Human embryonic stem cell research: Why the discarded-created-distinction cannot be based on the potentiality argument

Bioethics

Volumn 19, Issue 2, 2005, Pages 167-186

  Devolder, Katrien ^a  

^a GHENT UNIVERSITY   (Belgium)

Author keywords

[No Author keywords available]

Indexed keywords

BIOMEDICINE; EMBRYONIC STEM CELL; ETHICS; HUMAN; MEDICAL RESEARCH; MORALITY; PLURIPOTENT STEM CELL; REVIEW;

ANALYTICAL APPROACH; BIOMEDICAL AND BEHAVIORAL RESEARCH; GENETICS AND REPRODUCTION;

ATTITUDE; BEGINNING OF HUMAN LIFE; EMBRYO; EMBRYO DISPOSITION; EMBRYO RESEARCH; EMBRYONIC DEVELOPMENT; ETHICAL ANALYSIS; FERTILIZATION IN VITRO; HUMANS; MORAL OBLIGATIONS; PRINCIPLE-BASED ETHICS; RESEARCH EMBRYO CREATION; STEM CELLS; VALUE OF LIFE;

EID: 2442541844     PISSN: 02699702     EISSN: None     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2005.00432.x     Document Type: Review

References (76)

1. Health Council of the Netherlands. 2002. Stem cells for tissue repair; research on therapy using somatic and embryonic stem cells. The Hague: Health Council of the Netherlands: 14, 17. Some types of stem cells, such as those derived from bone marrow and skin, have already been used in therapies. Others are effectively being used in trials, for example foetal midbrain cells for Parkinson's disease, and pancreatic duct cells for diabetes. R. Lovell-Badge. The future for stem cell research. Nature 2001; 414: 88.
2. Health Council of the Netherlands. 2002. Stem cells for tissue re pair; research on therapy using somatic and embryonic stem cells. The Hague: Health Council of the Netherlands: 14, 17. Some types of stem cells, such as those derived from bone marrow and skin, have already been used in therapies. Others are effectively being used in trials, for example foetal midbrain cells for Parkinson's disease, and pancreatic duct cells for diabetes. R. Lovell-Badge. The future for stem cell research. Nature 2001; 414: 88.
3. Stem cells could be used (a) to gain a better understanding of the development process and the underlying mechanisms regulating stem cell growth, migration, purpose and differentiation in animals and humans, (b) to create better models of human diseases by using stem cells in laboratory animals, (c) to culture specific differentiated cell lines to be used for pharmacology studies and toxicology testing and to do research on the immunology of stem cells and (d) to learn about the functions of certain genes and proteins.
4. th June 2002) and carcinoma cells (P.J. Donovan, J. Gearhart. The end of the beginning for pluripotent stem cells. Nature 2001; 414: 92-97).
5. th June 2002) and carcinoma cells (P.J. Donovan, J. Gearhart. The end of the beginning for pluripotent stem cells. Nature 2001; 414: 92-97).
6. th June 2002) and carcinoma cells (P.J. Donovan, J. Gearhart. The end of the beginning for pluripotent stem cells. Nature 2001; 414: 92-97).
7. th June 2002) and carcinoma cells (P.J. Donovan, J. Gearhart. The end of the beginning for pluripotent stem cells. Nature 2001; 414: 92-97).
8. In therapeutic cloning, an embryo is created by introducing the nucleus of a somatic cell from the patient into an enucleated (donor) egg, so that, in the blastocyst stage (when the embryo is like a microscopic ball of about 100-200 cells), pluripotent cells that are genetically identical to the cells of the patient's body can be harvested from the inner cell mass and cultured. When they are introduced into the patient's body they will not be rejected as foreign.
9. The President's Council on Bioethics uses instead the term 'cloning-for-biomedical-research'. So called reproductive cloning is referred to as 'cloning-to-produce-children'. The President's Council on Bioethics. 2002. Human Cloning and Human Dignity: An Ethical Inquiry. Washington, D.C.: PBC.
10. Some people consider cells that result from SCNT not to be 'embryos'.
11. Health Council of the Netherlands, op. cit. note 1, 28; Lovell-Badge, op. cit. note 1, 88-91.
12. Health Council of the Netherlands, op. cit. note 1, 28; Lovell-Badge, op. cit. note 1, 88-91.
13. Donovan, Gearhart, op. cit. note 3.
14. Other difficulties with ASCs: (1) some adult tissues may not contain stem cells, (2) those that do are not always readily accessible, and (3) it is not yet proven whether the stem cells found in somatic tissue are truly stem cells and whether they can proliferate ex vivo.
