A Modest Proposal

The intense and heated discussion about the clinical use of stem cells and the advisability of embarking on research into all forms of cloning did not begin with President George W. Bush's address to the American people in August 2001. Moreover, it is unlikely that his speech will represent the final word on the topic. This is a good thing, because even though Bush has been a diligent student with many gifted teachers, this issue is something that most people probably did not consider determinative in their selection of a presidential candidate on 7 November 2000.

The depth of feeling engendered by this topic is profound. There are those who see stem cells as a monumental therapeutic opportunity and envision the possibility of treating previously hopeless diseases. On the other hand, many are worried that unrestricted research into stem cells will lead to the abuse of embryos and the upheaval of fundamental human notions about the sanctity of life and selfhood. As a physician I am struck at the lofty claims made by the advocates for stem cells, because I would have thought that experience had taught doctors that no treatment ever proves to be as good as it is initially hoped to be. At the same time, as a person I am impressed by the depth of feeling and the unexpected nature of people's responses. For example, witness a recent column by Peters and Bennett in The Scientist (2001), in which as theologians they adopt a stance in opposition to Pope John Paul II and advocate research into stem cells based upon the principle of beneficence. Much of the discussion has been articulate and wise. This makes it hard not to pay attention to the council of individuals like Leon Kass who have argued eloquently about the repugnance of cloning.

Zoloth (2002), Maienschein (2002), and Green (2002) underscore the uncertainties that surround the use of embryos and scientific investigations into stem cells. Maienschein's and Green's conclusions suggest that it may prove impossible to make meaningful distinctions that can withstand scrutiny in a court of law or religious practice. The risks and benefits range between the two extremes of human activity--unlicensed murder and healing the sick. How is one to reconcile these views in a coherent approach to this problem?

The American discussion of stem cells, like so many other topics in bioethics, always becomes unhinged when it confronts the problem of reconciling the numerous values and attitudes expressed about the topic in our multicultural society. Thus, it quickly becomes an insurmountable task to devise a solution that will satisfy those who view research with embryos as tantamount to murder and those who have a loved one who is suffering from a disease that may be alleviated by the clinical use of stem cells. Who is right and who has the right to decide?

I suggest that the standard way of viewing how to handle monumental new developments such as the therapeutic use of stem cells neglects a major organizing principle in our country, namely, an established tradition of democracy. The United States has never had and never will have a set of ethical rules that is equally binding on all people. Although most Americans share a number of core values about medical treatment, there is a wide divergence on a number of life-and-death problems. Therefore, the national modus vivendi has generally been framed by Isaiah Berlin's concept of negative liberty; that is, people should be free to pursue their goals and aspirations without restrictions provided they do not impinge on the rights of their fellow citizens.

The use of stem cells strikes me as a problem that cannot be solved to the satisfaction of all Americans based upon a decision issued from on high. The U.S. Supreme Court is only authorized to interpret the U.S. Constitution. The issues that swirl about the use of stem cells are not covered by that document...