the Ethics of Stem Cell Research

 

...the final stage is come when man by eugenics, by prenatal conditioning, and by an education and propaganda based on perfect applied psychology, has obtained full control over himself.  Human nature will be the last part of nature to surrender to man. (Lewis, 1947)

This sudden shift from a belief in Nurture, in the form of social conditioning, to Nature, in the form of genetics and brain physiology is the great intellectual event, to borrow Nietzsche’s term, of the late twentieth century. (Wolfe, 2001)

I begin with passages from an unlikely pair of authors because although C. S. Lewis and Tom Wolfe are somewhat distant in time, certainly different in temperament, and extravagantly different in personal style, they share an imaginative capacity to envision the possible consequences of modern technology.  The technology that occasioned Lewis’s reflections―“the aeroplane, the wireless, and the contraceptive” may now seem quaint, but his warning about turning humans into artifacts, that accompanied the passage quoted above, is eerily prescient.  Similarly, although he does not directly take up stem cell research, Tom Wolfe’s reflections on brain imaging technology, neuropharmacology, and genomics are worth noting in relation to the future of stem cell research.  In his inimitable way, Wolfe summarizes his view of the implications of this technology in the title of the essay from which the above passage comes.  “Sorry,” he says, “but your soul just died.”

The point of beginning with Lewis and Wolfe is not that I share their dire predictions about the fate to which they believe technology propels us; instead, I begin with these writers because they invite us to take an expansive view of technology.  I believe that a broader perspective is needed in the ongoing public debate over stem cell research and that such a perspective is in fact beginning to emerge.¹ This is not to say that the sort of traditional analysis that has framed much of the debate on stem cells, analysis that involves issues of embryo status, autonomy, and informed consent, for example, is unhelpful; far from it.  Nevertheless, traditional moral analysis of stem cell research is nicely complemented by a consideration of the “big picture” questions that Lewis and Wolfe both wish to press.  This report will therefore seek to draw attention to the literature on stem cell research that attends both to the narrow and to the expansive bioethical issues raised by this work.

The Moral Status of the Embryo

There is little doubt that public reflection on stem cell research in the United States has been affected by the extraordinarily volatile cross-currents of the abortion debate.  Although I will indicate below several reasons why framing the stem cell debate as a subset of that on abortion is problematic, nevertheless, in its current form, stem cell research is debated in terms dictated by the abortion controversy, and that has meant that  questions about the status of the embryo have been particularly prominent.²  For example, the National Bioethics Advisory Commission (NBAC) described the ethical issues raised by stem cell research as “principally related to the current sources and/or methods of deriving these cells” (NBAC, 1999, 45).  A policy brief from the American Association for the Advancement of Science (AAAS) begins its discussion of the ethical dispute over stem cell research by citing the disagreement over the status of the embryo as the decisive variable leading to fundamentally different views on this research (AAAS, 1999, 11).  The National Academy of Sciences’s report on stem cell research claims that “the most basic [ethical] objection to embryonic stem cell research is rooted in the fact that such research deprives a human embryo of any further potential to develop into a complete human being” (National Academy of Sciences, 2002, 44).  The Ethics Advisory Board of the Geron Corporation lists the moral status question as the first moral consideration relevant to deciding the acceptability of stem cell research (Geron Corporation Ethics Advisory Board, 1999, 32).  The list could go on.

Despite the fact that these statements all insist on the importance of the status question, they also recognize that the debate about the status of the early embryo is not new and that the controversy over stem cell research does not, strictly speaking, raise novel issues in this regard.  Indeed, it is probably best to place the initial skirmishes over stem cell research in the context of moral debates about human embryo research generally.  In fact, it is worth noting that the report of the NIH Human Embryo Research Panel (HERP), published in 1994, explicitly identified the isolation of human embryonic stem cells as one of thirteen areas of research with preimplantation embryos that might yield significant scientific benefit and that should be considered for federal funding (See NIH HERP, 1994, ch. 2).

Although the recommendations of the HERP were never implemented, the fact that a high-profile panel reviewed ex utero preimplantation human embryo research and explicitly endorsed stem cell research, meant that the panel report would affect the policy debate about stem cell research, even though its recommendation that the derivation and use of stem cells be federally funded was not adopted.  For one thing, the panel’s anticipatory support for stem cell research assured that when human stem cells were actually derived several years later, the debate that ensued would be tied to the abortion controversy.  As members of the HERP panel have made clear, from the start, the work of the panel was embroiled in controversy.  For example, shortly after the HERP was impaneled, thirty-two members of Congress wrote to Harold Varmus, the director of NIH, to complain about the composition of the panel.  A lawsuit was filed in an attempt to prevent the panel from meeting, and members of the panel received threatening letters and phone calls (Green, 1994; Tauer, 1995; Hall, 2003).
Given the pro-life opposition to the HERP panel and its recommendations, it is no real surprise that initial reactions to the prospect of human stem cell research fell out along the fault lines of abortion politics in the country. By and large, individuals and groups opposed to abortion tended to be opposed to stem cell research, and individuals and groups supportive of legalized abortion tended to support stem cell research.³  For example, the testimony that Richard Doerflinger, the principal spokesperson for the U.S. Catholic bishops on pro-life matters, offered before the Senate Appropriation Subcommittee on Labor, Health, and Education in 1998 was substantially the same as that he offered before the HERP in 1994 on stem cell research (Doerflinger, 1998, 1994).  In both cases, the fundamental issue was the status of the embryo.  Given Catholic teaching that the embryo must be treated as a person from conception, no experimentation on the embryo can be allowed that would not also be allowed on infants or children.  Hence, the Catholic church treats stem cell research as it has treated previous issues involving the destruction of human embryos; it is condemned as morally abhorrent. 

