Monitoring Stem Cell Research
The President's Council on Bioethics
(The following commissioned paper was prepared
at the request of the President’s Council on Bioethics;
the Council has not itself verified the accuracy of the information
contained therein, nor does it necessarily endorse any of the
author's conclusions or opinions. Additionally, the Council
has not edited this paper either for style or content.)
Report on the Ethics of Stem
Paul Lauritzen, PH.D.
Director, Program in Applied Ethics,
Professor, Department of Religious Studies,
John Carroll University, University Heights, Ohio
. . . the final stage is come when man
by eugenics, by prenatal conditioning, and by an education
and propaganda based on perfect applied psychology, has
obtained full control over himself. Human nature will
be the last part of nature to surrender to man. (Lewis,
This sudden shift from a belief in Nurture,
in the form of social conditioning, to Nature, in the
form of genetics and brain physiology is the great intellectual
event, to borrow Nietzsche's term, of the late twentieth
century. (Wolfe, 2001)
I begin with passages from an unlikely pair of authors
because although C. S. Lewis and Tom Wolfe are somewhat
distant in time, certainly different in temperament, and
extravagantly different in personal style, they share
an imaginative capacity to envision the possible consequences
of modern technology. The technology that occasioned
Lewis's reflections, "the aeroplane, the wireless, and
the contraceptive" may now seem quaint, but his warning
about turning humans into artifacts, that accompanied
the passage quoted above, is eerily prescient. Similarly,
although he does not directly take up stem cell research,
Tom Wolfe's reflections on brain imaging technology, neuropharmacology,
and genomics are worth noting in relation to the future
of stem cell research. In his inimitable way, Wolfe summarizes
his view of the implications of this technology in the
title of the essay from which the above passage comes.
"Sorry," he says, "but your soul just died."
The point of beginning with
Lewis and Wolfe, then, is not that I share their dire
predictions about the fate to which they believe technology
propels us; instead, I begin with these writers because
they invite us to take an expansive view of technology.
I believe that such a perspective is needed and is in
fact emerging in recent work on stem cell research. This
is not to say that the sort of traditional analysis that
has framed much of the debate on stem cells, analysis
that involves issues of embryo status, autonomy, and informed
consent, for example, is unhelpful; far from it. Nevertheless,
traditional moral analysis of stem cell research is nicely
complemented by a consideration of the "big picture" questions
that Lewis and Wolfe both wish to press. This report
will therefore seek to draw attention to the literature
on stem cell research that attends both to the narrow
and to the expansive bioethical issues raised by this
The Moral Status of the Embryo
There is little doubt that public reflection on stem
cell research in the United States has been affected by
the extraordinarily volatile cross-currents of the abortion
debate. Although I will indicate below several reasons
why framing the stem cell debate as a subset of that on
abortion is problematic, nevertheless, in its current
form, stem cell research is debated in terms dictated
by the abortion controversy, and that has meant that questions about the status of the embryo have been particularly
For example, the National Bioethics Advisory Commission
(NBAC) described the ethical issues raised by stem cell
research as "principally related to the current sources
and/or methods of deriving these cells" (NBAC, 1999, 45).
A policy brief from the American Association for the Advancement
of Science (AAAS) begins its discussion of the ethical
dispute over stem cell research by citing the disagreement
over the status of the embryo as the decisive variable
leading to fundamentally different views on this research
(AAAS, 1999, 11). The National Academy of Sciences's
report on stem cell research claims that "the most basic
[ethical] objection to embryonic stem cell research is
rooted in the fact that such research deprives a human
embryo of any further potential to develop into a complete
human being" (National Academy of Sciences, 2002, 44).
The Ethics Advisory Board of the Geron Corporation lists
the moral status question as the first moral consideration
relevant to deciding the acceptability of stem cell research
(Geron Corporation Ethics Advisory Board, 1999, 32).
The list could go on.
Despite the fact that these statements all insist on
the importance of the status question, they also recognize
that the debate about the status of the early embryo is
not new and that the controversy over stem cell research
does not, strictly speaking, raise novel issues in this
regard. Indeed, it is probably best to place the initial
skirmishes over stem cell research in the context of moral
debates about human embryo research generally. In fact,
it is worth noting that the report of the NIH Human Embryo
Research Panel (HERP), published in 1994, explicitly identified
the isolation of human embryonic stem cells as one of
thirteen areas of research with preimplantation embryos
that might yield significant scientific benefit and that
should be considered for federal funding (See NIH HERP,
1994, ch. 2).
Although the recommendations of the HERP were never implemented,
the fact that a high-profile panel reviewed ex utero
preimplantation human embryo research and explicitly endorsed
stem cell research, meant that the panel report would
affect the policy debate about stem cell research, even
though its recommendation that the derivation and use
of stem cells be federally funded was not adopted. For
one thing, the panel's anticipatory support for stem cell
research assured that when human stem cells were actually
derived several years later, the debate that ensued would
be tied to the abortion controversy. As members of the
HERP panel have made clear, from the start, the work of
the panel was embroiled in controversy. For example,
shortly after the HERP was impaneled, thirty-two members
of Congress wrote to Harold Varmus, the director of NIH,
to complain about the composition of the panel. A lawsuit
was filed in an attempt to prevent the panel from meeting,
and members of the panel received threatening letters
and phone calls (Green, 1994; Tauer, 1995; Hall, 2003).
Given the pro-life opposition to the HERP panel and its
recommendations, it is no real surprise that initial reactions
to the prospect of human stem cell research fell out along
the fault lines of abortion politics in the country. By
and large, individuals and groups opposed to abortion
tended to be opposed to stem cell research, and individuals
and groups supportive of legalized abortion tended to
support stem cell research.2
For example, the testimony that Richard Doerflinger, the
principal spokesperson for the U.S. Catholic bishops on
pro-life matters, offered before the Senate Appropriation
Subcommittee on Labor, Health, and Education in 1998 was
substantially the same as that he offered before the HERP
in 1994 on stem cell research (Doerflinger, 1998, 1994).
In both cases, the fundamental issue was the status of
the embryo. Given Catholic teaching that the embryo must
be treated as a person from conception, no experimentation
on the embryo can be allowed that would not also be allowed
on infants or children. Hence, the Catholic church treats
stem cell research as it has treated previous issues involving
the destruction of human embryos; it is condemned as morally
In similar fashion, the arguments reviewed by the HERP
panel that supported embryo research generally in 1994,
were mobilized again four years later when stem cell research
was the specific point of contention; and again the focal
point was embryo status. Consequently, just as the HERP
report opted for a "pluralistic" view of the embryo that
emphasized its developmental potential, so, too, did the
NBAC endorse the idea that the early embryo deserves respect,
but is not to be treated fully as a person.3
Moreover, the fact that the HERP defended its support
of stem cell research by stressing the developmental capacity
of the embryo also shaped the trajectory of much subsequent
support for this work, because insisting on respect for
the embryo but denying its personhood meant explaining
how one could respect the embryo while nevertheless destroying
it. Daniel Callahan, for example, posed this problem
very strongly in response to the HERP report. If "profound
respect" for the embryo is compatible with destroying
it, he asked, "What in the world can that kind of respect
mean?" It is, he says, "an odd form of esteem, at once
high-minded and altogether lethal" (Callahan, 1995). Callahan
was not alone in raising this issue and attempts to answer
his question continue to appear in the literature (See
Lebacqz, 2001; Meyer and Nelson, 2001; Ryan, "Creating
Embryos," 2001; Steinbock, 2001, 2000).
In retrospect, then, it seems that the HERP report served
almost as choreography for the initial debates about stem
cell research, and, as a result, the steps in the debate
closely followed those that are familiar from the abortion
controversy (On this point, see Hall 2003). The upshot,
in my view, is that much of the debate has been too narrowly
focused and has a kind of repetitive and rigid quality
to it. As I noted above, for example, the Catholic church
has repeatedly claimed that the central issue raised by
stem cell research is that it involves the destruction
of human embryos, embryos it believes should be treated
For that reason, the rhetoric with which the Catholic
church condemns embryonic stem cell research closely parallels
that used to condemn abortion. Yet, because the American
bishops do not want to be perceived as anti-science, they
have also repeatedly and uncritically praised adult stem
cell research, even though there are good reasons, given
Catholic concerns about social justice, to be concerned
about the pursuit of adult stem cell research. I will
return to this point below, but for now I wish simply
to note that much of the opposition to embryonic stem
cell work has resembled Catholic opposition in being circumscribed
by questions of embryo status, narrowly construed.
A similar constriction, however, is also apparent in
the preoccupations of supporters of stem cell research.
Just as opponents of this research have ritualistically
condemned the destruction of early embryos but uncritically
celebrated adult stem cell work, supporters of embryonic
stem cell research have typically insisted on using embryos
left over from IVF procedures, while repudiating the use
of embryos created solely for research. Indeed, insisting
on the distinction between so-called "spare" embryos and
"research" embryos and endorsing only the use of spare
embryos has been one way that supporters of embryo research
have tried to demonstrate their "respect" for the embryo.
