This paper was presented discussed at the Council's
April 2002 meeting.
It was prepared by the author solely to aid discussion and does not
represent the official views of the Council or of the United States
Government. Copyright © 2002, Gene Outka. All rights reserved.
The Ethics of Stem Cell Research
Gene Outka, Ph.D.
Dr. Outka is Dwight Professor of Philosophy and Christian Ethics, Yale University.
Dr. Gene Outka
Department of Religious Studies
PO Box 208287
New Haven, CT 06520-8287
ABSTRACT. The medical and clinical promise
of stem cell research is widely heralded, but moral judgments about it
widely collide. This article takes general stock of such judgments, and
offers one specific resolution. It canvasses first a spectrum of value
judgments on sources, complicity, adult stem cells, and public and private
contexts. It examines next how debates about abortion and stem cell research
converge and diverge. It proposes finally to extend the principle of nothing
is lost to current debates. This extension links historic discussions
of the ethics of direct killing with unprecedented possibilities that
in vitro fertilization procedures yield. A definite normative region
to inhabit is located, within a larger range of rival value judgments.
We should resist the creation of embryos for research purposes only, yet
we may engage in research on "excess" embryos by virtue of an appeal to
the nothing is lost principle.
Hype tempts us all. It would be naove to exempt scientists from sometimes
overstating the promise of their research. Early claims about what gene
therapy would accomplish, for example, were arguably exaggerated and eroded
public confidence. Yet claims about what stem cell research may accomplish
belong in a class by themselves. The general public is now convinced that
something momentous is occurring (for one early, engaging indication,
see Easterbrook 1999). Both professional and popular publications register
the excitement scientists evidence. This research, it is routinely said,
will not only expand significantly what we know about cellular life, but
it will bring dazzling clinical benefits. Those who suffer from Alzheimer's
disease, Parkinson's disease, et. al., are regularly identified
as eventual beneficiaries. The cumulative effect is to raise expectations
generally to a high pitch.
Whether these claims too will prove exaggerated awaits research efforts
that have only begun.1
We long for such benefits of course, and most of us sense a genuinely
other-regarding motive at work among those who make these claims. That
is, the prospect such research affords for bringing concrete benefits
to numerous human sufferers motivates scientists to engage in it. We
may discern and admire this motive even when we recognize that less
altruistic considerations, e.g., a search for windfall financial profits,
sometimes operate as well.
Yet concern about profits figures only marginally in the ethical controversies
that this research has so far generated. The controversies show rather
how a single other-regarding motive that accents benefits to human sufferers
cannot and should not go through untrammeled. Even as we praise the motive,
we confront a host of complicating questions. May research that accents
benefits to human sufferers trump all other considerations as it seeks
to secure these benefits? What of embryos and aborted fetuses? Should
we reduce their value totally to their importance for relieving
the suffering of third parties? Can a readiness to do anything
that we please with and to embryos and aborted fetuses be acceptably other-regarding
after all? What other moral considerations count and how much should they
I approach these questions with lenses through which I see a more encompassing
diagnosis of ourselves that sets the terms for appraising even novel developments.
Two basic generalizations about us that derive from this diagnosis influence
my reflections in what follows.
First, we are morally capable creatures, accountable
beings. We should assume responsibility for what we are doing, and we
go wrong when we seek to deny our agency. Not every outcome in stem
cell research is foregone; we may shape as well as be shaped by developments,
and much may depend on initiatives we take that accord with our own
convictions. Second, we are creatures who can exalt ourselves inordinately,
i.e., in ways that flout God and manipulate others. This condition is
called sin and moral evil in many religious communities. Reinhold Niebuhr
takes sin to extend in two directions: "The Bible defines sin in both
religious and moral terms. The religious dimension of sin is [our] rebellion
against God, [our] effort to usurp the place of God. The moral and social
dimension of sin is injustice. The ego which falsely makes itself the
center of existence in its pride and will-to-power inevitably subordinates
other life to its will and thus does injustice to other life" (Niebuhr
1949). To be tempted to usurp and to do injustice is endemic to human
life as we know it. In my own identity as an Augustinian Christian (Outka
1992), I take it that we are continually in danger, and that everything
is corruptible. If this is right, we should expect that stem cell research
is itself not immune to pressures that may usurp and do injustice. In
short, we are contending in the case of stem cell research with novel
opportunities and challenges, and with permanent capabilities and dangers,
and we should try to hold them together as we deliberate. As I try to
hold them together here, I concentrate on specifically ethical controversies
that surround such research. I characterize these controversies in section
I; I assess them for myself in section
II; and I offer concluding remarks in section
I focus on four points where colliding value judgments assume special salience.
Three of these concern the "sources" of stem cell research. Particular evaluations
of the three tend to cohere internally. That is, how disputants evaluate
the "status" of the embryo and the aborted fetus (point one) stays in circuit
with how they evaluate "complicity" (point two) and "the alternative of
research on adult stem cells" (point three). To compare particular evaluations
along a spectrum increases understanding of where disagreements lie.
RECURRING ETHICAL CONTROVERSIES
The fourth point shifts to political and legal contexts in which this
research proceeds, and specifically to proposals about how such research
should be organized, financed, and overseen. Value judgments are in contention
here as well. They do not yet receive, however, the rigorous examination
that characterize debates about "sources." Still their importance is obvious.
They impel us to mesh what is ethically desirable with what is politically
viable. I can only touch on such an immense subject now. But to ignore
institutional realities altogether, including institutional lacunae, amounts
to a certain kind of ethical failure, one that holds largely at bay questions
about which institutional arrangements conduce to the "common good."
The three points I take up initially are, then, the status of
the fetus and of the embryo; the question of complicity, where
research depends on someone destroying a fetus or an embryo; and
the alternative of concentrating on stem cells found in adults.
I review a spectrum of rival value judgments that pertain to each of the
- Views on the "Right"
Here I refer most of the time to Richard M. Doerflinger, who defends
in lucid prose Vatican instruction on human procreation. Yet we should
not suppose that only Roman Catholics reach the judgments I am about
to describe; many evangelical Protestants and (Eastern) Orthodox Christians,
for example, do as well (Meilaender 1999; Demopulos 1999).
First, the status of fetuses and embryos. Doerflinger considers
the moral status of the human embryo in light of the historic conviction
that each human individual has basic and equal human worth. No differences
in talents or other conditions should overturn this evaluation. If
we take the evaluation to heart, we infer that no one should be treated,
exhaustively and without remainder, as a means or instrument. "The
human individual, called into existence by God and made in the divine
image and likeness,...must always be treated as an end in himself
or herself, not merely as a means to other ends...." (Doerflinger
1999). And it is cogent to infer inviolability too. To kill the innocent
deliberately and directly is the prime instance of going against
such inviolability. Fetuses and embryos are assuredly innocent. Doerflinger
sees both abortion and the destruction of embryos as treating fetuses
and embryos merely as means to other ends, and as going against inviolability.
Since the moral status of fetuses and embryos is decisively similar,
he combats a view that certain liberal Catholics (among others)
espouse, in which "conception" differs from "individuation." For
this view, the early embryo is relevantly formless until the "primitive
streak" appears at around 14 days. Otherwise we cannot account for
the possibilities of "twinning" and "fusion" that occur after conception.2
This view allows moral room for maneuver, therefore, up to 14 days.
Doerflinger replies that the most recent studies show that the early
embryo is not simply formless, that the capacity for twinning is
established very early indeed, and in any event, that the overwhelming
majority of embryos lack the property of spontaneously producing
twins. A more general concern surfaces too. Some hold that even
if the argument from "twinning" allows for nontherapeutic experimentation,
it remains the case that this experimentation induces a kind
of attention to early life that regards it as "manipulable stuff,"
and not as a child, but as an entity that merely serves other, perhaps
laudable ends. And such attention jeopardizes our ability to welcome
children into the world and to care for them (Werpehowski 1997).
We thus fall victim to incompatible attitudes, and are at war with
Second, complicity. Doerflinger reviews and assesses various
arguments about complicity. Here certain differences between abortion
and the destruction of embryos do appear, but they give no
comfort to the advocates of research on embryos.
- He considers efforts that Congress has made since 1993 to distinguish
the actions and intentions of those who decide to abort from the
actions and intentions of federally funded researchers who use the
fetal tissue from induced abortions in human transplantation, under
certain conditions (Doerflinger 1999). While he does not altogether
approve of these efforts, or of some of the arguments urged on their
behalf, he grants that a researcher who uses fetal tissue is not
necessarily a supporter of the decision to request or perform an
- He refuses to say the same, however, about the derivation and
use of stem cells from embryos. "Here those who harvest and use
the cells are necessarily complicit in the destruction of the embryo.
This is illustrated by the fact that, if embryonic stem cell research
were governed by the same legal conditions that now govern the use
of fetal tissue from abortions in federally funded research -- e.g.,
harvesting to be done only after death, researchers' needs may not
determine the timing and manner of the destruction of the fetus
-- the research could not be done at all. These stem cells are taken
from embryos while they are still living. In effect, the harvesting
of cells is itself the abortion -- i.e., it is the act that directly
destroys a live embryo -- and the method of destruction, using microsurgery
to extract the embryo's inner cells from the outer trophoblast,
is determined entirely by the needs of the stem cell researcher"
- He rejects as incoherent any claim that governmental funding of
research on embryonic stem cells does not involve complicity in
the destruction of embryos as long as researchers did not participate
directly in such destruction. For this distinction strikes him as
little more than a "bookkeeping exercise," since the act of destruction
is not only presumed as with research on aborted fetuses,
but is directly undertaken as part of the research protocol.
