There is little doubt that public reflection on stem cell research in the United States has been affected by the extraordinarily volatile cross-currents of the abortion debate.  Although I will indicate below several reasons why framing the stem cell debate as a subset of that on abortion is problematic, nevertheless, in its current form, stem cell research is debated in terms dictated by the abortion controversy, and that has meant that  questions about the status of the embryo have been particularly prominent.1  For example, the National Bioethics Advisory Commission (NBAC) described the ethical issues raised by stem cell research as "principally related to the current sources and/or methods of deriving these cells" (NBAC, 1999, 45).  A policy brief from the American Association for the Advancement of Science (AAAS) begins its discussion of the ethical dispute over stem cell research by citing the disagreement over the status of the embryo as the decisive variable leading to fundamentally different views on this research (AAAS, 1999, 11).  The National Academy of Sciences's report on stem cell research claims that "the most basic [ethical] objection to embryonic stem cell research is rooted in the fact that such research deprives a human embryo of any further potential to develop into a complete human being" (National Academy of Sciences, 2002, 44).  The Ethics Advisory Board of the Geron Corporation lists the moral status question as the first moral consideration relevant to deciding the acceptability of stem cell research (Geron Corporation Ethics Advisory Board, 1999, 32).  The list could go on.

Despite the fact that these statements all insist on the importance of the status question, they also recognize that the debate about the status of the early embryo is not new and that the controversy over stem cell research does not, strictly speaking, raise novel issues in this regard.  Indeed, it is probably best to place the initial skirmishes over stem cell research in the context of moral debates about human embryo research generally.  In fact, it is worth noting that the report of the NIH Human Embryo Research Panel (HERP), published in 1994, explicitly identified the isolation of human embryonic stem cells as one of thirteen areas of research with preimplantation embryos that might yield significant scientific benefit and that should be considered for federal funding (See NIH HERP, 1994, ch. 2).

Although the recommendations of the HERP were never implemented, the fact that a high-profile panel reviewed ex utero preimplantation human embryo research and explicitly endorsed stem cell research, meant that the panel report would affect the policy debate about stem cell research, even though its recommendation that the derivation and use of stem cells be federally funded was not adopted.  For one thing, the panel's anticipatory support for stem cell research assured that when human stem cells were actually derived several years later, the debate that ensued would be tied to the abortion controversy.  As members of the HERP panel have made clear, from the start, the work of the panel was embroiled in controversy.  For example, shortly after the HERP was impaneled, thirty-two members of Congress wrote to Harold Varmus, the director of NIH, to complain about the composition of the panel.  A lawsuit was filed in an attempt to prevent the panel from meeting, and members of the panel received threatening letters and phone calls (Green, 1994; Tauer, 1995; Hall, 2003).

Given the pro-life opposition to the HERP panel and its recommendations, it is no real surprise that initial reactions to the prospect of human stem cell research fell out along the fault lines of abortion politics in the country. By and large, individuals and groups opposed to abortion tended to be opposed to stem cell research, and individuals and groups supportive of legalized abortion tended to support stem cell research.² For example, the testimony that Richard Doerflinger, the principal spokesperson for the U.S. Catholic bishops on pro-life matters, offered before the Senate Appropriation Subcommittee on Labor, Health, and Education in 1998 was substantially the same as that he offered before the HERP in 1994 on stem cell research (Doerflinger, 1998, 1994).  In both cases, the fundamental issue was the status of the embryo.  Given Catholic teaching that the embryo must be treated as a person from conception, no experimentation on the embryo can be allowed that would not also be allowed on infants or children.  Hence, the Catholic church treats stem cell research as it has treated previous issues involving the destruction of human embryos; it is condemned as morally abhorrent. 

In similar fashion, the arguments reviewed by the HERP panel that supported embryo research generally in 1994, were mobilized again four years later when stem cell research was the specific point of contention; and again the focal point was embryo status.  Consequently, just as the HERP report opted for a "pluralistic" view of the embryo that emphasized its developmental potential, so, too, did the NBAC endorse the idea that the early embryo deserves respect, but is not to be treated fully as a person.³

Moreover, the fact that the HERP defended its support of stem cell research by stressing the developmental capacity of the embryo also shaped the trajectory of much subsequent support for this work, because insisting on respect for the embryo but denying its personhood meant explaining how one could respect the embryo while nevertheless destroying it.  Daniel Callahan, for example, posed this problem very strongly in response to the HERP report. If "profound respect" for the embryo is compatible with destroying it, he asked, "What in the world can that kind of respect mean?" It is, he says, "an odd form of esteem, at once high-minded and altogether lethal" (Callahan, 1995). Callahan was not alone in raising this issue and attempts to answer his question continue to appear in the literature (See Lebacqz, 2001; Meyer and Nelson, 2001; Ryan, "Creating Embryos," 2001; Steinbock, 2001, 2000).

