riders that have been attached since the mid-1990s to De- partment of Health and Human ... to stick with the status quo so that necessary legislative business could be ... him on a collision course with the proresearch majority in the Congress ...
Open Peer Commentaries
formed decision to destroy their embryos—rather than use them or donate them to another couple—and their voluntary and informed decision to donate them for research. The research would then determine how the destruction occurs, not whether it will occur; as matters stand in most jurisdictions, couples may determine how to dispose of their embryos. It is possible to go further than either of these rst two policies and recommend, as NBAC did, a third option: the provision of federal funds for both the derivation of stem cells from embryos and research on those cell lines, again in accord with ethical requirements. One argument for this option is that a strict separation between derivation and use would adversely affect the development of scientic knowledge. For instance, the methods for deriving embryonic stem cells may affect their properties, and scientists may increase their understanding of the nature of such cells in the process of deriving them. In short, I see no compelling ethical reasons for limiting federal funding to research with cell lines derived by some arbitrary date, as long as future derivation, with nonfederal funds (option no. 2) or with federal funds (option no. 3), also respects the same moral limits. Indeed, our collective moral duty to alleviate human suffering and reduce the number of premature deaths provides a strong ethical reason to support this research, within appropriate limits. Whichever policies we adopt to enable important and promising stem cell research to go forward within ethical
limits, we will need a strong public body, as NBAC (1999) recommended, to review protocols for deriving stem cells from embryos (and from fetal tissue) and to monitor this research. Perhaps the Council on Bioethics, which Bush has announced, could fulll these functions. If not, some other public body will be needed, as the U.K. experience suggests. In the United Kingdom the Human Fertilisation and Embryology Authority was statutorily established to oversee embryo research (as well as fertility clinics), and that model merits careful consideration for privately-funded as well as publicly-funded research. It is safe to assume that no policy currently under discussion will be the nal one. We will need to revisit this research again and again as the science develops and as its ethical implications become clearer, particularly through a public body’s review and oversight. Thus, no policy will end the national conversation about how to balance, over time, the relevant ethical considerations. While our public dialogue continues, we need a policy with greater exibility than the one Bush announced, but still with close review and oversight. n References American Association for the Advancement of Science. 2001. A statement on ª President Bush’s stem cell policy.º 17 August. National Bioethics Advisory Commission. 1999. Ethical issues in human stem cell research, Vol. I: Report and recommendations. Rockville.
Stem Cell Politics: The New Shape to the Road Ahead Alexander M. Capron, University of Southern California
It is by now a commonplace observation that the policy announced by George W. Bush in his 9 August television address to the nation did not lay the contentious topic of human embryonic stem cell research to rest. As I write this (6 September 2001) the question seems to be which of the two alternative political responses will occur in the near term. On the one hand, the National Institutes of Health (NIH) could simply start funding researchers so they may begin to see what results can be obtained with the 24–25 cell lines that are now available. NIH researchers will probably start quite soon, while extramural researchers should have NIH support in hand within six to nine months, assuming they can negotiate agreements similar to the one NIH hammered out with Wi-Cell, the owner of
Winter 2002, Volume 2, Number 1
ve cell lines and the holder of the basic patent on the process (developed by Jamie Thomson) for deriving and culturing human embryonic stem cells. On the other hand, Congress—perhaps annoyed that reality falls far short of the 60-plus “robust and diverse” cell lines promised by the administration—may decide that biomedical progress is being unduly hampered and override the policy. Even if the former rather than the latter is the case, nearly everyone seems to agree that the state of affairs would be only temporary: sooner or later, the existing cell lines are going to be inadequate—in scientic terms, in terms of the research incentives that are hampered by present patents and licenses, or in therapeutic terms (because the lines aren’t diverse enough or because they are too
ajob 35
The American Journal of Bioethics
