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SharethisYesterday, President Obama lifted the federal ban on the funding of human embryonic stem cell research. This means that taxpayers--in this time of economic recession and record deficit--will be paying for research resulting in the destruction of human embryos which may or may not result in clinical benefit for patients. The money to fund this research will be paid by taxpayers whether or not they believe the human embryo is a human person and whether or not they believe that the destruction of such a human person is morally repugnant. I write this now in direct response to the 2004 CTSNet “In My Opinion” editorial by Dr. Lawrence I. Bonchek, which chastised the then President Bush for limiting federal funding of human embryonic stem cell research [1]. The article elicited responses from Drs. Tea Acuff and Lourens Willeke, both dissenting with Dr. Bonchek’s premise but for different reasons.
Since Dr. Bonchek’s editorial was written, notable events have occurred in the field of stem cell research:
- The reported human embryo cloning for stem cell research by South Korean researcher Hwang Woo Suk, of which the editorial glowingly speaks, seemingly as a model for the US, was discovered to be a fraud and the research discredited. Interestingly, the New England Journal of Medicine in the previous year vowed that the “editors will do our part” to influence the political debate “by seeking out highly meritorious manuscripts” extolling the virtues of human embryonic stem cell research and cloning [2].
- The scientific progress and direct clinical application of adult and cord blood stem cell research has continued unabated, resulting in tangible benefits for untold thousands of patients worldwide. One of the latest and most spectacular of these benefits was for a 30-year-old woman in Barcelona, Spain, who underwent replacement of her tuberculosis-damaged mainstem bronchus with a donor trachea lined with her own stem cells.
- Japanese and US investigators have reprogramming mouse and human skin cells into pleuripotent stem cells (iPS cells), a huge advance with enormous possibilities for direct clinical benefit.
- To date, even in countries that have no restriction of federal funding for this purpose, there is not a single report of a single patient benefiting clinically from human embryonic stem cell research.
The clinical and fiscal optimism with which human embryonic stem cell research was embraced seems to be waning in many ways. Nonetheless, in some sense, all the above important practical points do not fully address the real ethical issue, i.e., does the hypothetical possibility of practical cures being discovered someday utilizing human embryonic stem cell research morally justify the requisite destruction of human embryos?
Obama, in announcing the liberalized federal policy toward human embryonic stem cell research, stated that “ideology” must not hinder scientific progress. Is it “ideology,” or science, to view the human embryo as a genetically and embryologically complete biologic human entity? There is no debate in textbook after textbook of human embryology. It is, however, ideology – or philosophy, or pop-culture, or socioeconomics, or emotional hype, or modern social values swaying in the wind – which distorts the pure science of early human embryonic life into something morally relative, to have thrust upon it the utilitarian view of “what it can do” rather than “what it is.” There is little debate that in the typical scenario, there is a no more pivotal moment in the subsequent growth and development of a human being than when 23 chromosomes of the mother join 23 chromosomes of the father to form a unique, biologically and genetically complete, new individual, with a gender, that had previously simply not existed. The geneticist Jerome Lejeune, discoverer of the chromosomal basis of Trisomy 21, eloquently stated that “…each of us has a unique beginning, the moment of conception…a new human being is defined which has never occurred before and will never occur again…[it] is not simply a non-descript cell, or a ‘population’ or loose ‘collection’ of cells, but a very specialized individual…” [3].
It was at the Nuremberg Medical Trials in 1947 that another type of “ideology” was rejected. This ideology held that entire classes of persons could be categorized as “subhuman” and that destructive experiments – all in the name of science and medicine – could be performed on them, especially in view that these persons were destined for death anyway. This ideology subscribed to the utilitarian notion that a good end justifies a not-so-good means. In fact, this is precisely the legal argument that the Nazi attorneys used in cross examining Dr. A. C. Ivy, the expert medical advisor at the trials, asking “If you were ordered by a high political or military leader to perform an experiment which you know in advance would cause the death of three persons and … would save the life of twenty thousand, would you perform the experiment?”[4]. Ivy’s answer was astonishingly devoid of modern relativism: “There is no political and military leader … who could order or otherwise compel me to perform an experiment contrary to my moral convictions.” And when asked if he would then be willing to be shot for disobeying, Ivy answered affirmatively. Interestingly, a group of physicians in Germany during the Nazi regime protested when they learned that prisoners were being used as research subjects. Heinrich Himmler demonized these physicians as “traitors” and demanded a list of these doctors with “Christian medical ideals” [4].
