Discussing
Whatever happened to the stem cell debate?

Michelle Crotwell Kirtley

Melayton
December 12, 2011

This is the topic that I personally have struggled with. There are some hefty philosophical and theological questions involved here. Three that spring to mind, along with my (very provisional!) position on each:<br><br>&lt;ol&gt;&lt;li&gt;<b>Is a human clone distinct from the person who donated the source cells?</b> Human life is usually recognized as a new thing, a combination that did not exist beforehand, and since it is fundamentally human (if it is; not touching that question when I'm still loopy from decongestants!), the embryo is treated with the respect owed all humans.<br><br>But is a clone a unique human? What makes it different from, say, hair clippings or exfoliated skin cells? Okay, bad example, because those cells are dead, but what if you took my white blood cells, encouraged them to reproduce in a lab environment and then reintroduced them into my body? We don't necessarily think you are killing a person, though the cells are genetically human, there.&lt;/li&gt;<br><br>&lt;li&gt;<b>Does an embyro (cloned or otherwise) truly exhibit the image of God?</b> The Latin root <i>imago</i> (can't speak for Hebrew, unfortunately) has the connotation of characteristics - traits actually possessed, not traits you will express at some point in the future. Mature humans have this, but it's not all that clear to me that immature humans (certainly clumps of embryonic, genetically-human cells) can be said to bear God's image, in the same way a mature, decision-making human would - just because they don't have any of the <i>traits</i> we associate with the <i>imago dei</i>.&lt;/li&gt;<br><br>&lt;li&gt;<b>Does an embryonic clone truly have the potential to become human?</b> One way of answering the point above is that embryos have the potential to bear the image of God, even if they can't at their current point of evolution. No special miracle or evolutionary step forward necessary. Even if that's a fair point for most embryos - you know, naturally-conceived ones, or those resulting from IVF - I'm not sure it is for clones. As I understand it, the laboratory setup takes great pains to make sure the embryo will <i>never</i> develop past a certain level. And even if not for the lab safeguards, I know in other species they've shown that clones - not for stemcells but actually trying to produce organisms - only lived a few years. I suspect a strong case could be made that, at least right now, a clone that was allowed to mature wouldn't ever be able to exhibit those characteristics we connect to <i>imago dei</i>.&lt;/li&gt;&lt;/ol&gt;<br><br>These are very provisional answers, and I suspect that others could answer them better than I can. But I suspect that a Christian could make a very good case that embryonic cloning should be supported, even working within a framework of Christian ethics.<br><br>That said, I think you're absolutely right about the proper respect we need to have for science, and the need to regulate it. I think those factors need to be there before we can even have a meaningful discussion on the kind of questions I raise. If you believe science is a danger to faith, why risk getting into these dangerous (but oh-so-important) metaphysical questions about the proper use of it?

Mara
December 12, 2011

I find it noteworthy that the author does not actually apply her principles to the debate herself but rather jumps to a conclusion she would like others to agree with and presents it as if it were the only possible answer. I think there is much room for thought on this issue if people can be open minded. <br><br>Primarily I feel that claiming that stopping embryonic stem cell research will stop nascent human death is like saying you can stop people from dying from car crashes by stopping the organ donor program. <br><br>Current legislation in North America and most of the world, prevents the creation of human embryos solely for research. Embryos in the USA and Canada currently used in researched come from embryos produced in legal fertility clinics. <br><br>Childless couples need the guidance and support of their faith community in the difficult decisions to be made. When the in-vitro fertilization process produces too many embryos for any number of reasons they have few options: store them at a cost indefinitely; implant them all, which is sometimes impossible or dangerous; find an adoptive family, often impossible; allow them to be destroyed (thawed) or donated to scientific research to have the stem cells extracted. <br><br>Research Labs are using donor Embryonic Stem (ES) cells from embryos that would be destroyed and have no option for viability, or continued storage in either case. Clinics are getting better with time at reducing the number of wasted embryos as well but that number will never be zero. <br><br>My information is that at around five days, or upon thawing, the undifferentiated blastocyst needs to implant in the mother’s womb and receive hormonal input to continue to develop or it will die, a womb, that complicated internal universe created by God that science has not managed to duplicate. <br><br>God’s design of ES cells is truly amazing. When prompted to divide they produce one cell of whatever is needed - a neuron, muscle cell, skin cell, etc - while the other cell produces a new fresh ES cell with the potential to become anything else based on new input. Other types of stem cells do not retain this level of plasticity. An ES cell line can produce a great deal of good from a very small amount of starting material. <br><br>All that will happen by shutting down the embryonic stem cell research is that sick people will suffer a longer wait for a cure and die waiting. The same embryos will die, only now they will be left out to thaw leaving no legacy to science. They will save no lives. In the death of these embryos there will be no redemption. Churches will continue to thank God for the children born with help fertility clinics and put in prayer requests for the sick and dying who could have been helped by accepting the donor tissue when it was available. <br><br>The position I am quickly coming to is that if we live in a society where human embryos are created and destroyed as a process of the fertility industry then it is a disrespect to God’s creation to discard the healing power of their donated stem cells if we cannot find ways to provide them a viability of human life. <br><br>I propose there are some who should set aside their squeamishness and stop telling those with  Epilepsy and Parkinson's etc to be Christlike and suffer so they can sit in a peace of mind bought on the fallacious argument that embryos will be saved.<br>

