4.2 The Moral Status of Human Embryos
The moral status of human embryos is a central ethical question in connection with stem cell research and use. The stem cell reports indicate that the boards, organizations, and councils involved in the debate over human embryonic stem cell policies consider the moral standing of human embryos from the perspective of how embryos should be regarded morally and how their use should be regulated in research?666
Below, I describe the debate over the moral status of embryos from three perspectives.
First, I discuss how the question of the moral status of embryos is linked to the further question of whether the moral status limits or enables research on embryos. Second, I describe the debate about the status of pluripotent stem cells derived from human embryos, sometimes called the derivation-use
666 EGE Opinion no. 15 2000, 15; EGE Opinion no. 22 2007, 41; ESF 2001, 4; Kuusi & Parviainen 2003, 31; NordForsk 2007, 35;
PCBE 2004, 6/33.
142
distinction: Is there a morally relevant difference between deriving pluripotent stem cells from embryos and using the already derived pluripotent stem cells? Third, I describe the ethical debate over of the creation of research embryos: Is there a morally relevant difference between using supernumerary embryos versus research embryos? This can be called the discarded-versus-created distinction.
The question of the moral status of human embryos is most often discussed in terms of the respect owed an embryo.667 In the moral sense, respect is linked to the concept of dignity: “To respect something is to regard it as valuable in itself, to cherish it because of what it is.”668 The bioethical literature and stem cell reports indicate that the goal of moral discourse is to clarify and define the status of embryos in order to determine whether an embryo is an entity deserving respect. Furthermore, if the embryo deserves respect, then how should that respect be shown? The discussion is directed at establishing the degree of protection that embryos should have.669
Since respect is usually granted persons, the question of the moral status of an embryo could be framed as whether an embryo is a person.670 The stem cell reports do not discuss the personhood of human embryos per se. ESF and the NBAC refer to the personhood of human embryos only in passing.671 Accordingly, the question of whether a human embryo is a person is not a central issue in the stem cell reports. Nevertheless, the reports discuss the respectful use of embryos. For example, EGE does not discuss the personhood of a human embryo, yet it refers to “the respect due to the human embryo.”672 Furthermore, EGE, NordForsk, and the PCBE discuss whether the origin of the embryo affects the respect it is owed. In other words, may embryos of one origin be used for research, while embryos of another origin should be treated differently?673 The complexities are evident in EGE’s Opinion no. 15, which stresses the principle of proportionality leading to the adoption of a precautionary approach:
Calling for prudence, the Group [EGE] considers that, at present, the creation of embryos by somatic cell nuclear transfer for research on stem cell therapy would be premature, since there is a wide field of research to be carried out with alternative sources of human stem cells (from spare embryos, foetal tissues and adult stem cells).674
667 Baylis 2001, 53; Steinbock 2000, 127-128. See the following stem cell reports: EGE Opinion no. 15 2000, 15; EGE Opinion no. 22 2007, 41; ESF 2001, 4; Kuusi & Parviainen 2003, 31; NordForsk 2007, 29-36; PCBE 2004, 6/33.
668 Baylis 2001, 53.
669 Baylis 2001, 53; Geron Ethics Advisory Board 2006, 118-120; Lebacqz 2001, 150-152; Robertson 2006, 132.
670 Lebacqz 2001, 152. Lebacqz points out that the debate over the personhood of the human embryo is intense. Those who claim that a human embryo is a full human person from the moment of conception oppose ES and EG cell research and use. The Roman Catholic Church, for instance, argues against embryo research on the grounds that the embryo, from the first moment of fertilization, is a human subject with an identity. Furthermore, Aline Kalbian (2006, 244) points out that “from identity as a subject, the move is made to assign full personhood to the embryo.”
671 ESF 2001, 4; NBAC 1999, 4.
672 EGE Opinion no. 15 2000, 15.
673 EGE Opinion no. 15 2000, 16; NordForsk 2007, 31; PCBE 2004, 6/33.
674 EGE Opinion no. 15 2000, 16.
143
Some bioethicists have concluded that it is “incoherent to say that we can both respect embryos and accept their dismemberment in the research process.”675 However, others have argued that since the moral status of the embryo can be conceived differently, it is coherent to respect them differently.676 The stem cell reports seem to support this second line of argument.