risky, having been grown on mouse embryo feeder cells and bovine serum). At that point, whether now or in a year or three, the cries will be loud and clear from researchers in academia and at NIH, and—with a strong push from disease-advocacy groups—politicians in Congress and in the administration will have to respond, probably by allowing the use of cell lines derived after 9 August with nonfederal funds or even by adopting a bill to permit federal funding of stem cell derivation research, along the lines proposed for the past two years by Senators Tom Harkin (D-IA) and Arlen Specter (R-PA) (namely S. 723 introduced on 5 April 2001 and it’s companion, H.R. 2059, introduced by Representative Jim McDermott, M.D. (D-WA) on 5 June 2001. Thus, it is apparent that the president’s decision is just a way station along this particular policy highway, not the endpoint. What is less apparent is the way in which the president’s decision seems to have shifted the course of that highway to the left, which was not what his supporters expected when they elected him nor even what seemed likely as the issue heated up during the months of June and July. At that time it looked as though the debate was going to be framed in right-to-life terms—namely, as a battle pitting people who respect (and want to protect) human life against utilitarians who value quality-of-life, which they seek to enhance by nding cures for neurological diseases and injuries, cancer, diabetes, and heart disease, even at the cost of a few embryonic lives. The policy adopted by the Clinton administration (providing federal funds for research using human embryonic stem cells but not directly for deriving the cells) infuriated right-to-life supporters not simply because it represented a clever end run around the “no-embryo-research” riders that have been attached since the mid-1990s to Department of Health and Human Services (HHS) appropriations bills. What really upset them was that by insisting that research could only be conducted with cell lines that had been derived from frozen embryos that were being discarded, the Clinton policy shifted the debate away from the moral status of the embryo to the practical protections it guaranteed, such as consent of the donors, no payment to them, no prots to the in vitro fertilization (IVF) clinics, and so forth. These restrictions aimed both to protect the donors and to forestall the production of embryos (though IVF or cloning) solely for research; they were thus consistent with the White House’s summary rejection in 1994 of the recommendation by a majority of the Human Embryo Research Panel that NIH be allowed to support studies in which embryos were created for research purposes. The Clinton position was thus “we respect human life—we wouldn’t want to see it created just to have it destroyed—but that’s not an issue here, because these em-
36 ajob
bryos are about to die anyway.” (The issues were thus framed on the public stage in ways similar to how they were debated by the Geron Ethics Advisory Board, as Laurie Zoloth {2002} describes.) The House and Senate had been so divided on this issue in the 106th Congress that both those, like Senators Specter and Harkin, who wanted to loosen the restrictions, and those, such as most of the Republican leadership in the House, who wanted to tighten the existing law, were faced with the risk of stalemate and hence were persuaded to stick with the status quo so that necessary legislative business could be completed. With the election of Bush, however, the Clinton policy seemed certain to be replaced, even before HHS Secretary Tommy Thompson suspended the April meeting of the Human Pluripotent Stem Cell Review Group so that the policy could be reviewed. Indeed, the direction of future policy seemed clearer when the president—who on 18 May 2001, had reiterated to the pro-life Culture of Life Foundation his opposition to any “federal funding for stem-cell research that involves destroying living human embryos”—took the decision away from Secretary Thompson, who as governor of Wisconsin had promoted embryonic stem cell research. The president wrestled with the decision very publicly for months. If it was probably not a task Bush wanted (both because it diverted him from things he had hoped to do and because it was, as some commentators suggested, a lose-lose situation that would have confounded King Solomon), the White House used it to enhance his standing as a leader who took his responsibilities seriously and who consulted widely in making up his mind. The president was faced with the difculty of triangulating conicting needs: rst, to be responsive enough to researchers that he could hold off an embarrassing rebellion by pro-research legislators from his own party; second, to be respectful enough of his promises to pro-life groups that he wouldn’t be accused of being someone who makes promises during an election (“Read my lips!”) and then gives in to the enemy once elected; and third, to reect his own convictions about the sanctity of human life. At rst blush, his 9 August announcement succeeded. While some researchers were skeptical that 60 stem cell lines existed, many were willing to see what NIH could provide by way of details, and nearly all were relieved not to be faced with a total ban. Likewise, while some religious groups (especially the Catholic bishops) were displeased, many endorsed his decision (including some, such as the Methodists and Baptists, who had opposed stem cell research). The press suggested that this reected a division in the right-to-life community between the purists and the pragmatists, with the latter simply relieved that the president had not accepted the urgings of such stalwarts as Nancy Reagan,
