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Stem Cell Research The Bigger Picture Rebecca
Dresser
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PRELIMINARY POINTS I

• Cells used in embryonic stem cell research can
  come from fetal tissue from miscarriages or
  abortions, or from embryos that are created by
  fertility clinics for people who no longer
  require them. They could also be created
  specifically to be used in research.
• B,W,K,M Each source raises important moral
  questions.
• People who are opposed to abortion on moral
  grounds object to stem cell research on fetal
  tissue obtained in abortion.
• Those who are not morally opposed to abortion do
  not take issue with stem cell research on fetal
  tissue obtained in abortion.

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PRELIMINARY POINTS II

• B,W,K,M As a matter of public policy, so long
  as abortions are carried out in ways that are
  consistent with law and policy, the use of fetal
  tissue is acceptable.
• As indicated, embryos can be created in fertility
  clinics but then no longer be needed, or they can
  be created for research.
• Does what they are created for make a moral
  difference to their possible use in stem cell
  research?
• Do embryos deserve special respect because of
  what they are and the potential that they
  represent?
• What about the potential they may have to cure
  disease for existing and future persons?

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STEM CELL RESEARCH AND ABORTION

• The morality of stem cell research is not
  necessarily the same as the morality of abortion.
• B,W,K,M note important differences between human
  stem cell research and abortion
• 1) abortion is a procedure that takes place
  substantially later in development, well after
  the 10-14 day window for embryo research
• 2) abortion terminates a pregnancy, necessarily
  within a womans body, while human embryonic stem
  cell (hESC) research relies on embryos created in
  the laboratory and never implanted into a womans
  body.

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SOME FACTS AND QUESTIONS

• B,W,K,M Embryos created in vitro (outside the
  body, as in the laboratory) can only survive
  about fourteen days after fertilization, before
  they must be either frozen for some later use or
  implanted into a womans body.
• If it is acceptable to discard an embryo created
  in vitro, why would it not be acceptable to use
  it in research?
• Should someone who objects to human embryonic
  stem cell research also object to in vitro
  creation of embryos?
• Or should it be maintained that an embryo only be
  created in vitro if it is intended to be
  implanted in a womans body?

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PRELIMINARY POINTS III

• Dresser Stem cells are not human embryos, but
  they must be derived from embryos.
• Dresser To derive stem cells, scientists must
  destroy a human embryo.
• B,W,K,M Somehow, as the embryo divides, cells
  are programmed to become heart, liver, skin,
  hair, eyes, and the multitude of other body parts
  it takes to become a fully formed human.
• B,W,K,M Embryonic stem cells have the
  potential to become any of these so-called
  differentiated cells, a quality known as
  pleuripotency.

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PRELIMINARY POINTS IV

• B,W,K,M Because of this quality of
  pleuripotency they embryonic stem cells are
  extremely valuable in understanding what makes
  cells of one type instead of another, and also
  for the therapeutic potential that could come
  with understanding that process.
• B,W,K,M Once cell control is harnessed,
  researchers may be able to grow colonies of
  particular cell types to treat organ failure, and
  treat diseases in wholly new ways.

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THE MORAL STATUS OF EMBRYOS I

• On the view that human life begins at conception,
  embryos have the moral status of persons.
• Dresser says that, for people who believe that,
  possible knowledge gains cannot justify stem
  cell or any other research that requires embryo
  destruction.
• Others disagree, and maintain that embryos lack
  many characteristics that make persons morally
  significant, such as the ability to think and
  feel pain and pleasure.

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THE MORAL STATUS OF EMBRYOS II

• Dresser In early embryos, the beginning of the
  nervous system hasnt yet formed.
• And at the point that stem cells are derived,
  which is about five days after conception,
  embryos are not even clear individuals since
  twining can occur after that point.
• Dresser says that where an embryo is located
  inside or outside of a womb may make a moral
  difference to some they are only morally
  protected in a womb.

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THE MORAL STATUS OF EMBRYOS III

• As Dresser notes, the location of embryos
  separates the stem cell controversy from the
  abortion debate.
• The key moral issue of stem cell research comes
  from pitting the value of the embryonic life?
  against the social value of advancing
  knowledge.
• Dresser says that people who argue that embryos
  arent morally equivalent to persons usually
  adopt a developmental approach to moral status,
  in which prenatal life gains increased moral
  status over time.

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THE MORAL STATUS OF EMBRYOS IV

• Even if embryos are not considered to be persons
  we can still ask if they have moral value.
• If they arent persons are they just objects or
  property?
• Can anything be done with them?
• Some think that, because they have the potential
  to become persons, embryos deserve special
  respect.