In retrospect, then, it seems that the HERP report served almost as choreography for the initial debates about stem cell research, and, as a result, the steps in the debate closely followed those that are familiar from the abortion controversy (On this point, see Hall 2003). The upshot, in my view, is that much of the debate has been too narrowly focused and has a kind of repetitive and rigid quality to it.  As I noted above, for example, the Catholic church has repeatedly claimed that the central issue raised by stem cell research is that it involves the destruction of human embryos, embryos it believes should be treated as persons.⁴ For that reason, the rhetoric with which the Catholic church condemns embryonic stem cell research closely parallels that used to condemn abortion.  Yet, because the American bishops do not want to be perceived as anti-science, they have also repeatedly and uncritically praised adult stem cell research, even though there are good reasons, given Catholic concerns about social justice, to be concerned about the pursuit of adult stem cell research.  I will return to this point below, but for now I wish simply to note that much of the opposition to embryonic stem cell work has resembled Catholic opposition in being circumscribed by questions of embryo status, narrowly construed. 

A similar constriction, however, is also apparent in the preoccupations of supporters of stem cell research.  Just as opponents of this research have ritualistically condemned the destruction of early embryos but uncritically celebrated adult stem cell work, supporters of embryonic stem cell research have typically insisted on using embryos left over from IVF procedures, while repudiating the use of embryos created solely for research.  Indeed, insisting on the distinction between so-called "spare" embryos and "research" embryos and endorsing only the use of spare embryos has been one way that supporters of embryo research have tried to demonstrate their "respect" for the embryo.  Yet, it is worth asking whether the spare embryo/research embryo distinction does not, to borrow Daniel Callahan's image, provide a kind of "wafting incense" to mask what supporters still find a disquieting smell (Callahan, 1995).⁵

Although the debate about stem cell research might have been framed in terms of the abortion controversy in any event, the HERP report insured that the initial debate over stem cell work that followed in aftermath of the public announcement of the work of John Gearhart (Shamblott et al., 1998) and James Thomson in 1998 (Thomson et al.) would be navigated in the wake of the conflict over abortion. As I indicated, the upshot is that the discussion about stem cell research has been more cramped than it might otherwise have been.  The discussion has been too focused on the details of embryological development; too focused on the differences between those who view the early embryo as a person and those who do not; and far too individualistically oriented.  Before turning to ways that the debate might be become less cramped, let me focus more concretely on these difficulties.

The point about the debate being framed too individualistically is nicely illustrated in an article on abortion by Lisa Sowle Cahill entitled "Abortion, Autonomy, and Community" (Cahill, 1996).  Cahill begins this article by claiming that, in discussing the morality of abortion, there is no way to avoid the question of the status of the fetus.  Nevertheless, she says, the debate about fetal status is almost always conducted with the goal of determining the rights involved, where rights are understood very individualistically.  To the degree that the fetus is acknowledged to have rights, those rights are pitted against the rights of the pregnant women.  Although Cahill doubts that we can jettison the use of rights language altogether, if we are going to use rights language, she says, we must "remove that language from the context of moral and political liberalism" (361).  If we do so, we might be able to see that we have duties and obligations to which we do not explicitly consent.  As Cahill puts it, "such obligations originate simply in the sorts of reciprocal relatedness that constitutes being a human" (361).⁶ For example, moving away from an individualistic liberal view of the pregnant woman as primarily or exclusively an autonomous moral agent might lead us to recognize the obligations that individuals and communities have to support her during and after a burdensome pregnancy (363).

We do not need to accept Cahill's commitment to the Catholic common good tradition to recognize the truth in her conclusion that pitting the rights of the fetus against the rights of the pregnant woman individualistically construed leads us to overlook important social dimensions of the problem of abortion.  It seems to me that much the same dynamic is evident in the stem cell research debate.

Consider again the central argument that the Catholic church has made against stem cell research.  The Pontifical Academy for Life suggests that the fundamental ethical issue is whether it is morally licit to produce or use human embryos to derive embryonic stem cells.  The reasoning the Academy provides for concluding it is not licit is worth reproducing in full.  The Academy lists five points:

Notice that the core of the argument, namely points one and two, is framed in terms of the rights of the individual embryo.  We have seen this emphasis already in noting Richard Doerflinger's various statements on stem cell research.  Yet, notice also the claim that we know the embryo to be an individual with rights on the basis of "a complete biological analysis."  This is not, of course, the first time that the Catholic church has made this claim.  In the Declaration on Procured Abortion, the Congregation for the Doctrine of the Faith claimed that "modern genetic science" confirms the view that "from the first instant, the programme is fixed as to what this living being will be: a man, this individual-man with his characteristic aspects already well determined"  (Congregation, "Declaration on Procured Abortion,"1974, 13).  The Instruction on reproductive technology, Donum Vitae, also makes this claim.  "The conditions of science regarding the human embryo provide a valuable indication for discerning by the use of reason a personal presence at the moment of the first appearance of a human life: how could a human individual not be a human person?" (Donum Vitae, 13). 

One reason the Catholic church has played such a major role in framing the stem cell debate is that, in defending its position, it combines the two claims we have just noted, neither of which is explicitly religious.  First, the early embryo is an individual person with rights and, second, the fact that the embryo is an individual person is confirmed by modern science.  Indeed, a fair amount of the literature that supports embryo research generally can be read as an attempt to answer the question posed in Donum Vitae: How can a human individual not be a human person?