The seeming distain with which Dr. Bonchek’s article holds “the President’s [Bush’s] (and the so-called Religious Right’s) conviction that human life begins at conception” could also be applied to Hippocrates himself. It is, after all, the Hippocratic Oath itself – the same Oath I took when graduating from the UCLA School of Medicine in 1984 – which states “I will not give to a woman an instrument to produce abortion. With purity and holiness I will pass my life and practice my art.” As an interesting aside, the Supreme Court justices in 1973’s Roe v. Wade had difficulty rationalizing around this 2,400 year-old Oath. The justices hedged that the authority of Hippocrates did not prevent abortions in Greece and Rome, and that most Greek thinkers and physicians actually commended abortion and that only the Pythagorean philosophers frowned upon abortion and suicide. Only Hippocrates and the minority Pythagorean thinkers opposed abortion, and the future teachings of Christianity fit well with Pythagorean ethic. Thus, the justices concluded that the Hippocratic Oath is “a Pythagorean manifesto and not the expression of an absolute standard of medical conduct” [5]. The point, of course, is that it was Hippocrates’ opinion and intention to distinguish his school of doctors who practiced in an ethical framework set apart from Greek mainstream medicine. If the status-quo of the day satisfied Hippocrates, then he would not have needed to establish his new guidelines for medical ethics.
If any question remains, one should consider also the Geneva Declaration of Physicians, written as a direct result of the Nazi medical atrocities soundly condemned at the Nuremberg Medical Trials. This universal Declaration of Physicians states: “I will maintain the utmost respect for human life, from the time of its conception, even under threat. I will not use my medical knowledge contrary to the laws of humanity [6].” The Geneva Declaration understood well the unique status of the human person beginning at conception. This was also certainly understood by the 15 scientists of the Max Planck Institute who signed a letter published in Nature strongly condemning human embryonic stem cell research, calling it “unethical,” and calling for a moratorium on the work [7].
One argument that is often suggested by proponents of human embryonic stem cell research, surprisingly even by some of the researchers themselves, is the completely unscientific argument that the human embryo “is no bigger than the period at the end of this sentence.” This argument, which bases moral worth and intrinsic biologic reality on size alone, is preposterous. Over time in any individual, all the qualities of life change: size, form, function, and appearance. We can reduce any point in time in an individual’s development to a trivial value by comparing that point to any other reference point we might choose. If the moral worth of an embryo is not sufficient to prevent its destruction because of its size relative to an adult, what does this imply about our moral worth when comparing our size to the vastness of the universe?
Another argument to justify human embryonic stem cell research is that a prime source for the research would be the “excess” or “leftover” frozen embryos of in-vitro fertilization clinics, i.e., embryos destined to die anyway. This again leads to the moral analogy posed by the Nuremberg Medical Trials, in which the Nazi defense attorneys used this precise approach to justify medical experimentation on prisoners “destined to die anyway.” Blanket acceptance of such a philosophy would also justify the ethics of experimenting or organ procurement on prisoners on death-row for the sake of medical utility.
Of course, the taboo question to ask proponents of human embryonic stem cell research is “when does human life begin?” One biotechnology leader answered in Science [8] “I cannot answer that question…” and went on to talk about implantation and the primitive streak. If one is uncertain of when human life begins, how can one advocate for destruction of embryos, even for presumptive scientific merit? The less certain one is that the embryo is not a human being, the more cautious one should be in advocating its destruction. And if the embryo is not a human being, then when does the transition occur? At 3 weeks with a beating heart? Or at day 30 with ABO type-specific blood running through a closed circulatory system? Or 5 days later when 10 fingers are evident? Or 5 days later when brain waves are detected? Perhaps even more dangerous is the concept that “personhood” is not a precise moment, but a gradation of human worth. With this model, a fetus at 4 months is somewhat of a human being, but a newborn is more of a human being. So is a 10-year-old more of a human than a 1-year-old? Is a politician or athlete more of a human being than a wheelchair-bound paraplegic? Can intrinsic human dignity and worth really be stratified? Certainly, history has shown that such thinking has demeaned entire classes of people, stripping them of their intrinsic human dignity. Unfortunately, it is often those with the least certainty of when human life begins that are the most eager to roll the dice, with no appreciation of the apocalyptic nature of the risk. Last year, when asked at what point a pre-born baby gets “human rights,” the then candidate Obama famously stated that “answering that question with specificity…is above my pay grade.” And, yet, in just over a month in office, it has not been above his “pay grade” to sweepingly increase federal support for programs that clearly involve destroying early human life on a national and international level.