15. M.J. Shamblott, J. Axelman, I.W. Littlefield et al. Human embryonic germ cell derivatives express a broad range developmentally distinct markers and proliferate extensively in vitro. Proc. Natl. Acad. Sci. 2001; 1: 304-313.
16. National Institutes of Health. 2002. Stem Cells: A Primer. Available at http://www.nih.gov/news/stemcell/primer.htm.
17. The European Group on Ethics in Science and New Technologies to the European Commission. 2000. Adoption of an Opinion on Ethical Aspects of Human Stem Cell Research and Use. Paris: EGE, 15.
18. Most advisory or regulatory bodies argue for a temporary ban on therapeutic cloning. See, for example, Health Council of the Netherlands, op. cit. note 1, 17; PCB, op. cit. note 5; EGE, op. cit. note 12, 16. In France, where it is forbidden to create research embryos by IVF, a majority of the CCNE is in favour of controlled authorization of engagement in therapeutic cloning, but there remains much resistance from a group which may not be dominant in number, but which apparently is given much consideration in policy decisions. Comité Consultatif National d'Ethique. 2000. Avis N°67 sur l'avant-projet de révision des lois de bioéthique. Paris. CCNE: 10.
19. Most advisory or regulatory bodies argue for a temporary ban on therapeutic cloning. See, for example, Health Council of the Netherlands, op. cit. note 1, 17; PCB, op. cit. note 5; EGE, op. cit. note 12, 16. In France, where it is forbidden to create research embryos by IVF, a majority of the CCNE is in favour of controlled authorization of engagement in therapeutic cloning, but there remains much resistance from a group which may not be dominant in number, but which apparently is given much consideration in policy decisions. Comité Consultatif National d'Ethique. 2000. Avis N°67 sur l'avant-projet de révision des lois de bioéthique. Paris. CCNE: 10.
20. Most advisory or regulatory bodies argue for a temporary ban on therapeutic cloning. See, for example, Health Council of the Netherlands, op. cit. note 1, 17; PCB, op. cit. note 5; EGE, op. cit. note 12, 16. In France, where it is forbidden to create research embryos by IVF, a majority of the CCNE is in favour of controlled authorization of engagement in therapeutic cloning, but there remains much resistance from a group which may not be dominant in number, but which apparently is given much consideration in policy decisions. Comité Consultatif National d'Ethique. 2000. Avis N°67 sur l'avant-projet de révision des lois de bioéthique. Paris. CCNE: 10.
21. Most advisory or regulatory bodies argue for a temporary ban on therapeutic cloning. See, for example, Health Council of the Netherlands, op. cit. note 1, 17; PCB, op. cit. note 5; EGE, op. cit. note 12, 16. In France, where it is forbidden to create research embryos by IVF, a majority of the CCNE is in favour of controlled authorization of engagement in therapeutic cloning, but there remains much resistance from a group which may not be dominant in number, but which apparently is given much consideration in policy decisions. Comité Consultatif National d'Ethique. 2000. Avis N°67 sur l'avant-projet de révision des lois de bioéthique. Paris. CCNE: 10.
22. S. Holm. Going to the roots of the stem cell controversy. Bioethics 2002; 16 (6): 506.
23. I deal with their arguments in K. Devolder. The Embryonic Stem Cell Debate: Steered Toward Foregone Principles and Conclusions? in Human Embryonic Stem Cell Research: Asian Bioethical Reflections in Dialogue with the West. Shui Chuen Lee, ed. (at press). Dordrecht. Kluwer Academics Press.
24. Unless, of course, the research has therapeutic value for the embryo itself, and thus for the person that will eventually result from it.
25. R.M. Green. 2001. The Human Embryo Research Debates. New York. Oxford University Press: 156.
26. For an evaluation of this argument, I refer to R.M. Green. Benefiting from 'evil'; an incipient moral problem in human stem cell research. Bioethics 2002; 16(6): 544-556.
27. See for example National Bioethics Advisory Commission. 1999. Ethical Issues in Human Stem Cell Research. Vol. I. Rockville, Maryland. NBAC: iv. See also Commission of the European Communities. 2003. Commission Staff Working Paper: Report on Human Embryonic Stem Cell Research. Brussels. European Commission: 9.