Jason Summers
December 12, 2011

Mara,<br><br>You articulate that argument well and also the hypocrisy of certain churches who accept fertility treatment while rejecting embryonic stem cells as a possible medical treatment.<br><br>Of course, that argument is utilitarian in form. The most principled among those who reject use of embryonic stem cells also reject fertility treatment (e.g. Leon Kass). I may not agree with them, but from a deontology based in imago dei, they articulate a consistent position.<br><br>Of course, as you note, their views are not reflected in current laws and probably never will be. So, if politics is the art of the possible, ought we not try to seek the greatest good possible? That would favor a utilitarian argument like yours. But should we still if doing so would, as the deontologists suggest, make us monsters?<br><br>In the end it is a thorny political problem of competing moral and truth claims. Government must protect these consciences of all citizens, but it is not necessary that it abide by the most restrictive requirements among them.<br><br>is

Rickd
December 12, 2011

The issues aren’t clear to me so I may be just adding to the general confusion. However, it seems to me that just because embryos are implanted in infertile couples and there are extra embryos left over which are usually destroyed does not mean that we should begin to conduct experiments on them. For example, if we determine that people in a coma in the hospital are truly brain dead, we don’t take that as license to begin experimenting on them. They are allowed to cease bological activity with respect and dignity. There is an organ donor program that is safeguarded with explicit consent and very limited usage spelled out. But the idea of using embryos as ongoing subjects for stem cell experimentation just seems to lack respect. I could be wrong, but that is my thought.

Mara
December 12, 2011

Why would you feel like a monster for using donor ES cells from Embryos that were going to be destroyed anyways? <br><br>Would you feel like a monster if your child needed a kidney transplant?<br>

Mara
December 12, 2011

The individual embryos are destroyed in removing the stem cells just as the ventilated brain-dead donor patient technically dies during a heart transplant. The embryos would otherwise just be left out to thaw at the clinic, to be destroyed with the cells not donated. Informed consent from the biological parents is needed just as next of kin consent is needed in the organ donor program. <br><br>The donor ES cells then go on to have the potential to help find a cure for diseases like Alzheimer's and Diabetes. I guess respect is a personal point of view.

Jason Erik Summers
December 12, 2011

Mara,<br><br>It's not my position that I'm articulating, but if (1) one's ethics are based on rules he or she should never violate (deontology), and (2) not taking human life is a rule (or, similarly, that people are always ends, not means), and (3) one believes that any fertilized egg is human life, then embryonic-stem-cell treatment violates the rule. Utility or greatest good simply are not a part of that moral framework.<br><br>You can find similar moral logic among pietists and pacifists. Even if fighting a war will save more lives than it will take, a pacifist will refuse to fight---not withstanding that choosing such will not reduce the total deaths. Fighting would make them a moral monster in their eyes, even though, as just-war theorists might see it, they harm the common good by choosing not to fight.<br><br>js

