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Health Care Ethics USA The Missing Link in the Public Policies on Human Embryo Research Early embryos are proving to be valuable subjects of genetic engineering research in recent years. Stem cells extracted from these embryos are said to be the best and perhaps hold the key to providing several therapies to millions of people afflicted with lethal and dreaded diseases. Yet, because the research has a tendency to endanger or destroy the fragile embryonic life, establishing public policies to guide such research has been difficult and controversial. Since 1996, the appropriation bills of the Department of Health and Human Services have banned federal funding of research in which embryos are destroyed, discarded or knowingly subjected to risk or injury. Yet, on August 23, 2000, the National Institute of Health released its guidelines permitting scientists using public grants to research on human embryonic stem cells (ESC) derived without federal funds. The guidelines required the stem cells to be derived from excess embryos that were originally created in the course of infertility treatment, derived with informed consent of donors, and without any financial inducements to the donors.1 On August 9, 2001, President George W. Bush, in a televised speech, announced new guidelines for ESC research, limiting federal funding for ESC research. Under the guidelines, ESC must be derived with informed consent of donors, from excess embryos created solely for reproductive purposes, without any financial inducements to the donors, and must have been created prior to the time of the announcement. Approximately 64 cell lines potentially meet such criteria. Some members of the Congress are proposing introducing legislation to expand ESC research, despite the President’s veto threat. These guidelines, of course, received mixed reactions from proponents and opponents of ESC research hailing or denouncing the guidelines. The approval or disapproval of embryo research is usually influenced by one’s view of the status of the embryo because what we think of the human embryo determines what we may do to it, especially in terms of research. These guidelines and legislation often attempt to find a quick solution to the immediate concern rather than address the root of the controversies associated with the issue, i.e., determining the status of early embryos and what kind of protection they are entitled. This varied approach to issues arising from scientific research involving early embryos could result in inconsistent policies. As a result, there is a need for a coordinated approach to issues involving human embryo research. Principles The relevant principles applicable to the discussion are the principles of the sanctity of life and beneficence. There is an apparent conflict between these two principles when used in the context of human embryo research. Opponents of non-therapeutic embryo research apply the principle of the sanctity of life to fortify their position while proponents of non-therapeutic embryo research rely on a burden/benefit analysis of the principle of beneficence. The primary concern about non-therapeutic embryo research, such as ESC research, is that the research in most cases involves the destruction of the embryos. The principle of sanctity of life underlies the concern expressed by opponents of non-therapeutic embryo research. They resist the manipulation and destruction of what might be a human person because for them, there is no justification to engage in research that destroys human life. Opponents further contend that the medical benefits, which might accrue for some patients from non-therapeutic research such as ESC research, do not outweigh the grave consequences for the embryo, which is killed in order to procure stem cells for medical therapy. They argue that an early embryo is a human being because it contains a complete genome and all that is needed to develop into an adult human being.2 Thus, opponents contend we must not end one human life in an attempt to benefit another because it is absolutely forbidden to directly destroy an innocent human life in order to help another.3 On the other hand, proponents of ESC research relying on burden/benefit ratio focus on the potential benefits of the research. They argue that the research will yield therapies that will ease the suffering of millions inflicted with debilitating diseases such as Alzheimer’s, Parkinson’s, heart failure, liver failure, cancer, and diabetes. Proponents tend to minimize the destruction of the embryos and usually argue that the potential therapeutic benefits far outweigh the harm to the embryo. They argue that it is justifiable to modify or destroy certain human embryos in the pursuit of cures for dreaded and lethal diseases.4 Discussion The differences in the debate regarding non-therapeutic embryo research usually boils down to the differences in the respective parties’ views on the moral status of the embryo. The moral status of an embryo continues to be an enigma in moral, legal, and policy discussions. Views on the moral status vary, ranging from one end of a spectrum to the other. Some view early embryos as mere tissues or cellular material, which demands little, if anything, of us morally.5 Some view the embryo as a living being with potential to develop into a full human being, and as such, deserve the same moral status as a human being. The Roman Catholic Church is among those who adopt a protective stance towards embryos. In Donum Vitae of 1987, the Catholic Church asserted that the embryo must be treated with the respect due a person from the very instant of his or her existence. Thus, no objective can justify non-therapeutic experimentation on living human embryos or fetuses, whether viable or not, either inside or outside the mother’s womb.6 Also, in Evangelium Vitae of 1995, Pope John Paul II addressed the status of early embryos and essentially affirmed the teachings of Donum Vitae.7 