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Stem Cell Research: Bioethics
With Sister Carol Taylor, Ph.D.
Director of the Center for Clinical Bioethics
Georgetown University Medical Center
Friday, July 13, 2001; 1 p.m. EDT
Join Sister Carol Taylor, Ph.D., an ethicist and director of Georgetown University's Center for Clinical Bioethics, to discuss the controversy and bioethics of stem cell research. She is also an assistant professor of nursing at Georgetown University School of Nursing and Health Studies. She also teaches bioethics in Georgetown's School of Medicine and School of Nursing
and Health Studies
Taylor has a doctorale in philosophy with a concentration in bioethics from Georgetown University and a master's degree in medical-surgical nursing. Experienced in caring for chronically and critically ill patients, she works with health-care
professionals who are exploring the ethical dimensions of their practice. She is a member of the Ethics Committee and Consult Team and develops seminars in clinical ethics for health care professionals and the public. Taylor coordinates the Values-Based Health Care Initiative at Georgetown.
A transcript follows.
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over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
Sister Carol Taylor, Ph.D.: Good Afternoon... And welcome to this moral discourse...
I believe we are kidding ourselves if we don't think that stem cell research in this country is moving forward rapidly and in many instances in direct conflict with established, although not universally accepted, norms. Just this week the Washington Post carried two important announcements: 1) scientists in Virginia became the first in the world to harvest embryonic stem cells from human embryos that were created specifically for research and then destroyed to retrieve the potentially valuable cells (July 11) , and 2) scientists at a Massachusetts biotechnology company have started a series of experiments aimed at creating cloned human embryos from which embryonic stem cells could be derived (July 12). Both efforts involve the creation of human life solely for human use, the first by IVF and the second by cloning. Only Britain has set up a legal mechanism that allows the creation of new embryos for research, with strict rules governing the kinds of experiments that are eligible. To date none have been used to create stem cells. The central question facing the American people is whether the most vulnerable and defenseless of humans have an inviolable right to life or whether they can be sacrificed for the good of others.
Fairfax, Va.:
Sister Carol:
I have a friend that considers an embryo a human, and therefore, considers stem cell research immoral. I personally don't think it's a human until it has become a fetus. Where do you stand on this?
Sister Carol Taylor, Ph.D.: The official position within Roman Catholicism, which I espouse, opposes human embryonic germ (EG) and embryonic stem (ES) cells research primarily because obtaining stem cells from either aborted fetal tissue or cloned embryos or embryos that remain following clinical in vitro fertilization (IVF) procedures, involves the intentional destruction of a genetically unique, living member of the human species. No amount of benefit to others justifies the destruction of life in this manner.
I think we need to careful about semantics. The Post article about the bio-tech company starting a series of experiments aimed at creating cloned human embryos, immediately clarified this term with the phrase "or embryo-like entities." Calling something differently doesn't change the underlying reality. This said, I welcome whatever science can teach us about this reality.
HLB ~ Mt. Lebanon, Pa.:
Do you know the biology/chemistry/physics of stem cells & the research into their purpose/uses or are you just another one of these emotional doodles out here spouting off on something you know almost nothing about? The latter is frankly where most of the public commentary is driven from. And if your answer is: "Yes, I'm in the knowledgeable minority", then (1) what's a stem cell and, (2) why do I care about them? Thanks much. Signed.. an unemotional engineer who doesn't know about them
Sister Carol Taylor, Ph.D.: Hopefully I am more than an emotional doodle... but others will have to be the judge of that...
so here goes for the state of the science...
embryonic stem (ES) cells: are pluripotent, i.e., they retain the special ability to develop into nearly any cell type; derived from the early stage embryo.
embryonic germ (EG) cells: originate from the primordial reproductive cells of the developing fetus and have properties similar to ES cells; derived from the cadaveric fetal tissue.
At this time, human stem cells can be derived from the following sources:
human fetal tissues following elective abortion (EG cells),
human embryos that are created by in vitro fertilization (IVF) and that are no longer needed by couples being treated for infertility (ES cells),
human embryos that are created by IVF with gametes donated for the sole purpose of providing research material (ES cells), and
potentially, human (or hybrid) embryos generated asexually by somatic cell nuclear transfer or similar cloning techniques in which the nucleus of an adult human cell is introduced into an enucleated human or animal ovum (ES cells).
Why should we all care about this topic... because of potential benefits and harms...