Yet, it is worth asking whether the spare embryo/research
embryo distinction does not, to borrow Daniel Callahan's
image, provide a kind of "wafting incense" to mask what
supporters still find a disquieting smell (Callahan, 1995).5
Although the debate about stem cell research might have
been framed in terms of the abortion controversy in any
event, the HERP report insured that the initial debate
over stem cell work that followed in aftermath of the
public announcement of the work of John Gearhart (Shamblott
et al., 1998) and James Thomson in 1998 (Thomson et al.)
would be navigated in the wake of the conflict over abortion.
As I indicated, the upshot is that the discussion about
stem cell research has been more cramped than it might
otherwise have been. The discussion has been too focused
on the details of embryological development; too focused
on the differences between those who view the early embryo
as a person and those who do not; and far too individualistically
oriented. Before turning to ways that the debate might
be become less cramped, let me focus more concretely on
The point about the debate being framed too individualistically
is nicely illustrated in an article on abortion by Lisa
Sowle Cahill entitled "Abortion, Autonomy, and Community"
(Cahill, 1996). Cahill begins this article by claiming
that, in discussing the morality of abortion, there is
no way to avoid the question of the status of the fetus.
Nevertheless, she says, the debate about fetal status
is almost always conducted with the goal of determining
the rights involved, where rights are understood very
individualistically. To the degree that the fetus is
acknowledged to have rights, those rights are pitted against
the rights of the pregnant women. Although Cahill doubts
that we can jettison the use of rights language altogether,
if we are going to use rights language, she says, we must
"remove that language from the context of moral and political
liberalism" (361). If we do so, we might be able to see
that we have duties and obligations to which we do not
explicitly consent. As Cahill puts it, "such obligations
originate simply in the sorts of reciprocal relatedness
that constitutes being a human" (361).6
For example, moving away from an individualistic liberal
view of the pregnant woman as primarily or exclusively
an autonomous moral agent might lead us to recognize the
obligations that individuals and communities have to support
her during and after a burdensome pregnancy (363).
We do not need to accept Cahill's commitment to the Catholic
common good tradition to recognize the truth in her conclusion
that pitting the rights of the fetus against the rights
of the pregnant woman individualistically construed leads
us to overlook important social dimensions of the problem
of abortion. It seems to me that much the same dynamic
is evident in the stem cell research debate.
Consider again the central argument that the Catholic
church has made against stem cell research. The Pontifical
Academy for Life suggests that the fundamental ethical
issue is whether it is morally licit to produce or use
human embryos to derive embryonic stem cells. The reasoning
the Academy provides for concluding it is not licit is
worth reproducing in full. The Academy lists five points:
1. On the basis of a complete biological
analysis, the living human embryo is―from the moment
of the union of the gametes―a human subject
with a well defined identity, which from that point begins
its own coordinated, continuous and gradual
development, such that at no later stage can it be
considered as a simple mass of cells.
2. From this it follows that as a "human
individual" it has the right to its own life;
and therefore every intervention which is not in favor
of the embryo is an act which violates that right. .
3. Therefore, the ablation of the inner
cell mass (ICM) of the blastocyst, which critically and
irremediably damages the human embryo, curtailing its
development, is a gravely immoral act and consequently
is gravely illicit.
4. No end believed to be good,
such as the use of stem cells for the preparation of other
differentiated cells to be used in what look to be promising
therapeutic procedures, can justify an intervention
of this kind. A good end does not make right
an action which in itself is wrong.
5. For Catholics, this position is explicitly
confirmed by the Magisterium of the Church which, in the
Encyclical Evangelium Vitae, with reference
to the Instruction Donum Vitae of the Congregation
for the Doctrine of the Faith, affirms: "The Church has
always taught and continues to teach that the result of
human procreation, from the first moment of its existence,
must be guaranteed that unconditional respect which is
morally due to the human being in his or her totality
and unity in body and spirit: The human being is to be
respected and treated as a person from the moment of conception;
and therefore from that same moment his rights as a person
must be recognized, among which in the first place is
the inviolable right of every innocent human being to
life'"(No. 60). (Pontifical Academy for Life, 2000; emphasis
Notice that the core of the argument, namely points one
and two, is framed in terms of the rights of the individual
embryo. We have seen this emphasis already in noting
Richard Doerflinger's various statements on stem cell
research. Yet, notice also the claim that we know the
embryo to be an individual with rights on the basis of
"a complete biological analysis." This is not, of course,
the first time that the Catholic church has made this
claim. In the Declaration on Procured Abortion, the Congregation
for the Doctrine of the Faith claimed that "modern genetic
science" confirms the view that "from the first instant,
the programme is fixed as to what this living being will
be: a man, this individual-man with his characteristic
aspects already well determined" (Congregation,
"Declaration on Procured Abortion,"1974, 13). The Instruction
on reproductive technology, Donum Vitae, also makes
this claim. "The conditions of science regarding the
human embryo provide a valuable indication for discerning
by the use of reason a personal presence at the moment
of the first appearance of a human life: how could a human
individual not be a human person?" (Donum Vitae,
One reason the Catholic church has played such a major
role in framing the stem cell debate is that, in defending
its position, it combines the two claims we have just
noted, neither of which is explicitly religious. First,
the early embryo is an individual person with rights and,
second, the fact that the embryo is an individual person
is confirmed by modern science. Indeed, a fair amount
of the literature that supports embryo research generally
can be read as an attempt to answer the question posed
in Donum Vitae: How can a human individual not
be a human person?
Certainly Catholic writers who reject the church's teaching
on the status of the embryo have responded directly to
that question (See Cahill, 1993; Farley, 2001; McCormick,
1994; Shannon, 2001; Shannon and Walter, 1990), but so
too have non-Catholics. For example, in a statement issued
by their ethics committee, what was then called the American
Fertility Society rejected the claim in Donum Vitae
that science supports the personhood of the embryo. According
to the ethics committee ". . . it remains fundamentally
inconsistent to assign the status of human individual
to the human zygote or early pre-embryo when compelling
biological evidence demonstrates that individuation, even
in a primitive biologic sense, is not yet established.
Thus, homologues (identical) twins may result from spontaneous
cleavage of the pre-embryo at some point after fertilization
but prior to the completion of implantation. Furthermore,
during very early development, an embryo is not clearly
established and awaits the differentiation between the
trophoblast and the embryoblast" (American Fertility Society,
Arguably, writers like Mary Anne Warren and Bonnie Steinbock,
who distinguish between biological or genetic humanity
and moral humanity, are also at least indirectly answering
the question posed in Donum Vitae (Warren, 1997;
Steinbock 2001, 1992). Yet, whether writers are responding
more or less directly to Catholic discourse, or not at
all, the important point is that the stem cell debate
has been remarkably preoccupied with the question of whether
the early embryo is an individual person and whether and
how the minute details of embryological development help
us to answer this question. This is one reason why a
fair amount of the ethics literature on the topic reads
like a textbook on embryology.
I want to be clear here: I am not suggesting that the
details of embryological development are unimportant.
The maxim from the field of research ethics applies here
as well: bad science is bad ethics. My point is rather
that the preoccupation with the details of early embryogenesis
may lock us even more rigidly into an individualistic
human rights framework than we are in debates about abortion.
It also leads us to frame the debate as fundamentally
about one question, and, indeed, it tempts us to treat
the question as if there is one and only one answer.
In this frame of mind, once we have that answer, there
is not a lot more to talk about. Either the early embryo
is a person with the right to life, in which case embryonic
stem cell research is wrong, or the early embryo is not
a person with rights, and then there is no moral reason
to object to stem cell work. Gene Outka has made a similar
point in his assessment of stem cell literature. As Outka
puts it, in its starkest form, the crystallizing question
is whether it is cogent to claim that embryonic stem cell
research is morally indistinguishable from murder (Outka,
184). The problem with framing the question this way,
he says, is that it "encourages an unfortunate tendency
to restrict evaluative possibilities to a single either/or.
Either one judges abortion and the destruction of embryos
to be transparent instances of treating fetuses
and embryos as mere means to other's ends, or one judges
abortion and embryonic stem cell research to be, in
themselves, morally indifferent actions that
should be evaluated solely in terms of the benefit
they bring to others." (Outka, 2002, 184).
The frame of human rights reinforces this either/or because,
as I noted, a being is either a rights-bearing entity
or it is not. I have argued elsewhere, that this either/or
tends to drive people to the extremes. Either the embryo
is a person or it is essentially a kind of property (Lauritzen,
2001). Although I will not rehearse the argument for
rejecting the two extremes here, it is worth noting that
the rhetoric associated with each extreme does not appear
to match the practice of those who adopt the rhetoric
or in fact to match the considered moral judgments of
most Americans on these issues.
I can illustrate my point in relation to the view that
the early embryo is a person with the right to life by
describing a cartoon that hangs on my office door (See
Figure A). The cartoon depicts protestors in front of
a stem cell research lab condemning those who work there
as being anti-life. Down the street at the abortion clinic,
the workers are noting how quiet things have gotten at
their facility since the stem cell lab opened. The point
of the cartoon, of course, is that we may soon see protests
and demonstrations of the sort that are common at abortion
clinics at facilities that conduct stem cell research
and that there is an irony in the fact that pro-life advocates
would be demonstrating against research being done to
find treatments for Alzheimer's, Parkinson's, and other
devastating illnesses. This is not entirely fair to the
pro-life community, but it makes a point.
