The President's Stem Cells — A Dialogue from the "Stem Cell Dialogues"

“You put your finger on one of the peculiarities of the bifurcated sys­tem of ethics in our country—one set of principles for public funding and another for private funding. Embryo ethics straddles two moral universes, and scientists have had to navigate through that thorny divide. They must establish a firewall between publicly funded and privately funded laboratories.”

In the following dialogue from Stem Cell Dialogues: A Philosophical and Scientific Inquiry Into Medical Frontiers, the book’s central character Dr. Franklin talks with Bernard Stein about different president’s policies regarding stem cells:

Scene: The White House. Bernard Stein, M.D., is an ethics advisor to Presi­dent George W. Bush, head of a national bioethics think tank, and a lead­ing scholar on reproductive ethics. Dr. Franklin obtained an appointment with Dr. Stein to discuss President Bush’s policies on human embryonic stem cells.

FRANKLIN: [To Dr. Stein] Thank you for inviting me to your office. As you know from our correspondence, I am an editor of the Journal of Bioethics and Medicine, and we are preparing a special issue on stem cells. Dr. Stein, can we begin by you helping me understand how U.S. policy on stem cells evolved? Did it arise in the Bush administration?

STEIN: The federal policy on human embryos was catalyzed largely after two events: first, the Supreme Court decision on abortion in 1973 and the first baby (Louise Brown in England) born after in vitro fertiliza­tion in 1978. After the Roe v. Wade decision, which made early stage abortions legal, a moratorium was placed on government funding for embryo research. Then in 1979 an Ethics Advisory Board to the U.S. Department of Health, Education and Welfare issued a report on the ethics of research involving human embryos. This advisory board said it was ethically acceptable to do research on embryos used for IVF pur­poses but postponed any recommendations on research involving the collection and culture of early human embryos fertilized naturally— not used for IVF. But they had one major caveat: the embryos could not be sustained in vitro beyond fourteen days after fertilization.2

FRANKLIN: Why did they set the boundary at fourteen days? That sounds quite arbitrary. stein: At the fourteenth day of its development, an embryo exhibits a “primitive streak”—a faint white trace that is the first evidence of the embryonic axis. It is a precursor of the neural tube and the nervous system. Without a neural tube, there is no spinal cord, and the embryo cannot have feelings or exhibit any level of consciousness.

FRANKLIN: So the primitive streak is some kind of Maginot Line for bio­ethicists and shouldn’t be crossed.

STEIN: In 1979 the hope was that establishing a moral boundary would allow scientists to continue with their embryo research, as long as they stayed within that limit.

FRANKLIN: Between 1979 and 1980 there was a change in administration. Jimmy Carter had lost the election to Ronald Reagan. Were the advi­sory board’s recommendations adopted?

STEIN: Hardly. By 1980, the charter of the advisory board ran out and was not renewed. As you point out, Ronald Reagan was elected president. He and his administration opposed any research on embryos of any age. Republicans were, on the whole, more critical of research involv­ing embryos than Democrats. But there were many Democrats who supported the moratorium.

FRANKLIN: Dr. Stein, let me see if I get this. The Supreme Court ruled that embryos are not persons, and therefore abortion was not murder, and established a fundamental right of women over their bodies, at least for the first trimester of pregnancy. And then a president opposed any federal funding for embryo research on the grounds that embryos could not be harmed. Why didn’t Congress get into the act?

STEIN: Well, Congress did act, but not until another advisory committee was convened. In 1994, during the administration of President Bill Clinton, a federally appointed nineteen-member Human Embryo Research Panel issued its report. The panel concluded that embryos do deserve some moral consideration, but do not have the same moral status as persons because they lack specific capacities such as con­sciousness, reasoning, and sentience—at least, early embryos. The panel approved the use of federal funds for research on early embryos under specific guidelines.

FRANKLIN: Did that clinch it for President Clinton? After all, he is a Demo­crat and not doctrinaire on the issue. So he must have been receptive.

STEIN: No, it didn’t work out that way. In 1994 NIH convened a Human Embryo Research Panel to draft guidelines on the use of federal funding for research on human embryos. The panel recommended that funding for creating embryos for research be permitted.3 Clinton disagreed, but he was personally in favor of funding for scientific studies of embryos left over from IVF procedures. Nevertheless, responding to the political climate, Clinton wanted more deliberation and chose not to allocate federal funds to support research on leftover embryos until he could get a recommendation from a presidential ethics advisory committee. Perhaps he was anticipating congressional action.

FRANKLIN: Well, did Congress act then?

