Framing Stem Cell Arguments

Introduction

[1] On December 12, 2008 The Congregation for the Doctrine of the Faith released a teaching document, Dignitatis Personae: The Vatican’s New Instruction on Bioethics. On this occasion Chicago’s Cardinal Francis George, now president of the U.S. Conference of Catholic Bishops, applauded “developments which advance medical progress with respect for the sanctity of human life.”[1] On the topic of regenerative medicine, the Vatican instruction dubs human embryonic stem cell research to be “gravely illicit,” while it approves research on “adult stem cells.”[2] In the name of the sanctity of human dignity, the Vatican condemns one form of stem cell research and affirms another. What is going on here?

[2] It would be difficult to find anyone who would categorically oppose advancing medical research for the benefit of human health. Virtually everyone hopes for improvement in human well-being. Yet, with the prospect of a leap forward through developments in regenerative medicine, we find ourselves in a controversy with some Christians putting up moral stop signs to block this form of medical advance. We also find some outspoken naturalists putting up moral stop signs. In contrast we hear voices raised by others, both Christian and non-Christian, who support public policy that encourages laboratory research in regenerative medicine and therapy development. What is going on here?

[3] In what follows I will try to outline the structure of the ethical controversy over human embryonic stem cell research. I will suggest that the public debate finds itself at an impasse due in large part to fact that moral arguments are raised from parallel and noncompossible ethical frameworks. I will identify four such frameworks: (1) the future wholeness or medical benefits framework; (2) the embryo protection framework; (3) the human protection or anti-playing God framework; and (4) the professional standards framework. The first three rely upon theological or philosophical foundations, whereas the fourth represents what the scientific community discusses as it sets the ethical parameters within which research should be pursued. The first three will draw our interest in this paper.[3]

[4] I find myself working primarily within the first, the future wholeness or medical benefits framework; and I find myself providing theological reasons for encouraging human embryonic stem cell research. Yet, in order to argue on behalf of such support for regenerative medicine, I find myself obligated to respond to naysayers from within their respective frameworks. I would like to make the case that Christians should support public policy that encourages regenerative medicine, including research on human embryonic stem cells.[4]

Regenerative Medicine and the Language of the Human Embryonic Stem Cell

[5] The laboratory research in question is focused on regeneration of damaged or diseased tissue. Regenerative medicine seeks to harness the renewal potential of human embryonic stem cells (hES cells) to develop therapies for paralysis, heart disease, Alzheimer’s, diabetes, and many other maladies. If the potential expected for regenerative therapies becomes even only partially realized, the human race will leap significantly forward toward improving human health.

[6] The elixir is most likely to be found in the as yet undifferentiated nucleus of the human embryonic stem cell. Embryonic stem cells can be distinguished from adult stem cells. Adult stem cells appear naturally in partially differentiated and multipotent form. When we donate blood, our partially differentiated hematopoietic stem cells respond by accelerating the production of replacement blood cells. The regenerative power of these multipotent adult stem cells is limited to blood cells only. In contrast, pluripotent embryonic stem cells offer the promise of regenerating any and every tissue in the body. When an undifferentiated embryonic stem cell is placed within organ tissue, its genes express themselves as that tissue. Once the tissue regenerating power of stem cells is brought under technological control, they can be guided to make new tissue for the heart, brain, liver, pancreas, and spinal nerve system.

[7] Another distinction is worth noting. Adult stem cells occur naturally. Each of our bodies has a small supply of partially differentiated stem cells which are multipotent for a small range of regenerative tasks, such as cell replacement or healing. “Adult stem cells are still best defined in vivo, where they must display sufficient proliferation capacity to last the lifetime of the animal.”[5] Embryonic stem cells upon which research is currently being pursued, in contrast, are derived in laboratories in vitro—that is, ex vivo or outside a human body. In their isolated and characterized form, they are a product of scientific artifice. As pluripotent they replicate, clone themselves, and have multilineage differentiation—that is, they have capacity to produce any cell type in the body.[6]

[8] Human embryonic stem cells were first isolated and characterized in August of 1998. Scientists derived stem cells from a human zygote (a fertilized egg). Working in vitro (“in glass”), the researchers allowed the zygote to develop to the blastocyst stage—about five days. At this stage the zygote becomes a sphere consisting of an outer layer of cells (the trophectoderm) with a hollow fluid filled cavity and a cluster of cells inside this cavity (the inner cell mass). Breaking open the trophectoderm, scientists were able to isolate the inner cell mass. By placing those cells into a culture medium, they caused them to proliferate. After fifty doublings without deterioration, they could be dubbed “characterized.” Scientists named these isolated cells human embryonic stem cells (or hES cells).

[9] This naming has led to some unfortunate consequences. The term “embryonic stem cells” can be misleading in at least two ways. First, by reifying the term embryo, it implies that there is such as thing as “an embryo.” However, as a recent publication of the U.S. President’s Council on Bioethics has pointed out, in a strictly biological sense “there is no such thing as ‘the embryo,’ if by this is meant a distinctive being (or kind of being) that deserves a common, reified name—like ‘dog’ or ‘elephant.’”[7] From the Greek meaning “to grow,” the term “embryo,” used precisely, describes a stage of development—from fertilization until approximately the eighth week of gestation. Hence, specifically speaking, in 1998 scientists derived stem cells from the blastocyst at four to six days following activation. They might more properly have been called human blastocyst stem cells.

[10] The term “embryonic stem cells” can be misleading for a second reason. The term “embryo” often evokes an image of an infant-formed creature in miniature, a creature with a head, arms, legs, like a fetus within a mother’s body. In fact, at the blastocyst stage the cells of the zygote are virtually undifferentiated, consisting of only two types of cells, the cells of the trophectoderm and the inner cell mass. That the blastocyst does not yet “look like” a more developed human individual does not, in itself, constitute a salient ethical fact. Nevertheless, having noted these difficulties with the term “embryo” and with it “embryonic stem cells,” how should we proceed? These terms have become ubiquitous in the current discussion and, as such, it is virtually impossible to avoid using them.

