Stem cell research: the failure of bioethics

by Don Marquis

In recent years the issue of human embryonic stem cell (hereafter HESC) research has engendered fierce debate. Some object to HESC research because they say it involves taking a human life. Others argue that its prospective benefits are so huge that not to pursue it would be immoral. It is unreasonable to think that such a controversy will be resolved by journalists or politicians or, for that matter, by patients who hope for a cure from some dreadful disease.

However, it does seem reasonable that practitioners of academic bioetbics should be able to help us clarify this issue. Presumably academics have the proper interests and education to think clearly about bioethics controversies. Academic essays provide an opportunity for careful examination of relevant arguments. Since leading bioethics and medical journals have devoted whole recent issues or parts of recent issues to this controversy, (1) examining this literature should shed considerable light on the HESO controversy.

Such an expectation, in this reader’s experience, will be disappointed. It is amazing how much of the HESC bioethics literature confines itself to describing the science underlying the dispute, or to giving historical accounts of the committees that have reported on this issue, or to surveying the dispute in general terms rather than closely analyzing the arguments that bear on the central ethical issues. (2) The arguments that are offered are typically presented in a cursory way Indeed, often they are more suggested than presented. Arguments that deserve critical scrutiny are quickly set out as if any rational reader would regard them as obviously sound.

No doubt there are many explanations for this. One, however, may have particular relevance to the HESC issue. Obtaining HESCs requires the destruction (or disaggregation, to use the sanitized term) of human embryos. (3) Whether such embryo destruction is morally permissible is (or should be) at the heart of the debate over the morality of HESC research. This has led many to expect that to a great extent, the stem cell controversy will mirror the abortion controversy If one believes there are good arguments for the moral permissibility of fetal destruction, then many of the same arguments can apply to embryo destruction. If one believes that destroying a fetus destroys a human life with full moral status, then presumably the same arguments can apply to embryos. When these considerations are combined with the fact that most partisans on both sides of the abortion dispute seem to consider their positions so obviously true that only cursory argument in defense of them is needed, we may have a plausible explanatio n for the superficial nature of the HESC discussion.

The purpose of this essay is to provide evidence for the claims made in the above two paragraphs. Consider first the major arguments for the view that HESC research should be banned, or at any rate not funded. Richard Doerflinger has defended this view on the grounds that it is incompatible with a Catholic viewpoint. (4) Gilbert Mellaender has defended the view on more general religious grounds. (5) There are obvious problems with such defenses. Religious views are essentially matters of faith, and it is widely thought that there are no objective grounds for preferring one variety of religious faith to others. The fact that there are so many varieties of Christianity and of Islam and, I suppose, of many other religions of which I know little, is evidence for this. Accordingly in the absence of a great deal of convincing argument that has not yet seen the light of day, particular religious considerations cannot establish the wrongness of HESO research. Such religious views count as no more than comforting opin ions, like preferences in furniture or food, and we are left with no reason whatsoever to accept them as binding on the rest of us, or for that matter, even binding on their proponents.

No doubt, the weakness of the religious arguments has suggested to some proponents of HESC research that defending their position requires only a wave at some nonreligious arguments. This may count, therefore, as another reason arguments concerning HESC research seem less than compelling.

The letter that invited this article stated that many readers of this publication hold a view that, if it were true, might furnish a good argument in favor of HESC research. According to the editor, many FREE INQUIRY readers “support untrammeled freedom in scientific research.” Yet to accept this slogan entails endorsement of the Tuskegee studies of the natural course of syphilis, or the notorious Willowbrook experiments in which retarded children were deliberately given hepatitis in order to study how that disease progressed, or the Nazi hypothermia experiments on Jews. However, there is a consensus among decent persons of all political and religious persuasions that these studies were profoundly immoral. Thus such an “untrammeled freedom” argument is plainly unsound.

Another argument for HESC research is based on the hope that it might provide cures, or at least reasonably successful treatments, for Alzheimer’s Disease, spinal cord injuries, muscular dystrophy diabetes, and other diseases. This prospective benefits argument, although often offered in popular or political discussion, is as hopeless as the untrammeled freedom argument. The Tuskegee, Willowbrook, and Nazi studies were wrong, not because they were bad or useless science, but because the human subjects in them were treated inhumanely Basic interests of those subjects were sacrificed without their consent for the ends of the research. There is now a strong consensus, both in society and in academic bioethics, that this is wrong even when the research clearly will promote the common good. In short, conformity with a respect for human subjects (RHS) principle is a necessary condition of morally permissible research, whatever its benefits. (6)