Certainly Catholic writers who reject the church's teaching on the status of the embryo have responded directly to that question (See Cahill, 1993; Farley, 2001; McCormick, 1994; Shannon, 2001; Shannon and Walter, 1990), but so too have non-Catholics. For example, in a statement issued by their ethics committee, what was then called the American Fertility Society rejected the claim in Donum Vitae that science supports the personhood of the embryo.  According to the ethics committee ". . . it remains fundamentally inconsistent to assign the status of human individual to the human zygote or early pre-embryo when compelling biological evidence demonstrates that individuation, even in a primitive biologic sense, is not yet established.  Thus, homologues (identical) twins may result from spontaneous cleavage of the pre-embryo at some point after fertilization but prior to the completion of implantation.  Furthermore, during very early development, an embryo is not clearly established and awaits the differentiation between the trophoblast and the embryoblast" (American Fertility Society, 1988, 3S).

Arguably, writers like Mary Anne Warren and Bonnie Steinbock, who distinguish between biological or genetic humanity and moral humanity, are also at least indirectly answering the question posed in Donum Vitae (Warren, 1997; Steinbock 2001, 1992).  Yet, whether writers are responding more or less directly to Catholic discourse, or not at all, the important point is that the stem cell debate has been remarkably preoccupied with the question of whether the early embryo is an individual person and whether and how the minute details of embryological development help us to answer this question.  This is one reason why a fair amount of the ethics literature on the topic reads like a textbook on embryology.

I want to be clear here: I am not suggesting that the details of embryological development are unimportant.  The maxim from the field of research ethics applies here as well: bad science is bad ethics.  My point is rather that the preoccupation with the details of early embryogenesis may lock us even more rigidly into an individualistic human rights framework than we are in debates about abortion.  It also leads us to frame the debate as fundamentally about one question, and, indeed, it tempts us to treat the question as if there is one and only one answer.  In this frame of mind, once we have that answer, there is not a lot more to talk about.  Either the early embryo is a person with the right to life, in which case embryonic stem cell research is wrong, or the early embryo is not a person with rights, and then there is no moral reason to object to stem cell work.  Gene Outka has made a similar point in his assessment of stem cell literature.  As Outka puts it, in its starkest form, the crystallizing question is whether it is cogent to claim that embryonic stem cell research is morally indistinguishable from murder (Outka, 184).  The problem with framing the question this way, he says, is that it "encourages an unfortunate tendency to restrict evaluative possibilities to a single either/or.  Either one judges abortion and the destruction of embryos to be transparent instances of treating fetuses and embryos as mere means to other's ends, or one judges abortion and embryonic stem cell research to be, in themselves, morally indifferent actions that should be evaluated solely in terms of the benefit they bring to others." (Outka, 2002, 184).

The frame of human rights reinforces this either/or because, as I noted, a being is either a rights-bearing entity or it is not.  I have argued elsewhere, that this either/or tends to drive people to the extremes.  Either the embryo is a person or it is essentially a kind of property (Lauritzen, 2001).  Although I will not rehearse the argument for rejecting the two extremes here, it is worth noting that the rhetoric associated with each extreme does not appear to match the practice of those who adopt the rhetoric or in fact to match the considered moral judgments of most Americans on these issues.

I can illustrate my point in relation to the view that the early embryo is a person with the right to life by describing a cartoon that hangs on my office door (See Figure A). The cartoon depicts protestors in front of a stem cell research lab condemning those who work there as being anti-life.  Down the street at the abortion clinic, the workers are noting how quiet things have gotten at their facility since the stem cell lab opened.  The point of the cartoon, of course, is that we may soon see protests and demonstrations of the sort that are common at abortion clinics at facilities that conduct stem cell research and that there is an irony in the fact that pro-life advocates would be demonstrating against research being done to find treatments for Alzheimer's, Parkinson's, and other devastating illnesses.  This is not entirely fair to the pro-life community, but it makes a point.

In fact, I do not have trouble imaging protestors picketing stem cell research facilities for, as we just noted, when stem cell research and abortion are evaluated together and when the evaluative option is a single either/or, then abortion and stem cell research may appear indistinguishable from murder.  Certainly the rhetoric of someone like Richard Doerflinger has been consistent in condemning both abortion and stem cell research as equivalent to murder.  The cartoon draws attention to this consistency, even while it questions the commitment of pro-life advocates to scientific research designed to promote the quality of life.

In one sense, then, the cartoon probes whether there is an inconsistency between being pro-life and opposed to research an Alzheimer's disease, Parkinson's disease, and other devastating illnesses.  I do not myself think that there is any inconsistency in being pro-life and opposed to stem cell research, but the cartoon does point in the direction of a fairly significant disconnect between the rhetoric and the reality of those opposed to stem cell research because they believe the early embryo is a person.  To see this point, imagine that, instead of a stem cell clinic, the cartoon depicted on IVF clinic down the block from the abortion clinic and that the workers at the abortion clinic are noting how quiet things have gotten since the IVF clinic opened.  The dramatic tension that made the original cartoon funny would be missing from our revised cartoon precisely because it is hard to imagine protestors disrupting the work at IVF clinics.  To be sure, the Catholic church and others have argued that IVF is morally wrong, but the rhetoric condemning IVF is exceptionally muted compared to that condemning abortion or stem cell research.  Nor has there been a concerted effort to put an end to IVF practice in this country as there has been in the case of abortion and stem cell research.  Yet, if the embryo is a person from conception, then participating in IVF as it is practiced in this country, when early embryos are routinely frozen or discarded or both, is to be complicit with murder.  Why, then, are there no organized efforts to shut down IVF clinics in this country?⁷

