The question: What is life?
Ballot measure asks voters to consider profound ethical debate.
PHOTO By Odell Mitchell, Jr. Actor Michael J. Fox hugs Senate candidate ClaireMcCaskill after she introduced him Thursday at Monarch Restaurant where he was in town to stump for the Missouri stem cell research ballot initiative
By Matthew Franck
St. Louis Post-Dispatch
Missouri voters are being asked whether an issue before them would kill cloned human embryos or cure the world of disease.
At least that's what they're being asked in the notoriously oversimplified world of political ads, where differing views are presented as polar opposites, and candidates are portrayed as crooks or saints.
In the case of a statewide ballot measure on stem cell research, voters face a tug of war between those who argue for the sanctity of unborn life, and those who hail the promises of potential cures.
But in reality, say ethicists and scientists, the alternatives aren't so clear-cut.
In reality, voters are being asked to apply ancient definitions of life to the outer frontiers of science. They're being asked to supply a moral judgment today on research that won't take place until tomorrow, if it ever takes place at all.
They're being asked to declare certainty on an issue that divides people of the same faith, splitting even those who otherwise lock arms on the issue of abortion.
"I do sympathize with voters at this point in the debate, " said Jesse Reynolds, of the Center for Genetics and Society in California. "In a way, voters are between a rock and a hard place."
All eyes will be on Missouri for the Nov. 7 vote, the first of its kind in the nation. Some say the outcome could provide clues on national voter sentiment on a contentious political divide, perhaps spawning similar referendums in other states. To this point, the legislative battle has largely been confined to Congress and state legislatures. In the case of Illinois and a handful of other states, lawmakers have backed embryonic stem cell research with state funding.
At the core of the debate is the moral status of a cluster of human cells in a petri dish, and whether those cells can rightly be destroyed in the fight against paralysis and cancer.
Fundamental to that question is how voters define life itself, and at what point in the timeline of biological development they believe that living cells become a human being worthy of legal protection.
On its face, the stem cell measure might seem like a simple proposition.
The measure seeks to ensure that any forms of stem cell research that are legal under federal law also would be legal in Missouri.
But voters are being asked to do more than simply preserve the status quo. The measure would negate the state Legislature's ability to ban certain forms of controversial research, such as those involving cloning technology.
The debate over research cloning has eclipsed most all other issues surrounding Amendment 2, pitting anti-abortion groups against many others who oppose abortion, such as Missouri Gov. Matt Blunt.
But the roots of those ethical divisions date back millennia, to the age-old debate fought by religions and philosophers over when life begins.
While some pinpoint human existence at the union of egg and sperm, others say that threshold is crossed only when a fertilized egg is implanted in the womb. Still others point to other developmental milestones, such as the formation of a spinal column, lungs or birth itself.
The Missouri stem cell debate largely takes place on one end of that spectrum of viewpoints. The ballot measure would ban harvesting stem cells from embryos beyond 14 days of development. For the most part, the strongest opponents of the measure believe life begins at conception.
That definition of life -- held by most anti-abortion groups -- offers little ethical wiggle room on issues such as abortion.
But recently, the strictest definitions of human life have butted heads with new technologies. That's been true of certain forms of birth control, such as morning-after pills, which might stop a fertilized egg from implanting in the womb.
In vitro fertilization has raised similar concerns, because it involves fertilizing numerous eggs. Many of those who say life begins at conception say in vitro fertilization is unethical, unless the unused embryos are preserved rather than being discarded.
That explains why thousands are stored indefinitely in freezers. And those concerns also are at the heart of much of the debate over embryonic stem cell research and the Missouri ballot measure.
Currently, the only human embryos used for stem cell research are those left over from fertility clinics. Such research is legal under federal and state law, but federal money can be spent on research only involving stem cells harvested from those embryos.
Supporters of Amendment 2 want to preserve the legality of research on fertility clinic embryos. To do otherwise, they say, is foolish because the frozen embryos will inevitably degrade.
Former Sen. John Danforth, an abortion opponent who is among the lead supporters of the ballot measure, said he backs the research for the simple fact that the cells in question have never been implanted in a woman.
"My thoughts are, no human being who has ever walked this earth has ever not come from a mother, " he said.
But for many of those who believe human beings are formed at conception, using the embryos for research is unacceptable, whether the cells are in a freezer or a womb.
"Protecting human life is more than a matter of geography, " said C. Ben Mitchell, director of the Center for Bioethics and Human Dignity, a Chicago-based anti-abortion group.
Complicating the ethical debate even further is a process called somatic cell nuclear transfer.
For many who oppose using embryos from fertility clinics, the technology offers an alternative source for embryonic stem cells, while avoiding moral pitfalls. But for others, the procedure only fans the flames of controversy surrounding Amendment 2.
In somatic cell nuclear transfer, or SCNT, the nucleus from an adult cell is removed and transplanted into a donor egg that has had its own nucleus removed.
The egg is then shocked or chemically treated to trick it into behaving as if it has been fertilized. It divides and grows into a ball of cells that can be harvested for stem cells or implanted in a womb to produce a baby. Although the process has yet to work in humans, the technique is the same as that used to create Dolly, the cloned sheep, and other animals, including mules, cattle and cats.