- He also criticizes the argument that derivation of stem cells
from "spare" embryos donated by fertility clinics differs morally
from using embryos created solely for research purposes,
and that only the latter uses embryos as a mere means to
other peoples' ends. For one thing, to destroy an entity for body
parts because that entity will die in any case is not the same as
using cells from an entity already dead. For another thing, "a policy
that permits research only on 'spare' embryos is virtually impossible
to maintain in practice. Fertility clinics easily can produce a
few more embryos from each couple, ostensibly for reproductive purposes,
to ensure that there will be 'spares' for research at the end of
the process" (Doerflinger 1999).
Third, the alternative of adult stem cells. Doerflinger accents
the advances that researchers have made in their work on adult stem
cells. One major advantage of using adult stem cells on which everyone
agrees is that we avoid the problems of possible tissue rejection
when we treat a patient with his or her own cells. That we cannot
say with certainty whether research on embryonic cells has clinical
usefulness otherwise unavailable, strengthens the case on practical
grounds for limiting research attention to adult stem cells. We thereby
stand clear of putting morally contestable practices subject to challenge
firmly and probably irrevocably into place.
- Views in the "Middle"
First, the status of fetuses and embryos. A more liberal case is made
within the Catholic tradition that favors human embryo stem cell
research. It requires us to distinguish, as I mentioned earlier,
between conception and individuation. Margaret Farley accepts this
case. For her and a number of other Catholic moral theologians,
the human embryo is not considered "in its earliest stages (prior
to the development of the primitive streak or to implantation) to
constitute an individualized human entity with the settled inherent
potential to become a human person. The moral status of the embryo
is, therefore (in this view), not that of a person; and its use
for certain kinds of research can be justified. (Since it is, however,
a form of human life, some respect is due it -- for example, it
should not be bought and sold.)" (Farley 1999).3
She commends certain safeguards, e.g., donors may not specify who
is to receive stem cells for therapeutic treatment, and an "absolute
barrier" should be maintained between therapeutic and reproductive
Second, complicity. While those who occupy positions in the
middle may disagree in their evaluation of the moral standing of fetuses,
they tend to agree that one distinction respecting embryos has moral
relevance. They refuse to equate the destruction of embryos who already
exist but who will either be frozen in perpetuity or discarded, with
the creation of embryos in order to destroy them solely to benefit
third parties. Complicity in the former instance looks morally less
ominous. For the decisive role here is played by those responsible
for the existence of embryos in the first place and for electing subsequently
to freeze them or discard them. Researchers react rather than initiate,
after those responsible have reached their fateful determinations.
And the numbers of embryos effectively bereft of prospects are vast.
Some estimate that approximately 100,000 frozen spare embyros now
languish in in vitro fertilization clinics. The majority are
no longer wanted or claimed. They will never be implanted. Judging
complicity should reckon with this datum.
Third, the alternative of adult stem cells. Those who occupy
middle places across the spectrum are disposed generally to accept
(though sometimes reluctantly) a verdict that many scientists have
reached. It is that stem cell therapies deriving from adults are necessary
but not sufficient -- if we want to maximize the data available and
hence the possibility of break-throughs -- for obtaining the various
cell types that clinically important areas of research require. Research
on each of the "sources" should go forward, for each has its own advantages
and disadvantages. But in any event, embryonic stem cell research
embryos holds promise for which at present there is no adequate substitute.
- Views on the "Left"
Here I refer most of the time to John C. Robertson (much as I did
with Richard M. Doerflinger on the other side).
First, the status of fetuses and embryos. Those who stand
on the left side of the spectrum characteristically deny that the
value accorded to pre-viable fetuses should ever override pregnant
women's choices (for whatever reason) to terminate their pregnancies.
To attribute basic and equal human worth to each human individual
requires more than the presence of cells that have the potential to
develop into a person. Robertson extends this value judgment to embryos
in the following way: Those "holding this view about pre-viable fetuses
view preimplantation embryos, which are much less developed than fetuses,
as too rudimentary in structure or development to have moral status
or interests in their own right.... No moral duties are owed to embryos
by virtue of their present status and...they are not harmed by research
or destruction when no transfer to the uterus is planned" (Robertson
Robertson refuses to say, however, that because embryos lack moral
status in their own right we may do anything at all with them
(they are not "means" in this sense or to this extent), e.g., we may
not use them "for toxicology testing of cosmetics or buying and selling
them." One should deny intrinsic value to embryos and still accord
them "symbolic" value and "'special respect' because of their potential,
when placed in a uterus, to become fetuses and eventually to be born"
(Robertson 1999). This symbolic value should nevertheless be trumped
when we pursue a good scientific or medical end that we cannot pursue
by other means.
Second, complicity. Robertson thinks that any distinction
between the derivation and the use of embryonic stem cells does not
survive critical scrutiny. Researchers who use stem cells derived
from embryos are complicit in their destruction, whether or not they
actually participate in the act of destruction itself. Moreover, those
who support obtaining cells from spare embryos from in vitro
fertilization clinics should also support creating embryos
for the purpose of research. For in both cases embryos do become
a means to address the needs of others, once we decide to use them
in research. Robertson displays an ironic affinity with Doerflinger
here. Both insist on an either/or, though of course each draws the
opposite normative conclusion from the other. Either we should
stop opposing the creation and destruction of embryos for research
purposes only (when we accept Robertson's view of the status of the
embryo), or we should oppose not only the creation and destruction
of embryos for research purposes, but the research on spare embryos
from in vitro fertilization clinics too, (when we accept Doerflinger's's
view of the status of the embryo). Pressures come to those in the
"middle" from the "left" as well as from the "right."
Third, the alternative of adult stem cells. Those who take
the position Robertson does can only prefer limiting research to adult
stem cells if such a limit will in fact yield superior therapeutic
benefits for members of society generally. And their criteria for
determining this are, it seems, empirical and consequentialist: what
research on which sources will produce the greatest benefit overall?
Thus Robertson insists that at this juncture we have not established
definitively any empirical-consequentialist case for limiting research
to adult stem cells. The most promising course is to engage in research
that is free to employ any one of the three "sources."
- Political and Legal Contexts
I turn finally to the fourth point where controversies recur. Here
we should demarcate two levels. The first concerns controversies about
federal funding of stem cell research. These consume the bulk of disputants'
energies so far. Passions rise highest where taxpayer dollars figure
centrally. Disputants perceive expenditures on this level to attest
to society-wide convictions. Those who occupy particular positions
along the spectrum I characterized battle on behalf of criteria for
federal funding that support their respective normative conclusions
about "sources." A pastiche results. The second level concerns controversies
about the absence of coordination between research permitted in the
public and private sectors. I find it disquieting that research possibilities
lack any sort of society-wide oversight. Yet many either welcome the
status quo, or appear resigned to it. Some judge the current arrangements
to be desirable on the whole. Or at least they prefer to leave well
enough alone, so long as researchers are free somewhere to
pursue various research possibilities. To enjoy liberty from scrutiny
allows those in the private sector to conduct research that holds
promise of achieving major breakthroughs, and that societal scrutiny
might well forestall (for in light of societal pluralism, such scrutiny
is likely to be constraining, reflecting compromises). Others judge
the present situation to be ad hoc to a fault. They accept
that publically and privately funded research should be somehow coordinated.
Yet they view the practical chances of coordination to be distressingly
Let me evaluate more fully positions described so far. This requires that
I also indicate positions I am myself disposed to take.
I commend as a normative point of departure the conviction that Doerflinger
cites: "the human individual, called into existence by God and made in
the divine image and likeness,...must always be treated as an end in himself
or herself, not merely as a means to other ends...." Many hold this conviction,
not only those on the "right." To regard each person for his or her own
sake, as one who is irreducibly valuable, authorizes a sphere of inviolability,
as I noted. And it heightens sensitivity to multiple ways we may go wrong,
e.g., when we dominate, manipulate, and self-aggrandize. To affirm inviolability
and to abjure domination capture deeply important commitments. They direct
moral attention along lines I take to be permanently valid.
Many likewise draw on the language of ends and means to evaluate cases
of "killing and saving" (Reeder 1996). To commit murder is arguably the
quintessential instance of going wrong. Those who murder arrogate to themselves
a position of false superiority. They usurp or perversely imitate God
who alone is the "Author of life and death." Yet they possess the power
to accomplish this. That is, in the case of murder, they can do
what they ought not to do. They also effectively claim that they
are better than their victims, so much better that they are prepared to
"instrumentalize" them through and through. Murderers do their victims
incommensurable harm; in depriving them of life, they reduce them
to "mere means" to their own aims and projects. Those who save life do
the opposite. They pay homage on their own level to what they take the
character of God's love to be, by attesting that the one saved is not
a mere means, but someone for whom they should care, whose well-being
they should protect and promote.
To mix theological and Kantain ingredients in this way deserves examination
that I must waive.4
I focus now on how far this evaluation extends. Is it cogent to claim
that abortion and embryonic stem cell research are morally indistinguishable
Posing so blunt a question concentrates our thoughts. Yet it also encourages
an unfortunate tendency to restrict evaluative possibilities to a single
either/or. Either we judge abortion and the destruction of embryos to
be transparent instances of treating fetuses and embryos as mere
means to other ends. Or we judge the case for transparency to omit too
many morally relevant considerations, but then rush to the other end,
where we judge abortion and embryoic stem cell research as morally indifferent
actions in themselves, to be evaluated solely in terms of
the benefits they bring to others. I reject this simplifying restriction.