The question of moral status is often framed as “when the embryo becomes ‘a human being’ or when ‘human life’ in a moral sense is thought to begin.”677 The biological similarities and differences between live-born human individuals and embryos are considered morally significant. The PCBE points out that nearly all participants in the stem cell debate relate the beginning of human life in a moral sense to the biological basis of humanness.678 In addition, biological definitions seem to affect the regulation of the use of human embryos for research. Four of the stem cell reports analyzed in this study – NordForsk, the PCBE, the Finnish Parliament’s Committee for the Future report and Human Stem Cells, Cloning and Research – refer to the “fourteen-day limit”. The primitive streak – the formation of a nervous system – appears after fourteen days of embryonic development. After this, an embryo can no longer give rise to two separate embryos. Consequently, the appearance of the primitive streak is thought to denote the beginning of individuation. According to the fourteen-day limit, embryos older than fourteen days may not be used for research.679
There are different perspectives on the question of how the moral status or humanness is based on biology.680 For example, the Finnish Parliament Committee for the Future’s report discusses
“what kind of absolute value should be given to embryos or fetuses of different ages.”681 The report implicitly presumes that different value is given to embryos of different ages. Interestingly, when the question was presented to the experts, it was not elucidated by developmental descriptions of embryos of different ages nor accompanied by a listing of different ages. As a matter of fact, the report does not discuss age or developmental stage in relation to the question. Rather it states the degree of respect embryos should have. The following terms are used for embryos: “early embryos” and “embryos from the beginning of their development.”682 Therefore, the report does not clarify what it means by “embryos of different ages” nor describe different developmental stages. The experts who were interviewed for the report do not answer the original question, namely, what value should be given to embryos of different age? Thus, the report does not provide an answer to the very question it poses.
675 Parens 2001, 43 referring to Callahan.
676 Lebacqz 2001; Parens 2001, 43.
677 Green 2001, 26. See also PCBE 2004, 12/33.
678 PCBE 2004, 13/33.
679 Human Stem Cells, Cloning and Research 2005, 11; Kuusi & Parviainen 2003, 198; NordForsk 2007, 31; PCBE 2004, 15/33.
680 Geron Ethics Advisory Board 2006, 119; PCBE 2004, 12/33-13/33; Peters 2006, 235.
681 Kuusi & Parviainen 2003, 17; 196.
682 Kuusi & Parviainen 2003, 196-197.
144
The PCBE and NordForsk discuss how moral status may be based on biology and make reference to the continuity and the graduality arguments.683 According to the continuity argument, the human embryo should be recognized as having a full moral status from the moment of conception.
According to the graduality argument, several other biological occurrences that have been suggested may point to the beginning of human life. For example, the appearance of the unique diploid genome and the appearance of the primitive streak have been cited as showing the beginning of human life.684 Both the continuity and the graduality arguments endeavor to answer the following question: At which point is the embryo entitled to full protection? Both arguments relate the starting point of human life and the point of protection to the understanding of biological occurrences and their nature.685
Both the continuity and the graduality arguments have been opposed on the grounds that the recent advances in biological knowledge have made defining the beginning of human life a complex issue. In addition, the continuity argument has been opposed by demonstrations that there is no one moment of fertilization. Fertilization itself is a long process that takes from twenty-four to forty-eight hours.686 Furthermore, critics of the continuity argument claim that there is more to being a human being than possessing a human genome. The proponents of the continuity argument have responded first that, although an embryo changes in its dimensions, scope, and degree of differentiation, it is nevertheless persistently itself throughout the process. All developmental stages are part of the continuous development toward birth. Second, the proponents claim that developmental changes should not determine moral worth. For example, the PCBE points out that according to the proponents, it is
“dangerous to begin to assign moral worth on the basis of presence or absence of particular capacities and features.”687
The graduality argument, on the other hand, has been opposed on the following grounds.
From an ethical perspective, it seems dubious since, according to the graduality argument itself, human embryos have some moral value during all developmental stages. Is it right then to destroy an entity that has at least some value?688 From a biological perspective, the graduality argument is based on a questionable biological understanding. The gradual development process may not be as straightforward as it is claimed to be. Embryo splitting and blastomere separation show that chromosomally normal embryos that have a diploid genome can be divided after which they continue to develop into separate healthy embryos. Blastomere separation can be performed in laboratory settings, but most notably it
683 PCBE 2004, 13/33-17/33; NordForsk 2007, 31-32.
684 Geron Ethics Advisory Board 2006, 119-120; Green 2001, 29-31; Holm 2006, 175; NordForsk 2007, 31; PCBE 2004, 13/33-17/33.