At a recent inter-institute bioethics meeting at the National Institutes of Health I explored the ethics of stem cell research in the company of scientists and public citizens heavily invested in the issue because they or members of their families had diseases such as diabetes or Parkinsons and much to gain from potential scientific advances related to stem cell research. I can't be honestly present to people suffering with disease and hopeful for cures and at the same time callous and unfeeling in the application of moral principles. BUT, a good end doesn't justify the use of any and all means. And the fact that we can do something doesn't mean that we ought to do it. We could help a lot of people who desperately need organs if we sacrificed a few healthy inmates on death row, but most of us think that this option isn't morally justified. If we believe that as a member of the human species, the embryonic being has a special moral status and a claim on all of us for respect/protection, even the enticing prospect of helping many doesn't legitimate sacrificing embryonic beings.
We need to explore other morally legitimate ways to achieve the therapeutic advances we desperately need...
Washington, D.C.:
Sister Carol,
First, I would like to start by saying that I am an admirer of your work and the work that Georgetown does with bioethics. I had the pleasure of taking biomedical ethics with Father Wildes a few years ago, and have been enamored with the field ever since.
I have two questions First, many proponents of fetal stem cell research argue that if federal money is banned, then the focus will shift from public to private industry, where research will be unregulated and therefore, less responsible. If President Bush decides not to provide federal funds, what do see for the future of fetal stem cell research?
Second, in issues such as beginning of life, that are so personal they touch the very core of ones own individual belief system, how, and with what criteria/tools, does one go about drawing legal regulations that apply to everyone?
Thank you very much, and congratulations on the septuplets.
-Bill F
Sister Carol Taylor, Ph.D.: Dear Bill,
Thanks for the encouraging words...
One answer to your first question is to suggest that Congress extend the ban on the production and destruction of living human embryos as sources for stem cells to exclude the use of private as well as public funds.
If I or anyone knew the answer to your second question we would have solved the issues surrounding abortion in this country a long time ago... That said I believe their is a tremendous need for serious (dare I say prayerful?) reflection and discourse about all of these issues.
Columbia, Maryland:
St. Taylor,
Will you please say something about the resource allocation/distribution questions this and other advanced technology issues raise? Some of us are already concerned about the great injustice evident in US health care. Thank you. Ann
Sister Carol Taylor, Ph.D.: This question raises an important issue. How we allocate public money for basic and therapeutic research, as well as private money and research time and expertise, is a preeminently moral as well as practical matter. It perplexes me how the same individuals who purport to be so moved by the suffering of all those with Alzheimer's, Parkinson's, diabetes, and other diseases that they find it immoral to place any limits on stem cell research, live comfortably with the fact that both nationally and globally we are failing on a huge scale to use means readily available to us to treat the leading world causes of disease, suffering and death, such as poverty, malaria, diarrhea, etc. I think we can't ignore the huge commercial forces that are driving so much research and development today. A central question for citizens of a moral society is how best to discharge its moral obligation to identify and meet basic health care needs.
Plano, Texas:
Why is anyone pretending there is a moral issue involved in Fetal Stem Cell research when there clearly is not. The small groupings of cells involved are going to die anyway, and thus their fate is sealed beyond doubt. Since they are not able to suffer, lacking the ability to feel pain there is no possible moral issue involved.
The only real issue is the fear of the anti-choice crowd that this might increase the support of a woman's right to control her own reproduction is it not. This is purely a political and not a moral issue don't you agree.
Sister Carol Taylor, Ph.D.: Your statement reflects one ethical position: that only sentient life commands respect/protection. Their are other views...
Major ethical concerns with regard to both embryonic and nonembryonic stem cell research include the following issues: 1) the moral status of the early embryo, 2) complicity with abortion in using fetal tissue as a source of stem cells, 3) the need for safeguards, distributive justice, and just allocation of national resources, and 4) the difficulty in federally funding research to which many are opposed on moral and religious grounds (Summary of Presentation on Religious Perspectives relating to Research Involving Human Stem Cells, NBAC, May 7, 1999).
Annapolis, Md:
Thanks for taking my question.
Probably, like you I believe that life begins with conception. However, there is alot of suffering that could possibly be alieviated if we pursure stem cell research.
I assume that you also are pro-scr. What can you tell me to help reconcile these two.
Sister Carol Taylor, Ph.D.: Thanks for your question... which I may have answered in earlier replies... What I hope I have suggested is that embyronic stem cells aren't necessarily the only (even if they may turn out to be the best) solution to our problems.
The suffering we seek to alleviate via stem cell research may turn out to be just as readily addressed via adult stem cells as by embryonic. I have tried to engage different members of the scientific community in this analysis and am struck by their different assessments of the plasticity of adult stem cells.