In similar fashion, the arguments reviewed by the HERP panel that supported embryo research generally in 1994, were mobilized again four years later when stem cell research was the specific point of contention; and again the focal point was embryo status.  Consequently, just as the HERP report opted for a “pluralistic” view of the embryo that emphasized its developmental potential, so, too, did the NBAC endorse the idea that the early embryo deserves respect, but is not to be treated fully as a person.⁴

Moreover, the fact that the HERP defended its support of stem cell research by stressing the developmental capacity of the embryo also shaped the trajectory of much subsequent support for this work, because insisting on respect for the embryo but denying its personhood meant explaining how one could respect the embryo while nevertheless destroying it.  Daniel Callahan, for example, posed this problem very strongly in response to the HERP report.  If “profound respect” for the embryo is compatible with destroying it, he asked, “What in the world can that kind of respect mean?”  It is, he says, “an odd form of esteem―at once high-minded and altogether lethal” (Callahan, 1995).   Callahan was not alone in raising this issue and attempts to answer his question continue to appear in the literature (See Lebacqz, 2001; Meyer and Nelson, 2001; Ryan, “Creating Embryos,” 2001; Steinbock, 2001, 2000).
In retrospect, then, it seems that the HERP report served almost as choreography for the initial debates about stem cell research, and, as a result, the steps in the debate closely followed those that are familiar from the abortion controversy (On this point, see Hall 2003). The upshot, in my view, is that much of the debate has been too narrowly focused and has a kind of repetitive and rigid quality to it.  As I noted above, for example, the Catholic church has repeatedly claimed that the central issue raised by stem cell research is that it involves the destruction of human embryos, embryos it believes should be treated as persons.⁵  For that reason, the rhetoric with which the Catholic church condemns embryonic stem cell research closely parallels that used to condemn abortion.  Yet, because the American bishops do not want to be perceived as anti-science, they have also repeatedly and uncritically praised adult stem cell research, even though there are good reasons, given Catholic concerns about social justice, to be concerned about the pursuit of adult stem cell research.  I will return to this point below, but for now I wish simply to note that much of the opposition to embryonic stem cell work has resembled Catholic opposition in being circumscribed by questions of embryo status, narrowly construed. 

A similar constriction, however, is also apparent in the preoccupations of supporters of stem cell research.  Just as opponents of this research have ritualistically condemned the destruction of early embryos but uncritically celebrated adult stem cell work, supporters of embryonic stem cell research have typically insisted on using embryos left over from IVF procedures, while repudiating the use of embryos created solely for research.  Indeed, insisting on the distinction between so-called “spare” embryos and “research” embryos and endorsing only the use of spare embryos has been one way that supporters of embryo research have tried to demonstrate their “respect” for the embryo.  Yet, it is worth asking whether the spare embryo/research embryo distinction does not, to borrow Daniel Callahan’s image, provide a kind of “wafting incense” to mask what supporters still find a disquieting smell (Callahan, 1995).⁶

Although the debate about stem cell research might have been framed in terms of the abortion controversy in any event, the HERP report insured that the initial debate over stem cell work that followed in aftermath of the public announcement of the work of John Gearhart (Shamblott et al., 1998) and James Thomson in 1998 (Thomson et al.)  would be navigated in the wake of the conflict over abortion. As I indicated, the upshot is that the discussion about stem cell research has been more cramped than it might otherwise have been.  The discussion has been too focused on the details of embryological development; too focused on the differences between those who view the early embryo as a person and those who do not; and far too individualistically oriented.  Before turning to ways that the debate might be become less cramped, let me focus more concretely on these difficulties.

The point about the debate being framed too individualistically is nicely illustrated in an article on abortion by Lisa Sowle Cahill entitled “Abortion, Autonomy, and Community” (Cahill, 1996).  Cahill begins this article by claiming that, in discussing the morality of abortion, there is no way to avoid the question of the status of the fetus.  Nevertheless, she says, the debate about fetal status is almost always conducted with the goal of determining the rights involved, where rights are understood very individualistically.  To the degree that the fetus is acknowledged to have rights, those rights are pitted against the rights of the pregnant women.  Although Cahill doubts that we can jettison the use of rights language altogether, if we are going to use rights language, she says, we must “remove that language from the context of moral and political liberalism” (361).  If we do so, we might be able to see that we have duties and obligations to which we do not explicitly consent.  As Cahill puts it, “such obligations originate simply in the sorts of reciprocal relatedness that constitutes being a human” (361).⁷  For example, moving away from an individualistic liberal view of the pregnant woman as primarily or exclusively an autonomous moral agent might lead us to recognize the obligations that individuals and communities have to support her during and after a burdensome pregnancy (363).

We do not need to accept Cahill’s commitment to the Catholic common good tradition to recognize the truth in her conclusion that pitting the rights of the fetus against the rights of the pregnant woman individualistically construed leads us to overlook important social dimensions of the problem of abortion.  It seems to me that much the same dynamic is evident in the stem cell research debate.