Lydia Allen
December 13, 2011

Michelle, I appreciate your thoughtful article, but I feel I must point out a few things.<br><br>(1) Most scientists are not Christians. Most of us (yes, me. I'm a neuroscientist) are secular humanists. We have a set of morals that we follow which are based on real world observations, not on 2000 year old metaphysics. For instance, we know that an embryo has neither sentience nor sapience because it lacks a sufficiently developed nervous system. As such, it has no personhood and deserves no special consideration when it comes to medical technologies that can alleviate the suffering of those who *do* have fully developed nervous systems.<br><br>(2) Embryos not utilized for research go in the trash. That's right. When IVF embryos sit in the freezer long enough, they get freezer burn. They then go in the trash. So, why not use them for medical technologies? Refusal to use the cells isn't saving any of the embryos.<br><br>(3) Science is very tightly regulated for ethics considerations. Universities have ethics committees in place, scientists and doctors have professional organizations to which they belong, the NHS has regulations in place, etc. To presume "a principled approach to the regulation of technology" is even needed at this point is to belie not having any experience in the practice of science.<br><br>(4) When Obama reversed the executive moratorium that Bush ordered, it set off a legal cascade such that the legality of Federal funding for this research is now working its way through the courts. That's why you haven't heard much about it recently. Meanwhile, Harvard and the University of California schools are privately funding this vital research because they understand that it is important for millions of people.<br><br>(5) If you disagree with the research, then should the need ever arise, you should refuse treatment. You don't have the right to take that option away from me based solely on your religious conviction.  I don't share your convictions, and I live in a country that allows me to dissent. And thank goodness that is the case. How would you feel if Jehovah's Witnesses tried to enforce a ban on research into blood work or blood transfusions based on their religious convictions? Do you really want to die on an operating table because you can't get the blood you need? Would you want that for your child? No. You would probably find it infuriating to know that a vital medical technology was being denied to you because of someone else's dogma. That's how I feel about Christian interference into science and science policy-making that they don't fully understand or appreciate. If you have *secular* ethical reasons, that is one thing. But if all you have is religion, then you are attempting coerce me and others like me in an inappropriate way. We live in a liberal democracy that guarantees us a right to practice our ethical convictions. Mine tell me that it is wrong not to develop *any* technology that helps people without harming other people. The key word here is "people,"  and embryos are not people.

Jason Erik Summers
December 13, 2011

Lydia,<br><br>Thanks for this set of comments. I also disagree with Michelle on some of the issues (or at least her treatment of the issues). But, at the same time, I think your line of reasoning falls into certain traps also. I want to highlight two here.<br><br>First, you make a reasonable point regarding IRBs, ethics codes of professional organizations, and the like---all of which I am well familiar with. But the scope and mandate of these institutions differs quite a bit from what Michelle is advocating. For example, ensuring compliance with principles articulated in the Belmont Report---while important---is not equivalent to considering long-range consequences of technology development. IRBs are, for the most part, ad hoc and local; they are ill-structured and ill-equipped to address questions about the future direction of research in particular fields. In other words, assessing whether a method or even an entire study is ethically justified is not the same of as addressing the broader "should we?" question that Michelle is advocating ought to accompany the scientific "can we?" question. <br><br>Moreover, while some fields are moving ahead in this regard, physical scientists, for example, have no real oversight of their work except where experiments directly involve humans or animals. Technology is never ethically neutral. Yet, save the efforts of individuals, little is done to ensure technologies will actually serve society.<br><br>Second, I want to address the question of pluralism. I agree that government should not impose the ethical standards of a particular group on all. Nor should government impose a collective standard on every group where doing so would violate the deeply held beliefs of the group. But it is not reasonable to suggest that there is some absolute ethical ideal that is somehow secular and therefore universal (cf. Clouser's The Myth of Religious Neutrality). Certainly that was Kant's project, from which documents like the Belmont Report have inherited much. But such documents were also shaped by religious ethics (see the author lists for evidence). That is reasonable, because it is essentially impossible to make ethical statements without appealing to one's most deeply held beliefs, whether they be formally religious or not. This does create a challenge for the public realm when trying to ensure justice for all members of society. However, I'd suggest that laicite, by selectively suppressing public expression of certain deeply held beliefs, offers no better solution.<br><br>Finally, regarding your second point above, it is important to understand that not all people accept utilitarian ethics. While it is certainly a dominant mode in society at present and seems to offer a perspective that is "neutral" and "secular", it seriously conflicts with the deeply held beliefs of some individuals. The U.S. has a long history of recognizing and protecting such beliefs (for example in excepting certain groups from military service). To argue that the decisions of such groups to abstain from particular behaviors achieve little or nothing misses the point of their objection, which is not at all rooted in a calculus of utility.<br><br>js