[11] Perhaps Hans Tiefel illustrates the problem. Tiefel complains that “embryo” is a scientific word; and this word dehumanizes and commodifies. He seems to have it backwards. While Tiefel thinks this term scientizes; the President’s COB fears that it humanizes. The problem is this: the word “embryo” within the discussion of regenerative medicine actually functions to over-humanize the ex vivo blastocyst. It gives the misleading impression that we are speaking of an individual human person. So, Tiefel, coming from the opposite direction, proposes that Christian ethicists substitute the term, “the embryonic human,” in order to re-humanize.[8] He assumes he can ascribe to the ex vivo blastocyst the same moral status as a fetus in vivo. Actually the burden of proof should rest on Tiefel to demonstrate this equivalence, rather than to assume the consequent and blame the scientists for dehumanizing.

The Future Wholeness or Medical Benefits Framework

[12] When it comes to public policy discourse wherein moral arguments are raised to put a stop to hES research, or in some cases to support hES research, we find ourselves at an impasse. This impasse, I suggest, is due in large part to parallel and noncompossible ethical frameworks within which moral arguments are constructed. Seldom do we hear a face to face disagreement. Rather, what we hear are alternative positions which do not cohere with one another. This is because differing moral arguments rely upon differing focal targets with differing surrounding logics. At least three of these ethical frameworks rely upon implicit if not explicit theological commitments. Even in the secular public square, theologically founded moral arguments can be listened to and can influence what laboratory scientists are permitted to do.

[13] Each of the three ethical frameworks within which moral arguments are constructed in the worldwide stem cell debate begins with a focal concern. The focal concern in the future wholeness or medical benefits framework derives from the vision of the potential for improving human health and well-being that regenerative medicine offers. Some persons now living and most persons in future generations will benefit from the possible leap forward that today’s medical research might provide. The ethical focus is on persons who suffer from heart disease, brain deterioration, Parkinson’s disease, diabetes, spinal cord injury, and many cancers. The most promising scenario is that regenerative medicine could lengthen our longevity and, more importantly, provide good health right up to the point of death, avoiding the long and expensive and debilitating period of suffering that so frequently precedes our death. In short, the quality of human life could be enhanced significantly.

[14] Here the orienting bioethical principle is beneficence. Beneficence is “an action done to benefit others.” The principle of beneficence is “a moral obligation to act for the benefit of others.”[9] This principle holds that we are morally obligated to pursue the good when the opportunity presents itself. Research in regenerative medicine appears to be a way of doing good. Moreover, the promise of regenerative medicine is currently based upon a theory with considerable experimental corroboration. The promise of stem cell medicine is realistic, even if as yet it falls short of a certainty.

[15] Relief of human suffering, the lengthening of lives with improved health, and overall advances in human flourishing are taken as compelling by those who advocate from this framework. These considerations are used to frame all other concerns. The ancient Greek, Hypocrites, said, “Benefit and do not harm.” This is the first formulation of both beneficence and nonmaleficence. Those who advocate research from within the medical benefits framework embrace both. However, they understand these two principles as standing in a particular relationship to one another. Beneficence takes the initiative. Beneficence provides an orienting vision that calls us to actively engage in pursuit of human betterment. Of course this vision cannot be pursued by any means. Indeed, some means may come into conflict with the vision itself. Here the principle of nonmaleficence—avoiding harm—provides parameters within which beneficence can be exercised.

[16] Theologically, this ordering of beneficence and nonmaleficence can be grounded in Jesus’ parable of the Good Samaritan (Luke 10:29-37). The actions of the priest and Levite in Jesus’ story were oriented by the principle of nonmaleficence: they did not do any additional harm to the already beaten and suffering man on the side of the road. They simply passed by on the other side. The actions of the Samaritan, by contrast, were oriented by beneficence: he pursued an opportunity to be of help. The Samaritan went out of his way to provide medical services and nurse the suffering man back to health.

[17] This tells us why so many Christian hospitals are named “Good Samaritan Hospital.” Christians who vigorously support stem cell research out of a medical benefits framework are sharply critical of those who would shut it down. The number of persons now living and yet to be born whose lives could be saved or improved by regenerative medicine number in the millions, perhaps hundreds of millions or even billions. Any delays in the progress of this research could be measured in the numbers of persons who will not benefit from stem cell research. From the perspective of one who supports stem cell research from within the future wholeness framework, a stop sign ethic risks “passing by on the other side.”[10] It risks failure to love one’s neighbors.

[18] Here are three of the ethical questions which arise from within this framework. The first question is this: should Christians support public policy that encourages stem cell research? I would answer in the affirmative. My justification comes from within an ethical framework that begins with a focus on the future benefits of today’s medical research, benefits that could lead to wholeness flourishing for millions if not billions of suffering persons.

[19] The second question has to do with justice. When it comes to regenerative medicine, the justice question centers on access: who will have access to the medical benefits? Because genetic research is very expensive and today’s investors expect to reap tomorrow’s profits, how will costs and expectations affect distribution of benefits? Will people living in the poorer nations of our world benefit? Or will only citizens of the wealthier nations gain in health and longevity? What might be done to make expensive genetic therapies universally available?

[20] A third question is this: what might be the impact of stem cell research on women? All stem cell and cloning research requires human eggs. Women have to supply them. Will the hyperovulation necessary to obtain eggs in sufficient quantities threaten the health of the younger women who provide them? Should researchers pay women for eggs? Will such payment provide opportunities for poorer women to increase their income? Will we end up with a form of economic exploitation within the research industry?[11]

[21] The access question arises from a commitment to beneficence; whereas the question regarding the safety of women arises from a commitment to nonmalificence.

The Embryo Protection Framework

[22] The focal question of the embryo protection framework is this: should we protect the early embryo from destruction in the laboratory? In common parlance the key question is this: when does human life begin? If it begins at conception, would stem cell research include abortion? The principal principle is nonmaleficence, namely, the protection of the human embryo from harm.

[23] What garners attention with the embryo protection framework is the moral status of the embryo. This concern functions as an ethical focus for understanding and interpreting all of the stem cell debate. The Vatican, among others who argue from within this framework, takes the zygote as having a moral status equal to that of any living person. They argue that the destruction of the blastocyst is tantamount to taking a human life. Insofar as human embryonic stem cell research requires the destruction of a blastocyst, it is held to be morally illicit, regardless of the potential good it might offer.