In fact, I do not have trouble imaging protestors picketing
stem cell research facilities for, as we just noted, when
stem cell research and abortion are evaluated together
and when the evaluative option is a single either/or,
then abortion and stem cell research may appear indistinguishable
from murder. Certainly the rhetoric of someone like Richard
Doerflinger has been consistent in condemning both abortion
and stem cell research as equivalent to murder. The cartoon
draws attention to this consistency, even while it questions
the commitment of pro-life advocates to scientific research
designed to promote the quality of life.
In one sense, then, the cartoon probes whether there
is an inconsistency between being pro-life and opposed
to research an Alzheimer's disease, Parkinson's disease,
and other devastating illnesses. I do not myself think
that there is any inconsistency in being pro-life and
opposed to stem cell research, but the cartoon does point
in the direction of a fairly significant disconnect between
the rhetoric and the reality of those opposed to stem
cell research because they believe the early embryo is
a person. To see this point, imagine that, instead of
a stem cell clinic, the cartoon depicted on IVF clinic
down the block from the abortion clinic and that the workers
at the abortion clinic are noting how quiet things have
gotten since the IVF clinic opened. The dramatic tension
that made the original cartoon funny would be missing
from our revised cartoon precisely because it is hard
to imagine protestors disrupting the work at IVF clinics.
To be sure, the Catholic church and others have argued
that IVF is morally wrong, but the rhetoric condemning
IVF is exceptionally muted compared to that condemning
abortion or stem cell research. Nor has there been a
concerted effort to put an end to IVF practice in this
country as there has been in the case of abortion and
stem cell research. Yet, if the embryo is a person from
conception, then participating in IVF as it is practiced
in this country, when early embryos are routinely frozen
or discarded or both, is to be complicit with murder.
Why, then, are there no organized efforts to shut down
IVF clinics in this country?7
Indeed, opponents of stem cell research and cloning often
write as if these technologies raise the haunting specter
of human embryo research for the first time. The reality,
of course, is that the existence of in vitro fertilization
depended entirely on embryo research and that every variation
or innovation in IVF protocols involves experimentation
on human embryos. Carol Tauer is one of the few scholars
who has pressed this point. As Tauer sees it:
. . . the entire history of the research
leading to the first successful IVF is the history of
attempts to fertilize oocytes in the laboratory. Eventually
these attempts succeeded, and the first IVF baby was born,
followed by thousands of others in the ensuing decades.
The ethics literature contains scholarly
discussions as to whether it is ethically permissible
to make use of medical advances that result from unethical
research. This discussion sometimes focuses on medical
research conducted by the Nazis in concentration camps
and institutions for retarded, mentally ill, and handicapped
persons. Yet I have never seen reference to reproductive
technologies in this context. If the fertilization of
embryos in research is a practice that is abhorrent to
many or most people, then would it not be logical to question
the continuing use of the results of such research? (Even
the Catholic Church, which opposes the use of IVF and
most other forms of assisted reproduction, does not invoke
this argument to support its opposition.) (Tauer, 2001,
If the embryo research associated with IVF points to
a problem of consistency for those who oppose stem cell
research because it involves destroying persons, it is
no less problematic for those who support stem cell research
but insist on respecting the embryo and embrace the distinction
between "research" and "spare" embryos. For as Tauer
points out, Robert Edwards, the scientist involved in
the first successful IVF procedure, began studying fertilization
nearly thirty years before Louise Brown was born in 1978,
and the first successful laboratory fertilization of human
eggs took place a full ten years before she was born.
Tauer quotes Edwards' report on this work: "We fertilized
many more eggs and were able to make detailed examinations
of the successive stages of fertilization. We also took
care to photograph everything because we would have to
persuade colleagues of the truth of our discoveries" (Tauer,
Nor was the creation of these "research" embryos done
secretly: Edwards and Steptoe published their work in
the journal, Nature in 1970 (Edwards, Steptoe,
and Purdy, 1970).
At the very least, then, there is something of an irony
in the fact that so much attention has been devoted to
developing and defending the distinctions between embryos
created solely for research and embryos left over from
IVF procedures, because there would be no embryos left
over from IVF procedures had there not been embryos created
solely for research purposes to develop IVF in the first
place. Given this fact, and given that this fact is no
great secret even though it has not been discussed very
much it appears disingenuous to endorse the distinction
between "research" and "spare" embryos as a way of demonstrating
respect for the early embryo while nevertheless encouraging
I have suggested that the fact that so much of the stem
cell debate has been framed in terms of whether the embryo
is a person with rights has been unfortunate because it
has cast the debate in sharply individualistic terms and
has led to a preoccupation with embryological development
narrowly construed. In addition, however, framing the
debate in terms of embryo status and embryo rights tends
to exaggerate the differences among commentators in contrast
to their similarities. Consider, for example, the response
of conservative Judaism in the United States to this issue.
Rabbi Elliot Dorff has prepared a responsum on stem cell
research for the Rabbinical Assembly Committee on Jewish
Law and Standards, and his responsum is instructive.9
As responsa are, it is structured in terms of relevant
questions: in this case, two questions frame Dorff's discussion.
First, "may embryonic stem cells from frozen embryos originally
created for purposes of procreation or embryonic germ
cells from aborted fetuses be used for research?" (Dorff,
2002, 1). Second, "may embryonic stem cells from embryos
created specifically for research, either by combining
donated sperm and eggs in a petri dish or by cloning be
used for research?" (1) I think it is noteworthy that
the very questions that frame Dorff's analysis both reflect
and perpetuate a certain construction of the issue, but
at this juncture, my point is different: given the way
the debate has been framed, what most (non-Jewish) readers
of Dorff's analysis are likely to focus on is the difference
between his treatment of the early embryo and that of
others in the literature. Indeed, even where you might
expect to find and do in fact find on closer inspection
similarities between this Jewish analysis and Catholic
reflection on this issue, the first impression will be
that of difference. The reason, of course, is that our
attention is drawn to Dorff's analysis of the early embryo,
and Jewish views are sharply different about embryo status
than those of the Catholic church and other pro-life opponents
of stem cell work.
For example, Dorff points out that, according to the
Talmud, during the first forty days of gestation, the
embryo and the fetus are considered as simply water.
From the forty-first day until birth, Jewish tradition
considers the fetus as "the thigh of its mother." Moreover,
As it happens, modern science provides
good evidence to support the Rabbis' understanding. As
Rabbi Immanuel Jakobovits noted long ago, the Rabbis'
"forty days" is, by our obstetrical count, approximately
fifty-six days, for the Rabbis counted from the woman's
first missed menstrual flow, while doctors today count
from the point of conception, which is usually about two
weeks earlier. By 56 days of gestation by obstetrical
count the basic organs have already appeared in the fetus.
Moreover, we now know that it is exactly at eight weeks
of gestation that the fetus begins to get bone structure
and therefore looks like something other than liquid.
Indeed, the Rabbis probably came to their conclusion about
the stages of development of the fetus because early miscarriages
indeed looked like "merely water," while those from 56
days on looks like a thigh with flesh and bones. (16)
The contrast with Catholic teaching could hardly be more
striking. Not only are Jewish views of the status of
the early embryo notably different, but Jewish tradition
claims scientific validation for its view of the embryo,
just as Catholic tradition does. Not surprisingly, therefore,
where Dorff answers both questions posed by the responsum
in the affirmative, Catholic tradition would answer both
These differences are significant and must be attended
to, but it is worth asking whether focusing on these differences
does not obscure important similarities. Consider some
of the similarities. In sketching the Jewish view of
stem cell research, Dorff notes that certain theological
commitments are central. He lists at least three that
would be strikingly similar to Catholic and other Christian
Our bodies are not ours; they belong
to God and God commands that we seek to preserve life
All human beings, regardless of ability
or disability are created in the image of God and are
therefore to be valued as such.
Humans are not God. We are finite
and fallible and this fact ought to promote humility
and urge caution.
Now if we focused merely on questions of embryo status,
we would miss entirely these similarities between Catholic
and Jewish views. More importantly, we would miss the
fact that these similarities may underwrite significant
moral reflection on stem cell research that is not rooted
in concerns about the early embryo.
For example, Dorff notes that, given Jewish theological
and legal commitments, the provision of health care must
be understood as a communal responsibility. Thus, access
to therapies developed through stem cell research is a
crucial issue of justice for the Jewish community. This
theme is echoed in Laurie Zoloth's work on stem cell research.
As Zoloth puts it:
Research done always will mean research
foregone. Will this research help or avoid the problem
of access to health, given that poverty and poor health
are so desperately intertwined in this country?. . . How
can difficult issues of global justice and fair distribution
be handled in research involving private enterprise? (Zoloth,
Surely these are questions that any Catholic moral theologian
would gladly press.
Indeed, attending to the similarities between Zoloth's
work and Catholic reflection on stem cell research brings
us back to Lisa Cahill's observation about debates on
abortion: they tend to be too focused on questions of
rights individually construed. When one shifts the frame
of analysis, new and different issues and new and different
ways to approach the same issues come into view. Notice,
for example, how close Zoloth and Cahill are on the issue
of rights. According to Zoloth, Jewish tradition foregrounds
questions of "obligations, duties, and just relationships
to the other, rather than the protection of rights, privacy,
or ownership of the autonomous self" (96). This leads
Zoloth to ask: "Can the interests of the vulnerable be
heard in our debate?" (105). To be sure, the American
bishops have wanted to emphasize the vulnerability of
the early embryo when they have asked this question, but
Catholic tradition, like Jewish tradition, requires that
we ask this question in a way that is not captured when
moral emphasis is merely about individual rights and personal
Or consider another shared sensibility that emerges if
we move away from questions of embryo status, namely a
wariness about the human tendency to hubris and overreaching.
