A failure of ethical imagination

Human embryo stem cell (hESC) research has been making front-page news in both the United States and Canada for some time. This spring U.S. President Barack Obama lifted restrictions on this research so pluripotent stem cells, which can form all of the tissues and organs in the human body, can now be taken from embryos "left over" from in vitro fertilization. This kills the embryos.

Toronto researchers have recently created induced pluripotent stem cells (iPS) from ordinary skin cells, without using viruses or creating an embryo. This could make using embryos unnecessary.

Most people agree that stem cell research is a leading edge of the new frontier of regenerative medicine. But there is a deep ethical divide between those who support using human embryos for this research and those who believe it is a serious breach of ethics. I want to make the case for the latter position.

Louise Brown, the first in vitro fertilization baby, was born in 1978. Shortly after, in the early 1980s, I was on sabbatical leave at Monash University in Victoria, Australia, which had one of the first IVF clinical research units in the world. With the consent of the prospective parents, I was present in an operating room for the transfer of two IVF embryos to the woman's uterus. The woman was lying on the operating table swathed in white sheets with her feet raised up in stirrups to enable the transfer to take place. Her husband, gowned in sterile white, was at the top of the table holding her hand.

Dr Carl Wood drew up the embryos into a long, clear, flexible plastic pipette. "Now Mrs. Jones," he said, "we're going to transfer the embryos."

She instantly replied, "Doctor, please stop!" She paused, then continued, "Could we first see our babies?" Dr. Wood walked to the head of the table, held out the pipette and pointed to its end: "You can't see them, but they're right here. We can see them under the microscope."

The woman and her husband turned to each other with radiant smiles, squeezed each others' hands and gazed into each others' eyes, as parents often do on first seeing their newborn baby. My thought was that those "babies" had just come into existence for them, that we had moved back by nine months what parents usually experience at birth.

I recognize that embryos are not babies, but they are the earliest form of human life, with the innate potential to develop through the full human life span. Human embryo stem cell research kills embryos and destroys that potential. The central ethical issue it raises is: What does the value of respect for human life require that we not do to human embryos?

That depends, first, on whether embryos are "us" or "them" in terms of their moral status. There are three views:

* Embryos have no moral status, they're just a "bunch of cells," and there should be no restrictions on using them.

* They have moral status, but not yet the same status as the rest of us -- they're only potential human life. Some restrictions are justified, but they may be used in ways the rest of us must not, for instance, intentionally killed in research or to make therapeutic products.

* They are the earliest stage of each human life and deserve the same respect as the rest of us, they are human life with potential.

This approach looks to the innate potentiality of the embryo, its "capacity to become," keeping in mind that we are all ex-embryos and are all in the process of becoming from conception to natural death. It requires respect for that potential, which means we must not act with a primary intention to destroy the embryo. A distinction is often drawn, as President Obama has, between using embryos "left over" from IVF and making embryos for research. While I do not believe the former is ethical, only the latter involves the issue of respect for the transmission of human life.

Making embryos for research or to take their stem cells means human life is transmitted with the intention of killing it and for the purpose of using it as a product to benefit of the rest of us. Both that intention and that purpose constitute failures of respect for the transmission of human life. The mode of transmission can also contravene the ethically required respect. For example, cloning embryos -- creating them through asexual replication, not sexual reproduction -- which is regarded as important in hESC research, is such a contravention.

If we are to act ethically, we must explore what respect for the mode of transmission and the integrity of human life require that we not do in creating or using human embryos. Instrumentalism is the use of embryos as things or products -- as means, not ends in themselves. It is a failure of respect, because it involves the objectification, reification, and dehumanization of embryos and our dis-identification from them.

We use language to implement those outcomes, for instance, by describing embryos as just "bunches of cells" or "pre-embryos." But some language flowing from treating embryos as just things-that-can-benefit-the-rest-of-us, should alert our moral intuitions, for example, suggestions to establish "human embryo manufacturing plants." Language is also used to label and dismiss opponents of hESC research. They are described derogatorily as being anti-science, when they are really pro-ethics.

The model or framework we use to view our conduct with respect to an embryo, and the language, metaphors and analogies we use to describe that conduct, can radically alter our conclusions about whether or not our conduct is ethical. In particular, these choices affect our moral intuitions with regard to both the embryo and what we do to it.

German philosopher Jürgen Habermas, in his book, The Future of Human Nature, argues that respect for what he calls "pre-personal human life" is necessary to maintaining our ethical understanding of what it means to be human: "There is a long-established, widely shared, deep moral intuition that human embryos are not just things or just cells like any other cell as some argue, and we breach that moral intuition at our ethical peril."

We form our most important collective shared values around the two great events in every human life, birth (or, now, our earlier coming-into-existence) and death. Human embryo research will affect and harm values of respect for human life formed around our coming into existence.

As mentioned already, there are now ethically uncontroversial alternatives for obtaining pluripotent stem cells -- iPS technology. It might even prove to be better and safer than hESCs, for example, from the perspective of being an exact genetic match for the person needing treatment. This is an example of science being able to solve ethical problems rather than creating them. Stem cells can also be obtained from umbilical cord blood or consenting adults. So far somewhere around 200 therapies have been developed from these ethically uncontroversial alternatives, while none have yet come from embryo stem cells.

Even if one believes hESC research can be justified by its potential benefits, that could only be true, ethically, after other possibilities that are not ethically problematic are exhausted. That's currently far from the case.

The disagreement about whether hESC research is ethical is basically across the utilitarian/principle-based ethics divide. Utilitarian ethicists see the potential benefits of hESC research as justifying the harm done to human embryos. They give priority to "doing good," as they see it, and either argue "the ends justify the means," or some deny that any ethical justification is needed. Principle-based ethicists, in contrast, give priority to the value of respect for human life which includes embryos -- "the ends (potential benefits) do not justify the means (killing embryos)," so the benefits hoped for must be sought in other ways that are ethical.

Researchers' attitudes to hESC research parallel the three attitudes to the moral status of embryos: Some see no ethical problems; others that there are ethical issues, but one can still do the research; and yet others that the research is unethical.

We've seen the "if you won't let us do it we will go elsewhere to do our research" syndrome in relation to hESC research. But recently, we saw a reverse example. A well-known British stem cell researcher moved from England to France, because he believed what the new English law governing stem cell research allowed was unethical.

Journalist Charles Krauthammer quotes Dr. James Thomson, discoverer of embryonic stem cells as saying, "If human embryonic stem cell research does not make you at least a little bit uncomfortable, then you have not thought about it enough." I'd add, or there's something wrong with your sense of ethics.

To conclude, I suggest that seeing human embryo stem cell research as ethical is primarily a result of a failure of the ethical imagination.

Margaret Somerville is director of the Centre for Medicine, Ethics and Law at McGill University, and author of The Ethical Imagination: Journeys of the Human Spirit.


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