[24] On what grounds might we think the early embryo possesses a dignity that forbids scientists from harming it? The most sophisticated account is provided by Vatican bioethicists, who tie together ensoulment, dignity, moral protection, and genetic novelty. This position, articulated already in the 1987 encyclical Donum Vitae provides the foundational moral logic for what would later become the official Roman Catholic position on the stem cell debate. Donum Vitae argues that three elements are crucial to the creation of a morally defensible human individual: the father’s sperm, the mother’s egg, and a divinely infused soul. Donum Vitae notes that at fertilization a novel genetic code—neither that of the mother nor that of the father—is created. Donum Vitae takes this genomic novelty to be evidence of the presence of a unique individual, and thus reasonably the occasion for ensoulment. Ensoulment is the event which establishes a divine moral claim, so that the destruction of the blastocyst constitutes not only murder but an offense against God’s creation. Alleged empirical evidence that the early embryo has this divinely ascribed status is the uniqueness of the person-to-be’s unique genetic code. Once a unique genome has been established, then it is morally incumbent on us to protect it from harm. This is the position taken by Dignitatis Personae of 2008, which affirms that “the teaching of Donum Vitae remains completely valid.”[12]

[25] Theologically, the Vatican position relies upon the doctrine of ensoulment applied to the moment of fertilization of the ovum by the sperm within the context of the normal sex act. The presence of a spiritual soul combined with a new and unique genome establishes ontologically the existence of a person with dignity. Once this dignity has been ontologically established, it is morally illicit to reduce a person—even a person at the embryo stage—to a means for a further end. To have dignity is to exist as an end; and to destroy an embryo even in service of the end of medical research violates the embryo’s dignity. “To create embryos with the intention of destroying them, even with the intention of helping the sick, is completely incompatible with human dignity, because it makes the existence of a human being at the embryonic stage nothing more than a means to be used and destroyed. It is gravely immoral to sacrifice a human life for therapeutic ends.”[13]

[26] Vatican bioethicists recognize the difficulty of attributing to a zygote at conception the same moral status as a fetus or living person. They recognize that we cannot discern scientifically the moment of the divine impartation of a spiritual soul. “The spiritual soul cannot be observed experientially.” Yet, presence of the soul is essential to making the metaphysical case. The logic surrounding Donum Vitae fills in the gap by connecting three things: a unique genome, a unique individual, and the impartation of a spiritual soul. A unique genome defines an individual human person; and God responds by creating a new and immortal soul to correspond with the new genome. Dignitatis Personae alludes to the logic of Donum Vitae with a rhetorical question: “how could a human individual not be a human person?” This leads to the conclusion: “The human embryo has, therefore, from the very beginning the dignity proper to a person.”[14] When applied to stem cell research, Dignitatis Personae erects a stop sign: “the obtaining of stem cells from a living human embryo . . . invariably causes the death of the embryo and is consequently gravely illicit.”[15] Such action on the part of scientists belongs in “the category of abortion.”[16]

[27] The orienting bioethical principle of the embryo protection framework is nonmaleficence—that is, “Do no harm.” To take a life (the life of the developing zygote in this case) violates the do no harm principle. According to many working within this framework, our first ethical responsibility is to erect a stop sign against human embryonic stem cell research. Those who support hES cell research are accused of disrespect for the value of human life. When the issue is framed this way, those who support stem cell research must argue that an early embryo or blastocyst is not an individual human person and that destroying it is not equivalent to murder. These arguments can be difficult to make. If the blastocyst is not yet fully a human person and therefore protectable, when does a developing embryo become protectable? The public debate has largely raged over this question. The embryo protection framework has set the terms of the debate. Because so much public attention is given to this framing, we sometimes fail to notice that voices speaking out of two other frameworks are trying to be heard.

[28] Some Roman Catholic thinkers try to extricate their ethical deliberations from the confines of embryo protection in order to pursue the kind of justice issues that arise within the future wholeness framework. Margaret Farley, for example, contends that “Roman Catholics” are as concerned as other people “about issues of social justice, ecology, and the well-being of the whole Earth. Apart from the moral status of the embryo, Catholic concerns are focused on questions of equity in the shared lives of people across the world.”[17] Perhaps, to be accurate, we need to listen for the difference in tones between Farley’s voice and the notes sounded consistently by the Vatican from Donum Vitae in 1987 to Dignitatis Personae in 2008.

[29] The Vatican does not stand alone in placing stop signs in the road of stem cell research. Some Eastern Orthodox, Lutherans, and American evangelicals side with the Vatican. When testifying to the National Bioethics Advisory Commission, Lutheran Gilbert Meilaender placed the stem cell debate within the embryo protection framework. The stem cell issue is about destruction of embryos, he said. “I will be taken to be standing athwart history and yelling ‘Stop’,” he told the commission. “We may easily deceive ourselves about what we do—especially when we do it in a good cause, with a good conscience.”[18]

The Human Protection Framework

[30] Moral rhetoric that relies upon terms or phrases such as “Prometheus,” “hubris,” “Frankenstein,” Brave New World, or “Playing God” indicate that the argument arises from within the human protection framework. This is a naturalist position which defends nature against alteration through science and technology. The nature being protected here is our human nature, most frequently that aspect of human nature that we observe in traditional family life where children are born and raised within the setting of a natural family. Nature protectionists are usually secular, although some aspects of their arguments are given credence in Roman Catholic natural law arguments.

[31] Bioethicists working within the human nature protection framework focus their ethical attention on potential unforeseen negative consequences of stem cell and related research. They forecast dangerous calamities triggered by human limitation and human pride. Despite the good intentions that inform scientific pursuit, those who erect stop signs from within this framework perceive threats to nature, especially our human nature, in the face of advancing biotechnology.

[32] Two arguments for erecting stop signs cluster in this framework. Both arguments begin by imagining future negative consequences of research and work back to our present situation to assess whether or not contemporary science is on a trajectory toward those futures. The first argument is consequentialist: the use of our technologies is walking us down the path toward a Brave New World. Those who advance this argument fear that if we do not stop proliferating new technologies, we will drift toward the Brave New World that novelist Aldous Huxley warned us against in the 1930s. Whatever our good intentions might be today, lurking in the future is a world that we will not be able to control. Hence, we should not take the first steps. This is a version of the “slippery slope” or “camel’s nose under the tent” argument: once we take a first step, such as developing stem cells, we will not be able to draw a line and prevent further technologies; and eventually we will do something immoral and regret the consequences of our actions. Some argue, for example, that the destruction of the developing blastocyst will coarsen our collective conscience, desensitizing society to the value of human life. This desensitization, in turn, will signal a fundamental violation of our own humanity.