685 NordForsk 2007, 31; PCBE 2004, 13/33-17/33.
686 Green 2001, 27-29.
687 PCBE 2004, 14/33.
688 Holm 2006, 175.
145
takes place in nature whenever identical twins or triplets are born.689 Individuation is a complex process during which separate and distinct embryos can fuse in the course of early development.690
The problems of the continuity and the graduality arguments may be avoided by using the potentiality argument raised by NordForsk.691 In this argument, the potential of the embryo to become a fetus and to be born indicates that human embryos are not just any human tissue.692 The question is then framed as follows: Is it morally permissible “to halt the development of an entity that might go on to become a sentient being and, then, a conscious human being?”693 Human embryos are thought to have symbolic value. Accordingly, human embryos deserve special respect.694 For example, the bioethicist John A. Robertson proposes that embryos are “symbols for human life or constitute an arena for expressing one’s commitment to human life.”695 It is unclear, though, what Robertson means by “an arena for expressing one’s commitment to human life.” Does this rhetorical statement offer Robertson an opportunity not to take a stand on the moral status of the human embryo? Nor is the potentiality argument without its critics. In addition to the objections raised by NordForsk, the argument may also be criticized on the grounds that an embryo does not become a self-conscious being, but produces one. A human embryo brings into existence both the fetus and the surrounding and supporting tissues such as the placenta. Consequently, the whole embryo does not become an individual human being.696
As the PCBE report indicates, some writers have criticized the potentiality argument by comparing embryo loss in research to embryo loss in early miscarriages.697 It appears that most people are indifferent to a degree about the fate of an early embryo. This is reflected in their relative lack of concern about early miscarriages: later miscarriages are mourned more than early ones. The permissiveness toward using supernumerary embryos for research is thought to reflect the same attitude:
the embryos would be lost regardless whether the research took place or not. Most people do not condemn creating and discarding surplus embryos in IVF. Why then condemn the use of embryos for research? Furthermore, it has also been pointed out that nature is rather wasteful with embryos. Only a
689 Green 2001, 27-29. “If biological humanness starts with the appearance of a unique diploid genome, twins and triplets are living evidence that the early embryo is not yet one human being, but a community of possibly different individuals held together by gelatinous membrane.” Green 2001, 29.
690 Green 2001, 29-31.
691 NordForsk 2007, 31-32.
692 Marquis 2006, 195; NordForsk 2007, 31-32; Robertson 2006, 141.
693 Green 2001, 43-44.
694 Marquis 2006, 195; NordForsk 2007, 31-32; Robertson 2006, 141; Steinbock 2000, 129.
695 Robertson 2006, 141.
696 Marquis 2006, 195-196. However, for some bioethicists, such as Marquis (2006, 196), the criticism is not sufficient: “Such an argument appears to require the assumption that an entity cannot shed some of its parts and remain self-identical. However, this seems false: consider amputees.” Marquis seems to compare blastocysts with amputees. In his comparison, blastocysts and amputees’ integrity or moral status is not threatened by the loss of cells or body parts. Certainly Marquis is right: amputees’
personhood is not threatened. However, he can be criticized for making a poor comparison. He seems to downplay complex contextual details related to amputation and the individual experiences of it.
697 PCBE 2004, 19/33-20/33. See also Holm 2006, 176 (first published in 2003); Marquis 2006, 193 (first published in 2002-2003).
146
small number of fertilized eggs are implanted in the natural course of reproduction.698 These arguments have led some to argue for embryo and stem cell research:
These considerations suggest that the early embryo’s interests are not among those we need to take into account in establishing boundary points to protect it. Because it is not sentient, it is not physically harmed by its use in research, and its loss of opportunity to come into being is not something we appear to regard as a significant concern.699
Objections to this view have been made on the grounds that it misses the fact that an embryo is already a being. The point is not about the embryo becoming something that has a right to protection, since it already is that something.700 The critics of the “natural embryo loss” view have pointed out that we do not condone all things that happen in nature, nor wish them to be done deliberately. Moreover, the absence of moral sentiment does not imply an absence of moral obligation.701
The potentiality and the symbolic value arguments may be extended to the social consequences argument. According to the social consequences school, “personhood is a matter of definition rather than biological fact, based on socially constructed norms.”702 The Finnish Parliament’s Committee for the Future’s report seems to promote a social consequences argument when it states that the social definition of the value of the embryo is important.703
Some writers have argued that regardless of their moral status, human embryos may be both respected and used for research. For example, the Geron Ethics Advisory Board comments that
“early embryonic tissue is respected by ensuring that it is used with care only in research that incorporates substantive values such as reduction of human suffering.”704 This argument is further supported by the fact that supernumerary embryos would be destroyed regardless of whether research is carried out on them. For example, NordForsk proposes that it is better to do research on embryos than to destroy them.705 Glenn McGee and Arthur Caplan take this argument further by claiming that human embryos are not sacrificed in research, but rather their lives are preserved in stem cell lines: “[t]he life of a one hundred-cell embryo is contained in its cells’ nuclear material.”706 The continuity from embryos to cell lines is mentioned also in EGE’s report:
698 Green 2001, 44; PCBE 2004, 19/33-20/33.
699 Green 2001, 45.
700 Green 2001, 46.
701 PCBE 2004, 20/33.
702 Geron Ethics Advisory Board 2006, 120.
703 “Tässä keskustelussa [alkioiden käyttämisestä tutkimukseen] alkion itseisarvon yhteiskunnallisella määrittelyllä on merkityksensä.”
Kuusi & Parviainen 2003, 208.
704 Geron Ethics Advisory Board 2006, 121.
705 NordForsk 2007, 36. See also Peters 2006, 236; Robertson 2006, 139.
706 McGee & Caplan 2006, 165.
147
Human embryonic stem cell research is aimed at creating cell lines with appropriate
characteristics, in terms of purity and specificity. There is thus continuity from the embryonic cells to the therapeutic material obtained by culture.707
EGE does not clearly discuss whether the life of the embryo continues. It nevertheless observes the connection between embryonic cells and therapeutic material which is a result of the goals of the research.
Catherine Waldby and Susan Squier develop the argument further that the embryo does not die as a result of the creation of stem cell lines, but rather becomes immortalized:
[W]hat actually dies in the establishment of a cell line? The embryo’s tissues are not destroyed in the process – rather, they are removed from one form of organization, the blastocystic, whose order depends on particular patterns of intercell communication and gene-cytoplasm interactions, to another form, the cloned cell line, where tissues reproduce but do not differentiate or self-organize.708
According to Waldby and Squier, the status of a human embryo is contestable and its relationship to the human community ambiguous. This is evident when the stem cell debate is examined: different views of the ontological status of the human embryo compete. Biotechnologies that change the “temporal trajectory of human life” affect how being human are understood. The “temporal trajectory of human life”
refers to the journey from birth to death, which is considered straightforward in Western societies. Like other biotechnologies, stem cell technologies reroute and change this journey. The reshaped trajectory redefines what it is to be human.709 The trajectory’s beginning is not marked by birth, but by earlier developments. Since the development of embryology, “the narrative arc that describes identity across time has been extended to include the earliest moments of ontogeny.”710
Even without biotechnological interventions, human embryos do not have a predestined biological fate. And even if embryonic development is depicted as a biologically stable, linear, and progressive process, it is not linear, but open-ended and contingent. Statistically linear and progressive embryo development is rare: 22 percent of fertilized eggs do not develop into embryos; 20 percent of clinically recognized pregnancies spontaneously abort; blastogenic abnormalities and other developmental abnormalities and congenital diseases may arise during embryonic and fetal stages of human development.711 If stem cell research has been opposed on the grounds that it threatens the human potential in embryos, then the “human potential” needs to be redefined. Stem cell lines capture
707 EGE Opinion no 15 2000, 13. Emphasis added.
708 Waldby & Squier 2003, 35.
709 Waldby & Squier 2003, 32-33.
710 Waldby & Squier 2003, 36.
711 See Waldby & Squier (2003, 39) for more statistics.
“If ontogenic development is contingent and emergent, then embryos do not have a predestined biological fate, or a biological identity that is preserved or lost through particular developmental pathways.” Waldby & Squier 2003, 41.
148
the human potential because of their therapeutic potential. Cell-based therapies may help restore and rebuild damaged tissues or supplement deficiencies in adult human beings.
[S]tem cell lines do not “destroy the human potential of the embryo”; rather, it is precisely the human potential at that level of embryonic organization that they use. They modify and redirect this
[S]tem cell lines do not “destroy the human potential of the embryo”; rather, it is precisely the human potential at that level of embryonic organization that they use. They modify and redirect this