Just how should this RHS principle be formulated and qualified? Here is an issue that can provide a clear framework for analysis of the HESO dispute. Critics of HESC research claim in essence that it violates the principle of respect for human subjects. One can make at least a presumptive defense of the truth of this claim in the absence of any appeal to religion. Destroyed human embryos clearly belonged to our species. Therefore, they were human in one clear sense. Furthermore, the embryos in such research are clearly subjects, that is, the subjects of research. Thus, as the more thoughtful proponents of HESC research at least tacitly realize, arguments in favor of such research must appeal, not to an unrestricted or unqualified, RHS principle, but to a restricted or qualified, version. The case for HESC research requires the defence of a restricted version of the RHS principle that, on the one hand, does not include embryos and, on the other hand, includes those human subjects whose need for protection is uncontroversial.

How might such a case be made? Some authors have suggested that embryo destruction is permissible because embryos are not moral agents. (7) This in turn suggests a respect principle restricted to human subjects who are also moral agents. Plainly this will not do, since it is agreed by all decent people that scientific research that involves the destruction of two-year-olds is immoral, even though two-year-olds are not moral agents. It is worth noting, in this connection, that those retarded children who were deliberately infected with hepatitis in the Willowbrook experiments were not moral agents either.

Other authors have suggested that HESC research is morally permissible because embryos are not persons. (8) This is tantamount to claiming that the respect principle should be restricted to persons. A relevant meaning of person uses the term to refer to a cluster of psychological characteristics that human beings typically possess and animals do not. (9) But this restriction on the RHS principle is rejected by almost everyone. Infants clearly are not persons in this sense, and yet we believe that research that causes the destruction of infants is immoral.

One proponent of HESC research has offered a response to this objection. Carson Strong has defended the view that, although infants are not persons in virtue of any intrinsic property, good reasons exist for conferring the right to life on them because of the consequences for persons of doing so. Treating infants with love and concern will have good consequences for the persons they grow up to be. It will also have good consequences for other persons who may be affected adversely by those human beings who were treated badly when they were infants. Furthermore, treating some infants as expendable might lead us to lack concern for infants we intend to keep. (10) According to Strong these considerations, combined with the fact that infants “are viable, sentient, have the potential to become self-conscious, have been born, and are similar in appearance to the paradigm of human persons” are “significant enough to warrant conferring upon infants serious moral standing including a right to life.” (11)

Strong claims that, on a moral theory in which only persons have full moral status in and of themselves, our conferral of full moral status on infants is mandated. This is hard to believe. All of the reasons Strong cites for treating infants with love and concern apply as well to fetuses. Yet many believe that killing a fetus a woman does not intend to keep is perfectly compatible with love and concern for a fetus she does intend to keep. Strong might protest that this objection does not take account of the fact that infants are viable, sentient, have been born, and are like paradigm humans in appearance, whereas fetuses are not. The trouble with Strong’s view is that he argues that none of the more plausible of these factors is sufficient to underwrite full moral status. Given that, why should we assume that collectively they are of much help? Strong offers no argument here, only assertion. (12) Thus, we are left with good reason for thinking that restricting the RHS principle to persons is far too narrow

Some have suggested that the destruction of embryos is justified because embryos are not capable of sentience, that is, they lack the capacity for thoughts, feelings, or experiences.(13) For this argument to go through, the respect principle must be restricted to individuals with a capacity for consciousness. Embryos lack present capacity for consciousness. So do temporarily unconscious adults. We all agree that research on temporarily unconscious adults that causes their deaths is immoral. Hence, the present capacity for consciousness restriction on the RHS principle is untenable.

This problem with temporarily unconscious adults can be fixed by adopting a RHS principle that excludes only those in whom the absence of consciousness is irreversible. Because it is reasonable to think that a subject whose absence of consciousness is irreversible cannot be harmed in any morally significant way by his or her destruction, there is a good deal to be said for this change. However, an embryo’s lack of consciousness is not irreversible. In the proper environment embryos may develop mental capacities like our own. On this interpretation, a respect principle restricted to those with the capacity for consciousness (or a first cousin) might be defensible, but it does not exclude embryos.

One might attempt to deal with both of these problems by claiming that the RHS principle should be restricted to those who have in the past exhibited the capacity for consciousness. Critics of HESC research should respond that, instead, the RHS principle should be restricted to those who could in the future exhibit the capacity for consciousness. How should we resolve this disagreement? Society endorses medicine’s concern with prognosis. In view of this, critics of HESC research seem to have the more defensible view.

