The Ethical Dilemma of Stem Cell Research
By Verdell Goulding

In 1999, the editors of Science , a prestigious scientific journal, hailed stem cell research as the scientific breakthrough of the year.

Since that time, stem cells have generated much excitement and a great deal of controversy. Proponents of unlimited stem cell research claim that its potential benefits outweigh any moral objections to the method by which it is conducted. Opponents claim that unethical research can never be justified, not even by potentially good ends to that research.

Governments of developed nations around the world have been weighing the ethical issues involved as they attempt to establish regulations to guide federal funding of stem cell research. Such regulations are extremely important as they will establish the ethical parameters that determine what research will be funded. This will, to a large extent, control what research will be conducted.

In Canada, the Canadian Institute of Health Research (CIHR), the federal funding agency of health research in Canada, has established a Working Group on Stem Cell Research to examine the issue. Its recommendations have recently been released to seek public feedback.

Before examining these recommendations, however, it is first necessary to
gain an understanding of what a stem cell is, and exactly why this research is so controversial.

What is a Stem Cell?

Most cells capable of reproducing can only reproduce one specific type of cell. A skin cell, for example, can not produce brain cells or blood cells. It can only reproduce other skin cells.

Stem cells, on the other hand, are unique in that they are capable of producing many different types of cells. The two most commonly discussed forms of stem cells are embryonic stem cells (ES cells) and adult stem cells.

ES cells are cells present early in development from which all other body cells and tissues stem. In the course of normal development, they are responsible for producing virtually every cell within the human body.

Adult stem cells are found throughout the body of every child and adult. They are more specialized than ES cells, but still capable of producing a variety of different cells through further specialization. (See side bar on this page for further explanation.)

What are the Possible Benefits of Stem Cell Research?

The highest hope for stem cell research is that it might eventually lead to the successful treatment of diseases and conditions brought on by the destruction or deterioration of various human cells. Alzheimer's disease, Parkinson's disease, diabetes, heart disease, and spinal cord injuries are all the result of deteriorating or destroyed body cells that cannot currently be replaced. It is hoped that if we can learn to direct the pathway of stem cell specialization, then stem cells may be used as a source to replace cells that have been destroyed in these conditions.

Why the Controversy?

The main source of controversy involves the current sources of ES cells, which include: embryos created in fertility treatment clinics; embryos created by scientists specifically for research purposes; fetal remains left over from abortions; and embryos created by human cloning. All of these sources involve the destruction of the human embryo or fetus from which the stem cells are obtained.
Given most people acknowledge that life (or at least, potential life) is present in an embryo, this confers on that embryo some degree of human moral status and the accompanying right to protection and human dignity.

This moral status causes quite an ethical predicament for embryonic stem cell research. On the one hand is the tantalizing possibility of finding a cure for many current diseases and disablements. On the other hand, exploring this exciting possibility may require the destruction of early life that has an acknowledged degree of human moral value.

Therefore, the ethical challenge presented by this predicament is to determine 1) the value of human life during its earliest stages of development, and 2) whether or not this value is low enough to be outweighed by the potential good that may result from its destruction.

Current Regulations in Canada

In August, U.S. President George Bush announced his decision to federally fund research on existing stem cell lines, where stem cells have already been removed and the embryo already discarded. Any research that would destroy any more embryos would not receive federal funds.

At the moment, no specific guidelines exist in Canada to guide federally or privately funded cell research. The Working Group on Stem Cell Research established by the CIHR has recently released several recommendations based on its conclusions regarding the ethical boundaries of stem cell research.

First, both research that uses existing stem cell lines (where the embryo has already been discarded) and research that will create new stem cell lines (where embryos will continue to be created and then discarded) should be fundable.

Second, several limitations to creating new stem cell lines should be established. It was recommended that embryonic research should only be performed on "spare" embryos created in fertility clinics (fertility clinics create embryos to implant directly into a woman's uterus, but often create more than needed; excess embryos are usually frozen and stored indefinitely or discarded), and that embryonic research should be restricted to the first 14 days of development, after which time embryo destruction becomes unethical.

And third, research projects using fetal tissue from elective abortions as a source of stem cells should be fundable.

Response to Recommendations

Ethical Dilemma #1: Determining the value of early human life

As mentioned earlier, one of the ethical challenges of embryonic stem cell research is determining the value of human life at this early stage. In its discussion paper, the Working Group concluded that the human embryo has "a special moral status because of its potential to develop into a human being," but does not have "the full moral status of a person nor an absolute right to life."

In other words, the human embryo has moral value which is lower than it would be if the embryo were permitted to progress to later developmental stages. The Working Group calls this the "graduated approach" of determining human value, and bases several recommendations on this conclusion.

One such recommendation is to limit the continued destruction of human embryos to "spare" embryos created in fertility treatment clinics. This acknowledges at least a limited value of human life at this point, implying that it should not be recklessly created and destroyed at will. Nonetheless, there are still some problems with this recommendation.

If life is to be afforded a measure of respect at this stage, and if fertility clinics currently create a large enough excess of embryos to fill the demand for research purposes, then perhaps we should look at curbing the excess creation of embryos in fertility clinics rather than using these excesses to justify the destruction of the embryos created.

Furthermore, this token of respect is largely superficial in terms of its practical application. It will not provide any real restraint on the number of embryos used and discarded. It simply creates a loophole where virtually unlimited numbers of embryos can still be created for research purposes; they will just be created by fertility clinics rather than by scientists themselves.