Thus it appears that the scientific questions about the therapeutic possibilities of different sources of stem cells are yet to be answered. Stem cells from the bone marrow, placenta, and umbilical cords of live births are already in use in treating leukemia. There is a growing interest in new reports of previously unknown plasticity of select adult stem cells (or satellite cells) and more research is needed to establish if we can obtain desired therapeutic benefits without sacrificing embryos.
Washington, D.C.:
Is it possible to, from a moral foundation, prioritize some diseases over others for research methods (i.e. stem cell research) or money? For instance, do genetic diseases deserve more attention than communicable diseases?
Also, at what point do we slow down on researching diseases, especially those that occur very late in life? We can't all live forever, ya know!
Sister Carol Taylor, Ph.D.: If we look at the federal budget as a moral statement we are already prioritizing not only some diseases over others but also what portion of the health care dollar goes to basic research and development, public health, therapeutics, etc. And similarly, what portion of public monies goes to health care versus education, defense, art, etc. I believe most citizens fail to exercise a thoughtful vote on these matters and thus we live with the consequences of our inaction.
As for your second question, as you may know, some individuals are beginning to question research priorties especially late in life... Notable among these voices is Dan Callahan who in his 1987 book Setting Limits argued that "medicine should now restrain its ambitions at that frontier [aging]. It should give up its relentless drive to extend the life of the aged, turning its attention instead to the relief of their suffering and an improvement in their physical and mental quality of life."
I often ask audiences, "where do you put your hopes for a good life for your children?"
--science and technology (right genetic endowment and modern medicine)
--nurturing familes and communities
--knowing the Good and being able to make choices in line with this vision (wisdom)
Obviously, we need all three, but if you look at where we are currently putting our money and effort, it to my mind bespeaks a misguided confidence in science.
Washington, D.C.:
Why should your religous beliefs determine the availability of treatments and possible cures for juvenile diabetes, Alzheimer's disease, etc.? The majority of American believe that stem cell research should go forward, and they don't believe they are "sacrificing" lives to conduct this research. Frozen embryos will be discarded anyway-- why doesn't the Council of Catholic Bishops go protest fertility clinics, who are already "sacrificing" embryos for no benefit at all?
While you are entitled to your beliefs, I don't think religion should control our public policy decisions regarding science. We might as well stop teaching evolution in schools.
Sister Carol Taylor, Ph.D.: Religious beliefs are part of what many thoughtful and reasonable people bring to decision making tables and can no more be set aside than gender, race, culture, etc.
For those who believe in an objective moral order, i.e, there is something other than individual belief or even consensus that grounds morality, decisions must be made in light of this truth.
Vienna, Va.:
Religion aside: Are you opposed to the research even if it finds cures and helps ailing and dying patients? I mean the medecine that we do take now are experimented on humans, even when Tylenol first came out.
Wouldn't this research benefit society?
Sister Carol Taylor, Ph.D.: Interesting prospect... to set religion aside...
Your question raises an issue we haven't explored in this conversation... concerning the use of therapeutics discovered as a result of embryonic stem cell research which for some would be morally illicit. Specifically, would I be morally complicit in what I take to be an objectively morally wrong action (e.g., creation and destruction of human embryo) if I later avail myself of therapeutics derived from this act. Responses differ on this. In a recent conversation I used the analogy of the Nazi medical experimentation data. Some believe that not to use what is helpful from this data is wrong while others hold that because it was obtained in such morally egregious ways it should never be used.
a point of clarification please... I was certainly not suggesting that all therapeutic advances involving human subjects are wrong... Only those that violate fundamental moral principles such as the destruction of human life. Again, the central issue is not simply producing benefit, but benefit via morally licit means. The "do no harm" precept cannot be sacrificed.
Alexandria, Va.:
"misguided confidence in science"...now that's a good one, I'm sure they said that about Galileo too! And what of religions, who have said volumes about the love we must bear toward one another, but the reality of history is that millions of human souls have already been sacrificed over the centuries for simply being the "wrong" religion.
Science is a process, it doesn't "do" good or evil by itself, it must always rely on those who might use the results of inquiry to
do so for the benefit of mankind. We can disagree on what "good" science is, but when people's desire for inquiry is fired up, I can assure you that the work will get done somehow, no matter what the anti-intellectuals in the society do to try to "ban" it.
Sister Carol Taylor, Ph.D.: The reason for the qualifier "misguided" is because I think confidence in science is appropriate...
I do not believe that science is value-free and therefore we need responsible research conduct which depends upon the morality of investigators, funders, etc.
Washington, D.C.:
Thanks for doing this discussion.
Say we do use stem cells, and say we find a cure for something like diabetes. Should those opposed to using stem cells refuse treatment based on their opinion that it's somehow morally wrong?