An argument often given in defense of HESO research is that an embryo “is not clearly even an individual,” (14) that at the embryo stage, “it is doubtful one can speak of individuality.” (15) Carol Tauer has reported that a consensus of the National Institutes of Health Human Embryo Research Panel favoring BESC research found that the embryo is not “a distinct individual,” that it lacks “developmental individuation” and thus lacks full moral status. (16) Ronald Green has made essentially the same argument. (17) Restricting the RHS principle to individuals certainly seems reasonable. But why should we suppose that embryos are not individuals?

Here is a reason for supposing that they are. One can count them. One can unambiguously refer to one embryo, and then to a second, and then to a third. So it seems that embryos are indeed individuals and that restricting the RHS principle to individuals does not succeed in excluding embryos from its scope. Supporters of HESC research will protest that embryos are not individuals because of the possibility of twinning. [See Berit Brogaard’s “Stem Cell Research and the Moral Status of the Human Embryo” in this issue for an extended defense of the twinning argument.–Eds] But why should one suppose that this is a reason that embryos are not individuals? One amoeba can split into two. This should not tempt us to claim that it was not the case that there was one individual amoeba before the splitting. Indeed, how could one understand what splitting into two is unless the amoeba were an individual before the split? But unless one understands what splitting into two is, one cannot understand at all what it is for an embryo to twin. Therefore, the individuality restriction, although defensible, seems not to be helpful to the proponent of embryonic stem cell research.

Supporters of HESC research have also made the argument that:

If an embryo is maintained outside a woman’s body and those who provided the gametes for it have not decided to permit its development in a womb, it is not effectively a state in the early development of a person. Put differently an extracorporeal embryo–whether used in research, discarded, or kept frozen–is simply not a precursor to any ongoing personal narrative. (18)

For this claim to do the work its proponents want it to do, the RHS principle must exclude cases where we fall to provide a human subject with an environment in which it can develop into a person. Thus such a restriction allows research on infants in a neonatal intensive care unit that results in their destruction or, for that matter, on any abandoned infant whatsoever. Accordingly, such a restricted version of the principle is too narrow.

Jeffrey Spike has argued that HESC research is morally permissible because it is not the case that embryos can develop independently. (19) This is will hardly do, for the restriction on the RHS principle that is needed to make Spike’s argument go through would allow unethical research on the disabled.

Spike has also defended HESC research on the grounds that “Biologically if every one of those embryos was put into a woman, perhaps 10 or 20 percent would survive to birth.” This won’t do either. Research on patients with cancer in which the survival rate is only 10 to 20 percent is not exempt from the RHS principle.

This concludes my survey of the arguments that human embryo destruction is morally permissible, or, alternatively that the principle of respect for human research subjects should be restricted so that embryos are excluded. What has been surveyed is not a pretty picture. In spite of the vast amounts of ink that academic bioethicists have spiked over the HESC issue, and in spite of the apparent sentiment among so many of them that HESC research should proceed, the crucial arguments offered to support this view are both sketchy and subject to all sorts of fairly obvious difficulties. Perhaps there are no arguments that can justify proceeding with HESC research. But that would oblige academic bioethicists to acknowledge the fact, not to pretend that this unpleasant little difficulty does not exist.

It is possible to imagine objections to the preceding analysis. or example, one might say that embryos cannot possibly be included in the RHS principle because that principle concerns the basic interests of human subjects–and embryos, lacking the capacity for consciousness, cannot have interests at all. (20) The argument for the latter claim is that whatever lacks the capacity for consciousness cannot take an interest in anything and what cannot take an interest in anything cannot have interests. (21) This objection is subject to a number of difficulties. The notion of what is in one’s interest should not be too tightly associated with what one takes an interest in. Not everything that people take an interest in is in their (best) interest and not everything that is in people’s best interest is what they take an interest in. Smokers and drug addicts are obvious examples. Furthermore, this objection cannot account for acting in the best interest of a temporarily unconscious adult or an infant.

Someone also might object to the preceding analysis on the grounds that respect for an individual is compatible with destroying her. (22) It would follow that my interpretation of respect for human subjects principle is too strong. However, whether or not such a notion of respect is possible is beside the point. The respect for human subjects principle used in standard medical research ethics does not permit harming human subjects without their consent if that harm can be anticipated.