The Working Group further attempts to define the value of early human life through its recommendation to limit the destruction of human embryos to those younger than 14 days old. According to the Working Group, the embryo at this point becomes valuable enough that its destruction can no longer be outweighed by the potential benefits to other human life. Before this point, its value is low enough that its destruction is ethically justified.

This time point was selected because it is before the "first indication of neural (brain) development" usually appears. The problem, however, is attempting to explain how this provides a clear and unequivocal dichotomy capable of separating human life valuable enough to protect from human life which is not.

Human development is a continuous process of cellular changes where each new specialization evolves from the one before. A continuous line of these changes results in noticeable change over time, not instantaneously. Therefore, a stage where neural development "first begins" is really only an artificial dichotomy bridged by a continuous line of developmental change. It does not represent a sudden, abrupt change in development.

At Day 14, for example, embryonic cells are already specialized into three distinct layers, one of which is the precursor of the nervous system (which includes the brain). They have not reached this point through sudden or abrupt changes, but through a gradual and continuous process of cell specialization. Likewise, their development from this point to the first observed indication of early brain development does not occur suddenly or abruptly, but is also the result of a gradual, continuous accumulation of cellular changes. So how can any stage, developing so gradually, represent a drastically abrupt change in the value of human life as the Working Group suggests?

The problem is, no abrupt changes occur in the developmental process that warrant such a dichotomous change in value. The only abrupt change that occurs over the course of human development is at the very beginning (when fertilization occurs) and at the very end (when human life reaches a natural end). Any sudden change in value can only be determined by the presence or absence of life, not by any arbitrarily assigned values along the way.

Another problem that arises from the Working Group's method of determining the value of life at various stages is the contradiction between the Group's conclusion that it is morally unacceptable to destroy embryos for their stem cells after day 14 of development, yet at the same time morally permissible to use aborted fetal remains for this same purpose. Based on its own "graduated approach" of human development (where moral value increases with development), how can it claim that a 15 day old embryo has enough value to outweigh the possible benefits to millions suffering from disease, while at the same time not granting this same value to a fetus? According to a graduated approach, shouldn't a fetus be even more valuable than the 15 day old embryo which the Working Group says is unethical to discard?

Ethical Dilemma #2: Value of early human life vs. potential cure for disease

In addition to determining the value of early human life, the other key ethical challenge is to determine whether the value of the embryo is sufficiently low enough that its destruction can be outweighed by potential benefits to human life in later stages of development.

In this regard, the Working Group concluded that an embryo is valuable enough to warrant the right to protection, but that "this right is not absolute and can be overridden; for example, by the possibility of a major benefit to other humans and to society in general."

However, this conclusion is based on the aforementioned conclusion that life on Day 14 is less valuable than life on Day 15 of development. Therefore, if there are fundamental errors in reasoning in the Working Group's determination of the value of life at this point, these errors are only compounded when used as a base from which other conclusions are drawn.

This means that if an embryo, in reality, has more value than afforded it by the Working Group, then a re-evaluation is needed regarding its right to protection and the point at which this right can be "overridden" by other factors.

Another problem with the Working Group's attempt to weigh the relative value of human life is its failure to provide sufficient weight to the promise of adult stem cell research. As mentioned earlier, adult stem cells are cells that have become specialized to a point, but are still capable of producing a limited variety of different cells as required. However, recent research has discovered that these adult stem cells are

much more versatile than previously thought; capable, in fact, of even converting from one specialty to another. (See sidebar below.)

Despite all this promise, the CIHR Working Group essentially ignored this growing body of work. Its recommendations insist that the moral status of the embryo is outweighed by the potential benefit to others, but it does not reflect adequate consideration that this same beneficial end may also be achieved through a means that does not destroy human life at any stage.

As stated by Jakki Jeffs, Executive Director of Alliance for Life Ontario, in a response to the discussion paper published by the Canadian Institute of Health Research, the Working Group appears "not to have been totally impartial" and "has not fully served informed public opinion with the limited information it quotes concerning adult stem cell research." Given that embryonic stem cell research to date only holds the potential of developing therapeutic application, whereas adult stem cell research has already demonstrated such application, Ms. Jeffs says it is "curious that none of this [adult stem cell] research appears to have been taken into consideration when the group made its recommendations."

Conclusion

In 1982, my grandfather was diagnosed with Parkinson's Disease. He has been essentially bedridden for the past 10 years, and unable to talk for the past two years. It is a terrible, debilitating disease that has robbed him from being able to enjoy his grandchildren as they have grown, and robbed his grandchildren of ever really knowing their grandfather.

The possibility that such an awful disease might someday be eradicated is very appealing to me. However, even as we strive towards that admirable goal, we must not allow our enthusiasm for a cure to override our sense of moral conscience.

The recommendations of the CIHR Working Group imply an appropriate degree of enthusiasm for curing current diseases, but an inadequate degree of guiding that enthusiasm with appropriate moral conscience. It concludes that the value of life undergoes an abrupt and distinctive change after the 14th day of development, yet erroneously bases this conclusion on a developmental process that is both gradual and continuous. It then uses this flawed reasoning as a means of justifying the devaluation and destruction of human embryos, introduces recommendations that contradict its own faulty reasoning, and all the while ignores the alternative and non-controversial means of adult stem cell research.

What may be potentially even more dangerous, however, is the precedent these recommendations will set for research involving life along the continuum of human development. For if flawed reasoning can be sufficient to justify the devaluation and destruction of human life at one point along the developmental continuum, then every other point along that same continuum is opened to suffering the same fate.

Verdell Goulding is a part-time freelance writer, currently living in Toronto, where he also works full-time in the field of medical science research.