Over the last decade, policy-makers and theorists have been struggling to reconcile opposing views about developments in regenerative medicine, and the remarkable future possibilities these have opened up. Because of the enormous potential of this area of science in terms of both medical advance and commercial expansion, embryonic stem-cell research has become a major political issue, particularly in the USA, where it may recently have found some resolution in President Obama's decision to allow federal funds to be used for this purpose. But this has not rendered the ethical debate redundant, and Louis Guenin's book, The Morality of Embryo Use, provides a carefully argued and scholarly exposition of the issues. As an ethics adviser on medical research, and also as a member of the Department of Microbiology and Molecular Genetics at Harvard Medical School, Guenin is well-qualified to do this, and he brings to the task the resources of biology, genetics, logic, and metaphysics.
He begins by setting out the scientific picture in detail – perhaps indeed too much detail for the general philosophical reader, who may feel challenged by the author's willingness to create names de novo (e.g. ‘nonself cell’, ‘nonreprocloning’) and then deploy them freely throughout the book. However, the main picture is now familiar even to non-specialists. Embryonic stem cells are an essential ingredient in what has been called the ‘medicine of regeneration’. They are unspecialised cells that have the potential to develop into different cell types. Found in early-stage embryos (blastocysts) which need to be accessed before about the fifth day of gestation, and also in fetal and some adult tissue, they hold out hope of cures or treatments for a number of human ailments including Parkinson's disease, leukaemia, heart disease, Alzheimer's disease, cancer, diabetes and spinal cord injuries. They are self-renewing and are capable, in the laboratory, of multiplying exponentially. A single embryo can produce a long cell-line which may be used indefinitely for both research and pharmaceutical purposes.
Guenin confines his ethical assessment to the early embryo prior to implantation in the womb, and to the elements from which it originated. In his words: ‘no possible persons correspond to oocytes, gamete pairs, somatic cells, or embryonic stem cells.’ (24) He acknowledges that there are moral rules that should govern the way we treat the earliest stage of an actual human-being and begins by giving detailed consideration to the widely-held view that this is the stage, around the 14th day, when the primitive streak appears, and there is a genetically complete individual entity. The United Kingdom and most other jurisdictions which permit embryo research have set this as the limit up to which that research can be permitted, and have imposed an absolute ban on allowing embryos to develop outside the body beyond it. The argument that has prevailed is that up to that point, individual identity has not been established, since there is still the possibility of monozygotic twinning, i.e. the single embryo may become two. Guenin quotes Quine's dictum “No entity without identity”, but he is sympathetic to Bernard Williams' observation that, although it may not be possible to draw a non-arbitrary or uniquely reasonable line, it is nevertheless reasonable that we do draw a line.
Nevertheless, Guenin declares himself no longer satisfied with the twinning argument and hence with the view that that line should be drawn at the 14th day. He argues that divisibility does not preclude an embryo from being a person ‘nor does there obtain any reason to deny that an early embryo satisfies any condition of human individuality requisite for personhood.’ (98). He chooses instead to draw the line at implantation and to make the case for embryo research strictly in relation to embryos that never will be implanted either in a human-being or in an artificial uterus because they, or the separate gametes from which they come, have been willingly donated by their progenitors for research purposes. He describes this as the Argument from Nonenablement, and uses the term epidosembryos (derived from the Greek for a gift for the common good) for the entities to which it applies.
Guenin's criterion, then, is political and libertarian rather than analytic or conceptual. He holds that a decision about how gametes or embryos should be used belongs to the person who is their source, subject to the condition that the proposed scientific use is humanitarian and benevolent. Two categories of embryos would be covered by this principle: first, embryos specifically created, and to oocytes (eggs) specifically donated, for research, and second, so-called ‘surplus embryos’ – embryos created for fertility treatment but not needed, perhaps because an excessive number have been created, or because their progenitors have achieved the family they desired. It would be right, he argues, to use these, too, for scientific research, if they are donated with the informed consent of the donors and would otherwise be allowed to perish. The distinction between embryos created for research and those created for procreation is important, given the consensus that exists in favour of using surplus embryos and against creating embryos in the laboratory. Indeed, this was the position taken in the Convention on Human Rights and Biomedicine of the Council of Europe in 1999. As far as Guenin's position is concerned, however, the distinction is overtaken by his ‘nonenablement’ principle.
In marking implantation as the critical point where a moral case must be argued in the public domain, Guenin's position is not without precedent. In the case of religious opponents of embryo research, particularly Catholics, there has, as he points out, been a well-established traditional belief that human life begins, not at conception, but at some stage after implantation in the womb. In selecting a later time for recognising personhood, however, Guenin is not seeking to construct a utilitarian defence of embryonic stem cell research against its opponents. He believes it is not possible to sum utilities across a population in any meaningful way, and he recognizes that for many people, moral principles take precedence over maximizing welfare.