One might also object to my analysis on the grounds that it holds proponents of HESC research to standards that are overly strict. Meyer and Nelson say:

Our goal, however, is not to provide a knock-down argument about the moral status or the embryo, but to show how one systematic, reasonable view on moral status in general can be used to defend thc moral propriety of destroying embryos that truly deserve respect. (23)

Meyer and Nelson refer to Mary Anne Warren’s “developmental view” of human moral status. (24) Other defenders of stem cell research also have appealed to her view. (25) Warren is best known for her view that abortion is morally permissible because fetuses lack full moral status. (26) Warren’s developmental view is indeed widely regarded as reasonable–precisely to those who consider abortion morally permissible on the grounds that fetuses lack full moral status because they are only developing human beings and not yet persons. If one holds this, then, of course, one will hold that a human being at the very earliest stages of development lacks moral standing. The triviality of this move boggles the mind. It has all the force of John Paul II’s defense of his views of the morality of abortion and euthanasia in terms of–well–his own moral theology. (27) What is required for the success of the Meyer-Nelson point is a criterion for the reasonableness of a view that can be accepted by any rational person.

An adequate analysis of Warren’s developmental view is far beyond the scope of this essay. In my view, a theory such as hers that bases full moral standing on moral agency cannot account even for the moral standing of adolescents, much less younger human beings, without some backing and filling and other moves that are utterly arbitrary. If proponents of HESC research are willing to tolerate arbitrariness, then they should not object to what they perceive as the arbitrariness of religious perspectives.

Another objection to the preceding analysis might be that the RHS principle includes embryos only if the embryo’s status as a potential human being gives it the same moral status as an actual human being. (28) It is clearly not wrong to destroy isolated human cells. The only difference between a zygote and some arbitrary skin cell is that the zygote is a potential human being. And why should we suppose that being a merely potential human being is sufficient to underwrite full moral status?

The critic of HESC research can reply by holding that embryos are actual human beings. They are very, very young human beings. Not all human beings look like middle-aged professors. It seems doubtful that the ordinary notion of actual human being is sufficiently precise to underwrite either this objection or the response to it.

Another objection to my analysis might concern its strategy. I considered candidate restrictions on a RHS principle individually, and argued that each is indefensible or does not exclude embryos. One might argue that each of those qualities (except for individuality) should be considered to be “candidate sufficient conditions” for full moral standing. One might go on to argue that since embryos meet none of the candidate sufficient conditions for full moral standing, then there is no reason to think that they have moral standing. And if there is no reason to think that they have moral standing, then HESC research is morally permissible.

The trouble with this objection is that in order for it to be successful, one would have to show that all of the candidate sufficient conditions for full moral standing had been considered. In the first place, this has not been done. In the second place, it is easy to think of candidates for full moral standing that proponents of HESC research have not considered.

Another objection to the preceding analysis is that I have presupposed that morality must be objective in a way that it cannot possibly be, and that therefore I have held the defenders of HESC research to impossibly high standards. Such a critic might argue that morality is a social construct, that it is not based on some natural property or other of individuals. (29) This objection opens a very large can of worms. One problem with a somewhat subjectivist conception of morality is showing that it does not permit too much; that in the course of showing that research on human embryos is morally permissible, it does not also show that practices that seem clearly immoral are also morally permissible. That is a difficult, and to my knowledge, not successfully attempted task.

This essay has endorsed no positive thesis. It has been concerned almost exclusively with criticizing the arguments of others. Can something positive and nonreligious be said in favor of banning human embryonic stem research? Here’s a suggestion for an argument: Falling to respect the basic interests of ordinary human beings for the purpose of scientific research is wrong. Age discrimination is morally wrong. When we were very, very young, we were mere embryos. Therefore, destruction of human embryos for the purposes of scientific research is wrong.

Carson Strong would object to this argument on the grounds that embryos do not become self-conscious beings, they only produce beings that are capable of self-consciousness. His reason for this claim is that the embryo that was your precursor was also the precursor of the placenta that supported you. (30) Such an argument appears to require the assumption that an entity cannot shed some of its parts and remain self-identical. However, this seems false: consider amputees.

I would not pretend that the preceding suggestion for an argument is anything more than that. Furthermore, even I find the claim that embryos deserve the same moral respect as adult human beings counterintuitive. Nevertheless, because I think that on issues like this, the moral intuitions of others are not authoritative, it would be outrageous for me to believe that my own intuitions are more authoritative. I’m inclined to think that some argument or other concerned with individuality might be successful in showing that HESC research is permissible. However, I used to think that arguments concerned with the individuality issue were much better than they actually are, so I have no confidence at all in this conjecture. Furthermore, the dismal failure of the arguments of so many who think that HESC research is morally permissible suggests that HESC research is not morally permissible. Of course, this conclusion could be shown to be false by only one good argument from HESC proponents.

Notes

(1.) Here are some leading examples. JAMA 284, no. 24 (December, 2000); Hastings Center Report 31, no. 1 (January/February 2001); Kennedy Institute of Ethics Journal 9, no. 2 (1999); American Journal of Bioethics 2, no. 1 (2002); Journal of Medicine and Philosophy 22, no. 5 (October 1997).

