Determinants of National Policy on Human Embryonic Stem Cell Research in Selected Countries: A Comparative Study by Virginia Clair Hughes A dissertation submitted to the Graduate faculty of Auburn University in partial fulfillment of the requirements for the degree of Doctor of Philosophy Auburn, Alabama May 10, 2015 Keywords: stem cells, culture, logistic regression Copyright 2015 by Virginia Clair Hughes Approved by: Murray Jardine, Chair, Professor of Political Science Kalu Kalu, Professor of Political Science Paul Harris, Professor of Political Science Denise Harmening, Director of Online MS in Clinical Laboratory Management at Rush University Abstract Embryonic stem cells have remained a polarizing issue around the globe. The plethora of potential applications and technologies are unfamiliar to most of society. Politicians and policy analysts continually work to pass laws acceptable to a public with diverse cultural, educational, and religious backgrounds. In this comparative study, fifty countries are analyzed regarding their stem cell policy, type and size of government, literacy rate, age, religiosity, and public and private research funding. Using binary logistic regression, religiosity demonstrated a significant inverse relationship, and public funding demonstrated a direct significant relationship on permissive ESC polices. As religiosity increased permissive policies decreased; whereas, when public funding increased permissive policies increased. There was no relationship found with age of predominant citizen, literacy, private funding, type of government, or size of government on ESC policy. In the realm of comparative policy theory, culture impacted a country’s position on ESC policy in the form of religion and a pro-science culture evidenced by both public and private funding for ESC research. Future studies should consider using a mixed methods approach in correlating frequency of religious activities and age with opinions on ESC research. Annual funding for research from both public and private sources should also be pursued. The addition of the scientific literacy rate to future studies would also be beneficial in assessing the general understanding of stem cells in the public sphere and how well it correlates with current and future policy on ESC research. The trajectory of ESC research is dependent on both policy ii and funding. Culture will continue to be a formidable factor in elucidating the nexus between moral issues and advances in stem cell research. iii Acknowledgements I would like to thank Dr. Murray Jardine for serving as chair of my dissertation committee and the members of my committee Dr. Paul Harris, Dr. Kalu Kalu, and Dr. Denise Harmening. I would like to thank Dr. Harmening for first initiating my interest, knowledge, and research into stem cells. I would also like to thank Dr. Paula Bobrowski for her guidance throughout my tenure at Auburn University and to Dr. Allen Furr for serving as the dissertation reader. I greatly acknowledge my family who instilled in me at a young age the idea that experiencing different cultures enriches our lives and increases our understanding of the world around us. iv Table of Contents Abstract…………………………………………………………………………………….….…ii Acknowledgments…………………………………………………………………….……...….iv List of Tables………………………………………………………………………….................vi List of Figures…………………………………………………………………………...............vii Chapter I: Introduction……………………………………………………………………...….…1 Chapter II: Embryonic Stem Cell Research and Funding…………………………………...…..22 Chapter III: Literature Review………………………………………………………………......99 Chapter IV: Methodology, Data Analysis, and Findings……………………………………....119 Chapter V: Discussion and Limitations of Study……………………………………................129 Chapter VI: Conclusion and Recommendations for further Research….……………...............146 References…………………………………………………………………………………...…151 Appendix…………………………………………………………………………………...…..168 v List of Tables Table 1. Binary Logistic Regression Analysis……………………………………….….…..…127 Table 2. Study Data………………………………………………………………………….…168 Table 3. Collinearity Statistics…………………………………………………………………170 Table 4. Public and Private Funding Data……………………………………………………...171 vi List of Figures Figure 1. Catholic States and Funding………………………………………………..