The Ethics of Moral Compromise for Stem Cell Research Policy

ORI GIN AL ARTICLE

The Ethics of Moral Compromise for Stem CellResearch Policy

Zubin Master • G. K. D. Crozier

Published online: 12 April 2011

� Springer Science+Business Media, LLC 2011

Abstract In the US, stem cell research is at a moral impasse—many see this

research as ethically mandated due to its potential for ameliorating major diseases,

while others see this research as ethically impermissible because it typically

involves the destruction of embryos and use of ova from women. Because their

creation does not require embryos or ova, induced pluripotent stem cells offer the

most promising path for addressing the main ethical objections to stem cell

research; however, this technology is still in development. In order for scientists to

advance induced pluripotent stem cell research to a point of translational readiness,

they must continue to use ova and embryos in the interim. How then are we to

ethically move forward with stem cell research? We argue that there is personal

integrity and value in adopting a ‘moral compromise’ as a means for moving past

the moral impasse in stem cell research. In a moral compromise, each party con-

cedes part of their desired outcome in order to engage in a process that respects the

values and desires of all parties equitably. Whereas some contend that moral

compromise in stem cell research necessarily involves self-contradiction or loss of

personal integrity, we argue that in the US context, stem cell research satisfies many

of the key pre-conditions of an effective moral compromise. To illustrate our point,

we offer a model solution wherein eggs and embryos are temporarily used until non-

egg and non-embryonic sources of pluripotent stem cells are developed to a state of

translational readiness.

Z. Master (&)

Health Law Institute, Rm 462, Law Centre, University of Alberta, 89 Avenue and 111 Street,

Edmonton, AB T6G 2H5, Canada

e-mail: [email protected]

G. K. D. Crozier

Department of Philosophy, Laurentian University, 935 Ramsey Lake Road, Sudbury,

ON P3E 2C6, Canada

e-mail: [email protected]

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Health Care Anal (2012) 20:50–65

DOI 10.1007/s10728-011-0171-2

Keywords Moral compromise � Stem cell research � Stem cell policy � Embryo �Moral status � Women’s health

AbbreviationsANT Altered nuclear transfer

hESC Human embryonic stem cell

iPSC Induced pluripotent stem cell

SCR Stem cell research

Introduction

The debates on the moral legitimacy of pluripotent stem cell research (SCR) have

focused on two central moral concerns: the moral status of human embryos and their

destruction for research, and the potential harms to women who provide ova to

create embryos for SCR. Several technological proposals have been developed that

aim to circumvent these moral issues by obtaining pluripotent stem cells without

destroying embryos or by creating pluripotent stem cells from embryo-like entities

that are (allegedly) devoid of moral status. In addition, several scientific methods

have been developed that attempt to employ ova from sources other than women for

research.

In this paper, we analyze many of these scientific proposals to derive stem cells

and conclude that most of them are not scientifically feasible and/or violate other

moral norms. Arguably, methods for inducing pluripotency of a patient’s own cells,

which do not require the use of ova from women or embryos, can address the two

central moral concerns surrounding the derivation of pluripotent stem cells.

However, current research proposals for inducing pluripotency still require the

continued use of both embryos and ova in order to bring these techniques to a state

of translational readiness.

The novel argument presented here is that a ‘moral compromise’ in SCR—in

both outcome and process—is an objective that is morally worthy and can preserve

personal integrity. A moral compromise requires all parties to acknowledge the

limitations of their values and reciprocally concede desired outcomes by accom-

modating some of the values and desires of opposing parties. We sketch a possible

moral compromise for SCR and describe how it can be applied to current US policy

and funding for SCR.

Destruction of Embryos and Harms to Women

There is richness in the diversity of views on the moral status of human embryos and

the potential physical and social harms to women ova providers. These beliefs

strongly influence the positions taken on whether ova and embryos can be used for

SCR [18]. Although some scholars have attempted to neatly link certain beliefs on

Health Care Anal (2012) 20:50–65 51

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moral status and harms to women with particular desires regarding SCR policy

choices [15, 24, 27, 55, 58, 59], there is no simple calculus for this. Nevertheless, for

the purposes of discussing a moral compromise on these two ethical issues, we

highlight the diversity of views on the moral status of human embryos and the

physical and social harms to women, and how these relate to choices on SCR policy.

