Now in its second edition, The Stem Cell Controversy has been an invaluable anthology for my own personal research, and in my teaching as well. I should say, right away, that in my experience this is one of the best books available for introducing the issue to students and really discussing the scientific, ethical, and religious implications of embryonic and adult stem cell research. One of the main reasons that this book is so helpful and accessible is that it is broken down into five distinct sections that provide comprehensive overview of the different aspects of this current and divisive issue. I will mostly deal with the contents of the second edition, since this is the one currently available, but will refer back to the first edition if I believe that it was superior to the second edition in any respect.

The book begins with the full text of President George W. Bush's August 9, 2001 speech, where he announced his decision to allow federal funding for stem cell research only on existing stem cell lines derived from embryos prior to that point in time, but that no new embryos were to be killed for the research using tax-payer dollars. I like that the students, and readers in general, are able to read exactly what Bush's reasoning was when he made this decision, and I usually go through it carefully with them, extracting some philosophical arguments from the speech and then critically evaluating them. For future editions, it may be beneficial to include the full transcript of his more recent 2006 decision to veto the Stem Cell Research Enhancement Act.

All the sections of this book begin with very concise and helpful editors' introductions. A rather useful addition in the second edition for those who are interested in using the book as a teaching tool is a section entitled "Questions to think about," located at the end of each editors' introduction, which can serve as insightful discussion questions or may be used for the purposes of concentrating the reader's mind on certain specific issues. In both editions, there is also an extensive and very helpful glossary of key terms located in the back of the book.

The first section of the book contains articles on the science of stem cell research, which served to, firstly, educate me while I was conducting research for my dissertation and, secondly, helps to disabuse many of my students of the misconceptions a number of them have in regards to the research (e.g., that mid- to late-term fetuses were the main ones being aborted expressly for the purposes of deriving stem cells).

The National Institutes of Health's "Stem Cell Primer" is a very basic and clear article that defines key terms, clarifies exactly what stem cells are, explains the different ways in which stem cells can be derived (making it clear that developed fetuses are not the main source of stem cell derivation), and discusses the many potential therapeutic applications of pluripotent stem cells. The article also briefly discusses the distinction between embryonic and adult stem cells. One of the main strengths of this article is its honesty. While it delineates all the positive aspects of embryonic stem cell research, it also informs the reader that there are hurdles to overcome, and it does the same when it discusses adult stem cells. In other words, the article not only clearly and accurately explains what stem cell research is, it is direct and honest concerning the benefits and drawbacks of both types of research, rather than exclusively touting one and deriding the other.

Jane Maienschein's "The Language Really Matters" mainly focuses on how the use of language in order to explain different aspects of stem cell research really makes a difference concerning how the public conceives of the issue. For example, in her discussion concerning the exact difference between cells that are totipotent and pluripotent, she clearly illustrates how stem cells produced from the inner cell mass of a five-day-old zygote are not themselves ontologically distinct organisms. Maienschein's article helps to make the important point that the quality of our thoughts on any matter can only be as good as the language that we use, and she implores us to understand certain key concepts in order to further our critical thinking on this important ethical issue.

Gretchen Vogel's "Can Old Cells Learn New Tricks?" and Sidney Houff's "Adult Stem Cells — A Positive Perspective" delineates the therapeutic potential of adult stem cells. Vogel's article discusses both the benefits and drawbacks of adult stem cell research, and is successful in making the point that neither adult nor embryonic stem cells are ideal or problem-free. As a result, the point is made that true advancements in the field require research with both types of stem cells. Houff's article makes a similar point. While it is acknowledged that adult stem cells lack the same amount of plasticity as embryonic stem cells, Houff argues that this perceived weakness can actually be construed as a benefit. For example, adult stem cells are more likely to respond to the molecular signals in adult tissue than embryonic stem cells, precisely because of their antecedent differentiation into certain cell types. What is most beneficial about these two articles is that they illustrate the objectivity present in the whole book: the editors are obviously not out to convince anyone that either embryonic or adult stem cells are clearly superior. It is acknowledged in the various articles in this section that each have benefits and obstacles that the other does not. This gives the reader a fair an unbiased introduction to the issue, away from the slanted views that permeate the media by both supporters and detractors of stem cell research.

