The creepy side of embryonic stem cells

by emptypockets

While reading some of the debate last month over Missouri's Amendment 2, a Constitutional amendment banning human cloning and protecting stem cell research, I found myself trying honestly to empathize with the beliefs of its numerous, vocal opposition activists. The amendment passed after a heated debate played out in the media that pitted patient advocates including Michael J. Fox against the traditional right-wing gasbags like Rush Limbaugh as well as champion athletes like former Rams quarterback Kurt Warner and Cardinals pitcher Jeff Suppan -- leading AOL to coin the ugly phrase "stem celeb".

I was surprised to see the opposition was not all fire and brimstone -- in fact, they made several subtle arguments about the wording of the amendment as well as suggesting concerns about unintended consequences they imagined would promote the exploitation of poor women for eggs. While I disagreed with those arguments, they made me appreciate that some research opponents are not blindly following church doctrine but are genuinely interested in implementing the best policy for the greatest number. Realizing that, I took more seriously statements like this one from Warner: "As much as I'm for research, nothing outweighs the pro-life issue... You're taking human life."

A human blastocyst is, of course, human and alive, as are hundreds of cell lines we routinely use in the lab without controversy. However, as one anti-research advocate argued, "This human being [i.e., the blastocyst] has as many chromosomes as us all and if allowed to grow unimpeded from day one to day eight, it is a human. It’s not a dog or a cat embryo. Saying that a human embryo is not a person because it is not fully developed is very dangerous reasoning." The fallacy here is obvious: the research is done on embryos that will not be allowed to "grow unimpeded" because they will not be implanted in a womb -- they are leftovers, and they will otherwise be discarded.

The religious right got the frame exactly right when they named these embryos "snowflakes," a term endorsed by the White House and echoed by the President: "Like a snowflake, each of these embryos is unique, with the unique genetic potential of an individual human being." Like a snowflake, the life of a blastocyst is inherently transient -- they are not meant to exist for more than a few days before going on to the next stage, and the idea of "saving" them makes no more sense than saving snowflakes.

Therefore, if you believe an embryo is a "human life", the question is not whether to keep it alive -- that is out of the question -- but whether it is acceptable to end a doomed life a few days early in order to save others. Intriguingly, that is exactly the question of organ donation from a brain-dead or fatally injured patient. Like those patients, an unimplanted blastocyst is biologically terminal and its "parts" could help others live. Whether it is all right to collect those parts in the case of organ donation is a subject of active debate in some religious circles -- in this case, among rabbis who met last week at Albert Einstein College of Medicine, in the Bronx:

What Judaism says about the issue is open to fervent debate among scholars because the Torah, like other religious texts, predates organ transplantation and does not address it directly. But religious concerns, including a reluctance to not bury a corpse intact, contribute to a widespread hesitancy about donating, medical experts say. Based on the number of people with organ donor cards, Israel has the lowest rate of people willing to contribute organs, at about 4 percent. In other countries, including the United States, the rate is 30 percent or more, according to organ donation groups.

Rabbi Shmuel Eliyahu, the chief Sephardic rabbi of the holy city of Safed, or Tzfat, in Israel and the son of the former Sephardic chief rabbi of Israel, said that Jews can donate organs because, according to his analysis, death occurs when the brain stem stops functioning...

Rabbi Shabtai Rappaport, 56, of Jerusalem, cited numerous chapters and verses from the Torah, and commentary on it, to support using brain-stem death as the standard for organ harvesting...

Rabbi Flaum argued that the criteria be the shutdown of the heart and lungs, citing Jewish religious commentators. Rabbi Flaum is a member of the medical ethics commission of the Rabbinical Council of America, an organization of mostly Orthodox rabbis.

There was an interesting post about this very topic -- respect for the body, and how it relates to Jewish attitudes towards organ donation and Catholic attitudes towards abortion, as well as American attitudes towards torture at Abu Ghraib -- two and a half years ago on Body And Soul:

Respect for the human body is a good thing. Think of the recent Abu Ghraib pictures of two MPs grinning over the bruised corpse of a prisoner. Logically, it should be the least offensive of the pictures. When those photos were snapped, Manadel al-Jamadi was beyond pain, fear, and humiliation, something that can't be said of the victims in any of the other photographs. And yet the treatment of his body -- cellophane wrapped, packed in ice, and squabbled and joked over -- is still obscene. Some basic respect for human beings breaks down in the desecration of a body. That insult may not have the power to hurt Manadel al-Jamadi, but it shrivels all our souls.

