Stem-Cell Research | How Catholic
Ethics Guide Us
by Thomas A. Shannon |
January 2002 |
Over the last two decades scientific
developments have been proceeding at a rapid pace. Nowhere has this been
more true than in human genetics. One cannot pick up the daily paper or
listen to a news show without hearing of yet another new discovery,
development or application of a new procedure.
There are two main
problems with this steady stream of information: The information itself
is becoming more and more complex and the applications are predicted to
be revolutionary. Frequently the research is only at the very beginning
stages. Much of this research has an ethical dimension. In this Update
we'll take a look at the field of stem-cell research. We'll explain what
stem cells are and why there are ethical concerns.
Most
Americans have had some sort of a biology course in high school; some
have had a college-level course; but few have had specific courses in
molecular genetics or bioengineering. Thus we may have some sort of
general idea of the topic, but not grasp the real core issues. Several
ethical issues were raised with the recent near-completion of the Human
Genome Project (the project that identified and mapped the structure of
human DNA)privacy, potential disqualification for insurance, the
possibility of predicting some aspects of one's health at birth, to name
just a few. The technology goes forward, however, and often without
sufficient breathing room to understand the technology, much less
consider its implications.
This happened again with the debate
over embryonic stem-cell research. Research on adult and embryonic stem
cells of animals and humans has been going on for several years, and a
national bioethics commission made some recommendations about this
research. On August 9, 2001, President Bush announced his decision to
allow the federal government to provide funding for research on 64 lines
of embryonic stem cells. These lines came from destroyed human embryos
obtained from in vitro fertilization clinics. The president's decision
caused an enormous debate in terms of both science and ethics. Many
commentators, religious leaders, scientists and members of the public
weighed in on various sides of the debate, and an advisory committee
will now monitor the research. But what is the debate about?
WHAT ARE STEM CELLS, ANYWAY?
First, what are stem cells and
why are they so important? Essentially, stem cells are cells that have
the potential to become many different kinds of cells. They are the
means by which cells in the body can be replenished. In the very early
embryo these cells are totipotentthat is, they have the potency to
become any kind of body cell. In adult stem cells, the cells are
pluripotentthey have the capacity to become a variety of cells, but not
all. Scientists hope to obtain lines of these embryonic stem cellslarge
numbers of them grown from a common sourceand coax them into becoming
specific kinds of cells.
For example, a biologist at my college
recently succeeded in having blood cells from bone marrow grow into
nerve cells. Other scientists have recently reported success in having
embryonic stem cells grow into three different types of blood cells. The
goal of this research is to use these stem cells to develop various
tissues that can then be used to repair damaged tissues in the bodyheart
tissue to repair a damaged heart, nerve tissue to repair a damaged
spinal column or reverse the effects of Alzheimer's disease. The
research is very interesting, complex and promising.
WHICH
STEM CELLS?
Now let's look at a particular kind of ethical
problem. Which stem cells should be used for research, adult or
embryonic? Many have argued that adult stem cells are difficult to
obtain, very hard to coax into developing into other tissues and,
consequently, their use would involve much more time and money to obtain
the desired results. Up until very recently, this was generally true.
But now research has shown that adult stem cells can be isolated and
developed. If this research continues to be successful, there may no
reason whatsoever to use embryonic stem cells, which requires
destruction of early embryos and poses a serious ethical problem. Many
argue that adult stem cells are where the resources for stem-cell
research should be directed. Continued success in this area would
essentially eliminate the need for embryonic stem cellsand put an end to
a major ethical problem.
But the problem is that the Bush
proposaland indeed the desire of many scientists and many in Congressis
to use federal funds to support research on stem cells extracted from
already destroyed human embryos. Is this ethical? There are actually two
ethical questions here: First, is the destruction of the very early
embryo immoral? Second, if a vaccine or tissue is generated from these
human embryonic stem cells, would someone act unethically in using it?
Over the last few decades there has been a strong affirmation by the
pope and bishops that the human embryo is to be valued and, in effect,
treated as a person from the time of fertilization forward. It is not to
be destroyed or seen as disposable tissue that can be used in research
as any other tissue might be. Nor should such embryos be generated
specifically for research purposes. This of course is possible, given
the technology of in vitro, "outside the body," fertilization. And in
fact, one fertility clinic in Virginia has reported that in fact that is
exactly what it is doing.
REACTIONS FROM POPE AND BISHOPS
What is the moral status of the early embryo? Pope John Paul II
gave his perspective on this debate in an address to President Bush on
July 23, 2001, during his papal visit. The pope rearticulated his
position on the use of embryos by saying: "Experience is already showing
how a tragic coarsening of consciences accompanies the assault on
innocent human life in the womb, leading to accommodation and
acquiescence in the face of other related evils such as euthanasia,
infanticide and, most recently, proposals for the creation for research
purposes of human embryos, destined to be destroyed in the process." The
pope also called for the United States to show the world that we can be
masters and not products of technology.
