (supported by a 14:8 vote) barely six zation went hand in hand with the absence of months after its creation, never generated enough successful trust-building, as no undisputed regu- ethos to count as an institution of public trust. latory authority emerged. Behind all this, of On 30 January 2002, the German Parliament course, stands a tradition of sharp separation engaged in a 5-h-long debate, after which a between governmental competencies and the majority of 339 versus 266 members favored the sphere of individual freedom, making possible legalization of importing hESC lines for research the unique distinction between what is permissi- from abroad. The creation of hESC on German ble for privately and state-funded as opposed to soil remained illegal. In effect, the Parliament federally funded research in the USA. had succeeded in outlawing a contested field of research in principle but at the same time left a Germany: search for an ethical nation loophole that rendered a potentially profitable The 1998 news of the first cloned sheep, Dolly, field of research possible at the practical level. was met with shock and horror in large sectors of The build-up of the debate, and the creation the German public. While hESC (including of meanings connected with hESC research took cloning for research purposes) was illegal in Ger- on completely different forms in Germany than many, some younger German scientists had in the USA. Far from creating a clear divide worked in hESC research in the USA and had between religiously motivated opponents of started to apply their knowledge on animal mod- hESC research on the one hand and its propaga- els at home. With increasing unease those scien- tors using the rhetoric of scientific progress and tists saw their work on animal models being used empathy with the suffering of patients on the in experimental research on human stem cells other, the lines of antagonism in Germany cut abroad. In an attempt to mobilize logos, the scien- across the religious-secular divide, as well as tific community allied itself with key German across the political spectrum. Not only Christian research funding agencies and politicians from churches, but also many other actors mobilized Authordifferent parties to convince the German publicProofthe image of the suffering embryo whose dignity of the worthiness and necessity of pursuing hESC should be protected, often accompanied by research in Germany [108]. What they had under- reminders of what the devaluation of human life estimated was the increasing public importance had led to in the relatively recent past. In stark of the question of whether and how hESC could contrast to the UK and the USA, the voices and be compatible with the German self-image of an images of suffering patients were virtually absent ‘ethical nation’. The latter proved to be an impor- from the debate. Instead, much of the contro- tant aspect of German collective identity in light versy unfolded as a search for the morally and of a collective memory of inflicting suffering and ethically proper course of action [11], the ques- death on millions of people [10]. tioning of the ethical status of institutions and A broad coalition of actors considered this an individuals, and the compatibility of the dis- unresolvable conflict and fiercely rejected cussed policy measures with different collective research on hESC. Catholic and Protestant self-images in Germany. In the background of all churches, the Green Party, major sectors of the this was the attempt to establish Germany as the Christian Democrats (CDU/CSU), a part of the ‘world champion of ethics’ [12]. www.futuremedicine.com 3 SPECIAL REPORT – Gottweis & Prainsack

The strategy of rendering hESC research a the UK. In addition, consensus-building was topic that one had to oppose – or at least be very also actively sought by increasing transparency sceptical about – if one did not want to run the and including public concerns. risk of being labeled unethical, cold-hearted, and In June 1999 the Government set up an expert greedy, was largely successful. It was also able to group chaired by the Chief Medical Officer, succeed because of the greater ethos possessed by Liam Donaldson, to ‘advise on whether new actors who were seen as driven by genuine moral areas of research could lead to a broader under- concerns, independent of political and economic standing of, and eventually to new treatments for profit considerations, as opposed to, for exam- a range of disorders where there is disease or ple, members of the National Ethics Council, or damage to tissues or organs’ [111]. scientists themselves, who were seen as morally The Donaldson report, released in June 2000, reprehensible in weighing research and economic recommended that cell nuclear replacement tech- objectives against ‘human dignity’. As the late niques were to be allowed for the development of President Johannes Rau, one of the participants treatments for mitochondrial diseases. At the same in the debate who possessed a lot of ethos, stated: time, research using human embryos created by “Where human dignity is concerned, economic cell nuclear replacement was permissible but only arguments do not count” [110]. to be conducted if there were no other means to pursue the research objectives. The subsequent UK: reason, passion, transparency political debate, which unfolded in a context of While in the two previous cases a coherent policy accentuated openness and transparency, was dom- on hESC had either developed relatively late inated by the argument of the supporters of hESC (Germany) or could be maintained only for a research, who mobilized ethos, pathos, and logos brief period (USA), in the UK stem cell and equally. For them, a revision of the HFEA Act to cloning research were defined as government pri- allow hESC research represented a position of orities very early on. Unlike in the USA, where ‘pragmatism’. Core elements of this position were from 2001 emotional polarization (pathos) had the highly successful, respected, trusted structure dominated, and in Germany, where the quest for of the HFEA system and the fact that only a few – an ethical nation had shaped the debate and but crucial – modifications were needed to extend mobilized pathos and ethos in close connection the scope of permissible research that might even- with each other, the situation in the UK was tually alleviate the suffering of many. Before and characterized by a relatively balanced mobiliza- during parliamentary debate this message was tion of ethos, pathos and logos in the political powerfully communicated by patients and patient arena [13]. advocacy groups, and also by many members of A coherent, long-term government-backed the House of Commons and House of Lords, who strategy of building trust in institutions, the in debate again and again referred to cases of suf- attempt to highlight the benefits of hESC fering patients. Colin Blakemore of the Medical research, and a communication style that Research Council described the role of ‘ex-Super- focused on transparency and the active inclusion man’ Christopher Reeve in this context: “His role of multiple stakeholders, including lay citizens was very significant. He spoke with the authority and patient groups, were central elements of the of someone suffering from the conditions he was UKAuthor approach. Proofcampaigning for...” [112]. Eventually, on 19 The discussion of embryo research dates back December, 2000, the House of Commons voted to the 1980s, when it culminated in the War- clearly in favor of the proposed change in legisla- nock report in 1984. This report recommended tion. With that decision, one of the world’s most that embryo research up to the 14th day after liberal regulations for hESC research and cell fertilization should remain legal but be restricted nuclear transfer had passed parliamentary scrutiny in scope and monitored by a body outside the – although it is one which entails effective moni- research community. This body was to become toring of hESC research through the prescribed the Human Fertilisation and Embryology licensing and reporting requirements operated by Authority (HFEA), created in 1990. The HFEA, the HFEA. a designated institution of trust set up with the intent of operating independently of personal Israel: response to the losses of the past objectives of researchers and moral convictions In Israel, the ethical permissibility of hESC can of single individuals, played a key role in reach- be best described as a non-issue [14]. HESC ing policy consensus on stem cell governance in research has never been a contested political sub-