Consider again the central argument that the Catholic church has made against stem cell research.  The Pontifical Academy for Life suggests that the fundamental ethical issue is whether it is morally licit to produce or use human embryos to derive embryonic stem cells.  The reasoning the Academy provides for concluding it is not licit is worth reproducing in full.  The Academy lists five points:

1. On the basis of a complete biological analysis, the living human embryo is―from the moment of the union of the gametes―a human subject with a well defined identity, which from that point begins its owncoordinated, continuous and gradual development, such that at no later stage can it be considered as a simple mass of cells.
2. From this it follows that as a “human individual” it has the right to its own life; and therefore every intervention which is not in favor of the embryo is an act which violates that right. . . .
3. Therefore, the ablation of the inner cell mass (ICM) of the blastocyst, which critically and irremediably damages the human embryo, curtailing its development, is a gravely immoral act and consequently is gravely illicit.
4. No end believed to be good, such as the use of stem cells for the preparation of other differentiated cells to be used in what look to be promising therapeutic procedures, can justify an intervention of this kind. A good end does not make right an action which in itself is wrong.
5. For Catholics, this position is explicitly confirmed by the Magisterium of the Church which, in the Encyclical Evangelium Vitae, with reference to the Instruction Donum Vitae of the Congregation for the Doctrine of the Faith, affirms: “The Church has always taught and continues to teach that the result of human procreation, from the first moment of its existence, must be guaranteed that unconditional respect which is morally due to the human being in his or her totality and unity in body and spirit: The human being is to be respected and treated as a person from the moment of conception; and therefore from that same moment his rights as a person must be recognized, among which in the first place is the inviolable right of every innocent human being to life’”(No. 60). (Pontifical Academy for Life, 2000; emphasis in original) 

Notice that the core of the argument, namely points one and two, is framed in terms of the rights of the individual embryo.  We have seen this emphasis already in noting Richard Doerflinger’s various statements on stem cell research.  Yet, notice also the claim that we know the embryo to be an individual with rights on the basis of “a complete biological analysis.”  This is not, of course, the first time that the Catholic church has made this claim.  In the Declaration on Procured Abortion, the Congregation for the Doctrine of the Faith claimed that “modern genetic science” confirms the view that “from the first instant, the programme is fixed as to what this living being will be: a man, this individual-man with his characteristic aspects already well determined”  (Congregation, “Declaration on Procured Abortion,”1974, 13).  The Instruction on reproductive technology, Donum Vitae, also makes this claim.  “The conditions of science regarding the human embryo provide a valuable indication for discerning by the use of reason a personal presence at the moment of the first appearance of a human life: how could a human individual not be a human person?” (Donum Vitae, 13). 

One reason the Catholic church has played such a major role in framing the stem cell debate is that, in defending its position, it combines the two claims we have just noted, neither of which is explicitly religious.  First, the early embryo is an individual person with rights and, second, the fact that the embryo is an individual person is confirmed by modern science.  Indeed, a fair amount of the literature that supports embryo research generally can be read as an attempt to answer the question posed in Donum Vitae: How can a human individual not be a human person?

Certainly Catholic writers who reject the church’s teaching on the status of the embryo have responded directly to that question (See Cahill, 1993; Farley, 2001; McCormick, 1994; Shannon, 2001; Shannon and Walter, 1990), but so too have non-Catholics. For example, in a statement issued by their ethics committee, what was then called the American Fertility Society rejected the claim in Donum Vitae that science supports the personhood of the embryo.  According to the ethics committee “...it remains fundamentally inconsistent to assign the status of human individual to the human zygote or early pre-embryo when compelling biological evidence demonstrates that individuation, even in a primitive biologic sense, is not yet established.  Thus, homologues (identical) twins may result from spontaneous cleavage of the pre-embryo at some point after fertilization but prior to the completion of implantation.  Furthermore, during very early development, an embryo is not clearly established and awaits the differentiation between the trophoblast and the embryoblast” (American Fertility Society, 1988, 3S).

Arguably, writers like Mary Anne Warren and Bonnie Steinbock, who distinguish between biological or genetic humanity and moral humanity, are also at least indirectly answering the question posed in Donum Vitae (Warren, 1997; Steinbock 2001, 1992).  Yet, whether writers are responding more or less directly to Catholic discourse, or not at all, the important point is that the stem cell debate has been remarkably preoccupied with the question of whether the early embryo is an individual person and whether and how the minute details of embryological development help us to answer this question.  This is one reason why a fair amount of the ethics literature on the topic reads like a textbook on embryology.

I want to be clear here: I am not suggesting that the details of embryological development are unimportant.  The maxim from the field of research ethics applies here as well: bad science is bad ethics.  My point is rather that the preoccupation with the details of early embryogenesis may lock us even more rigidly into an individualistic human rights framework than we are in debates about abortion.  It also leads us to frame the debate as fundamentally about one question, and, indeed, it tempts us to treat the question as if there is one and only one answer.  In this frame of mind, once we have that answer, there is not a lot more to talk about.

