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Academic Research Associate, Institute on Ethics & Policy for Innovation, Faculty of Humanities, Department of Philosophy, McMaster University, Hamilton, Ontario, Canada.
The controversy over human embryonic stem cell (hESC) research has often been framed in terms of the conflict between religion and science, especially in the United States of America, where considerable political mobilization of religious constituencies opposing embryo research had occurred since the landmark decision on the issue of abortion by the U.S. Supreme Court in the case of Roe v. Wade (1973). Religion has also influenced the public debates and regulatory regimes of European countries with predominantly Catholic populations such as Ireland, Italy, Poland, Austria, Lithuania, Malta, and Slovakia. Representatives of different religious traditions have given testimony to bioethics advisory bodies worldwide, including the U.S. National Bioethics Advisory Commission (NBAC), the President Council on Bioethics (PCBE), and the European Group on Ethics of the European Commission, and their policy decisions have often been informed by ethical arguments derived from religious principles and beliefs (Walters, 2004). Since the early years of discovery, hESC research has thus become inextricably linked to the question of whether religion should be allowed to influence public life and has presented a paradigmatic case to question the legitimacy of religious arguments and values in the public spheres of post-secular societies.
In this paper, I scrutinize religious arguments regarding the use of human embryos in stem cell research and related biomedical technologies derived from major monotheistic religions (Catholicism, Judaism and Islam) and provide a broader theoretical refection on the validity of religious arguments in science policy debates in the post-secular society. Additionally, I examine secular bioethical perspectives on the embryo’s moral status, the ethics of human cloning, and feminist concerns about women’s reproductive work in embryo donation for stem cell research. My analysis aims to shed light on complex ethical considerations arising from hESC research that are not reducible to the conflict between religion and scientific knowledge, by considering ethical and social challenges arising from its intersections with other controversial technologies such as human cloning and assisted reproductive technologies (ART). I argue that framing the ethics of hESC research exclusively around the embryo’s moral status can potentially impede the public understanding of the multiple social and political controversies entangled in the stem cell debate. Similarly, reductionist framings of public deliberations around the false dichotomy of “religion versus science” (i.e., the tendency to juxtapose the respect and protection owed to blastocysts to the moral obligation to conduct life-saving research) tend to simplify the complexities involved in stem cell debates. A close examination of the interplay between science, ethics, religion, societal values, and political forces in the stem cell controversy can reveal the many ways in which research data and scientific knowledge are used as a resource in social and political struggles. It is also important to elucidate how assessments of rationality by proponents and opponents have informed models of political decision concerning stem cell research and related conflicts of socio-technical nature. My analysis therefore emphasizes how participants in the controversy have laid conflicting moral claims to rationality in attempts to validate their arguments as rational, while dismissing the opponents’ position as purely irrational and hence irrelevant to the policy debate.
1. Religious perspectives on stem cells and embryo research
The stem cell controversy has highlighted fundamental disagreements between major monotheistic religions on the moral status of early embryos (blastocysts) and their use in biomedical research. While religious perspectives have become prominent in stem cell debates worldwide, many have questioned their validity for decisions regarding science and technology policy in the 21 century. At the risk of oversimplifying, questions about the role of religion fall into two broad categories: (1) “To what extent are moral judgments derived from ancient religious texts relevant to the rapid advancement of scientific knowledge in embryology, genetics, molecular biology, and biomedicine?,” and (2) “Do ethical concerns that are religious in nature provide a legitimate basis for public policy decisions in our secular, pluralistic societies?” The latter concern appears especially pertinent in the light of courts, lawmakers, parliaments and legislatures’ general reluctance to impose narrow religious viewpoints on the rest of society. This attitude is consistent with John Rawls’ argument in Political Liberalism (1996) that the state should be neutral between various conceptions of the good and may not enact policies that ignore the fact of reasonable pluralism, that is, the coexistence of incompatible yet reasonable comprehensive doctrines in modern societies. Nevertheless, a certain bifurcation of opinions could be observed on the issue of whether religious values should count in public debates on stem cell research. On the one hand, there is a tendency to easily dismiss religious concerns as irrelevant to science policy and research regulation. Proponents of this view have argued that there would never be a happy medium between religion and science and, therefore, policy decisions on stem cell research should be primarily guided by scientific considerations. On the other hand, arguments have been raised that the exclusion of religious communities from public deliberations is unjust since it only empowers non-religious groups that share similar values and concerns. In order to discuss further these two fundamental questions relevant to the stem cell debate, I present a brief intercultural perspective on religious arguments regarding the moral status of the human embryo and the ethics of stem cell research. This comparative perspective highlights fundamental differences between the major theological traditions on issues concerning the beginning and sanctity of life.
