Science, 25. Feb 2000, Vol 287, No. 5457, page 1424
A Time for Restraint
The debate on the use of human embryos for research will be one of
the more important issues of the 21st century. Unlike recombinant 'DNA technology,
embryonic stem cell research most probably will result in the destruction of living
embryos. Many people consider this research immoral, illegal, and unnecessary. Therefore,
it is imperative to proceed cautiously. Federal funding of research using human embryos or
pluripotent cells derived from them would be inappropriate until further resolution of the
ethical issues has been achieved.
Frank E. Young
The ability to grow human embryonic stem (ES) cells in vitro challenges governments,
regulatory agencies, and scientific organizations to define the ethical boundaries of
using these cells in research. In the United States, President Clinton charged the
National Bioethics Advisory Commission (NBAC) to review the medical and ethical
considerations of this technology. In September 1999, the NBAC released the Executive
Summary of its report (1). While noting the existence of diverse views, it formulated a
utilitarian approach, justifying public funding of research with human ES cells on the
basis of the potential medical benefits. NBAC's primary concern was whether the
"scientific merit and substantial clinical promise of this research justifies federal
support, and if so with what restrictions and safeguards." Its ethical concern was
focused on restricting the sources of embryos.
After National Institutes of Health Director Harold Varmus publicly supported the use of
human ES cells for research, based on a decision of the General Counsel of the Department
of Health and Human Services, 70 members of Congress signed a letter of objection. In a
letter to Science in March 1999 (2), 73 scientists, including 67 Nobel laureates, endorsed
Varmus' position, claiming that it protects "the of sanctity of life without impeding
biomedical research." They noted many promising uses for ES cells, including
therapeutic advances and reduction of animal studies and clinical trials needed for drug
development. Again, the emphasis was on potential benefits, and the ethics of embryo
destruction were not addressed.
The fact that experiments using ES cells, as currently performed, result in killing an
embryo cannot be ignored so readily. In the United States, such action is in violation of
many state laws that protect the embryo (3). The disintegration of human embryos or the
extraction of cells from blastocysts of human embryos [as has been described in primates
(4)] for the promised but as yet unrealized benefit of patients disregards concerns about
the value of the individual that have already been raised by the prospect of human cloning
(5). The devaluation of humans at the very commencement of life encourages a policy of
sacrificing the vulnerable that could ultimately put other humans at risk, such as those
with disabilities and the aged, through a new eugenics or euthanasia.
Although there is great scientific interest in ES cell research, other recent advances
suggest that adult stem cells may be more widely distributed than heretofore recognized
and may thus obviate the need for ES cells (6). Rather than risking public sanction and
mistrust from those concerned with the ethical, legal, and moral status of the embryo, is
it not wiser to give more than a passing mention to those concerns and in the meantime to
do no harm to living embryos? It may be tempting to pursue a scientific imperative that
impels us ever forward, but there are major costs. Regulatory policies and processes
should take into account public confidence as well as the classical standards of safety
and effectiveness. Our pluralistic society must consider the social, religious, medical,
environmental, and scientific interests of its citizens. Once credibility is lost,
acceptance is eroded.
Should scientific research be limited only by the value of its potential benefits? And who
should make the decisions about the limits? To quote J. A. Robertson (7), "Society,
as the provider of the resources, the bearer of the costs, and the reaper of the benefits,
has an overriding interest in the consequences of science, hence an interest in the routes
and direction that research takes " Scientists who proclaim First Amendment freedom
of inquiry are countered by a public suspicion of an inherent conflict of interest when
their research support depends on funding from federal and industrial sources. Therefore,
any commission regulating research should be composed of individuals of many persuasions
and should include people who have no direct or indirect dependence on public monies.
Observations from the recombinant DNA (rDNA) debate can be useful in considering policies
regarding human embryo research. The process of policy development was public, and
committees consisted of individuals with diverse expertise, opinions, and backgrounds,
including those who opposed rDNA research. Although public debate was contentious, careful
analysis of the issues prevailed. The results demonstrated that scientists and the public
can successfully work together to decide the appropriate use of public funds and formulate
regulatory guidelines (8).
The following recommendations are made to facilitate a consensus. Every nation conducting
ES cell research should develop a national policy. In. the United States, a representative
commission should be appointed to review ES and adult stem cell research, develop an
ethical framework for such research, and communicate with the public. It should also
examine the adequacy of current guidelines and regulations for in vitro fertilization. A
3-year moratorium on human embryo research should be instituted while the commission
completes its work. Sufficient funding for research on human adult stem cells and animal
embryonic and germinal stem cells should be provided during the moratorium (9).
International harmonization of guidelines could be accomplished through the Organization
for Economic Cooperation and Development.
To rush to approve the destruction of embryos in order to harvest and experiment on ES
cells is inadvisable and unnecessary. We should address the ethical concerns first.