[33] For some, however, the immoral step is not eventual, but immediate. Here we find the second argument in this framework. This argument suggests that the use of stem cell technologies violates something essential about human nature. This is not simply a question of consequences, but of not violating important natural and human boundaries. Some will argue, for example, that the fertilization of an egg outside the human body is “unnatural” and therefore wrong. Such technologies (e.g. cloning) are said to elicit within us a deep sense of repugnance; our moral judgment should be guided by this intuitive sense of repugnance. Repugnance leads to wisdom; and wisdom leads to sound moral judgment. So, the argument goes.

[34] Both of these arguments claim that any manipulation of human genes—even to support better human health—risks violating something sacred lying deep within our nature. As such, these manipulations reflect human pride or hubris. The central ethical agenda becomes one of prohibiting our scientists from “playing God”—that is, to prevent our society from thinking that we can improve ourselves by genetic technologies. Instead, we should appreciate what nature has bequeathed us, including our limitations and our imperfections.

[35] These two concerns are forcefully articulated by the former chair of the U.S. President’s Council on Bioethics, Leon Kass. That “biological truths about our origins foretell deep truths about our identity and about our human condition altogether” counts ethically for Kass.[19] Stem cell research and kindred pursuits such as cloning which withdraw the early embryo from its natural place in sexual procreation provoke within us a sense of yuck, of repugnance. We should listen to the voice of repugnance within us when confronted with contemporary research agendas by scientists. “We are compelled to decide nothing less than whether human procreation is going to remain human . . . whether we wish to say yes in principle to the road that leads to the designer hell of Brave New World.”[20] Stem cell research, fears Kass, is like a genie in a bottle: once out, there will be no stopping what will happen.[21] His vehemence is directed toward “the Frankensteinian hubris to create a human life and increasingly to control its destiny; men playing at being God.”[22] In order to prevent Brave New World, Frankensteinian hubris, and playing God, such naturalists feel the need to erect moral stop signs now.

[36] The corner where human protection meets stem cells is not the primary location for a stop sign. Nature protectionists have broad concerns regarding reproductive technology; and they see stem cell proposals as only one small item on a long list of challenges to traditional family life. Kass and the Vatican are kindred spirits when it comes to defending what nature has allegedly decreed to be moral for human families. “The Church moreover holds that it is ethically unacceptable to dissociate procreation from the integrally personal context of the conjugal act: human procreation is a personal act of a husband and wife. . . . [Reproductive technology] leads to a weakening of the respect owed to every human being.”[23]

[37] President George W. Bush formulated White House policy regarding hES cell research in a televised speech on August 9, 2001. At this time he restricted federal funding to existing stem cell lines, denying government support for the establishment of new lines. In preparation for that speech, he consulted first with Pope John Paul II, who, from the perspective of embryo protection, placed stem cell research into the category of the “culture of death.” He also consulted with Leon Kass, who took a stand against stem cell research from within the human protection framework. Shortly after his August 9 address, President Bush appointed Kass to chair his newly formed President’s Council on Bioethics. Embryo protection and human nature protection have to date provided the White House with its frameworks for ethical deliberation.

Jewish and Islamic Stands on Stem Cell Research

[38] Both Jewish bioethics and Muslim bioethics tend toward support of regenerative medicine, including hES cell therapy. When Jewish ethicists approach issues arising from genetic research, they most frequently find themselves working from within the medical benefits framework. The Jewish commitment to Tikkun Olam—the responsibility to join God in repairing and transforming a broken world—provides theological support for scientific research in general, and medical research in particular. The Jewish interpretation of the Bible includes God’s mandate to the human race to engage in healing, in making this world a better place. Jewish theology presumes that God’s creation is not done yet. It’s still on the way. We look to the future rather than the past to discern God’s will. And God’s will includes creative and redemptive activity yet to come. In short, healing and transforming are godly. The potential for medical benefits will play the decisive role in Jewish ethical thinking. Jewish ethicist Elliot Dorff writes:

“The potential of stem cell research for creating organs for transplantation and cures for diseases is, at least in theory, both awesome and hopeful. Indeed, in light of our divine mandate to seek to maintain life and health, one might even contend that from a Jewish perspective we have a duty to proceed with that research.”[24]

[39] If we ask questions from within the embryo protection framework, we note that the Jewish tradition does not date morally protectable personhood with conception, as does the Vatican. Rather, the question of personhood and ensoulment does not arise until quickening, thought to be at forty days. Because of this, Jewish ethicists seldom make claims from within the embryo protection framework.

[40] When we turn to Islam, we find that in America Muslims fully support human embryonic stem cell research. They oppose human reproductive cloning. Still, the majority support stem cell research when discarded embryos are used; and nearly half support the creation of embryos for research purposes. We find in Islamic capitals around the world such as Cairo and Tehran scientific institutes springing up to pursue stem cell research.

[41] When Muslim ethicists support stem cell research, even hES cell research, they begin arguing from within the future wholeness or medical benefits framework. Abdulaziz Sachedina, for example, contends that “research on stem cells made possible by biotechnical intervention is regarded as an act of faith in the ultimate will of God as the Giver of all life as long as such an intervention is undertaken with the purpose of improving human health.”[25]

[42] Having begun with beneficence toward future patients who might benefit from regenerative therapies, Muslim ethicists then turn to questions arising from within embryo protection. They ask: when does morally protectable human life begin? Their situation is similar to that of the Jews. In some sections of the Qur’an we find quickening dated at 40 days after conception, elsewhere ensoulment at 120 days. In neither case would this produce an equivalent to the Roman Catholic commitment to ensoulment accompanied by dignity already at conception. The blastocyst is not considered a person; and the use of it for stem cell research does not violate Islamic law. The Ethics Committee of the Islamic Medical Association of North America (IMANA) appeals to medical benefits when it states: “In principle, stem cell research, including the use of hESC’s and SCNT, is acceptable due to its therapeutic potential.” Then, IMANA argues from within the embryo protection framework: “fertilized eggs before implantation are not considered fully human because without implantation they can not survive and develop into a human being.”[26]

[43] Now, we turn to a most interesting aspect of Islamic thinking. The Islamic Institute in Washington strongly supports transferring excess embryos from freezers into laboratories. “It is a societal obligation to perform research on these extra embryos instead of discarding them.” Rather than merely permit the use of excess embryos, such use for research is encouraged. Why?