Gene Outka has made a similar point in his assessment of stem cell literature.  As Outka puts it, in its starkest form, the crystallizing question is whether it is cogent to claim that embryonic stem cell research is morally indistinguishable from murder (Outka, 184).  The problem with framing the question this way, he says, is that it “encourages an unfortunate tendency to restrict evaluative possibilities to a single either/or.  Either one judges abortion and the destruction of embryos to be transparent instances of treating fetuses and embryos as mere means to other’s ends, or one judges abortion and embryonic stem cell research to be, in themselves, morally indifferent actions that should be evaluated solely in terms of the benefit they bring to others.” (Outka, 2002, 184).

The frame of human rights reinforces this either/or because when the issue is shaped by the question whether a being has the right to life, the answer is either yes or no.  I have argued elsewhere, that this either/or tends to drive people to the extremes.  Either the embryo is a person or it is essentially a kind of property (Lauritzen, 2001).  Although I will not rehearse the argument for rejecting the two extremes here, it is worth noting that the rhetoric associated with each extreme does not appear to match the practice of those who adopt the rhetoric or in fact to match the considered moral judgments of most Americans on these issues.

I can illustrate my point in relation to the view that the early embryo is a person with the right to life by describing a cartoon that hangs on my office door (See appendix A). The cartoon depicts protestors in front of a stem cell research lab condemning those who work there as being anti-life.  Down the street at the abortion clinic, the workers are noting how quiet things have gotten at their facility since the stem cell lab opened.  The point of the cartoon, of course, is that we may soon see protests and demonstrations of the sort that are common at abortion clinics at facilities that conduct stem cell research and that there is an irony in the fact that pro-life advocates would be demonstrating against research being done to find treatments for Alzheimer’s, Parkinson’s, and other devastating illnesses.  This is not entirely fair to the pro-life community, but it makes a point.

In fact, I do not have trouble imaging protestors picketing stem cell research facilities for, as we just noted, when stem cell research and abortion are evaluated together and when the evaluative option is a single either/or, then abortion and stem cell research may appear indistinguishable from murder.  Certainly the rhetoric of someone like Richard Doerflinger has been consistent in condemning both abortion and stem cell research as equivalent to murder.  The cartoon draws attention to this consistency, even while it questions the commitment of pro-life advocates to scientific research designed to promote the quality of life.

In one sense, then, the cartoon probes whether there is an inconsistency between being pro-life and opposed to research on Alzheimer’s disease, Parkinson’s disease, and other devastating illnesses.  I do not myself think that there is any inconsistency in being pro-life and opposed to stem cell research, but the cartoon does point in the direction of a fairly significant disconnect between the rhetoric and the reality of those opposed to stem cell research because they believe the early embryo is a person.  To see this point, imagine that, instead of a stem cell clinic, the cartoon depicted on IVF clinic down the block from the abortion clinic and that the workers at the abortion clinic are noting how quiet things have gotten since the IVF clinic opened.  The dramatic tension that made the original cartoon funny would be missing from our revised cartoon precisely because it is hard to imagine protestors disrupting the work at IVF clinics.  To be sure, the Catholic church and others have argued that IVF is morally wrong, but the rhetoric condemning IVF is exceptionally muted compared to that condemning abortion or stem cell research.  Nor has there been a concerted effort to put an end to IVF practice in this country as there has been in the case of abortion and stem cell research.  Yet, if the embryo is a person from conception, then participating in IVF as it is practiced in this country, when early embryos are routinely frozen or discarded or both, is to be complicit with murder.  Why, then, are there no organized efforts to shut down IVF clinics in this country?⁸

Indeed, opponents of stem cell research and cloning often write as if these technologies raise the haunting specter of human embryo research for the first time.  The reality, of course, is that the existence of in vitro fertilization depended entirely on embryo research and that every variation or innovation in IVF protocols involves experimentation on human embryos.  Carol Tauer is one of the few scholars who has pressed this point.  As Tauer sees it:

...the entire history of the research leading to the first successful IVF is the history of attempts to fertilize oocytes in the laboratory.  Eventually these attempts succeeded, and the first IVF baby was born, followed by thousands of others in the ensuing decades.

The ethics literature contains scholarly discussions as to whether it is ethically permissible to make use of medical advances that result from unethical research.  This discussion sometimes focuses on medical research conducted by the Nazis in concentration camps and institutions for retarded, mentally ill, and handicapped persons.  Yet I have never seen reference to reproductive technologies in this context.  If the fertilization of embryos in research is a practice that is abhorrent to many or most people, then would it not be logical to question the continuing use of the results of such research?  (Even the Catholic Church, which opposes the use of IVF and most other forms of assisted reproduction, does not invoke this argument to support its opposition.) (Tauer, 2001, 153)

I have suggested that the fact that so much of the stem cell debate has been framed in terms of whether the embryo is a person with rights has been unfortunate because it has cast the debate in sharply individualistic terms and has led to a preoccupation with embryological development narrowly construed.  In addition, however, framing the debate in terms of embryo status and embryo rights tends to exaggerate the differences among commentators in contrast to their similarities.  Consider, for example, the response of conservative Judaism in the United States to this issue.  Rabbi Elliot Dorff has prepared a responsum on stem cell research for the Rabbinical Assembly Committee on Jewish Law and Standards, and his responsum is instructive.¹⁰

