 |
 |
|
Health Care Ethics USA The Relevance of the Principle of Cooperation for the Ethical
Human Embryonic stem cell ("hES") research is one of the greatest controversies in medical ethics in recent times. The controversy followed the announcement in the fall of 1998 by two groups of scientists who had successfully isolated and cultured self-renewing embryonic stem cells.1 Since then, the ethics debate of hES research has flared. The debate focuses on the source of the stem cells insofar as hES research involves the use of immortalized cell lines created from stem cells isolated from early embryos. The extraction of stem cells from the early embryos results in their destruction. Many of the ethical challenges posed by hES research and therapies would disappear if non-embryonic cell sources are developed or if the extraction of the stem cells does not result in the death of the developing human embryos. Since such other sources or methods have proven elusive thus far, the issues surrounding hES research and its potential therapies will continue to elicit debate on ethics and public policy. Those who support hES research, relying on the principle of beneficence, argue that it is justifiable to modify or destroy early human embryos in the pursuit of treatments or cures for serious diseases. Proponents, relying to some extent on consequentialist/utilitarian considerations, argue that hES research is justified because the research will yield medical therapies for most in the society.2 In contrast, opponents of hES research, relying on deontological theory, argue against the instrumentalization of human embryos by using them as a means to find cures for others suffering from diseases. In addition, opponents, relying on natural law principles, argue that the medical benefits derived from hES research do not justify destroying the embryos involved.3 Underlying the differences in the debate is each participant's views on the moral status of the embryo. Some view early embryos as mere tissues or cellular material, which demands little, if anything, morally. In contrast, others view the developing embryo as a personal living being that warrants the same moral status as a developed human being. Some appear to adopt a posture between these two stances, viewing the early embryos as neither mere tissues entitled to no protection nor persons yet entitled to full moral protection. While recognizing that the polarized debate on the moral status of the early human embryo will not disappear, it is nonetheless important to seek some common ground for science and medicine in the public arena. Hence, there is a need to include in the debate on hES research a broader range of considerations to help address the stalemate between those who support and those who oppose this research. The moral principle of cooperation offers a helpful approach to find such common ground for science and medicine for hES research and therapies. The principle draws a basic distinction between formally cooperating with the evil actions of others (which is not permitted) and materially cooperating with the evil action of others (which can be permitted in particular circumstances). The principle's success in resolving other public moral dilemmas suggests that it possibly can be an effective principle for this debate. For instance, the principle was effective in resolving the public debate on the use of vaccines originating from immortalized cell lines created from aborted fetal tissues. Using the vaccines entails a material connection with previous abortion via the immortalized cell lines obtained from aborted fetal tissue. But using these vaccines is not morally complicit with the previous abortion because the use is distinct from the original abortion and there is a sufficient distance between the different acts. Given the medical benefits that such vaccines yield, there is proportionate reason to justify their use.4 Similarly, vaccine research is materially connected to previous abortions via the immortalized cell lines obtained from aborted fetal tissues. But such research is not necessarily morally complicit with the previous abortions. Likewise, the principle of cooperation may be well suited to address the issue of hES research and therapies. Because the principle of cooperation is a conflict principle, its use assumes the antecedent respect for human life at the earliest stage of development. It is because of the conflict between such respect and the pursuit of problematic research and therapies that the principle can be helpful. But using the principle does not justify any form of medical research in this new field. For example, the principle cannot justify therapeutic cloning which entails the creation of embryos via nuclear transfer method and their subsequent destruction via the extraction of stem cells; moreover, the principle of cooperation cannot justify the creation of embryos for research. However, the future use of potential hES therapies, utilizing immortalized cell lines created from stem cells extracted from human embryos (despite their unavoidable destruction in the process) in principle may possibly be justified under the principle of cooperation. Such potential therapies would have a material connection to the previous wrongdoing of extracting immortalized cell lines created from embryonic stem cells that involved destroying embryos. But such therapies would not necessarily make the user complicit in the previous destruction of embryos insofar as the use of therapies would be distinct from the act of destruction and there would appear to be a sufficient distance between the different acts. Given the medical benefits that such therapies would yield, there might be proportionate reason to justify the use of such controversial future therapies. Similarly, hES research can possibly be materially connected to the underlying wrongdoing of the destruction of the embryos via extracting immortalized cell lines. But such research is not necessarily morally complicit with the previous wrongdoing. The research on the immortalized cell lines for cures and treatments for severe diseases must be distinct from the previous wrongdoing, and there must be a sufficient distance between the different acts. Given the potential medical benefits, there can be sufficient reason to consider justifying the use of the immortalized cell lines for such research. While this essay argues that in principle hES research and therapies may be ethically justified using the principle of cooperation, the pursuit of such research and therapies in Catholic health care facilities would need to consider further practicalities and circumstances.5 Moreover, the success of non-embryonic stem cell therapies would have significant ethical implications for the development of hES therapies. Specifically, the availability of effective non-embryonic therapies or immortalized cell lines for research would challenge whether the above reasons adduced for hES research and therapies is proportionate. Many researchers argue that both embryonic stem cell and adult stem cell research are necessary and neither should be restricted. But the problem of such a sweeping approach is that for many, respect for developing human life should not be sacrificed to discover cures or to alleviate human suffering and disease. For those who want to respect human life from its inception and also pursue hES research and therapies, the ethical principle of cooperation can provide guidance for both the personal and the public domain. That is, the principle can guide both personal decisions and public policies in the continuing debate on hES research. Perhaps the most urgent use of the principle of cooperation for emerging research and therapies pertains to designing astute public policies that seek to respect personal belief perspectives and also to foster medical breakthroughs for the public interest. 
Martin U. Onwu, J.D., Ph. D., Washington, DC* *Martin U. Onwu is an Assistant General Counsel, United States Department of Justice, Office of Community Oriented Policing Services, in Washington DC. The views expressed in this article do not necessarily represent the view of the United States Department of Justice or the United States. Suggested Readings James F. Keenan, "Prophylactics, Toleration, and Cooperation: Contemporary Problems and Traditional Principles," International Philosophical Quarterly XXIX, 2, no. 114 (June 1989): 205-220. The President's Council on Bioethics, Monitoring Stem Cell Research (Washington, D.C., January 2004). www.bioethics.gov
|
|
 |