1.1 The Catholic position on the ethics of hESC research
In framing the public discourse on hESC research, the Religious Right and social conservatives in America have intuitively followed the Vatican’s position that human life begins at conception and that the embryo at all stages of development should be considered morally equivalent to born persons. Although the Roman Catholic Church does not condemn all types of stem cell research, it strongly opposes experimentation with pluripotent stem cells derived from human embryos. There is a widespread misconception that this opposition stems from the belief that embryos are persons. Father Tadeusz Pacholczyk (2008) presents a more nuanced account of the Church’s teachings on this moral dilemma. While the Catholic doctrine admits that there is no definitive answer on the question of whether human being is present at the time of fertilization and that it is false to assume that zygotes or early-stage embryos are persons, it nevertheless teaches that the destruction of human embryos is always immoral. This position was clearly formulated in the Declaration on Procured Abortion (1974) by the Congregation for the Doctrine of Faith:
“This declaration expressly leaves aside the question of the moment when the spiritual soul is infused. There is not a unanimous tradition on this point and authors are as yet in disagreement. For some it dates from the first instant; for others it could not at least precede nidation [implantation in the uterus]. It is not within the competence of science to decide between these two views, because the existence of an immortal soul is not a question in its field. It is a philosophical problem from which our moral affirmation remains independent” (Qtd. in Pacholczyk, 2008, p. 77).
Subsequently, the moral affirmation of the Church regarding the status of the human embryo prescribes that “the human embryo must be treated as if it were already ensouled, even if might not yet be so […] as if it were a person from the moment of conception, even if there exists the probability that it might not yet be so (Pacholczyk, 2008, p.77). In the past, the adoption of this more nuanced view has served to reconcile conflicting perspectives on the precise timing of ensoulment/personhood within the Catholic philosophical tradition. Historically, the prevailing view in Catholicism had been the doctrine of delayed ensoulment or delayed “hominization” (consistent with the Aristotelian belief in ensoulment 40 days after conception), while the notion of immediate ensoulment has gained popularity only from the 1600s onwards. Given that we do not have a certainty as to when exactly God ensouls the human embryo, and we may never resolve this dilemma, it would make sense that the ethical stance of the Church on destruction of early embryos in stem cell research should not be guided by attempts to determine the timing of personhood. Instead, the Catholic doctrine reasons that the human zygote should be considered a human being from the very beginning since it is the only kind of entity upon which God could bestow the gift of an immortal soul. The emphasis is on “the absolute primacy of the value of personhood over all other considerations” and the moral imperative that “the human person, even in his or her most incipient and precursorial installation in the embryonic human being, is to be safeguarded in an absolute and unconditional way” (Pacholczyk, 2008, p. 73).
The Vatican’s position on the use of embryos in biomedical research was initially outlined in a bioethical directive from February 22, 1987 titled Donum Vitae: Instruction on Respect for Human life in Its Origin and on the Dignity of Procreation. Their latest instruction on bioethical issues by the Congregation for the Doctrine of the Faith, Dignitas Personae, issued on December 28, 2008 with the approval of Pope Benedict XVI, reaffirms the moral imperative of treating embryos as if they were persons from the moment of conception, even if there was a possibility that the act of ensoulment has not yet taken place. A fundamental principle defended by this declaration is the affirmation of human dignity from the earliest stages of embryonal development. It is, therefore, asserted that “the human embryo has, from the very beginning, the dignity proper to a person” (Dignitas Personae, 2008). In outlining the Church’s position on the most significant beginning-of-life issues, the document condemns a whole range of embryo technologies such as the cryopreservation of human embryos in IVF, genetic manipulations that could lead to inheritable genetic modification, the use of somatic cell nuclear transfer for both reproductive and research purposes, hybrid embryo research (i.e., the creation of animal/human genetic hybrids), and a number of other biotech procedures dismissed as affronts to human dignity.