The views on moral status include the position that: (a) embryos at the moment of

conception have moral status equal to persons [11]; (b) the moral status of an entity

stems from its potential for experiencing a life like ours [43]; (c) moral status is tied

to cognitive capacities such as consciousness or sentience [6, 68], the capacity to

feel joy, pain and other emotions, or the capacity to have interests and desires [23];

and (d) embryos are sacred or have symbolic weight deserving of respect [21, 55,

57, 58]. In general, those who believe embryos are sacred, persons, or perhaps

potential persons, would desire banning any SCR involving the destruction of

embryos. Those who believe that moral status requires entities to possess higher

cognitive capacities and interests, or that embryos are symbolically important,

would accept embryo destruction for SCR. Alternatively, those that believe that

embryos or embryo-like entities are symbolically monumental could also demand

the protection of embryos from destruction [47].

The policy positions accepted by individuals also considers their views on the

physical and social harms to egg donors relative to the benefits of SCR for society.

Physical risks include (a) those associated with ovarian stimulation, including

ovarian hyperstimulation syndrome, abdominal pain, fatigue, mood changes,

strokes, renal failure, heart attacks and possibly ovarian or uterine cancer and

(b) those associated with the surgical retrieval of ova such as bleeding and

hemorrhage, pelvic injury, and infection [24, 48]. The social risks to women ova

providers include exploitation and undue influence due to substantive compensation

(financial or other) [3] and gratitude for services towards physicians [34], both of

which may undermine the ability of some women to provide voluntary informed

consent. A marginalized population of women may fall victims to such exploitation,

especially in nations where the provisions on research ethics are less stringent and

where poverty is more pronounced [20, 67]. Additional concerns may arise

regarding the commodification of women’s reproductive resources that is implicit in

the provisioning of ova for SCR [69]. Furthermore, ethical issues arise in relation to

genetic privacy since immortal hESC lines derived from embryos contains the

genetic information of gamete donors [32]. Concern such as these have led many

scholars to advocate a ban on payments to egg and embryo donors for SCR.

Thus the diversity of views on moral status and the potential physical and social

harms to women create a range of policy choices for SCR including the payment

versus reasonable compensation of ova and embryo providers; the use of surplus or

excess embryos; or the creation of embryos for SCR.

Alternatives to Eggs and Embryos

Several alternative ways to derive pluripotent stem cells have been developed to

circumvent, in part, one or both of the above ethical issues by: (a) using molecular

52 Health Care Anal (2012) 20:50–65

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techniques to derive stem cells without destroying embryos; (b) manipulating ova to

prematurely halt development; and (c) using non-human animal sources of ova or

ova created from the differentiation of human embryonic stem cells (hESCs). Many

bioethics scholars have questioned whether these alternatives truly solve the above

ethical issues.

The blastocyst transfer method [41] and blastomere biopsy [10, 39] aim to use

some cells from embryos to derive pluripotent stem cells while the remainder is

transferred into women. However, the cells used to derive stem cells may

themselves be totipotent and could become a new individual (an identical twin of

the embryo) [19]. In addition, these micromanipulative techniques could impose

considerable physical damage to embryos and are unlikely to be used by parents to

create children [45]. Furthermore, they fail to recognize the potential harms to ova

providers.

A second technique called altered nuclear transfer (ANT) uses nuclear transfer

technology to create an entity with a known genetic defect that prevents normal

development [36]. Defenders of ANT claim that such entities are non-embryos and

can be used for research. It is unclear whether entities created by ANT are not

embryos in a morally significant sense despite their superficial classification and

even if they are not embryos, it doesn’t necessarily morally justify their destruction

[16, 29, 50]. Lastly, the creation of entities by ANT fails to recognize the physical

and social harms on women.

