Some day medical science may be able to heal or alleviate ailments like Alzheimer's Disease, Parkinson's Disease, diabetes, spinal cord injuries, heart disease and cancer by giving patients that have been guided to act as replacements for their own damaged tissue. Sometimes the starting "stem cells" could be culled from organs and tissue in the recipient's own body, like the bone marrow, ensuring a perfect match. But many scientists argue that more promising research is being conducted on even less specialized and hence more versatile stem cells taken not from adults but from very early embryos, about a week after fertilization. At that point the embryo is a sphere whose inner cell mass contains many cells that are as yet undifferentiated. They can still form any tissue of the body, perhaps even a new embryo. About two years ago, scientists began culturing these cells to develop new therapies for disease. But harvesting stem cells means destruction of the embryo.
Research on embryonic stem cells thus presents bio-ethics with a classic moral dilemma: is it ever right to cause some evil to achieve a greater good? Does the end justify the means? Those who put a priority on advancing medical relief for physical suffering focus attention on the good to be gained and minimize or negate the value of the embryo lost. Others, who see the embryo as having value in its own right and who put a priority on protecting "the unborn", believe saving lives through medical advances justify the direct taking of other lives. To the means/end conflict must be added still another complication. Neither means nor end can be looked at in isolation from their context and all the ramifications any attempt to balance the two would have for the welfare and moral fabric of society. Does sacrificing embryos lead to a general disrespect for life and even its commercializa1ion? Would prohibition of such research dangerously restrict scientific inquiry and signify callousness toward those who suffer serious illness? And how about the value our society puts on technology, especially medicine? Are we too trusting that new biotech discoveries will solve age-old human problems like aging, suffering and death? What do we have to say to the justice question about who will get these new therapies if they are produced?
Institutes of Health (N.I.H.) interpreted the law to mean that federally funded researchers could use stem cells if they were derived from embryos by private companies. Many critics called this policy hypocritical. So last August, N.I.H. issued revised guidelines, permitting scientists using public grants to use stem cells derived by others, but also prescribing rules to be followed by those extracting cells from donated embryos. Thus, although stem cells cannot be derived with public money, activity is still brought under the purview of federal regulation and monitoring.
Publicly funded scientists may now use frozen human embryos that were originally created in the course of infertility treatment for couples who no longer need them. Under the new guidelines, the couples consent to donate their embryos and would neither receive payment nor be permitted to designate a recipient of the resulting tissue. Moreover, the stem cell research would have to be reviewed scientifically and ethically four times--once in the researchers' home university and three times at N.I.H.
When Is an Embryo a Person?
What does appropriate respect for an early embryo really demand? Precise answers here are not easy to attain. The Roman Catholic Church takes a strongly protective stance toward embryos, asserting in the 1987 Vatican instruction on reproductive technologies, Donum Vitae, that the embryo must be treated with the respect due a person. Many hesitate to treat the embryo with unqualified personal respect; even in Roman Catholicism, liturgical and pastoral care for those experiencing a miscarriage and those experiencing the death of a child are quite different. Many bio-ethicists, including Catholics, have made the argument that the embryo cannot be considered a person until after about two weeks of development, at which point it implants in the uterine lining and can no longer split into identical twins. Their rationale is that it is implausible to attach "personhood" to a being whose individuality is still unsettled and for whom there is naturally about a 40 percent chance of not making the transition to implantation and survival.
The counter argument is that as long as an embryo is a developing life with a human genetic code, it is a person despite its uncertain identity and prospects. This ongoing debate is partly a response to new birth control methods that prevent the early embryo from implanting in the uterine lining, as well as to in vitro fertilization and preimplantation genetic diagnosis, both of which also involve manipulation and sometimes destruction of early embryos.
I personally am not convinced that we will find some all - or - nothing developmental line of demarcation, after which an embryo must be treated with all the dignity of a person and before which its value is negligible. Even Donum Vitae grants that there is no scientific proof of the personal status of the fertilized egg and acknowledges that the magisterium has not taken a definitive philosophical position on this matter. Practically, the search for such a line seems to result more in denial of status before the "magic moment" than in enhanced protection after, and this is no doubt a major motivation of the church's repeated insistence that the early embryo be given the benefit of the doubt.