Commentators have observed that the new guidelines, which reiterate the Vatican’s condemnation of hESC research, the destruction of embryos in in-vitro fertilization, and emergency contraception (the “morning after pill”) are in some respects more restrictive than Donum Vitae, especially on five issues that had previously remained open to consideration (Allen Jr., 2008, p. 2): First, there is a rather critical perspective on prenatal adoption of frozen embryos, which would permit women and couples to bring other people’s unused IVF embryos to term. Second, the church has advised caution regarding the use of the so-called “altered nuclear transfer” (ANT) method, which scientists have proposed as a morally acceptable alternative for the procurement of hESCs (Hurlbut, 2005). Third, there is an ambiguity in the Church’s position on the “morning after pill” which could affect the practice in Catholic hospitals of offering emergency contraception to rape victims. Fourth, there seems to be a stronger opposition against biomedical research that involves biological materials obtained from aborted fetuses or human embryos. Lastly, the new regulations express a harsher position on therapeutic genetic interventions that can be passed on to subsequent generations than the opinion expressed in by Pope John Paul II in his 1983 speech. Regardless of variations in the Church’s position on the afore-mentioned bioethical issues, the new guidelines have preserved the spirit of Donum Vitae in their focus on beginning-of-life issues and unconditional affirmation of the human embryo’s inviolable dignity from the moment of fertilization.
The Catholic interpretation of the embryo’s moral status stands in stark contrast to moral insight provided by religious traditions such as Judaism, Islam, and some Protestant denominations. While in Judaism and Islam the pre-implantation embryo has a greater moral status than other body tissues and collections of cells, the respect owed to pre-personal life forms by no means contradicts the use of its cells for goals such as healing and saving life, to which the faithful should be committed (Weckerly, 2005). Generally, Jewish and Islamic religious traditions are supportive of hESC research since they place an obligation on seeking out knowledge, which is believed to be an indispensable component of human nature as created by God. Moreover, the acquisition of scientific knowledge is not only regarded as a form of worship, but it is argued that its practical applications should be guided by the imperative to ascertain equity and justice for all of humanity (Al-Hayani, 2008). Below I present major theological principles that have influenced perspectives on hESC research within these two traditions.
1.2 Judaism and hESC Research
In the Jewish religious tradition, most interpreters of the Talmud have established that the human embryo prior to 40 days of gestation is not recognized as an entity with the same moral status as a born person. Instead, the prevailing belief is that the fetus in the very early stages of development lacks “humanity” (Eisenberg, 2007). This position is well-articulated in the testimony given by Rabbi Elliot N. Dorff to the U.S. National Bioethics Commission (NBAC) in 1999 on the issue of the use of spare IVF embryos in stem cell research. He pointed out that “genetic materials outside the uterus have no legal status in Jewish law, for they are not even a part of human being until implanted in a woman’s womb, and even then, during the first forty days of gestation, their status is ‘as if they were simply water’ (Babylonian Talmud)” (Qtd. in Ruse & Pynes, 2003, p. 197).
Four major principles in Jewish theology inform our understanding of the ethics of hESC research (Dorff, 2000). The first principle claims that our bodies ultimately belong to God and that we are obligated to preserve human life and health by taking proper care of them. This belief further entails a moral duty to actively seek and develop new medical treatments and cures. The second is the acceptance of both natural and artificial treatments of illness. In this sense, physicians and healers are seen as the God’s agents in fulfilling the act of healing. The third principle postulates that all humans are created in the image of God and should be valued and respected as such. The last principle that is used to derive an ethical perspective on stem cell research is the realization that humans are not omnipotent, but rather appear to be very limited creatures in comparison to God. What follows from this aspect of human nature is the requirement that our actions do not impose harm on ourselves or the world. Overall, the Jewish tradition teaches a certain epistemological humility and a balanced approach to the pursuit of scientific knowledge and advancements in biomedicine such as embryonic stem cell research.