Michelle Kirtley
December 13, 2011

<br>Mara,<br><br>Thanks for your comments.  It's true that I did not show <br>how the principles I outlined led me to the conclusion I drew about the <br>EScell debate (in part due to space reasons), and I apologize for <br>thereby trivializing what is definitely a complex issue.  <br><br>A couple of comments.  <br><br>First,<br> federal law in the US is actually quite different from Canadian law <br>when it comes to research on human embryos.  In the US it legal to <br>conduct research on human embryos of any kind, regardless of the method <br>used to create the embryo.  In the US the debate has centered on what <br>the federal government should fund.  The US does have a prohibition on <br>federal funding for research in which a human embryo would be harmed or <br>destroyed, which in essence does prohibit government funding for <br>creating human embryos.  In Canada, on the other hand, the creation of <br>embryos for research is prohibited, while research on discarded embryos <br>from fertility treatment is permitted.  While I may not fully agree with<br> Canada's policy, they have actually done what the US has not: They have<br> thoughtfully considered an emerging technology and enacted policies <br>accordingly.<br><br>Second, on the issue of the embryos leftover from <br>fertility treatment, in my view, this is a case where "two wrongs don't <br>make a right."  Ultimately, I think it is a tragedy that there are <br>several hundred thousand embryos "in limbo."  Had we more thoughtfully <br>considered, debated, and then regulated IVF (which remains unregulated <br>at the federal level), we could have minimized the number of embryos <br>"leftover."  In Louisiana, doctors are permitted--per couple-- to create<br> only as many embryos as they intend to implant.  Such a policy would <br>have greatly reduced the number of embryos currently in storage.  <br><br>While<br> I can see how the analogy to organ donation makes sense at one level, <br>comparing the two situations leads me to very different conclusions.  In<br> the case of organ donation, we have very carefully crafted regulations <br>to ensure that the donor is in fact "dead."  Donors die because they are<br> beyond medical intervention.  The means of their final hours may be <br>altered so that the donation can proceed with the organ intact and <br>living, but ethicists and physicians go to great lengths to be sure that<br> the person could not otherwise live.  This is clearly not the case for <br>embryos in the freezer.  Leaving aside for the moment the fact that they<br> are no longer wanted by their parents, many of these embryos, had they <br>been implanted, would have lived.  Some of these--although certainly not<br> most--would still live were they to be implanted today.  This fact--the<br> life trajectory for the organ donor versus the embryo--separates the <br>two situations in my view.  <br><br>Yes, they are unwanted and we don't know <br>what to do with them, but that does not therefore make it permissible to<br> use them for research.  Even if one were to adopt a utilitarian <br>position, I would hope that our view of human dignity--as a society-- <br>would be such that we would only allow human life to be sacrificed if <br>these two conditions apply: (1) That this is the only way to accomplish <br>the desired outcome (in this case, curing people of debilitating <br>diseases) and (2) That the prospect of success is extremely high.  <br>Embryonic stem cell research from IVF embryos meets neither of these <br>criteria. The advent of IPS cells (induced pluripotent stem cells, <br>embryonic-like stem cells which are programmed back from more developed <br>cells) have opened a potential alternative path to the use of embryos, <br>and the success of any of these techniques at all is speculative at <br>best.  In fact, few scientists expected treatments to emerge directly <br>from EScells derived from leftover embryos.  This has long been seen as a<br> stepping stone to other regenerative medicine technologies.  So, even <br>from a utilitarian point of view, the cost/benefit analysis becomes very<br> murky when trying to balance--as some see it--the competing dignity <br>claims of an embryo and a suffering patient.<br><br><br><br>--Michelle