That formidable arguments come from the "right" and the "left" ends of
the spectrum, I do not deny. Still, the most fitting place to inhabit
is, I think, a particular region in the "middle." Here one engages
such formidable arguments and appropriates as much as one consistently
can, but one retains a distinctive vantage point. From this point, one
finds a position less cogent than many conservatives do that extends
simpliciter (morally, if not legally) the prohibition of murder
to the prohibition of abortion and embryonic stem cell research. But one
ascribes greater importance to fetuses and embryos than many liberals
do, an importance not reduced to the benefits that research on them may
bring to third parties. Let me say more about this region as the most
fitting place to be, but also acknowledge dangers in locating ourselves
- From the "Right": Specificity and Stringency
The tradition of moral reflection that shapes conclusions on the
"right" elevates two considerations that those in the "middle" should
heed as well.
- One consideration is moral specificity. I am drawn to the
strand in the tradition that endeavors to identify certain actions
-- which persistently affect our weal and woe -- in a definite and
non-tautological way. To consider the action that concerns us most:
murder is prohibited, but not all killing is murder. How shall we
discriminate? We should not do so by writing morally evaluative
references into the characterization of what murder is. For then
we make this characterization morally decisive by definition. So
for example murder is defined as "wrongful" or "unjust" or "irresponsible"
killing. But resorting to tautology forecloses debate. The tradition
favors instead specification that leaves the wrongfulness of the
action open, to be "settled only by a further nondefinitional judgment"
(Finnis 1991). Here the prohibition of killing in the Decalogue
is construed more precisely to mean that we should not intentionally
kill innocent human life. This construal specifies what "murder"
is. It is a delimited action-kind. The judgment that murder in this
sense is wrong purports to be true, yet is not a tautology. (I accept
that who is requisitely "innocent" is sometimes difficult to ascertain
and deeply controversial, but not in the cases before us here.)
It is the judgment under scrutiny and it remains possible to dispute
To construe more precisely the prohibition of killing introduces
on the one hand a certain flexibility. It helps to make sense
of society's organized efforts to provide security for its citizens
against arbitrary, unprovoked, or otherwise unjust assaults on
life and limb, and to accommodate policing, courts of law, and
soldiering. We should by no means idealize here; activities that
fall under these organized efforts are always corruptible, and
in some measure, distinctively so. To recognize general and particular
corruptibility, however, need not consign the efforts to a godforsaken
realm. Yet on the other hand, this construal limits flexibility.
When we meet cases that fall within its range of applicability,
as we surely do, we may not then go roaming around, redescribing
at will. Instead, we acknowledge the moral features of the case
we confront, and either condemn or seek special justification
- A second consideration is moral stringency. To reiterate
an ancient question: may we (ever) do evil to achieve good? (McCormick
and Ramsey 1978). When we meet cases that fall within the prohibition's
range of applicability, we face two choices: the prohibition against
killing as precisely construed possesses either absolute
or prima facie authority in any circumstance to which it
A familiar historical example brings out the difference between the two kinds
of authority. President Truman reasoned that to drop atomic bombs
on Hiroshima and Nagasaki served to hasten the end of the war and
it cost fewer lives than a full scale invasion of Japan would have.5
We cannot ascertain whether he was empirically correct, but we can
ask whether he was morally right that the criterion of "fewer lives
lost" should trump. Those who adhere to the prohibition against
killing as precisely construed normally extend it in circumstances
of war to forbid the direct and intentional killing of noncombatants
(as "material innocents"). To accord absolute authority to
the prohibition thus extended means that Truman erred morally when
he calculated total outcomes in the fashion he did. No argument
from outcomes (that included his readiness to pursue a "countercity"
rather than "counterforce" strategy to shorten the war and kill
fewer persons) can override what by prior determination is judged
to be wrong in itself to do, whoever does it. In this sense, we
may never do evil to achieve good. To accord prima facie
authority but not invariably actual bindingness to the prohibition
thus extended means that noncombatant immunity has presumptive validity.
This is strong enough to query Truman's decision. For we assume
in advance that there is a presumption in the prohibition's favor,
that any violation has the burden of proof. And the prohibition
retains authority in that it may never be disregarded in any circumstance
to which it applies, but only overridden, and always with compunction.
Still, we may consider in tragic cases whether we should do something
morally repellent (something we would not do for its own sake),
to prevent something far worse.
Unless we understand how the prohibition against killing is construed,
and that it may be accorded absolute authority, we fail to grasp where
and why many on the "right" judge abortion and embryonic stem cell
research as they do, and where and why many on the "left" demur.
Those on the "right" judge that the prohibition extends to fetuses
and embryos. Both are innocent, and aborting a fetus and disaggregating
an embryo are direct actions that kill. Whether death is strictly
intended is a more complicated question in the case of abortion.
Certain defenders of abortion claim that a pregnant woman may justly
withdraw her bodily life support from the fetus, but that she may
not thereby have a "right" to the fetus' death, if the fetus can survive
outside her womb (Thomson 1971). Before 20 weeks of the pregnancy,
however, this distinction has strictly theoretical interest. Death
accompanies withdrawal of bodily life support, whatever hypothetical
speculations we append. Death also accompanies the disaggregation
of embryos, and affords no room for distinguishing between intending
withdrawal but not death. As for "human life," the last part of the
specified prohibition, those on the "right" maintain that each human
entity, from the time of conception, is irreducibly valuable. Indeed,
each is judged to have an equally protectible status. If embryos are
currently genderless and removed from the naked eye, they differ from
the rest of us in that they await implantation, growth, and subsequent
entry into the world of social interaction (Sullivan 2001). But they
contain the requisite genetic information that renders each unique.
And all of us began at this stage. Why then discriminate? Does
our self-absorption blind us to injustices we may commit because at
present we enjoy superior power? Assuredly, fetuses and embryos cannot
now fight back on their own behalf. Yet none of us could at
the point of our origins. We transcend our self-absorption when we
revere human entities by doing nothing that would jeopardize their
inviolable status, just as our parents earlier revered ours (and fought
for our survival, when we needed it). To intervene and destroy fetuses
and embryos, palpably instrumentalizes them, for the sake of those
who are presently stronger. We do well to remember what our parents
did, and that we are grateful for what they did, when we evaluate
abortion and embryonic stem cell research.
Those on the "right" go next from specificity to stringency. We
should make others' ends our own, provided that these ends are
morally permissible. Violating the prohibition against killing
as precisely construed is an impermissible end. We may not
do or approve this evil, even when it achieves good. For we
should always relate any benefits we aim to secure to what we are
prepared to do to obtain them. We do best to consider first
what we do and forbear, and not simply what will happen,
and to live within the absolute limits that the prohibition against
murder sets for us.
- In the "Middle": Potentiality, and When "Nothing
I have identified arguments from the "right" that I find formidable.
Why do I not simply accept them without further ado? I take no pleasure
in objecting, yet I judge certain extensions less cogent than their
defenders assume. Two lines of argument prevent my saying that abortion
and embryonic stem cell research are morally indistinguishable from
murder, and permit my occupying a particular region in the "middle."
- One line of argument concerns "potentiality," as applied to fetuses
and embryos. This word recurs in the literature, yet is a red flag
to many on the "right" and the "left." Conservatives think it nullifies
a serious commitment to fetuses and embryos; liberals deride it
as "mere" potentiality, a referent too indeterminate ever to be
permitted to trump decisions to abort and to conduct research on
embryos. The truth seems to me complicated in ways these contrary
I claim the following about "potentiality." It has a two-sidedness
that leads me to draw back from unqualified extensions, but to
draw back a lesser distance than those on the "left" do. It yields
appraisals that show how debates about abortion and debates about
embryonic stem cell research are sometimes allied and sometimes
not. How they diverge needs especially to be recognized. I consider
these claims in turn, and attend first to fetuses.
"Potentiality" on one of its sides registers what fetuses are
not yet. They are entities who at least during the first 20
weeks of their existence (or until their lungs are sufficiently
developed) cannot live except in total physical dependence
on one and only one person in all the world. Talk of artificial
placentas and hypothetical preferences should not divert us. Assuming
the medical technology available now and in all the future we
can empirically foresee, pregnancy involves unique physical dependence.
Here and now, every pregnant woman is non-interchangeable. No
one else can take her place. This state of affairs is not
at all odd (not numerically uncommon), yet it is distinctive (though
numerically common). The distinctiveness means that in certain
respects pregnancy is sui generis. Analogies that are entirely
satisfactory elude us.
Consider two sorts of cases where this total dependence allows
us to ascribe to the fetus a status less than that of equally
protectible human life when weighed against the pregnant woman
who is as well an end in herself.
The first sort involves parity-conflicts where one physical
life collides with another physical life, and we cannot save both.
Such cases include conflicts between the pregnant woman and her
fetus, where the pregnant woman will die, unless we end the life
of the fetus (though thankfully these are now rare). A random
lottery solution lacks advocates in this set of circumstances.
In brief, such a case differs from lifeboat scenarios, because
unlike the latter, we do not propose drawing straws. Rather, we
unhesitatingly save the pregnant woman. "Potentiality" captures
accordingly the sense that commitment to fetal life here is prima
facie but not absolute. We override when the fetus imperils
the pregnant woman's physical life. We abort when the fetus stands
fatally in the way of actions intended to save the woman's life.
Parity-conflicts of this sort are resolved in one way.