Winter 2002, Volume 2, Number 1
Open Peer Commentaries
Senators Orrin Hatch (R-UT) and Bill Frist (R-TN), and former Senator Connie Mack (R-FL), to allow broader federal funding of the research. The president’s rationale for a 9 August cutoff was that it permitted him to adhere to his promise—the Federal government wasn’t giving any funds that would even indirectly go for “research that involves destroying living human embryos,” because all the relevant embryos had already been destroyed. Most commentators have focused on the dilemma this creates for the president at such time when more cell lines are needed for research: he has been absolutely insistent that he will not allow an expansion of the eligibility list, which (as mentioned above) will put him on a collision course with the proresearch majority in the Congress, including many in his own party (unless, of course, he is saved by rapid advances in adult stem cell science that obviate the need to use embryonic stem cells, which is not a course now favored by the NIH or National Academy of Science). The rationale for differentiating between the pre– and post–9 August cell lines is already thin enough that were Bush to invoke it again, the current policy would appear to have been a political expedient rather than a wise compromise, and many on the pro-life pragmatist side would desert the president. But even before we get to that point, the more profound effect of the president’s decision is that it basically legitimates the premises of the Clinton policy: At some point, it is all right to prot from using embryos that would have died anyway. The only difference between the
two policies is the matter of timing, since both were premised on the notion—one is tempted to say the ction— that federal funds won’t support embryo destruction. Plainly, the embryo cell lines—be they 24 or 64 or some number in between—that federally-funded researchers will be purchasing were created with the clear intent that they would be used in research. Thus, although the stem cell lines’ creators won’t be paid (with federal dollars) until some time after they destroyed the embryos, they acted expecting that the time would come when researchers would buy the cell lines. This reality lurks in the background of all debates on stem cell policy now, and when the question arises whether the government should expand the list of eligible cell lines, staunch right-to-life advocates will object, but the Bush administration will be unable to reject such a change in principle, since it can hardly claim that using the products of embryo destruction is wrong. Thus, rather than nding themselves with the strong ally they expected to have in the White House, opponents of embryonic stem cell research face a map that the president redrew on 9 August, a map on which the policy road now takes research with embryonic stem cells as the starting point and asks only how far do we go? n References Zoloth, L. 2002. Jordan’s banks: A view from the ® rst years of human embryonic stem cell research. The American Journal of Bioethics 2(1): 3± 11.
Stem Cells and the Man on the Moon: Should We Go There from Here? George Khushf and Robert G. Best, University of South Carolina
In a review of the epoch-making accomplishments of science, Michael Guillen (1995) notes how “we see science going from being a source of light and hope to its also becoming a source of darkness and dread” (5). With Newton we see the earth and the order of nature in a new way, ultimately leading to the moon landing: an entrance into a heavenly realm, unimaginably distant in a previous era. Surely this is “Exodic,” opening up a vista for exploration that fundamentally alters the categories and norms of our self-understanding. But when we got there we found it
Winter 2002, Volume 2, Number 1
was not the promised land. The moon was barren and dead. In fact, we found this before we even got there: the very condition of our getting there involved divesting ourselves of any myths about its celestial character. Demystied and subject to laws we could master, the moon became something we could conquer. But the rhetoric of conquest is incommensurate with the reality of the ends obtained. So the dialectic of enlightenment outlined by Horkheimer and Adorno (1990) can be seen in science generally: enlightened science promises the means for entering a realm
ajob 37
