Stem Cell Debate

The Human Embryonic Stem Cell Debate by Suzanne Holland, Karen Lebacqz, Laurie Zoloth (M I T Press) offers a foundation for thinking about the many issues involved in human embryonic stem cell research. It considers questions about the nature of human life, the limits of intervention into human cells and tissues, and the meaning of our corporeal existence. The fact that stem cells may be derived from living embryos that are destroyed in the process or from aborted fetuses ties the discussion of stem cell research to the ongoing debates on abortion. In addition to these issues, the essays in the book touch on broader questions such as who should approve controversial research and what constitutes human dignity, respect, and justice. The book contains contributions from the Ethics Advisory Board of the Geron Coroporation; excerpts from expert testimony given before the National Bioethics Advisory Commission, which helped shape recent National Institutes of Health policy; and original analytical essays on the implications of this research.

The book is divided into several themes.The first three chapters are on the basic science and history of stem cell research, and the editors' choice of contributors is impeccable: they include James Thomson, who first isolated human embryonic stem cells, and Thomas Okarma, president and CEO of Geron Corp., which is the private firm that has spearheaded the development of Thomson's discoveries.

The second section segues from history to public policy and ethics, including analyses of the National Bioethics Advisory Committee's report on stem cells in 1999. This by and large was a good introduction to how the government, and specifically the Clinton administration, began to respond to stem cells. Erik Parens has a good article on how people tried to differentiate between the morality of experimenting on embryos from IVF clinics and embryos made specifically for research, and a few other dilemmas stemming from current human embryonic stem cell (hES) sources and protocols.

We then go into the third section, which contains religious perspectives on ESCR. This is where I found the term "debate" a misnomer, as for the exception of Gilbert Meilaender, a Protestant thelogian, all the religious commentators tried to show how their traditions could tolerate, if not actively approve of, ESCR. Now I know that many religious people approve of ESCR, but the deafening silence on the opposition's part (excepting Dr. Meilaender's rather short piece) concerns me. Ironically, in the following section, sociologists Paul Root Wolpe and Glenn McGee note that the majority of the ESCR dialogue has been within a community with an active interest in promoting ESCR. This seems to be just the case in this book.

The fourth chapter is a public policy section, with the aforementioned good essay by Wolpe and McGee on the nature of the ESCR debate. The essays treat issues like whether pressure will be exerted on women in fertility clinics to donate unused embryos to labs, whether the poor will get stem cell therapy, government oversight, and several other practical concerns that must be addressed if one promotes ESCR and any future applications it may bring. During the height of the ESCR debate, I didn't hear much of the minority or feminist viewpoint on ESCR, so the opinions of Suzanne Holland (who appears earlier in Section II), Margaret McLean, and Cynthia Cohen were particularly handy.

Interview with Laurie Zoloth and Suzanne Holland, editors of The Human Embryonic Stem Cell Debate: Science. Ethics, and Public Policy

 

Laurie Zoloth is Professor of Social Ethics and Jewish Philosophy and Director of the Program. in Jewish Studies at San Francisco State University. Suzanne Holland is Assistant Professor of Religious and Social Ethics at the University of Puget Sound.

What is the consensus in the bioethics community regarding President Bush's decision for the limited funding of stem cell research?

LZ: The bioethics community has a wide range of responses to the decision. Some support this as a limited political compromise, understanding that it is a way to address the competing values at stake in a deeply divided society.

SH: I think that most of us in the bioethics community are pleased that the President "okayed" the ongoing research, although many of us think that the limitations are somewhat artificially imposed. Some of us think the President did not go far enough towards supporting the research.

How do you think his decision will affect scientific research in the U.S.? Do you foresee an exodus of U.S. scientists to other countries where there are no restrictions?

LZ: Much scientific research in the U.S. is in fact privately funded. Public support for stem cell research is important because it allows greater oversight, and greater accessibility in research. It is certainly the case that scientists, facing the political intensity of the debate, might find it easier to work in a climate of public support, as in Britain.

SH: I do not foresee a mass exodus of U.S. scientists to other countries, although there will indeed be some who will leave here as Roger Pederson did. Scientific research in the U.S. will proceed but will be somewhat hampered by the restrictions; the restrictions themselves could result in giving other nations the edge in this research. The decision also places more power in the hands of the (unregulated) private sector than I think we should feel comfortable with.

Human embryonic stem cell research seems to be less controversial overseas than it is in the U.S. But the ethical issues must be fairly universal. How do you account for this difference between the U.S. and other countries ‑ or is there indeed such a difference?

LZ: Many of the issues are religious in nature, and different religions have differing political standings in various societies.

SH: In my view, the difference between the U.S. and most other nations on this question is the difference made by the historical and ongoing role of religion in the public square in this country. The objections to stem cell research in the U.S. are largely shaped by concerns over the destruction of the embryo, and this is driven, in large part, by the Roman Catholic Church and the Right to Life movement. I do think that Germany has some concerns about this issue, though these are framed by the legacy of National Socialism and its eugenics movement.

Your book offers a wide array of scientific, ethical and religious viewpoints on the stem cell debate. How do you hope your book will shape the discourse on this controversial topic?

