President George W. Bush's August 9, 2001, addressto the nation on embryonic stem cells was an exercise in politico-moral bumperbowling. He acknowledged the hopes of desperate patients and their families, thenbounced across the alley to embrace the moral arguments of right-to-life allies.It was fascinating to watch this slow, lurching journey down the lane and towonder where the ball would actually strike. The biggest surprise was not that heoffered a compromise on research with embryonic stem cells but rather his claimthat 60 cell lines had already been created and were potential candidates forresearch grants from the U.S. National Institutes of Health (NIH). Mostscientists were aware of only a dozen lines at most; hearing that there were manytimes that number was startling.
The official number is now 64. Lana Skirboll, associate director forscience policy at NIH and a well-respected scientist and administrator, wasthe source for the figure, which was based on an exhaustive worldwide search tofind any possible embryonic-stem-cell line. Dr. Skirboll found them in Israel,India, Australia, Sweden, and the United States. Sixty-four lines met thecriteria set by the Bush administration: They were derived from embryos in excessof those needed for a couple's reproductive purposes; the couple who authorizedtheir creation consented for the embryo to be used for research; the embryo hadnot originally been created for research; and no monetary or other inducementshad been offered for the embryo. The president added an additional condition:Destruction of the embryo must have been initiated by 9:00 P.M. on August9, 2001.
The president's announcement did not please everyone. That was always animpossibility given the mutually incompatible goals. On the side favoringresearch funding were patients and their advocacy organizations, who see stemcells as a bright new hope for afflictions like Parkinson's disease, spinal-cordinjuries, and diabetes. On the same side were scientists fiercely resistant towhat they view as politically inspired limitations on embryonic-stem-cellresearch. Arrayed against them were the forces of the right-to-life movement,some of whom saw in embryonic-stem-cell research an issue that might causeAmericans to think hard, perhaps for the first time, about the moral significanceof the earliest human embryos. As it happened, some of the Americans who engagedin those reflections were reliably anti-abortion politicians; and so the debateover embryonic stem cells has fractured the pro-life movement itself.
Whether Bush's announced policy was a political masterstroke, a muddled butserviceable compromise, or a latent disaster waiting to unfold, time will reveal.Whatever its apparent appeal, the president's policy has four significant defects:It alters previously proposed ethical standards for embryonic-stem-cell lines; itreinforces an oligopoly over the existing lines; it is inherently unstable givenlikely scientific developments and the prospect of future experimental stem-celltherapies; and it drives a wedge into the heart of the pro-life movement. (Thislast will not be seen as a defect in all quarters.)
Make no mistake, there are vexing ethical questions concerning how wetreat human embryos and about the new powers our investigations into embryonicstem cells may give us to manipulate or genetically select our future children.But these moral misgivings would never have derailed the enthusiasm for suchresearch. Disease causes such misery and grief for so many families that researchon stem cells, with its great promise (though no certainty) of success, wassupported by most Americans--and passionately so by many. No, the principalpolitical roadblock to such research was fierce opposition by those in theanti-abortion community for whom human embryos are full moral persons, end ofstory.
Because most of the notable battles fought by right-to-life groups concernedmuch later stages of prenatal human development--"late-term abortion," forexample--the right-to-life movement has successfully avoided calling publicattention to implications of its views about the earliest days of embryonic life.Among these implications is the startling inference that common practices atfertility clinics amount to mass murder (more about that later). Public supportfor embryonic-stem-cell research posed a quandary for anti-abortion leaders: Ifthe president banned all public monies for the research, it would have beeninescapably clear that the right-to-life movement had imposed its minority viewon the majority of Americans--an obstructionism likely to anger many people. Onthe other hand, if the president permitted any public funding, that would amountto complicity with evil: If you believe that destroying an embryo is murder, andif the creation of embryonic-stem-cell lines can only be accomplished bydestroying embryos, then it is difficult to see how you can escape the charge ofcomplicity with that murder, whether it was done before or after an arbitrarydeadline of 9:00 P.M. on August 9, 2001. A number of pro-life leadershave already reached that conclusion.
An Ethics of Convenience
What the president offered allowed the pro-life movement to escapepublic opprobrium for favoring a disputable metaphysical view that favored themoral status of embryos over relief of palpable human suffering. Beyond that, itis difficult to see what ethical reasoning would commend a policy that takes asits central distinction the time chosen for political convenience to deliver apresidential address. Human embryos will continue to be destroyed in largenumbers in fertility clinics. Some fraction of those will be donated to research,and a smaller number still will be used to make stem cell lines, all with privatemoney. This would have been the case whatever the president had said. In anyevent, imposing an arbitrary deadline has its own costs--moral, economic,political, and scientific.
