The Ethics of Stem Cells

The Forward | Published on

By Eric Cohen

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[The following exchange, between Eric Cohen, editor of The New Atlantis and director of EPPC's program on Biotechnology and American Democracy, and Arlen Specter, U.S. Senator from Pennsylvania, appeared as a "Both Sides" feature in the newspaper The Forward on May 21, 2004.]

 

ERIC COHEN: Last month, more than 200 congressmen sent a letter to President Bush demanding more federal funding for more embryonic stem-cell lines. Last week, Elias Zerhouni, director of the National Institutes of Health, responded by explaining the great scientific progress we have made under the current policy, while acknowledging that the science might move faster if there were no ethical limits at all.

In the meantime, Harvard University and the University of Wisconsin have announced the creation of new, large-scale, privately funded institutes to promote embryonic stem-cell research. New Jersey has announced a $50 million funding initiative for embryonic stem cells, and California is considering a $3 billion bond issue to support stem-cell research.

With the debate swirling, it is worth stepping back to remember why there is a debate here at all, and to clear up the many misconceptions and misleading claims that have so far shaped public dialogue about this controversial area of biomedical research.

Everyone wants to cure terrible human diseases — especially those that strike the young before they have had the chance to grow up, marry and pass down their traditions to the next generation. And no one can doubt America’s strong commitment to biomedical progress: We provide more public funding for basic scientific research than any country in the world, and the NIH budget has doubled in the last five years alone.

But modern medicine, for all its great blessings, occasionally presents us with ethical dilemmas — and thus the need to set certain limits. We do not engage in reckless experiments on human subjects, even if the scientific benefits of doing so would be great. We do not buy and sell human organs for transplantation, even though creating an organ market would almost certainly increase the organ supply. We do not euthanize the sick or elderly, even if their lives seem to us too miserable to continue.

Embryonic stem-cell research is clearly in this ethically thorny category. It requires the deliberate destruction of an early-stage human embryo, produced by joining egg and sperm together in the laboratory.

These early embryos are existentially puzzling. They are microscopic, developing, genetically whole human beginnings — not just any beginnings, but the beginnings of a particular human life. They may be small — but size does not define a person’s humanity. They may lack normal human consciousness — but we do not use human beings just because they have lost their mental powers, and it is precisely the development of consciousness that embryonic life possesses in-potential. They may be frozen in fertility clinics and unlikely to be implanted in a woman’s womb — but the notion that someone is “going to die anyway” is not an ethical justification for exploitation. They may not look human — but we are left to wonder: What else can they be? And what respect do we owe them?

Of course, the embryo research debate overlaps with the long-standing ethical and political divide over abortion. Both involve questions about the dignity or moral standing of nascent human life. But the two issues are also very different: There is no woman directly involved in embryo research and thus no issue of “bodily rights.” The end being sought in embryo research is humanitarian: to cure disease and ease suffering. But embryo research is also a national project in a way that abortion is not. If funded with taxpayer dollars, it would become something we celebrate, not something we tolerate.

Different religions have different views about when life begins. But no religion, Judaism included, can ignore the biological reality of continuous human development — from embryo to fetus to birth. We cannot look only at the scientific promise of stem-cell research without also facing the scientific fact that human embryos are not really “like water” for 40 days, as defined in the prevailing Jewish legal view. They may or may not be fully human from the very beginning. But they do have a genetic plan from the very beginning; they are whole organisms from the moment of conception onward. Surely they are not simply things for our use.

It is these ethical realities that lie at the center of the stem-cell debate, and these ethical concerns that underlie the current limits on federal funding of research. Specifically, the country faces two large questions: Should we create and destroy nascent human life as a medical resource? And should we compel those who object to this research to support it with taxpayer funding?

As we debate these issues, it is important to clear up some recurring misconceptions.

First, the current Bush policy is about federal funding for embryonic stem-cell research. It does not stop such research from proceeding in the private sector — as the recent announcement of 17 new stem-cell lines at Harvard demonstrates.

Second, Congress, not the president, made the law that prohibits federal funding of embryo research. The Bush policy seeks to advance embryonic stem-cell research within the letter of this law, but without creating taxpayer incentives for embryo destruction in the future.

Third, the number of stem lines currently available for federal funding — that is, those lines that are adequately prepared for research purposes — has grown steadily since the announcement of the Bush policy: from a single line in April 2002 to 19 lines and counting today.

Finally, while the science is advancing, it remains at present entirely speculative: No one has been cured using embryonic stem cells, and no one yet knows what therapeutic fruit, if any, this research will bear in the decades ahead. To speak about “100 million people” being cured is irresponsible; it risks giving false hope to those who already suffer so greatly.

This research may work and it may not — we cannot know in advance. There are powerful reasons to do it, as the faces of the suffering remind us daily. But there are also clear ethical reasons not to use the “seeds of the next generation” as tools to aid our own: because it will coarsen our ethical sensibilities; because it will make us users of life in the very effort to be savers of life; and because, as theologian Paul Ramsey once put it, “the moral history of mankind is more important than its medical history.” Most often, medicine and morality advance together — but not always.

In the end, one can respect those scientists who proceed soberly with embryo research — heavy hearted about destroying human embryos, but with the belief that they are morally obligated to do something morally troubling. But research advocates also must respect those who believe embryo destruction is wrong, and not demand that their fellow citizens subsidize a research project that they find ethically unjustifiable, especially when private funding is available. The Bush policy strikes this pluralistic balance: It does not ban embryo research; it does not fund experiments that require or reward further embryo destruction, and it seeks to advance stem-cell research as much as possible within ethical limits.