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ject; its legality has never been challenged. Also suffering of the victims of the Holocaust, as well the production of embryos for research through as the suffering of the survivors in light of nuclear replacement is legal; however, such pro- unbearable losses, are common. This reasoning cedures need to be approved by the Supreme also applies to hESC research: Everything that Helsinki Committee in the Ministry of Health. has the potential to benefit the health of human The Prohibition of Genetic Intervention Law, beings is to be supported. As a well-known Israeli which came into effect in 1999, prescribed a scientist put it, “For therapeutic purposes, you temporary ban on human reproductive cloning can justify doing anything” (Prainsack B, Pers. Comm.). and germ line intervention (it was extended for In sum, it can be stated that in contrast to our another 5-year period in 2004). The law left first three examples, consensus on the ethical per- therapeutic cloning untouched, and the debate missibility of hESC research has always been surrounding it had been generally restricted to present in Israel. This is the case partly because of debates in the Knesset and bioethics committees. the absence of religious concerns, and partly Israel’s permissive attitude towards hESC because science and technology are generally val- research and human cloning is commonly associ- ued very highly. Scientists – in their role as repre- ated with specific religious teachings that differ sentatives of those positive values – possess a high substantially from Christian values which many level of ethos, and they are trusted to engage in Western bioethics discourses are embedded in. research in responsible ways. The mobilization of For example, in Jewish Law ex utero embryos are pathos (mainly by alluding to the suffering result- not regarded as needing the same protection as an ing from present and past attacks on Jewish lives) implanted embryo, not to speak of a full- fledged and logos (it is not reasonable to hinder research human being. Another characteristic of Judaism that might help many people) becomes necessary is that ‘playing God’ does not have the same neg- only when the relatively large leeway granted to ative connotation as it does in other parts of the medical research comes under attack. Western world. According to Jewish Law, human capacity to participate in God’s creation includes Conclusion the command to improve it [15]. In this brief comparative analysis, we have These religious considerations, however, argued for a broadened view of the reasons for account only partly for the uncontroversially different regulatory frameworks for hESC permissive regulatory approach to hESC in research and cloning. Whereas path-dependent Israel. Besides the absence of clear religious phenomena, such as previous histories of embryo obstacles to medical research that promises to regulation, religion, or culture, play an impor- alleviate or even cure human suffering, it is also tant role in the making of stem cell policies, the the omnipresent threat to Jewish existence in the importance of the public (re)presentation of Middle East that is mobilized when the freedom stem cell research should not be underestimated. of and support for medical research comes under It is in this context of policy persuasion that the attack from abroad. This current threat is discur- mobilization of the Aristotelian categories of sively linked to persecution and mass murder in ethos, pathos, and logos gains key importance for the past. A bioethicist involved in drafting the regulatory outcomes. 1999 Prohibition of Genetic Intervention Law With this in mind, we arrive at a number of Authornoted that “whenever the religious people Proofspoke conclusions. Clearly, as our four cases have in the Knesset, they always stressed man’s obliga- shown, policy persuasion tends to incorporate tion to improve creation” in an attempt to fend strong components of logos, of ‘rational’ argu- off arguments of propagators of a permanent ban mentation. In addition, however, the forces of on reproductive cloning (Prainsack B, Pers. Comm.). pathos and ethos have occupied prominent places This argument is often linked to the need for in policy-making stages in our case studies. Jewish Israelis to compensate for the ‘loss of the Traditionally, emotional argumentation has had reproductive capacity of a major segment of its a bad reputation, as it has been associated with population’ [113]. “We are survivors”, explained manipulation and demagogy. Often, in debates on Tel Aviv professor of philosophy Asa Kasher, a science and technology, emotionalization is seen as leading bioethicist in Israel, when asked by a a threat to feasible and meaningful regulatory out- journalist to explain the permissive regulation of comes and should therefore be avoided at all costs. reproductive technology in his country [16]. We argue, in contrast, that the mobilization of Thus, when the limits of ethically permissible pathos and the reference to emotional aspects of research are being established, allusions to the policy issues do not necessarily lead to unreflected www.futuremedicine.com 5 SPECIAL REPORT – Gottweis & Prainsack