As responsa are, it is structured in terms of relevant questions; in this case, two questions frame Dorff’s discussion.  First, “may embryonic stem cells from frozen embryos originally created for purposes of procreation or embryonic germ cells from aborted fetuses be used for research?” (Dorff, 2002, 1)  Second, “may embryonic stem cells from embryos created specifically for research, either by combining donated sperm and eggs in a petri dish or by cloning be used for research?”  At the risk of oversimplifying Dorff’s analysis, his answer to these questions can be summarized as follows.  Because in Jewish tradition during the first forty days of gestation, the embryo and the fetus are considered to be simply water and because, from the forty-first day until birth, Jewish tradition considers the fetus to be equivalent to “the thigh of its mother,” the answer to both questions is “yes.”  My point is this: Given the attention to the issue of embryo status, what most (non-Jewish) readers of Dorff’s analysis are likely to focus on is how sharply at odds Jewish views of the embryo are with that of pro-life opponents of embryonic stem cell research, like the American Catholic bishops.  Thus, the first impression one might take away comparing Jewish and Catholic views on stem cell research is that of difference, even though apart from the question of the status of embryo, one would find important similarities. 
These differences are significant and must be addressed, but it is worth asking whether focusing on these differences does not obscure important similarities.  Consider some of the similarities.  In sketching the Jewish view of stem cell research, Dorff notes that certain theological commitments are central.  He lists at least three that would be strikingly similar to Catholic and other Christian theological commitments.

• Our bodies are not ours; they belong to God and God commands that we seek to preserve life and health.
• All human beings, regardless of ability or disability are created in the image of God and are therefore to be valued as such.
• Humans are not God.  We are finite and fallible and this fact ought to promote humility and urge caution.

Now if we focused merely on questions of embryo status, we would miss entirely these similarities between Catholic and Jewish views.  More importantly, we would miss the fact that these similarities may underwrite significant moral reflection on stem cell research that is not rooted in concerns about the early embryo.
For example, Dorff notes that, given Jewish theological and legal commitments, the provision of health care must be understood as a communal responsibility.  Thus, access to therapies developed through stem cell research is a crucial issue of justice for the Jewish community.  This theme is echoed in Laurie Zoloth’s work on stem cell research.  As Zoloth puts it:

Research done always will mean research foregone.  Will this research help or avoid the problem of access to health, given that poverty and poor health are so desperately intertwined in this country?...How can difficult issues of global justice and fair distribution be handled in research involving private enterprise? (Zoloth, 2001, 238)

Surely these are questions that any Catholic moral theologian would gladly press.
Indeed, attending to the similarities between Zoloth’s work and Catholic reflection on stem cell research brings us back to Lisa Cahill’s observation about debates on abortion: they tend to be too focused on questions of rights individually construed.  When one shifts the frame of analysis, new and different issues and new and different ways to approach the same issues come into view.  Notice, for example, how close Zoloth and Cahill are on the issue of rights.  According to Zoloth, Jewish tradition foregrounds questions of “obligations, duties, and just relationships to the other, rather than the protection of rights, privacy, or ownership of the autonomous self” (96).  This leads Zoloth to ask: “Can the interests of the vulnerable be heard in our debate?” (105).  To be sure, the American bishops have wanted to emphasize the vulnerability of the early embryo when they have asked this question, but Catholic tradition, like Jewish tradition, requires that we ask this question in a way that is not captured when moral emphasis is merely about individual rights and personal autonomy.

Or consider another shared sensibility that emerges if we move away from questions of embryo status, namely a wariness about the human tendency to hubris and overreaching.  Zoloth put this point eloquently in relation to the biblical story of the Tower of Babel.  She notes a rabbinic midrash on this text: “when a worker was killed, no one wept, but when a brick fell, all wept.”  Zoloth comments on this midrash as follows:

It was this decentering of the human and reification of the thing that was the catastrophe that felled the enterprise... It is not just that they breached a limit between what is appropriate to create and what is not, the process of the creation must be carefully mediated, with deep respect for persons over the temptations of the enterprise.  Such a text elaborates on the tension between repairing the world ... and acts that claim that the world is ours to control utterly (Zoloth, 2001, 106-107).

The “gift of life” is big business in America.  For a nonprofit tissue bank, one typical donation can yield between $14,000 and $34,000 in downstream sales, sometimes far more than that.  “Skins, tendons, heart valves, veins, and corneas are listed at about $110,000.  Add bone from the same body, and one cadaver can be worth about $220,000.”  Four of the largest nonprofit tissue banks told the Orange County Register that together they expected to produce sales totaling $261 million in 2000. (226)

Although the ethical objections to commodifying stem cell work can not be sorted out as neatly as this table suggests, Resnik correctly identifies a variety of such objections.  I will not try to defend it here, but my own view is that the problem is not just that stem cells and their products may be commodified, but that market rhetoric may come to dominate the discussion (and practice) of regenerative medicine in a way that is dehumanizing.  That is, market-rhetoric may lead us ultimately to think of humans as artifacts.  In short, I take very seriously Margaret Radin’s argument that the rhetoric in which we conceive our world affects who and what we are (Radin, 1996, 82).¹²  At the same time, however, stem cell research is most likely to bear therapeutic fruit, if there is a market in stem cells and their products.  The pressing moral question, then, is how do we promote the benefits that stem cell research may yield without succumbing to a market rhetoric that reduces humans to commodities?