Respect for our bodies, dead or alive, is essential. But in this case, something valuable, enshrined in (possibly misunderstood) religious law, and clung to with too much fervor and too little thought, becomes twisted and evil. In order not to "desecrate" a body, people have to either die or enter into arrangements of horrible exploitation. A great sin committed in the name of avoiding sin.

In fact, there are ancient religious taboos against dismantling a body, before or after death -- ones of which I, for one, was unaware, and which have not explicitly entered the ES cell debate although I suspect they have left a strong mark there. As one belligerent commenter in the Body and Soul thread explains, "Some of us don't want to be mutilated. Why is it OK for women to have control over their bodies, but not orthodox Jews? ... One is supposed to die and be buried whole. There is a rule that says (in effect) that almost anything is OK to save a life, which is why (e.g.) many kinds of surgery are acceptable. Technically, autopsies aren't acceptable, but there are arguments about that too."

Using Google as a course in comparative religion has severe limitations, but I found that, for example, the Greek Orthodox Archdiocese of America endorses organ donation "as an expression of love" while emphasizing respect for the body (and the organ). Likewise, they permit autopsy providing the body is treated with respect. To my surprise, however, they adamantly forbid cremation of the deceased: "The Church consid­ers cremation to be the deliberate desecration and destruction of what God has made and ordained for us." The Catholic Church forbade cremation until recently, and only allowed cremated remains to be physically present at funeral Masses within the last decade.

From what I can glean, religious restrictions on organ donation, autopsy, and cremation share a common firmament: the belief in the sanctity of the body and strictures against its desecration, as well as in some religions a belief that the dead will be resurrected and therefore must be buried whole. These restrictions are ancient and many have yielded, in modern times, to new practical compromises brought about by technology: the ability to save lives with organ donation, the medical necessity in some cases for autopsy, and even financial considerations associated with transporting and burying uncremated bodies in modern times. Different religions have drawn the line in different ways and those lines are still on the move.

As the Body and Soul post points out, these restrictions aren't just for the religious: the desecration of a corpse, as at Abu Ghraib, is a hideous thing to see. Here in New York, at the South Street Seaport, there is on display an exhibition called "Bodies" in which unclaimed human cadavers from China have been dissected to reveal organs or organ systems and had vasculature, muscle, tissue replaced by silicone rubber and finally have been posed artistically, arranged in a gallery, and customers charged to see them. While controversy has swirled around how the bodies were collected and the lack of consent given, personally I find it repugnant to use the dead as commercial art. Weirdly, I find I might feel differently about it if the exhibit were free, and I would certainly feel differently if it were at the American Museum of Natural History rather than the South Street Seaport. I'm not religious so I just call displaying these bodies "creepy" -- but if I were religious, I might call it a desecration.

That subject of desecration and its relationship to organ donation is, I think, a more apt context for discussing embryonic stem cells than the abortion rubric under which stem cells are usually put. Unlike a fetus, which likely would become a person, an unimplanted blastocyst is terminal and the moral issues about how we treat it are closer to end-of-life issues than conception ones. At least, that analogy is more apt biologically -- whether it is helpful politically, I don't know.

What does emerge from this analysis is, for me, a better understanding of what may be on the minds of stem cell research opponents. The sanctity of life may mean, for them, not only the call to preserve life itself -- something which is, for an unimplanted blastocyst, impossible -- but the demand to treat the elements of human life with respect and dignity. Some opponents may be appalled not by the demise of a ball of cells, but by what they see as an undignified death, in the polished steel of a tissue culture hood with a lab-coated graduate student bearing a pipetteman in place of a funeral Mass.

Call it a desecration or just plain creepy, that cold alien-autopsy vision of life's end may be what drives some segments of the opposition. It is partly relieved by shifting the view to patients the research might help, just as rabbis struggling with organ donation may yield most often when they confront the potential for saving another life. But it may also be partly relieved by writing into future stem cell legislation explicit language requiring the blastocysts be treated with respect, and by acknowledging in debate that scientists recognize this concern and are sensitive to it.

Comments

[mamayaga]

Framing embryonic stem cell use in terms of organ donation from a terminal donor may slip the noose of the abortion debate, but it rather directly brings the acceptability of in vitro fertilization into the mix. The reason those blastocysts are terminal is not that that can't develop, but rather that there aren't wombs available in which to implant them. This is because IVF entails overproduction of embryos as insurance. Emphasizing the terminal nature of the blastocysts could lead to the unintended consequence of prohibiting the overproduction of embryos via IVF or the prohibition of IVF itself. I realize that this result would be even more problematic for those who oppose embryonic stem cell use (most of whom want to avoid a debate over IVF) than for those of us who support it, but that really is one place that this frame leads.

