Theological and Moral Reflections on Stem Cell Research
 Rather than discussing the scientific aspects of embryonic stem cell (ESC) research, I will turn immediately to the central issue of the stem cell debate for people of faith: the theological and moral status of the embryo. Christians historically have been concerned to respect life at every stage of its development, but what I call a gradualist or developmental understanding of human life recognizes the need of making distinctions in the way we understand our obligation toward that life as it emerges. A gradualist understanding has found significant support among Christian theologians from the beginning, and it appeals to me today as an eminently sensible and responsible point of view with obvious implications both for abortion and stem cell research.
 I believe the gradualist view expresses the implications of a Lutheran anthropology. Our understanding of human nature is relational, which means we understand who we are in terms of the relations that literally make our human identity possible. At the embryonic level we are potentially but not actually human subjects because we are not yet relational beings. Thus we become who we are as human beings in relation to God and to our fellow human beings. As the embryo in the womb becomes a fetus and progresses to term, the reality of living in relationship - the reality of one's humanity - is more intensely anticipated from the side of the mother and family, reflecting the growing moral status of prenatal life. This view runs counter to the Roman Catholic position that takes a substantialist view, which means that because the elements of human life are present in the embryo, its moral worth must be equal to that of persons living in relationship.
 Those who maintain the substantialist view might argue that the relational view fails in its subjectivity. Our humanity is due to the fact that it is God who stands in relation to us, bestowing our humanity from our microscopic beginnings. The fact that our subjectivity, the capacity to relate, and other marks of human identity are absent is thus irrelevant. The developmentalist response is that relationships are the prerequisite to moral obligation. The remoteness of life in its beginning stages inevitably means that our sense of obligation to it does not carry the moral weight that life in relationship confers. The moral argument on behalf of life in its beginning stages betrays a theoretical character compared to the obligations we experience toward actual human beings. Furthermore, the developmentalist would note that the very process of reproduction refutes the substantialist claim. Some 40 to 60 percent of fertilized eggs never complete their journey to implantation and eventual birth. It staggers one's credulity to attribute a divinely bestowed humanity, conferring the rights of citizenship, upon millions of embryos destined to destruction.
 Churchly deliberations concerning the human soul also have a bearing on the ESC debate. The Catholic position going back to Thomas Aquinas is called creationism, meaning that each soul is created by an act of God. Since the mid-nineteenth century, and contrary to the thinking of Thomas and many other theologians, the Catholic Church has placed ensoulment at the point of conception. In the current discussion this means that from that moment a fully human being is present who is worthy of the full protection of the law. The theology of Lutheranism (and the Eastern Orthodox Church) has taken a different route, espousing the traducianist view that regards both soul and body as a parental inheritance; they develop together in the womb until reaching their completion at birth. Current developments in Christian thinking about the soul render these older distinctions less than helpful or germane; nevertheless, the gradualist position in the ESC debate obviously relates better to the traducianist than to the creationist position.
 It goes without saying that human life demands respect whatever the circumstance or condition being addressed, but the gradualist position calls for distinctions to be made concerning the nature of that respect during the course of embryonic and fetal development. Thus, contrary to the way it is commonly framed, the issue is not when human life begins; the question, rather, is what the nature of our obligation to human life is as it develops from its beginning stages. From common experience we recognize that the sense of moral obligation toward prenatal life increases as the development of that life proceeds from its microscopic, non-sentient state to a recognizable member of the human family. This point is validated in the way we respond to miscarriage, for example, as well as to abortion, which causes far greater moral anguish if it occurs at a late stage in the pregnancy.