In a similar, though
more specific response to the Bush stem-cell proposal, Bishop Joseph A.
Fiorenza, then president of the U.S. Conference of Catholic Bishops,
said: "However, the trade-off [Bush] has announced is morally
unacceptable." The federal government, for the first time in history,
will support research that relies on the destruction of some defenseless
human beings for the possible benefit to others. However such a decision
is hedged about with qualification, it allows our nation's research
enterprise to cultivate a disrespect for human life....The President's
policy may therefore prove to be as unworkable as it is morally wrong,
ultimately serving only those whose goal is unlimited
embryo
research."
These claims are reflective of the traditional
teaching recently restated, for example, in the Instruction from the
Congregation for the Doctrine of the Faith, Donum Vitae, that the "human
being is to be respected and treated as a person from the moment of
conception and therefore from that same moment his rights as a person
must be recognized" (I, 1).
The Instruction is careful to note
that the Church has not taken a philosophical position on the time of
ensoulment. However, "From the moment of conception, the life of every
human being is to be respected in an absolute way" (Donum Vitae,
Introduction).
While the hierarchy of the Catholic Church has
left open the resolution of the actual time of ensoulment, it has in
fact insisted that the prudent response would be to recognize that as a
practical matter ensoulment is coincident with fertilization. This
position, combined with the traditional respect-for-life position of the
Church, is what propels its opposition to embryonic stem-cell research.
THE BEGINNING OF LIFE
Some, while respecting this
teaching of the Church, make further ethical observations about the
early embryo. First, fertilization is a process that takes about 24
hours to complete and therefore is not a specific moment one can point
to. As a side note, should a human be cloned, there would be no
fertilization at all because the nucleus of one cell is placed into
another cell that has its nucleus removed and is stimulated to begin
cell division. The life of that individual would not begin at
fertilization.
Second, the whole development of an embryo into a
fetus and eventually into a child is a process, not a series of sharply
defined steps. This is important because it is really difficult to tell
precisely where a fetus is in the process of development. One knows
where the fetus is after the stage has been entered into. It is not easy
to make precise developmental statements and then moral judgments made
in relation to them.
But more specifically, many ethicists focus
on the fact that up until about a week or so into the pregnancy, the
fertilized egg has the capacity to divide and become identical twins. In
some cases it has been observed that such divided eggs blend back
together into one blastocyst (what the fertilized egg is called at
around 4-5 days of development).
And if the egg is fertilized in
vitro, one cell can be removed (to have its genetic structure analyzed)
and the developmental process is not harmed. In fact, all the cells of
the blastocyst can be separated and each has the capacity to become a
whole human being. This point is clearly important biologically: These
cells can become either a whole organism or be coaxed into becoming any
specialized cell in the body.
But this is important
philosophically also. Because the cells of the blastocyst can be divided
so that each part can become a whole, the blastocyst lacks true
individualitythe capacity not to be able to be divided.
If one
were to divide me, you would wind up with two halves. If one divides the
cells of the blastocyst, one obtains several cells all capable of
becoming individuals. The reason why this is philosophically important
is that if the organism is not first an individual, it is difficult to
understand how it could be a person. Being an individual organism is a
first necessary, though certainly not sufficient, stage for being a
person.
On the basis of the argument that the blastocyst is not
yet an individual, some would argue that while the blastocyst is a
living organism, possessing the human genetic code, such an organism is
indeed valuable, but its value is not yet that accorded to a person.
Therefore some would conclude that killing the human blastocyst is
not murder because there is as yet no personal subject to experience
that wrong. Such a killing is a disvalue, to be sure, but a disvalue
that might be offset by other positive values, such as health. The
conclusion that some would draw, then, is that at least a case can be
made for the use of human embryos in stem-cell research.
Once
again, the Church does not endorse this view. The specific reason for
the rejection of this position is the affirmation that fertilization,
the time when egg and sperm merge and form a new genotype, is considered
to be the biological beginning of the new human life. Together with this
affirmation is the correlative presumption that this is the time of the
infusion of the soul. Although there is no official doctrine on this
position, the attitude of the Church is that moral priority should be
given to this position.
The second problem is, could someone use
a vaccine or tissues from such research in an ethical way? The term for
this problem in moral theology is called cooperation. It can be either
formal or material. Formal cooperation involves a person directly
intending to participate in the evil act of another. For example, a
person would be formally cooperating with a moral wrong if he or she
obtained drugs and helped prepare them so they can be used for
euthanasia.
Cooperation may be material, not formal, if a person
does not intend the evil act but may be involved in some of its
consequences. For example, a nurse who is opposed to abortion but works
in a hospital where abortions are occasionally performed may still
provide nursing care for the woman who came for abortion.
In the
case of stem-cell research, this framework of degrees of cooperation
allows several responses to be proposed. First, the patient need not
intend the destruction of the embryos and thus any cooperation would not
be formal. Thus, one could use the vaccines without an ethical breach.
Second, the moral distance between the use of the vaccine by the patient
and the original research is so great as to render any cooperation
remote at best.
