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Ethics and Embryos

Ethics and Embryos.

by JAMES LINDEMANN NELSON

Consensus on the use of human embryonic stem cells may be impossible, but all voices need to be heard in the deliberations.

On November 5, 1998, scientists at Johns Hopkins and the University of Wisconsin announced they had succeeded in establishing culture lines from human embryonic stem cells. This announcement added new urgency to a longstanding controversy: can the hope of scientific progress and potential medical advances justify the destruction of human embryos?

The stems cells, which researchers isolated at the biopharmaceutical company Geron Corporation, are intriguing entities. They are, in principle, capable of producing any form of human tissue--this is the biological property known as pluripotency. Thus, they are even more therapeutically promising than stem cells derived from other sources such as adult bone marrow or umbilical cord blood. Better understanding the nature of these special cells may well lead to effective therapies for such scourges as Alzheimer's disease, Parkinson's disease, cancer, diabetes, heart disease, and other illnesses.

Human embryonic stems cells are also intriguing entities ethically, however, and herein lies the rub. In order to obtain these stem cells, blastocytes--human embryos in very early stages of development--have to be destroyed. The outer cellular layer, which is the precursor to the placenta, is dissolved, allowing access to the inner cell mass of the blastocyte. In other circumstances, those inner cells might develop into the fetal body. (See "A Stem Cell Primer" in this issue of FORUM.)

Treating blastocysts in this fashion can be enormously distressing to some citizens who may have to help foot the bill if federal funding becomes available for such research. Yet the hope of immense medical benefits from human embryonic stem cell research is enormously attractive to others.

Shortly after Geron's announcement, a number of authoritative groups, hoping to guide both publicly and privately funded research on human embryonic stem cells, issued reports on the ethical problems involved. These bodies include the Ethics Advisory Board constituted by Geron Corporation; the American Association for the Advancement of Science (AAAS) in concert with the Institute for Civil Society [1] the Center for Bioethics and Human Dignity [2] and, most recently, the National Bioethics Advisory Commission, which was established by executive order of the president in 1995 to provide recommendations concerning governmental policies or activities as they involve ethical issues emerging from biological research and its clinical applications. [3]

Of these four bodies, only the Center for Bioethics and Human Dignity, a Christian educational foundation, has been implacable in its opposition to all research involving the destruction of embryos, no matter how it is funded. The other committees have given a more or less cautious green light to stem cell research. They warn, however, that the forms and limits of federal support must be clarified. Other recommendations range from ensuring appropriate forms of review and approval of ongoing work to idealistic calls for private corporations involved in human embryonic stem cell work to respect global justice by ensuring that emerging therapeutic benefits are widely available, even in impoverished regions.

While these issues are of considerable importance, the central moral issue remains the status of human embryos. In short, can destroying embryos to obtain human embryonic stem cells be ethically justified under any circumstances? If so, does it matter ethically whether the cells are derived from left-over embryos originally derived from assisted reproduction technologies such as in vitro fertilization, from tissue gathered from aborted fetuses (see "Empowerment or Danger" in this issue of FORUM), or from embryos created for the sole purpose of conducting research?

A second issue, the ethics of funding such research, enters the realm of political policy. If public funding of research involving human embryonic stem cells is deemed appropriate, should such federally supported research restrict itself to cell lines derived from private sector research, or should public funding be used in the derivation as well as the research uses of these cells?

Controversies over funding reflect the contentious character of the central question: what are embryos in the moral sense?

Ethics in the Open

In a recent essay, the legal theorist and bioethicist Alta Charo reinvigorated the discussion over what comprises appropriate goals and procedures governing public deliberation about ethical issues. [4] Charo, who has served on a number of public ethics committees, revisited the concept of ethics in the public square--that is, the civic involvement of citizens who might expect to have a voice in what their government endorses and supports fiscally.

Charo's work challenges the idea that public ethics advisory bodies should address the issue of what embryos are, from a moral perspective. She argues that such groups can effectively sidestep these vexing issues and still produce recommendations that will be effective in forming ethically defensible research policies.

As Charo notes, the concept of public ethics faces challenges and limitations that do not trouble private efforts to form our consciences on such matters. While groups representing particular religious organizations may in principle use any argument their traditions offer, the repertoire of arguments open to them seems considerably restricted if they hope to influence public policy. Secular, and in particular governmentally instituted bodies, are even more restricted. In a pluralistic community, where the state professes its incompetence to determine issues of religious doctrine or to adjudicate philosophical conflicts, how can particular positions on matters of deep moral controversy be defended?