Mara
December 13, 2011

Michelle,<br><br>Thank you for replying,<br><br>There are a few things of which I am most certain.<br><br>Tomorrow more embryos will be destroyed in your country and mine despite your objections and they do have much potential to solve and repair tissue even if you want to claim they don't. I take my neurologist's word for that over yours. Sorry about that.<br><br>Q-ideas "Sanctity of Life" article just made an excellent case that Levitical Law indicating that life begins with blood and since 5 day old blastocysts don't have blood cells Biblically there is a good argument to be considered there.<br><br>The chances of me dying waiting for a cure is very high while people argue that we should let the embryos die in the trash because it provides more sanctity of life or try to convince private clinics to maintain unwanted embryos without being paid on moral grounds to a moral code the may not share.<br><br>Thank you for your article. This is more than a hypothetical argument for me. I have a form of epilepsy that could kill me in my sleep so I take the issue rather seriously.<br><br>My Utilitarian reality is a tad more real in this regard than most folks. My Jesus healed on the Sabbath, touched the bleeding, lepers and the dead and all kinds of things that were not Kosher at the time.<br><br>- Mara

Josh Larsen
TC Staff
December 14, 2011

FYI, the Q Ideas article Mara is referring to can be found here: <a href="http://bit.ly/unFh92" rel="nofollow">http://bit.ly/unFh92</a>

Lydia Allen
December 17, 2011

Jason-<br><br>The "we can, but should we" argument is best left to scientists, philosophers of science, and bioethicists... not lay people.<br><br>Lay people believe things like "evolution means social darwinism" and "global climate change isn't happening". In short, these people are ill educated and untrustworthy.<br><br>I recently completed a graduate course called Science and Democracy plus a course called Church and State. (I'm getting ready to apply to PhD programs in philosophy/history of science/neuroscience.) We talked extensively about the role of government in science funding and regulation, and my position lines up with Rawls' later doctrine of religious restraint:<br><br><a href="http://plato.stanford.edu/entries/religion-politics/#Raw" rel="nofollow">http://plato.stanford.edu/entr...</a><br><br>In my opinion, it is perfectly acceptable to leave people with intolerant/dogmatic religious beliefs out of the conversation in a plural, liberal democracy. People who are unwilling to compromise or recognize that their particular belief is oppressive of others are dangerous to democracies that value liberty. If such people feel that they must live out their convictions, then they should refuse participation in procedures that they find morally unacceptable. Jehovah's Witnesses regularly refuse blood transfusions, but they are not allowed to make that choice for the rest of us. The same should be true for stem cells. If you morally disagree with this technology, then don't use it. The rest of us, however, will make that decision for ourselves.

Jason Summers
December 17, 2011

Lydia,<br><br>Thanks for your thoughtful reply.<br><br>I'd say that's a wise choice in your direction of study, particularly as the intersection of philosophy of science and neuroscience seems to me to be in the place today where quantum mechanics was over fifty years ago. <br><br>It's helpful of you to bring up Rawls's views and the link to the material at Stanford. As you might imagine, both I and (I suspect) Michelle are sympathetic to some aspects of MacIntyre's critique of liberalism as well as Wolterstorff's arguments that rights can be properly grounded only in religious thinking.<br><br>I am not quite as optimistic as you in a Rawlsian vision of justice because I don't believe that any reasoning is ever fully "secular" nor that a veil so thick could ever exist that it turns people into isolated individuals rather than members of diverse and related institutions.<br><br>My old professor Brint might (far more eloquently) say that we are stuck with differences that cannot be reconciled as a Rawlsian liberal vision might imagine and must recognize the tragedy of pluralism.<br><br>I'm more hopeful that a robust and principled pluralism can be based on recognizing our legitimate religious plurality, but I think more than Rawls's laicite is needed to get us there.<br><br>js