28. See for example National Bioethics Advisory Commission. 1999. Ethical Issues in Human Stem Cell Research. Vol. I. Rockville, Maryland. NBAC: iv. See also Commission of the European Communities. 2003. Commission Staff Working Paper: Report on Human Embryonic Stem Cell Research. Brussels. European Commission: 9.
29. Ibid. See also Health Council of the Netherlands, op. cit. note 1, 46.
30. Ibid. See also Health Council of the Netherlands, op. cit. note 1, 46.
31. National Bioethics Advisory Commission, op. cit. note 19, 56.
32. Health Council of the Netherlands, op. cit. note 1, 46.
33. For example, lobby groups in the USA, such as the Coalition of Americans for Research Ethics. At a US Senate hearing, this group passed out a flyer entitled: Current Clinical Use of Adult Stem cells to Help Human Patients. On the front it lists a dozen ailments, including auto-immune diseases, anaemia and cancer, all of which have been treated with stem cells derived from mature tissue. At the bottom, the flyer reads: "Other side of page: complete list of conditions for which embryonic stem cells are in clinical use to help human patients." The other side is blank. What the flyer says is true, but it is also misleading. Adult bone marrow cells have been used for more than a decade, whereas hESCs were isolated and cultured for the first time in 1998.
34. G. Vogel. Can Adult Stem Cells Suffice? Science 2001; 292: 1820-1822; Health Council of the Netherlands, op. cit. note 1, 47.
35. G. Vogel. Can Adult Stem Cells Suffice? Science 2001; 292: 1820-1822; Health Council of the Netherlands, op. cit. note 1, 47.
36. President's Statement on Funding Stem Cell Research. Available at http://www.whitehouse.gov/news/releases/2001/08/20010809-2.html. President Bush, however, ultimately rejects the principle of the avoidance of waste. He banned federally funded labs from using frozen spare embryos as a source of new stem cells.
37. J. Harris. 2002. The ethical use of human embryonic stem cells. In Proceedings of the Third International Conference of Bioethics: Ethics, Legal and Social Issues in Human Pluri-potent Stem Cells Experimentation. S.C. Lee, ed. National Central University. Chungli, Taiwan ROC: C-20.
38. National Bioethics Advisory Commission, op. cit. note 19, 53.
39. Because early embryos are, in the intermediate view, not considered to be humans, they cannot be instrumentalised in the Kantian sense. According to Kant a person is a being, which through its self-awareness is an end in itself and which, consequently, can never be reduced to the mere status of a means. The characteristic human dignity that has been cited many times since Kant is not applicable to the embryo itself.
40. This is also evidenced by the reproductive behaviours of people who defend the intermediate viewpoint. Many early embryos are lost in 'normal reproduction'. An estimate for early embryo loss in normal, healthy women shows that between two-thirds and three-quarters of all the zygotes do not proceed to implant themselves in the womb. For references on the various sources of data concerning spontaneous early embryo-loss I refer to Green, op. cit. note 17, N 185.
41. Ibid., 81.
42. For an analysis of the issue of the use of symbolic arguments against the creation of research embryos, I refer to D.S. Davis. The Kennedy Inst Ethics J 1995; 5(4): 343-354.
43. Some hold that the embryo, because it is a potential person, deserves our full moral respect and protection. The concept of 'potential person' is then used as a step in the argumentation for the prohibition of so called destructive embryo research. Others (e.g. CCNE) use the same expression to forbid embryo research, except under certain conditions, while some members of the Belgian Consultative Bioethics Committee use it to defend the legalization of embryo research.
44. J. Savulescu. 2001. Should we Clone Human Beings? Cloning as a source of tissue transplantation. In Cloning: Responsible Science or Technomadness. M. Ruse and A. Sheppard, eds. New York. Prometheus Books: 220.
45. M. Reichlin. The argument from potential: a reappraisal. Bioethics 1997: 11(1): 1-23.
46. Belgian Chamber of Representatives. Dec 2002. Bill Concerning Research on Embryos In Vitro.
47. I only mention the 'general' interpretations of potentiality. Going deeper into the variety of other interpretations and their nuances would lead me too far from the aim of this paper.