Dr. Bonchek makes an interesting statement that “Those with religious objections to stem-cell research are free to refuse its therapies, but the rest of us must be free to benefit from them” (seemingly analogous to the refusal of blood by Jehovah Witnesses). But is it really so simple? How about making the analogy with something as seemingly innocuous as vaccines? What is the origin of the overwhelming preponderance of childhood vaccines used in this country? You guessed it – aborted human fetuses. Are those with objections to abortion really free to deny vaccines to their children? Perhaps, but only in a very limited and difficult sense. Our culture in a sense has really started to become uncomfortably comfortable with this form of neo-cannibalism. Are we really prepared to tell our children and grandchildren that the new therapies used to treat their illnesses were derived from destroying human embryos? Or will we simply sweep it under the rug, like is done about the origins of vaccinations, subjugated to a pop-culture which has no interest or moral resolve to worry about such questions? Or will we become so accustomed to our neo-cannibalism that it simply won’t matter to us in 50 years?
Dr. Bonchek’s editorial quotes Ellen Goodman and Rabbi Moshe Tendler as advocating such research from religious perspectives. What does the Holy Roman Catholic Church say? Time and time again, the Church has been emphatic in its defense of human life from conception until natural death, emphasizing the dignity of the human person for what it is, per se, not simply for what it can do. With regard to whether a good end can ever justify an evil means, Pope Paul VI’s Humanae Vitae in 1968 emphasized “it is not licit, even for the gravest reasons, to do evil so that good may follow therefrom” [9]. Pope John Paul II strongly addressed human embryonic stem cell research in the 1995 Evangelium Vitae stating that “the killing of innocent human creatures, even if carried out to help others, constitutes an absolutely unacceptable act” [10]. Most recently, Pope Benedict XVI in December 2008 in Dignitas Personae states “The obtaining of stem cells from a living human embryo…invariably causes the death of the embryo and is consequently gravely illicit. Research, in such cases, irrespective of efficacious therapeutic results, is not truly at the service of humanity. In fact, this research advances through the suppression of human lives that are equal in dignity to the lives of other human individuals and to the lives of the researchers themselves. History itself has condemned such a science in the past and will condemn it in the future, not only because it lacks the light of God but also because it lacks humanity” [11].
We must not allow the tyranny of relativism to corrupt the purity and integrity of our noble purpose in medicine, which starts out with “Do no harm.” Mentioning the contribution of Hippocrates relative to the Nuremberg Medical Trials, A.C. Ivy wrote that “[Hippocrates] realized that a scientific and technical philosophy of medicine could not survive through the ages unless it was associated with a sound moral philosophy. One cannot conceive of a sound society with medicine that does not have a sound moral philosophy” [4]. Jerome Lejeune gave a chilling appraisal of human embryonic stem cell research and cloning when he stated “These are a few of the foolish games we are playing with our own children, with our own flesh … They are the cheapest thing you can experiment on because they are thrown away…We are dealing with a new defamation of science…Some of today’s scientists are twisting science to give science a horrible aspect…which will spoil more and more our already partially spoiled world…Science is a tree that bears good and bad fruit. Now we can select the fruit we wish…It is time for you to understand that what is at stake is… the life of the soul of our civilization” [12]. Eventually, we all will be accountable for our decisions, and the crutches and rationalizations we use to justify our professional actions will become transparent. We are now at yet another landmark in the slippery slope which further erodes authentic scientific and medical ethics. Do we think that, when the profound immorality of our means is finally admitted, the nobility of our hoped-for ends will absolve us?