[44] Here is why. Inheritance is extremely important in cultures influenced by Islamic tradition. Inheritance is dependent upon blood lines; so genetics is an area of science put to use in determining just who is eligible to inherit family property. Clarity in this regard is paramount. Muslims who take advantage of reproductive technologies such as IVF worry about the excess fertilized ova in frozen storage. Might a mistake occur? Might one or more of these frozen zygotes accidentally get planted in another woman? Might there be a possibility—even if remote—that one family’s genes might appear in the genome of a stranger? Could that person eventually make a claim on inheritance? Now, such a worry can be eliminated if all frozen embryos are eliminated. Muslim families frequently offer their excess embryos for laboratory use, because this guarantees that genes with potential inheritance claims will not get out. The result is that laboratories will find a source for research materials among Muslims.

Adult Stem Cells and iPS Cells

[45] In a brochure published by the Michigan Catholic Conference, “The Science of Stem Cells,” we find this question: “is the Catholic church opposed to all stem cell research?” The answer provided is this: “not at all. Most stem cell research uses cells obtained from adult tissue, umbilical cord blood, and other sources that pose no moral problem. Useful stem cells have been found in bone marrow, blood, muscle fat, nerves, and even in the pulp of baby teeth.”[27] The reader might get the impression that, if adult stem cells can provide what science needs, then research on hES cells is unnecessary. This brochure reflects Vatican thinking.

[46] While in Dignitatis Personae the Congregation for the Doctrine of the Faith puts up stop signs to block embryonic stem cell research, it gives the green light to adult stem cell research. The theological argument is that harvesting adult stem cells does not put an unborn person at risk. The scientific argument is that adult stem cells provide what embryonic stem cells provide. “Numerous studies . . . show that adult stem cells also have a certain versatility.”[28] Although technically this is true, it is definitely misleading. By suggesting “a certain versatility,” one gets the false impression that hES cell research is unnecessary. No research scientist would agree.

[47] As we mentioned above, “adult stem cells” refer to partially differentiated multipotent stem cells such as those found in the blood stream. They can be derived from living persons or umbilical cords and would not involve destruction of an early embryo. Here again, we note that the term “adult” may be misleading, for the just-born infant is considered an “adult” for purposes of adult stem cell research. Others argue that adult stem cells will not solve the ethical issues. Adult stem cells are already partially differentiated, already designated for a limited range of tissue types. The versatility they exhibit is restricted to a limited range of cell types. They are not pluripotent. To date, no credible experiments on adult stem cells have demonstrated that their value to regenerative medicine is equal to that of embryonic stem cells.

[48] Some studies have suggested that adult stem cells from one tissue type can migrate to and integrate into other tissues. However, it has not been demonstrated that these stem cells actually become the new tissue type; that is, it has not been demonstrated that they function as a stem cell of this new tissue type—they do not produce daughter cells of that tissue type nor do they appear to regenerate that tissue. In order for transplanted stem cells to be valuable for regenerative medicine they need to be capable of three things: 1) they must lodge in the host tissue, 2) they must become that tissue type, and 3) they must regenerate that tissue. As of this writing, only embryonic stem cells have demonstrated all three capabilities. Most scientists recommend that adult stem cell research continue, to be sure; but they recommend that embryonic stem cell research also be continued.

[49] Working from within the embryo protection framework, some scientists are racking their brains to come up with sources for hES cells that avoid so-called embryo destruction. Might it be possible to reprogram existing somatic cells so that they take on embryonic characteristics? If so, we could avoid using gametes yet still derive pluripotent cell lines. We are talking here about dedifferentiation techniques such as cytoplasmic reprogramming, DNA nucleus reprogramming, somatic cell nuclear transfer, and cell fusion. In each case, the pluripotent stem cells that would result would have the same genetic code as the recipient—that is, they would be patient specific and avoid immune rejection.[29]

[49] Experiments first on mice and then humans at Kyoto University and Harvard University during 2006 and 2007 have shown special promise here. We are talking here about iPS or induced pluripotent stem cells. Laboratory researchers began with a skin cell. Into this cell they sent a retrovirus carrying auxiliary genes, genes that ordinarily induce embryo development (Oct4, Sox2, eMye, and Klf4).[30] When expressed, these genes activated the skin cell, and it became the equivalent of an embryonic cell. It became totipotent as well as pluripotent—that is, it became capable of both making a baby (totipotent) as well as making all other cell types (pluripotent). The difficulty, however, is that all four of these auxiliary genes are carcinogenic. Any stem cell lines derived from this source risk causing cancer in the recipient. Experiments are continuing using an adenovirus, which stays out of a cell’s own DNA, rather than a normal virus that does not. Ethically, what we have here could be a promising source of pluripotent cells that avoids the destruction of what the Vatican thinks is the early embryo.

[50] I must stress: what the Vatican currently “thinks” is the early embryo. Should DNA reprogramming (or even cytoplasmic reprogramming) of skin cells successfully create totipotent embryos, in principle these could be implanted and grow into a child. They would not be limited to being a source for pluripotent cell lines. Even though this method would bypass the naturally occurring gametes which have been used since the dawn of the human race for procreation, reprogrammed somatic cells might gain the moral status of human beings in potentia. Ethically speaking, we might find ourselves right back where we started from.[31]

[51] The list of laboratory attempts to derive hES cells without destroying the blastocyst goes on. One attempt proposes to derive stem cells might from “organismically dead” embryos – those that were frozen following IVF and upon being thawed fail to divide. If they are declared organismically dead, then using them does not involve killing. Another derivation attempt begins by removing one or two cells from the inner cell mass in order to culture stem cells. Just as one or two cells are often removed from an IVF embryo in order to check for genetic disease, this process would not destroy the blastocyst. A third derivation proposal is that we create an organism that is genetically engineered so that it could not develop into a full-fledged human embryo or fetus. Called “altered nuclear transfer” or ANT, this crippled embryo could provide stem cells but not be given the status of totipotency. A fourth derivation proposal is parthenogenesis; it might be possible to stimulate an egg into dividing without having fertilized. With parthenogenesis, there is no “embryo” but only a dividing egg.[32]

[52] Three things should be noted about these proposals. First, it should be noted that their development attests to the significant influence of the embryo protection framework on the professional standards framework. Each represents a way of trying to avoid the problem of disaggregating the early blastocyst. Second, the scientific drawback in each is that some sort of defect is likely to enter the derived stem cell line; and this defect could be passed on to the recipient. Laboratory scientists filter the genetic material they examine, looking for only the best. Each of these proposals provides something less than the best genetic material with which to work. Third, it should be noted that these proposals raise new and difficult ethical issues. For instance, removal of one or two cells from the inner cell mass might put that blastocyst at risk for anomalies if brought to birth. For this reason, the President’s Council rejects this option.