Several writers have suggested that one answer may be to promote greater governmental regulation. (For a view that regulation will not work, see Resnik 1999).  For example, Holland argues for moving beyond a policy of restricting federal funding of stem cell research but allowing an unregulated private market in this field to active regulation to curb the private sector’s work on stem cells.  Lori Knowles suggests that the United States might adopt a body like Canada’s Patented Medicine Prices Review Board as a way to allow a market to function, but with oversight that would provide access to potential cells for further research and price controls of products to insure widespread access (Knowles, 1990, 40).  George Annas has suggested that we need to establish a federal Human Experimentation Agency to regulate in the area of human experimentation. (Annas, 1998, 18).  As Annas puts it:

Virtually all those who have studied the matter have concluded that a broad-based public panel is needed to oversee human experimentation in the areas of genetic engineering, human reproduction, xenografts, artificial organs, and other boundary-crossing experiments. (19)

Stem cell technologies have profound temporal implications for the human life course, because they can potentially utilize the earliest moments of ontogenesis to produce therapeutic tissues to augment deficiencies in aging bodies.  Hence they may effect a major redistribution of tissue vitality from the first moments of life to the end of life.  In doing so, however, they demonstrate the perfect contingency of any relationship between embryo and person, the non-teleological nature of the embryo’s developmental pathways.  They show that the embryo’s life is not proto-human, and that the biology and biography of human life cannot be read backwards into its moment of origin. (Waldby and Squier, forthcoming)

We live all our lives in bodies of a certain sort, whose possibilities and vulnerabilities do not as such belong to one human society rather than another.  These bodies, similar far more than dissimilar (given the enormous range of possibilities) are our homes, so to speak, opening certain options and denying others, giving us certain needs and also certain possibilities for excellence.  The fact that any given human being might have lived anywhere and belonged to any culture is a great part of what grounds our mutual recognitions; this fact, in turn, has a great deal to do with the general humanness of the body, its great distinctness from other bodies.  The experience of the body is culturally shaped, to be sure; the importance we ascribe to its various functions is also culturally shaped.  But the body itself, not culturally variant in its nutritional and other related requirements, sets limits on what can be experienced and valued, ensuring a great deal of overlap. (Nussbaum, 1995, 76)

Nussbaum’s work is suggestive in another way, for she also notes how anxiety about our embodied existence, and the vulnerability that bodily existence entails, may be a profound impediment to compassion.  I can not do justice to the richness of Nussbaum’s account of the emotional obstacles to compassion, but one aspect of her account is worth noting here.  In addition to analyzing the emotion of compassion, Nussbaum examines the experiences of shame and disgust. ²⁷  Drawing on psychological studies of these emotions, she notes that both appear to concern a sense of vulnerability that arises from the fact that we are embodied beings.   For example, a sense of inadequacy may lead to the emotion of disgust, which in turn serves to distance the self from its own vulnerabilities.

The problem with this emotional dynamic is the almost universal human tendency to project the disgust reaction outward onto others as a way of shoring up one’s own sense of stability and power.  “Thus,” says Nussbaum, “throughout history, certain disgust properties—sliminess, bad smell, stickiness, decay, foulness—have repeatedly and monotonously been associated with, indeed projected onto, groups by reference to whom privileged groups seek to define their superior human status” (Nussbaum, 2001, 347). Whether it is Jews, women, homosexuals, untouchables, or blacks who have been labeled and treated as disgusting, the underlying anxiety appears to be “the intolerance of humanity in oneself” (Nussbaum, 2001, 350).

Of course, once we label the other as disgusting, it becomes difficult to see the shared vulnerability that underwrites compassion.  That is why social hierarchies based on class, race, religion, ethnicity, or gender are such an impediment to compassion; they lead one group to see itself as vastly superior to another group and thus erode the possibility of seeing the common humanity of the other.  In such a situation, compassion can easily wither.  Here, then, we see the danger to which Nussbaum’s work draws our attention.  To the degree that applications of stem cell research may erode a sense of common humanity, to the degree that such applications may promote a social hierarchy rooted in genetics, they run the risk of blocking compassion and advancing intolerance.

Nussbaum’s work identifying the judgments that underwrite compassion and tying a universalist account of rights to common human function and capabilities thus highlights what is at stake with stem cell research and with a growing list of biotechnological developments that appear to destabilize the concept of human nature.  Her work suggests why we need to think carefully about the social implications of a situation in which some humans have access to these technologies while other humans do not. At the very least, the combination of what Paul Rabinow describes as the biologicalization of identity around genetics rather than gender and race with the possibility of manipulating that genetic identity for those with the money or power to do so does not bode well for securing wide-spread compassion across economic or technological divides.  Even more important, however, is the recognition that the very notion of human rights may ultimately rest on the idea (and what, until recently has always been the reality) of a natural human condition that is relatively stable.