The third technique aims to use animal ova [7, 31, 52] or ova differentiated from

hESCs [46, 65] to circumvent the shortage of human eggs needed for SCR and

research cloning. There are reasons to doubt the efficacy of human-animal cybrid

research (i.e., interspecies somatic cell nuclear transfer) to resolve social justice

concerns arising from the demand for ova because stem cells derived from cybrids

may not be effective for regenerative medicine due to cross-species differences in

either gene expression [9] or energy production by the stem cells [60]. In addition,

the generation of pluripotent stem cells from cybrid embryos risks carrying cross-

species contamination and may result in moral confusion in regards to an entity that

is part human and part non-human animal [1]. Furthermore, this technique may

require the sacrifice of non-human animals in order to obtain large numbers of ova

needed for interspecies somatic cell nuclear transfer experiments which raises

significant concerns regarding animal welfare [2]. It is likely that those who support

minimizing or eliminating the use of non-human animals in research would have

good reason to question this technique. The creation of hESC-derived gametes is

only a theoretical possibility and at this time is not a substitute for using ova from

women donors as several scientific uncertainties remain [42].

In addition to the scientific and clinical effectiveness, and the ethical qualms

associated with these alternative techniques at deriving hESCs, there is also doubt in

their feasibility for clinical translation based on the costs associated with the need of

rapid and effective cell processing of large numbers of unique samples especially if

their creation involves somatic cell nuclear transfer [28, 44]. The high costs

associated with the creation of hESCs that are personalized to individuals using

somatic cell nuclear transfer technology raises questions of justice regarding who

would be able to afford such therapies [22].


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Pluripotent Stem Cells from Non-Embryonic and Non-Egg Sources

We and others have argued that the aforementioned techniques fail to resolve the

ethical challenges related to the destruction of human embryos and the potential

harms to women. We contend that to fully circumvent these two ethical issues,

pluripotent stem cells should be derived from non-embryonic and non-egg sources.

Although scientific obstacles persist, this feat could be accomplished using different

strategies to induce pluripotency of patients’ own cells.

The first method induces pluripotency of differentiated cells through fusion with

hESCs resulting in a tetraploid hybrid cell [13]. Yet scientific issues including

cytotoxicity, immunogenicity, tetraploidy, and possible tumorigenecity post-trans-

plantation remain [62] as well as moral concerns with the use of hESCs since they

are originally products of embryos.

A second theoretical scientific alternative to creating patient-specific pluripotent

cells may be to transfer the nucleus of a somatic cell into an enucleated hESC or to

inject cytoplasm from hESCs or human ova into differentiated cells. Although

nuclear transfer experiments have been performed using ova, the ovum is the largest

cell of the body making transfer technically possible. Microinjection into cells

would be technically challenging requiring the development of more sophisticated

microsurgical techniques. This technique also uses hESCs and possibly ova.

A third method to induce pluripotency that received the most attention is the

overexpression of key genes into differentiated cells [63]. Originally there were

concerns with using viral-based vectors for overexpression, since then, viral free

techniques, the addition of exogenous factors and modified culture medium have

been used to generate these induced pluripotent stem cells (iPSCs) [35, 70, 72].

There are several issues with overexpression of genes such as their integration into

key genes and if misregulated could cause abnormal cellular processes, i.e., cancer.

Upon surpassing many of the technical hurdles associated with iPSCs, it has been

suggested that personalized regenerative medicine using iPSCs is likely to be low

tech, low cost, and easy to implement in a clinical setting [33]. That is, although the

creation of iPSCs would still require the production of individualized, high quality

cell culturing, this would be less costly than the generation of individually cloned

hESCs through somatic cell nuclear transfer.

Although iPSCs have been heralded as free of moral concern [26, 51, 56], these

techniques still require further scientific investigation prior to being substitutes for

hESCs [37]. It is also noteworthy that there are different ethical concerns

associated with iPSCs, beyond the moral status of embryos and harms to women,

including the procurement of cells, clinical translation, intellectual property,

genetic privacy, informed consent and withdrawal from consent, and conflicts of

interest [61, 71]. At present, both hESCs and iPSCs should be used in order to

further understand fundamental cellular processes, the surgical/medical risks

associated with transplantation, inappropriate stem cell behaviors post-transplan-

tation, and cell procurement, processing and manufacturing strategies [38, 49].

Despite the remaining scientific and ethical questions, we advocate techniques that

do not obtain eggs from women or create embryos to derive at patient specific

stem cells.


