For most proponents of abortion rights, this summer's debate over human embryonic stem-cell research did not present much of a debate at all: If embryos are not living humans, then their destruction for medical research should pose few questions.
But a funny thing happened when it came time for opponents of such research to stand up. Despite widespread analogies of research on such cells to abortion, many politicians who oppose abortion tossed aside the comparison and spoke out in favor of federal funding for the research. The apparent contradiction confounded political supporters, many of whom flooded the television and radio airwaves claiming to have been forsaken in favor of campaign contributions from pharmaceutical companies.
When the seemingly turncoat politicians pointed to the immense potential benefits of embryonic stem cells, however, they opened a whole new can of worms in the medical ethics debate.
Stem cells from various parts of the human body have long been used in medical research. They differ from other cells--blood cells and fat cells, for example--because stem cells have yet to be assigned to a specific task; new functions can "stem" from the cells. As a result, scientists have had some success in manipulating stem cells to take on certain functions, and then using those cells to replace defective or damaged cells in humans.
Stem cells that originate from human embryos are a more recent subject of scientific inquiry. And because obtaining the cells requires the destruction of the embryos, federal funding for the research drew the rapt attention of even the highest rungs on the political ladder.
In early August, President George W. Bush said he would allow federal money for research on the 60 known stem-cell colonies from private laboratories. Like many abortion-rights opponents, Bush said he could not ignore the possibilities stem cells hold for curing some human diseases, from diabetes to Parkinson's disease.
"There are many moral and scientific claims being made in this whole debate of stem cells. One of the issues is the benefits of stem-cell research, and those benefits are pretty exciting," says Dr. Jeremy Sugarman, director of the Center for the Study of Medical Ethics and Humanities and professor of medicine and philosophy. "Frequently, if people call me, it's because there are competing moral claims on an issue," he adds. "In an ethical debate, what you want to say is, ODoes the outcome of an action justify the reasons for doing it?'"
Sugarman is not advocating a Machiavellian approach to stem-cell research. Rather, he says that debates of this nature can only be resolved by carefully weighing the benefits of the research against its costs. He likens the stem-cell debate to the dilemma of whether to cheat on an exam.
The potential benefits--great grades and a job after college--are high, but they can also be outweighed by the violation of ethical rules and the potential of getting caught. Procedures must be used, Sugarman says, to reach a conclusion.
That the good from stem-cell research is still just an uncertain promise makes the ethical decision even tougher. Amy Hall, assistant professor in the Divinity School in the area of theological ethics, compares the debate to theories of "just war" and suggests that scientists may be rushing into their research too quickly.
She agrees that the benefits of research ought to be considered, but suggested several stipulations must also be met.
"In the past in Western ethics, we have said that we should not kill innocent life unless it is absolutely necessary, unless we know that all other means for producing the good intended have been exhausted, and we're fairly certain that we can reach the intended good by destroying innocent life," she says.
Few scientists express certainty about the good promised by stem-cell research, but many reject a delay to exhaust alternatives as unnecessary--to abortion-rights proponents, at least--or too costly. Research on stem cells should progress as soon as possible, they say, if the benefits are to be fully recognized.
"That gets into a difficult point because what are Othe alternatives' and what is Oexhaustive'? Do you want to use a tremendous amount of resources rather than work on something with more potential?" asks Thomas Tedder, chair of the Department of Immunology. "Scientifically, I think it's appropriate to move ahead. Morally, I can't say that, but as a scientist I think it's important to have an open and public debate."
Such justifications are "vampiric" of embryos, Hall says, and demonstrate an overzealousness by scientists to reap the benefits of embryonic stem cells. There are alternatives to examining embryonic stem cells, though of a limited amount, and such research is well-established at Duke. Dr. Joanne Kurtzberg directs the Pediatric Stem Cell Transplant Program and studies stem cells from other areas of the human body--including bone marrow and the umbilical cord.
She and her colleagues modify the cells and implant them into patients. Kurtzberg says the method is helpful, for example, to bone marrow transplant patients, only a quarter of whom have a transplant match in their family. "Our program treats children and adolescents with cancers and genetic diseases that are otherwise lethal but can be rescued by the infusion of blood stem cells," she says.
Although she sees first-hand the benefits of alternatives to embryonic stem cells, Kurtzberg does not view the controversial cells as living humans and sees value in examining them. The alternatives may be beneficial, she says, but embryonic stem cells may prove better, and their study should not be delayed.
The potential benefits are also present in current research on stem cells that originate from animal embryos. John Klingensmith, assistant professor of cell biology, experiments with embryonic stem cells from mice, attempting to cure mice diseases with techniques similar to those imagined for humans. "Mouse embryo stem cells have allowed us to manipulate genes to develop models for human diseases," he says. "Of course one of the benefits of this is possible cures for diseases."
In any case, research on embryonic stem cells is advancing without much delay. In late August, the National Institutes of Health released its list of institutions in possession of the 60 stem-cell colonies, and congressional hearings on the issue are ongoing.
Assuming the benefits of the research will be high, that still leaves the essential question of whether they can ever be high enough to justify the destruction of human embryos. That is again a moot point for abortion-rights proponents, but one that will likely remain divisive for opponents.
For Kathleen Joyce, assistant professor of religion, this summer's debate represents a growing trend of involving science in moral issues. More such debates will crop up, she says, and people must be prepared to hear difficult questions without a definitive answer.
"I think it's possible for people to find individual answers to these questions," she says. "I think we're going to have to live with this tension, that people are going to have different ideas about what is moral in each situation."
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