Stem Cells: Ethics, Law and Politics

Abstract

Over the past three years, human stem cells have moved from being something of esoteric interest for basic researchers and of therapeutic value for clinicians to being a highly visible source of distress in the relationship between right-to-life advocates and their traditional political allies. In recent decades, countless biomedical developments have become entangled in—and disrupted or even derailed by—the fallout from abortion-related political debates. For a while, human stem cell research seemed to be headed for the same fate. But for once the reverse appears to be true, for in this case, science has disrupted politics rather than the other way around: during the spring and summer of 2001, some prominent Republican right-to-life loyalists publicly urged federal funding of research with human embryonic stem cells, even as others warned President George W. Bush that such funding would make him complicit in “an industry of death.”1 Finally, on August 9, in his first televised address to the nation since becoming President, Mr. Bush announced a compromise that allowed him to keep to the letter of a campaign pledge not to finance the destruction of live embryos while also providing some opportunity for federally funded researchers to use human embryonic stem cells.2 It is too soon to know whether the compromise will work in scientific terms, much less whether it will provide the results that the President sought politically, but the importance of the field now seems firmly established in the mind of the public. This article examines the scientific aspects of the field and how the science came to be entangled with politics (with a look at the policy options that were before the President and that remain before Congress), the ethical debate (which is almost certainly not been resolved by the President’s decision), and the resulting legal problems (which have their own complexities). Stem cells have only recently entered public consciousness but—media commentaries notwithstanding—they are nothing new to scientists and physicians. Stem cells have long been understood (as their name implies) as the foundation of organisms, the stalk from which everything buds and branches. In developmental terms, the first cells of a new organism are totipotent, that is, each one has the ability to develop into an entire organism—indeed, when the cells of a two-celled zygote separate, identical twins are produced. After several days of cell division, the next developmental step is these cells to begin differentiation. Some will form the trophoblast and placental layers that will support the growing fetus; these cells form into the outside of the blastocyst, a hollow sphere, like a tiny beach ball, that will become attached and take sustenance from the lining of the uterus. The remaining stem cells—those clumped together inside the blastocyst, which are known as the inner cell mass—become the basis for the fetus itself. The latter cells are pluripotent; this means that they no longer possess a totipotent cell’s ability to become an entire organism but they are able to develop into the more than 200 cell types present in a mature organism. In the words of Caltech biology professor David Anderson, “They are infant cells that have not yet chosen a profession.”3 Under stim-