Souls, Embryos, and Persons

[53] The presupposition made by the Vatican that God creates an immortal or spiritual soul and infuses it in the zygote at or shortly after conception almost, but not quite, relies upon a substance dualism. On the one hand, the soul is a specially created spiritual thing that can be infused into a zygote with a new and unique genome. On the other hand, when it comes to life beyond death, the soul’s substance is not automatically immortal. That is, our promised resurrection from the dead requires a divine act of raising us. The soul’s spiritual substance is not independently immortal.

[54] The Vatican also presupposes that fertilization produces a human individual; and this individuality is attested to by the appearance of a unique genome. This physical genome cries out for the infusion of a spiritual soul, according the 1974 Declaration on Procured Abortion, a position favored by popes John Paul II and Benedict XVI. “Supposing a later animation, there is still nothing less than a human life, preparing for and calling for a soul.”[33] The physical receptivity for the soul—prior to the actual creation and infusion of the soul—becomes the criterion for applying personhood to the embryo at its earliest stage.

[55] These presuppositions made by the Vatican are not uniformly shared. As we have seen, Jews and Muslims are likely to disagree regarding the time of ensoulment, even if they accept substance dualism. They do not presuppose a doctrine of physical—genomic—readiness for a spiritual soul that presses dignity back to the pre-ensouled zygote stage. Also, Protestants who are uneasy with substance dualism per se are likely to deny the metaphysical status of a spiritual soul. Protestants today tend to think more relationally than substantially.

[56] What might a more relationalist understanding of the soul look like? Let me begin with appeal to the Bible. Many passages in Scripture dramatically demonstrate the care and attention that God has for each one of us, calling us from nonbeing into being and finally into fellowship within the divine life. “The Lord called me before I was born,” says Isaiah; “while I was in my mother’s womb he named me” (Isaiah 49:1). Psalm 139:16 is a powerful statement of God’s knowledge and love for us when we are not yet formed: “Thy eyes beheld my unformed substance; in thy book were written, every one of them, the days that were formed for me, when as yet there were none of them.” What gives the prophet, the psalmist, and the rest of us dignity are God’s call, God’s knowing us and naming us as God’s own.

[57] Soul is not a matter of a private, spiritual substance that we possess or that inheres in us or that is added by God to a unique genome. What is decisive is our relationship to God, an eternal relationship God established even before we are formed by calling us toward the divine. However it is imagined, “soul” describes the way in which our life overlaps with God’s life and that we enjoy a spiritual and eternal relationship with God. In a sense, soul and vocation belong together. In this understanding, we might be ‘called’ by God in many ways and for many purposes.

[58] What I have said here provides us with a theological alternative to the Vatican position. Scientifically, there are also problems with the embryo protectionist view that a zygote is a person and therefore should be protected from the moment of conception. First, there is no “moment of conception.” Conception is a process, not an instant. When, exactly, in that process should protectable status be declared? Further, the development of a zygote into an infant goes through many stages. If we respect and protect people differently at different stages of life, then what kinds of respect and protection are appropriate at these many stages of development in the womb or in vitro? It is true that conception creates a new entity with a new genome. But it does not create an individual person, nor necessarily even genetic uniqueness. What happens in vivo, naturally within the mother’s body, is this: the zygote can divide into two, four, eight, or more individuals, all with the same genetic code. Identical twins or triplets are one possible result of such a division. Two or three children result that have the same genome. In addition, two eggs can be fertilized after one event of sexual intercourse; and these two zygotes can combine to form a baby with two genetic codes (technically known as a chimera). Two or more babies can be born with the same genome; and one baby can be born with two genomes.

[59] In short, within the first dozen to fourteen days after conception, the early embryo can divide and recombine in various ways. There is no established individual human being until approximately the fourteenth day after conception, and this only when the embryo has been implanted in the uterine wall. Not until this time, when a primitive streak appears, can we identify a single individual who will become a baby. If receiving an infused soul because one is a unique human being is a criterion for protection, then that protection would not come into play until about 14 days after fertilization. The crucial structures that develop at around 14 days help to explain why an informal but widely accepted practice has been adopted by scientists: called the “14 day rule.” Professional standards by which laboratory scientists work routinely specify that no embryos are kept developing in vitro beyond 14 days. Indirectly, embryo protectionists have had an influence on laboratory practice; but the stop sign goes up at 14 days rather than conception.

The Interesting Argument of Paul Jersild

[60] For the sake of discussion, let me briefly outline an argument in support of human embryonic stem cell research raised by Paul Jersild. Although my destination might coincide with his, Jersild’s route differs.

[61] The route Jersild takes is to begin arguing from within the embryo protection framework. What he calls “the central issue of the stem cell debate for people of faith” is “the theological and moral status of the embryo.”[34] We commonly refer to this as the question: when does human life begin? Even though he centers his argument within the same framework as the Vatican, he arrives at the opposite conclusion.

[62] Jersild rejects the Vatican assumption that ensoulment at conception establishes the same level of dignity and moral protectability that we ascribe to an autonomous living person. Jersild makes two commitments that lead him away from the Vatican stand. His first commitment is to the gradualist position, which holds that moral respect develops as we develop. “Human life demands respect whatever the circumstances or condition . . . but the gradualist position calls for distinctions to be made concerning the nature of that respect during the course of embryonic and fetal development. Thus, contrary to the way it is commonly framed, the issue is not when human life begins; the question, rather, is what the nature of our obligation to human life is as it develops. . . . The sense of moral obligation toward prenatal life increases as the development of that life proceeds from its microscopic, non-sentient state to a recognizable member of the human family.”