Due to this strong emphasis on healing in Judaism, it is believed that we have a moral duty to conduct stem cell research on the condition that human beings are not harmed in this process. This imperative to heal, once again, raises the question of the status of human embryos in the early stages of development according to the Jewish law. As Dorff (2000) has indicated in his analysis of authoritative codes and statements of the Oral Tradition, the Talmud determines that the embryo during the first 40 days of gestation is “simply water” and has not acquired the form of a human being until the 41st day, when the gender of the child is already determined. Similarly to the Catholic position, Jewish religious perspectives on fetal development seek scientific evidence that would support Talmudic Rabbis’ observations that early miscarriages looked as “merely water.” Some interpretations extend the 40-day threshold to 56 days of gestation, counted by the Rabbis from the time a woman first misses her menstrual cycle. This interpretation is compatible with scientific knowledge of fetal development since it is now well-known that the fetus does not develop bone structure until 8 weeks of gestation, when it starts to resemble a human being of flesh and bones. Dorff (2000) further argues that the 40-day marker was prominent in Catholicism, with the concept initially developed by Aristotle, and then adopted by Augustine and Aquinas. The notion that the zygote should be viewed as a person was adopted only in 1869 when the Fist Vatican Council attempted to affirm the virgin birth of Jesus Christ by presenting him as a person immediately upon conception by the Holy Spirit. In fact, change in Canon Law did not happen until 1917.
Since Judaism defines the embryo until the 40th day of gestation as “simply water,” it assigns even lesser value to pre-implantation embryos (before the 14th day) used for stem cell derivation. The standing of an embryo situated outside the womb, which has no chance to develop into a human being given the current state of technology, “is at most “simply water” and, therefore, “our respect of such gametes and embryos outside the womb should certainly be superseded by our duty to seek to cure disease” (Dorff, 2000, p. 82). It is important to note that the argument about the embryo outside the womb being less than a person is not derived from the mere fact of its location in a petri dish. In order to procure viable embryonic stem cells, scientists are limited to the use of embryos prior to the development of neural streak around the 14th day of gestation, after which the capacity for differentiation of these stem cells appears to be greatly diminished. The embryo in a petri dish is different from a human being not only because of its location outside the womb and inability for further development in vitro, but also due to “its low level of cell organization, the short period of time that it will remain in this state, and its incapacity to live without further development” (Dorff, 2000, p. 83). For this reason, Judaism asserts that hESC research may bring enormous health benefits without posing any risks to human beings. Furthermore, couples are encouraged to donate their spare IVF embryos to stem cell research, and this is seen as a mitzvah, a commanded act.
1.3 Muslim perspectives on hESC research
The only textual source in Islam that provides guidance on how questions concerning embryonic sanctity and all other aspects of human life should be interpreted and answered is the Quran. The Quran, however, does not provide clear definitions of the terms “embryo” or “fetus” and there is hardly any discussion of specific questions related to scientific experiments. This deficiency is hardly surprising given that the scripture was compiled in the years 646-650 C.E. from sources that had most likely originated at least 200-300 years earlier. Currently, there are disagreements among Muslim jurists and interpreters of the Quran about the precise moment of the fetal development in which the ensoulment of the fetus occurs. The tradition does not help dispel uncertainty and confusion, since there are no Quranic passages that refer to the embryo as a living thing from the moment of conception. Some Islamic scholars have claimed that this lack of clarity regarding the moral status of fetal viability and embryonic sanctity creates significant ethical and legal dilemmas, especially on the contentious issue of abortion, but also on questions concerning ART and embryonic research (Sachedina, 2008). If determining the ethical and legal status of the embryo and the fetus is so hard, than how can we come up with a clear answer as to whether abortion is legal or illegal? Similarly, if there are no ethical and legal reasons to prohibit abortion in general, after what point it should become illegal to abort an embryo or fetus? And, more importantly, does the embryo’s ethico-legal status prohibit its use for stem cell research?
