Undifferentiated human embryonic stem cells photo:courtesy University of Wisconsin-Madison

If and when stem-cell research breakthroughs begin to have a significant impact on the amelioration of disease, the ownership and availability of frozen embryos may become an even greater concern.

n ancient Bedouin parable suggests that if you let a camel stick his nose in your tent, before long, the whole camel will be in the tent. The phrase "the camel's nose" is another name for the usually fallacious reasoning known as "the slippery slope," in which one event is deemed to lead inevitably to another. With President George W. Bush's decision in August to allow the limited use of embryonic stem cells in federally funded research, the phrase "slippery slope" was in common use in academe. Scholars and scientists weighed in on the president's decision from a variety of angles--medical, ethical, religious, political, legal, and commercial.

At the heart of the debate is a complex maze of questions. Do embryos created for in vitro fertilization have the same moral and legal status as persons before they are implanted in the womb, or are they the property of the parents? Do the potential benefits of curing debilitating disease outweigh the cost of destroying these human embryos to obtain their stem cells? What is the appropriate federal role in setting the boundaries of research on human subjects? Do embryonic stem cells really hold the immediate promise for the cure of chronic disease that has been reported in the press?

Embryonic stem cells were isolated and grown in culture for the first time in 1998 by James Thompson, a developmental biologist at the University of Wisconsin. Thompson derived the cells from four- to five-day-old embryos, known as blastocysts. Stem cells--which are also present in adult tissues--have the capacity to grow into almost any specialized cell in the human body, such as heart, brain, liver, or pancreas. Thus, the potential use of stem cells to repair or replace diseased or damaged organs and tissues has become a subject of intense interest in the medical community and to patients suffering from diseases ranging from Parkinson's to diabetes to Alzheimer's.

Because stem cells found in the early-stage human embryo are believed by many researchers to have a greater ability to transform themselves into many more types of specialized cells than stem cells derived from adult tissues, the National Institutes of Health requested an opinion from the Clinton administration's Department of Health and Human Services soon after the Wisconsin breakthrough. NIH wanted to know whether federal funds could be used to support research on human stem cells derived from embryos or fetal tissue. (The Wisconsin research and similar research at Johns Hopkins University had been privately funded by the Geron Corporation of California: Thompson, the biologist, extracted the stem cells from embryos left over from an in vitro fertilization, or IVF, procedure, embryos that had been donated by couples who underwent IVF.)

The opinion rendered by Health and Human Services general counsel Harriet Rabb argued that the existing statutory ban on human-embryo research defines an embryo as an organism. Because human stem cells, once removed from the embryo, cannot develop into an organism, even if transplanted into a uterus, Rabb held that NIH could support research on embryonic stem cells but could not, under current law, fund research that actually harvests stem cells from embryos and thus destroys the embryos. The implicit presumption, then, is that federally funded researchers would have to obtain stem cells from private sources that have no restrictions on the destruction of embryos--the first of many slippery slopes.

As might be expected, this ruling by the Clinton administration did not sit well with some members of Congress. In the presidential campaign, George W. Bush took a stand against government financing of embryonic stem-cell research, yet he was in office for eight months before issuing his surprise ruling to limit federally funded research to sixty-some existing stem cell lines already derived from human embryos and that are purportedly self-sustaining.

“I believe that embryonic stem cells will not ultimately be neccssary. Eventually, we'll only need the DNA.” —Joanne Kurtzberg Director of Duke's Pediatric Stem-Cell Transplant Program

Researchers who had feared an outright ban from Bush were relieved. Others argued that the president's restrictions were too severe, and they questioned the viability of the sixty lines of cells that Bush claimed were already available to researchers. Still others considered the Bush decision only a short-term response to a much larger issue--namely, the absence of any comprehensive federal law regulating the parameters of medical experimentation on children or adults, whether that research is publicly funded or not.

The potential of stem-cell research to crack open new avenues for the cure of chronic, debilitating disease caused even some of the staunchest opponents of abortion--such as Utah Senator Orrin Hatch and Tennessee Senator Bill Frist, a physician--to push the president toward his compromise decision. And already advocates of the research from both the anti-abortion-rights and pro-choice sides of the abortion issue are hoping that Congress will open the field beyond the sixty stem-cell lines.

Amy Laura Hall, assistant professor of theological ethics at Duke Divinity School, is deeply troubled by the Bush decision to approve even the limited use of embryonic stem cells. "We have crossed a significant moral boundary without a sense of transgression and moral responsibility," she says. "While these are cells, they are not mere cells."

“We have crossed a significant boundary without a sense of transgression and moral responsibility. While these are cells, they are not mere cells.” —AMY LAURA HALL Assistant professor of theological ethics Duke Divinity Schools

Hall recently spoke to a group assembled by Duke's Center for the Study of Medical Ethics and Humanities. In the same way that communion wine to a Catholic is not mere wine, nor is the soil of Israel mere dirt to a Jew, Hall argued, so too must we be encouraged to see the human blastocyst from which stem cells are extracted as more than a clump of cells. Hall, who is not a strict opponent of abortion, suggests that we must nevertheless recognize the blastocyst as nascent life and therefore sacred.

"Which worries your average 'pro-life' senator more?" Hall asks. "The thought of women ending embryonic life, or the thought of a male-dominated, multi-million-dollar pharmaceutical industry using human embryos for research? It should come as little surprise that some supposedly pro-life leaders are making an exception on the issue."

Kathleen Joyce, a historian in the department of religion, sees the situation differently. "The stem-cell debate is not converting or changing anyone's idea of where life begins," she says, "but advocates of the Bush policy are saying that the evil [destruction of the embryos to extract the stem cells] has already been done, and we can make use of it. Stem-cell research can be life-giving."

The technological capacity to keep human embryos in storage indefinitely has preceded the full consideration of the legal ramifications of the warehousing of frozen clusters of human cells or whose property they might be. Doriane Lambelet Coleman, who teaches a course on genetics, genomics, and the law at Duke Law School, points out that "each clinic has its own protocols, individual state laws differ, and some clinics don't discard unused embryos even if the parents ask them to." She also points to a recent divorce case in Tennessee where the "custody" of these frozen embryos has even been contested.

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