Opponents of embryo research who take this view often do so by appealing to Kant, but Guenin argues that since Kant recognizes a duty of beneficence, this should persuade us, whether Kantians or utilitarians, that we ought to foster embryo research that could ultimately help people who are suffering from the distressing conditions that this research might alleviate or prevent. Guenin says that he himself does accept the Kantian legacy – the principle that we should never treat humanity simply as a means but always as an end. But he argues that, since Kant holds that respect for human dignity is grounded in autonomous reason, this restricts its application to rational beings – a criterion that does not include the early human embryo.
After Kantianism, Guenin sees Catholicism as the second most important challenge to stem-cell research, first because it holds to the doctrine of the sanctity of life, and secondly because it places the genesis of an individual person at conception (fertilization). This he describes as the doctrine of zygotic personhood and he sees it as in conflict with what the Catholic church has held in the past. For example, until the mid-nineteenth century, it seems to have accepted Aristotle's view that conception is not complete for forty days (later in the case of females), and that it is only after this that the conceptus acquires a distinctively human intellectual soul. Indeed, centuries before this, in 1211, Pope Innocent III had placed ensoulment even later, at quickening (between 12 and 16 weeks). It was not until 1974 that a declaration appeared which seemed to support the doctrine of zygotic personhood by identifying personhood with a unique individual genome.
This genetic reductionism, Guenin argues, is inconsistent with earlier Catholic doctrines about the mind and the soul. It also appears to condemn, not only experimentation with embryos, but also, more fundamentally, many of the practices involved in fertility treatment, and specifically the generation of embryos outside the body. Guenin argues, however, that, given that embryos are now created outside the body and are often cryopreserved, decisions inevitably arise as to what to do with them when they are not wanted by their originators. His own opinion is that the principle of respect for life justifies the judgement that it is morally better that these embryos be used for research and the prevention of suffering than that they be allowed to perish. Indeed, he argues that this is something that even those who are opposed to abortion should be willing to accept. As he puts it: ‘My account does not purport to resolve a woman's moral obligations in respect of a conceptus inside her. It does affirm her discretion as to a conceptus outside her.’ (56–7)
In a concluding chapter ‘Shaping Norms’, Guenin seeks to spell out the public policy implications of his position. He formulates as a proposed rule: ‘Scientists may conduct, and the government shall support, biomedical research using human embryos that, before or after formation, have been donated to medicine under donor instructions forbidding intrauterine transfer.’ (234) He regards the situation in the USA, which until recently permitted privately funded research and experimentation while refusing federal funds, as immoral because it ignored the requirement for justice in the distribution of resources. This, he says, risked an outcome in which commercial bodies would be able to patent and control most of the transplantable cell types – something that could benefit the rich who could afford the new and expensive treatments and penalize the poor who could not.
Guenin is at pains to say that his arguments would not necessarily mean giving scientists an ethical free-for-all on early-stage generative material – he insists that this could and should still be governed by established ethical boundaries. His arguments are consistent, he believes, with recognising the moral gulf between allowing short-lived ethically-approved experiments on inanimate generative material in the laboratory and having no rules at all to govern the way we treat the earliest stage of an intended human life. Nevertheless, the clarity of this distinction is dissipated when Guenin discusses what could in the long term be permitted. Subject only to qualifications about safety, this includes human cloning, the commercial sale of oocytes (human eggs), and germ-line intervention and enhancement (the creation of designer babies, including ‘saviour siblings’). In all these cases, the emphasis is on satisfying society's aspirations and those of individual adults, and it is easy to underestimate the consequences for the actual human beings – clones, commercially traded children, saviour siblings, genetically ‘enhanced’ beings – who would ultimately have to confront the question of their own identity and origins. Others, including John Harris, Ronald Dworkin and Peter Singer, have also defended a broadly permissive approach that would allow at least some of these developments. But Guenin has chosen a different ground on which to argue his case, and it seems to me that his own much more careful and scientifically informed arguments do not justify carrying his libertarian conclusions as far as his horizon-scanning remarks suggest.
So can the scientific research at issue in this debate be ethically defended? In favour of moving forward, Guenin cites the duty of medical science to relieve suffering. But while human happiness does matter morally, he is careful not to rest his case on anything so crude as the principle that the end justifies the means. The reservations of those who fear the commodification and trivialising of human life are not without substance, however. And while Guenin's central arguments make a strong case for human embryonic stem-cell research, they do not support dramatic interventions in human reproduction, or the re-shaping of human nature.