Indeed, opponents of stem cell research and cloning often write as if these technologies raise the haunting specter of human embryo research for the first time.  The reality, of course, is that the existence of in vitro fertilization depended entirely on embryo research and that every variation or innovation in IVF protocols involves experimentation on human embryos.  Carol Tauer is one of the few scholars who has pressed this point.  As Tauer sees it:

If the embryo research associated with IVF points to a problem of consistency for those who oppose stem cell research because it involves destroying persons, it is no less problematic for those who support stem cell research but insist on respecting the embryo and embrace the distinction between "research" and "spare" embryos.  For as Tauer points out, Robert Edwards, the scientist involved in the first successful IVF procedure, began studying fertilization nearly thirty years before Louise Brown was born in 1978, and the first successful laboratory fertilization of human eggs took place a full ten years before she was born.  Tauer quotes Edwards' report on this work:  "We fertilized many more eggs and were able to make detailed examinations of the successive stages of fertilization.  We also took care to photograph everything because we would have to persuade colleagues of the truth of our discoveries" (Tauer, 154).⁸ Nor was the creation of these "research" embryos done secretly: Edwards and Steptoe published their work in the journal, Nature in 1970 (Edwards, Steptoe, and Purdy, 1970).

At the very least, then, there is something of an irony in the fact that so much attention has been devoted to developing and defending the distinctions between embryos created solely for research and embryos left over from IVF procedures, because there would be no embryos left over from IVF procedures had there not been embryos created solely for research purposes to develop IVF in the first place.  Given this fact, and given that this fact is no great secret even though it has not been discussed very much it appears disingenuous to endorse the distinction between "research" and "spare" embryos as a way of demonstrating respect for the early embryo while nevertheless encouraging its destruction.

I have suggested that the fact that so much of the stem cell debate has been framed in terms of whether the embryo is a person with rights has been unfortunate because it has cast the debate in sharply individualistic terms and has led to a preoccupation with embryological development narrowly construed.  In addition, however, framing the debate in terms of embryo status and embryo rights tends to exaggerate the differences among commentators in contrast to their similarities.  Consider, for example, the response of conservative Judaism in the United States to this issue.  Rabbi Elliot Dorff has prepared a responsum on stem cell research for the Rabbinical Assembly Committee on Jewish Law and Standards, and his responsum is instructive.⁹

As responsa are, it is structured in terms of relevant questions: in this case, two questions frame Dorff's discussion.  First, "may embryonic stem cells from frozen embryos originally created for purposes of procreation or embryonic germ cells from aborted fetuses be used for research?" (Dorff, 2002, 1).  Second, "may embryonic stem cells from embryos created specifically for research, either by combining donated sperm and eggs in a petri dish or by cloning be used for research?" (1)  I think it is noteworthy that the very questions that frame Dorff's analysis both reflect and perpetuate a certain construction of the issue, but at this juncture, my point is different: given the way the debate has been framed, what most (non-Jewish) readers of Dorff's analysis are likely to focus on is the difference between his treatment of the early embryo and that of others in the literature.  Indeed, even where you might expect to find and do in fact find on closer inspection similarities between this Jewish analysis and Catholic reflection on this issue, the first impression will be that of difference.  The reason, of course, is that our attention is drawn to Dorff's analysis of the early embryo, and Jewish views are sharply different about embryo status than those of the Catholic church and other pro-life opponents of stem cell work.

For example, Dorff points out that, according to the Talmud, during the first forty days of gestation, the embryo and the fetus are considered as simply water.  From the forty-first day until birth, Jewish tradition considers the fetus as "the thigh of its mother."  Moreover, says Dorff:

The contrast with Catholic teaching could hardly be more striking.  Not only are Jewish views of the status of the early embryo notably different, but Jewish tradition claims scientific validation for its view of the embryo, just as Catholic tradition does.  Not surprisingly, therefore, where Dorff answers both questions posed by the responsum in the affirmative, Catholic tradition would answer both negatively.

These differences are significant and must be attended to, but it is worth asking whether focusing on these differences does not obscure important similarities.  Consider some of the similarities.  In sketching the Jewish view of stem cell research, Dorff notes that certain theological commitments are central.  He lists at least three that would be strikingly similar to Catholic and other Christian theological commitments.

Now if we focused merely on questions of embryo status, we would miss entirely these similarities between Catholic and Jewish views.  More importantly, we would miss the fact that these similarities may underwrite significant moral reflection on stem cell research that is not rooted in concerns about the early embryo.

For example, Dorff notes that, given Jewish theological and legal commitments, the provision of health care must be understood as a communal responsibility.  Thus, access to therapies developed through stem cell research is a crucial issue of justice for the Jewish community.  This theme is echoed in Laurie Zoloth's work on stem cell research.  As Zoloth puts it:

Surely these are questions that any Catholic moral theologian would gladly press.

Indeed, attending to the similarities between Zoloth's work and Catholic reflection on stem cell research brings us back to Lisa Cahill's observation about debates on abortion: they tend to be too focused on questions of rights individually construed.  When one shifts the frame of analysis, new and different issues and new and different ways to approach the same issues come into view.  Notice, for example, how close Zoloth and Cahill are on the issue of rights. According to Zoloth, Jewish tradition foregrounds questions of "obligations, duties, and just relationships to the other, rather than the protection of rights, privacy, or ownership of the autonomous self" (96).  This leads Zoloth to ask: "Can the interests of the vulnerable be heard in our debate?" (105).  To be sure, the American bishops have wanted to emphasize the vulnerability of the early embryo when they have asked this question, but Catholic tradition, like Jewish tradition, requires that we ask this question in a way that is not captured when moral emphasis is merely about individual rights and personal autonomy.

