The Ethics of Embryonic Stem Cell Research

When setting out to write on the subject of embryonic stem cell research I came in with my own set of opinions on the subject but very little knowledge except that which was gleaned from radio talk shows and the evening news. I read two speeches hoping to derive some direction for my journey: President Bush's speech and Ron Reagan's speech to the Democratic National Convention. I found the president’s speech amazingly impartial throughout reflecting much thought with the decision ultimately lying in religious conviction. Reagan’s speech in my opinion was a thinly veiled plucking of vulnerable heartstrings. While researching these two speeches, I discovered that the president did not ban stem cell research as Reagan purported. President Bush actually provided federal funding for stem cell research for the first time ever and lifted the ban in place during the Clinton administration.
I then decided to go back to the beginning of medicine and discover what Hippocrates might have to say on the subject of embryonic stem cell research. In doing so, I discovered a statement in “The Law” written by Hippocrates approximately 2400 years ago, that would become the guiding force behind my research, “There are, indeed, two things, knowledge and opinion, of which the one makes its possessor really to know, the other to be ignorant.” It was time to cast away my opinions. I had to, in the words of Master Kim, “unlearn so that I could learn.”
I discovered that there are essentially two types of cells generalized into the single category of embryonic stem cells, embryonic stem and embryonic germ cells. There exists a significant scientific difference between the two different types of stem cells, which may translate into different moral status assigned to them. Embryonic germ cells are those cells derived from cadaveric fetal material. These are cells that are obtained from abortions either to protect the woman’s life or from elective abortions. Embryonic stem cells however are manufactured in the laboratory using either in-vitro fertilization techniques or somatic cell nuclear transfer techniques (a method whereby the nucleus that has been removed from one cell is mechanically injected into a cell that has had it nucleus removed).
Since my position on life is that life is sacred, I must first provide a definition for life. In “The Oath” Hippocrates states, “ I will… abstain from whatever is deleterious and mischievous. … I will not give to a woman a pessary to produce abortion.” This position is consistent with mine in that I am opposed to abortion. Relying on the wisdom of Hippocrates, with the addition of my own opinions, my conclusion is that a life begins when a woman becomes aware that she is pregnant. I realize that this is a somewhat subjective conclusion, but I cannot hold someone accountable for what she might do when there is no awareness that what she is doing is wrong.
The opens me to the question, do I support the use of embryos gained from abortions for use in stem cell research? The question of conceiving a child or creating an embryo through in-vitro fertilization, for the sole purpose of scientific research or medical treatment is a foregone conclusion in my mind - this is unethical. Those who are involved in medical research, although they may not be directly treating people and their ailments, because they have chosen to support this treatment have tacitly agreed to comply with the "Hippocratic Oath." This opinion is shared by James Burchaell who “maintains that those involved in research on fetal tissue enter a symbolic alliance with the practice of abortion in producing or deriving benefits from it.” A response to this is that this would be comparable to stating that the doctor who perform organ transplants and the recipients of those organs support homicide. I can see that there are similarities between the two, but they are not equivalent behaviors.
This led me to consider the question that George Bush had to ask of himself when considering funding for this research, “if they are going to be destroyed anyway, shouldn’t they be used for a greater good, for research that has the potential to save and improve other lives?” That question gets at the crux of the issues surrounding the ethics of embryonic stem and germ cell research. This same issue is not present when considering adult stem cell research since the donors are doing so voluntarily.
Before continuing it should be understood that when I write that something is unethical, I do not necessarily mean that it ought to be or should be illegal. As and example, it is unethical to drink or take drugs to escape from life’s problems - this is a form of cowardice. I do not believe that it ought to be or should be illegal to drink to excess or take drugs. One should be free to do as one chooses provided, that person’s actions do not infringe on the property or liberties of others.
There are those who say that using germ cells from aborted fetuses is wrong. They call these stem cells “morally tainted.” Although I oppose abortion, I cannot immediately agree with a statement that says that all germ cells obtained from abortions are morally tainted. There may be times when the abortion is morally justifiable as is the case to save a woman’s life - everyone however, does not share this view. Although the act that made these germ cells available may have been immoral, does the morality of the abortion transferred to these cells? Is it therefore immoral to perform research on these cells? What is the case if the researcher does not know the source of the cells? Perhaps it is a greater evil to destroy those cells since there is the possibility that scientists may be able to make use of them in finding a treatment or a cure for a disease.