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THE MORAL STATUS OF EMBRYOS V

• Dresser says though that simply saying that
  embryos should be treated with special respect
  fails to resolve the stem cell research
  question.
• Anyone holding this view must decide what
  special respect means in the research context.
• Is it possible to show special respect to an
  organism while at the same time allowing it to be
  used in destructive research to advance the
  interests of others?

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TWO KINDS OF EMBRYO

• As seen, an embryo created in the laboratory
  through in vitro fertilization (an IVF embryo) is
  different from one that is created specifically
  for research purposes.
• Some think that surplus IVF embryos can be used
  in stem cell research, but that embryos should
  not be created specifically for stem cell
  research.
• People who support the use of IVF embryos in
  research think that it is better to use them in
  research that might benefit others than to
  discard them.
• Those who object to creating embryos for research
  see treating such embryos as products to be
  manufactured for utilitarian reasons.

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CREATING RESEARCH EMBRYOS

• Is it acceptable to create embryos purely for
  medical research if humanity would benefit, and
  perhaps immeasurably, from such research?
• Or is the production of human embryos for
  research unacceptable because it treats an entity
  deserving of respect as an object?
• Would therapeutic cloning creating an embryo by
  cloning a living persons cell for biomedical
  research purposes be morally acceptable if it
  could cure some diseases that might otherwise not
  be cured?
• Would this threaten to lessen respect for other
  forms of human life?

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THE USE OF WOMEN I

• Dresser points out that there are risks to women
  in providing the eggs necessary to create
  research embryos.
• This is because they must take high doses of
  hormones and undergo numerous tests and
  procedures . . . that may carry a small risk of
  serious injury and, rarely, death.
• There may also be a risk of health and fertility
  problems later in life.

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Amedeo Modigliani 1884-1920
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THE USE OF WOMEN II

• Using women in the manufacturing of research
  tools providing eggs to be used to create
  embryos seems to regard their bodies as means
  of production.
• Women would probably have to be paid to donate
  eggs to ensure an adequate supply of eggs for
  research. That both makes it look as if embryos
  are created as research property, and that this
  may be undue inducement of students and
  low-income women to provide eggs for research.
• Dresser recognizes that many of these same
  problems apply when women supply eggs to help
  infertile people have children.

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Study for Woman I
Woman I 1950-1952
Willem de Kooning 1904-1997
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MORAL INTERMEDIATES

• Something that is morally intermediate is between
  a thing with no moral value or rights such as a
  stone and a thing with full moral value or
  rights such as a normal adult human being.
• Some medical research might involve entities that
  are moral intermediates.
• Dresser This is research that involves the
  destructive study of organisms generally viewed
  as having appreciable moral significance, but not
  the moral worth of a fully developed human
  being.
• This might include human embryos and fetuses and
  non-human animals.

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SPECIAL RESPECT AND RESEARCH

• Some argue that human embryos should be treated
  with special respect that precludes their
  creation to be used purely for research.
• Karen Lebacqz thinks that, at the same time that
  embryos can be viewed with awe and reverence
  and having special value, they can be used and
  killed in limited circumstances, when necessity
  is established.
• As Native Americans respected animals that they
  killed of necessity for food, we might respect
  embryos that we kill of necessity for research.

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JUSTIFICATION OF RESEARCH I

• For Dresser, justification of embryonic stem cell
  research depends on assessing the value of a
  studys proposed objectives, which requires us to
  rank the good of various research ends.
• One has to look at the human interests that might
  be advanced by stem cell research and determine
  which, if any, is important enough to warrant
  creation and destruction of human embryos, and
  other potential harms, such as injury to women
  providing eggs, that could accompany research.

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JUSTIFICATION OF RESEARCH II

• For embryonic stem cell research to be justified,
  it must also be shown that the goals of the
  research depend on the use of embryos, and cannot
  be reached without their use.
• Dresser what is the likelihood that a proposed
  embryo study will advance important human
  interests?
• To what extent could the human interests at
  stake be satisfied by an alternative approach?

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JUSTIFICATION OF RESEARCH III

• Although Dresser thinks that the moral and
  scientific justification of stem cell research
  will inevitably be an imperfect process, she
  says that human embryos may be viewed as
  organisms of extraordinary moral value, to be
  reserved for the most promising and worthwhile
  projects that could contribute to benefits
  unavailable through other means.