STEIN: Soon after the president made his preliminary decision to withhold funds, Congress closed the door on any research involving the destruc­tion of a human embryo. The Dickey-Wicker Amendment (sponsored by Representative Jay Dickey, House Republican from Arkansas, and Roger Wicker, Senate Republican from Mississippi), which Clinton signed into law, has been attached to appropriations bills every year, starting in 1996. It essentially prohibits the Department of Health and Human Services from using appropriated funds for the creation of human embryos for research purposes or for research in which human embryos are destroyed.

FRANKLIN: It seems to me there could be ways around the amendment. Suppose private money is used to create and destroy embryos and public funds are used to experiment on the cells removed from them. In many countries, like Germany, when a moral decision on embryo research is reached, it applies to everyone, not only those receiving funds from the government.

STEIN: You put your finger on one of the peculiarities of the bifurcated sys­tem of ethics in our country—one set of principles for public funding and another for private funding. Embryo ethics straddles two moral universes, and scientists have had to navigate through that thorny divide. They must establish a firewall between publicly funded and privately funded laboratories.

FRANKLIN: What happened with the president’s advisory committee?

STEIN: In 1999, the president’s National Bioethics Advisory Commis­sion recommended that use of embryonic stem cells harvested from embryos discarded after in vitro fertility treatments—but not from embryos created expressly for experimentation—be eligible for federal funding. The Clinton administration decided that it would be per­missible under the Dickey Amendment to fund human embryonic stem cell research, as long as such research did not directly cause the destruction of an embryo. In other words, women could donate their unused frozen embryos to research if the stem cell derivation, which involved destroying an embryo, was conducted under private auspices. Clinton published the guidelines for embryonic stem cell research on August 23, 2000. They allowed scientists to use federal funds to obtain stem cells from private suppliers who extracted the cells from donated frozen embryos.

FRANKLIN: But then President George W. Bush took office. As I recall, he embraced the Dickey-Wicker Amendment. It seems like he was opposed to using public funds for any stem cell research. It was, I believe, part of his moral/religious compass. Did he follow Clinton’s plan?

STEIN: Hardly! Bush changed the playing field. He created his own Magi­not Line. On August 9, 2001, before any funding was granted under these guidelines, Bush announced modifications to allow public funds to be used only for what was then a well-defined number of existing stem cell lines that were produced before a certain date—more than sixty embryonic stem cell lines that already existed from privately funded research. These were embryos on which the “life and death decision” had already been made.

FRANKLIN: Wasn’t this number somewhat of an exaggeration, according to most scientists, since many of the stem cell lines were unusable? The cell lines eligible for NIH funding have been shown to have genetic instabilities. NIH-funded scientists would also like to have access to cell lines that have been derived without the use of animal feeder cells—a layer of mouse cells were typically used to culture human embryonic stem cells to activate their growth—or animal products that contami­nate the human cells. Also, many cell lines that have been generated since that policy was put into place have mutations specific to certain human diseases like Huntington’s, ALS, and Parkinson’s that would be valuable for research into the progression of these diseases and for drug testing. Other human ESCs exhibited chromosomal abnormali­ties that make them unsuitable for research. It strikes me that President Bush was trying to appease his political base rather than listening to
the scientific community.

STEIN: There were many complaints from scientists after the president’s message. They claimed they could only use a minimum of eleven and a maximum of twenty cell lines that the Bush administration approved.

FRANKLIN: What you are saying is that President Bush had chosen a very restricted collection of stem cell lines—the president’s stem cells—that were permissible to use under his watch.

STEIN: Essentially, that is correct. His advisors, I among them, felt that because these lines were already established—the unethical act of destroying human embryo life had already occurred—it would be ethically correct to do good things with them. But destroying new embryos, whatever their origin, was not ethically justified, and we shouldn’t weigh costs and benefits to determine the correct moral choice.

FRANKLIN: But aren’t we losing the opportunity to make remarkable medical discoveries that will save or improve the quality of human life? Is embryo life worth that loss?

STEIN: We must be concerned about going down a road where the early stages of human life become a natural resource to be mined for other people’s benefit. There are alternative paths that can be pursued toward the same ends without destroying an embryo’s life.

FRANKLIN: It seems that the Bush administration had reached a conclu­sion about the moral status of embryos, and the scientists opposed to it were not persuasive. They did have a way out, though: get private funds to do their work.

STEIN: That is currently the situation. But under President Bush public funds were denied for research on embryonic stem cells if those cells were obtained by the destruction of embryos, regardless of whether that was paid for by public or private funds.