Or consider another shared sensibility that emerges if we move away from questions of embryo status, namely a wariness about the human tendency to hubris and overreaching.  Zoloth put this point eloquently in relation to the biblical story of the Tower of Babel.  She notes a rabbinic midrash on this text: "when a worker was killed, no one wept, but when a brick fell, all wept."  Zoloth comments on this midrash as follows:

Beyond Questions of Embryo Status

This passage from Zoloth helps to illustrate the point I wish to make in arguing that the stem cell debate has been too focused on questions of embryo status and that we must move beyond status questions if we are fully to do justice to the moral questions raised by technological developments associated with stem cell work.  For concern about human efforts utterly to control the world is not a moral worry narrowly tied to status questions.

Let me put this point in the form of a question that has not typically been asked in the stem cell debate:  Is adult stem cell work as unproblematic as it is often assumed to be?  That this is a productive question is suggested by testimony of Francis Collins before the President's Council on Bioethics in December 2002.  Collins was asked to speak about the topic, "genetic enhancements: current and future prospects" and he specifically addressed the issue of pre-implantation genetic diagnosis (PGD).  Although PGD is usually understood to involve screening IVF embryos and discarding unwanted ones, it is also possible to screen gametes.  Because gamete screening may not have broad utility, Collins did not discuss the issue at length.  He did, however, offer an interesting observation about gamete selection.  Focusing on gametes, he says, is useful because it "isolates you away from some of the other compelling arguments about moral status of the embryo and allows a sort of cleaner discussion about what are the social goods or evils associated with broad alterations in the sex ratio and inequities in access to that technology" (Collins, 2002, 7).  In other words, if in the future we could screen gametes in the same way that we can now screen embryos, most of the moral issues raised by PGD would apply to gamete screening, even though gametes are not embryos.  Might we not make a similar claim about embryonic and adult stem cell research? Do not many of the most pressing issues raised by embryonic stem cell technology remain when our focus is adult stem cell work rather than embryonic stem cell research?

The fact that we do not immediately answer yes to this question, is testament to how decisively the debate about abortion has structured the stem cell debate.  Nevertheless, we need to see that the answer to this question is yes and we need to see why.

Although I will not try to address all of the issues raised jointly by embryonic and adult stem cell research, it is worth highlighting several that I think require fuller discussion particularly with respect to adult stem cell work than they have yet received.

Commodification Issues

Moral concerns about the commodification of gametes and embryos have been discussed extensively in the bioethics literature both in relation to reproductive technology and in connection with embryonic stem cell work (See Andrews and Nelkin, 2001; Annas, 1998; Corea, 1986; Radin, 1996; Resnik, 2002; Ryan, Ethics and Economics, 2001).  Suzanne Holland, for example, has discussed the growing commodification of the human body in the biotech age.  She cites a series of articles published in the Orange County Register that documents a vast for-profit market in human body tissue (Holland, 2001, 266).  The Register's investigative reporters documented that most nonprofit tissue banks obtain tissue from cadavers donated by family members of the deceased for altruistic reasons.  Most relatives are not told, and in fact have no idea, that donated body parts will be sold for profit.  As Holland puts it:

Nor is the issue of downstream commodification restricted to the sale of donated cadaveric tissue; it arises in relation to IVF embryos donated for research.  As Dorothy Nelkin and Lori Andrews point out in their book, Body Bazaar, IVF patients are not generally told what the research involving their donated embryos will include.  Many will be unaware that their embryos will be used to develop commercial stem cell lines (Nelkin and Andrews, 2001, 35).

It is significant that even the most vocal advocates of procreative liberty and laissez-faire arrangements in reproductive matters recoil from the prospect of selling human embryos.  Yet, although the commodification of tissue may be particularly troubling when it involves embryos, if there is a problem with commodifying and commercializing human tissue, it is a problem we confront with adult stem cell research as well as with hES cell work.¹⁰ Lori Knowles has made a similar point about being consistent in our moral judgments about commodifying embryos.  She notes that fears about commodifying reproduction have led many to oppose the sale of embryos and to reject the idea that couples who donate embryos have any proprietary interest in the result of the research done with their embryos.  As Knowles puts it, "if it is wrong to commercialize embryos because of their nature, then it is wrong for everyone.  It is simply inconsistent to argue that couples should act altruistically because commercializing embryos is wrong, while permitting corporations and scientists to profit financially from cells derived by destroying those embryos" (Knowles, 1999, 40).

Knowles draws attention here to the fact that there is a tension between our moral and legal traditions as they apply to developments brought about by cloning, stem cell research, and the existence of ex utero human embryos, among other technological breakthroughs.  For example, we patent embryonic stem cell lines, thereby insuring massive profits for patent holders, while decrying the commodification of embryonic life.  Knowles is correct that there is a tension between our profit-based medical research model and our commitment to altruism and the access to health care that a commitment to justice demands.  Adult stem cell research, of course, raises very similar issues, because the same tension exists between the need for proprietary control of technology and the need for affordable access.  For example, patents have been sought and granted for human adult stem cells work as well as for embryonic stem cell technologies.  According to a study on the patenting of inventions related to stem cell research commissioned by the European Group on Ethics in Science and New Technologies, as of October 2001, two thousand twenty-nine patents were applied or granted for stem cells and 512 patents were applied or granted for embryonic stem cell work (Van Overwalle, 2002, 23; see also McGee and Banger, 2002).  As a result, access to therapies developed from adult stem cell research is likely to be as serious an issue as access to embryonic stem cell therapies.