[emptypockets]

I agree that politically, it may not make sense. There has been long and extended debate about abortion rights and there is a solid majority in favor of them that the stem cell advocacy groups have been able to rally. By comparison, end-of-life ethics are much more murky, the debate there is less mature, and a clear public consensus hasn't emerged. I think for these reasons as well as what you mention, hitching stem cells to the pro-choice wagon is, politically, sensible. On the other hand, it bothers me that it doesn't really make sense biologically and that it makes it difficult for someone like Bob Casey to hold on to his pro-life positions while ceding ground on stem cell research -- by falsely equating the issues we may be painting some potential advocates into a corner from which they can't reach us.

As to IVF in particular, I think it is publicly accepted to the point that no one could mount a serious campaign to undo it. Of course, that's what I would have said several years ago about teaching evolution, as well.

[emptypockets]

There is a nice reply to this post on mahablog.

[Argonaut]

We can debate religious views on any topic until we are blue in the face, but the real question is, can someone from a religion not my own make me behave according to his/her religious beliefs? It may be good politics to act with respect towards corpses and blastocysts, but we will never convince everyone. One man's desecration is another man's veneration (e.g. Greek Orthodox vs. Hindi regarding cremation). The only sensible solution is to maintain separation of church and state, and let each religion work out its own ethics.

[emptypockets]

Naturally, I agree, Argonaut. But isn't all policy-making fundamentally an exercise in ethics? How much to spend on the youth versus the elderly, how much to help the poor? I'm not sure religion and ethics are so easily cleaved.

[Paul Lyon]

``I'm not sure religion and ethics are so easily cleaved.''

Jeremy Bentham, 1774:

``Morality may well say of religion---Wherever it is not for me, it is against me.''

As a practical matter, in a culture in which religion is taken seriously in the way it is in the US, and also in countries with strong Catholic churches (e.g, the total ban on abortion just passed in Nicaragua) or Muslim establishments (many examples) one cannot separate these matters, since one has to deal with large numbers of believers and strong institutions who will not permit it. But in ethical theory, as it has developed in the West, moral ideas based on revealed religion are simply not taken seriously, unless they can be refounded on secular grounds. The argument for this actually goes back to Plato, but it is also well put by Bentham (1789):

``We may be perfectly sure, indeed that whatever is right is conformable to the will of God: but so far is that from answering the purpose of showing us what is right, that it is necessary to know first whether a thing is right, in order to know from thence whether it be conformable to the will of God.''

[Argonaut]

"I'm not sure religion and ethics are so easily cleaved."

By whom? I have no trouble separating them. If I agree with someone who has arrived at his position because it's his God's will, that's a happy coincidence. Religious people will insist that religion and ethics are inextricably linked when in fact they are parallel lines that only appear to meet if you squint really hard.

[emptypockets]

I see now that I misunderstood your first comment, Argonaut. Sorry about that. I am still feeling a bit lost in this terrain however -- when you say "maintain separation of church and state, and let each religion work out its own ethics," where do the state's ethics come from? It's not obvious to me that what an academic ethicist comes up with is less of a religion than the institutional ones.

Paul Lyon, the Bentham was extremely helpful by the way -- thank you. But I'm left at the same question. "To know first whether a thing is right" -- who decides, and how?

[hitchhiker]

This conversation seems all too much about the dance moves angels are making on the head of that pin . . . cures derived from embryonic stem cell research will be part of all our lives. The Chinese (and many others) are aggressively going after them while we dither endlessly (and, I have to say, foolishly, as if this were really about confusing ethics). Before my kids are my age, this whole debate will seem quaint, like when we read the old arguments for and against heart transplants.

Here is one thing that researchers would like to use escs to find out: what is the protein that blocks damaged neural cells from repairing themselves the same way all other cells repair themselves?

ESC research is not about disrespect for the sacred human form or growing replacement body parts . . . it's about decoding some very complicated secrets. Most of the people I know who have a personal stake in the outcome of this conversation moved their hopes overseas a long time ago; it's just too painful to look on helplessly while politicians--even the most honest, well-intentioned ones--treat this as if it were an ethically difficult question.