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A Moral Compromise in SCR

Although non-egg and non-embryonic techniques seem the most ethically suitable

option to circumvent the two major ethical objections to SCR, at present, eggs and

embryos are needed for SCR to develop iPSC technology, or possibly other similar

techniques, to a state of translational readiness [37].

What are the Prospects for Agreement?

For explanatory purposes, the political positions in the US can be subdivided into

two groups: those who support continued hESC research—referred to hereafter as

‘Enthusiasts’—and those who object to hESC research on the grounds that it is

unethical (due to the embryos moral status or the potential harms to ova providers or

both)—referred to hereafter as ‘Interdictionists.’ Note that this categorization is an

abstraction, useful in the simplicity it offers for the purpose of modeling how a

moral compromise might be undertaken. In reality, the categories themselves

contain a diversity of perspectives, and some people may even identify with aspects

of both categories. Nevertheless, this categorization offers an abstraction that is both

non-arbitrary (insofar as it maps roughly onto the actual political landscape of the

US) and useful for clarifying the value of moral compromise.

It is not possible for both of these groups to have their desires regarding SCR

completely satisfied. Are we thus at an impasse? We contend that this is not the

case. In this section, we argue that the model of ‘moral compromise’ is a viable

option—indeed, it may be the most ethically sound alternative available.

Although the members of these two groups will typically diverge in the policies

they support, and are commonly conceived of as being at loggerheads, it is useful to

note that there are several points on which members of both camps will be in

agreement.1 Specifically, both Enthusiasts and Interdictionists will agree on the

following points:

1. There is value in arriving at an agreement.

All things being equal, a quick resolution to this debate would have benefits in

terms of saving public and human resources which could be dedicated to other

important projects.

2. It is the case that hESC research is morally significant.

Though some in the Enthusiast camp might argue that ethics has no role to play

in science, which should proceed unfettered by considerations of morality, this

would be an extreme view. Most would agree with the Interdictionist camp that

(a) women participants can be physically harmed while some even coerced and

(b) that human embryos at minimum are symbolic of human life and thus of moral

significance.

1 The structure of this argument is based loosely on DeGrazia’s [14] work on animal ethics.


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3. There is value in reducing the usage of embryos and ova when possible, and

alternative methods of research should be explored.

Even the staunchest Enthusiast will concur that alternative methods might have

benefits not offered by hESCs, that these alternatives might be cheaper, and that the

political support for such research would offer benefits for scientific progress

(insofar as public support for projects can be beneficial in terms of securing public

funding and making it generally easier for researchers to pursue their projects).

4. The objectives pursued by SCR are valuable goals.

Despite disagreement on whether the ends justify the means, the ends themselves

(healing the sick, advancing biological understanding, etc.) are objectives valued to

some degree by members of both camps.

5. In principle, SCR need not be morally objectionable.

This might seem like a stretch at first for those in the Interdictionist camp. But if,

however hypothetically, it could be guaranteed that pluripotent stem cells could be

procured without any harm to embryos or women in either the short or the long

term, nearly all members of the Interdictionist camp would not find this research

objectionable.

6. Some destruction of embryos can be justified, as can some procurement of ova

from women.

At first glance this point might also seem implausible, but closer reflection

reveals that this claim is not all that farfetched. Consider the first part of this claim,

regarding the destruction of embryos. In the US, most citizens—even those who

oppose the destruction of embryos for hESC research—contend that there are some

circumstances under which embryos can be destroyed: for example, when the

embryo is a product of rape or incest, when the health of the pregnant woman or

another fetus (in cases of higher order multiples) is at serious risk, for improving

assisted fertility procedures such as IVF or for providing training of technicians, or

when the embryo is of poor quality or carries a disease mutation that will severely

harm the resulting child. Similarly, consider the second part of this claim. Most

concerns regarding the procurement of ova stem from concern for the health of

women and the potential coercion they may be under from high fees or to offset the

costs of fertility treatments. If these material conditions were different such that

freedom from coercion was guaranteed and harms to women were eliminated—for

example, if medical techniques were developed so that ova providers were as safe as

those who provide semen for banks or sell their hair to wig manufacturers—there

would be no objection to the procurement of ova per se.