For many, the morality of stem cell research revolves around the theological concept of “playing God” in addition to the moral philosophy of what should we do. The morality of embryonic stem cell research is closely tied to the morality of abortion, therefore when considering the ethics of embryonic stem cell research one is invariably thrown into the debate surrounding abortion. When Hippocrates wrote, “I will not give to a woman a pessary to produce abortion”, he probably did not have an understanding of prenatal human development in the way that we do today. He probably did not have to deal with the moral dilemma posed by the ectopic pregnancy. Where does the answer lie with respect to the modern understanding of human life?
The most conservative scientific statement regarding the beginning of human life is that life begins when the fertilized ovum implants itself on the uterine wall. In the case of the ectopic pregnancy, a human life is not considered viable. Since there is no viable human life, and the only two possible outcomes of an attempt to carry the pregnancy to term are the death of the fetus or the death of the fetus and the mother, terminating the pregnancy does not involve performing an evil act to accomplish the good. The most conservative theological definition of human life comes from the Vatican. The Catholic church has stated, “from the time an ovum is fertilized, a life is begun which is neither that of the father nor the mother; it is rather the life of a human being with its own growth.” From this perspective an evil act, abortion, must be performed to obtain the good of saving the woman. Since I am viewing the ethics of embryonic stem cell research from the humanist perspective, I must base my decisions on the scientific definition. This is one possible source of embryonic germ cells. This opinion also extends to those embryos created using in-vitro fertilization. During the process of fertilization, many more ova become embryos than necessary for the infertility treatment. The Catholic Church maintains that these remaining ova ought to be treated as full human persons and should not be destroyed. This places the donor parent and the fertility clinic in the position of either having to find recipients for all of the fertilized ova or preserving them indefinitely in a frozen state.
Another situation arises when a woman is not healthy enough to carry a baby to term. Given that the embryo implants itself on the uterine wall, is it ethical to terminate this pregnancy to save the woman’s life? Since the intent is to save the woman’s life and not kill the child, maybe, but then one must ask what is the method of saving the woman’s life. This violates one of the rules in the principle of double effect therefore this abortion is an unethical action. A utilitarian perspective might hold that it is ethical to terminate the pregnancy since the woman may be able to extend other benefits to society whose ends justify this abortion. I hold that a person who knows that they are medically unfit to carry a pregnancy full term should take measures in the beginning to prevent the pregnancy from ever occurring. In the case of the woman who becomes pregnant and then finds that she her life is in threatened as a direct result of the pregnancy it would be morally justifiable in that she did not intend to place herself at risk.
Another argument for abortion, is that one should be performed because the fetus is unlikely to be born alive or with some form of disability. These two cases fall into the category of an abortion performed for the convenience of the parents. In a situation where the abortion is taking place simply to destroy the life that is growing, regardless of its potential, if no harm will befall the mother in carrying to term or until the miscarriage occurs then this is unethical.
There exists another source for embryonic germ cells. Some people will choose to conceive a child solely as a source for embryonic germ cells. The June 20, 2003 edition of USA Today contains an article involving a British couple denied fertility treatment by their government. They came to the United States for in-vitro fertilization and implantation so that they could have a child with the intent to use the cord blood to treat their son who had a rare blood disorder. Admittedly, this did not involve the destruction of a developing fetus but it is a step in that direction. This is a situation where a life was created to save another life and is something to be applauded. If the reason for creating the life was simply to destroy it to obtain germ cells, the conception should never have occurred in the first place. It is anathema to create life simply to destroy it no matter the nobility of the end.
President Bush said in his speech that he was going to allow funding for embryonic stem cell research, but only on existing stem cell lines. His position leads me to assume that he believes that embryonic stem cell research is ethical, so long as no additional embryos are used. Does he believe that the embryonic stem cells already obtained were obtained ethically and that it is impossible to ethically obtain additional stem cells? I hope not, that position is inconsistent with reason. What is a reasoned approach? Many scientists argue that as a stem cell line ages there are irreversible genetic changes to that line that will forever alter the usefulness of that cell line for research. This is why it is necessary to maintain a continuing source of new stem cells.
Earlier I stated that there is a direct correlation between the ethics involved in embryonic research and the ethics of abortion. This is certainly the case for stem cells derived from embryonic germ cells. Their association with the ethics of an elective abortion has morally tainted cells obtained from elective abortions. Although we cannot judge the moral status of the cells, we can judge the further use of them. It would be immoral to use cells acquired through intentionally immoral actions.
A scientist performing research at this level is obligated, as a minimum, to ensure that the source material is morally pure just as a used car dealer should ensure that he is not selling a stolen car. The germ cells obtained from a pregnancy where the intention was the derivation of stem cell material or elective abortions performed for convenience are morally tainted. In either case, the intention that the fetus should live was nonexistent. Further use of these cells would be unethical because the original intent was unethical. Through the principle of double effect, the morality does transfer from the act of abortion to the stem cells. In the case of terminating an ectopic pregnancy or other situations where the occurrence of the pregnancy, through no fault of the woman, the intent was to save the woman’s life, the embryonic stem cells obtained from that procedure would be morally pure. I would conclude that the only moral source for embryonic stem cells derived from cadaveric fetal tissue would be those derived from those procedures where the intent was to save the woman’s life. Additionally, before using the fetus in research, the woman should provide consent. To use the cadaver without this consent is theft and the research becomes morally tainted.