Rick Weiss' "'Parthenotes' Expand the Debate on Stem Cells," the last article in this section, brings to light even more interesting philosophical questions.  By discussing the issue of parthenogensis in human eggs (when the unfertilized egg begins to divide on its own to form a zygote), Weiss forces the reader to consider the proper way of defining the term "human embryo," and whether unfertilized eggs that begin to divide on their own conform to this definition. If not, then it seems that we can derive cells from the inner cell mass of a parthenote in order to produce stem cells with no moral qualms. Yet if parthenotes are considered embryos, on a par with fertilized eggs, deeper philosophical questions arise, for the common adherence by conservatives to the idea that "life begins at conception" seems to be in danger here. If a parthenote embryo was never conceived, when did life begin then? What type of beings deserve rights, and when would those rights begin for a parthenote? What does this say about extending rights onto human zygotes or embryos that began as fertilized eggs? While Weiss' article is short, and does not attempt to answer any of these questions to any in-depth extent, it does a good job of bringing them to light and may serve as a good springboard for classroom discussion concerning the nature of rights and when human life truly begins.

            Part two of the book contains essays that discuss the therapeutic promise of stem cell research. All the articles in this section are clear and accessible, easily aiding in the reader's comprehension of why this research is so alluring, exciting, and desired by so many. A notable article in this section is Katty Kay's and Mark Henderson's "Paralyzed Mouse Walks Again as Scientists Fight Stem Cell Ban." The article is particularly effective in conjunction with videos of the experiments discussed in the article; my students were very much affected when they saw the actual paralyzed mice dragging their feet and then walking again after being injected with human embryonic stem cells. The untimely death of Christopher Reeve in 2004 makes the article that much sadder to read, as the piece directly mentions him as one of the many people who could have benefited from this research in his attempts to regain mobility after his 1995 horse-riding accident and subsequent spinal cord injury.

Carol Martin's "60 Minutes II, Holy Grail" introduces the reader to the story of Keone Penn, who was cured from sickle cell anemia by the use of another person's umbilical cord stem cells. The article, thus, emphasizes the therapeutic potential of umbilical cord stem cells, which, again, serves the reader by keeping the debate honest, i.e., the reader is never lead to believe that research on embryonic stem cells is the only possibility where effective cures can  be found, although it is also emphasized that they present the most potential.

The National Bioethics Advisory Commission's "Human Stem Cell Research and the Potential for Clinical Application" is an excellent article for those who are interested in a brief overview of the variety of different medical applications possible with stem cell research: from cancer therapy to Parkinson's disease to blood disorders. The article is not too technical, and thus it provides an accessible introduction to how stem cell therapy actually works in treating these, and other, afflictions. Marcia Barinaga's "Fetal Neuron Grafts Pave the Way for Stem Cell Therapies" accomplishes a similar task, but with a particular focus on the potential that embryonic stem cells possess for alleviating Parkinson's disease.

An addition to the second edition is Leigh Shoemaker's "Promises of Stem Cells Kept," which again explains some of the potential applications of both adult and embryonic stem cells. Shoemaker emphasizes that the true promise of stem cells lies in the hands of the researchers and physicians who continue to conduct research; research that should be encouraged and allowed to progress in order to benefit future generations, no matter how frustratingly slow some of the research can be in terms of developing affective cures for diseases such as Type I diabetes or Parkinson's disease.

The third section of the book is where I take the majority of the readings from when I teach this issue in my applied ethics courses. There are seven articles in this section, all excellently written, some more difficult than others. For the sake of brevity, I will mention just a few of them, although all are recommended.

Michael Novak's "The Stem Cell Slide: Be Alert to the Beginnings of Evil" is useful as an opportunity to illustrate to readers how moral theories can be applied to practical issues. Novak quite rightly points out that President Bush's 2001 speech possesses Kantian undertones, and he brings those out clearly. He further uses Kant's 2^nd Categorical Imperative to argue that President Bush's concession to allow federal funds on stem cell lines that already existed at that point also violated Kant's imperative. That is, humans, including embryos on Novak's interpretation, ought not to be treated solely as a means to an end, rendering the killing of embryos for research morally impermissible at all times. Novak's article is also a good tool for going back to Kant and attempting to interpret what he meant by the term "humanity", i.e., whether he meant to denote all and only Homo sapiens as the subject of his imperative or all and only persons, for if Kant  meant the latter, Novak's application of the imperative to embryos is erroneous. Nevertheless, the article serves as a good tool for discussing questions about personhood, what counts as a person, and what type of beings may or may not be instrumentalized.