Conclusion

I began this report with a passage from C. S. Lewis’s essay, “The Abolition of Man,” and I end with another quotation from that essay, one that captures the concerns I have just raised.  Lewis writes:

Now I take it that when we understand a thing analytically and then dominate and use it for our own convenience we reduce it to the level of ‘Nature’ in the sense that we suspend our judgements of value about it, ignore its final cause (if any), and treat it in terms of quantity.  The repression of elements in what would otherwise be our total reaction to it is sometimes very noticeable and even painful: something has to be overcome before we can cut up a dead man or a live animal in a dissecting room.  (Lewis, 1947, 81)

Although it is perhaps justifiable to reduce the world of nature to mere nature, as Lewis puts it, I am inclined to agree with him that something is lost when we do so.  Re-reading “The Abolition of Man” in the context of debates about stem cell research, I was struck by the fact that the sort of dynamic Lewis describes in his essay is very close to that recorded in Jonathan Glover’s impressive work, Humanity: A Moral History of the Twentieth Century (Glover, 1999).  Glover writes that: “Human responses are the core of the humanity which contrasts with inhumanity. They are widely distributed, but to identify them with humanity is only partly an empirical claim. It remains also partly an aspiration.”   As Glover powerfully argues, morality must be rooted in human needs and values, and these needs and values are both rooted in “human nature” and grounded in human aspiration.

As we move forward to wrestle with issues of stem cell research, we ought to be conscious of what is at stake in the possibility of redefining either our natures or our aspirations, for as Glover makes clear, the inhumanity of humans is frightening and all too familiar.²⁸

Appendix A

Jimmy Margulies, Editorial Cartoonist
The Record, Hackensack, New Jersey
Cartoon used with permission of the artist.