[Eric Cohen, a senior consultant to the President's Council on Bioethics, is editor of The New Atlantis and director of the Project on Biotechnology and American Democracy at the Ethics and Public Policy Center. The views expressed here are his own.]

*   *   *   *

ARLEN SPECTER: I have a constituent by the name of Jim Cordy who suffers from Parkinson’s disease. When I am at events in the Pittsburgh area, I often see Jim hold up an hourglass to demonstrate how delays in critical medical research have left him watching the hours of his life slip away just as the sand slips a grain at a time through the hourglass.

Jim contracted Parkinson’s when he was 40 years old, and has been waiting for scientific progress against the disease ever since. Over the years, I have watched as his condition has deteriorated. It is literally a race against time for Jim and millions of others with similar diseases.

For them, the debate regarding stem cells is much more than a debate about “research.” It is a debate about saving lives.

Stem cells have the extraordinary ability to replace damaged or diseased cells in the body, and have the potential to be used to treat the more than 100 million Americans — like Jim Cordy — who are affected by deadly and disabling diseases and conditions, including cancer, heart disease, diabetes, Parkinson’s, Alzheimer’s, spinal cord injuries and multiple sclerosis.

Embryonic stem cells can be derived from in vitro-fertilized embryos that are developed in excess of those needed for the procedure used to enable infertile couples to have children. The in vitro fertilization process results in more embryos than are needed by the couple. There are estimated to be more than 400,000 such embryos — which are currently frozen and likely will be destroyed if not donated — available for research, with the informed consent of the couple.

The concern of many opponents of the research has been that stem cells derived from human embryos would potentially destroy life. The fact is that the only human embryos that are used as a basis for stem-cell research are those that would otherwise be discarded from in vitro fertilization clinics. This is not a matter of using a human embryo that has the potential to produce life. Rather, these otherwise discarded embryos have the potential to save lives.

From my position as chairman of the Labor, Health and Human Services Appropriations Subommittee, I took the lead in allocating $2 million for embryo adoption, but the unused frozen embryos continue to grow in number.

Some say that we should ban medical research related to stem cells because it is unproven and may lead to unintended consequences. These fears were heard 25 years ago during a debate on a new biotechnology called recombinant DNA.

At the time, many believed that recombinant DNA could be used to cure diseases, while others thought the technology was unproven and unsafe. In the end, Congress allowed this research to go forward. The results are clear: Recombinant DNA has led to the development of vaccines, insulin for diabetics and drugs to fight AIDS, cancers and many other diseases.

President Bush allowed the first federal funding of embryonic stem-cell research by making funding available for research on stem-cell lines that had been derived before August 9, 2001. Originally, it was thought that 78 stem-cell lines were available for federal funding, and that these lines would allow significant progress toward cures. The president made a sincere and thoughtful effort to strike an acceptable balance on this issue.

Unfortunately, more than two years after the policy was instituted, only 19 stem-cell lines are available to federally funded scientists. All these lines are contaminated by the use of mouse-feeder cells and probably will never meet the standards required for human treatment. There is no doubt that these lines are inadequate for the quality of research needed.

Since August 9, 2001, significant progress has been made in the science of stem-cell derivation and handling. Several stem-cell lines derived after that date have been either derived or grown without the use of mouse-feeder cells — but under Bush’s current policy, these more advanced stem-cell lines are not available to federally funded scientists.

In other words, the embryonic stem-cell lines eligible for federal funding will not be suitable to promote life-saving research. With more than 400,000 spare embryos available at in vitro fertilization clinics — again, embryos that would otherwise be discarded and destroyed — there is a real question of why the National Institutes of Health funding should be available only for stem-cell lines in existence as of 9:00 p.m. on August 9, 2001. It is essential that the current policy restrictions be relaxed to allow this research to be fully explored. The time has come to expand the current policy on human embryonic stem cells so that American scientists and physicians can continue to make strides toward cures and treatments.

There is no doubt that the debate on human embryonic stem cells makes us question our priorities, compassion, morals and ethics. That is as it should be with any new scientific journey. We must choose a path that does not impede the progress of science, that gives us the best chance to help those who may benefit from stem-cell research, and that does so in a moral and ethical fashion.

Recently, Nancy Reagan came out strongly in favor of stem-cell research. She sees the chance to help others through her support of the research that might one day help those like her husband, President Reagan, who is afflicted with Alzheimer’s disease. “Ronnie’s long journey has finally taken him to a distant place where I can no longer reach him,” she recently said. “Because of this, I’m determined to do whatever I can to save other families from this pain. I just don’t see how we can turn our backs on this.”

The American playwright Howard Sackler once wrote, “To intervene between our fellow creatures and their suffering or death, is our most authentic answer to the question of our humanity.” Now is the time for the healing to begin.

Before we close off the opportunity to save lives, we owe it to ourselves and future generations to at least give this research a chance. With the limited number of stem-cell lines currently available, and their contamination with mouse-feeder cells, the potential for “breakthrough therapies and cures” noted by Bush in his 2001 announcement of federal funding for stem-cell research cannot be achieved.

These therapies could change the practice of medicine forever. They also might prevent others from following President Reagan on his long journey, and might just allow Jim Cordy to put down his hourglass.

[Senator Arlen Specter, a Pennsylvania Republican, is chairman of the Labor, Health and Human Services Appropriations Subcommittee.]

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