Another notable article in this section is John A. Robertson's "Ethics and Policy in Embryonic Stem Cell Research." In this article, Robertson covers a plethora of issues, from theories of complicity and its role in making stem cell researchers complicit in the death of embryos or aborted fetus, to the issue of creating embryos solely for research, rather than using only surplus In Virto Fertilization (IVF) embryos, to applying both utilitarian and deontic moral theories to this issue. Robertson's article offers a wealth of topics to discuss; when I teach the article I usually do so in on session of a three hour seminar class, and we still do not manage to cover all of his arguments. Students, and perhaps the beginning reader, may find it difficult to follow, but working through it results in thinking about a variety of difficult, but interesting, issues.

Another interesting article included in this section is "Research with Human Embryonic Stem Cells: Ethical Considerations" by the Geron Ethics Advisory Board. The article illustrates how advisory boards come to the decisions that they do and, more specifically for the topic at hand, the article also brings up complex ethical issues, e.g., what does it means for a blastocyst to be treated with respect even when one is endorsing its death at the hands of researchers?

Two philosophical articles included in the second edition that were not in the first are Søren Holm's "The Ethical Case Against Stem Cell Research" and Don Marquis' "Stem Cell Research: The Failure of Bioethics." Both articles present thought-provoking arguments against embryonic stem cell research, and therefore provide a good contrast to Robertson's article, which makes very strong arguments in favor of the research.

Other articles included in this section are Glenn McGee's and Arthur Caplan's "The Ethics and Politics of Small Sacrifices" and Ruth R. Faden's, Liza Dawson's et. al.'s "Public Stem Cell Banks: Considerations of Justice in Stem Cell Research and Therapy."

In both editions, section four is rather invaluable for offering a comprehensive view of the stem cell research issue: in this section, the reader is exposed to a variety of different religious views concerning the topic. There are some articles absent in the second edition that I was sorry to see go, e.g., "The Testimony of Nathan Salley" and "Testimony of Rabbi Elliot N. Dorff." I was particularly disappointed in the absence of the latter, since it provided a window into the Jewish religion and their view regarding the moral status of early embryonic life. I also appreciated Rabbi Dorff's emphasis on the Jewish view that humans have a duty to God and each other to proceed in the discovery of medical therapies.

Despite these omissions, good articles remain in this section of the second edition. "Patient's Voices: The Powerful Sound in the Stem Cell Debate" delineates the millions of people that may be helped by the enhancement of stem cell therapy, a total of 128.4 million. According to the editors' introduction in this section, the main reason they included this piece is to raise the question concerning whether religious groups have a right to impose their belief system on others, especially the dying and afflicted individuals that stem cell research could potentially help.   

Aline H. Kalbian's "Stem Cells and the Catholic Church" and Abdulaziz Sachedina's "Testimony for the National Bioethics Commissions" deals with the Catholic and Muslim responses to the issue. Both articles are, of course, edifying, but, for anyone familiar with the first edition, Rabbi Dorff's article is glaringly absent as a complement to these two essays.  

A nice addition to this section in the second edition, however, is LeRoy Walters' "Human Embryonic Stem Cell Research: An Intercultural Perspective." The article first addresses the differing embryonic stem cell research policies in places like Europe, the Middle East, Asia, Australia, Canada, and the United States of America, amongst others. Walters then discusses differing religious traditions and how these groups approach the issue. Walters specifically discusses Sachedina's article, and hence Walter's essay compliments it nicely. I was particularly pleased to see Walters' inclusion of various eastern religions' (Buddhism, Hinduism, and Taoism) stance on this issue, since these voices are not often heard in our Western culture. Walters' article, therefore, gives a nice survey of both the religious and cultural differences concerning the ethics and practice of embryonic stem cell research. It is certainly a good teaching tool, and a good tool for anyone interested in a broader multicultural perspective on this issue.

