The American editors of this volume have put together a workmanlike collection of essays on the technology used in the production of embryonic stem cells in the laboratory, and the ethical issues that they believe to proliferate round any decision to permit or prohibit the production of stem cells, or their use for research.
The book is part of a series entitled Basic Bioethics, designed to present innovations in science and the ethical problems they may raise to a broad and generally non-scientific readership. The essays are therefore intelligible to lay readers (though, inevitably, some are better written than others). The editors all come from the Graduate Theological Union in Berkeley, California. They first became interested in the problems here explored when the union was approached for ethical advice by a biotech company, the Geron Corporation, which had begun to work on the derivation of human pluripotent stem cells in 1998.
Stem cells have the capacity for prolonged, perhaps never-ending, self-renewal in the laboratory, and can be caused to develop either into many or all of the 216 types of cell that make up the human body. Scientists and ethicists in the United States make much of the difference between pluripotent cells that can develop into only some of the normal cell-types, and totipotent cells that can, in principle, develop into any of the cell-types, and that could therefore, in principle, develop into a complete human being. (In this country, the words pluripotent and totipotent are used more or less interchangeably.) Ethical problems arise because the most useful stem cells come from embryos, either those left over, surplus to requirements, in an IVF procedure, or specially brought into being in the laboratory by cell nuclear transfer - the first step in the cloning experiments that resulted in the birth of the famous sheep Dolly, at the Roslin Institute outside Edinburgh. In either case, once the stem cells had been removed, the embryo from which they came would be destroyed.
Those who regard any human life at whatever stage of development as morally "sacred", that is deserving of protection against destruction, are of course totally opposed to research, however beneficial in the conquest of disease or the treatment of injury, that involves the deliberate destruction of embryos. Others believe that it is only the bringing into existence of embryos with the already-formed intention of destroying them (in contrast to bringing them into being as part of a fertility treatment, and subsequently finding that not all are needed for implantation) that is morally abhorrent. Others again, who take a more gradualist view of the moral status of the human being, regard the method by which the embryo is brought into existence as a matter of indifference. Provided that the embryo is destroyed at an early stage of its development, and that there is a good chance that medical benefit will result from such procedures, they are justified.
These moral issues, concerned with the status that should be accorded to the human embryo, whether from the earliest stages or thereafter, and the moral weight that should be given to possible medical developments such as cell transplant in cases of degenerating or damaged organs, are explored in the essays. One of the most useful is that contributed by John C. Fletcher, who examines the conclusions of the American National Bioethics Advisory Commission, called on by government to examine the moral issues arising from stem-cell research using "spare" embryos. They concluded that such research was justified on the grounds that it would be beneficial, and sought to answer the "conservatives" who oppose abortion as well as the deliberate destruction of embryos in the laboratory by pointing to the fact that abortion is permitted in cases where manifest harm would come from the continuation of the pregnancy, arguing by analogy that the destruction of embryos could likewise be permitted where manifest good would come from it (which they presumably equate with harm coming from not using the embryos). Fletcher has some powerful arguments against this line of reasoning, and some suggestions for what their conclusions should have been. In the course of his paper, he sets out the moral issues extremely clearly.
Another excellent contribution is that from Erik Parens, a philosopher from the Hastings Centre for Bioethical Research, who critically examines the assumption that one can separate the issue of embryo research in general from that of research using human stem cells (the line taken by President Clinton, who, bowing to political pressure, opposed the former but, perhaps bowing to commercial pressure, supported the latter). This is a fascinating example of philosophical acumen being brought to bear on public policy-making.
Other papers present the issues from various points of view: Roman Catholic (surprisingly "liberal"); Jewish (almost unintelligible, unless one is familiar with Jewish law); feminist; and sociological. It makes altogether a well-balanced collection, and a quite useful source book for anyone interested in the debate in the US. But, by an unfortunate accident, the collection was published before the most recent and dramatic developments occurred.
In August 2001, President Bush announced that stem-cell research would be federally funded, but only if it involved 60 cell lines already established (the embryos from which these cell lines were derived having already been destroyed). No new embryos or new cell lines could be used.
This was a desperate attempt to effect a compromise between those who were wholly opposed to the destruction of embryos and those who were determined that the US should not be left out of the international race to develop new knowledge and new drugs. But it was, as it turned out, a futile move; it was not clear that the cell lines in existence were useful for research; it was not even clear that they were accessible. Some had already been patented by the University of Wisconsin, in collaboration with a private biotech company. In any case it seemed absurd, if the destruction of embryos for the sake of scientific research was wrong and therefore not to be funded, to fund such research on the grounds that the embryos in question had been destroyed before a particular date.
Then, in November, scientists at Advanced Cell Technology in Worcester, Massachusetts, announced that they had succeeded in creating the world's first cloned human embryos. Admittedly these embryos did not survive beyond the six-cell stage; nevertheless, if this had happened earlier, it would surely have been something for discussion in any such collection as this.
The book is concerned exclusively with the US. And this is, for British readers, one of its drawbacks. In this country we have had new legislation specifically to prohibit the development of human clones (in somewhat over-reactive response to the claims of the Italian professor, Severino Antinori, to have found a partner to help him clone human babies in Britain); and at the beginning of 2001 we passed regulation to permit the use of human embryos for stem-cell research (though this has to be further debated; and no applications for a licence to carry out such work have yet come to the Human Fertilisation and Embryology Authority). But if these regulations were upheld, the prospects for valuable research in this country would be far more hopeful than they are across the Atlantic.
This leads to a final reflection: in the US, while federal funding may be withheld or ineffectively and partially allowed, private companies are entirely without regulation, and may do whatever they think they can afford. In this country all research using human embryos, however funded, is subject to regulation by the HFEA; none can be carried out without licence, and all are submitted equally to inspection. Some breaches of the 1990 act, which set up the HFEA, constitute criminal offences carrying penalties of up to ten years in prison. Reading the arguments in this collection of essays, it is impossible not to conclude that our way, in this particular respect, is better.
Baroness Warnock chaired the government Committee of Inquiry into Human Fertilisation and Embryology, 1982-84.
The Human Embryonic Stem Cell Debate
Editor - Suzanne Holland, Karen Lebacqz and Laurie Zoloth
ISBN - 0 262 08299 3 and 58208 2
Publisher - MIT Press
Price - £48.95 and £16.95
Pages - 257