………173 Figure 2. Non-Catholic States and Funding…………………………………………………..174 Figure 3. Three Tiered Model for evaluating ESC Policy………………….............................175 vii Chapter I Introduction Science as National Policy History has shown that science can impart great benefits to society as well as great harm (Burke et al, 1985). The discovery of vaccines eradicated smallpox and prevented numerous other disease outbreaks on a global scale. On the other hand, the atomic bomb and poisonous gas led to innumerable deaths during WWII. It is this dichotomy that requires government officials to formulate policies carefully when discoveries are made. Of the thousands of research studies published annually in scientific journals very few of them necessitate or lead to the implementation of a national policy. Examples of science policies that have been passed and implemented by governments due to a palpable medical threat include those related to transmissible diseases like smallpox, bubonic plague, and the Human Immunodeficiency Virus (HIV). Growing fears of a pandemic generally prompt immediate action by health and government officials to safeguard the public. Some scientific discoveries appear to have great potential to improve lives but raise questions with regard to religious tenets or morals. In vitro fertilization (IVF), reproductive cloning, and the subject of this study, embryonic stem cell (ESC) research, are prime examples. In addition, unethical scientific and medical research have been the impetus for both policies and laws to oversee and regulate research misconduct by scientists and physicians. The unethical medical experiments conducted during WWII in German concentration camps led to the World Medical Association Declaration of Helsinki in 1964, and syphilis studies conducted on black men in Tuskegee, AL led to passage of the National Research Act of 1974 both aimed at protecting 1 human subjects in research studies. This study examines factors that affect the development of ESC policy in fifty countries using binary logistic regression. The countries are Albania, Australia, Austria, Belgium, Brazil, Bulgaria, Canada, Chili, China, Costa Rica, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Hong Kong, Iceland, Israel, Italy, Ireland, Japan, Latvia, Lebanon, Lithuania, Malta, Mexico, Morocco, New Zealand, Norway, Poland, Peru, Portugal, Singapore, Slovakia, Slovenia, South Africa, South Korea, Spain, Sweden, Switzerland, The Netherlands, Trinidad and Tobago, Tunisia, United Kingdom (UK), United States (US), Uruguay, and Vietnam. The criteria for selection of countries is 1) the legislature has passed a law on ESC research policy, and 2) the legislatures are characterized as unicameral or bicameral. The research question for this study is what factors influence the development of national ESC policy in most countries around the world. The factors being investigated are religiosity, literacy, age, type and size of government, and type of funding. The purpose of the study is to determine the reasons for national differences in attitudes (permissive or non-permissive) regarding ESC policy. Chapter I introduces the theoretical framework and the key methodological approach for this study. Moral Status of an Embryo The major concern surrounding the use of human embryos in research is the moral imperative. Two moral principles that are highly valued in society are the duty to alleviate or prevent suffering and the duty to respect human life (Hug, 2006). When harvesting ESCs the latter duty is violated when in the process the embryo dies (Doerflinger, 1999). There are many 2 salient issues worthy of discourse and discussion surrounding the moral status of an embryo. These may include the relationship between humans and their environment, mental faculties in a comatose adult versus a developing human embryo, etc… For this dissertation I am going to focus on the question of when life begins. Most people believe life begins at conception (Nisbet, 2004). The majority of religions not only preach this tenet but also that all human life is sacred because it is created in God’s image. This presents a major obstacle for scientists as billions of people in the world belong to religions that oppose ESC research. Embryonic stem cell research presents a unique ethical dilemma. Society is being asked to allow the killing of a life so that society can benefit in the future by proven treatments. How have people responded and what factors influence their opinion? There are many factors that play a role and many circumstances that influence a citizen’s position on ESC research. Factors such as a family member with an incurable disease, political party platform, profession, or religion may impact the publics’ policy preference. Some religious leaders are very absolute in their beliefs while some are willing to concede to other sides of the issue. The Roman Catholic Church and conservative Protestants are absolute in their belief that personhood begins with the zygote but would allow research on existing stem cell lines as they have already been created (Walters, 2004). More liberal Protestants concede the fact that although all life is sacred this must be weighed against potential