Zoloth put this point eloquently in relation to the biblical
story of the Tower of Babel. She notes a rabbinic midrash
on this text: "when a worker was killed, no one wept,
but when a brick fell, all wept." Zoloth comments on
this midrash as follows:
It was this decentering of the human
and reification of the thing that was the catastrophe
that felled the enterprise. . . It is not just that they
breached a limit between what is appropriate to create
and what is not, the process of the creation must be carefully
mediated, with deep respect for persons over the temptations
of the enterprise. Such a text elaborates on the tension
between repairing the world . . . and acts that claim
that the world is ours to control utterly (Zoloth, 2001,
Beyond Questions of Embryo Status
This passage from Zoloth helps to illustrate the point
I wish to make in arguing that the stem cell debate has
been too focused on questions of embryo status and that
we must move beyond status questions if we are fully to
do justice to the moral questions raised by technological
developments associated with stem cell work. For concern
about human efforts utterly to control the world is not
a moral worry narrowly tied to status questions.
Let me put this point in the form of a question that
has not typically been asked in the stem cell debate:
Is adult stem cell work as unproblematic as it is often
assumed to be? That this is a productive question is
suggested by testimony of Francis Collins before the President's
Council on Bioethics in December 2002. Collins was asked
to speak about the topic, "genetic enhancements: current
and future prospects" and he specifically addressed the
issue of pre-implantation genetic diagnosis (PGD). Although
PGD is usually understood to involve screening IVF embryos
and discarding unwanted ones, it is also possible to screen
gametes. Because gamete screening may not have broad
utility, Collins did not discuss the issue at length.
He did, however, offer an interesting observation about
gamete selection. Focusing on gametes, he says, is useful
because it "isolates you away from some of the other compelling
arguments about moral status of the embryo and allows
a sort of cleaner discussion about what are the social
goods or evils associated with broad alterations in the
sex ratio and inequities in access to that technology"
(Collins, 2002, 7). In other words, if in the future
we could screen gametes in the same way that we can now
screen embryos, most of the moral issues raised by PGD
would apply to gamete screening, even though gametes are
not embryos. Might we not make a similar claim about
embryonic and adult stem cell research? Do not many of
the most pressing issues raised by embryonic stem cell
technology remain when our focus is adult stem cell work
rather than embryonic stem cell research?
The fact that we do not immediately answer yes to this
question, is testament to how decisively the debate about
abortion has structured the stem cell debate. Nevertheless,
we need to see that the answer to this question is yes
and we need to see why.
Although I will not try to address all of the issues
raised jointly by embryonic and adult stem cell
research, it is worth highlighting several that I think
require fuller discussion particularly with respect to
adult stem cell work than they have yet received.
Moral concerns about the commodification of gametes and
embryos have been discussed extensively in the bioethics
literature both in relation to reproductive technology
and in connection with embryonic stem cell work (See Andrews
and Nelkin, 2001; Annas, 1998; Corea, 1986; Radin, 1996;
Resnik, 2002; Ryan, Ethics and Economics, 2001).
Suzanne Holland, for example, has discussed the growing
commodification of the human body in the biotech age.
She cites a series of articles published in the Orange
County Register that documents a vast for-profit market
in human body tissue (Holland, 2001, 266). The Register's
investigative reporters documented that most nonprofit
tissue banks obtain tissue from cadavers donated by family
members of the deceased for altruistic reasons. Most
relatives are not told, and in fact have no idea, that
donated body parts will be sold for profit. As Holland
The "gift of life" is big business in
America. For a nonprofit tissue bank, one typical donation
can yield between $14,000 and $34,000 in downstream sales,
sometimes far more than that. "Skins, tendons, heart
valves, veins, and corneas are listed at about $110,000.
Add bone from the same body, and one cadaver can be worth
about $220,000." Four of the largest nonprofit tissue
banks told the Orange County Register that together they
expected to produce sales totaling $261 million in 2000.
Nor is the issue of downstream commodification restricted
to the sale of donated cadaveric tissue; it arises in
relation to IVF embryos donated for research. As Dorothy
Nelkin and Lori Andrews point out in their book, Body
Bazaar, IVF patients are not generally told what the
research involving their donated embryos will include.
Many will be unaware that their embryos will be used
to develop commercial stem cell lines (Nelkin and Andrews,
It is significant that even the most vocal advocates
of procreative liberty and laissez-faire arrangements
in reproductive matters recoil from the prospect of selling
human embryos. Yet, although the commodification of tissue
may be particularly troubling when it involves embryos,
if there is a problem with commodifying and commercializing
human tissue, it is a problem we confront with adult stem
cell research as well as with hES cell work.10
Lori Knowles has made a similar point about being consistent
in our moral judgments about commodifying embryos. She
notes that fears about commodifying reproduction have
led many to oppose the sale of embryos and to reject the
idea that couples who donate embryos have any proprietary
interest in the result of the research done with their
embryos. As Knowles puts it, "if it is wrong to commercialize
embryos because of their nature, then it is wrong for
everyone. It is simply inconsistent to argue that couples
should act altruistically because commercializing embryos
is wrong, while permitting corporations and scientists
to profit financially from cells derived by destroying
those embryos" (Knowles, 1999, 40).
Knowles draws attention here to the fact that there is
a tension between our moral and legal traditions as they
apply to developments brought about by cloning, stem cell
research, and the existence of ex utero human embryos,
among other technological breakthroughs. For example,
we patent embryonic stem cell lines, thereby insuring
massive profits for patent holders, while decrying the
commodification of embryonic life. Knowles is correct
that there is a tension between our profit-based medical
research model and our commitment to altruism and the
access to health care that a commitment to justice demands.
Adult stem cell research, of course, raises very similar
issues, because the same tension exists between the need
for proprietary control of technology and the need for
affordable access. For example, patents have been sought
and granted for human adult stem cells work as well as
for embryonic stem cell technologies. According to a
study on the patenting of inventions related to stem cell
research commissioned by the European Group on Ethics
in Science and New Technologies, as of October 2001, two
thousand twenty-nine patents were applied or granted for
stem cells and 512 patents were applied or granted for
embryonic stem cell work (Van Overwalle, 2002, 23; see
also McGee and Banger, 2002). As a result, access to
therapies developed from adult stem cell research is likely
to be as serious an issue as access to embryonic stem
Indeed, issues arising from commodification of both adult
and embryonic stem cells are likely to dominate the next
phase of the debate, if only because corporate interest
in this work, both nationally and internationally, is
so strong (Hill, 2003). Noting that, as of 2002, "a dozen
biotech companies have entered the stem cell industry
and have invested millions of dollars," David Resnik suggests
that the next stage of the stem cell debate will involve
a battle over property rights relating to stem cells (Resnik,
To be sure, the battle over property rights raises important
legal and policy question, but it also raises ethical
questions as well. For example, Resnik provides the following
table of possible ethical objections to patenting stem
Objections to Property Rights in ES cells
Objections to Property Rights in ES cells
(and their products) should not be treated as property;
they should be viewed as having inherent dignity
ES cells should not be treated as private property;
they are res communis or common property.
ES cells as property will have dire social consequences,
such as exploitation, destruction of altruism, and
loss of respect for the value of human life.
Treating ES cells as property will undermine scientific
discovery and technological innovation in the field
of regenerative medicine. (Resnik, 2002, 139)
Although the ethical objections to commodifying stem
cell work can not be sorted out as neatly as this table
suggests, Resnik correctly identifies a variety of such
objections. I will not try to defend it here, but my
own view is that the problem is not just that stem cells
and their products may be commodified, but that market
rhetoric may come to dominate the discussion (and practice)
of regenerative medicine in a way that is dehumanizing.
That is, market-rhetoric may lead us ultimately to think
of humans as artifacts. In short, I take very seriously
Margaret Radin's argument that the rhetoric in which we
conceive our world affects who and what we are (Radin,
At the same time, however, stem cell research is most
likely to bear therapeutic fruit, if there is a market
in stem cells and their products. The pressing moral
question, then, is how do we promote the benefits that
stem cell research may yield without succumbing to a market
rhetoric that reduces humans to commodities?
Several writers have suggested that one answer may be
to promote greater governmental regulation. For example,
Holland argues for moving beyond a policy of restricting
federal funding of stem cell research but allowing an
unregulated private market in this field to active regulation
to curb the private sector's work on stem cells. Lori
Knowles suggests that the United States might adopt a
body like Canada's Patented Medicine Prices Review Board
as a way to allow a market to function, but with oversight
that would provide access to potential cells for further
research and price controls of products to insure widespread
access (Knowles, 1990, 40). George Annas has suggested
that we need to establish a federal Human Experimentation
Agency to regulate in the area of human experimentation.
(Annas, 1998, 18). As Annas puts it:
Virtually all those who have studied
the matter have concluded that a broad-based public
panel is needed to oversee human experimentation in the
areas of genetic engineering, human reproduction, xenografts,
artificial organs, and other boundary-crossing experiments.