48. See for example S. Buckle who considers the potential to become as a specific case of the potential to produce. The former he defines as 'developmental potential': the power of an entity to undergo changes to itself. The entity preserves some form of individual identity. The potential to produce does not require that any form of identity be preserved, neither is its application limited to individuals. S. Buckle. 1990. Arguing from the potential. In Embryo Experimentation - Ethical, Legal and Social Issues. P. Singer, H. Kuhse, S. Buckle, K. Dawson, P. Kasimba. Victoria, Australia. Cambridge University Press: 90-180.
49. I b i d.
50. According to some, this inherent potential can be present not until a certain stage of development is reached. R. McCormick, for example, considers developmental individuation at day 14 as a marker line after which the embryo has to be fully protected.
51. See for example M. Lockwood. Warnock versus Powell (and Harradine): when does potentiality count? Bioethics 1988; 2(3): 187-213. See also M. Reichlin who states that the nature of the embryo is decisive: it possesses from the moment of conception a perfect human nature. In W. Wolbert. The potentiality argument in the debate relating to the beginning of personhood. Human Reproduction and Genetic Ethics 2000; 6(2): 19-26.
52. See for example M. Lockwood. Warnock versus Powell (and Harradine): when does potentiality count? Bioethics 1988; 2(3): 187-213. See also M. Reichlin who states that the nature of the embryo is decisive: it possesses from the moment of conception a perfect human nature. In W. Wolbert. The potentiality argument in the debate relating to the beginning of personhood. Human Reproduction and Genetic Ethics 2000; 6(2): 19-26.
53. See for example Hare's argument of 'possibility for future change'. R.M. Hare. 1993. Essays on Bioethics. London. Oxford University Press: 85.
54. P. Singer, K. Dawson. IVF Technology and the argument from potential. In P. Singer (et al.), op. cit. note 37, 76-89. See also S. Buckle, op. cit. note 37
55. P. Singer, K. Dawson. IVF Technology and the argument from potential. In P. Singer (et al.), op. cit. note 37, 76-89. See also S. Buckle, op. cit. note 37
56. See for example John Noonan in J.T. Noonan Jr. 1970. An almost absolute value in history. In The Morality of Abortion. J.T. Noonan Jr., ed. Cambridge, Mass. Harvard University Press. See also H.T. Engelhardt Jr. who understands potentiality in the sense of 'probability' and proposes not to speak of "X's being a potential Y", but "of its having a certain probability of developing into Y" instead. (In W. Wolbert, op. cit. note 40, 19).
57. See for example John Noonan in J.T. Noonan Jr. 1970. An almost absolute value in history. In The Morality of Abortion. J.T. Noonan Jr., ed. Cambridge, Mass. Harvard University Press. See also H.T. Engelhardt Jr. who understands potentiality in the sense of 'probability' and proposes not to speak of "X's being a potential Y", but "of its having a certain probability of developing into Y" instead. (In W. Wolbert, op. cit. note 40, 19).
58. Potentiality is not the only way to justify gradualism, but because the aim of this paper is restricted to the potentiality argument, I think it is unnecessary to mention all the other arguments.
59. See for example R.M. Green in Green, op. cit. note 17. Mary Anne Warren also defends a "multi criterial" view of moral status. MA. Warren. 1997. Moral Status: Obligations to Persons and Other Living Things. Oxford. Clarendon Press.
60. See for example R.M. Green in Green, op. cit. note 17. Mary Anne Warren also defends a "multi criterial" view of moral status. MA. Warren. 1997. Moral Status: Obligations to Persons and Other Living Things. Oxford. Clarendon Press.
61. Which status to accord to the 7-month-old foetus is another, and in my view, more difficult question. But this is not at issue here. I only want to point out here that a gradualist approach to the moral status of the embryo and the foetus has the advantage that it is compatible with the attitudes and feelings of many people and, therefore, may open the way to a broader consensus on the issue of hESC-research. (Even if two people accept the gradualist view, there may be differences in viewpoint concerning late termination of pregnancy, but they will have the same opinion on research on in vitro embryos). It would have better consequences than the current compromise position which disapproves of the creation of research embryos.