Finally, for use of the research to be immoral,
the act of destroying a blastocyst must itself be immoral. If one
follows the line of reasoning that the blastocyst is not yet an
individual and, therefore, not yet a person, its killing would certainly
be a disvalue but would not be a moral evil having the equivalence of
murder. Thus individuals would be able to use the clinical products that
come from such research.
Such reasoning would be unacceptable to
the teaching of, for example, Donum Vitae or the encyclical letter of
John Paul II Evangelium Vitae. The basis for rejecting such procedures
is the recognition of the human embryo's being accepted as a full human
person from the moment of conception and, therefore, having an intrinsic
dignity and value that cannot be compromised in the name of other
values.
THE BROADER ETHICAL QUESTION
But there is
another question that is, I think, equally as important as the ethics of
the use of human embryos in research. That question is a public policy
question: Should we continue with our policy of research into high-tech,
expensive therapies that may not be available to many citizens because
they are uninsured, underinsured, or because their insurance plans might
not cover experimental treatments? The dominant trend in American
medicine is high-tech intervention to cure or try to maintain the status
quo of a patient. The implantation of a new model of an artificial heart
is another example of such high-tech intervention. Clearly many of these
interventions do save lives. And significant developments have been made
in the treatment of many forms of cancer. But some perceptions of the
success of these interventions are inflated. One study showed that on
television shows the success rate of cardiopulmonary resuscitation is
over 70%. In real hospitals, however, the success rate is under 5%. This
is not in itself a reason not to do CPR, but perhaps we might question
whether it is appropriate in the particular circumstances of this
patient.
The stem-cell debate might be an opportunity for us to
ask if we should not, as a nation, begin to focus on prevention rather
than cure as our dominant health-care strategy.
Prevention will
not prevent all diseases and will not help if there is a trauma such as
a car accident. But a strategy of prevention including services such as
care for pregnant women including proper diet information, well-baby
exams including vaccinations, and information on lifestyle issues such
as diet, smoking and excess drinking would go a long way to preventing
the early onset of many diseases.
The resistance to removing or
restricting the use of soda and candy machines in elementary and
secondary schools shows that we have a long way to go in even thinking
about the most elemental forms of prevention of disease.
Of
course prevention is rather boring. It certainly would make for very
dull TV shows. Who would not rather watch the fast-paced, high-tech ER
than a physician instruct a person in a proper diet? Anyway, who wants
to watch his or her diet all the time? Who has time for exercise and all
the other things we learn are good for us? Prevention is a hard sell.
But, in the long run, it is better to try to prevent heart disease than
repair a damaged heart. It is better to manage one's diet than take
insulin continuously or have a leg amputated because of circulation
problems resulting from diabetes.
SPENDING CAREFULLY
I am not arguing that we should abandon research or high-tech
medicine. I am arguing that we as a country seriously need a national
debate on health care and the kind of interventions that would be
beneficial for all citizens, not just the wealthy.
Currently, it
seems like much research on specific diseases is driven by powerful
lobbying groups who have celebrity spokespersons who sometimes have the
disease for which funding is sought. Parents whose children are
afflicted with terrible diseases bring their children to congressional
hearing rooms. The implication is that if Congress does not fund this
particular legislation and a relative dies, it is the direct fault of
Congress. But we know that we cannot fund research for all diseases, and
certainly we cannot fund them equally. While all of us are sympathetic
to the plight of the sick and suffering, a genuine ethical question is,
who get access to such congressional hearings? One seldom sees the poor,
the socially marginalized, the unemployed, the underinsured moving about
in these circles. How does health-care policy affect their lives,
particularly since they probably have no insurance to begin with?
What I am arguing here is that the stem-cell debate focuses our
attention on yet another critical and important technical development in
the fight against disease. Yet it also should make us question whether
we as a country should channel all our resources to this form of
research, or should we also begin to devote resources to prevention. Our
health-care budget is limited; thus the question of the justice of how
such resources are allocated is a critical one.
In addressing
all of the questions covered in this Update, it's important to remember
the Church does not wish merely to be a naysayer against development and
scientific progress. In fact, the Church is very positive and supportive
about
advances in science that improve the quality of human life.
Most of the world knows that the Church works in many places, often
in areas of high poverty, seeking to help liberate the human family from
disease. In evaluating how to move ahead, whether it is in the
laboratory or in society at large, always we are to remember an
underlying principle: to value the dignity of human life.
Thomas A.
Shannon is Professor of Religion and Social Ethics in the
Department of Humanities and Arts at Worcester Polytechnic
Institute, Worcester, Mass. He is the author of many articles on
bioethics as well as several books including An Introduction to
Bioethics (Paulist Press, 1997) and Made in Whose Image? Genetic
Engineering and Christian Ethics (Humanity Books, 2000).
Extracted from
http://www.americancatholic.org/Newsletters/CU/ac0102.asp
AmericanCatholic.org
Copyright 1996-2002 St. Anthony Messenger Press.
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