The second sort involves encounters with evil, where a woman
is pregnant because she is raped or the victim of incest. It
is at this juncture that the absence of satisfactory analogies
asserts itself most forcefully. No one except the pregnant woman
can carry in her body someone conceived in rape but non-transferable
just the same, who combines her own genes with those of her
violator. She is uniquely near the fetus, yet is alienated from
it by virtue of the crime that affects her intimately and in
which she is not complicit. This evil case brings three factors
together. The first concerns unique dependency. The woman can
help in a way no one else can. The second concerns agency. She
is not responsible for being pregnant. The third concerns cost.
She carries the offspring of violence. The first holds for all
pregnancies. The second and third do not, and they go together.
How far these three factors are severally necessary as well
as jointly sufficient to set this case apart points to the intricacies
of debates about abortion as such that I cannot address here.6
But at least in this case, to judge that she is obliged to bring
the fetus to term exceeds what the conditions of her own inviolability
accommodate. Potentiality again stops short of equal protectibility
that would prohibit termination in every such instance.
"Potentiality" on the other of its sides registers what fetuses
are. Here I take potentiality to be something more than
mere possibility. The "more" refers to an entity actually in motion,
a force that is there, a power underway (after the primitive
streak and implantation). This power includes existent
capacities to acquire in future various characteristics
we attribute to those who "bear the human countenance," e.g.,
self-awareness, personal accountability, and conscious relations
with other human beings. Since fetuses possess these capacities
to acquire, traditional appraisals are correct that fetuses have
a value greater than zero, a value separate and independent from
their parents (Noonan 1970). In short, they are irreducibly
valuable. I take their real value to mean that from conception
forward, a presumption holds that they should come to term. Overriding
this presumption carries the burden of proof.
Such commitment to fetal life makes theological sense to many
for whom bibilical passages count in weighing matters of life
and death. Believers adduce passages that trace the working of
providence back to the womb, for example (Isaiah 44:2; Psalm 138:13,
for Jews and Christians; Luke 1:31-39, 42-44, for Christians).
We should not dismiss citations like these as mere "proof-texting."
For they cohere with a conviction that God's covenant love stands
as our alpha and omega. In this case, our own love should correspond
to far-reaching providential action. To err on the side of inclusiveness
looks fitting. That a biblical depiction of providence encompasses
potentiality implies that our love should start before recipients
These evaluations of the status of the fetus locate me on the
right side of the tortured "middle," within the vast territory
of debates about abortion. It is essential to make these evaluations
explicit, if one hopes to add anything useful to the widely-voiced
opinion that debates about stem cell research chiefly reprise
debates about abortion. This opinion captures something right.
Given what I say above about two-sidedness, both fetuses and embryos
are irreducibly valuable in that both have a value greater
than zero, a value separate and independent from their parents;
and both cannot live and develop except in total physical dependence
for a certain time on one and only one person in all the world.
Yet we should not stop here. The opinion misses divergences
that I find important to notice in staking out a particular region
in the "middle," within the smaller but rapidly expanding territory
of debates about stem cell research. I allude to three such divergences
now. The first concerns the kinds of conflict that are
at issue. The second concerns the parameters of cost. The
third concerns the range of choices that present themselves.
I take them in turn.
First, we miss in debates about embryos the characteristic tensions
resident in the two sorts of cases I reviewed, where total dependence
allows us to ascribe to the fetus a status that is less than equally
protectible human life when weighed directly against the
pregnant woman. For these cases focus on conflicts between two
parties where a one-to-one correspondence obtains. While the stakes
differ -- saving one physical life by ending another physical
life, deciding whether a fetus conceived by the act of rape that
transgresses the inviolability of one party should be brought
to term and parented with all of the deep and permanent commitments
this carries -- the correspondence does not. It is otherwise with
embryos. In typical circumstances, no similar conflicts exist.
While we take an active step by implanting the embryo, something
that the two conflict cases do not require and have in any event
passed beyond, the decision to implant is not a conflicted one.
The circumstances here center on infertile couples who want a
child and who embrace emphatically the deep and permanent commitments
parenting brings. If a conflict emerges, it is neither immediate
nor one-to-one, between the fetus and the woman. Rather, it is
between those embryos who are not implanted and are to be frozen
in perpetuity or discarded, and the needs of third parties
who suffer from various maladies that research on embryos may
Second, the cost to affected parties is constant in the case
of fetuses and embryos, but diverges notably in the cases of pregnant
women and third parties suffering from maladies mentioned earlier.
Fetuses aborted and embryos disaggregated undergo incommensurable
physical harm, i.e., lethal harm beyond our powers to reverse
or compensate. I argue elsewhere that it is this incommensurable
harm that constitutes a decisive similarity between abortion and
infanticide, and one may extend this argument to embryos. Conservatives
judge this similarity to fall under the prohibition against murder,
and accord the prohibition absolute priority, as we have seen.
I do not go so far, as we have also seen. But we should not shrink
from soberly acknowledging the similarity itself. On the other
hand, we encounter important divergences when we turn to the cases
of pregnant women and third parties suffering from maladies. Let
us recall the instance of pregnancy following rape, and the three
factors that go together here (unique dependency, agency, and
cost). The woman is not obliged to carry the fetus to term
who is conceived in these circumstances. Yet the sphere of discretion
she enjoys includes the possibility that out of extreme generosity
and despite excruciating personal cost, she may elect to bring
the fetus to term. The sacrifices she makes are hers, though after
the fact. That is, the rapist deprives her of the exercise of
her agency, and yet she exercises it post eventum; she
may choose voluntarily to bear the cost. This sort of personally
incurred cost disappears in cases of third parties suffering from
maladies that stem cell research may alleviate. That they suffer
excruciatingly as well, from maladies over which they exercise
no agential control and yet which may eventually obliterate their
agency, and that alleviating their suffering is something to be
lauded, I would be the last to deny. Still, their standing as
possible beneficiaries of embryonic stem cell research is initially
unrelated to the circumstances of conception. They are not themselves
actors within these circumstances. Unlike a pregnant woman,
they cannot connect the plight they face with what they do,
at voluntary cost to themselves. Moreover, no researcher
of stem cells currently suffers, or faces permanent changes to
his or her future life, that compare at all with the suffering
a woman knows whose pregnancy is due to rape, and who elects to
bear and parent a child.
Third, the choices a woman confronts whose pregnancy is due
to rape are stark. Either she elects to terminate or she does
not, and if she does not, she may either bear and place the child
for adoption, or she may parent. Her reasons for deciding as she
does may vary, from honoring her own inviolability to honoring
the well-being of the fetus who is another innocent. Yet some
reason must trump. And the time to decide is short: if she does
not terminate, she will bear, by affirmation or default. Whatever
she decides, she will live with a host of physical and emotional
effects, from a single point of origin. Once more, the circumstances
surrounding stem cell research diverge markedly from her case.
The reasons to conduct such research include the alleviation of
suffering and the advancement of scientific knowledge. Neither
reason must trump; they may reinforce each other. And our choices
in how we pursue such research are several, as the debates about
"sources" make clear. No one source is the narrow gate through
which all promising lines of research must pass. We debate
relative advantages and disadvantages, as well as the place of
moral constraints. Finally, we are not bound by fixed and knowable
temporal limits. And these are early days for such research.
The respects in which debates about abortion and debates about
stem cell research converge and diverge pressure those in the
"middle" in contrary directions, as I observed earlier. Some are
disposed to be more permissive about embryonic stem cell
research than about abortion for these reasons: (a) Prior to implantation,
we may distinguish conception from individuation. (b) After implantation,
the fetus is indeed a "power underway," who left to self-elaborating
processes is likely to become "one of us." Abortion actively intervenes
to terminate "a force that is there," and has the burden of proof,
whereas an embryo must still be implanted, and until it is, we
cannot describe it as now a self-elaborating power underway.
Others are disposed to be less permissive about embryonic
stem cell research than about abortion, for this reason: abortion
may involve bona fide conflicts between two entities who
are both ends in themselves, whereas embryonic stem cell
research is morally simpler. It concerns only one such
entity about whom we can say with certainty, here and now, that
the action we take, disaggregation, causes incommensurable harm.
That third parties may benefit from the research subsequently
done, is an outcome for which we fervently hope. But such benefit
lies in the future. It does not lend itself to similarly determinate
judgment. And we cannot gainsay the possibility that it may be
attained without taking any lethal step, e.g., through research
on other, morally unambiguous sources of stem cells (from adults,
umbilical cord blood, and the like).
The two-sidedness of potentiality supports the less permissive
side, it seems, yet we should weigh a further argument that furnishes
some room for maneuver and nuances the distinctiveness of debates
about embryonic stem cell research.
- A second line of argument prevents my saying that abortion and
embryonic stem cell research are morally indistinguishable from
murder, and permits me to occupy the particular region in the "middle"
I do: nothing is lost.
I propose to invoke and extend the nothing is lost principle.
I first learned of this principle from Paul Ramsey. While he was
committed to an absolute prohibition against murder as the intentional
killing of innocent life, he was prepared to attach two exempting
conditions to it. One may directly kill when two conditions
obtain: (a) the innocent will die in any case; and (b) other innocent
life will be saved (Ramsey 1961). These two conditions stipulate
what nothing is lost means. They originally extend to parity-conflicts,
where one physical life collides directly and immediately with
another physical life, and we cannot save both. (Ramsey may not
have continued to uphold the principle in later writings, and
I doubt in any case that he would have accepted the further extension
I now offer.) I will argue that it is correct to view embryos
in reproductive clinics who are bound either to be discarded or
frozen in perpetuity as innocent lives who will die in any case,
and those third parties with Alzheimer's, Parkinson's, et. al.,
as other innocent life who will be saved by virtue of research
on such embryos.