While it remains unclear when exactly the ensoulment of the embryo takes place, Muslim jurists have deducted claims about the embryo’s dignity and legal status from precedents in criminology dealing with destruction of fetuses in abortions and miscarriages (Sachedina, 2008). The prevailing legal view is that the fetus has no independent claim to life outside of the mother’s womb and, subsequently, no personhood and absolute inviolability until it becomes separated from the uterus and capable of surviving on its own. Therefore, abortion rulings in Islamic jurisprudence are not framed in terms of conflicting rights, e.g., the right of the pregnant woman versus the right of the fetus. This view has led to liberal attitudes towards clinical abortion in the Muslim world and wide societal acceptance of ART in most Muslim countries, including a permissive stance towards biomedical research with stem cells derived from frozen supernumerary IVF embryos. For some commentators, the failure of traditional Muslim sources to address critically the sanctity of life in the early stages of embryonic development and the morality of clinical abortion poses additional questions regarding the overall value of human beings in the context of Islam tradition. Sachedina (2008) has argued that the reason for this lack of ethical and philosophical reflection on issues concerning the beginning of life in Islam is that debates in Islamic jurisprudence have focused exclusively on the legal implications of feticide. Moreover, Muslim jurists have applied the sanctity of life principle only to the embryo in the womb, thus leaving the question of the moral standing of embryos that are outside the womb unresolved. The failure to extend this principle to embryos used for the purpose of assisted human reproduction or for biomedical research is indicative of a “total disregard for the embryonic inviolability” in the early stages of development (Sachedina, 2008, p. 92).
The Islamic perspective on the human embryo’s moral status is significantly complicated by the often conflicting rulings and opinions issued by leading Muslim scholars, both Sunni and Shiites. It is impossible to identify a single, unifying position given that the Muslim world is divided into many sects and there are variations in authoritative opinions on the issues of the embryo’s moral status, abortion and stem cell research derived from the teachings of Quran and the Islamic Law (Shariah). Nevertheless, as Weckerly (2005) has claimed, the fetus in the Islamic tradition is perceived as human life only in the late stages of fetal development. More specifically, most commentators within the Sunni tradition have asserted that the ensoulment of the fetus does not occur until the end of 4th month of pregnancy. Similarly, a comparative analysis of verses in both Shiite and Sunni compilations of the tradition by Sachedina (2008) clearly indicates that the event of ensoulment, described as the breathing of the spirit (rūh) into the embryo by an Angel sent by God, had been recorded as taking place either on the 40th, 42ond, or 45th night or after 120 days of gestation. While the developmental stage when the fetus becomes a human being has been identified, it should be noted that the moral-legal implications of the ensoulment have not been addressed by these traditions since “ancient Muslim jurists did not emphasize the distinction between two periods of pregnancy to deduce decisions about the culpability and accruing penalty in the matter of induced abortion” (Sachedina, 2008, p. 97). Some jurists have argued that all three early stages of embryonal development described in the tradition, from a coagulated drop (nutfa) to a blood clot (ʿalaqua) to a lump of flesh (mudgha), are covered in the first 40 days, rather than in the first 120 days of gestation, as outlined in the Bukhārī’s compilation (d. 870), which is considered to be the most authentic collection (Sachedina, 2008). They have also concluded that there is no spirit in the fetus until the end of the 40th day, when the Angel is sent to write the child’s destiny regardless of the particular stage of development. Their account of the embryo’s ensoulment clearly contradicts the position that the fetus attains the identity of a person after the first trimester of pregnancy. Nonetheless, some Shiite traditions have suggested that the beginning of human life could be traced to the very moment of conception and have subsequently ruled out abortion as illicit, even at the earliest stages of gestation (Sachedina, 2008).
The challenges faced by legal Muslim scholars in outlining a coherent ethical and philosophical position on scientific innovations such as hESC research are by no means limited to discrepancies in the interpretative traditions. There are a variety of factors that contribute to the general uncertainty on contested issues in biomedical ethics, with the three most important ones identified by Al-Hayani (2008) as: (1) the lack of a religious hierarchy and a highest religious entity in Islam that would undertake the task of studying and evaluating the theological validity of new discoveries in biomedicine; (2) the significant variance in traditional and cultural practices; and (3) the profound distrust of non-Islamic science within the Muslim world. Defining the Islamic perspective on the moral status of hESC research is additionally complicated by the fact that many Islamic nations have not yet caught up with the most recent scientific innovations in biomedicine. These countries have not yet declared their position on the moral status of pre-implantation IVF embryos and the ethics of hESC research and related technologies such as human cloning, genetic enhancement and inheritable genetic modification.