Lydia Allen
December 18, 2011

"rights can be properly grounded only in religious thinking"<br><br>(1) What does this mean? Are you including philosophies such as secular humanism in your term 'religion'?<br><br><br>(2) Whose religion? Is there any legitimate reason to prefer one over another? <br><br>(3) We MUST attempt a Rawlsian approach to public reason if we are to get along. You simply cannot avoid pointless squabbling over theological commitments unless you agree to dismiss those points upon which people will never agree and try to find honest common ground. A commitment to liberty needs to be central to anyone who chooses to participate in American politics. Our Constitution guarantees it. Those "traditionalists" who would deprive me of my rightful liberties (the central one being freedom of conscience) are destructive to liberty, are dismissive of plurality, and are, in short, tyrants. I will not accept tyranny in a liberal democracy such as ours. I will especially not accept religious tyranny when I have the 1st Amendment to protect me. To me, the stem cell debates (and the way in which George Bush went around the legislature process by issuing an executive moratorium) are a worrisome development in the way in which we view and treat individual's liberties.<br><br>Again, you are free to decline any medical technology you feel is inappropriate for your moral system. You are not free to decline these technologies *for me*.

Jason Summers
December 21, 2011

Lydia,<br><br>To your point 1: yes, this includes secular humanism. And this inevitable religious basis for rights is Wolterstorff's claim. The notion is that one cannot extract one's beliefs from their grounding in basic beliefs and, as such, all thought is religious in character (i.e., is shaped by basic beliefs). There really cannot be the kind of naked public square of isolated individuals Rawls imagined.<br><br>To your point 2: all religious views. This is the nature of religious freedom in a pluralistic society. And, of course, we all have reasons to prefer our own religious beliefs over others. I happen to believe mine are correct, as I'm sure you do regarding your own.<br><br>To your point 3: Rawls approach might work well, but we'll never know since we cannot become isolated individuals with no basic beliefs (MacIntyre and Wolterstorff again) and a religiously neutral (i.e., free of commitment to basic beliefs) dialog can never occur. However, I don't believe we need to create a naked public square in order to achieve pluralism and ensure freedom of conscience. In fact, I'd argue that a naked public square deprives people of liberty by limiting their expression of their religious belief. A tyranny of religious belief is no different from a tyranny of secularism. Both remove the religious freedom of groups that oppose the religious norm imposed on the public square.<br><br>Finally, N.B., I am not trying to impose my religious belief on you or anyone. Rather, I'm just arguing that everyone should be free to make moral arguments based on their religious beliefs since it is impossible for them to do otherwise.<br><br>For example, I think your arguments are based in a basic belief in the autonomy of the individual being primary in moral considerations together with a basic calculus of utility. That is not the basic belief of all people, including those with no formal religious commitments. However, I would be quite outside my rights to suggest that you cannot use such basic beliefs as grounds for your moral arguments, just as you are outside your rights to suggest that others cannot use their basic beliefs as grounds for moral arguments.<br><br>js

SiarlysJenkins
December 22, 2011

I am not a scientist, although I have a good general background in science. Nor am I a secular humanist; I am a heterdox monotheist who leans toward Christian because it is familiar, and because I don't aspire to impose a fixed set of rituals on my day.<br><br>I agree that "an embryo has neither sentience nor sapience because it lacks a <br>sufficiently developed nervous system. As such, it has no personhood and<br> deserves no special consideration when it comes to medical technologies<br> that can alleviate the suffering of those who *do* have fully developed<br> nervous systems."<br><br>I disagree that "The 'we can, but should we"'argument is best left to scientists, philosophers of science, and bioethicists... not lay people." I come from a long line of lay people, including a great grandmother who belonged to the Church of Christ in Tennessee, some who fought in the Revolution, some who fled pogroms in Europe shortly after 1900. I respect scientific inquiry, but I am wary of experts saying "I'm an expert, take my word for it." An expert should be able to apply their expertise in such a manner that they can explain their findings to a lay audience, in a manner that is both respectful and understandable. That's what I would expect of an expert witness, were I serving on a jury. That's what I expect in public debate.<br><br>Ultimately, the good and bad results of any course of action are going to fall on all of us, expert, lay, and other. Give us the benefit of your expertise, and then we will ALL make the decision together, for better or for worse.

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