Indeed, issues arising from commodification of both adult and embryonic stem cells are likely to dominate the next phase of the debate, if only because corporate interest in this work, both nationally and internationally, is so strong (Hill, 2003).  Noting that, as of 2002, "a dozen biotech companies have entered the stem cell industry and have invested millions of dollars," David Resnik suggests that the next stage of the stem cell debate will involve a battle over property rights relating to stem cells (Resnik, 2002, 130-31).

To be sure, the battle over property rights raises important legal and policy question, but it also raises ethical questions as well.  For example, Resnik provides the following table of possible ethical objections to patenting stem cells.

Although the ethical objections to commodifying stem cell work can not be sorted out as neatly as this table suggests, Resnik correctly identifies a variety of such objections.  I will not try to defend it here, but my own view is that the problem is not just that stem cells and their products may be commodified, but that market rhetoric may come to dominate the discussion (and practice) of regenerative medicine in a way that is dehumanizing.  That is, market-rhetoric may lead us ultimately to think of humans as artifacts.  In short, I take very seriously Margaret Radin's argument that the rhetoric in which we conceive our world affects who and what we are (Radin, 1996, 82).¹¹ At the same time, however, stem cell research is most likely to bear therapeutic fruit, if there is a market in stem cells and their products.  The pressing moral question, then, is how do we promote the benefits that stem cell research may yield without succumbing to a market rhetoric that reduces humans to commodities?

Several writers have suggested that one answer may be to promote greater governmental regulation.  For example, Holland argues for moving beyond a policy of restricting federal funding of stem cell research but allowing an unregulated private market in this field to active regulation to curb the private sector's work on stem cells.  Lori Knowles suggests that the United States might adopt a body like Canada's Patented Medicine Prices Review Board as a way to allow a market to function, but with oversight that would provide access to potential cells for further research and price controls of products to insure widespread access (Knowles, 1990, 40).  George Annas has suggested that we need to establish a federal Human Experimentation Agency to regulate in the area of human experimentation. (Annas, 1998, 18).  As Annas puts it:

Francis Fukuyama has argued that a new agency with a mandate to regulate biotechnology on broad grounds and in both the public and private sector may be needed (Fukuyama, 2002, 215).  Vanessa Kuhn argues that "it is time to put in place legislation that will deter stakeholders from licensing their technology to one exclusive distributor and thus creating a monopoly market, which would set artificially-high prices and lead to less access for the sick especially for the uninsured, the poor, and the elderly" (Kuhn, 2002).  To that end, Kuhn identifies four possibilities:

I do not have the expertise to make policy recommendations, but let me stress two points.  First, the policy issues with regard to commodifiying adult stem cell work will be as vexing as those confronting regulation of embryonic stem cells.  Second, although these questions may at first appear to be strictly legal or largely political matters, they involve serious value judgments about the common good that are every bit as morally vital as questions about the status of the embryo.  I thus agree with Gene Outka, that not to confront directly questions about how stem cell research will be organized, financed, and overseen is a kind of ethical failure (Outka, 2002, 177). Obviously, for example, the institutional arrangements for conducting stem cell research have implications for the questions of justice we previously noted.  The fact that so much stem cell research is being done by private corporations insures future conflict. On the one hand, corporations have fiduciary obligations to their shareholders and will therefore seek to control access to stem cell lines or therapies developed from those lines through patent protection and licensing agreements. On the other hand, such a system is likely to further widen the gap between the health care haves and have-nots (See Lebacqz 2001; McLean 2001). 

Moreover, as Karen Lebacqz notes, if justice is an important consideration in deliberations about stem cell work, then it ought to shape the research agenda.  The example she gives to make this point is worth noting.  Just as with organ transplants, tissue rejection may be a major problem for stem cell therapies.  This is one reason that the prospect of combining stem cell work with somatic cell nuclear transfer (SCNT) has been so enticing.  With this combination, you could in theory develop tissue that would be completely histocompatible.  Nevertheless, according to Lebacqz, developing stem cell therapies with SCNT is "highly questionable," if justice is a primary consideration.  The reason is that unique cell lines would need to be created for each patient, and that is likely to be very expensive and thus unaffordable for many.  Although it would certainly be less expensive, the same would likely be true for adult stem work.  For that reason, rather than pursuing an individualized approach to stem cell research, concerns about affordable access to new therapies might urge the pursuit of universal donor cell lines.