 There is another significant aspect to this argument. The setting for ESC research is the laboratory rather than the womb. Through in vitro fertilization (IVF) an embryo is produced in a Petri dish, which lacks the nurture that guarantees a future with eventual birth. Thus the dismantling and destruction of an embryo that takes place in stem cell research ought not be labeled an abortion. Jewish law acknowledges this point by not attributing legal status to genetic materials outside the uterus, even if embryos are involved; such materials lack potential humanity until they are implanted in a woman's womb. But the question can still be raised, "Are we acting irresponsibly before God and the human family when we work with genetic materials in the laboratory?" My answer to this question is twofold: Given the fact that human life in its beginning stages has long been the object of laboratory manipulation, and because of its non-sentient, microscopic character in this setting, it does allow for experimentation under carefully maintained guidelines. However, this is a responsible position only if the reasons for such experimentation are morally acceptable: where it is motivated by the promise of regenerative medicine and the desire to alleviate the tragedy and anguish of genetic diseases. Within that context, it is indeed responsible for scientists to pursue ESC research.
 An argument often raised and which until recently had been persuasive in my own thinking is whether there may not be serious, detrimental moral consequences for society - a general cheapening of human life - if we are systematically engaged in the continuing destruction of embryos. Here I believe the argument of Francis S. Collins, Director of the Human Genome Project and confessing Christian, is pertinent. He notes that an important goal of ESC research is to arrive at the point where stem cell nuclear transfer (SCNT), commonly called cloning, can be successfully achieved. It is a procedure that overcomes the immunity problem because it involves taking the patient's own genetic material and inserting it in the diseased tissue. SCNT does not involve the fusion of sperm and egg as in IVF, which creates an embryo; it involves taking a single cell from a person's skin (we shed millions of them daily), which provides the DNA instructions, and uniting it with an enucleated egg. It is an artificial procedure performed in the laboratory that does not occur in nature "and is not part of God's plan to create a human individual." I share Collins' conviction that this procedure does not constitute a meaningful assault on our moral sensibilities, and seriously doubt that there could be any long-term detrimental consequences as a result of it.
 Successful utilization of SCNT still eludes us, however, and current practice involves the destruction of embryonic life. While I reject the notion that this research destroys the lives of human subjects, or "actual" human life, it is obviously preferable to avoid taking life in any form if alternative procedures are available. Pursuing such alternatives is an expression of our respect for embryonic life. One option is to limit the use of embryos to those that are left over from IVF procedures in fertility clinics, destined to destruction rather than implantation and eventual birth. Unfortunately, the policy of the current administration prevents scientists from pursuing this option since it doesn't allow for a sufficient number of embryos to establish the stem cell lines, or lineage, that are needed. Another often recommended alternative is the use of adult stem cells (ASCs), which at this point have actually provided the most success in stem cell therapy (largely hematopoietic stem cells in combating diseases of the blood). But ASCs appear to lack the plasticity and potency of ESCs, which limits their promise. Scientists point out that research with both ASCs and ESCs is required because of their complementarity; what we learn from research with one contributes to the promise of the other. It is conceivable that ESC research may turn out to be the prerequisite to learning how best to reprogram ASCs to make them as effective therapeutically as ESCs. In other words, ESC research today may well make it unnecessary tomorrow.
 Opponents of ESC research argue both deontologically and consequentially in making their case. The former argument maintains that not only is human life present from conception, it bears the same moral value as the lives of human beings living in society. The implications of such a view would require that embryonic life receive the same legal protections enjoyed by a U.S. citizen, which, if pursued (it has been advocated in suits brought before California courts), would lead to a legal nightmare. Among other absurdities, all the embryos in cold storage at fertility clinics - now estimated at over 400,000 - would have the right to be born; any denial of such a right could constitute an act of homicide.
 Among consequential arguments, there is concern over the enormous profits that will likely come from ESC research, causing intense pressure to utilize this research beyond the context of alleviating disease. Are we not naïve in thinking we can harness this research for this purpose alone? This is a legitimate concern; we need a national policy on embryo research that applies to both publicly and privately funded research, carrying significant penalties for those who fail to comply. Among other things, such a policy could prohibit the patenting of information obtained from ESC research to insure that its primary focus remains its healing potential and the common good of society rather than the pursuit of profits. Another common argument cites the deception and hype involved in stem cell research and the raising of false expectations among the public, a situation also related to the pursuit of profits. This is certainly an important point and needs to be addressed by the scientific community. While these consequences (and other "slippery slope" arguments) are important in raising red flags and inspiring an appropriate caution, I do not believe that they should determine national policy on this matter. The potential good of ESC research bears sufficient moral weight to overrule these concerns.