On the subject of embryonic stem cells derived from embryos created in a laboratory environment, the ethical issues become clouded. This class of stem cells are those; derived from embryos remaining after in-vitro fertilization that would normally be destroyed once they are no longer desired, stem cells created from embryos developed specifically for research, and stem cells created using somatic cell nuclear transfer techniques. A subject filled with much debate is whether these cells are human-persons (an individual with its own distinct identity) or a collection of proto-human cellular material. Demonstrating this difference are the views of the Vatican and Jewish Theologians. As Rabbi Elliot Dorff notes, “Genetic materials outside the uterus have no legal status in Jewish law, for they are not even a part of a human being until implanted in a woman’s womb and even then, during the first 40 days of gestation, their status is ‘as if they were water.’ As a result, frozen embryos may be discarded or used for reasonable purposes, and so may stem cells be procured from them.” The official Catholic view is that from the moment of fertilization the zygote that results is fully human. These views, although they come from theology, reflect the range of views of secular ethicists.
The first source for embryonic stem cells are those created using somatic cell nuclear transfer techniques. Utilizing somatic cell nuclear transfer, we have manufactured material for therapeutics utilizing cord blood and adult derived stem cells. Medical science has not developed therapeutics with embryonic stem cells derived using this technique. Stem cells created using this technique do not currently have the potential for creating human life although this technique is currently used for cloning of other mammals. Presently the moral implications associated with this class of cells are in the discipline of cloning. The thought with many bioethicists is that these cells cannot have the moral status of human life since they cannot achieve full human life. The caveat associated with this belief is that when science progresses to the point where human cloning becomes possible using this technique science must revisit the ethics of research using these cells.
Probably the least controversial source of embryonic stem cells is those derived from the remaining embryos used for infertility treatment. The creation embryos during infertility treatments exist with the intention of creating a child. Often, after the child has been born, there are many fertilized ova remaining that must be kept cryogenically frozen or destroyed. Since the expense of maintaining these ova in this state is expensive, it is common practice to destroy these embryos or use them for research, which inevitably destroys the embryos. Eventually, organic matter that has been cryogenically frozen begins to decompose through the loss of water and the inevitable chemical reactions that continue to take place. The attempt at preserving these cells actually results in their destruction. It seems reasonable and ethical to utilize these cells when their destruction is imminent through either direct action or the passage of time. Naturally, one would expect that obtaining the donor’s consent before beginning research using these embryos ought to be mandatory. I feel that this is probably the least controversial of all sources for embryonic stem cells. This position falls between those given by the Vatican and Rabbi Dorff. I feel that this is a scientifically valid position since it simultaneously acknowledges the value of embryonic life, even outside of the uterus, while maintaining that there are times when it is morally justifiable to use those embryos.
Identical in creation but different in intent are those embryos created using in-vitro fertilization with the intent of destroying them in research. As is the case with the conception of a child with the sole intention of obtaining embryonic germ cells, this method of creating embryonic stem cells is questionable. There was never any intent of creating a life, which is the natural purpose of an egg and a sperm. From the beginning, the intent violates the rule of natural purpose. The creation of life or proto-life with its destruction being our intention is unethical. It reduces the value of life and places the definition of life in a more subjective role.
Performing research on embryonic stem cells poses numerous problems not encountered with adult stem cells. This type of research places these cells outside of their natural purpose. Since these cells are highly active, there is a greater chance of unpredictable branching and tumorous growths. Human beings are the only creatures capable of violating the natural purpose. We must wield this discretionary power with great care and with consideration given to both the ethical and evolutionary ramifications.
Currently there are laws prohibiting the use of embryonic stem cells for any use other than research. There is also a prohibition against manufacturing cells using embryos for a specific recipient.
The debate surrounding embryonic stem cell research is not a debate over whether or not the research is ethical. The lack of debate over adult stem cell research provides evidence that there is little debate over the morality of stem cell research in general. The debate pertains to the ethics of the destruction of potential human lives. Research on embryonic stem cells cannot occur without the source embryos. I believe that the use of discarded embryos from infertility treatment and abortions performed to save the woman’s life are both morally justifiable sources provided that the donor’s consent is obtained following the recommendations outlined by the National Bioethics Advisory Committee.

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