notes

1.  See Parens and Knowles, 2003.
2. Given the current status of technology, deriving human embryonic stem cells requires destroying embryos.  If the cells could be derived without the destruction of embryos or if parthenogenetically stimulated eggs produced stem cells, issue of status would almost certainly fade.  Nevertheless, serious ethical issues would still remain.  This is one reason I believe it is a mistake to focus narrowly on embryo status.
3. Gene Outka has argued that there is an “internal coherence” to views of the embryo, issues of complicity, and views on adult stem cell research (Outka, 2002).  
4. Although the HERP report claimed that “it is not the role of those who help form public policy to decide which of these views [of the embryo] is correct,” there is little doubt that the panel adopted the pluralistic view.  For that reason, most commentators found the above claim disingenuous.
5. Compare, for example, the various statements that Richard M. Doerflinger has made on the U. S. bishops’ behalf. See Doerflinger, 1988, 1998, 1999, 2001.  Margaret Farley has argued that the Catholic preoccupation with abortion has eroded its credibility on other important social issues, including stem cell research.  (See Farley, 2000).
6. Another debate that is at least partly shaped by focusing on embryo status revolves around the question of complicity.  For example, supporters of stem cell research may harbor a residual uneasiness about endorsing the destruction of human embryos, at least if the number of articles in the literature explaining the concept of complicity with wrongdoing is any indication.  John Robertson, Ronald Green, and Thomas Shannon, have all written on the issue of cooperation with evil in relation to stem cell research. (Robertson, 1999; Green, 2002; Shannon, 2001; see also Kaveny, 2000; and Gilliam, 1997).  To be sure, the issue of complicity or cooperation with wrongdoing is a very traditional one in moral philosophy and theological ethics.  Still, if the early embryo does not deserve the respect accorded persons and if destroying the embryo is compatible with respecting it, then deriving stem cells is not an act of wrongdoing and issues of complicity do not arise.
7. Cahill also emphasizes the way a liberal individualist view of the person discounts the significance of embodiment.  I will return to this point below. 
8. That both those who view the embryo as a person and those who do not but who insist on respect for the embryo, have been remarkably cavalier with regard to the use of embryos in IVF programs can be seen by the fact that there are currently over 400,000 embryos frozen in the United States, a number we did not even know until quite recently (Hoffman et al. in association with The Society for Assisted Reproductive Technology and RAND, 2003).
9. In a commentary published in Nature, in September 2001, Edwards writes:  “On the verge of clinical application, stem cells offer a startlingly fundamental approach to alleviating severe incurable human maladies.  Fondly believed to be a recent development, they have in fact been part and parcel of human in-vitro fertilization (IVF) from as long ago as 1962.”
10. Dorff’s responsum was accepted by the Committee on Law and Standards by a vote of twenty-two to one in March 2002.  On the basis of Dorff’s responsum the Rabbinical Assembly passed a resolution in April 2003 supporting stem cell research for therapeutic purposes.  (Resolution in Support of Stem Cell Research and Education, April 2003:  available at www.rabassembly.org.)
11.Alpers and Lo draw the distinction between commodification and commercialization as follows: “The issue of commodification involves treating either human beings or symbols of human life as merchandise or vendible goods. . . . Commercialization refers to the practice of realizing large profits from the development and sale of techniques or products that involve distinctive human material, such as embryos, eggs, or tissue” (Alpers and Lo, 1995).
12. Radin quotes Georg Lukács on the reification of commodities and the effects on human consciousness.  Lukács writes: “The transformation of the commodity relation into a thing of ‘ghostly objectivity’ cannot therefore content itself with reduction of all objects for the gratification of human needs to commodities.  It stamps its imprint upon the whole consciousness of man; his qualities and abilities are no longer an organic part of his personality, they are things which he can ‘own’ or ‘dispose of’ like the various objects of the external world” (Radin, 1996, 82).  When we think about genes for enhancing memory or muscle mass, it is worth keeping in mind Lukács’s claim that human qualities and abilities may come to be thought of as objects for sale in the external world.
13. Erik Parens has noted the importance of attending to the big picture raised by stem cell work and how the politics of abortion has obscured that picture.  See Parens, 2000.
14. In another essay, Glannon argues that substantially increasing the human life span would profoundly affect issues of personal identity and thus a sense of personal responsibility for one’s action.  He ties his argument in interesting ways to the biology of memory function (Glannon, “Identity”).  For a classic philosophical discussion of the problems associated with immortality, see Williams, 1973.
15. Although he is not discussing stem cell research explicitly, Paul Rabinow’s discussion of technological change wrought during the last two decades is worth noting.  He writes:  “In the United States, for example, in the last two decades, while the most passionate value conflicts have raged around abortion, a general reshaping of the sites of production of knowledge has been occurring.  To cite the biotechnology industry, the growing stock of genomic information, and the simple but versatile and potent manipulative tools (exemplified by the polymerase chain reaction) is to name a few key elements; a more complete list would include the reshaping of American universities, the incessant acceleration in the computer domains, and the rise of ‘biosociality’ as a prime locus of identity―a biologicalization of identity different from the older biological categories of the West (gender, age, race) in that it is understood as inherently manipulable and re-formable” (French DNA: Trouble in Purgatory [Chicago, IL: The University of Chicago Press, 1999], 13).  A couple of pages later, he writes: “My analysis points to the fact that the basic understanding and practices of ‘bare life’ have been altered.  The genome projects (human, plant, animal, microorganismic) are demonstrating a powerful approach to life’s constituent matter.  It is now known that DNA is universal among living beings.  It is now known that DNA is extremely manipulable.  One consequence among many others is that the boundaries between species need to be rethought; transgenic animals made neither by God nor by the long-term processes of evolution now exist (16).   See also, L. Sharp, “The Commodification of the Body and Its Parts,” Annual Review of Anthropology, vol. 29, (2000): 287-328.
16. Donna Haraway has argued that concerns about boundary crossing are disturbingly reminiscent of racial and immigration discourses of an earlier era. “In the appeal to intrinsic natures,” she writes, “I detect a mystification of kind and purity akin to the doctrines of white racial hegemony and U.S. national integrity and purpose ...” (“Mice into Wormholes” in Cyborgs and Citadels, ed. G. L. Downey and J. Dumit [Sante Fe: School of America Research Press, 1997], 218).  A recent “target article” in the American Journal of Bioethics on crossing species boundaries may stimulate a more sustained discussion on this topic.  See especially J. D. Robert and F. Baylis, “Crossing Species Boundaries,” American Journal of Bioethics, vol. 3, no. 3, (summer 2003): 1-13.
17. Her work can be found at: http://www.patriciapiccinini.net/.  Thanks to Lee Zwanziger for drawing my attention to this website.
18.   On this aspect of Piccinini’s work, see Rachel Kent, “Fast Forward: Accelerated Evolution.” Available at: http://www.patricia piccinini.net/.
19. Patricia Piccinini, “Artist Statement” (1999).   Available at: http://www.patricia piccinini.net/.
 20. For a very interesting study of non-human animals in postmodern art, see Baker, 2000.
21. Information about Kac’s work can be found at:http://www.ekac.org/gfpbunny.html.
22. For a discussion of Kac’s work, see Britton and Collins, 2003.
 23. W. S. Merwin captured the danger of this kind of reductionism in a poem entitled, “Dog”:  “. . . Whatever he was to guard/Is gone.  Besides, his glazed eyes/Fixed heavily ahead stare beyond you/Noticing nothing; he does not see you.  But wrong:/Look again: it is through you/That he looks, and the danger of his eyes/Is that in them you are not there . . .” in Merwin, 1956.
24. Diana Fritz Cates has criticized Nussbaum’s account of compassion, particularly Nussbaum’s insistence that compassion requires the judgment that the person suffers undeservedly.  Cates notes that this condition is sharply at odds with the understanding of compassion in some Buddhist and Christian traditions. D. F. Cates, “Conceiving Emotions: Martha Nussbaum’s Upheavals of Thought,” Journal of Religious Ethics, vol. 31 (2003): 325-41. Although I agree with Cates’s criticism on this point, I do think that the condition of shared possibilities/vulnerabilities is crucial.  Nussbaum herself offers a subtly different account of the importance of shared vulnerabilities in Upheavals of Thought (New York: Cambridge University Press, 2001).  See especially pp. 315-21.  Thanks to Tom Schubeck for pressing me on this point.
25. Midgley’s work on the notion of a “species-bond” is also relevant here.  See Animals and Why They Matter (Athens, GA: University of Georgia Press, 1983).
  26. Given the way that talk about “human nature” has been used in the past to justify excluding groups from full membership in the human moral community, there are good reasons to be careful about the use of this language.  Nevertheless, I agree with Kate Soper that unless we maintain some sense of nature that is not culturally constructed, we have no meaningful grounds for complaining about the lack of humane treatment of others. See Soper, 1995.
27. Nussbaum discusses the relation of disgust and compassion at various points in Upheavals of Thought.  See also her essay, “‘Secret Sewers of Vice’: Disgust, Bodies, and the Law,” in  Bandes, 1999.
28. A number of people helped with the preparation of this report.  Thanks to Christa Adams, Diana Fritz Cates, William FitzPatrick, James L. Lissemore, Charlie Ponyik, Mary Jane Ponyik, Kristie Varga, Lisa Wells, and the ethics writers group at John Carroll University.  I am also grateful to the members of the President’s Council for their comments on an earlier draft of this work.

_____________________

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