Embodiment, Boundary Issues, and Human Nature

In discussing the debate about embryo status, I focused primarily on the contested question of whether the early embryo is a person with the right to life.  We saw that this question tends to lead to the mobilization of minute details of embryological development to support one's view of the embryo.  Yet, if attention to embryo status tends to focus us on the microscopic, viewing stem cell research through the lens of embryological development can also have a kind of telescopic function through which larger issues come into view.¹²  For example, Catherine Waldby and Susan Squier argue in a forthcoming issue of the journal Configurations that focusing on stem cells and embryonic life leads us fundamentally to question what it means to be human.  According to Waldby and Squier:

The claim that there is a perfect contingency in the relationship between embryo and person may at first appear to be just another "microscopic" claim about embryo status, but it is clear that Waldby and Squier mean to imply much more in asserting that the embryo's development is non-teleological.  In effect, they reject the notion that there is a meaningful trajectory to human life.  What was killed, they say, when stem cells were first derived from the inner cell mass of a blastocyte was not a person, but a "biographical idea of human life, where the narrative arc that describes identity across time has been extended to include the earliest moments of ontogeny" (Waldby and Squier, forthcoming).

That much more is at stake here than the question of whether the embryo is a person is clear if we attend to the notion of a trajectory of a human life.  Gilbert Meilaender, for example, has argued that our attitudes toward death and dying are importantly shaped by our conception of what it means to have a life (Meilaender 1993).  Indeed, according to Meilaender, two views of what it means to have a life of what it means to be a person have been at war with each other within the field of bioethics over the past thirty years and these views underwrite sharply different views not just about the issues of abortion or euthanasia that are implicated here but with regard to practically every moral issue we might confront in the field of bioethics.

On Meilaender's view, having a life means precisely that there is a trajectory that traces a "natural pattern" in embodied life that "moves through youth and adulthood toward old age and, finally, decline and death" (29).  As he puts it elsewhere in this essay, "to have a life is to be terra animata, a living body whose natural history has a trajectory" (31).  Although Meilaender develops the notion of a natural trajectory of bodily life primarily to address the issue of euthanasia and not stem cell research, his talk of "natural history," "natural pattern," and "natural trajectory" draws attention to one of the most significant issues raised by stem cell research and related technologies.  Does stem cell research undermine the very notion of a human life constrained by natural bodily existence?  The example on which Meilaender focuses here is instructive for thinking about the broad implications of stem cell research in this regard.  If stem cell therapies fundamentally alter our sense of a natural pattern to aging would they not also fundamentally alter our sense of what it means to be human? Meilaender's answer is that such a change would fundamentally affect what it means to be human precisely because we are embodied creatures and for that reason our identity is tied to the body and the body's history.

Leon Kass has made a similar point recently in reflecting on the prospect that regenerative medicine might significantly lengthen the human life span (Kass, 2003).  He, too, invokes the notion of a natural trajectory, one that stem cell research may undermine.  Although it is possible to approach the prospect of extending the human life-span in an abstract way, he says, to think of what such a change would mean experientially is to recognize that "the 'lived time' of our natural lives has a trajectory and a shape, its meaning derived in part from the fact that we live as links in the chain of generations" (13).  Indeed, says Kass, without something like the natural trajectory of bodily life that currently exists, the relationship between the generations would be decidedly different, and probably not better.  "A world of longevity," writes Kass, "is increasingly a world hostile to children" (13).  Walter Glannon has argued that, at the very least, increased longevity would increase competition for scarce resources between older and younger generations.  According to Glannon, "it is at least intuitively plausible that an over populated world with substantially extended human lives and scarce resources could adversely affect the survival and reproductive prospects of the young and harm them by thwarting their interest in being healthy enough so that they could survive and procreate" (Glannon, "Extending," 347).¹³

Francis Fukuyama has also suggested some of the reasons why increased longevity may imperil children, but he also notes that our relationship to death may change as well (See 2002, ch. 4).  "Death," he says, "may come to be seen not as a natural and inevitable aspect of life, but a preventable evil like polio or measles.  If so, then accepting death will appear to be a foolish choice, not something to be faced with dignity or nobility" (Fukuyama, 2002, 71).

Sometimes the question of the transformative possibilities that come with stem cell research is raised even more starkly when the question asked is not how may stem cell work affect what it means to be human, but instead: Does stem cell research open the door to a post human future? This is a point Waldby and Squier raise explicitly when they discuss the combination of genetic engineering and stem cell therapy.  They suggest, for example, that xenotransplantation forces us to confront the prospect of transgressing species boundaries.¹⁴ The conclusion of their paper is worth quoting in full:

Regrettably, with some notable exceptions, the ethical debate about stem cell research has not taken up in a sustained way what it would mean to pursue stem cell therapies that might significantly undermine the notion of a natural human life or erode the boundary between human and non-human species.  When the issue is framed in terms of the status of the embryo, the question tends to be whether the research should be conducted at all.  By contrast, when the issue is framed in terms of adult stem cell work, the question is not whether, but how and with what consequences.  Yet, that is a question we have not systematically answered.  Given the potential for good embedded in the prospects of adult stem cell research, it is not surprising that there appears to be widespread and largely uncritical acceptance of adult stem cell research. But, if the promise of stem research is as revolutionary as is often claimed, we are going to need a much more expansive discussion of stem cell research both embryonic and adult than we have had heretofore.  Obviously, I cannot explore this more expansive horizon in any detail in this report, but let me in closing suggest one direction we need to explore.