Paradoxically, getting to 64 actually required the administration to loosenethical constraints recommended by the National Bioethics Advisory Commission andthe National Institutes of Health. Rather than limiting researchers to frozenembryos left over from in vitro fertilization after a couple had had ample timeto reflect on their decision to give them up, the president's policy would simplypermit federal funding of all previously created stem cell lines from embryoscreated in excess of clinical need, whether or not they were frozen. Therequirements for the embryo donors' "informed consent" were loosened in two ways:Rather than listing the specific information that had to be given to prospectivedonors, the new policy simply required "informed consent." Nor does theretroactive policy require researchers to have waited until after the embryos hadbeen created to approach the donors; they could be asked before. (Without thesemore relaxed ethical standards, the University of Wisconsin's pre-existing stemcell lines, among others, would not be eligible for federal research funds.)Finally, the new policy does away with an ethics review panel for stem cellresearch, replacing it with a more generic Council on Bioethics that will nothave oversight powers.
Said Richard Doerflinger of the U.S. Conference of Catholic Bishops: "It's verytroubling to find that this policy may actually grandfather in cell lines thatwere ineligible on ethical grounds even under the Clinton guidelines." Nor isthere any guarantee that the committees reviewing the ethics of research withhuman subjects will accept the informed-consent statements accompanying each cellline, especially from countries whose cultural practices of informed consent maydiffer from the United States'.
Another irony of the Bush policy, coming from an administration ferventabout the virtues of competition, is that by limiting federal funding to the 64lines in existence by August 9, 2001, it locks in an oligopoly. Those few sourcesthat hold stem cell lines and can defend their intellectual-property claims incourt are assured of no new competition. NIH is the engine that drivesbiomedical research in the United States; researchers vie for federal funding,which has three great virtues: prestige, reasonable coverage of the actual costsof research, and enormous intellectual freedom. Other embryonic-stem-cell lineswill be created with private money, but researchers likely will prefer to uselines approved for federal funding. Some subset of the 64 lines will probablybecome the dominant models for basic research in embryonic stem cells for thenear future, bolstering the oligopoly that this policy reinforces.
Scientists have complained about barriers to research, too few cell lines, andthe uncertainty about how many of the 64 lines will be scientifically useful andpractically available without unacceptable conditions. Scientists, it should benoted, hold a wide range of political views. But when it comes to research, abipartisan community of scientists rallies reliably in favor of more funding withan absolute minimum of strings. Both Republicans and Democrats havesupported--and funded--an evergrowing National Institutes of Health.
If there are many scientists opposed to funding embryonic-stem-cell research,they have been fairly quiet--with one exception: David Prentice, from IndianaState University, was plucked from obscurity to became a regular at hearings, ontelevision, and in print reports, insisting that stem cells from adults wereevery bit as promising as those from embryos. One of the researchers cited insupport of this claim is Baylor College of Medicine professor Margaret Goodell,who reported in 1999 that stem cells derived from muscle were able to produceblood cells. This study and similar ones suggested that adult stem cells, ratherthan being committed to a particular tissue type, might be more versatile.Subsequent research by Goodell, however, has demonstrated that she had discoveredan unanticipated type of blood stem cells that happen to reside within muscle. InJune she said: "The science doesn't justify ... saying 'adult stem cells can doanything.'"
Misrepresenting Science
There is an interesting lesson here about science and public policy.Taking a cue from the tobacco industry, pro-life operatives learned that you donot need masses of scientists on your side. For decades tobacco lobbyists trottedout a handful of scientists who were willing to express their doubts about one oranother facet of the scientific evidence linking smoking with illness and death.The industry could then say, see, even scientists disagree. They did not botherto inform policy makers and the public that the overwhelming consensus amongscientists was that the connection was long since proven. For any given hearingor public forum, they had only to produce a scientist to say what they wanted theaudience to hear, even if the opinion was far off the mainstream scientific map.Opponents of embryonic-stem-cell research hoped to impress policy makers andinfluence reporting by having even one scientist to provide "balance," much theway the tobacco industry salted hearings and occasionally the scientificliterature with their smattering of scientist allies.