Ted Peters, a former member of the Geron Ethics Advisory Board, lends his voice to the second edition with his article "The Stem Cell Controversy." Peters begins the article by noting the religious influence behind President Bush's 2001 decision (he visited Pope John Paul II the night before his speech) and is critical of the attempt to approach the embryonic stem cell research debate as simply a new incarnation of the abortion impasse. Moreover, Peters argues that there is an ethical and theological basis for pursuing embryonic stem cell research. He appeals to the duty of beneficence, the duty that all humans possess to benefit others and engage in good actions towards others. Moreover, he gives this duty a religious spin by stressing that, for those who take Christianity seriously, it should always be remembered that one of Jesus' primary activities was to the heal the sick. Peters does not, however, wish to rob early human life of any dignity whatsoever, and therefore he argues against creating embryos expressly for research purposes. However, he supports using surplus IVF embryos, those that are slated for destruction and thus will meet an inevitable death. According to Walters, the duty of beneficence behooves us to take those embryos that will never be implanted and use them, instead, to help human beings that are suffering from a variety of crippling afflictions and diseases.

Section five, the last part of the book, contains articles dealing with policy issues. While there are many good articles in this section, I was surprise to see absent from the second edition the National Bioethics Advisory Commission's "Ethical Issues in Human Embryonic Stem Cell Research: Conclusions and Recommendations." This article was pivotal in my own research, and its absence in the second edition is unfortunate.

Nevertheless, the articles that are present in the second edition are insightful ones. Kenneth L. Ryan's piece, "The Politics and Ethics of Human Embryo and Stem Cell Research" is notable for its section on the history of federal funding regulations for destructive research on embryos and fetuses in the United States of America. Maureen L. Condic's "The Basics about Stem Cells" discusses some difficulties and disadvantages of transplanting embryonic stem cells into human patients, e.g., the issue of immune rejection when foreign cells enter the body of a patient (the same issue that renders organ transplantation a delicate practice), amongst others.

Cindy R. Towns' and D. Gareth Jones' "Stem Cells: Public Policy and Ethics" brings to light what has always seemed to me to be a glaring inconsistency in the current administration's embryonic stem cell policy. As Towns and Jones point out, it is blatantly contradictory to oppose embryonic stem cell research on the grounds that it destroys embryos, but simultaneously laude and support the practice of IVF, which is responsible for the creation and destruction of thousands of surplus embryos. As a manner of rectifying this inconstancy, the authors argue that we should move towards sanctioning the practice of using surplus IVF embryos for stem cell research, rather than allowing them to be destroyed in fertility clinics. Simon Clarke's article "Ethical Consistency in Embryonic Stem Cell Research" takes this argument one step further and argues in favor of creating embryos specifically for research purposes. His reasoning is a strong one: if we allow for the creation and destruction of embryos for the purpose of allowing a childless couple to conceive, it seems that we should also allow for the creation and destruction of embryos for the purpose of seeking therapy or possible cures for life-threatening illnesses. Indeed, Clarke argues, helping to attain cures for these illnesses is a much more important goal than relieving infertility, although the latter, he stresses, is a notable goal as well.

Other articles included in this section are Frank E. Young's "A Time for Restraint," and Andrew W. Siegel's "Locating Convergence: Ethics, Public Policy, and Human Stem Cell Research," For future editions, I hope the editors include, once again, the National Bioethics Advisory Commissions' article.

Overall, The Stem Cell Controversy is an invaluable book to read and own if you are interested in either teaching this issue, conducting your own research, or just if you are looking for an extensive introduction. Almost every possible manner of approaching the issue is covered: from a philosophical approach, to a religious approach, to a discussion concerning the science underlying stem cell research, and policy issues. I would advise someone who is really interested in stem cell research to acquire both editions, since each edition contains excellent articles that the other lacks. However, the book is a must-have for anyone interested in this topic in particular, or in biomedical ethics in general. This is certainly one of the best and most extensive introductory anthologies to the issue of stem cell research I have encountered.

 

© 2007 Bertha Alvarez Manninen

Bertha Alvarez Manninen, Ph.D., Arizona State University at the West Campus

 

Categories: Ethics