and/or restrictive regulatory frameworks. Emo- demonstrate that a strong mobilization of pathos tions are a key element in dealing with uncertainty in the public debate – without receiving signifi- in political–scientific decision-making processes. cant counterbalance from the mobilization of logos In some cases, granting room for emotion in pub- and ethos – can lead to a relatively static ‘war of lic debates has the effect of generating a sufficient positions’ without much potential for resolution. level of trust and openness among the participants In Israel, the situation was fundamentally dif- that makes the legalization of controversial tech- ferent also because no one has ever argued nologies possible if monitoring agencies accepted against hESC research on the basis of infringe- as trustworthy exist. The UK might be a case in ment of the dignity of the embryo. As bioethicist point, as emotions were an important part of the Asa Kasher explains, “the embryos from which political debate and have not impeded regulation the stem cells are produced...look like a micro- or led to political stalemate. Jointly ‘working scopic ball of cells and have not yet developed through’ a difficult topic might constitute a the special characteristics that we perceive as a precondition for accepting it. person” (Prainsack B, Pers. Comm.). This view is in As the German case seems to indicate, however, accordance with Jewish Law, and therefore repre- providing room for emotions in public debates is sents both an ethical and rational standpoint. In no guarantee for a public embrace of the value of Israel, pathos enters the debate primarily as a biomedical research. The existence of trust in reg- response to attempts to pose obstacles to potentially ulatory institutions institutions (not only key beneficial medical research. individuals) seems to be a prerequisite for social To summarize, while we certainly do not pro- experiments with new medical technologies. For pose the public display of emotions to be a sub- example, one of the reasons why the regulation of stitute for substantial political debate, together medical research and new medical technologies with an institutional setting which enjoys signif- has never instigated public debate in Israel is that icant public trust, the mobilization of pathos can science as an institution has traditionally received be seen as a productive tool to reach a publicly a lot of public trust [17,18]. In Germany, on the acceptable and sustainable regulatory frame- other hand, where trust in the institutions of sci- work for contested fields of medical research ence and ethics is low (because both “have failed and technology. to prevent the Nazi catastrophy”, as a member of a German medical ethics listserv once phrased it), Acknowledgements the result of public soul-searching on the occasion Both authors contributed equally to this work. of debating hESC research resulted in arresulted The research for this paper has been supported by the Aus- in a policy compromise that, in the end, almost trian Federal Ministry for Education, Science and Culture´s no one found satisfactory. GEN-AU (Genomeresearch in Austria) Program (www.gen- In the USA, emotional escalation combined au.at), and by the European Union´s 6th Framework Pro- with the unsuccessful generation of trust in regu- gramme, STREP Project PAGANINI. The authors are lation led to a constellation in which hESC grateful to Jane Neuda for editorial assistance and for valua- research turned into a battle-field comparable to ble comments on the manuscript, as well as to the anonymous the struggle over abortion. The US case seems to peer reviewers for Regenerative Medicine.

Executive summary Author Proof • An analysis of how the Aristotelian categories of pathos (passions and emotions), logos (reason) and ethos (a property capable of generating trust) are mobilized in a public debate on medical research and technology is crucial to understanding particular regulatory outcomes.

• Emotions are a key element in dealing with uncertainty in political-scientific decision-making processes.

• Allowing emotions into political debate on new medical technologies does not necessarily render policy outcomes hasty and/or restrictive.

• Creating space for emotions in public and regulatory debates can be a means to generate trust in a regulator’s ability to deal with a new technology in a responsible manner.

• ‘Emotional politics’ alone cannot persuade a public of the positive value of biomedical research. Trustworthy institutions are a prerequisite for social experiments with new medical technologies. We do not propose the public display of emotions to be a substitute for substantial political debate.

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