On the ethical evaluation of stem cell research: remarks on a paper by N. Knoepffler

This response to Nikolaus Knoepffler's paper in the same issue of the Journal agrees that if the arguments supporting the first two of the eight human embryonic stem cell research policy options discussed are unsound, as Knoepffler argues, then it seems natural to move to the increasingly permissive options. If the arguments are sound, however, then the more permissive options should be rejected. It is argued that three of the rejected arguments, taken together, constitute very good reasons to hold that a human embryo is endowed with dignity from fertilization onward. Thus, countries that want their public policies to match the moral imperative of respect for human beings should refrain from allowing destructive human embryo research and should devote considerable energy and public funds to research and clinical trials using non-embryonic ("adult") stem cells.     

The Therapeutic Promise of Pluripotency and its Political use in the Italian Stem Cell Debate

Stem cell research is considered one of the most promising branches of contemporary biomedicine. The capacity to develop into almost any cell type of the mature organism—pluripotency—is associated with human embryonic stem cells (hESCs) and is regarded as having great therapeutic potential. Harvesting stem cells destroys the human embryo, however; so research on embryonic stem cells has provoked controversies. In some countries such as Italy, the use of human embryos for research and therapeutic purposes is strictly forbidden. The Italian restrictive regulation has been explained by structural–cultural factors such as religion, but a better explanation lies in the policy dramaturgies deployed in the Italian debate. It was a struggle between two research trajectories—research on hESCs and on adult stem cells—for monopoly over the most credible therapeutic promise. Each was linked to different views of the Italian social order; each was epistemically legitimized by discourses on pluripotency and on the therapeutic potential of different stem cell types. Catholic actors articulated epistemic discourses on the therapeutic promises of different stem cell sources. The battle to define the social order—between a secular and a confessional view—became a struggle between two research trajectories for monopoly over the most credible therapeutic promise. The restrictive regulatory framework resulted from successfully transforming a policy dramaturgy into a new regulatory order. Thus structural–cultural variables such as religiosity matter only through the agency of institutional actors in local political cultures.     

Human embryonic stem cell research: an intercultural perspective

In 1998, researchers discovered that embryonic stem cells could be derived from early human embryos. This discovery has raised a series of ethical and public-policy questions that are now being confronted by multiple international organizations, nations, cultures, and religious traditions. This essay surveys policies for human embryonic stem cell research in four regions of the world, reports on the recent debate at the United Nations about one type of such research, and reviews the positions that various religious traditions have adopted regarding this novel type of research. In several instances the religious traditions seem to have influenced the public-policy debates.     

Ethical issues and approaches in stem cell research: from international insights to a proposal

In recent years and months, human stem cell research has dominated many scientists' interests, the media, public debate, and social policy. This paper aims to consider, first, the major scientific data on stem cell research that are available. Second, I reflect on them by examining how they shaped policies in Europe and the United States. I also point to current changes in policy-making concerning the creation of ad hoc committees to address this novel issue and how, in a few instances, different ethical positions are part of the documents produced. In other words, diverse approaches are not solved but kept in tension. Finally, I suggest that the current state of research on human stem cell will benefit from an ethics of risk.     

Patently controversial: markets,morals, and the President's proposal for embryonic stem cell research

This essay considers the implications of President George W. Bush's proposal for human embryonic stem cell research. Through the perspective of patent law, privacy, and informed consent, we elucidate the ongoing controversy about the moral standing of human embryonic stem cells and their derivatives and consider how the inconsistencies in the president's proposal will affect clinical practice and research.     

Human embryonic stem cell therapy

The author presents an overview (completed on September 15, 2001) of three issues involved in the ethics of human embryonic stem cell therapy: the ethical implications of some of the scientific issues involved, the specific ethical issues of the moral standing of the early human embryo and the problem of cooperation, and a consideration of two public policy issues: should the research go forward, and what kind of health care system should the United States adopt. The author argues that the public policy questions are the most important agenda.     

Human embryonic stem cell research,justice, and the problem of unequal biological access

In 2003, Ruth Faden and eighteen other colleagues argued that a "problem of unequal biological access" is likely to arise in access to therapies resulting from human embryonic stem cell research. They showed that unless deliberate steps are taken in the United States to ensure that the human embryonic stem cell lines available to researchers mirrors the genetic diversity of the general population, white Americans will likely receive the benefits of these therapies to the relative exclusion of minority ethnic groups.     

日本的人类胚胎干细胞研究

干细胞研究的进展体现了人类智慧的一个胜利,但同时也对人类的生命提出了极大的挑战,因为这意味着无论是作为一个整体的社会还是个体,都将面临严肃的伦理、法律及社会问题.通过成人干细胞临床研究原则草案论纲,讨论日本的人类胚胎干细胞研究.     