Francis Fukuyama has argued that a new agency with a
mandate to regulate biotechnology on broad grounds and
in both the public and private sector may be needed (Fukuyama,
2002, 215). Vanessa Kuhn argues that "it is time to put
in place legislation that will deter stakeholders from
licensing their technology to one exclusive distributor
and thus creating a monopoly market, which would set artificially-high
prices and lead to less access for the sick especially
for the uninsured, the poor, and the elderly" (Kuhn, 2002).
To that end, Kuhn identifies four possibilities:
Development of a new kind of patent.
Set limits on exclusive licensing
through compulsory licensing.
Lower the lifespan of hES cell patents
Set stricter guidelines for hES patent
I do not have the expertise to make policy recommendations,
but let me stress two points. First, the policy issues
with regard to commodifiying adult stem cell work will
be as vexing as those confronting regulation of embryonic
stem cells. Second, although these questions may at first
appear to be strictly legal or largely political matters,
they involve serious value judgments about the common
good that are every bit as morally vital as questions
about the status of the embryo. I thus agree with Gene
Outka, that not to confront directly questions about how
stem cell research will be organized, financed, and overseen
is a kind of ethical failure (Outka, 2002, 177). Obviously,
for example, the institutional arrangements for conducting
stem cell research have implications for the questions
of justice we previously noted. The fact that so much
stem cell research is being done by private corporations
insures future conflict. On the one hand, corporations
have fiduciary obligations to their shareholders and will
therefore seek to control access to stem cell lines or
therapies developed from those lines through patent protection
and licensing agreements. On the other hand, such a system
is likely to further widen the gap between the health
care haves and have-nots (See Lebacqz 2001; McLean 2001).
Moreover, as Karen Lebacqz notes, if justice is an important
consideration in deliberations about stem cell work, then
it ought to shape the research agenda. The example she
gives to make this point is worth noting. Just as with
organ transplants, tissue rejection may be a major problem
for stem cell therapies. This is one reason that the
prospect of combining stem cell work with somatic cell
nuclear transfer (SCNT) has been so enticing. With this
combination, you could in theory develop tissue that would
be completely histocompatible. Nevertheless, according
to Lebacqz, developing stem cell therapies with SCNT is
"highly questionable," if justice is a primary consideration.
The reason is that unique cell lines would need to be
created for each patient, and that is likely to be very
expensive and thus unaffordable for many. Although it
would certainly be less expensive, the same would likely
be true for adult stem work. For that reason, rather
than pursuing an individualized approach to stem cell
research, concerns about affordable access to new therapies
might urge the pursuit of universal donor cell lines.
Embodiment, Boundary Issues, and Human Nature
In discussing the debate about embryo status, I focused
primarily on the contested question of whether the early
embryo is a person with the right to life. We saw that
this question tends to lead to the mobilization of minute
details of embryological development to support one's
view of the embryo. Yet, if attention to embryo status
tends to focus us on the microscopic, viewing stem cell
research through the lens of embryological development
can also have a kind of telescopic function through which
larger issues come into view.12
For example, Catherine Waldby and Susan Squier argue in
a forthcoming issue of the journal Configurations
that focusing on stem cells and embryonic life leads us
fundamentally to question what it means to be human.
According to Waldby and Squier:
Stem cell technologies have profound
temporal implications for the human life course, because
they can potentially utilize the earliest moments of ontogenesis
to produce therapeutic tissues to augment deficiencies
in aging bodies. Hence they may effect a major redistribution
of tissue vitality from the first moments of life to the
end of life. In doing so however they demonstrate the
perfect contingency of any relationship between
embryo and person, the non-teleological nature of the
embryo's developmental pathways. They show that the embryo's
life is not proto-human, and that the biology and biography
of human life cannot be read backwards into its moment
of origin. (Waldby and Squier, forthcoming)
The claim that there is a perfect contingency in the
relationship between embryo and person may at first appear
to be just another "microscopic" claim about embryo status,
but it is clear that Waldby and Squier mean to imply much
more in asserting that the embryo's development is non-teleological.
In effect, they reject the notion that there is a meaningful
trajectory to human life. What was killed, they say,
when stem cells were first derived from the inner cell
mass of a blastocyte was not a person, but a "biographical
idea of human life, where the narrative arc that describes
identity across time has been extended to include the
earliest moments of ontogeny" (Waldby and Squier, forthcoming).
That much more is at stake here than the question of
whether the embryo is a person is clear if we attend to
the notion of a trajectory of a human life. Gilbert Meilaender,
for example, has argued that our attitudes toward death
and dying are importantly shaped by our conception of
what it means to have a life (Meilaender 1993). Indeed,
according to Meilaender, two views of what it means to
have a life of what it means to be a person have been
at war with each other within the field of bioethics over
the past thirty years and these views underwrite sharply
different views not just about the issues of abortion
or euthanasia that are implicated here but with regard
to practically every moral issue we might confront in
the field of bioethics.
On Meilaender's view, having a life means precisely that
there is a trajectory that traces a "natural pattern"
in embodied life that "moves through youth and adulthood
toward old age and, finally, decline and death" (29).
As he puts it elsewhere in this essay, "to have a life
is to be terra animata, a living body whose natural
history has a trajectory" (31). Although Meilaender develops
the notion of a natural trajectory of bodily life primarily
to address the issue of euthanasia and not stem cell research,
his talk of "natural history," "natural pattern," and
"natural trajectory" draws attention to one of the most
significant issues raised by stem cell research and related
technologies. Does stem cell research undermine the very
notion of a human life constrained by natural bodily existence?
The example on which Meilaender focuses here is instructive
for thinking about the broad implications of stem cell
research in this regard. If stem cell therapies fundamentally
alter our sense of a natural pattern to aging would they
not also fundamentally alter our sense of what it means
to be human? Meilaender's answer is that such a change
would fundamentally affect what it means to be human precisely
because we are embodied creatures and for that reason
our identity is tied to the body and the body's history.
Leon Kass has made a similar point recently in reflecting
on the prospect that regenerative medicine might significantly
lengthen the human life span (Kass, 2003). He, too, invokes
the notion of a natural trajectory, one that stem cell
research may undermine. Although it is possible to approach
the prospect of extending the human life-span in an abstract
way, he says, to think of what such a change would mean
experientially is to recognize that "the 'lived time'
of our natural lives has a trajectory and a shape, its
meaning derived in part from the fact that we live as
links in the chain of generations" (13). Indeed, says
Kass, without something like the natural trajectory of
bodily life that currently exists, the relationship between
the generations would be decidedly different, and probably
not better. "A world of longevity," writes Kass, "is
increasingly a world hostile to children" (13). Walter
Glannon has argued that, at the very least, increased
longevity would increase competition for scarce resources
between older and younger generations. According to Glannon,
"it is at least intuitively plausible that an over populated
world with substantially extended human lives and scarce
resources could adversely affect the survival and reproductive
prospects of the young and harm them by thwarting their
interest in being healthy enough so that they could survive
and procreate" (Glannon, "Extending," 347).13
Francis Fukuyama has also suggested some of the reasons
why increased longevity may imperil children, but he also
notes that our relationship to death may change as well
(See 2002, ch. 4). "Death," he says, "may come to be
seen not as a natural and inevitable aspect of life, but
a preventable evil like polio or measles. If so, then
accepting death will appear to be a foolish choice, not
something to be faced with dignity or nobility" (Fukuyama,
Sometimes the question of the transformative possibilities
that come with stem cell research is raised even more
starkly when the question asked is not how may stem cell
work affect what it means to be human, but instead: Does
stem cell research open the door to a post human future?
This is a point Waldby and Squier raise explicitly
when they discuss the combination of genetic engineering
and stem cell therapy. They suggest, for example, that
xenotransplantation forces us to confront the prospect
of transgressing species boundaries.14
The conclusion of their paper is worth quoting in full:
Thus the ontological status of the embryo
is not the only thing in question. The ontological status
of the graft recipient must be negotiated, when the graft
involves genetically-engineered stem cells from another
species. And the ontological status of the illnesses
to which biomedical technology responds is equally challenged,
in an endless regression, as the division between veterinary
and human medicine, or between zoonoses (diseases humans
can catch from animals) and what has recently been dubbed
humanooses, is called into question. This increasingly
permeable, increasingly constructed barrier between
human and animal presents us with another form of life
to negotiate, whose boundary lies not between silicon
and carbon, but rather between steps in the evolutionary
ladder or the branching development tree of phylogenetic
lifeforms. Stem cell technologies thus challenge both
the temporal and spatial boundaries of human life, both
our biography and our biological niche, giving a much
broader meaning to the questioning of embryonic personhood.
(Waldby and Squier, forthcoming)
Regrettably, with some notable exceptions, the ethical
debate about stem cell research has not taken up in a
sustained way what it would mean to pursue stem cell therapies
that might significantly undermine the notion of a natural
human life or erode the boundary between human and non-human
species. When the issue is framed in terms of the status
of the embryo, the question tends to be whether the research
should be conducted at all. By contrast, when the issue
is framed in terms of adult stem cell work, the question
is not whether, but how and with what consequences. Yet,
that is a question we have not systematically answered.