(2.) A recent issue of American Journal of Bioethics (2, no. 2) devoted to the stem cell issue is especially noteworthy in this respect.

(3.) This wonderful term is found in Robert P. Lanza, Arthur L. Caplan, Lee M. Silver, Jose B. Cibelli, Michael D. West, and Ronald M. Green, “The Ethical Validity of Using Nuclear Transfer in Human Transplantation,” JAMA 284, no. 24 (December 27, 2000): 3175-3179. I shall henceforth refer to this essay as “Caplan.”

(4.) Richard Doerflinger, “The Ethics of Funding Embryonic Stem Cell Research: A Catholic Viewpoint,” Kennedy Institute of Ethics Journal 9, no. 2: 137-150. Doerflinger does offer some non-religious considerations, but these are so cursorily presented that it is unclear exactly what they are. See p. 139.

(5.) Gilbert Meilaender, “The Point of a Ban, Or, How to Think about Stem Cell Research,” Hastings Center Report 31, no. 1 (January-February, 2001): 9-15.

(6.) I assume that some authors who appear to reject this principle, such as Glenn McGee and Arthur Caplan, “The Ethics and Politics of Small Sacrifices in Stem Cell Research,” Kennedy Institute of Ethics Journal, op. cit., 151-158 and Ronald M. Green, “Determining Moral Status,” American Journal of Bioethics, op. cit, pp. 20-30 are instead committed to qualification of the principle.

(7.) This is suggested in Michael J. Meyer and Lawrence J. Nelson, “Respecting What We Destroy: Reflection on Human Embryo Research,” Hastings Center Report 31, no. 1 (January-February 2001): 18.

(8.) Ibid. Carson Strong seems to hold this view. See his “The Moral Status of Preembryos, Embryos, Fetuses, and Infants,” The Journal of Medicine and Philosophy 22, no. 5 (October 1997): 457-78.

(9.) Dan Brock uses the term this way in Life and Death (Cambridge: Cambridge University Press, 1993), p. 372. Others do also.

(10.) These arguments can be found, as Strong notes, in S.I. Benn “Abortion, Infanticide and Respect for Persons,” and Joel Feinberg “Potentiality, Development and Rights.” Both are in Joel Feinberg (ed.) The Problem of Abortion, 2nd ed. (Belmont, Calif.: Wadsworth, 1984). See Strong, p. 464.

(11.) Strong, p. 468.

(12.) Ibid.

(13.) This argument can be found both in Caplan, p. 3177 and Meyer and Nelson, p. 18.

(14.) Meyer and Nelson, p. 18.

(15.) Caplan, p. 3177.

(16.) Carol Tauer, “Embryo Research and Public Policy,” Journal of Medicine and Public Policy 22, no. 5 (October 1997): p. 430.

(17.) Ronald Green also gives this argument. See op. cit. p. 22.

(18.) Meyer and Nelson, p. 18.

(19.) Jeffrey Spike, “Bush and Stem Cell Research: An Ethically Confused Policy,” American Journal of Bioethics 2, no. 1 (2002): 45.

(20.) Carson Strong would endorse this principle. See Strong, op. cit. p. 467.

(21.) This line of argument can be found in Bonnie Steinbuck, Life Before Birth: The Moral and Legal Status of Embryos and Fetuses (New York: Oxford University Press, 1992).

(22.) Meyer and Nelson, p. 19.

(23.) Ibid., p. 18.

(24.) Mary Anne Warren, Moral Status: Obligations to Persons and Other Living Things, (Oxford: Clarendon Press, 1997).

(25.) Eric Juengst and Michael Fossel, “The Ethics of Embryonic Stem Cells–Now and Forever, Cells Without End,” JAMA 284, no. 24 (December 27, 2000): 3180-3184.

(26.) Mary Anne Warren, “On the Moral and Legal Status of Abortion,” The Monist 57, no. 1 (January 1973): 43-61. This essay has been widely reprinted.

(27.) See John Paul II Evangelium Vitae (Boston: Daughter of St. Paul, 1995)

(28.) Caplan, p. 3177.

(29.) Ronald M. Green, op cit., pp. 20-30.

(30.) C. Strong, op. cit., p. 460. This argument originally is due to Steven Buckle, “Arguing from Potential,” Bioethics 2 (1988): 227-53.

Don Marquis is professors of philosophy at the University of Kansas, Lawrence. He has authored a widely reprinted secular argument that abortion is immoral.