关于干细胞研究的伊斯兰教观点

干细胞的来源主要有3个,分别是胚囊阶段的人胚胎细胞内物质,胎儿和成人细胞。从伊斯兰教观点来分析干细胞研究,干细胞研究具有巨大潜力使人们受益。但是,胚胎的道德地位是讨论的实质。特别指出仅为胚胎干细胞研究的目的而创造胚胎是不能被接受。     

State-Supported Science and Imaginary Lock-in: The Case of Regenerative Medicine in Japan

Abstract

Regenerative medicine (RM) in Japan lays strong emphasis on a specific trajectory of its development, which deploys human induced pluripotent stem (iPS) cells as the primary sources for the technology. The technique to create these stem cells was developed in 2006 by a Japanese stem cell scientist, Shinya Yamanaka, and since its applicability to human cells was established about a year later, this new type of cells has become to be considered as a potential substitute for human embryonic stem cells. While the clinical value of these cells are yet to be confirmed, the Japanese Ministry of Education, Culture, Sports, Science and Technology decided to concentrate its support on iPS cells research and turned it into a national project. This decision reflected the state's vision of initiating the transition to a knowledge-based society, which was adopted in the 1990s to tackle the prolonged deflation in the country. As the research became intertwined with this policy vision, however, the Ministry came to see bringing its success as more important than ever, while other trajectories of RM were left underrated and largely unsupported. Industrial actors counteracted this situation and developed an initiative to recognize existing technical capability in the country, but its impact has been so far negligible. This indicates that the nation is locked in the particular trajectory of RM. Hence, this Japanese RM research enterprise presents an interesting case to understand how states' commitment may not only shape the course of scientific research but also reduce flexibility in technological development.     

人类胚胎干细胞的伦理学应用

人类胚胎干细胞研究和使用面临很多问题,并且大部分已经进行了广泛的讨论,但目前仍有一些问题很少进行讨论。对这些问题的讨论将有助于更好地研究人类胚胎干细胞的使用问题,这些问题是：（1）干细胞研究与社会政策,各个国家有关的政策制定并不一致,除了禁止人的生殖性克隆的国际性公约外,国际性准则在胚胎研究的也没有提供明确的规定;（2）欧洲有些国家在相关的问题的立法一致性上存在着许多问题,有些甚至是相互预报的;（3）干细胞研究应用的预防原则的适宜性问题已引起人们的争论;（4）有利及避免浪费原则在干细胞研究中的应用。     

Confronting deep moral disagreement: the President's Council on Bioethics, moral status, and human embryos

The report of the President's Council on Bioethics, Human Cloning and Human Dignity, addresses the central ethical, political, and policy issue in human embryonic stem cell research: the moral status of extracorporeal human embryos. The Council members were in sharp disagreement on this issue and essentially failed to adequately engage and respectfully acknowledge each others' deepest moral concerns, despite their stated commitment to do so. This essay provides a detailed critique of the two extreme views on the Council (i.e., embryos have full moral status or they have none at all) and then gives theoretical grounding for our judgment about the intermediate moral status of embryos. It also supplies an account of how to address profound moral disagreements in the public arena, especially by way of constructing a middle ground that deliberately pays sincere respect to the views of those with whom it has deep disagreements.     

For love or money? The saga of Korean women who provided eggs for embryonic stem cell research

In 2004 and 2005, Woo-Suk Hwang achieved international stardom with publications in Science reporting on successful research involving the creation of stem cells from cloned human embryos. The wonder and success all began to unravel, however, when serious ethical concerns were raised about the source of the eggs for this research. When the egg scandal had completely unfolded, it turned out that many of the women who provided eggs for stem cell research had not provided valid consents and that nearly 75% of the women egg providers had received cash or in-kind payments. Among those who did not receive direct benefits, some cited patriotism as their reason for participating in embryonic stem cell research, hence the question “for love or money?”—namely, patriotism versus payment. This paper summarizes the Hwang debacle with particular attention to the egg scandal and ends with some preliminary thoughts on patriotism as a motive for research participation.     

At the edge of humanity: human stem cells, chimeras, and moral status

Experiments involving the transplantation of human stem cells and their derivatives into early fetal or embryonic nonhuman animals raise novel ethical issues due to their possible implications for enhancing the moral status of che chimeric individual. Although status-enhancing research is not necessarily objectionable from the perspective of the chimeric individual, there are grounds for objecting to it in the conditions in which it is likely to occur. Translating this ethical conclusion into a policy recommendation, however, is complicated by the fact that substantial empirical and ethical uncertainties remain about which transplants, if any, would significantly enhance the chimeric individual's moral status. Considerations of moral status justify either an early-termination policy on chimeric embryos, or, in the absence of such a policy, restrictions on the introduction of pluripotent human stem cells into early-stage developing animals, pending the resolution of those uncertainties.     