This final point, of course, merits further discussion. Although most members of

both camps would, on reflection, support this statement, there are some who will

not. For example, some will contend that embryo destruction is impermissible under

any of these circumstances (for example, some who strictly follow the doctrine of

the Catholic Church). However, these voices are few in the US. Although we

believe that moral minorities of this type have a valuable role to play in the creation


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of public policies regarding hESC research, we admit that for these groups a moral

compromise of the sort we propose will be incompatible with their personal

integrity, and thus unacceptable to them. This is one of the reasons that the moral

compromise proposed below is attuned to the US political climate, and might not be

appropriate for other countries.

The six points of agreement might not seem like much, but in the heated political

climate of US hESC debates it is useful to show that there is some overlap in the

beliefs and interests of parties on all sides. This does not mean, however, that there

are not important and deep points of moral disagreement that remain. Specifically,

these camps diverge on the following important points: (i) how much moral status to

ascribe to embryos; (ii) how heavily the harms to women are to be weighed; and (iii)

whether current protections for these groups are adequate. By clarifying these points

of agreement and disagreement, we are laying the groundwork for a theory of moral

compromise in SCR.

Moral Compromise

By compromise, we refer to a situation whereby two or more parties who are in

fundamental moral disagreement on a particular issue come to agree on a resolution

that ‘splits the difference’—that is, every party concedes some part of their

expectations. Although none of the parties obtains exactly what they prefer, the

overall outcome is valuable to all parties because: (a) none of the parties concede

their entire set of expectations, meaning it is not the worst possible outcome for any

of the parties; and (b) the alternative of failing to reach any agreement could result

in the worst possible outcome for at least one of the parties, and it is not clear which

one. In situations of severe moral disagreement, a compromise is not meant to end

the disagreement, but rather to find an acceptable solution for a contentious issue.

Compromises require concessions, but why should anyone concede on matters of

moral principle when they do not recognize the legitimacy of their opponent’s moral

principles? Indeed, it could be argued that such actions would be insincere or a

betrayal of one’s beliefs or values at the cost of diminished personal integrity [53].

Although many see no value in compromise solutions, others have argued that,

under the right circumstances, moral compromises can be both ethical and integrity-

preserving. As members of a society that values the participation of all citizens in

the development of rules and regulations, US citizens must engage in moral

compromise as a part of everyday life. In a modern democratic society with a

plurality of moral views, to lead a well-integrated life requires both concession and

reciprocity [5, 25]—especially in situations where there is an indeterminacy of

value-rankings on particular moral issues [66]. The preservation of integrity in a

pluralistic society requires more than ensuring consistency in one’s beliefs and

practices; it requires individuals to acknowledge both the limits of their own

moralities and the legitimacy of the competing interests of others. A moral

compromise requires persons to be open to rational persuasion and mutual trust [5,

25, 40]. While acknowledging the reasonableness of others’ views, a moral

compromise likewise requires receiving equal recognition of one’s own views,


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thereby permitting the preservation of integrity for all those who engage in mutual

concessions [40].

There is however a practical side to compromises. Theodore Benditt [4] argues

that most compromises are not over principles, but over a policy or program on a

given issue where each party has taken a position based on the principles they

believe. Policy choices are tangible items that can be bartered, traded and

compromised on. It is thus not surprising that democratic politics is the art of

compromise; politicians need to concede some things in order to obtain others. In

the context of SCR, some Interdictionists could be more concerned with harms to

women than with the moral status of human embryos and thus may be willing to

concede to using surplus embryos for research but definitely not to permitting

payments. Thus different individuals and groups can concede certain desires while

receiving some of their interests that are more closely aligned to their beliefs.

Moreover, compromises are not meant to explain the rightness or wrongness of

different positions; their value derives from settling disagreements on policy choices

in a peaceful manner, through reciprocity and respect, so as to advance towards

social goals. In this sense, a moral compromise is not indicative of compromising on

deep moral beliefs, but engaging in a process of reciprocal appreciation and

understanding of different positions in a liberal democracy and attempting to resolve

the issue to reach mutually satisfactory interests.