I grant that this extension at best stretches the nothing
is lost principle nearly to the breaking point. For I defend
the extension (and perhaps the original principle) as a move to
the effect that (a) nothing more is lost, and (b) less
is lost, or at least, someone is saved. One reason it is
worth considering is because we face a particular instance of
a general phenomenon, namely, that novel developments arise, for
which no clear precedents suffice to guide us. We should seek
both to extend traditional moral commitments and incorporate new
developments as cogently as we can. To labor the obvious: some
of the controversies we are examining only make sense after
the age of in vitro fertilization dawned. It stands
behind them, amplifying questions about "end" and "means" that
our forebears could not foresee. Unless we are prepared to repudiate
in vitro fertilization as such, so that we sympathize with
infertile couples but refuse them a right to overcome their
condition by any means that science and their financial resources
make available, we must take the moral measure of these new possibilities.
In the instance before us, I sympathize with the plight of infertility,
but am disquieted by the way in vitro fertilization is
practiced in our culture. I will return to this disquiet. But
rightly or wrongly, "excess" embryos are a tenacious datum,
for they are a result of the practice as it currently exists.
I welcome the day when such necessity vanishes, and welcome
in the meantime "adopting" mothers willing to implant embryos,
when the genetic couple consents.7
Not to welcome these things belies the claim that embryos as
well as fetuses are irreducibly valuable. Nevertheless, it looks
as if embryos in appreciable numbers will continue to be discarded
or frozen in perpetuity. They will die, unimplanted, in any
case. (Nothing more will be lost by their becoming
subjects of research.) Again, it is the absence of prospects
of these innocents that partly extends the first exempting
condition. It is the enhancement of prospects to other
innocent life that partly extends the second exempting condition.
(Less will be lost, or at least, someone may benefit.)
These judgments taken together summarize the case I wish to
I say "partly." I do not say "wholly" and certainly not "transparently."
The case for extension I put forward shows both continuities and
discontinuities with prior judgments on the ethics of direct killing.
I take the prior judgments seriously and extend them to novel
possibilities as far as I can. But I acknowledge that the present
debates attest to a moral space embryonic stem cell research occupies
that is to a degree unprecedented. Let me give two examples of
continuities and discontinuities.
First, consider this point of continuity. My extension goes
so far, and no further. It includes embryos conceived to enhance
fertility, but who will never be implanted. It excludes embryos
created exclusively for research, where we intentionally create
them, in order to disaggregate them. This limited extension
accords with the "timbre" of nothing is lost in that we
encounter circumstances we did not initiate and that we wish were
otherwise. That we contemplate doing repellent things, things
that again we would not do for their own sake, indicates how intentional
killing was not "part of our plan" from the start. This timbre
matters, yet a difference presents itself even here. The parity-conflict
cases assume a contingent disaster that no one intends or foresees,
nor is it made part of any established procedure. The circumstance
of in vitro fertilization includes a recognition that "excess"
embryos are endemic to the procedure to date. At a minimum, we
foresee this. Still, we intend in the procedure to alleviate
infertility, not to create embryos for research. Thus a significant
continuity holds, despite this difference.
Second, consider this point of discontinuity. The nothing
is lost principle, as originally formulated, is narrower and
more exact than an extension to the novel case of unimplanted
embryos can be. In parity-conflict cases that goad us to articulate
the nothing is lost principle in the first place, unless
we directly kill one, we cannot save the other, and this allows
us to claim that we would save both if we could.
In cases of unimplanted embryos, we face no similar temporal and
causal limits. No other party will directly and immediately die
if we elect to save embryos by freezing them. Any "conflict,"
as I said earlier, is much further removed and comparatively indeterminate,
plainly from parity-conflict cases, and arguably from abortion
decisions more generally.
- From the "Left": Derivation and Use, and Ends and
While a particular location in the "middle" that I seek to inhabit
has led me so far to pursue boundary questions with the "right" side,
what I have said anticipates as well how I pursue boundary questions
with the "left" side. I noticed previously that Doerflinger and Robertson
as representatives of each side sometimes concur that our moral choices
are less complicated than I take them to be. They hold respectively,
we recall, that either we should oppose not only the creation
and destruction of embryos for research purposes, but the research
on spare embryos from in vitro fertilization clinics too, or
we should stop opposing the creation and destruction of embryos for
research purposes only. I have sought to show morally relevant differences
between the creation and destruction of embryos for research purposes,
and the research on spare embryos from in vitro fertilization
clinics. To the degree these differences make sense, they suggest
how those in the "middle" differ from those on the "left" and not
only from those on the "right." I examine these boundary questions
now more closely.
Robertson makes two claims under my earlier "complicity" heading
that we should not conflate. He contends first that the distinction
between derivation and use is chimerical. Researchers are complicit
in destroying embryos when they use stem cells derived from them,
whether or not they engage in the actual destroying themselves.
So far, I agree. The earlier NIH Guidelines promulgated during the
split the difference, perhaps for political reasons, to promote
civil peace by not ignoring conservatives' concerns altogether,
but funding research all the same. Robertson contends secondly that
if one supports research on embryos obtained as "spares" from in
vitro fertilization clinics, one should also support creating
and destroying embryos for the purpose of research. For embryos
do become a "mere means," once we decide to use them in research.
I think we may compatibly accept his first contention and reject
his second. And if I am right to extend in a qualified way the nothing
is lost principle, we have important reasons to reject the second.
To recount the reasons clarifies where boundaries lie. Such reasons
focus on what status we ascribe to embryos, and on how we interpret
the injunction to treat persons as ends in themselves.
Regarding status, we remember that Robertson holds, along with many
others, that embryos are too rudimentary to have moral status in their
own right. He ascribes "symbolic" value to them, and this means for
example that they may not be bought and sold, but they lack "intrinsic"
value. The account of potentiality and irreducible value that I offered
does ascribe status to them in their own right. And this account warrants
resistance to so thin a view of their value that virtually any reason
(excepting qualms about commercialization) trumps it. I intend potentiality
to be robust enough, in the case of both fetuses and embryos, to resist
the view that fetal life and embryonic life lack any weight that might
ever be determinative, as soon as they conflict with other
interests. Without such resistance, we reduce concern for such life
to a platitude, a mere expression of good will, that never has efficacy,
that can always be trumped.
Regarding the injunction, Robertson insists that once we decide
to use embryos in research, they do become a "mere means." This announces
moral equivalence between two circumstances that I have argued differ
relevantly. It is one thing to say that innocent life "will die" in
any case, when we refer to a condition that we did not, by our own
that embryos are too rudimentary to have moral status in their own
right. He ascribes "symbolic" value to them, and this means for example
that they may not be bought and sold, but they lack "intrinsic" value.
The account of potentiality and irreducible value that I offered does
ascribe status to them in their own right. And this account warrants
resistance to so thin a view of their value that virtually any reason
(excepting qualms about commercialization) trumps it. I intend potentiality
to be robust enough, in the case of both fetuses and embryos, to resist
the view that fetal life and embryonic life lack any weight that might
ever be determinative, as soon as they conflict with other interests.
Without such resistance, we reduce concern for such life to a platitude,
a mere expression of good will, that never has efficacy, that can
always be trumped.
Regarding the injunction, Robertson insists that once we decide
to use embryos in research, they do become a "mere means." This announces
moral equivalence between two circumstances that I have argued differ
relevantly. It is one thing to say that innocent life "will die" in
any case, when we refer to a condition that we did not, by our own
hands, bring about, and in most instances cannot alter. It is another
thing to say that innocent life will die at our own hands, a condition
that we plan and bring about from the beginning, and where
we could have done otherwise. This latter procedure does reduce
embryos to a menial status through and through. We would distort the
nothing is lost principle beyond recognition if we proposed
to "extend" it to say that nothing is lost when we create an entity
whose prospects are nil because of what we intend from the start.
For in that case, we see to this.
The difference is there, yet I must still ask, and Robertson's insistence
valuably presses me to ask: how much remains of the injunction to
treat persons as ends in themselves when we allow research on frozen
and eventually-to-be-discarded embryos? I reply that the normative
force of the injunction diminishes significantly when we take to
heart their prospects. It diminishes for everyone, and not
only for those who allow research. Some seek to witness to the dignity
of embryos by refusing to do anything to them other than to freeze
them. They adhere to the norm I mentioned when canvassing conservative
views, that we do best to consider first what we do
and forbear, and not simply what will happen. While this
norm counts for me across a range of other circumstances, I find
in the present circumstance that such a witness threatens to idle
in relation to what the injunction paradigmatically summons us to
undertake. It is difficult to specify what interests we protect
and promote, for example, when freezing and discarding are all
that we can seriously envisage. To honor potentiality, where there
is no hope of implantation, is to honor perpetual potentiality.9
It diminishes action-guiding content, either present or future,
from the injunction to treat as an end. It even affects what we
say in the theological context to which I alluded earlier concerning
providence and our corresponding love. For we cannot precisely equate
the affirmation that our love should start before recipients become
self-aware with an affirmation that we should love recipients who
will never become self-aware. To deny equation is emphatically
not to disbelieve in providence in both cases. And it is not to
withhold corresponding love in both cases. It aims only to acknowledge
that our room for exercising fidelity in action over time
may differ. What we can and cannot do in treating persons as ends
will be affected by their prospects. Our love for an anencephalic
infant destined to live a few days without self-awareness and our
love for an embryo who will live at most in a perpetually frozen
state without self-awareness, has less prospective room than our
love for a fetus who is a power underway and who will acquire
self-awareness by virtue of his or her self-development. What we
can envisage and do, now and later, has greater scope in the latter
instance, which is why termination obliterates a future that the
fetus now has in prospect, a future that an embryo frozen
in perpetuity itself still lacks.
