To condone or to condemn? On the ethics of stem cell research.

Depending on the origin of the cells, stem cell research can be classified into embryonic or nonembryonic stem cell research. In the latter group, cells are harvested from a variety of hosts without detriment to the donor. Embryonic stem cell research, on the other hand, entails the deliberate destruction of human embryos. Those against it maintain that it is the equivalent of the deliberate killing of a person. Those who favor it maintain that embryos are essentially not human organisms, and therefore can be used freely.

The fundamental question that needs to be answered is when does human life start? Is it at conception or at some other time? Some suggest that an embryo should be considered "human" only when it is "viable" and can sustain its life outside the uterus. If one were to accept this, one would assume that at a certain stage of development the embryo is endowed with "human life." In other words, the human embryo is at first not human, and then acquires human life. Even if this were plausible, one should bear in mind that what is viable now was not viable a few decades ago. Therefore if the onset of human life is linked to viability outside the uterus, today embryos would acquire human life at a much earlier stage than 20 years ago and probably much later than 20 years from now.

Continuing this line of reasoning, destroying an embryo of a certain age now would be morally acceptable, but may not be acceptable in say, 20 years. In other words, what was morally acceptable a few decades ago is no longer acceptable now and what is morally acceptable today may no longer be acceptable in the future. Unlike scientific "facts" which often change, that which is morally acceptable should not change; what was true a thousand years ago, is true now and will remain true for the next thousand years. Murder was morally wrong a thousand years ago, is morally wrong now, and will remain wrong a thousand years from now.

If life starts at the time of conception, then any human embryo, even one that is only a nanosecond old, is essentially a human organism, has the same rights as all other human beings and should have the full protection of the law. The fact that it may not survive without help is irrelevant; newly born infants cannot survive alone and yet, do we consider destroying them to harvest their cells?

We have made great strides during the past few decades to ensure that any human being participating in any research is not harmed and is fully aware of the implications of that research. Institutional Review Boards, or other similar bodies, have been empowered with overseeing research conducted in their institutions, including the assurance that individuals enrolled in research have given "fully informed consent."

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There are good reasons why research on human subjects needs to be so regulated. Unfortunately, medical researchers sometimes can get so focused on their research that they may overlook basic principles. This has been the case even with prominent physicians. It is said, for instance, that John Hunter inoculated his relative's penis with spirochetes to study the natural course of syphilis. The Nurenberg trials have documented that some medical researchers in Nazi Germany exposed human beings to inhuman conditions to study wound or fracture healing or the effects of inclement weather. Similarly, they often sacrificed their subjects to satisfy scientific curiosity. The Tuskeegee experiments in the USA may also have included ethically questionable procedures.

It is to protect human beings that research cannot be conducted in most countries without the prior approval of an independent ethics committee or its equivalent. Even research on experimental animals has to comply with certain rules and regulations to ensure that experimental animals are not subjected to "inhuman conditions" and that any suffering is kept to the absolute minimum.

Most medical journals do not publish research results without ensuring first that the research protocol had been approved by an ethics or similar committee. I personally had to reject an original manuscript for this reason. I did so with great reluctance; the research was sound and did not involve significant risks, yet I could not compromise on this issue.

If human embryos are "human beings," albeit embryonic, how could they be destroyed, even if this destruction may someday help cure many diseases? Is what we are doing to embryos today that different from what was being done in Nazi Germany or Tuskeegee? How could we be so hypocritical as to demand that all those who conduct research on human beings and indeed also on experimental animals abide by the highest standards to ensure full consent and to minimize trauma and suffering, yet at the same time condone the destruction of human embryos? Even worse, how can we condone the production of human embryos solely for the purpose of harvesting their cells?

To resolve the issue of whether embryonic stem cell research should be condoned or condemned, we need the answer to a basic question: When does human life start? It is doubtful whether scientists or physicians, on their own, can answer this question. Scientists can tell us about scientific facts; physicians can tell us about health and diseases. But the question regarding the beginning of life is more in the realm of the spiritual. We need to urge our spiritual leaders to answer this question.

If the answer is not at conception, then they need to define when it does start. If, on the other hand, the answer is at conception, then we need to make sure that any research on embryos treats them as "human beings" and that no reputable journal publishes any paper on any embryonic research that does not follow all the rules and regulations governing research on human beings. To do otherwise would be hypocritical.

Ronald C. Hamdy, MD, FRCP, FACP 

Editor-in-chief