Conditions for Moral Compromise in SCR

Benjamin [5] outlines five criteria for determining when a moral compromise is

appropriate. While there is no algorithm for determining in which cases a moral

compromise is acceptable, these criteria suggest some of the conditions which are

conducive to selecting moral compromises. Although individually none is

necessary, and jointly they may not be sufficient, the following criteria outline

common preconditions for an effective moral compromise: (a) factual uncertainty,

(b) moral complexity, (c) the need for a relatively immediate decision or action,

(d) the desire to maintain a continuing cooperative relationship, and (e) a scarcity of

resources.

The case could be made that all five of Benjamin’s conditions apply, to some

degree, to SCR. However, the first three are the most salient. First, there is factualuncertainty regarding the potential benefits of various forms of SCR: for example,

the feasibility and time-frame required for the development of clinical applications

from hESCs, or techniques for inducing pluripotency as substitutes for hESCs.

Second, the SCR debate is morally complex, involving multiple layers of deep

disagreements regarding what is the moral status of various types of embryos, what

measures would be appropriate for protecting women ova providers, and what

weight should be given to the chance that SCR may benefit individuals in the future.

Many of the diverse and conflicting positions voiced are supported by morally

worthy considerations, even if these positions are not universally accepted. Finally,

there is a need for immediate decisive action since suspending decision making

would be tantamount to supporting one position over another. Since several of

Benjamin’s criteria are present in the case of SCR, there is good reason to think that


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the moral disagreements regarding SCR are amenable to moral compromise. In the

following section, we outline how such a moral compromise can proceed.

A Model of Moral Compromise in SCR

Many scholars have expounded upon the difficulties in preserving personal integrity

on a belief of moral status and the use of surplus embryos for research concluding

that such compromises are a betrayal of values and principles [15, 17, 64]. Our

proposal is that a compromise on conducting SCR can satisfy the majority of

interested parties through a process involving two procedures. Note that our purpose

here is not to propose a specific policy or set of policies, but rather to propose one

possible outcome of a moral compromise in SCR that could serve as a model in the

real world. Interested groups and individuals would deliberate and outline the actual

conditions of a compromise in order for the policy framework to have any real

political traction.

A compromise can satisfy Enthusiasts and Interdictionists equitably by equally

respecting the values and desires of both parties. We propose the following two-

phase procedure as one possible way for these two polar positions on SCR to reach a

moral compromise (outlined in Table 1). Broadly speaking, our proposal is that the

use of eggs and embryos would be permitted in the initial phase of the procedure

and prohibited in the subsequent phase. Notably, the shift from the first to the

second phase is initiated once a reliable and plentiful source of stem cells can be

secured without the destruction of embryos or the procurement of ova from women.

The first procedure terminates after an agreed upon time has passed. At this time,

either the goals of a non-oocyte and non-embryo source of pluripotent stem cells

will be achieved, or it will not. If it has, then the second phase begins. If, however, it

has not, a moratorium will be placed on research that involves destroying embryos

and procuring ova, and the parties must return to deliberations on how to proceed in

the future.

Although this may appear to be a procedure that heavily favors the interests of

Enthusiasts because they would be satisfied by the circumstances outlined in both

phases, more detail reveals how the interests of Interdictionists are also respected.

Specifically, several concessions are made by Enthusiasts throughout the first phase

which include: (1) limiting the use of embryos to surplus and non-viable embryos;

(2) prohibiting substantive payments to ova donors (though allowing for reasonable

compensation); (3) developing and following a concrete plan for the efficient use

and distribution of embryos; and (4) concentrating research funds on projects with

the best chance of furthering the laudable goal of deriving stem cells from non-

embryo sources and without using ova from women. These last two points are

explained below.

After the time limit on the initial phase has expired, the degree to which these

concessions are satisfied will be influential in determining what will occur

subsequently. To the extent that progress has been made in reducing, rather than

increasing, social dependency on oocytes and embryos, Interdictionists might be

more amenable to repeating the conditions of the first phase of the moral


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compromise. Below we further describe how our example of moral compromise can

be used to develop SCR policy and influence funding priorities.

Application of a Moral Compromise in SCR Policy and Funding

A compromise can be applied in SCR policy and funding in order to achieve the

desires and concessions discussed above in our model compromise. Several policy

and funding tools will need to be implemented. Initially, this would require

repealing the Dickey-Wicker Amendment (a rider on the appropriations bill

renewed annually) [12] and the development of policies on the conduct of embryo

research, reimbursements to donors, and other aspects of donation (such as consent).