They're going to lose one way or another.

[Argonaut]

"It's not obvious to me that what an academic ethicist comes up with is less of a religion than the institutional ones."

Ethics is the determination of right and wrong by reason; religious right and wrong is anchored on belief. An ethicist is, like a physical scientist, amenable to having his theories proven wrong by argument and/or evidence; the believer is willing to deny evidence if it conflicts with belief.

Stem cell research is a very easy call, as hitchhiker says. The only argument against it is a religious one - belief in the soul of the blastocyst (although I have to admit I don't see why the soul is better served by being thrown in the garbage). Ethically speaking, it's a slam dunk; either we throw them away or we use them to research the saving of lives. If we want a more difficult issue from both perspectives, we should look at the fertility industry that creates blastocysts knowing that most are doomed.

[emptypockets]

I think it's obvious by this point that I don't have any grounding in the study of ethics, so let me just say at the outset that I'm not really arguing with you -- I know I'm ignorant here -- I am just interested in learning more. Here is what I'm not getting:

A physical scientist's theory is evaluated by the accuracy of its predictions. I don't get how that translates to what the ethicist does. What kind of argument or evidence could be used to determine the 'correct' ethical theory? Because it seems to me that in the absence of making predictions that allow us to test a belief system empirically (as we do in the sciences), then any internally-consistent set of tenets is equally likely to be right.

(If that makes sense, then you may see where I was coming from when I said that ethics seems like replacing one religion with another, and that religion and ethics seem difficult to separate.)

[emptypockets]

oh, and to both hitchhiker and argonaut -- naturally, to me, the ethical questions around stem cells are not in dispute. and you may be right, hitchhiker, that in a generation these debates will be seen as quaint (although I for one am not prepared to wait that long). This post was really an exercise for me in trying with some earnestness to take the other side seriously as thoughtful individuals rather than vilifying them as blind Bible-thumpers. Yeah, I know... it's not easy for me either. But I'd like to imagine their minds can be changed, and for me to imagine that I need to think they are approaching the issue with some thoughtfulness rather than as sheep -- the alternative is just too depressing (never mind if it may be right).

[Paul Lyon]

``The only argument against it is a religious one - belief in the soul of the blastocyst (although I have to admit I don't see why the soul is better served by being thrown in the garbage).''

It is, of course, never explained how the soul is not there in the sperm and the egg, but suddenly appears when the two are joined.

[Argonaut]

Emptywheel, I'm no expert on ethics myself. I agree that there are many similarities between religious philosophy and practice, and ethics. But, the apparently small difference is all important. As Twain said, there's a heap of difference between lightning and the lightning-bug.

Both systems are a search for truth and both are subject to trial and error. Both have moral principles, and frequently they are the same. There are significant philosophers, like Plato, who believed that moral principals were absolute and existed in a spirit-like realm. For religious people, moral values are likewise eternal and spiritual, but they are also the will of God.

The big difference began with the skeptics, who said that moral values are created by humans, and I think that is the one really important difference between modern ethics and religion. Ethicists point to societal differences, such as pro- and anti-cremation attitudes we talked about earlier, as evidence that values are human artifacts. Religious people call this "moral relativism" and it's a bad thing for them.

It's also true that if values are human-generated, they are subject to constant re-examination. In the 'church', such re-examinations are few. Women got the vote 100 years ago, but still can't become Catholic priests.

"What kind of argument or evidence could be used to determine the 'correct' ethical theory?" That's not really the question, because there are so many 'normative principles' that often conflict, e.g. personal benefit vs. societal benefit. There is no unified field theory of ethics. There are normative principles of honesty, paternalism, benevolence, lawfulness and doing no harm, to name a few more. The best we can do at crunch time is try to balance the relevant norms and see where consensus lies.

[Paul Lyon]

``The best we can do at crunch time is try to balance the relevant norms and see where consensus lies.''

This sounds familiar :-) Been reading The Right and the Good lately?

There is better available, I think, but very difficult to apply in practice, precisely because of the problem that embryos are not human beings but merely prospective human beings, tho' this latter is a problem the pro-life folks rarely acknowledge, and as far as I can see, they have little useful to offer to substantiate their claim that a living (but not viable) human organisim that is only a prospective human being should be treated as the moral equivalent of the paradigmatic normal human adult.

[heyyyyyyyyyy]

Hey how are you? i'm wonderful! leave a comment next time you stop by! thanks a lot buddy oh pal : ).