The bottom line on adult stem cells is that they are promising, and researchon them should be funded as well. But they are more difficult to gather in largenumbers, more difficult to grow in the laboratory, and--so far at least--lessversatile. Adult stem cells may turn out to be clinically important. Butknowledgeable scientists observe that research on embryonic stem cells isnecessary to learn how to grow, channel, and perhaps ultimately use adult stemcells.
Will 64 embryonic-stem-cell lines be enough? Will these lines be safe andfunction correctly? We will begin to know in the next few years, once studies onhuman subjects get under way. It will not be sufficient merely to have "goodenough" stem cell lines: Scientists and the people into whose bodies these cellsare placed will want to know that they are the very best we can design.
Imagine a government edict that prohibits drug companies from creatingor testing any new compounds and limits them to the ones they've already created.Even if research shows that tweaking the chemical structure a bit would likelyyield a better drug--fewer side effects, better therapeutic value--thegovernment's response is: "That's tough." The pressure to lift such a ban wouldbe nearly irresistible. The Bush administration must be hoping that progress isslow enough to avoid such pressures--at least until the next presidentialelection.
Behind the Lines
While there is no reason to doubt the existence of the 64 stem celllines reported by NIH, nothing guarantees that all the lines will be suitablefor research or that those who control the lines will be able and willing toprovide them to U.S. researchers. An embryonic-stem-cell line can lack some ofthe properties researchers require. The NIH list of eligible cell lines,released on August 27, shows Sweden with the most--24--and the United States with20. It is now clear that the scientific barriers set to declare a particular lineas a genuine embryonic-stem-cell line were very low. This confirms concernsexpressed by scientists that not all of the 64 eligible lines may be stable anduseful for research.
Cell lines can also come with too many strings attached. Late last year, itwas reported that Doug Melton, who works at Harvard and is supported by theprestigious Howard Hughes Medical Institute, was unable to use stem cells fromthe WiCell Research Institute, a subsidiary of WARF, the Wisconsin AlumniResearch Foundation, because of two conditions rejected by both Harvard andHughes. One gives Geron Corporation the rights to certain discoveries that arisefrom Melton's research using these cells. The other--even more unpalatable, Isuspect--gives WiCell the authority to order Melton to destroy the cells and anyexperiments using them within 90 days. Harvard, with the support of the HowardHughes Medical Institute, has since struck a deal for embryos with BostonIVF, a fertility clinic.
Geron funded the work at Wisconsin and at Johns Hopkins University that openedthe door to human-stem-cell research. Wisconsin holds the key patent on humanembryonic stem cells, and has granted exclusive rights to Geron forcommercialization of six cell types: blood, bone, liver, muscle, nerve, andpancreas. Nerve cells will be of great interest to people suffering withParkinson's disease or from a spinal-cord injury; islet cells in the pancreasfail in people with diabetes. The Wisconsin Alumni Research Foundation filed alawsuit against Geron in August. Geron wants exclusive rights to an additional 12cell types; WARF argues that Geron was obligated to make substantial progresson the six types for which it already holds the rights and has not done so.Geron, by the way, has doubters in other corners as well. A recent column postedon the Motley Fool, a popular finance Web site, was less interested in the ethicsof stem cell research than in Geron's balance sheet, which showed the companyburning through its remaining cash at a fair clip with little evidence of abreakthrough product in the near future. Scientists are understandably concernedthat disputes such as this will make it more difficult to gain access to embryonicstem cells.
Another legal morass also looms. The Wisconsin patent is very broad; itcovers both embryonic stem cells and the process for deriving them. The legalstatus of stem cell lines from other countries will need to be clarified. WARFwill want to protect its patent rights from infringement, and the holders oflines outside the United States may not want to risk costly legal battles.
At least one notable U.S. researcher, Roger Pedersen of the University ofCalifornia San Francisco, has announced his plan to leave for CambridgeUniversity and the more politically hospitable environment of the United Kingdom.If additional scientifically valuable lines are created, or if researchers findways to create lines without infringing Wisconsin's patent, then scientistsworking in the United Kingdom and other nations will have an edge over theirAmerican counterparts. Other U.S. scientists may follow Pedersen's lead.
There are two additional reasons to worry whether the 64 cell lines areadequate. Pedersen points out that mouse "feeder" cells and bovine serum havebeen used in developing current cell lines, thus creating the possibility thatanimal viruses or proteins may have contaminated those lines and made them unfitfor transplantation into humans. It will be difficult to prove that cell linescreated in this manner are free of contaminants.