62. Analogue to Hare's view. R.M. Hare, op. cit. note 41, 88.
63. See also P. Singer and K. Dawson, op. cit. note 42.
64. th Annual Meeting of the European Society for Human Reproduction and Embryology. Bologna, Italy (Abstract P-251).
65. Worthiness-of-protection in such a situation should be understood mainly as the use of all possible means to facilitate the fertilization, implantation and further development of the embryo and the foetus, with a maximal guarantee for the quality of the expected child's life.
66. HFEA figures show that between August 1991 and March 1999, 53, 497 embryos from IVF programs were donated for research compared to the 118 embryos created for research. Parliamentary Office of Science and Technology. Stem cell research. Postnote 2002; 174: 4.
67. In Belgium, 504 of the 14,407 frozen spare embryos become humans, i.e. 3.5%. Oral information, P. Devroey. 1999. The fate of embryos in different cases. Symposium organised by the Special Interest Group on Ethics of the European Society of Human Reproduction and Embryology (ESHRE). Cryopreservation of Human Embryos. Brussels, AZ-VUB. To be correct you would need to donate more than 3.5% of the; research embryos to infertile couples, since only a fraction implants and goes to term. But that is irrelevant for what I want to point out.
68. For a similar line of reasoning see J. Savulescu. The embryonic stem cell lottery. Bioethics 2002; 16(6): 508-529.
69. It is important to know that a common practice in fertility clinics is that the creation of embryos for infertility treatment is not clearly separated from the decision to donate the spare embryos for research. Before they start the IVF treatment, couples have to decide on the destination of the embryos at the end of the treatment or storage period.
70. Y. Englert. 1998. The Fate of Supernumerary embryos: What do Patients Think about It? In In Vitro Fertilisation in the 1990's: towards a medical, social and ethical evaluation. E. Hildth & D. Mieth, eds. Aldershot. Ashgate: 227-232.
71. Hammarberg and Oke, op. cit. note 49. G.T. Kovacs, S.A. Breheny & J.D. Melinda. Embryo donation at an Australian university in-vitro fertilisation clinic: issues and outcomes. MJA 2003; 178(3): 127-129.
72. Hammarberg and Oke, op. cit. note 49. G.T. Kovacs, S.A. Breheny & J.D. Melinda. Embryo donation at an Australian university in-vitro fertilisation clinic: issues and outcomes. MJA 2003; 178(3): 127-129.
73. Oral information. A. Trounson. 2003. Human Embryonic Stem Cells. Lectures in Medicine. Embryonic Stem cells. Organised by the Belgian Faculties of Medicine. Faculty of Medicine and Pharmacy. Brussels.
74. The aforementioned examples show the feelings and attitudes of intentional parents, but they also reflect the revealed beliefs of people who defend d-c-d, because they approve of these practices. (It is legal and there is, for example, no social disfavour towards people who have a child by IVF and/or opt for the (immediate) destruction of their spare embryos).
75. Any study that begins with gametes or that requires fertilization as an end point necessitates the use of research embryos (e.g. research on contraceptives, IVM, etc.). Another reason why research embryos are needed is that some studies, such as those on the role of certain drugs in birth defects and pediatric cancers, cannot be conducted without a control population of normal, healthy embryos. Many of the cryopreserved embryos have cytoplasmatic, chromosomal or nutritional deficiencies. Green, op. cit. note 17, 74-75. Moreover, research embryos are needed to study the proliferation and (de) differentiation process of stem cells. Controlling these processes is a necessary condition for working with ASCs. According to some, therapeutic cloning offers advantages that cannot be efficiently obtained by any other means. Here also research embryos are needed.
76. See P.R. Wolpe & G. McGee. 2001. 'Expert Bioethics' as Professional Discourse: The Case of Stem Cells. In The Human Embryonic Stem cell Debate. Science, Ethics, and Public Policy. S. Holland, K. Lebacqz & L. Zoloth, eds. Cambridge, Massachusetts. MIT Press: 185-196.