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The Stem-Cell Debate
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Moral seasoning
Regarding the second issue I mentioned above - that of derivation of PSCs—presuming that at least initially such stem cells will likely come from discarded human embryos from IVF clinics, then research or no research, the embryos will be destroyed. This means they will be thawed and eventually incinerated or otherwise discarded. British infertility clinics, in the course of performing their legally mandated duty of discarding 3,300 unwanted or unclaimed embryos, are reported to have thawed and administered a few drops of alcohol to each embryo before incinerating them. It would seem that even for those who oppose embryo destruction, the morally relevant conduct here is the destruction, not how it is accomplished. Once one has set about destroying an early embryo, it seems immaterial whether this is done by thawing and allowing it to die in a petri dish, by dropping it into a lethal solution, or by using a micropipette to disaggregate it.

No one denies that early embryos lack sensory organs or tissues. They cannot suffer pain.

No one denies that early embryos lack sensory organs or tissues. They cannot suffer pain. Their moral worth, if any, resides in their potential for further development. The "wrong" here (if there is any wrong at all) is the ending of that potential, not how it is ended. Downstream researchers may thus be involved in encouraging clinicians and others to adopt a particular method of embryo destruction, but that is morally unimportant. They are in no way involved in encouraging the destruction itself, which will occur in any case. That is, downstream researchers would merely be encouraging adoption of a morally neutral method that is most likely to produce some benefit from an otherwise unavoidable situation of loss.

IVF If ES cells come from rejected IVF embryos slated for imminent destruction, Green feels that the potential benefits of stem-cell research outweigh right-to-life concerns.

Working through these thoughts, I had no illusions that this approach would end the controversy over ES cell research. Some people would continue to abhor even the most remote connection with what they regarded as evil deeds. Others would see symbolic issues within these debates that threatened the sanctity of human life. They would see the involvement of researchers in the killing of a form of human life as a dangerous precedent that outweighed the benefits of ES cell research.

Though I appreciated these concerns, I did not see them as outweighing the possible benefits of ES cell research. I believed that many people who hold a different view of the early embryo's status than I do could share my conclusions about using embryos that would otherwise be destroyed. My aim was to develop a position that could attract enough support from a middle ground to shape public policy. The challenge was to understand the issues sufficiently to determine which analogies, precedents, or illustrations best conveyed their underlying logic. Once that determination was made, one could identify those arguments most likely to convey the issues honestly and effectively to a larger audience.

The image of researchers dissecting tiny human beings should not be allowed to dominate the discussion.

Simultaneously, one could better understand the force of one's opponents' views and how to respond to them. The image of researchers dissecting tiny human beings should not be allowed to dominate the discussion. The public had to understand that the key issue was whether spare embryos would be used for valuable research that could save human lives or would merely be thrown away. This was not a matter of countering one emotionally evocative image with another. Rather, it was an attempt to articulate the real nature of the choices and their most likely moral implications.

Down the road
Future developments may erode the emphasis on spare embryos implicit in the use-versus-derivation distinction. As I have argued, the moral logic of separating use from derivation rests on the fact that the needed embryos can come from the population of those embryos left over from infertility procedures that will otherwise be destroyed. However, we can already imagine a future in which it may be desirable deliberately to create embryos in order to produce autologous pluripotent stem cell lines. This is the prospect I sketched earlier of using a somatic cell from an individual to produce an embryo (via somatic cell nuclear transfer technology), and from this embryo, a histocompatible ES cell line for cell-replacement therapy.

Embryo At the moment, the notion of creating new ES cell lines using human embryos fashioned by means of "therapeutic cloning" is fraught with moral and technical uncertainties.

Before "therapeutic cloning" of this sort becomes a reality, and certainly before it merits federal research support, many questions will have to be asked. Is it really not possible to avoid this alternative by manipulating immunity factors in existing pluripotent stem cell lines produced from spare embryos (research that could be done with federal dollars)? Does the actual bench research in this area need federal support and oversight, or is it something that can be accomplished effectively with private funding? And if this possibility becomes a clinical therapy, will it need federal support, or can it be offered as a purchased clinical service?

The answers to these questions are by no means evident. If cell-replacement therapies using deliberately created embryos prove highly successful, we may also have to consider issues of federal funding beyond the research context, in the area of clinical services. Would it be just to deny Medicaid or Medicare recipients access to these therapies merely because other citizens morally object to them?

Medicaid patient Would it be right, Green asks, to deny, say, a Medicaid patient access to cell-replacement therapies just because some people may morally object to them?
Fortunately, these are questions for the future. I introduce them here to illustrate how ongoing experience can force a rethinking of moral conclusions from one period to the next. This is exactly what happened with fetal tissue transplantation research, support for which has been reinforced by increasing clinical successes and the efficacy of morally sound regulations.

I must stress that there are two things I am not saying in indicating the importance of ongoing experience and the possibility of revising our conclusions. First, I am not suggesting that we should advocate the least offensive research initiatives now as a political device for expanding these initiatives later. I am not a political scientist and have no idea whether this is the best way to proceed. I am making a moral, not a political, argument. It is respect for others, not political efficacy, that requires the use of the least offensive means needed at each stage of research.

Second, I am not suggesting that success makes something that is wrong right. I personally do not believe that human embryo research, including the deliberate creation of embryos for valid research or clinical purposes, is wrong, but I acknowledge that many people do. I am not saying that the mere fact of scientific or clinical success will convince these people otherwise or prove them wrong.

Moral reasoning must always be in conversation with human experience.

I am saying that moral reasoning must always be in conversation with human experience. Because so many aspects of moral decision require difficult balancing judgments often based on uncertain predictions about future harms or benefits, it is very important to stay in touch with moral realities as they evolve "on the ground." It may be that all the promises of human embryo or pluripotent stem cell research will prove to be fruitless. In that case, the urgency of this research and the justification of continued federal funding for research will decline.

Conversely, the clinical successes may be enormous. They may also spur new techniques for producing pluripotent stem cell lines that reduce or minimize the need to destroy embryos. In that case, those currently opposed to these research directions may find themselves altering their opposition to some forms of this research. Remaining open to experience does not mean sacrificing principles to success. It merely expresses the wisdom that as human beings we are not omniscient or unerringly right in our moral judgments.

Dr. Ronald M. Green is The Eunice and Julian Cohen Professor for the Study of Ethics and Human Values, Chair in the Department of Religion, and Director of the Ethics Institute at Dartmouth College. In 1996 and 1997, he served as the founding Director of the Office of Genome Ethics at the NIH's National Human Genome Research Institute. This article was adapted from Green's book, The Human Embryo Research Debates: Bioethics in the Vortex of Controversy (Oxford University Press, 2001), with kind permission of the publisher.

Photos: (1-2, 6-8) WGBH/NOVA; (3-4) Courtesy of Dr. Thomson and Dr. Gearhart; (5) Corbis Images; (9) Courtesy of Dr. Green.

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