At this moment, no one knows how the problem of immune rejection will behandled when embryonic stem cells are placed into the human body. Each of ourcells carries a set of markers--flags, if you like--on its outside. Our immunesystem uses these flags to tell friend from possible foe. Preventing suchrecognition and the subsequent attack on tissue identified as foreign is alifelong problem for people who receive transplanted organs. Researchers willhave to find ways to tame or eliminate immune responses to transplanted stem cellsif they are ever to become useful treatments. One of the most likely ways toaccomplish this is to create a catalog of stem cell lines representing all thesets of flags (or, if you want to be scientifically precise, the majorhistocompatibility complex alleles) likely to be found. This might requirehundreds or even thousands of lines.
We do not yet know how broad an array of flags is represented in those 64existing lines, but there is no guarantee that they cover a broad spectrum. Withthe current limited set, some Americans might be fortunate enough to find goodmatches; many others might not. And because particular flag combinations show upwith predictable frequency in different populations, it could be that theout-of-luck folks are disproportionately from specific ethnic groups. Imagine theoutcry, the deep feeling of injustice, if Americans whose ancestors came fromsouthern Europe, or Africa, or Asia found that there were no good matches forthem in the available pool. Depending on the extent of the mismatch, they mightnonetheless be offered stem cell transplants; but they might have to take higherdoses of drugs to ward off immune rejection and endure all of the side effectssuch higher doses bring. In this scenario, entire groups of Americans would becondemned to inferior therapies, solely as a consequence of the president'spolicy dictum. Any or all of these factors may challenge the stability of theWhite House policy on stem cell research.
An Embryonic Split
The most significant and lasting political effect of the debate overembryonic stem cells may be its role as a wedge dividing usually reliable alliesin the anti-abortion camp. Conservative commentator George F. Will hailed theaddress as one that "changes American politics profoundly." Will may be morecorrect than he realizes. In lofty language more suited to a college commencementaddress than a political column, he applauded Bush's "measured and principled"position as far better than any compromise. Rather, he wrote, it is nothing lessthan a "solution ... in strict fidelity to his campaign promise" not to fundresearch "that involves destroying living human embryos." He further assertedthat the president's critics are "in danger of embracing extremism." In hisapplause for Bush's statement, Will has plenty of company on the right, includingPat Robertson, Jerry Falwell, and James Dobson of Focus on the Family.
But there is serious grumbling in the right-to-life camp. Columnist Cal Thomascomposed a screed condemning the Bush policy as "fruit of the poisoned tree"--adoor opened on a culture headed to perdition ever since Roe v. Wade. Thomascompared Europe's exterminated Jews to the "millions of unborn babies" who "hadthe bad luck to be conceived in the anti-life era that began in 1973 ... but hadits roots in an anti-God culture which began decades earlier." Why not, Thomaswonders, kill the elderly and the infirm, or the relative whose estate you aretired of waiting to inherit? The logic, he writes, starts with using embryos forresearch and carries us relentlessly onward to euthanasia and beyond. The RomanCatholic bishops have been consistent in their criticism, and the editor of aCatholic magazine laments the decision to fund embryonic-stem-cell research as a"descent into chaos, barbarism, anarchy, tyranny and death." So much for unitywithin the pro-life movement.
It was no accident that one of the earliest important voices amongabortion opponents to support embryonic-stem-cell research was a Mormon,Republican Senator Orrin Hatch. Mormon theology holds that all of us begin asspirit children of God; our earthly lives begin when our spirit is united withour physical body, and that may not coincide with conception. (It is misleadingto refer to the "moment" of conception, as the actual process is complex,involving multiple steps over a period of time.)
Doerflinger, of the U.S. Conference of Catholic Bishops, derided as"amateur theology" the efforts of another Mormon senator, Gordon Smith of Oregon,to distinguish between the flesh and the spirit in the creation of life. In asimilar vein, he ridiculed Senator Hatch as claiming that there is "somethingmagical about the mother's womb," alluding to the Utah senator's argument that anembryo frozen in liquid nitrogen is different from one implanted in a woman.Doerflinger said one more thing worth noting. Acknowledging that he cannotpersuade Senator Hatch to abandon the tenets of his faith, he concludednonetheless: "I don't think he should make the rest of us fund this researchbased on them." Or refuse to fund it?
It isn't only Mormons within the nominally pro-life camp who supportembryonic-stem-cell research. Just as defenders of a woman's right to abortionfound that not all who shared their general view were equally ardent in theirdefense of late-term abortion, not all abortion opponents are equally convincedthat the (relatively) clear and bright line of fertilization marks theindisputable beginning of a human person. Whatever your stance on abortion, youcan believe that human embryos even in their first few days of development aremuch more than mere pinpoints of human tissue, though not identical physically ormorally with children or even fetuses. Indeed, that statement, vague as it is,probably describes roughly what most Americans believe.