[63] To this I offer some comments. I do not hold the gradualist position. I believe we should ascribe full dignity to an unborn fetus living in its mother’s womb, even at relatively early stages of development. I can still support stem cell research, however, because the ex vivo blastocyst is not an individual human person living as a fetus in a mother’s womb. Even though the gradualist position is a reasonable position for an ethicist to hold, I do not rely upon this particular commitment to sustain an argument in support of stem cell research.

[64] A second of Jersild’s commitments I find interesting is the fundamental role he ascribes to relationality. The Vatican position, perhaps unreflectively, relies upon an autonomous ontology of the human individual. An ensouled blastocyst sitting in a Petri dish deserves a level of rights protection equal to that of an adult going to the voting both. Jersild, in contrast, begins ethical deliberation within a relational framework. “We become who we are as human beings in relation to God and to our fellow human beings.” I agree. Without any compromise to the dignity or moral protectability of the human individual, I hold that ethical deliberation begins with person-in-relationship. Ethical reflection deals with how we relate with one another, and with God. Or, to apply this point of departure to the stem cell controversy, the relationship of a fetus to a mother counts ethically. This relationship is absent when dealing with a stem cell line created in the laboratory. I agree with Jersild when he says, “the dismantling and destruction of an embryo that takes place in stem cell research ought not to be labeled an abortion.”

[65] Even though Jersild begins his analysis within the embryo protection framework, he escapes it for a moment when affirming beneficence toward future patients who could be helped by regenerative medicine. “My conclusion is that when one sees ESC research within the context of potential healing of diseased and suffering people, the most weight clearly lies on the side of healing people. There is no moral revulsion over the destruction of the life at the embryonic level that begins to compare with the anguish and grief caused by the premature demise of people afflicted with a genetic disease, or who are severely disabled by injury.” While I appreciate his appeal to future wholeness for those who suffer, I hesitate to pit beneficence over against nonmaleficence. I hesitate to cast the debate in terms of a competition between living people, on the one hand, and nascent human persons, on the other. Arguing for future wholeness for those who suffer need not rely upon a relatively lesser value ascribed to embryonic persons. For us supporters of stem cell research who begin ethical deliberation from within the future wholeness or medical benefits framework, we still have an obligation to provide counter arguments to stop sign ethicists working from within embryo protection. Jersild helps provide such arguments.

Conclusion

[66] Should Christians support laboratory scientists in their research on human embryonic stem cells? Yes, is my answer. This answer is first formulated within a framework of ethical deliberation that focuses on the promise of this medical research. Stem cell therapies hold the promise of regenerating diseased or traumatized tissue. This could lead to incalculable relief from suffering by patients who have heart disease, brain deterioration, diabetes, paralysis, and numerous other maladies. It could lead to a longer and healthier life for a large portion of persons living on our planet. Despite the expense and the difficulty to be shouldered by the present generation in taking on research into regenerative medicine, the long term rewards for future generations are enormous. Guided primarily by beneficence, I believe a Christian can make a strong moral argument in favor of society’s support for this enterprise.

[67] Yet, courtesy requires extending respect to those who wish to put up stop signs and shut down hES research. The naysayers debating from within the embryo protection and human protection frameworks provide coherent and sometimes passionate arguments for their stands. Whenever I find myself in disagreement with a conscientious opponent who provides an internally coherent argument, I take pause. The difference in stand must be due to a difference in one or more basic assumptions, or perhaps a difference in focal question or maybe ethical framework. I must ask: just how sound is the justification for my own starting point? Is it apodictic? Is it God’s eternal will? Or, is my starting point only relatively preferable to that of my opponent?

[68] This is where I find myself in the current stem cell debate. Working with an orientation toward beneficence within the future wholeness framework seems to me to be the best among the alternatives. In making this commitment, I feel I must acknowledge the possibility that a better ethical argument might come along that would persuade me to adopt an alternative position. In the meantime, I intend to take a moral stand on what I deem to be the best of the existing alternatives. Stem cell research should proceed forward, at least until a better argument comes along to alter this direction.

Endnotes

[1] “Bioethics Document Released,” NCRegister.com http://www.ncregister.com/daily/tags/dignitas_personae (accessed 12/20/08).

[2] Dignitas Personae, 31, 32; at Women for Faith and Family, full text at http://wf-f.org/DignitasPersonae.html (accessed 12/20/08).

[3] My research on this topic is co-dependent. These categories of analysis were developed as part of a team effort with two of my colleagues, Karen Lebacqz and Gaymon Bennett. See the book we co-authored, Sacred Cells? Why Christians Should Support Stem Cell Research (New York: Roman and Littlefield, 2008).

[4] Currently an ELCA Task Force on Genetics is preparing a social statement, “Genetics & Faith: Power, Choice, & Responsibility.” Copies of the study can be ordered for $4 each from the ELCA Resource Catalog or call 800-638-3522.

[5] Douglas Melton and Chad Cowan, “’Stemness’: Definitions, Criteria, and Standards,” in Robert Lanza, Ed., Handbook on Stem Cells, 2 Volumes (Amsterdam: Elsevier Academic Press, 2004) 2:xxiii.

[6] Ibid. 2:xxvii.

[7] The President’s Council on Bioethics, Monitoring Stem Cell Research: A Report of the President’s Council on Bioethics (Washington, D.C.: Government Printing Office, 2004), 12.

[8] Hans Tiefel, “Watching Our Language: The Human Embryo Stem Cell Controversy,” Journal of Lutheran Ethics (February 2007) http://www.elca.org/What-We-Believe/Social-Issues/Journal-of-Lutheran-Ethics/Issues/March-2007/Watching-Our-Language-The-Human-Embryo-Stem-Cell-Controversy.aspx (accessed 4/4/2012).

[9] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 5th ed. (Oxford: Oxford University Press, 2001) 166.