Given the potential for good embedded in the prospects
of adult stem cell research, it is not surprising that
there appears to be widespread and largely uncritical
acceptance of adult stem cell research. But, if the promise
of stem research is as revolutionary as is often claimed,
we are going to need a much more expansive discussion
of stem cell research both embryonic and adult than we
have had heretofore. Obviously, I cannot explore this
more expansive horizon in any detail in this report, but
let me in closing suggest one direction we need to explore.
To signal the decisive break that I think we may need
from the usual bioethics frame, I want to draw attention
to Martha Nussbaum's recent article in the journal Daedalus
entitled, "Compassion & Terror" (Nussbaum, 2003).
Discussing Euripides' play, Trojan Women, Nussbaum
reflects on the fact that the Greek poets returned obsessively
to the sacking of Troy and the acts of the "rapacious
and murderous Greeks." She explores the poets' compassionate
imagining of the fate of Trojan women and children to
reflect on the conditions and limits of a compassionate
vision. Although Nussbaum is ultimately concerned about
engendering a compassionate vision for Americans in the
face of terror and particularly compassion for innocent
women and children far from our shores, her analysis of
compassion is thought-provoking in relation to stem cell
Nussbaum notes that compassion is a complex emotion requiring
a series of judgments involving another person's suffering
or lack of well-being. We must judge that someone has
been harmed, that the harm is serious, and that it was
not deserved. Moreover, says Nussbaum, Western tradition
has stressed what could be called the "judgment of similar
possibilities." In other words, "we have compassion only
insofar or we believe that the suffering person shares
vulnerabilities and possibilities with us" (Nussbaum,
Now surely in just about everyone's catalogue of human
vulnerabilities are illness, old age, and death. Yet,
as we have just seen, stem cell research might significantly
transform the "human" experience of illness and death,
at least for some. If stem cell therapies were to erode
the notion of human nature or species membership, might
they not also erode some basic moral sensibilities? Mary
Midgley, for example, has argued that both the notion
of human nature and that of human rights are importantly
tied to membership in our species because rights are "supposed
to guarantee the kind of life that all specimens of Homo
sapiens need" (Midgley, 2000, 9).
Although Nussbaum avoids the language of human nature,
it is precisely this sort of point that she highlights
when she argues that compassion requires the belief that
others share vulnerabilities and possibilities with us.
Indeed, like Midgley, Nussbaum ties the notion of universal
human rights to important human functions and capabilities.
The basic idea, she says, is to ask what constitutes the
characteristic activities of human beings. In other words:
'What does the human being do, characteristically,
as such―and not, say, as a member of a particular
group, or a particular local community?' To put it another
way, what are the forms of activity, of doing and being,
that constitute the human form of life and distinguish
it from other actual or imaginable forms of life, such
as the lives of animals and plants, or, on the other hand,
of immortal gods as imagined in myths and legends (which
frequently have precisely the function of delimiting the
human)? (Nussbaum, 1995, 72)
Nussbaum notes that this inquiry proceeds by examining
a wide variety of self-interpretations and that comparing
characteristic human activities with non-human activities
and, through myths and stories, comparing humans and the
gods is particularly helpful. For one thing, such an
inquiry helps us to define limits that derive from membership
in the world of nature.
Indeed, although Nussbaum is particularly attentive to
the wide variety of cultural interpretations of what it
means to be human, she insists that to ground any essentialist
or universal notion of human rights, one must attend to
human biology. Although her account of the human is neither
ahistorical nor a priori, it is linked to an "empirical
study of a species-specific form of life" (1995, 75).
When she develops her account of central human capabilities,
she begins with the body. She writes:
We live all our lives in bodies of a
certain sort, whose possibilities and vulnerabilities
do not as such belong to one human society rather than
another. These bodies, similar far more than dissimilar
(given the enormous range of possibilities) are our homes,
so to speak, opening certain options and denying others,
giving us certain needs and also certain possibilities
for excellence. The fact that any given human being might
have lived anywhere and belonged to any culture is a great
part of what grounds our mutual recognitions; this fact,
in turn, has a great deal to do with the general humanness
of the body, its great distinctness from other bodies.
The experience of the body is culturally shaped, to be
sure; the importance we ascribe to its various functions
is also culturally shaped. But the body itself, not culturally
variant in its nutritional and other related requirements,
sets limits on what can be experienced and valued, ensuring
a great deal of overlap. (Nussbaum, 1995, 76)
Nussbaum's work both in identifying the judgments that
underwrite compassion and in tying an account of rights
to human function and capabilities that are presumably
universal highlights what is at stake, not merely with
stem cell research but with a growing list of biotechnological
developments which appear to destabilize the concept of
human nature and which require that we think carefully
and hard about what it might mean for some humans to have
access to these technologies while other humans do not.15
At the very least, the combination of what Rabinow describes
as the biologicalization of identity around genetics rather
than gender and race with the possibility of manipulating
that genetic identity for those with the money or power
to do so does not bode well for securing wide-spread compassion
across economic or technological divides. Even more important,
however, is the recognition that the very notion of human
rights may ultimately rest on the idea (and what, until
recently has always been the reality) of a natural human
condition that is relatively stable.
I believe that Nussbaum is correct when she claims that
inquiring into characteristic human activities and comparing
these to non-human activities helps us to define limits
and thereby to promote human flourishing. Unfortunately,
what Susan Squier calls the "pluripotent rhetoric" of
stem cell research is that of limitless possibilities
(Squier, Liminal Lives). The ultimate limit, of
course, is death and yet even this limit appears illusory
in some visions of our biotech future.
It is worth noting in closing that William Safire's New
Year's Day column at the dawn of the twenty-first century,
in January 2000, was entitled "Why Die?" The longing
behind this question is neither new nor unfamiliar. What
is new is that this longing to escape the vulnerabilities
and limitations of the body is united with a technology
that holds out the prospect of fundamentally changing
that body. Yet, I agree with Gerald McKenny that we need
to ask whether we wish to accept and promote a view of
bodily vulnerability as merely an obstacle to human flourishing,
which ought to be overcome at any cost (McKenny, 1998,
Although a longing for invulnerability is perhaps a quintessentially
human trait, and although the quest to reduce the human
suffering wrought by illness and disease is morally admirable,
there is no mistaking the hubris behind the question,
Why Die? Opponents of stem cell research have, from the
start, argued that there is a kind of idolatry in a science
that would reduce the human embryo to just so much biological
material. What I have tried to show in this report is
that such concerns need not be limited to those who think
that the early embryo is fully a person. Nor should this
kind of concern be limited to those who oppose stem cell
research. I do not think the early embryo is a person
and I believe that both embryonic and adult stem cell
research should go forward under a system of strict regulation.
Nevertheless, I confess to being haunted by the passages
with which I began and I believe that future debates on
stem cell research must take very seriously the worries
about commodification and the possibility of fundamentally
changing the trajectory of a human life.16
Jimmy Margulies, Editorial
The Record, Hackensack, New Jersey
Cartoon used with permission
of the artist.
1. Given the current
status of technology, deriving human embryonic stem cells
requires destroying embryos. If the cells could be derived
without the destruction of embryos or if parthenogenetically
stimulated eggs produced stem cells, issue of status would
almost certainly fade. Nevertheless, serious ethical
issues would still remain. This is one reason I believe
it is a mistake to focus narrowly on embryo status.
2. Gene Outka has
argued that there is an "internal coherence" to views
of the embryo, issues of complicity, and views on adult
stem cell research (Outka, 2002).
3. Although the HERP
report claimed that "it is not the role of those who help
form public policy to decide which of these views [of
the embryo] is correct, there is little doubt that the
panel adopted the pluralistic view. For that reason,
most commentators found the above claim disingenuous.
4. Compare, for example,
the various statements that Richard M. Doerflinger has
made on the U. S. bishops' behalf. See Doerflinger, 1988,
1998, 1999, 2001. Margaret Farley has argued that the
Catholic preoccupation with abortion has eroded its credibility
on other important social issues, including stem cell
research. (See Farley, 2000).
debate that is at least partly shaped by focusing on embryo
status revolves around the question of complicity. For
example, supporters of stem cell research may harbor a
residual uneasiness about endorsing the destruction of
human embryos, at least if the number of articles in the
literature explaining the concept of complicity with wrongdoing
is any indication. John Robertson, Ronald Green, and
Thomas Shannon, have all written on the issue of cooperation
with evil in relation to stem cell research. (Robertson,
1999; Green, 2002; Shannon, 2001; see also Kaveny, 2000;
and Gilliam, 1997). To be sure, the issue of complicity
or cooperation with wrongdoing is a very traditional one
in moral philosophy and theological ethics. Still, if
the early embryo does not deserve the respect accorded
persons and if destroying the embryo is compatible with
respecting it, then deriving stem cells is not an act
of wrongdoing and issues of complicity do not arise.
also emphasizes the way a liberal individualist view of
the person discounts the significance of embodiment.
I will return to this point below.
both those who view the embryo as a person and those who
do not but who insist on respect for the embryo, have
been remarkably cavalier with regard to the use of embryos
in IVF programs can be seen by the fact that there are
currently over 400,000 embryos frozen in the United States,
a number we did not even know until quite recently (Hoffman
et al. in association with The Society for Assisted Reproductive
Technology and RAND, 2003).
