Embryonic Stem Cells: Expanding the Analysis

In the embryonic stem cell debate bioethicists tend to focus on the morality of using early embryos for research. Yet this is not the only ethical issue relevant to the debate. I will discuss two others that merit consideration.

One issue is related to the nearly unquestioned assumption that stem cell research will generate valuable therapies for patients. Many participants in the public debate seem to expect that embryonic stem cell research will bring imminent cures. Columnist William Safire (2001), for example, predicts that "the stem cell genie . . . will help us lead much healthier, longer lives." Another columnist writes about "the real, live human beings [who] need the possible cures this vital research could provide" (Cohen 2001). A quadriplegic patient criticizes President George W. Bush's decision on grounds that it

will likely sentence me and thousands of others to a lifetime in a wheelchair, those with diabetes to a lifetime of struggle and pain, those with Alzheimer's to dementia and deterioration, and those with Parkinson's to near-certain progressive tremors and death." (Thomas 2001)

It is not unusual to hear scientists make uplifting predictions about the therapeutic benefits their work could yield, especially when they are seeking funds to investigate intriguing research questions. In discussing stem cell research, patient advocates, politicians, and journalists echo and embellish the scientists' predictions. Public enthusiasm for the research endeavor is common in the United States, but in this case the enthusiasm has reached new heights.

No article author in this journal promises definite benefits from research, but no author expresses much caution or skepticism, either. In my view, caution and skepticism are warranted. We know that promising laboratory developments often fail to produce actual treatment advances. A National Institutes of Health report (2001) describes some of the challenges facing scientists attempting to produce clinical interventions using embryonic stem cells. These include the development of methods to direct the differentiation of embryonic stem cells, to control the cells after they are placed in patients, and to keep patients' immune systems from rejecting the cells. As the report warns, "much basic research lies ahead before direct patient application of stem cell therapies is realized."

For many years bioethicists have urged doctors to be truthful in communicating with seriously ill patients. Unrealistic optimism is unethical because it denies patients accurate information about their current and future prospects. Besides compromising their ability to make healthcare decisions, unrealistic optimism about prognosis can prevent patients from attending to important personal matters. Clinicians may intend to help patients by implying that recovery is likely. But the failure to supply an honest explanation is disrespectful to patients as moral agents entitled to know the facts about their situations.

Unrealistic optimism is an ethical problem in communicating about stem cell research as well. When scientists, politicians, or journalists portray stem cell research as rescue medicine for patients, they show disrespect for the people receiving that message. Such portrayals can reinforce patients' and families' hopes for a miracle cure and then exacerbate their disappointment when they realize that clinical applications are years away. Inflated predictions about clinical benefits also risk a loss of public and congressional support if stem cell research fails to generate those benefits quickly.

Stem cell research is just beginning. Many obstacles could emerge to delay and even prevent the development of effective therapies. Treatments are far from guaranteed, and any that do develop are likely to be years away. It is misleading to suggest that stem cells will bring cures, particularly cures for patients now coping with the serious diseases the research targets. Bioethicists should challenge such suggestions and instead stress that actual clinical benefits are possible but highly uncertain.

A second ethical issue concerns the disproportionate emphasis on stem cell research in contemporary health politics. Support for stem cell research is an easy and cheap way for politicians and other public figures to show concern for suffering patients. Meanwhile, millions of...