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).