The Catholic Church’s view is grounded in its moral teaching which views human life as a continuum. The Church views all human beings from conception onwards as being made in the image and likeness of God and as meriting the same respect for their fundamental right to life. However, some scholars view early embryos as neither mere tissues entitled to no protection nor persons entitled to full moral protection. These scholars usually agree that an early embryo is a form of human life that deserves a respect commensurate with its progressive development. Proponents of this view base their argument on physiological evidence and philosophical reasoning. They argue that early embryos are not to be treated with respect due a person because at such an early stage in the development of the embryo, such life is not genuinely individuated in the morally required sense. For them, the early embryo though human, living, and genetically unique, is really not yet an individual in the sense in which persons are necessarily individuals. They note that these early embryos could split and/or recombine until individuation. Individuation is typically claimed to occur about fourteen days following fertilization or conception with the appearance on the embryo of the primitive streak, which indicates a decisive moment of cellular differentiation or restriction. Thus, while acknowledging that these early creatures deserve some moral protection, they would not accord them full moral protection prior to their individuation.8 There is a high degree of polarization in the debate regarding the status of early embryos. The majority of the participants in the debate agree that early embryos have intrinsic worth and are not just mere tissues. An early embryo is a form of human life at the initial stage of human development. As such, the fragile embryonic life needs to be protected. However, the disagreement stems from the amount of protection that is due to the embryos. The debate rages on regarding the status of the embryo. The debate permeates the entire spectrum of society and recently ESC research has catapulted the issue, via the media, to the larger community. Thus, the issue of the status of the embryo is not just an important issue in medical ethics, but it is also an important issue to society as a whole. It is an important question in ethics, law and politics that has significant practical implications, not only for non-therapeutic embryo research, but also for other issues regarding the embryos such as the disposition of excess frozen embryos from in vitro fertilization and cloning of human embryos. Unfortunately, the different views on the status of the embryo continue to divide participants in the debates and the gap does not appear to be closing. The lack of consensus invariably impacts the ability to enunciate public policies dealing with human embryos. As the debate goes on, there is a need to have a coordinated public policy approach, perhaps by enacting comprehensive legislation that will address both present and future issues regarding human embryos. There is a need to establish a broad based public panel to examine the social, ethical and legal implications of recent and potential developments regarding human embryo research. The panel would be charged to provide a broad and flexible regulatory framework using general propositions and terms, which allow for current and future issues to be addressed as they arise. A comprehensive national legislation would help curtail court battles, inconsistent executive guidelines, and ad hoc legislation, which leave the society in disarray. Congressional legislation influenced by the panel’s careful report is preferable to executive guidelines or court decisions in this instance. Executive guidelines most likely will be dependent on whoever is in charge of the executive branch of the government and this could potentially lead to inconsistencies. Furthermore, the courts are not well equipped to deal with the issue concerning embryos. Human embryos do not enjoy the constitutional rights of a person. Roe v. Wade, decided on the ground of a woman’s right to terminate an unwanted pregnancy as an exercise of her right of privacy, would not be helpful because the embryos in question are ex utero. Procreative autonomy, which includes the rights to procreate or not to procreate, does not fully help in addressing all the issues involved. The issues involved are vast and significant. Courts’ decisions are likely to be limited to the issue(s) before them because courts in the United States do not issue advisory opinions. Therefore, neither court decisions nor executive guidelines seem to be the adequate forum for resolving the issues. Conclusion The United States, unlike England and Australia, lacks a uniform approach to dealing with issues concerning early embryos. Issues such as ESC research, cloning of human embryos and disposition of frozen embryo continues to divide the nation. These issues are being addressed by the three branches of the government without an underlying comprehensive framework. As the nation’s health focus shifts away from issues such as healthcare reform, cloning and stem cells, to national security and bioterrorism, Congress may take the opportunity to set a panel to provide a comprehensive framework which will influence legislation dealing with human embryo research and related issues such as the disposition of excess frozen embryos from in vitro fertilization and the cloning of human embryo. Congressional legislation providing a comprehensive framework will definitely provide the missing link to the public policies dealing with issues concerning human embryos. 
Martin U. Onwu, JD
Suggested Readings Lisa S. Cahill, “Stem cells: A bioethical balancing act,” America (March 26, 2001):14-19. T. A. Shannon and A. B. Wolter, “Reflections on the moral status of the pre-embryo,” Theological Studies 51(1990): 603-626. Questions for Discussion
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