[10] “To elect an unsure commitment to nonmaleficence rather than an unsure commitment to beneficence would be, as in Jesus’ parable of the Good Samaritan, passing by on the other side.” Ted Peters and Gaymon Bennett, “A Plea for Beneficence: Reframing the Embryo Debate” in God and the Embryo: Religious Voices on Stem Cells and Cloning, edited by Brent Waters and Ronald Cole-Turner (Washington DC: Georgetown University Press, 2003) 128. Paul T. Nelson objects to this interpretation for being “too simple and one-sided. An unqualified commitment to an unsure beneficence may lead us to do evil that good might come. Christian ethics must hold means as well as ends in view and that requires us to resist the utilitarian imperative to achieve all the good we can no matter by what means.” “Embryonic Stem Cells 2007,” Journal of Lutheran Ethics (March 2007) http://www.elca.org/What-We-Believe/Social-Issues/Journal-of-Lutheran-Ethics/Issues/March-2007/Embryonic-Stem-Cells-2007.aspx (accessed 4/4/2012). I would like to respond by saying that beneficence may provide the orientation to this ethical framework, but nonmaleficence provides a limiting factor. Beneficence does not imply “no matter by what means.”

[11] Formulating policy regarding informed consent and safety for women who donate eggs has been an issue that has occupied the Scientific and Medical Accountability Standards Working Group of the California Institute for Regenerative Medicine (Prop 71). See: http://www.cirm.ca.gov/reg/default.asp . On this issue, commitments arising from within the future wholeness or medical benefits framework feeds directly what we find discussed within the professional standards framework.

[12] Dignitatis Personae, 1. See: Congregation for the Doctrine of the Faith, Instruction on Respect for Human Life in its Origins and on the Dignity of Procreation (Donum Vitae) (22 February 1987), Acta Apsotolicae Sedis (AAS) 80 (1988) 70-102. See also: John Paul II, Evangelium Vitae (25 March 1995), Acta Apostolicae Sedis 87 (1995) 401-522.

[13] Dignitatis Personae, 30.

[14] Dignitatis Personae, 5.

[15] Dignitatis Personae, 32.

[16] Dignitatis Personae, 34. What about cloning (SCNT: somatic cell nuclear transfer)? The Vatican opposes reproductive cloning because it denies “a connection to the act of reciprocal self-giving between spouses.” (Ibid., 28) With regard to therapeutic cloning to establish patient specific stem cells, the document raises “questions of both a scientific and an ethical nature.” (Ibid., 30) Francis S. Collins, molecular biologist and outspoken evangelical Christian, weighs in on the transfer of a dedifferentiated skin cell nucleus into an enucleated egg. “The immediate product of a skin cell and an enucleated egg cell fall short of the moral status of the union of sperm and egg. The former is a creation in the laboratory that does not occur in nature, and is not part of God’s plan to create a human individual. The latter is very much God’s plan, carried out through the millennia by our own species and many others.” The Language of God (New York: Free Press, 2006) 256. Collins, somewhat like the Vatican, associates what is natural with God’s plan and what is human artifice as morally distinct. The difference is that Collins approves of the latter, while the Vatican doubts the latter.

[17] Margaret A. Farley, “Stem Cell Research: Religious Considerations,” in Handbook of Embryonic Stem Cells, 1:765-73.

[18] Gilbert C. Meilaender, “Testimony,” in Ethical Issues in Human Stem Cell Research: Vol. 3: Religious Perspectives, (Rockville MD: Governmental Printing Office, 2000) F-6; or http://bioethics.georgetown.edu/pcbe/reports/past_commissions/nbac_stemcell3.pdf .

[19] Leon R. Kass, Life, Liberty and the Defense of Dignity: The Challenge of Bioethics (San Francisco: Encounter Books, 2002) 153.

[20] Ibid. 146.

[21] Ibid. 106.

[22] Ibid. 149.

[23] Dignitatis Personae, 16.

[24] Elliot N. Dorff, “Stem Cell Research—A Jewish Perspective,” The Human Embryonic Stem Cell Debate, Suzanne Holland, Karen Lebacqz, and Laurie Zoloth, eds. (Cambridge: MIT Press, 2001) 92.

[25] Abdulaziz A. Sachedina, “Islamic Perspectives on Research with Human Embryonic Stem Cells,” in Ethical Issues in Human Stem Cell Research, G-4 at http://bioethics.georgetown.edu/pcbe/reports/past_commissions/nbac_stemcell3.pdf .

[26] The Islamic Medical Association of North America, “Stem Cell Research: the IMANA Perspective,” http://www.abidsheikh.com/IMANA/IMANASearch/PDF%20Files/Stem%20Cell%20Position.pdf, p.13 (accessed 12/22/08).

[27] Michigan Catholic Conference, The Science of Stem Cells (2007); www.micatholicconference.org.

[28] Dignitatis Personae, 31.

[29] J.B. Gurdon and D.A. Melton, “Nuclear Reprogramming in Cells,” Science 322 (19 December 2008) 1811-1815.

[30] See: K. Takahashi and S. Yamanaka, “Induction of Plutipotent Stem Cells from Mouse Embryonic and Adult Fibroblast Cultures by Defined Factors, Cell 126:4 (August 2006) 652-55 and “Simple Switch Turns Cells Embryonic,” Nature 447 (June 2007) 618; plus D. Egli, J. Rosains, G. Birkhoff, and K. Eggan, “Developmental Reprogramming after Chromsome Transfer into Mitotic Mouse Zygotes,” Nature 447 (June 2007) 679-85.

[31] Richard Doerflinger, spokesperson for the U.S. Conference of Catholic Bishops, leaped upon the news of iPS cells with affirmation. This procedure “raises no serious moral problem, because it creates embryonic like stem cells without creating, harming or destroying human lives at any stage.” “Washington Insider,” National Catholic Bioethics Quarterly 7:3 (Autumn 2007) 458. I suspect this is premature. Once Doerflinger thinks this through, he might discover the inconsistency in the Vatican position. Whether a totipotent cell comes from a pair of gametes or a skin cell, its potential for producing a human person should be ethically counted.

[32] These proposals are discussed in a “white paper” of the President’s Council on Bioethics published in May 2005 and entitled “Alternative Sources of Human Pluripotent Stem Cells.”

[33] [33] Congregation for the Doctrine of the Faith, Declaration on Procured Abortion in Acta Apostolicae Sedis 66 (1974), note 19.

[34] The citations here are drawn from Paul Jersild, “Theological and Moral Reflections on Stem Cell Research,” Journal of Lutheran Ethics (February 2007).