There is nearly universal distaste for the idea of allowing a cloned embryo to grow into a human child. Hence, the ballot measure would ban cloning to produce an infant, or even implanting the embryo into a womb.
Many supporters of SCNT say the technique serves two purposes: It provides a source of stem cells tailored to a patient; and, because no sperm fertilizes the egg, there is no "conception."
For that reason, Blunt and other abortion opponents have found it safe to support SCNT, saying that it does not violate their strict definitions of life.
Some say the cells produced by SCNT are morally no different from ordinary skin cells and should be used without hesitation in the fight against disease.
"I don't think personally those are tough calls to make, " said F. Sessions Cole, director of newborn medicine at Washington University.
But for many abortion opponents, SCNT research produces human life as surely as if a sperm and egg were involved.
"I liken it to carrot cake, " said Sen. Matt Bartle, R-Lee's Summit, who led a failed effort in the Legislature to ban SCNT. "I've seen a number of different recipes, but it all tastes like carrot cake to me."
Amid the war of words over cloning and the definition of life, some fear the current political debate on Amendment 2 has eclipsed more subtle ethical questions.
Reynolds' group, the Center for Genetics and Society, supports abortion rights, and has no ethical concerns about the moral status of cells used for embryonic stem cell research.
But the group does raise concerns about the health risks posed to women who might donate eggs for research. The drugs used in egg extraction can have strong side effects, and in rare cases have killed women.
The group also questions whether potential cures -- which would be extremely expensive -- would be accessible to patients regardless of income.
Myra Christopher is head of the Center for Practical Bioethics in Kansas City. The organization takes no position on Amendment 2, but it has circulated 50,000 guides on the ethics of the research, dealing with the issue ranging from egg extraction to the affordability of treatment.
"Our concern is how we make sure that the research is conducted ethically, " she said.
Rebecca Dresser, a professor of law and medical ethics at Washington University, said she's concerned it might be too soon to move ahead with research cloning, given issues such as the risks of egg extraction.
Dresser said she does not personally think the research destroys human life. But she said the cells probably shouldn't be equated with mere skin cells either. She said researchers haven't yet done a good job of defining how the cells should be regarded ethically.
"We should only allow their use in important research, " she said. "It's owed special respect. It's potential human life."
Many opponents of embryonic stem cell research say most, if not all, ethical concerns can be satisfied by limiting research to adult stem cells. Such research extracts stem cells while posing virtually no risk to the donor. And unlike embryonic stem cells, the research has already produced treatments.
But scientists overwhelmingly reject such limits, saying that only embryonic stem cells have the flexibility of becoming almost any kind of human cell, a key to fighting disease. At least for now, they say, the best source for embryonic cells is SCNT.
Others, however, are looking for other alternatives. Even though SCNT has yet to produce a single human stem cell, scientists are already hoping to sidestep ethical issues by working to make the technique obsolete.
Earlier this year, researchers at the Massachusetts research firm Advanced Cell Technology claimed they had developed a method of extracting embryonic stem cells without destroying the embryo. But other scientists have yet to repeat the results, raising questions about the viability of the technique.
In the meantime, new technologies likely won't roll out in time to be of use to Missouri voters who vote in November.
If both sides of debate agree on anything, it's that the grand questions of life and ethics are ones that voters must ultimately answer for themselves.
That's been a message that Steven Teitelbaum, of the Department of Pathology and Immunology at Washington University, has repeatedly carried as he's toured the state offering lectures on the issue.
While Teitelbaum is among the ballot measure's most fervent supporters, he knows his detailed scientific explanations only take voters so far.
"At the end of the day, this is an ethical debate, " he said.
Choose your words
The battle over Amendment 2 has spawned a war of words. Much of the debate focuses on two terms:
Embryo, or embryonic
What opponents of the amendment say: The research involves human embryos, produced either through fertilization or a scientific equivalent. It's deceptive to use any other term but embryonic stem cell research.
What supporters say: The research involves a pinpoint-sized group of cells that have not been implanted in a womb. In some cases the cells were created without sperm. That doesn't fit the popular definition of embryo held by many, if not most, people.
What scientists say: Generally, the broadest definition of an embryo applies to fertilization onward. But some use more restrictive definitions, suggesting that an embryo must be at least 14 days old, or implanted in a womb.
Human cloning, or research cloning
What opponents say: Somatic Cell Nuclear Transfer involves human cloning as surely as the technology produced a cloned sheep. The ballot measure falsely claims to ban human cloning. Terms like "research cloning" merely sanitize the issue.
What supporters say: Among the public, human cloning is understood to mean a cloned infant, which the ballot measure would criminalize. If the term cloning is used at all to refer to stem-cell research, it should be described as research cloning, or therapeutic cloning.
What science says: Science can't resolve the moral question of whether the cloned cells in a petri dish constitute a human. But scientists agree that the process involves cloning at the earliest stages of biological development.
Split within a group
Some abortion opponents back the ballot measure because the cells in question have not been implanted in a mother. Others oppose the measure, saying the issue is "more than a matter of geography."
Some without ethical concerns about the moral status of cells worry that the women who donate eggs for research might not be aware of the health risks that procedure poses.
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