Sister Carol Taylor, Ph.D.: This would be a highly personal decision... And hopefully informed by different viewpoints...
Seattle, Wash.:
Dear Sister Carol,
Thank you for your rational and knowledgable perspective. However, the more I think about this issue and others that it raises, the more I am convinced that are solutions are at some point morally indefensible. For example, what do you propose doing with the "leftover" embryos from IVF? Also, if this is not too off-topic, but you did mention genetic uniqueness earlier, what are your and the Catholic Church's position on cloning? Finally, not to be too much of a question hog, but do you have any ideas about how the public can understand, process and make decisions about the ever-burgeoning advances in biotechnology? Thank you.
Sister Carol Taylor, Ph.D.: Time is short. A quick response to your second question.
The Roman Catholic Church does not support human cloning because of the fundamental conviction that we as humans lack the authority to create or end human life. Life is God's gift. Also, each human being has the right to a nonmanufactured unique existence.
Washington, D.C.:
The same groups that advocate for increased federal and private funding of research are also concerned about equal access to quality healthcare. To imply that these groups are not is misrepresenting the work they do in helping those who suffer from disease and are also uninsured. There is also a question of how much of our nation's resources will we spend on curing third world suffering. Many of the same groups that oppose stem cell research, also oppose universal health care, or throwing money down the drain of social programs designed to reduce health disparities.
Sister Carol Taylor, Ph.D.: I honestly did not mean to imply that many who advocate for increased federal and private funding of research are not also concerned about equal access to quality healthcare. Thus I want folks to see your reply. My point is that these allocation decisions need to be made carefully and that there are multiple motivations that move participants in the decision. Thanks for keeping us all honest...
Washington, D.C.:
Splitting hairs is unpleasant business but maybe that's what we need here. The report about the Advanced Cell Technology company of Worcester, MA raises an interesting question. The report has little detail, but it looks like they propose to take a somatic cell nucleus (or something other than a sperm nucleus) and put it into a human egg. Would the resulting "embryo-like entities" be morally equivalent to embryos derived from the union of sperm and egg?
This is similar to what was done to produce Dolly, the sheep and so could be considered "human cloning". But we now know that most of products of this procedure are not capable of developing into a viable fetus or adult. Successful cloning is a rare event. Yet "embryo-like entities" obtained this way may contain stem cells with enough of the properties of stem cells derived from embryos initiated by normal fertilization as to make them useful for regenerative therapy. Does the fact that they cannot develop into a viable fetus put them into a different moral category from stem cells derived from normal fertilization?
Dan G
GU SNHS
Sister Carol Taylor, Ph.D.: I don't pretend to be a scientist but here is my understanding... There is difference between adult stem cells and embryonic stem cells generated asexually by somatic cell nuclear transfer or similar cloning techniques in which the nucleus of an adult human cell is introduced into an enucleated human or animal ovum (ES cells). This is a good example of the need for scientists, ethicists, and others to collaboratively reflect on and discuss what we are doing. Uniformed opinions are dangerous and often wrong! Thanks...
Washington, D.C.:
Dear Sr. Carol,
I find it surprising, despite one's opinion on experimenting on "spare" IVF embryos, that few if any have spoken out strongly against the new ethical threshold crossed by researchers who are creating new human embryos for the express purpose of research. Roe v. Wade grants the embryo "potential life" status, but these researchers seem to redefine the purpose of the newly created embryos (through IVF or cloning) as mere fodder for research. Any embryo intentionally created solely and specifically for research in which it is destroyed does not comport with a definition of an embryo as "potential life" because the potential for life is negated at the onset. This new ethical breach seems to run contrary to social mores, professional scientific ethics, and even the Supreme Court's opinion on the matter.
Why do you think that the "bioethicists" are so nonchalant in their acceptance of this new ethical threshold. Are there any limits?
Mike
Sister Carol Taylor, Ph.D.: A quick response... I don't think some bioethicists are nonchalent about these issues at all... You may want to review the current literature and the librarians at the National Reference Center for Bioethics Literature here at the Kennedy Institute of Ethics are a great resource. Also, We have just established a new chair, The David Lauler Chair for Catholic Health Care Ethics, here at the Center for Clinical Bioethics and we recruited a Jesuit ethicist, Kevin Fitzerald, SJ, PhD who has dual doctoral degrees, one in molecular genetics and one in philosophy, to fill this chair.
Sister Carol Taylor, Ph.D.: Thanks to everyone who submitted questions or commentaries and my regrets to anyone whose reply was missed because of our time constraints. Hopefully this conversation will continue in many venues.
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