This severely diminished force bears on the second exempting condition,
that other innocent life will be saved. The case to extend this condition
is imperfect as well, indeed more so, for reasons already given. I
observe, however, that as we disallow the intentional creation and
destruction of embryos for research purposes only, we draw more closely
together the moral considerations we weigh in judging the permissibility
of research on fetal cadavers and certain-to-be-discarded embryos.
In both cases, the genetic parents decide whether to donate them for
research. Researchers play a lesser role (they lack a voice in the
decision to abort or to attempt in vitro fertilization) than
when they guide the intentional creation and destruction of embryos.
Political and Legal Contexts I ask next how the normative
orientation that locating ourselves in the "middle" yields, affects
our engagements in political and legal contexts in which stem cell
research proceeds. Four broad observations must do for the present.
First, the range of applicability of such an orientation
needs itself to be clarified. Do I take it to be relevant to the entire
body politic, at least in the United States, or only to certain segments
of it? I divide this question into two parts.
- Since I referred to Augustinian Christian convictions at the start,
do I address persons in the church only, or persons in the wider
society also? The answer is that in this instance I address neither
audience exclusively. On the one side, particular convictions influence
how I depict the orientation in various ways. For example, I have
in view certain Christian accounts of agape-love as I interpret
the notion of persons as ends in themselves (Outka 1972); I extend
a principle from Ramsey, a Christian writer who claimed that his
own formulation of nothing is lost came from a Christian
understanding of charity; I dwell on the prohibition against murder
as precisely construed, and my senses of "intentional," and "innocent"
are influenced by my own tradition. On the other side, the subject
of stem cell research demonstrably engages the wider society, and
much of the literature on moral issues and scientific developments
that I have read and incorporated focuses on no religious tradition.
Moreover, to cite examples again, the prohibition against murder
is one on which Jews, Muslims, and secularists likewise have innumerable
things to say, from which I have learned; to protect citizens from
murder is a "rock-bottom" duty of any political government,
and this partly explains the urgency of debates about whether abortion
and/or embryonic stem cell research are morally indistinguishable
from murder; the maladies from which stem cell research may rescue
us fall within the range of common human woes (Alzheimer's strikes
members of many faiths and of no faith).
- Does the orientation apply with equivalent normative force in
the public and the private sectors? It does, "in principle," but
insofar as "ought implies can," the prospects in American society
for de facto adherence differ greatly. I alluded to some
of the reasons much earlier. Disputants from all parts of the spectrum
have concentrated chiefly on what federally funded research should
include. Comparatively little has been said about conduct in the
private sector, where currently a thousand research flowers bloom.
Some liberals especially look nowadays to the private sector for
much of the most promising and innovative research. As they see
it, for the government to issue and enforce definite rules that
apply not only to the research it funds, but to all research, including
privately funded research, would be a poison gift. To implement
such a step would curtail substantially the kinds of research presently
allowed in the private sector. They prefer to rely instead on ethical
standards that professional bodies most directly involved propound,
and on ethics advisory committees that Geron and the Advanced Cell
Technology group, for instance have established. These matters are
beyond the scope of our inquiry. I add only that one need not attack
indiscriminately all free market undertakings in this area, to entertain
certain justified worries. The results of privately funded research
may not be immediately or universally available to the general public,
in the fashion that federally funded research is. And "commercial
organizations" are after all designed to make money. Neither in
their objectives nor in their management are they designed to balance
conflicting interests or to pay homage to the distinctive non-commercial
qualities of medical research and medical care. The government should
not, at a minimum, ignore the paucity of coordination I mentioned
previously, or permit so many decisions to be made by default.
Second, the subject of stem cell research remains volatile
all the way up and down. It so far resists any repetition of a pattern
we sometimes see, where, when we theorize about moral matters, divergent
and rival points of departure and lines of argument abound, but when
we weigh political possibilities and institutional policies, agreements
and points of consensus (a modus vivendi of sorts) more readily
appear. We should beware of assuming here that once we turn to institutional
policies, we no longer need to engage in "theoretical" debates. On
this subject, we are never done with moral points of departure. These
determine, in key part, what we take desirable and undesirable institutional
policies to be. We make claims as I have done here, weighing arguments
about where to place ourselves along a spectrum, how far judgments
about abortion and stem cell research diverge, and so on. If we give
these enduring moral concerns short shrift, we enter the political
fray with undefended assumptions that we merely announce.
To avoid such an outcome, we must not grow weary of moral debates.
They matter, and views taken exert vast influence. Between those who
evaluate embryos as equally protectible human life and those who evaluate
embryos as only "clumps of cells in petri dishes," there is no peace.
I have tried to suggest why neither of these evaluations is adequate.
And I for my part then must continue to attempt to address conservative
and liberal objections. For example, conservatives may discern a consequentialist
flavor in the nothing is lost principle (the innocent will
die in any event; other innocent life will be saved). I claim
it is fitting to ask, in the case before us, what actual benefits
we can confer, and are conferring, and on whom. Yet I hardly comment
on the intricacies of consequentialist theories. I only consider actual
benefits in a case that the anomalous practice of in vitro
fertilization presents to us, that leaves us with entities we did
not directly intend to destroy from the start. Liberals may protest
my refusal to keep concern about the status of embryos in circuit
with every other morally estimable consideration, without benefit
of even prima facie ranking. While I extol possible benefits
to third parties from embryonic stem cell research, I resist allowing
concern about the status of embryos to recede again to a platitude,
where it never has efficacy and can always be trumped.
Third, I should also specify further the orientation overall
that emerges from this particular location in the "middle." To extend
the nothing is lost principle in the way I do sets a deontological
constraint on "sources" that applies in principle to stem cell research
in the public and private sectors. It draws a line between research
on embryos created solely for this purpose, and research on embryos
slated to be discarded or frozen in perpetuity from in vitro
fertilization clinics. It disallows the first sort of research and
allows the second. This constraint makes concern about embryos more
than an ineffectual afterthought. We should acknowledge any costs
it may incur. Some liberals worry for instance that such a limit might
affect adversely the "quality" of available embryos for research,
a difficulty that intentional creation for research would surmount.
Researchers debate whether this worry is well-founded empirically,
but if we are unwilling to risk this much, we transmute concern about
the status of embryos once more into a mere expression of good will.
If we hold the constraint hostage to interminable bargaining, we deprive
it of normative force that makes a discernible difference. We should
leave the line intact, and be content to derive as many scientific
and medical benefits from research on "excess" embryos as we can.
The constraint matters then as it marks the drawing of a line. It
matters in a further way. It registers an attitude of ongoing mourning
for a plight. We regard research even on excess embryos as something
to which we only reluctantly acquiesce. This attitude begins in sympathy
for those who view their own infertility as an affliction they seek
to overcome. It continues in allowing unprecedented in vitro
technology that sometimes triumphs over this affliction. But such
technology brings one outcome we foresee and lament, namely, the presence
of embryos to be discarded or frozen in perpetuity. The case for extension
occurs, once more, in circumstances we take as diminishments. We welcome
neither infertility nor excess embryos. The attitude concludes in
a desire that one day we may get out and get out for good. That is,
we look forward to a time when we may reprogram adult stem cells so
that we no longer require embryos as a source. Once research on embryonic
stem cells enables us to identify the genes responsible for pluripotency,
we may develop methods to de-differentiate adult stem cells so that
we will no longer need to derive from embryos. And we hope that this
time comes quickly, that the establishment of cell lines will prove
to make the use of donated embryos a transitional matter. In short,
to destroy embryos never leaves us at ease or becomes simply
unproblematic, a permanently acceptable part of routine procedures.
Our research priorities should attest to such an attitude.
Fourth, when I claimed initially that the most fitting place
to inhabit is a particular region in the "middle," I said there were
dangers in locating ourselves there. Let me give one example of such
a danger. It suggests how moral judgments and socio- political realties
display volatility. We would accordingly be wrong to anticipate a
static existence when we inhabit this region.
This example falls within my third broad observation, that the constraint
draws a line and registers an attitude. The danger derives from practical
undermining more than from outright repudiation. Here the over-used
metaphor of "slippery slope" comes into play. We recall Doerflinger's
contention that researchers and those in charge of in vitro
fertilization clinics might in effect collude, to produce by the "back-door"
spare embryos in accordance with research needs, and no longer plausibly
internal to the procedure to alleviate infertility. The "slope" at
issue here is not so much one of theoretical argument, where the "logic"
of a position we take carries us inexorably to conclusions we deplore.
It is more "performative." That is, the line--between research on
embryos created solely for this purpose, and research on embryos slated
to be discarded or frozen in perpetuity from in vitro fertilization
clinics -- is accepted provisionally by some on the "left," perhaps
because fewer public qualms presently accompany concentration on spare
embryos. Yet they reserve their passion for the benefits to third
parties this research promises. To collude occasions no crisis of
conscience on their part. For their governing aim is to secure embryos
for research. If the line one day evaporates, if such research actually
brings demonstrable benefits for numerous sufferers, so that public
pressure to obtain these benefits one way or another becomes irresistible,
they will have little to lament. In the meantime, their task is to
exploit a distinction as far as one can, to make the most of all the
opportunities for research it can possibly yield. The pressure to
go down this slope tells us something important. A line is harder
to maintain when the attitude of permanent unease with research on
embryos is not shared. And such an attitude derives from complex sources,
some of which I have tried to delineate. It requires a set of interlocking
I said at the beginning that two basic generalizations about us inform my
reflection in these pages. We are morally capable creatures, accountable
beings, and we are creatures who can exalt ourselves inordinately, in ways
that usurp and do injustice. The debates about stem cell research I have
canvassed and evaluated attest to the relevance of both generalizations
in one definite space where, as I also said, we meet novel opportunities
and challenges, and permanent capabilities and dangers.