 I believe the decisive issue in this debate concerns the moral and theological validity of a gradualist/developmental position that makes a critical moral distinction between microscopic life and personal, human existence. One can certainly argue that human life is all of one fabric, but its beginning as a single thread is far removed from the completed garment - sufficiently removed to require a different set of ethical judgments. The moral impact of destroying embryos in the laboratory by doing research driven by beneficent purposes does not begin to compare with the impact of destroying the lives of individual persons, for whatever reason. Our language about the embryo reveals this fact: it is not injured but damaged; in miscarriage it is not killed but lost; its destruction in the laboratory is an act of disassembling or disaggregating, not killing or murder; we use the impersonal "it" in referring to the embryo because it lacks personal identity. Those who insist on using such terms as killing or murder in this context are straining too hard; they risk credibility in their effort to make a moral point that most of us fail to see.
 My conclusion is that when one sees ESC research within the context of potential healing of diseased and suffering people, the moral weight clearly lies on the side of healing people. There is no moral revulsion over the destruction of life at the embryonic level that begins to compare with the anguish and grief caused by the premature demise of people afflicted with a genetic disease, or who are severely disabled by injury. I can appreciate the argument that there are boundaries to what we can achieve in alleviating the pain and burden of human existence, but I'm not convinced that we should draw that boundary in a way that removes the promise of healing in ESC research. To insist that microscopic, non-sentient life must receive the very same respect as living people is to make an intellectual distinction that lacks moral force; it does not compel a strong sense of obligation.
 Ian Barbour makes an astute observation that is pertinent to this discussion: "With a new technology, it may be easier to forbid everything or to forbid nothing than to make and enforce careful judgments about potential uses." A more nuanced position is always more demanding in the discernment it requires; it also places a heavier responsibility on those who espouse it because of the risks involved. I would avoid the two opposite poles in the ESC research: the embryo is not a human being with the same moral weight and status as human subjects living in society, but neither is it a mere collection of cells without any moral claim on society. The one viable alternative to these positions is the gradualist/developmental position, driven by the possibilities of healing and adamantly committed to protecting the procedure from every form of self-serving misuse. The end result should be, and I believe can be, the serving of the common good of society.
Elliot N. Dorff, "Stem Cell Research - A Jewish Perspective," Suzanne Holland, Karen Lebacqz, and Laurie Zoloth, eds.,The Human Embryonic Stem Cell Debate: Science, Ethics, and Public Policy (Cambridge, MA: The MIT Press [A Bradford Book], 2001), 91.
Francis S. Collins, The Language of God (New York: Free Press [Simon & Schuster], 2006), 256.
Michael Bellomo, The Stem Cell Divide (New York: AMACOM, 2006), 148.
Lisa Sowle Cahill, Theological Bioethics (Washington, D.C.: Georgetown University Press, 2005), 234.
One does not establish an ethical position on the basis of public polls, but they do provide insight into the attitudes of people that is pertinent to the establishing of public policy. According to a survey reported in September, 2005 by the Genetics and Public Policy Center at Johns Hopkins University, the public does not support the federal stem cell policy established in 2001. Some 67 percent of Americans are in favor of ESC research in spite of the required destruction of embryos. The breakdown of the survey reveals the support to be widespread: Republicans at 55 percent, Roman Catholics at 69 percent, Protestants at 74 percent, and even 50 percent of those identified as Fundamentalist or Evangelical. See Stephen S. Hall, "Stem Cells: A Status Report," HastingsCenter Report 36, no. 1 (January-February, 2006), 18.
This point is made by the conservative columnist, David Brooks, whose writings commonly display a sensitive and thoughtful perspective on moral issues. He opines that those who oppose stem cell work appear to be closing off the possible alleviation of human suffering "for the sake of a theoretical abstraction." See his op-ed piece in The New York Times, November 30, 2006.
Ian Barbour, Nature, Human Nature, and God (Minneapolis: Fortress Press, 2002), 66.
© March 2007
Journal of Lutheran Ethics
Volume 7, Issue 3