To signal the decisive break that I think we may need from the usual bioethics frame, I want to draw attention to Martha Nussbaum's recent article in the journal Daedalus entitled, "Compassion & Terror" (Nussbaum, 2003).  Discussing Euripides' play, Trojan Women, Nussbaum reflects on the fact that the Greek poets returned obsessively to the sacking of Troy and the acts of the "rapacious and murderous Greeks."  She explores the poets' compassionate imagining of the fate of Trojan women and children to reflect on the conditions and limits of a compassionate vision.  Although Nussbaum is ultimately concerned about engendering a compassionate vision for Americans in the face of terror and particularly compassion for innocent women and children far from our shores, her analysis of compassion is thought-provoking in relation to stem cell research.

Nussbaum notes that compassion is a complex emotion requiring a series of judgments involving another person's suffering or lack of well-being.  We must judge that someone has been harmed, that the harm is serious, and that it was not deserved. Moreover, says Nussbaum, Western tradition has stressed what could be called the "judgment of similar possibilities." In other words, "we have compassion only insofar or we believe that the suffering person shares vulnerabilities and possibilities with us" (Nussbaum, 2003, 15).

Now surely in just about everyone's catalogue of human vulnerabilities are illness, old age, and death.  Yet, as we have just seen, stem cell research might significantly transform the "human" experience of illness and death, at least for some.  If stem cell therapies were to erode the notion of human nature or species membership, might they not also erode some basic moral sensibilities?  Mary Midgley, for example, has argued that both the notion of human nature and that of human rights are importantly tied to membership in our species because rights are "supposed to guarantee the kind of life that all specimens of Homo sapiens need" (Midgley, 2000, 9).

Although Nussbaum avoids the language of human nature, it is precisely this sort of point that she highlights when she argues that compassion requires the belief that others share vulnerabilities and possibilities with us.  Indeed, like Midgley, Nussbaum ties the notion of universal human rights to important human functions and capabilities.  The basic idea, she says, is to ask what constitutes the characteristic activities of human beings.  In other words:

Nussbaum notes that this inquiry proceeds by examining a wide variety of self-interpretations and that comparing characteristic human activities with non-human activities and, through myths and stories, comparing humans and the gods is particularly helpful.  For one thing, such an inquiry helps us to define limits that derive from membership in the world of nature. 

Indeed, although Nussbaum is particularly attentive to the wide variety of cultural interpretations of what it means to be human, she insists that to ground any essentialist or universal notion of human rights, one must attend to human biology.  Although her account of the human is neither ahistorical nor a priori, it is linked to an "empirical study of a species-specific form of life" (1995, 75).  When she develops her account of central human capabilities, she begins with the body.  She writes:

Nussbaum's work both in identifying the judgments that underwrite compassion and in tying an account of rights to human function and capabilities that are presumably universal highlights what is at stake, not merely with stem cell research but with a growing list of biotechnological developments which appear to destabilize the concept of human nature and which require that we think carefully and hard about what it might mean for some humans to have access to these technologies while other humans do not.¹⁵ At the very least, the combination of what Rabinow describes as the biologicalization of identity around genetics rather than gender and race with the possibility of manipulating that genetic identity for those with the money or power to do so does not bode well for securing wide-spread compassion across economic or technological divides.  Even more important, however, is the recognition that the very notion of human rights may ultimately rest on the idea (and what, until recently has always been the reality) of a natural human condition that is relatively stable.

I believe that Nussbaum is correct when she claims that inquiring into characteristic human activities and comparing these to non-human activities helps us to define limits and thereby to promote human flourishing. Unfortunately, what Susan Squier calls the "pluripotent rhetoric" of stem cell research is that of limitless possibilities (Squier, Liminal Lives).  The ultimate limit, of course, is death and yet even this limit appears illusory in some visions of our biotech future.

It is worth noting in closing that William Safire's New Year's Day column at the dawn of the twenty-first century, in January 2000, was entitled "Why Die?"  The longing behind this question is neither new nor unfamiliar.  What is new is that this longing to escape the vulnerabilities and limitations of the body is united with a technology that holds out the prospect of fundamentally changing that body.  Yet, I agree with Gerald McKenny that we need to ask whether we wish to accept and promote a view of bodily vulnerability as merely an obstacle to human flourishing, which ought to be overcome at any cost (McKenny, 1998, 223).

Although a longing for invulnerability is perhaps a quintessentially human trait, and although the quest to reduce the human suffering wrought by illness and disease is morally admirable, there is no mistaking the hubris behind the question, Why Die?  Opponents of stem cell research have, from the start, argued that there is a kind of idolatry in a science that would reduce the human embryo to just so much biological material.  What I have tried to show in this report is that such concerns need not be limited to those who think that the early embryo is fully a person.  Nor should this kind of concern be limited to those who oppose stem cell research.  I do not think the early embryo is a person and I believe that both embryonic and adult stem cell research should go forward under a system of strict regulation.  Nevertheless, I confess to being haunted by the passages with which I began and I believe that future debates on stem cell research must take very seriously the worries about commodification and the possibility of fundamentally changing the trajectory of a human life.¹⁶

FIGURE A

Jimmy Margulies, Editorial Cartoonist
The Record, Hackensack, New Jersey

Cartoon used with permission of the artist.

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ENDNOTES

1. Given the current status of technology, deriving human embryonic stem cells requires destroying embryos.  If the cells could be derived without the destruction of embryos or if parthenogenetically stimulated eggs produced stem cells, issue of status would almost certainly fade.  Nevertheless, serious ethical issues would still remain.  This is one reason I believe it is a mistake to focus narrowly on embryo status.