CONCLUDING REMARKS ON NOTHING IS LOST
Yet the results of canvassing and evaluation here display varying grades
of moral clarity and accountability, and different kinds of usurpation
and injustice. I conclude by summarizing and elaborating such results
in one concrete instance, my attempt to apply the nothing is lost
principle to debates about stem cell research.
I proposed to apply the principle against a background of claims about
the status of human life from conception forward. I take conception
and all that it alone makes possible as the point at which we
ascribe a judgment of irreducible value. Once conceived, each entity
is a form of primordial human life, a being in its own right, that should
exert a claim upon us to be regarded as an end rather than a mere means
only. We should view its potentiality as constituting a presumption
in favor of its coming to term. If this presumption is not robust enough
to trump other claims on some occasions, the judgment of irreducible
value becomes a platitude. "Symbolic respect" stands too near the chimerical
because it trumps little or nothing whenever conflicts occur.10
After conception, I find no comparable bright line, but defend some
proximate discriminations. Before individuation and implantation, the
entity does not yet have the full fledged moral standing that an implanted
fetus has. Yet for its part, the fetus' value is not equally protectible
with the pregnant woman's, for she too is an end in herself and potentiality
still characterizes the fetus. Equal protectibility holds after the fetus
becomes capable of independent existence outside the womb.
These claims about status indicate why I deny that abortion and embryonic
stem cell research are morally indistinguishable from murder, and also
why I deny that abortion and embryonic stem cell research are morally
indifferent actions in themselves, to be evaluated wholly by the benefits
they bring to others.
The claims indicate as well why I object to the sort of embryonic stem
cell research that creates embryos in order to disaggregate them.
To conduct this research clashes directly with the judgment that entities
conceived have irreducible value. For it is one thing to allow that we
need not yet ascribe full moral standing or equal protectibility to embryos.
It is another thing to "instrumentalize" them through and through when
what we intend in the actions we perform exhaustively concerns
benefits to third parties. But the claims also indicate why I object
to an ironic alliance that those on the "right" and "left" sometimes form,
to the effect that we confront a single either/or: we should forbid all
embryonic stem cell research or we should permit it all. There is, I believe,
a more nuanced possibility, where we may distinguish creating for
research and only employing for research. The latter allows us
to consider the tangled aftermath of in vitro fertilization as
a practice in our culture. Employment for research connects with the datum
of discarded embryos, where the original creation of embryos possesses
a non-instrumentalist rationale, namely, the promotion of fertility, so
that what we intend does not exhaustively concern benefit to third parties,
yet the aftermath allows us to pursue benefits to third parties when we
may do so without from the start creating in order to disaggregate. These
differences lead me to argue that the nothing is lost principle
illumines a morally significant distinction between creation for research
and employment for research.
I want to offer four concluding observations that illustrate varying
grades of moral clarity and accountability available, and different kinds
of usurpation and injustice.
First, consider a clear instance of a difference. An appeal to nothing
is lost remains distinct from the kind of calculus President Truman
favored. He elected to take certain innocent lives intentionally for
the sake of saving many more. If this kind of calculus operates in stem
cell debates, as it surely does in certain circles, we should not run
it together with nothing is lost. The latter principle limits
itself to two sorts of cases, neither of which possesses the balancing
of lives lost and saved that Truman's calculus encompassed. In the first
sort of case between two parties, or among a limited number of parties
(e.g., a lifeboat with too many occupants), we can choose whom
we save, but we cannot save both, or we cannot save all.
Here we must invoke some distributive criterion, e.g., a lottery. In
the second sort of case, we cannot choose whom we save. The embryos
in question fall under the second case. They will be lost no
matter what we do. They will die if we do nothing (we may assume that
the embryos will be frozen and eventually destroyed, and not kept in
limbo for all time), and we cannot save them by killing others or letting
Second, consider another reasonably clear but less widely recognized
distinction regarding the status of moral claims. I believe my appeal
to nothing is lost reaches a moral judgment that should endure
rather than one that holds only "for the time being." It is one thing
to seek both to extend traditional moral commitments and to incorporate
new insights as cogently as we can in the development of enduring moral
judgments regarding novel moral issues. It is another thing to seek for
the most judicious judgment we discern to be acceptable at the present
time, where the judgment remains provisional and revisable in response
to shifting social consensus. In the latter case disputants sometimes
tacitly assume and hope that what is beyond the pale now may not be later.
I follow the former route. Once we take the measure of combining traditional
commitments and incorporating new developments, we should reach definite
moral judgments. If the principle that nothing is lost rules out
creating embryos for research and permits research on spare embryos, then
shifts in public opinion should not cause us to change course.
Third, consider a possible difficulty internal to the nothing is
lost principle itself. Here clarity is harder to attain. The difficulty
is that "nothing is lost" may permit more extensions than I seek. Recall
the difference Doerflinger cites, that I noted much earlier: to destroy
an entity for body parts because that entity will die in any case is
not the same as using cells from an entity already dead. Some may worry
that the principle may also allow the general "harvesting" of organs
or tissues from the living who are, e.g., terminally ill, or comatose,
or condemned to die by authorities of the state as criminals. The specter
of Nazi doctors may well appear before us: if certain people were slated
for death anyway, why not experiment on them to the point of ending
their lives to acquire knowledge?12
These possible extensions differ from the one I propose here because
the embryos in question are in physical limbo, without history or prospects.
I judge that the general difference Doerflinger cites should otherwise
continue to claim allegiance. It is impermissible to destroy
any entity for body parts who has an agential history even if
he or she does not now have any considerable future, entities for instance
whose maturity (their "potentiality" has long since been realized)
deprives their genetic parents of authority to end their existence or
to elect to donate them for research. But the "perpetual potentiality"
of the embryos in question distinguishes them markedly enough from these
other entities. "Perpetual potentiality," assuming the claims I made
about the two-sidedness of potentiality as we focus on embryos and fetuses,
leads us intelligibly to find more affinities than differences between
fetal cadavers and the embryos in question. Whatever other extensions
nothing is lost may warrant then, in cases of tragic forced choices
(I have not considered these at any length), the extension I offer here
pertains to a peculiar case by virtue of what the embryos in question
currently are and are not. John Reeder observes in quoting Baruch Brody
that "the basic point of nothing is lost is that, as Brody puts it,
the one to be killed does not 'suffer any significant losses...in unrealized
potential'" (Reeder 1996; Brody 1976). I claim that "unrealized potential"
carries for the embryos in question distinctive finality that
Fourth, consider another difficulty for nothing is lost that
derives from the very features that render this case peculiar. I ask now
whether these features may complicate my proposed extension beyond what
I have so far allowed. I only touched on what complicates when I registered
"disquiet" over the way in vitro fertilization is practiced in
our culture (and I now return to this, as promised). It is the practice
itself that gives possible trouble for my proposed extension.
I want however to begin far enough back to acknowledge the original
conflict, and locate my disquiet in this larger setting. This original
conflict, as I noted earlier, is that we welcome neither infertility nor
excess embryos. Those of us who are spared infertility should show "epistemic
humility" toward those not spared, and try to understand from a respectful
distance their sense of deprivation. We rejoice in what is hardly a trivial
gain: in vitro fertilization has overcome a condition that would
have otherwise consigned many to having no genetic children of their own.
We should remember this and feel the force of the conflict that has ensued.
Yet excess embryos remain a tenacious datum too, and it is here that
disquiet centers. It persists on three levels. The first I noticed as
I contended that we should never regard as simply unproblematic our
destruction of embryos or our leaving them in perpetual storage; and
we should extend the attitude of permanent unease to research on them
as well. Something inestimably valuable is at stake and at risk. A second
level pertains to current practices in American society. Approximately
10,000 embryos are added each year, within arrangements free of much
society-wide oversight (a general circumstance I lamented previously),
where the profit motive plays a large but ill-considered role. We do
know that many more embryos are generated than we can hope to implant,
to maximize success rates particularly in cases (e.g., maternal age)
where implantation prospects are meager. A third level concerns the
moral diagnosis that accompanies these practices. We also know that
such practices are a human achievement, not a contingent natural disaster.
Matters could have been otherwise.14
That such disquiet complicates my proposed extension, it would be idle
to deny. At a minimum, the permanent unease and the mourning for a plight
that I defended should not end in passive resignation to these status
quo practices. (We should not exhaust our energies in mourning, that might,
ironically, assuage us in our resignation.) Such unease should prompt
instead far more critical and skeptical appraisals of the practices presently
in place. Again, in this area the government is permitting too many decisions
to be made by default.
Yet I continue to uphold the extension, albeit in a chastened mood,
rather than jettison any distinction between creation and employment,
as those on the "right" and "left" propose. My reasons are also three.