8. In a
commentary published in Nature, in September 2001,
Edwards writes: "On the verge of clinical application,
stem cells offer a startlingly fundamental approach to
alleviating severe incurable human maladies. Fondly believed
to be a recent development, they have in fact been part
and parcel of human in-vitro fertilization (IVF)
from as long ago as 1962."
responsum was accepted by the Committee on Law and Standards
by a vote of twenty-two to one in March 2002. On the
basis of Dorff's responsum the Rabbinical Assembly passed
a resolution in April 2003 supporting stem cell research
for therapeutic purposes. (Resolution in Support of Stem
Cell Research and Education, April 2003: available at
and Lo draw the distinction between commodification and
commercialization as follows: "The issue of commodification
involves treating either human beings or symbols of human
life as merchandise or vendible goods. . . . Commercialization
refers to the practice of realizing large profits from
the development and sale of techniques or products that
involve distinctive human material, such as embryos, eggs,
or tissue" (Alpers and Lo, 1995).
quotes Georg Lukács on the reification of commodities
and the effects on human consciousness. Lukács writes:
"The transformation of the commodity relation into a thing
of 'ghostly objectivity' cannot therefore content itself
with reduction of all objects for the gratification of
human needs to commodities. It stamps its imprint upon
the whole consciousness of man; his qualities and abilities
are no longer an organic part of his personality, they
are things which he can 'own' or 'dispose of' like the
various objects of the external world" (Radin, 1996, 82).
When we think about genes for enhancing memory or muscle
mass, it is worth keeping in mind Lukács's claim that
human qualities and abilities may come to be thought of
as objects for sale in the external world.
Parens has noted the importance of attending to the big
picture raised by stem cell work and how the politics
of abortion has obscured that picture. See Parens, 2000.
another essay, Glannon argues that substantially increasing
the human life span would profoundly affect issues of
personal identity and thus a sense of personal responsibility
for one's action. He ties his argument in interesting
ways to the biology of memory function (Glannon, "Identity").
For a classic philosophical discussion of the problems
associated with immortality, see Williams, 1973.
he is not discussing stem cell research explicitly, Paul
Rabinow's discussion of technological change wrought during
the last two decades is worth noting. He writes: "In
the United States, for example, in the last two decades,
while the most passionate value conflicts have raged around
abortion, a general reshaping of the sites of production
of knowledge has been occurring. To cite the biotechnology
industry, the growing stock of genomic information, and
the simple but versatile and potent manipulative tools
(exemplified by the polymerase chain reaction) is to name
a few key elements; a more complete list would include
the reshaping of American universities, the incessant
acceleration in the computer domains, and the rise of
'biosociality' as a prime locus of identity a biologicalization
of identity different from the older biological categories
of the West (gender, age, race) in that it is understood
as inherently manipulable and re-formable" (Rabinow, 1999,
13). A couple of pages later, he writes: "My analysis
points to the fact that the basic understanding and practices
of 'bare life' have been altered. The genome projects
(human, plant, animal, microorganismic) are demonstrating
a powerful approach to life's constituent matter. It
is now known that DNA is universal among living beings.
It is now known that DNA is extremely manipulable. One
consequence among many others is that the boundaries between
species need to be rethought; transgenic animals made
neither by God nor by the long-term processes of evolution
now exist (16).
a science fiction exploration of this theme of selected
genetic enhancement, species boundary crossing see Octavia
number of people either helped with the preparation of
this report or provided feedback on an earlier draft.
Thanks to Christa Adams, Diana Fritz Cates, William FitzPatrick,
James L. Lissemore, Charlie Ponyik, Mary Jane Ponyik,
Kristie Varga, Lisa Wells, and the ethics writers group
at John Carroll University.
Alpers, Ann, and Bernard Lo. "Commodification
and Commercialization in Human Embryo Research." Stanford
Law and Policy Review, vol. 6, no. 2 (1995): 40.
American Association for the Advancement
of Science and Institute for Civil Society. Stem Cell
Research and Applications Monitoring the Frontiers of
Biomedical Research. (November 1999).
American Fertility Society Ethics Committee.
"Ethical Considerations of the New Reproductive Technologies
in Light of Instruction on the Respect for Human Life
in Its Origin and on the Dignity of Procreation." Fertility
and Sterility, vol. 49, (1988): Supplement.
Andrews, Lori, and Dorothy Nelkin. Body
Bazaar: The Market for Human Tissue in the Biotechnology
Age. New York, NY: Crown Publishers, 2001.
Annas, George J. Some Choice: Law,
Medicine, and the Market. New York: Oxford University
Butler, Octavia E. Dawn. Boston,
MA: Warner Books, 1997.
Cahill, Lisa Sowle. "Abortion, Autonomy,
and Community." In Abortion: A Reader. Ed. Lloyd
Steffen (Cleveland: Pilgrim Press, 1996), 359-72.
______. "The Embryo and the
Fetus: New Moral Contexts." Theological Studies,
vol. 54 (1993): 124-42.
Callahan, Daniel. Hastings Center Report,
vol. 25, no. 1 (1995): 39.
Collins, Francis S. "Testimony before
the Presidents Council on Bioethics." (December 13, 2002).
Available at: http://www.bioethics.gov.
Congregation for the Doctrine of the Faith,
"Declaration on Procured Abortion," 1974.
______. "Donum vitae,"
Corea, Gena. The Mother Machine.
New York: Harper and Row, 1985.
Doerflinger, Richard M. "Hearing on Stem
Cell Research," Testimony of Richard M. Doerflinger on
behalf of the Committee for Pro-Life Activities United
States Conference of Catholic Bishops before the Subcommittee
on Labor, Health, and Human Services, and Education Senate
Appropriations Committee (July 18, 2001):
available at http://www.usccb.org/prolife/issues/bioethic/stemcelltest71801.htm.
______. "Public Comment before
the National Bioethics Advisory Commission," National
Conference of Catholic Bishops (April 16, 1999): available
______. "Hearing on Legal Status
of Embryonic Stem Cell Research," Testimony of Richard
M. Doerflinger on behalf of the Committee for Pro-Life
Activities, National Conference of Catholic Bishops before
the Senate Appropriations Subcommittee on Labor, Health,
and Education (January 26, 1999): available at http://www.usccb.org/p;rolife/issues/bioethic/test99.htm.
______. "Testimony of Richard
M. Doerflinger on behalf of the Committee for Pro-Life
Activities National Conference of Catholic Bishops before
the Senate Appropriations Subcommittee on Labor, Health
and Education," Hearing on Embryonic Cell Research (December
2, 1998): available at http://www.usccb.
______. "Public Comment: NIH
Human Embryo Research Panel." United States Conference
of Catholic Bishops (February 2, 1994).
______. "Ethical Problems in
the Use of Tissues from Abortion Victims," Public Comment,
Meeting of the Human Fetal Tissue Transplantation Research
Panel, (Bethesda, Maryland: National Institutes of Health,
September 14, 1988): available at
Dorff, Elliot N. "Stem Cell Research."
Final Draft (August 2002).
Edwards, R. G. "IVF and the History of
Stem Cells." Nature, vol. 413 (September 27, 2001):
Edwards, Steptoe, and Purdy. "Fertilization
and Cloning In Vitro of Preovulation Human Oocytes."
Nature 277 (1970): 1307-1309.
Farley, Margaret A. "Roman Catholic Views
on Research Involving Human Embryonic Stem Cells." The
Human Embryonic Stem Cell Debate: Science, Ethics, and
Public Policy. Cambridge, MA: The MIT Press, 2001.
______. "The Church in the
Public Forum: Scandal or Prophetic Witness?" The Catholic
Theological Society of America, Proceedings of the
Fifty-fifth Annual Convention, Vol. 55 (June 8-11, 2000):
Presidential Address, 87-101.
FitzPatrick, William. "Surplus Embryos,
Nonreproductive Cloning, and the Intend/Foresee Distinction."
Hastings Center Report (May-June 2003): 29-36.
Fukuyama, Francis. Our Posthuman Future.
New York: Farrar, Straus and Giroux, 2002.
Gearhart, John. "New Potential for Human
Embryonic Stem Cells." Science, vol. 282 (November
6, 1998): available at:
Geron Ethics Advisory Board. "Research
with Human Embryonic Stem Cells: Ethical Considerations."
Hastings Center Report, vol. 29, no. 2 (March-April
Gilliam, Lynn. "Arguing by Analogy in
the Fetal Tissue Debate." Bioethics, vol. 11, no.
5 (1997): 397-412.
Glannon, Walter. "Extending the Human
Life Span." Journal of Medicine and Philosophy,
vol. 27, no. 3 (2002): 339-54.
______. "Identity, Prudential
Concern, and Extended Lives." Bioethics, vol. 16,
no. 3 (2002): 266-83.
Green, Ronald M. "Benefiting from 'Evil':
An Incipient Moral Problem in Human Stem Cell Research."
Bioethics, vol. 16, no. 6 (2002): 544-56.
______. The Human Embryo
Research Debates: Bioethics in the Vortex of Controversy.
New York: Oxford University Press, 2001.
______. "At the Vortex of Controversy."
Kennedy Institute of Ethics Journal vol. 4, no.
4 (1994): 345-56.