Stem cell research in a Catholic institution: yes or no?

Catholic teaching has no moral difficulties with research on stem cells derived from adult stem cells or fetal cord blood. The ethical problem comes with embryonic stem cells since their genesis involves the destruction of a human embryo. However, there seems to be significant promise of health benefits from such research. Although Catholic teaching does not permit any destruction of human embryos, the question remains whether researchers in a Catholic institution, or any researchers opposed to destruction of human embryos, could participate in research on cultured embryonic stem cells, or whether a Catholic institution could use any therapy that ultimately results from such research. This position paper examines how such research could be conducted legitimately in a Catholic institution by using an ethical analysis involving a narrative context, the nature of the moral act, and the principle of material cooperation, along with references to significant ethical assessments. It also offers tentative guidelines that could be used by a Catholic institution in implementing such research.     

Ethics and policy in embryonic stem cell research

Embryonic stem cells, which have the potential to save many lives, must be recovered from aborted fetuses or live embyros. Although tissue from aborted fetuses can be used without moral complicity in the underlying abortion, obtaining stem cells from embryos necessarily kills them, thus raising difficult questions about the use of embryonic human material to save others. This article draws on previous controversies over embryo research and distinctions between intrinsic and symbolic moral status to analyze these issues. It argues that stem cell research with spare embryos produced during infertility treatment, or even embryos created specifically for research or therapeutic purposes, is ethically acceptable and should receive federal funding.     

胚胎干细胞研究面面观

人胚胎干细胞来自具有发育成一个个体潜力的人胚胎,其研究引发了一场伦理大辩论。就胚胎干细胞的概念、人胚胎干细胞研究将带给人类的巨大效益和研究所面临需要解决的技术难题,进行了重点阐述,提出了科学技术的发展是解决伦理争议的根本手段。     

Human embryonic stem cell research and the discarded embryo argument

Many who believe that human embryos have moral status are convinced that their use in human embryonic stem cell (hESC) research can be morally justified as long as they are discarded embryos left over from fertility treatments. This is one reason why this view about discarded embryos has played such a prominent role in the debate over publicly funding hESC research in the United States and other countries. Many believe that this view offers the best chance of a compromise between the different sides in this debate. This paper focuses on what seems to be the most plausible argument for this view about discarded embryos. It shows that this argument is unsound regardless of how one understands the claim that embryos have moral status. It also discusses the implications of this conclusion for attempts to use this argument as a basis for public policy.

The ethics of funding embryonic stem cell research: a Catholic viewpoint

Stem cell research that requires the destruction of human embryos is incompatible with Catholic moral principles, and with any ethic that gives serious weight to the moral status of the human embryo. Moreover, because there are promising and morally acceptable alternative approaches to the repair and regeneration of human tissues, and because treatments that rely on destruction of human embryos would be morally offensive to many patients, embryonic stem cell research may play a far less significant role in medical progress than proponents believe.     

“You are our only hope”: Trading metaphorical “magic bullets” for stem cell “superheroes”

In the wake of two recent developments in stem cell research, it is a fitting time to reassess the claim that stem cells will radically transform the concept and function of medicine. The first is the U.S. Food and Drug Administration’s decision in January 2009 to approve Geron Corporation’s Phase I clinical trial using human embryonic stem cells for patients with spinal cord injuries. The second is the National Institutes of Health’s decision to permit federal funding of research using donated IVF human embryos in their July 2009 Guidelines on Human Stem Cell Research. We are now poised to see whether stem cell research can deliver on what it promises. However, what exactly does it promise and how? Moreover, who is doing the promising? Turning to the use of metaphor can help us to answer these questions and enable us to develop a better appreciation of the unique features of promised stem cell therapies. Indeed, metaphors have exerted profound influence in medicine, and it is fitting that we seek new metaphors for new therapies where appropriate. In this case, other metaphors such as magic bullets or the Holy Grail cannot capture what is unique about stem cells. Accordingly, I propose a new metaphor: the stem cell superhero. Stem cell superheroes are characterized by the following traits: they are seemingly capable of fighting the evil of virtually all disease (unlike “magic bullets”) and they seem to be our only hope of doing so, although to summon them we must make difficult moral choices. In the course of assessing the merits of three recent yet covert references to the superhero metaphor, I conclude that this powerful new paradigm employs a problematic logic (i.e., we cannot know that something is “our only hope”), but that the aspiration as such is a good one.