Yet although the promise of liberation from intransigent, seemingly interminable ethical tangles might be attractive, it is too good to be true. If we want to find out more about some of the most scientifically and medically fascinating things about embryos, we are going to have to continue to explore what is most morally fascinating about them as well--and do it in public.

Destroying Embryos?

Although scientific understanding of the biology of human embryos is becoming ever more profound, there is little real consensus about what embryos are from the perspective of morality. Some think of embryos as very tiny children who possess a right not to be killed that is as robust as the right of any other human being. Other no less thoughtful people regard embryos as morally on a par with other renewable human tissues such as blood and hair, and therefore see them as a means to whatever ends we might choose. Between these extremes are those who claim for the embryo a right to respect, but differ about why such entities deserve our respect, and even about what a right to respect means as a practical matter.

This controversy mirrors, of course, the furor over abortion; and governmental response to embryo research controversies is strikingly similar to governmental abortion policies. Just as the federal government in principle protects women's right of access to abortion, so too it has passed no law forbidding research on embryos and fetuses. Just as the public purse does not fund abortions, it also withholds funding for research that threatens the viability of human embryos. A rider to that effect on the appropriations bill for the Department of Health and Human Services, which funds the National Institutes of Health, has been persistently renewed.

The AAAS and the National Bioethics Advisory Commission want to shift the terms of this compromise, at least as it relates to research funding. AAAS advocates that public funds be made available for research that uses human embryonic stem cells, but it does nor support using such money to support the actual derivation of the cells, which requires the destruction of human embryos. AAAS believes that such a socially contentious task is better left in the hands of privately funded scientists.

The National Bioethics Advisory Commission goes even further. Since important scientific information may emerge solely through studying how such tissue might best be collected from the embryonic source, the Commission recommends that the law be amended to allow funding for research protocols involving derivation as well as use of embryonic tissue. The Commission draws its line at the creation of embryos for the express purpose of research, which it does not regard as appropriate for public funding. While the Commission advocates federal funding for protocols that involve the destruction of already existing embryos left over from assisted reproduction therapies, it does not countenance public support for any protocol that merges human gametes for the express purpose of creating "research" embryos.

This position disturbs ethicists at the Center for Bioethics and Human Dignity In their statement on the matter, "On Human Embryos and Stem Cell Research," the Center maintains that any such shift in the social compromise about embryos would be tragic. They also express considerable skepticism about whether the use of embryonically derived stem cells is necessary to achieve the kinds of health benefits proponents promise. They maintain that current research results indicate that stem cells whose source is bone marrow or umbilical cord blood may turn out to be just as valuable as human embryonic stem cells, notwithstanding the findings of groups such as AAAS and the National Bioethics Advisory Commission. But their primary concern is that human embryonic stem cell research, whatever its benefits might be, is gravely wrong. In their view, it involves the direct killing of innocent human beings.

Bioethics or Political Ethics

The challenge to those who hope to direct public policy on such matters is to find forms of argument that do not involve appeals to particular religious traditions or philosophical positions. Charo calls the standard approach to this job bioethical. The strategy is to boldly take on the central argument about whether and when fetal life gains personhood or other kinds of moral status, to sort out what is rationally defensible in the arguments from what is not, and to construct and justify a position. To that end, policymakers use arguments that will resonate with a religiously and philosophically diverse population.

The Center for Bioethics and Human Dignity; whose position is clearly consistent with the official stance of the Roman Catholic Church, for instance, provides an argument that is not in any explicit way sectarian: it does not rely on an interpretation of religiously authoritative writing, nor on any religious teaching authority. The case stands on what are presented as biological facts and on reasoning by analogy from the historical record.

As the Center sees the matter, the pertinent biological fact is a supposed international scientific consensus that embryos are biologically human beings from fertilization, at which point there begins a continuous process of human growth and development. So smoothly incremental is this process that any effort to mark out a point after fertilization at which the developing entity goes through some change sharp enough to plausibly mark a morally relevant shift of status is simply arbitrary.

The Center's report is particularly vigorous in attacking the distinction many ethics boards have drawn between embryos and pre-embryos. The term pre-embryo denotes the human conceptus prior to the formation of the primitive streak, or first appearance of the spinal cord, about 14 days after conception. The development of the streak has been seized upon as a morally significant threshold in fetogeny by an earlier federal advisory committee, the National Institutes of Health's 1994 Human Embryo Research Panel as well as by European bioethics commissions such as the United Kingdom's Warnock Commission, and is endorsed in the National Bioethics Advisory Commission stem cell report. [5] The Center for Bioethics and Human Dignity, however, regards the importance assigned to this distinction as biologically unfounded, and therefore as a nonstarter, morally.