LZ: Good ethics begins in good science, and this book grounds the debate in science. We offer a wide and diverse set of views on the topic, allowing, hopefully, for full range of responses to our work.

SH: It is my great hope that our book will be used by policy makers as well as by "ordinary citizens" to help inform their thinking about a range of issues related to this vexing topic. I would love to see it in the briefcases of congressional aides on the Hill and in statehouses all over the country. And really, it is the first book to come out on the topic so it ought to go some way towards giving people an educational framework for talking intelligently about the topic.

We've heard a lot about the advantages of stem cell research, and about its great potential to advance medical science and the treatment of otherwise intransigent and debilitating diseases. What are the disadvantages, besides requiring human embryos? Are there other costs or dangers associated with this research?

LZ: We are at a very early stage in our understanding of the human developmental process. There will be errors in our understanding‑which is why careful basic research is needed before any other work is done in human subjects. The cells need to be stable, and need to be uniform before they are used. Later effects may occur in human tissue that are yet to be seen in animal models.

SH: One of the cautions about stem cell research, in my view, has to do with the issue of resource allocation and social health care costs and goods. One has to ask some deep questions about the levels of funding going into this research: who will benefit from it, and who will be asked to bear the burdens of this social resource allocation? When 48 million Americans do not even have health insurance policies, is it an ethical use of public goods to divert scarce dollars to this kind of therapy while millions suffer from lack of basic health care? Very few people are asking these macro resource allocation questions.

What would you like readers to learn from your book? How would you hope they would use it?

LZ: As a basic introduction to the issue‑I hope this book can be used as a source text in classrooms, faith communities, and other venues.

SH: I hope church synagogue and mosque study groups would make use of it to further conversation, education and dialogue.

What should people consider as they attempt to take a position or a view of this research? Are there 3 or 4 key points that should influence the view of citizens who are unsure whether and how much scientific use of embryonic stem cells they might favor?

LZ: 1. What is our duty to heal? What does that consist of, and how do we meet our duty to heal?

2. Are there limits to research and who should set the limits?

3. What is the role of religion in public discourse?

SH: People might want to consider the social costs and benefits of doing the research vs. not doing the research. Who will be helped? Harmed? Another issue that might influence one's decision making on this topic is how one regards the life of the human embryo. This, in my view, is not an issue that science will decide, nor is it an issue around which we will be able to reach a national consensus. It is an issue that seem to be framed by what one's faith commitments are. Each person must decide where he or she stands on this issue and then, given this, how far one thinks the research should proceed or not. I think that it might be very useful for persons of faith to consult the statements of their religious traditions, both official and unofficial, and then to allow their own view to coalesce in response to their respective traditions.

Bioethics itself has been in the news a lot lately. Many Americans are probably unfamiliar with the field or even with the notion of bioethics. What is a bloethicist? What kind of training does such a person have? What role do you see bioethicists playing in this and comparable debates?

SH: A bioethicist is someone whose training equips him or her to reflect critically on the problems, pitfalls and promises presented to us by the life sciences, particularly the biological sciences, and the whole context of human health and health care. Bioethics arose out of the field of theology; the early bioethicists were moral theologians and Christian ethicists. It is customary for a bioethicist to have a doctorate in philosophy, religious studies, or perhaps sociology of medicine, or to have a medical degree. Some institutions train clinical bioethicists at the Master's level, as well, although these persons are usually not teaching in universities.

Like abortion, stem cell research evokes strong feelings among Americans. Is there more middle ground here than there Is in the abortion debate? Can bloethics help to find/navigate this middle ground?

LZ: Yes, stem cell debates cut across traditional lines of conflict.

SH: I think that bioethics could help navigate this middle ground. First, I think we need to make clear that this issue is not to be equated with the abortion debate. There is no abortion going on here, except insofar as one source of embryonic stem cells is the gonadal ridge of the aborted fetus (Gearhart et al). I would like to see bioethics help grassroots church/synagogue/civic study groups in various cities with stem cell trainings and think sessions that explore the ethical and religious dimensions to be considered. This would take a huge influx of funding to make such a plan reality, but that is one way I think we could help.

Suzanne, your essay talks about the effects of stem cell research on women, especially women of color, and the poor. Could you explain your main concerns with how this research could negatively affect these groups of people?

SH: I am concerned that we focus so much on the moral status of the embryo in this research that we risk leaving out the larger health care concerns of women and the poor. Some of this I touched on above. I am also concerned that limiting public sector funding while not regulating the private sector can have deleterious consequences for these two groups. We do not know, for example, what the demand will be for eggs to produce embryos, and how much money will be offered for them at whose expense and for whose benefit? Nor do we know if these groups of people will stand to benefit from the results of stem cell research since it is likely that the therapies will be prohibitively expensive for all but the wealthy or the well insured. These are some of my concerns. I also think that when the Federal government commits taxpayer funding to this type of research, then the government should take steps to ensure that its most vulnerable citizens will have access to the benefits of the research that public funds made possible. In this sense, federal research might become research‑as‑advocacy for the have‑nots.

Do you expect the Bush administration will adequately address these concerns?

SH: I would hope that the Bush administration would adequately address these concerns, but I have not seen much evidence of it in other related arenas.

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