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JUSTIFICATION OF RESEARCH IV

• Proposals for stem cell research should be
  reviewed by groups that include philosophers,
  theologians, and other nonscientists in addition
  to scientists.
• Reviewers should also have different views on
  the moral issues raised by creating and
  destroying human embryos for research.
• Thus we need a lively and serious exchange of
  ideas to get at the moral value of this kind of
  research rather than a consensus on one side or
  the other that does not reflect that sort of
  exchange.

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WHERE DO WE DRAW THE LINE? I

• If we allow the creation and destruction of human
  embryos for medical research to benefit persons,
  how far can we allow embryos to develop before
  killing them in the process of research?
• Some say we can go up to 14 days, and some permit
  embryo destruction beyond that point. How far
  can we go before destruction is impermissible?
• Dresser At what point would we say that no
  benefit to others could justify the instrumental
  creation and destruction of developing human
  life?

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WHERE DO WE DRAW THE LINE? II

• Dresser Because there is likely to be pressure
  to allow destructive research on developing
  humans past the point at which stem cells can be
  retrieved, we need to establish a strong moral
  and policy basis for drawing the line at a
  particular point, a line that will prevent a
  slide down the slippery slope and enable us to
  stand firm against the allure of achievements
  that could come from permitting research that
  destroys human life at later stages of
  development.

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PROBLEMS WITH THE PUBLIC DEBATE I

• Dresser says that the public debate over the
  moral status of human embryonic stem cell
  research has several problems.
• The first is responses to the question of where
  we are to draw the line.
• Some opponents exaggerate the threat of the
  slippery slope, while some proponents minimize
  the slippery slope threat.
• In a world where vulnerable humans have often
  been seen as resources for experimentation to
  benefit the powerful, it would be dangerous to
  dismiss the line-drawing challenges implicit in
  policy making about research that destroys
  developing human life.

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PROBLEMS WITH THE PUBLIC DEBATE II

• A second problem with the public debate is
  exaggeration about potential cures and therapies
  from stem cell research.
• Embryonic stem cells are a new tool for
  research, not a sure cure for serious illness.
• Dresser says that the goal of biomedical research
  is to advance knowledge, while the goal of
  medicine is to heal and prevent disease. These
  should not be confused, as they sometimes are in
  the public debate.
• Portraying any kind of stem cell research as
  therapeutic is highly misleading.

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PROBLEMS WITH THE PUBLIC DEBATE III

• Dresser A third problem with the public debate
  is a failure on all sides to consider the
  distributive justice implications of stem cell
  research. Distributive justice is concerned
  with who ought to get what goods. Here it
  specifically pertains to who should get the goods
  or the benefits of stem cell research.
• Should the ability to extend the average U.S.
  life span be a priority in biomedical research,
  over research that may be of greater world
  benefit in targeting diseases, such as malaria,
  that are responsible for high rates of premature
  death worldwide?

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PROBLEMS WITH THE PUBLIC DEBATE IV

• Is it more important to promote stem cell
  research or obtain universal health care?
• Dresser millions of people in this country lack
  access to high quality health care. Many, many
  patients cannot obtain existing therapies that
  could extend and improve lives.
• We should not allow the stem cell issue to
  divert our elected leaders from this nations
  deepening health care crisis.

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PROBLEMS WITH THE PUBLIC DEBATE V

• Dresser Public and policy discussions should
  also acknowledge the challenge of supplying
  patients with any stem cell treatments that might
  emerge, which are likely to be expensive.
• Would stem cell therapies be available solely to
  the wealthy?
• Because helping patients is the ultimate ethical
  justification for conducting stem cell research,
  access to potential therapies should be part of
  the national discussion.

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PROBLEMS WITH THE PUBLIC DEBATE VI

• Dresser says that the final problem with the
  public debate over stem cell research is that it
  sometimes lacks civility.
• Partisans in the debate too often dismiss the
  concerns of those who disagree, and they dismiss
  as well the idea that deliberation,
  accommodation, and compromise might be warranted.

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DELIBERATIVE DEMOCRACY

• Dresser thinks that those involved in the stem
  cell debate who are vituperative and
  disrespectful of opposing views should recognize
  the importance of deliberative democracy to this
  key moral issue.
• Dennis Thompson and Amy Gutman say that
  deliberative democracy is based on the idea that
  citizens and officials must justify any demands
  for collective action by giving reasons that can
  be accepted by those who are bound by the action.
  When citizens morally disagree with one another,
  they should deliberate with one another, seeking
  moral agreement when they can and maintaining
  mutual respect when they cannot.