The Center's fundamental argument is that temptation to make any moral distinction between human life in its earliest phase and more developed versions should be stilled by a consideration of research medicine's dismal history of exploitation of the weak. The report invokes the use of slaves in the American South, the continuation of that legacy in the Tuskeegee syphilis experiment scandal, and the experiments conducted by Nazis at Dachau and Auschwitz. The Center suggests that embryos are, in many respects, like American slaves or Jews in Hitler's Europe: the moral dignity they deserve is altogether ignored, and they are left vulnerable to the worst forms of exploitation.

This line of reasoning points clearly to a ban, not just on federally funded human embryonic stem cell studies, but on all destructive uses of embryos including embryos created in vitro for research or reproductive purposes.

Moral Threshold

As the ethics advisors to a corporation, Geron's ethical advisory board did not have to address the issue of federal funding. Nevertheless, Geron's board took on the task of responding to the argument that embryos at all stages are human beings with all the rights accorded to them.

In the end, all four of these advisory bodies advocate what might be termed a pluralist, developmental understanding of moral status, in which the respect owing to fetal life is not determined abruptly either by fertilization or by its passing one or another developmental threshold, but grows in seriousness steadily throughout gestation.

This position is perhaps best developed in the 1994 NIH Research Panel Report on Human Research, which recommended that the federal government fund significant embryo research, but only if embryos were used sparingly and not beyond the 14th day of their development. In support of its view, it rejected the most prominent criteria that might mark embryos as fully morally protected beings-such events as conception, implantation, and inception of brain activity. The research panel argued that none of these criteria is sufficient to demonstrate that embryos, or any later state of the developing fetus, are to be regarded as human persons. The panel then claimed that the whole set of such criteria should be seen as incremental moral steps. Gestation's ethical story starts with the embryo, which ought not to be treated with disrespect but has no valid claim to a right to life-and concludes with the newborn child, which is fully a member of the moral community. [6]

Geron's advisory board takes a similar position based in part on the claim that progressive development toward full moral standing during gestation is congruent with the moral traditions of most mainstream Protestant churches, the Jewish tradition, and even with the views of many Roman Catholics, although, as they note, not with the Vatican. Of course, this kind of argument does not so much tell us why we should accept a developmental account of the gradually increasing human status of the fetus, as inform us that many people do.

The National Bioethics Advisory Commission report endorses a view similar to that held by the bodies that advised the NIH and Geron. The commission characterizes its view as an intermediate position in which the embryo merits respect as a form of human life, but not as much respect as fully developed persons. [7] The board also implicitly assumes there's nothing so uncommon about its stand on the moral status of the embryo.

These bioethical approaches, Charo argues, are something of a mug's game-one you can only lose. For example, the 1994 NIH research panel report, to which Charo contributed, aimed to show that every criterion that designates a point at which embryos or fetuses have full moral status is unfortunately defective. Yet in trying to support its own developmental view, it merely mixed together all the criteria it had found uncompelling individually and claimed that, taken as a group, the passing of each threshold confers on the fetus a new ground for heightened respect. But it is hard to see how raking bad arguments into a pile makes them into a good argument.

Pragmatic Approach

Rather than argue about the timing or nature of personhood, Charo recommends an analytical approach that will justify the use of embryos as a last resort-in cases where there is no alternative-for purposes crucial to health and welfare.

The moral assessment of research involving human embryos should proceed by asking hard questions concerning its potential to benefit and harm humankind. For example, how deeply might such research hurt citizens who believe that embryos are persons? What can be done to reduce their pain? How strong is the need to pursue this research? How certain are we that the research will yield real benefits? If embryo research is publicly funded, will the benefits go to those who oppose the research as well as those who support it? Is the research being pursued in the way least offensive to its opponents? How strongly felt are the objections? Will opponents be harmed physically or financially? Is there anything about the structure of society or its institutions that prevents opponents of such research from effectively using the political system to try to convince others? Would opposition to pursuing research deny human rights to anyone? [8]

Charo's position is similar to the kind of judicial deliberation that produced contemporary public policy concerning abortion. The U.S. Supreme Court maintained in Roe v. Wade that the federal government may not interfere with women's decisions to terminate pregnancies and may not allow states to block women's access to abortion services.