The anti-abortion movement has been able to escape confronting latentdisagreements over the moral standing of frozen in vitro human embryos--untilnow. The debate over embryonic stem cells has brought the fate of excess in vitrofertilization (IVF) embryos before the public as people are increasinglyaware that embryos are routinely created through IVF, frozen, and discarded.Some are flushed down the drain, some taken out as medical waste, others thawedand permitted to expire on their own. The precise number of embryos destroyed inthe United States is not known, in part owing to the astonishingly minimalregulation of IVF and related reproductive technologies. Britain has recordedsome 50,000 IVF births since 1991, with nearly 300,000 embryos discarded. TheAmerican Society for Reproductive Medicine estimates that roughly 100,000 babieshave been born through IVF in the United States. If the same ratio holds hereas in Britain, approximately 600,000 embryos would have been destroyed in thelast decade.
Where, you might ask, is the outcry over the mass murder taking place ininfertility clinics? The moral logic seems inescapable: If you believe that humanembryos are persons, then their intentional destruction is a grievous moraloffense. Disposing of an embryo after five years in the Deepfreeze is morallyindistinguishable from aborting a mid-trimester fetus, or killing a child or anadult. Yet there is no broad social movement to condemn in vitro fertilization,to close the clinics performing it, or to harass or intimidate the physicians whowork there. Nor are there crowds of demonstrators accusing couples who enter suchclinics of being murderers.
The Catholic Church has been consistent in its disapproval of IVFbut has not chosen to highlight its position to the American public or to expendpolitical resources to try to stop the practice. The National Right to LifeCommittee has gone lately from saying that IVF "is outside our purview" torefusing to comment in a recent Christian Science Monitor story on theincreasing calls for regulation of fertility clinics.
The truth is that most Americans probably do not agree with the founder of theSnowflakes Embryo Adoption Program that frozen embryos are "pre-born children,"nor with his employee who asserted, "We believe life begins at conception, soevery one of these frozen embryos is a baby waiting for a home." In his August 9address, the president borrowed the snowflake metaphor to describe embryos.According to the Snowflakes Program, eight children have been born thus far fromits "adopted" embryos, with seven more on the way (being carried by four women).We can take delight when people have a wanted child, rejoicing for them and fortheir baby. But that does not oblige us to believe that every single one of the150,000 or 200,000--no one knows the actual number--frozen embryos in the UnitedStates must be placed in a womb, or that choosing to thaw an embryo withoutimplanting it is murder.
Ethical Threads
Thinking responsibly and sensitively about human embryos is not easy.Some years ago, when I was writing The Worth of a Child, I tried a thoughtexperiment: Imagine some new fact or argument so utterly persuasive that itcaused virtually all persons on one side of the moral-status-of-the-embryo divideto acknowledge that they had been wrong all this time and that, yes, the otherside was correct.
Maybe my imagination is defective, but I don't see that happening. For onething, there seems little or nothing new to be said. For another, there is faintprospect that great masses of people would turn 180 degrees on a metaphysicaldime.
Note that I did not say which side was changing its mind. A philosophicalconversion is equally unlikely for both. You can recruit a variety of scientificevidence, moral arguments, or metaphysical claims to support whichever positionyou hold. Treating folks who disagree with you as mental (and moral) midgetsaccomplishes nothing worthwhile. It would be far better to reflect on the centralthreads of the tapestries formed by our images of good lives for women, children,and men, the reasons we value families, and the losses we most fear. I believethat we would find important differences between the threads of those who assertthat embryos, even those immersed in liquid nitrogen, are morally identical withborn children and adults and the threads of those who discern a distinction.These differences likely will have to do with whether good lives for women andfor men are fundamentally similar or distinct; whether men are capable ofnurturing and women of competing; whether women are meant to raise children whilemen, in Newt Gingrich's unforgettable description, are meant to hunt giraffes.
If the dispute over funding research on human embryonic stem cells brings tolight some of the implications of the view that embryos are full and completemoral persons and holds those implications out for public inspection, that willbe useful. If it leads to closer scrutiny of the infertility industry, that willbe good. If it prompts us to look deeply into the tapestries that inform andorder our lives and examine their relationship to public debates over abortion,affirmative action, and family policy, that will be an extraordinarily valuableoutcome.