Hall, Stephen S. Merchants of Immortality:
Chasing the Dream of Human Life Extension. New York:
Houghton Mifflin Company, 2003.
Hoffman, David I. et al. "Cryopreserved
Embryos in the United States and Their Availability for
Research." Fertility and Sterility, vol. 79, no.
5 (May 2003): 1063-69.
Holland, Suzanne. "Contested Commodities
at Both Ends of Life: Buying and Selling Gametes, Embryos,
and Body Tissues," Kennedy Institute of Ethics Journal,
vol. 11, no. 3 (2001): 266.
Kass, Leon R. "Ageless Bodies, Happy
Souls: Biotechnology and the Pursuit of Perfection." The
New Atlantis, no. 1 (spring 2003).
______. Life, Liberty and
the Defense of Dignity: The Challenge for Bioethics.
San Francisco, CA: Encounter Books, 2002.
Kaveny, M. Cathleen. "Appropriation of
Evil: Cooperation's Mirror Image," Theological Studies,
vol. 61, no. 2 (June 2000): 280-313.
Knowles, Lori P. "Property, Progeny, and
Patents." Hastings Center Report, vol 29. no. 2
Kuhn, Vanessa. "Stem Cells: Equity or
Ownership?" The American Journal of Bioethics,
vol. 2, no. 1 (winter 2002): 2.
Lauritzen, Paul. "Neither Person nor Property:
Embryo Research and the Status of the Early Embryo," America
(March 26, 2001).
______. Cloning and the
Future of Human Embryo Research. New York: Oxford
University Press, 2001.
______. "Expanding the Debate
over Stem Cell Research," Dialog: A Journal of Theology,
vol. 41, no. 3, (fall 2002): 238-39.
Lebacqz, Karen. "Stem Cells and Justice,"
Dialog, vol. 41, no. 3 (fall 2002).
______. "On the Elusive Nature
of Respect." The Human Embryonic Stem Cell Debate:
Science, Ethics, and Public Policy. Cambridge, MA:
The MIT Press, 2001. 149-162.
Lewis, C. S. The Abolition of Man.
New York: The Macmillan Company, 1947.
Macklin, Ph.D., Ruth. "Ethics, Politics,
and Human Embryo Stem Cell Research." Women's Health
Issues, vol. 10, no. 3 (May/June 2000): 111-15.
Magnus, David, Arthur Caplan, and Glenn
McGee, ed. In Who Owns Life? Amherst, New York:
Prometheus Books, 2002.
McCormick, R. A. "Who or What is the Preembryo?"
In Corrective Vision: Explorations in Moral Theology.
Kansas City: Sheed & Ward, 1994.
McGee, Glenn, and Elizabeth Banger. "Ethical
Issues in the Patenting and Control of Stem Cell Research."
In Who Owns Life? Ed. David Magnus, Arthur Caplan,
and Glenn McGee. Amherst, New York: Prometheus Books,
McKenny, Gerald P. "Enhancements and the
Ethical Significance of Vulnerability." In Enhancing
Human Traits: Ethical and Social Implications. Washington,
D.C.: Georgetown University Press, 1998. 222-37.
McKibben, Bill. Enough: Staying Human
in an Engineered Age. New York: Henry Holt and Company,
McLean, Margaret. "Stem Cells: Justice
at the Gate." Dialog, vol. 41, no. 3 (fall 2002).
Meilaender, Gilbert. "Terra es animata:
On Having a Life." Hastings Center Report, vol.
23, no. 4 (July-August 1993): 25-32.
Meyer, Michael J., and Lawrence J. Nelson.
"Respecting What We Destroy: Reflections on Human Embryo
Research." Hastings Center Report, vol. 31, no.
1 (January/February 2001).
Midgley, Mary. "Biotechnology and Monstrosity:
Why We Should Pay Attention to the 'Yuk Factor.'" Hastings
Center Report, vol. 30, no. 5 (2000): 7-15.
National Academy of Sciences. Stem
Cells and the Future of Regenerative Medicine. Washington
D.C.: National Academies Press, 2002.
National Bioethics Advisory Commission.
Ethical Issues in Human Stem Cell Research. vol.
1. Rockville, Maryland: NBAC, 1999.
Nelkin, Dorothy, and Lori B. Andrews.
Body Bazaar: The Market for Human Tissue in the Biotechnology
Age. New York, NY: Crown Publishing, 2001.
National Institutes of Health, "Report
of the Human Embryo Research Panel." (September 1994).
Nussbaum, Martha C. "Compassion and Terror."
Daedalus, vol. 128, no. 4 (winter 2003):
______. "Human Capabilities,
Female Human Beings." Women, Culture, and Development:
A Study of Human Capabilities. Ed. Martha C. Nussbaum
and Jonathan Glover (Oxford: Clarendon Press, 1995), 61-104.
Outka, Gene. "The Ethics of Stem Cell
Research." Kennedy Institute of Ethics Journal
vol. 12, no. 2 (2002): 175-213.
Parens, Ph.D., Erik. "Embryonic Stem
Cells and the Bigger Reprogenetic Picture." Women's
Health Issues, vol. 10, no. 3 (May/June 2000): 116-20.
Pontifical Academy for Life. "On the Production
and the Scientific and Therapeutic Use of Human Embryonic
Stem Cells." Vatican (August 25, 2000): available at Http://www.petersnet.net/browse/
Rabinow, Paul. French DNA: Trouble in
Purgatory. Chicago, IL: The University of Chicago Press,
Radin, Margaret Jane. Contested Commodities.
Cambridge, MA: Harvard University Press, 1996.
Resnik, David. "The Commercialization
of Human Stem Cells: Ethical and Policy Issues." Health
Care Analysis, vol. 10 (2002):127-54.
Robertson, John A. "Ethics and Policy
in Embryonic Stem Cell Research." Kennedy Institute
of Ethics Journal, vol. 9, no. 2 (1999): 109-36.
Roche, J.D., Patricia A. and Michael A.
Grodin, M.D., F.A.A.P. "The Ethical Challenge of Stem
Cell Research." Women's Health Issues, vol. 10,
no. 3 (May/June 2000): 136-39.
Ryan, Maura. "Creating Embryos for Research:
On Weighing Symbolic Costs." Cloning and the Future
of Human Embryo Research. Ed. Paul Lauritzen. New
York: Oxford University Press, 2001.
______. The Ethics and Economics
of Assisted Reproduction. Washington, D.C.: Georgetown
University Press, 2001.
______. "The Politics and Ethics
of Human Embryo and Stem Cell Research." Women's Health
Issues, vol. 10, no. 3 (May/June 2000): 105-10.
Safire, William. "Why Die?" The New
York Times (January 1, 2000).
Shamblott, M. J. et al. "Derivation of
Pluripotent Stem Cells from Cultured Human Primordial
Germ Cells." Proceedings of the National Academy of
Sciences, vol. 95 (1998): 13726-31.
Shannon, T. A., and A. B. Walter. "Reflections
on the Moral Status of the Preembryo." Theological
Studies, vol. 51 (1990): 603-26.
Shannon, Thomas. "Human Embryonic Stem
Cell Therapy." Theological Studies, vol. 62, (2001):
Squier, Susan. Liminal Lives, unpublished
Steinbock, Bonnie. "Respect for Human
Embryos." In Cloning and the Future of Human Embryo
Research. Ed. Paul Lauritzen. New York: Oxford University
______. "What Does 'Respect
for Embryos' Mean in the Context of Stem Cell Research?"
Women's Health Issues, vol. 10, no. 3 (May/June
______. Life before Birth:
The Moral and Legal Status of Embryos and Fetuses.
New York, NY: Oxford University Press, 1992.
Tauer, Carol. "Responsibility and Regulation:
Reproductive Technologies, Cloning, and Embryo Research."
In Cloning and the Future of Human Embryo Research.
Ed. Paul Lauritzen. Oxford University Press: New York,
______. "Preimplantation Embryos,
Research Ethics, and Public Policy." Bioethics Forum,
vol. 11, no. 3 (1995): 30-37.
Thomson, James A. et al. "Embryonic Stem
Cell Lines Derived from Human Blastocysts." Science,
vol. 282 (November 6, 1998).
Van Overwalle, Geertrui. Study on the
Patenting of Inventions Related to Human Stem Cell Research.
Luxembourg: Office for Official Publications of the
European Communities, 2002. 23.
Waldby, Ph.D., Catherine, and Susan Squier,
Ph.D. "Ontogeny, Ontology, and Phylogeny: Embryonic Life
and Stem Cell Technologies." Configurations (Forthcoming).
Warren, Mary Anne. Moral Status: Obligations
to Persons and Other Living Things. New York, NY:
Oxford University Press, 1997.
Williams, Bernard. Problems of the
Self: Philosophical Papers 1956-1972. Cambridge,
England: Cambridge University Press, 1973.
Wolfe, Tom. Hooking Up. New York,
NY: Farrar, Straus and Giroux, 2001.
Zoloth, Laurie. "Jordon's Banks: A View
from the First Years of Human Embryonic Stem Cell Research."
In The Human Embryonic Stem Cell Debate. Ed. by
Suzanne Holland, Karen Lebacqz, and Laurie Zoloth. Cambridge,
MA: The MIT Press, 2001. 238.