Yet the policy that has developed since Roe v. Wade has taken on a dimension of compromise. While states cannot deny access to abortions, they are not required to fund them. Presumably, the political philosophy rationale for shifting and extending this compromise respecting funding embryo research, while it may sidestep questions about the moral status of the fetus, will rely on claims that the good emerging from federally funded experimentation with embryos is more significant than the good to be gained by allowing poor women subsidized access to abortion. This reasoning depends on a judgment call, that the losers in social disputes about public funding for abortion--poor women who can't afford abortions--suffer less than those who would be the losers in the research case, people who might remain ill or disabled longer should federal funding not be available.

So determining who would be hurt more than whom by different funding policies may not be so much easier than dealing directly with the embryo's moral status. For example, the Center for Bioethics and Human Dignity might argue that citizens opposing abortion are continually being outraged by the nation's policies. If what Charo suggests we do is spread pain around more fairly, why isn't it time for those who support federally funded embryo resarch to do their share of the suffering?

Further, it is unclear for now whether advisory groups weighing in on human embryonic cell research can really sidestep the central moral issue of the embryo's personhood. Erik Parens, in a paper prepared for the National Bioethics Advisory Commission's stem cell hearings, argued that government bodies cannot avoid taking a position on the moral status of the embryo. Parens points out that what we think is appropriate to do with things is to a large extent a function of what we think those things are. When an advisory body makes a policy concerning the disposition of embryos, it has already, in effect, made a determination about their moral status. [9]

The National Bioethics Advisory Commission report reflects this line of reasoning, admitting the near impossibility of skirting the issue of the embryo's moral status. The commission claims that Charo's approach would be acceptable only to those who do not regard embryos as having the status of persons. Those who do think of embryos as persons will regard deciding their fate by weighing the harms and benefits befalling others as unacceptable.

Public Participation

I have argued that the kinds of issues that Charo wants to place at the center of "public ethics" are not necessarily easier than those she wishes to avoid. Parens and the National Commission have argued that these issues are not truly avoidable. Even if Charo can show that moral status issues can be sidestepped and that weighing harms and benefits is easier, still we should not exclude the moral status issue from the deliberations of public ethics bodies. Attending respectfully to these arguments may, in fact, be our best chance to give those who lose out in social policy formation a sense that they are not being dismissed by a society that regards their moral concerns as merely idiosyncratic whims. To hear these arguments is not inherently socially divisive and practically vain. Instead, close, careful, respectful engagement with those who may consider themselves the losers in this debate may have the effect of improving their acceptance of the outcome.

It is a commonplace of the past few decades to remark that scientific advances have outstripped moral wisdom. The proliferation of ethics advisory committees deliberating painstakingly and publicly about extremely difficult issues represents an effort by society to play a good catch-up game. To be successful, we will need not only to encourage our advisory bodies to think hard about the tough problems they confront, but to make the way in which they go about their task an object of our careful scrutiny as well. In examining how ethics advisory bodies have responded to the challenge of those intriguing entities, human embryonic stem cells, we have a prime opportunity to do just that.

James Lindemann Nelson is a professor of philosophy at the University of Tennessee, Knoxville, Tennessee.

NOTES

(1.) "Stem Cell Research and Applications: Scientific, Ethical and Policy Issues" (August 18, 1999) is available at the AAAS website [less than]http://www.aaas.org/spp/dspp/sfrl/proiects/stem/findings.htm[gre ater than].

(2.) "On Human Embryos and Stem Cell Research: An Appeal for Legally and Ethically Responsible Science and Public Policy" is available at the Center website [less than]http://www.stemcellresearch.org/statement.htm[greater than].

(3.) National Bioethics Advisory Commission, Ethical Issues in Human Stem Cell Research.

(4.) A. Charo, "The Hunting of the Snark: The Moral Status of Embryos, Right-to-Lifers, and Third World Women." Stanford Law and Policy Review 6 (2) 1995.

(5.) NBAC, Ethical Issues in Human Stem Cell Research, p. 7.

(6.) National Institutes of Health, Report of the Human Embryo Research Panel (Bethesda, MO: NIH, September 27, 1994).

(7.) National Bioethics Advisory Commission, Ethical Issues in Human Stem Cell Research, p. 68.

(8.) Charo, "The Hunting of the Snark".

(9.) Erik Parens, "What Has the President Asked of NBAC? On the Ethics and Politics of Embryonic Stem Cell Research," Ethical Issues in Human Stem Cell Research, vol. 2, forthcoming.

(10.) NBAC, Ethical Issues in Human Stem Cell Research, p. 51.

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