Surely it is no more adequate to dismiss the embryo as simply a "clump" than it is to regard it as the moral equivalent of an infant. Even those who are not willing to view it as a "person" or individual with a full set of rights, as does official Catholic teaching, should be able to agree that an embryo is a form of human life in its beginning stages. My concern is that the new regulations are one more instance of scientific and legal erosion of the respect due early human life and the procreative process itself. Both are increasingly being commercialized and subjected to technological incursions. Research on and use of embryos is intended to help couples and relieve suffering, but it is also driven by gains for researchers, clinics and pharmaceutical companies. Hence policies that encourage research on embryos deserve intense scrutiny.
Commercial interest in the embryo and its cells tends to vitiate the integrity of the arguments of those who want to use it - that respect for the embryo can and will set significant limits on exploitation of its utility and that legal restraints are unnecessary. Private companies supplying stem cells must be remunerated for their services. There are also tremendous financial incentives for researchers to investigate medical uses of stem cells so as to sell their knowledge to for-profit pharmaceutical companies or to work directly for those companies. Under U.S. law, the only protection the embryo is afforded in recognition of that status is its immunity to being bought or sold. Is that enough? And is this limit even observed in practice if products derived from embryos, like stem cells, can be sold? Bishop Sgreccia's concerns about "commercialization" must be addressed.
Partly because of market incentives to pursue certain kinds of profitable new techniques in genetic science, temporary or provisional bans on various types of research are frequently overridden once the public becomes accustomed to a new technology and starts to trust that assurances of enormous benefit may be less fantastical than they initially seemed. A temporary moratorium on human cloning was removed in 1997, after the National Bioethics Advisory Commission recommended not only that cloning to produce children be banned, but also that "non-reproductive" cloning be permitted to advance research. In non-reproductive cloning, an embryo is created by transplanting an adult cell's nucleus into an ovum, but it is not placed in a uterus or gestated. Since creating embryos for research remains banned in general in this country, federal funding for non-reproductive cloning was never approved. The British guidelines of August 2000 now explicitly permit non-reproductive cloning of embryos to supply stem cells for new therapies. This sets a precedent for creating embryos for research alone in the United States as well.
In the United States, the ban on using stem cells had already been reinterpreted to permit publicly funded scientists to use stem cells derived by others; the new N.I.H. guidelines extend regulation and hence tacit approbation to researchers taking stem cells as long as they adhere to the guidelines. It does not take a huge stretch of the imagination to anticipate that scavenging stem cells from "leftover" frozen embryos will eventually be federally funded and may convert into permission to expand the embryo supply by cloning embryos from such spares (which would amount to creating, not just using, embryos). If this is followed sooner or later by permission to create research embryos outright from sperm and ova, then the present ban on creating embryos for research will have been gradually but completely overturned. Conception will be a laboratory means to advance a new technology expected to result in the cutting-edge medical treatments that people in the wealthier social sectors have come to take for granted.
Laws should not be inflexible. Scientists have a right not only to acquire knowledge and expertise, but to earn a living commensurate with their skills. And it is undeniable that there are important competing values in the stem cell debate, as in many other debates that arise with the emerging astounding power and promise of biotechnology. Even those who see the embryo as worthy of much more significant legal protection than it now enjoys should be able to appreciate that the good of the embryo can conflict with other equally important goods, especially the needs of those who are indisputably human persons. But that is exactly the point. In the stem cell debate we are dealing with a conflict-even a clash-of important values that should not be ignored or sidestepped just to make our moral and policy choices seem more simple and easy, as when "infanticide" is set off against the destruction of a mere "clump of cells." Instead, we need to take a long critical look at what we do, can and should expect from technology, medicine and big business. It is disconcerting to witness the frequency with which public standards in biomedical research change to follow the money.
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