Above all, we should not avoid the brute fact of the 100,000 embryos
who are languishing in vats and whose prospects for implantation are nil
(and many are unviable). Even if in vitro fertilization stopped
from now altogether, this phenomenon confronts us. Accounts of nothing
is lost do allow for circumstances where the fact that innocents will
die is seen as a moral evil and not a natural accident (e.g., situations
a tyrant creates). The reasoning is this. We need not approve of how the
situation was created to judge that it is better to save some than none
when those who die would die anyway. I regard employment of discarded
embryos for research as morally tolerable, and no more. It remains difficult
for me to see what treating them as ends leads us to do, how freezing
or flushing respects them more, or is less evil, than employing them for
Second, I grant that the recognition of human construction of the in
vitro fertilization industry puts pressure on my earlier distinction
between a condition we did not, by our own hands, bring about, and in
most instances cannot alter; and a condition where we plan and bring about
the death of an innocent life at our hands, and we could have done otherwise.
Yet I draw back from any grand use of the societal "we" in this prior
account of human construction. We may now become complicit if we do not
criticize, yet the circumstances of the original construction attest to
the realities of our social pluralism. Those most deeply affected -- the
infertile -- and those prepared to respond -- the organizers of the industry
-- were the driving forces behind such construction. So it continues to
matter whether one creates these particular embryos in order to disaggregate
them, or whether one only knowingly foresees that unspecified excess embryos
form part of the practice.
Third, the particular region of the "middle" I extol averts the excesses
of a debate that engages those on the "right" and the "left" concerning
the necessity of embryonic stem cell research. The former denies
such necessity (there are alternative ways, even if slower ones, e.g.,
research on adult stem cells, that will bring the desired benefits),
and the latter insists on it in order to alleviate immediate mass suffering
as quickly as we can. I opt for something less sweeping. Let us bracket
the debate about necessity. Instead, let us not elide the difference
between creation and employment, but rather draw this line for good,
and permit the kinds of research in accordance with it.15
The performative dangers to which I alluded will endure. Yet we may
nevertheless defend certain commitments as always in force, such as the
injunction to treat persons as ends in themselves. And I think that the
constraint I identified that follows from this injunction continues to
do important normative work in calling attention to a limit and in lauding
research within it. For there is still lasting value in seeking moral
integrity, after we engage -- with critical respect -- points on a spectrum.
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Some of these pages began as the Wofford Lecture in Religion,
Society, and Ethics, given at Wofford College in Spartanburg, South Carolina,
on September 26, 2000. I am grateful to John Bullard, who issued the original
invitation and kindly hosted me there. I thank Margaret Farley, Richard
Fern, Wayne Meeks, Gilbert Meilaender, Paul Outka, John Reeder, Brian Sorrells,
and Sondra Wheeler, for their reading of an earlier draft in its entirety.
I also owe thanks to Ronald M. Green, who introduced me to important literature
and with whom I had several stimulating conversations. Finally, monthly
meetings over a two year period with the Yale Faculty Working Group on the
Ethics of Stem Cell Research were indispensable. It was my good fortune
to chair this Group. We disagreed among ourselves on many occasions (sometimes
vigorously but never rancorously), and the others should not be held accountable
for the views I articulate here. Still, my debts to these discussions are
incalculable. The members for one or both years included John Booss, Robert
Burt, Thomas Duffy, Margaret Farley, Arthur Galston, Myron Genel, Albert
Jonsen, Robert J. Levine, Maurice J. Mahoney, Theodore Marmor, William F.
May, Carol Pollard, Pasko Rakic, Dennis Spencer, Michael Weber, and John
- Scientific uncertainties may go deeper than the public now largely
supposes. Maureen L. Condic queries whether the merit of embryonic stem
cell research is as widely accepted by researchers as it is routinely
alleged to be (Condic 2002). She dwells on the scientific and medical
disadvantages of using embryonic stem cells and their derivatives
in treating disease and injury, and the scientific and medical advantages
of using adult stem cells, even though the latter field is not as far
advanced. That her article appears in a "conservative" journal should
not afford grounds for briskly dismissing or upholding the scientific
case she offers. One report testifies at any rate to the volatility
of current scientific judgments on the respective merits of adult stem
cell and embyronic stem cell research (Dominguez 2002).
- This view holds that embryos up to 14 days are preindividual and prepersonal
(e.g., Shannon, 1998). He sees a distinction between cells drawn from
a preimplantation embryo and cells drawn from an aborted fetus. I compare
ahead stem cell research on embryos and fetal cadavers.
- In addition to the papers already cited by Farley, Meilaender, and
Demopulos, others given on that occasion (May 7, 1999) display the diversity
of views within religious traditions. (See, e.g.,Dorff, 1999; Pellegrino,
1999; Sachedina, 1999; Tendler, 1999; Zoloth, 1999).
- I try to sort out these ingredients in two places especially (Outka,
1986; Outka, 1992).
- Moral assessments of Truman's decision are legion. (See, e.g., Anscombe,
1981; Walzer, 1977; Glover, 2000; and with reference to stem cell debates,
- I gesture elsewhere to the intricacies of these debates (Outka, 1999).
While I incorporate several sentences from this booklet in my own account
of abortion here, I simplify now by dwelling on the case of rape, and
do not consider moral responsibilities that arguably arise from requisitely
voluntary sexual relations.
- I welcome for example any changes in the future that qualify the generalization
that the production of spare embryos is endemic to in vitro fertilization.
One possibility pertains to the micromanipulation procedure that goes
under the acronym ICSI (intracytoplasmic sperm injection). Here a single
egg receives a single sperm to render fertilization more likely in couples
where the sperm is of poor quality. In ICSI as currently practiced,
scientists typically produce more embryos than are needed in a given
cycle, since the survival of each of the eggs treated is never guaranteed.
Hence with this procedure too there will be excess embryos into the
foreseeable future. Still, the procedure allows us to ask not only whether
there will be excess embryos, but whether there must be.
Yet even if we suppose there must not be, we leave the proposal
intact to extend the nothing is lost principle to the large number
of excess embryos who exist already in in vitro fertilization
clinics. This aspect of the "plight" at least is a fait accompli.
I am indebted to Margaret Farley for drawing my attention to the slight
caveat about the future in the case of ICSI. More generally, see also
my last remark in section III here.
- These NIH Guidelines have now been withdrawn. On November 20, 2001,
NIH posted the Human Embryonic Stem Cell Registry. It lists the human
embryonic stem cell lines that satisfy the eligibility criteria President
Bush specified on August 9, 2001. These criteria are more restrictive
than the position I defend in this paper requires, for they "allow Federal
funds to be used for research on existing human embryonic stem cell
lines as long as prior to his announcement...the derivation process...had
already been initiated" (NIH, 2001). Compare the earlier comprehensive
report and recommendations (NBAC, 1999).
- Brian Sorrells suggested this phrase while reading an earlier draft
and I gratefully appropriate it.
- For my subsequent account of the nothing is lost principle,
I owe a great debt to John Reeder's volume, Killing and Saving,
and to his detailed comments on my earlier draft.
- Those who endorse "symbolic respect" for embryos rarely ask directly
whether this respect should ever trump when it conflicts with
the welfare of third parties, except for repeating qualms about commercialization.
Michael Meyer and Lawrence Nelson offer a fuller discussion, however,
as they defend the claim that we may respect embryos even as we intentionally
destroy them (Meyer and Nelson 2001). We may, because the moral status
of embryos is "weak or modest." Although they are "alive" and "valued,
in some cases very highly, by many people," they are not "agents," or
"persons" (prior, at least, to "individuation" around 14 days), and
they lack "ecological significance" (p. 18). Destruction should occasion,
nevertheless, a sense of "regret and loss" (p. 20). My judgments differ
from theirs at two points. First, I claim that the irreducible value
embryos have trumps the possible welfare of third parties in that we
may not create embryos in order to destroy them, for this instrumentalizes
them through and through. Meyer and Nelson stress that the "gamete sources"
must give voluntary and informed consent "for any disposition of their
embryos" (p. 21), but neglect the distinction between creation in order
to destroy, and employment where creation has another rationale. Yet
nothing they say about "respect" strictly forbids taking the former
step, as far as I can tell. If this is right, their case permits more
than I do, at the end of the day. Second, my appeal to the two-sidedness
of potentiality yields an account of how embryos and fetuses are like
and unlike each other that retains the following link. Like fetuses,
embyos now possess the genetic wherewithal to become "one of
us." This distinguishes them decisively from sperm and eggs before conception.
Unlike fetuses, they are not now a self-elaborating power
underway, until they are implanted. Meyer and Nelson approach this account,
but then draw back from it. They hold that embryos are not yet "effectively
a stage in the early development of a person." I accept their "effectively,"
if it means "not now a self-elaborating power underway." But then they
add: "Put differently, an extracorporeal embryo -- whether used in research,
discarded, or kept frozen -- is simply not a precursor to any ongoing
personal narrative. An embryo properly starts on that trajectory only
when the gamete sources intentionally have it placed in a womb" p. 18).
This is a distinct appraisal; it is not the same point "put differently."
I take embryos to be the precursors to any ongoing personal narrative
by virtue of the genetic properties they already have. Implantation
does not create these properties, or start the "trajectory" that only
these properties make possible. It allows them to develop "properly."
Thus it seems more cogent to take conception and all that it alone makes
possible as the point at which we should ascribe a judgment of irreducible
value, for once conceived, each entity is a form of primordial human
- This question was helpfully posed to me by Gilbert Meilaender in correspondence.
- Conversations with Richard Fern shed light on the matter I raise in
this paragraph, and on much else besides.
- Sondra Wheeler led me to see that the normative position I defend
requires a critical assessment of in vitro fertilization as currently
practiced in the United States, and I thank her for perceptive counsel.
- This position stands closer, it seems, to the regulations that the
Canadian Institutes of Health Research have proposed than to the more
restrictive policies of the United States and the more permissive policies
of the United Kingdom.