The time periods for the two phases can be applied in policy through the use of

sunset provisions.

Table 1 The benefits and concessions in an example of moral compromise on SCR

Category Benefits Concessions

Phase 1: Eggs and embryo use is permitted with restrictions

Enthusiasts Continued progress in SCR using ova

and embryos

Use of embryos limited to surplus

and non-viable embryos

Use of ova limited due to a lack of

offering substantive payments, but

reimbursements are permitted

Efficient use and sharing of human

biological resources

Emphasize SCR designed to reduce

use of ova and embryos

Interdictionists No payments to ova providers

Limitations in use of embryos

Concrete steps taken towards

reducing social dependency on ova

and embryos

Temporary use of embryos in

research

Temporary use of ova in research

Phase 2: Eggs and embryos are not permitted or their use is substantially limited

Enthusiasts Continued progress in SCR Have to use non-embryo methods

for SCR

Have to use non-ova methods

for SCR

Interdictionists No embryos destroyed for SCR

No ova procured for SCR

The model compromise sketched in this essay uses two phases to satisfy both Enthusiasts and Inter-

dictionists. In the first phase, Enthusiasts receive benefits of continued progress in SCR while making

several concessions on the type of embryos used, payments to ova donors, the efficient sharing of

biological resources, and emphasizing research using non-ova and non-embryo techniques to derive stem

cells. Interdictionists on the other hand receive the benefits of ova providers not being solicited or coerced

through payments, that embryos used for SCR are limited, and that steps are being taken to reduce the

social dependency of ova and embryos for SCR. Interdictionists concede that some ova and embryos are

still being used for SCR. In phase 2, Enthusiasts benefit from continued SCR using methods that do not

use ova or embryos while Interdictionists benefit by not having ova and embryos being used for SCR


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Along with permitting publically funded SCR in a regulated and time-dependent

manner, policy focusing on the efficient use of embryos should also be developed in

order to balance concessions between Enthusiasts and Interdictionists. For some

Interdictionists, every embryo lost may be considered a loss of a human life and so

embryos should be used to their fullest potential [32] based on the principle of

efficiency.2 To maximize the use of limited embryonic material in the initial phase,

we propose that excess embryos created for any purpose (e.g., assisted reproduction,

training, or research) should be used to subsequently derive pluripotent stem cells

after having satisfied the original purpose for which they were created.3 This will

require great efforts to communicate and coordinate with researchers and assisted

reproductive clinics to not destroy embryos after they have been used for the initial

purpose. A national system for coordinating the efficient sharing of embryos could

go a long way towards reducing the generation (and destruction) of more embryos

than what might be considered necessary. Such a system could involve providing

powers to a governing body to oversee the execution of the compromise.

As part of a commitment to the efficient use of embryos—an important part of

preserving fairness in the concessions between Enthusiasts and Interdictionists—

research should focus efforts on pursuing the development of ovum- and embryo-

free techniques. This research will require coordinated efforts with funding focused

in key areas of SCR (e.g., iPSC technology) by the major state and federal funding

organizations—including the National Institutes of Health and the National Science

Foundation.

Our paper has both a political and philosophical dimension. Not all political

compromises involve moral compromises, and vice versa; however, in the case of

stem cell policy these seem inseparable. In the context of SCR, the policies a person

advocates are determined by their moral position; and the various parties cannot

achieve a common policy decision without some flexibility regarding the objectives

that they believe to be warranted by their diverse moral positions. Thus, in terms of

politics, we are proposing policies that the different sides could agree to; however,

we are not proposing that our specific model of moral compromise is one that ought

to be implemented. Because of the deep moral convictions in the embryo and SCR

debate, the concessions made take on a distributive approach for compromise where

the concessions are minimized and the overall outcome is only slightly more

satisfactory to both sides [8].

The political significance of this paper is abundantly clear in the popular

messages of the US’s Tea Party movement, which vociferously opposes policies

that ‘split the difference’ between liberal and conservative positions on the basis

2 Resnik [54] outlines several principles in the ethics of science one of which is that scientists should use

limited resources efficiently which includes economic, human, and technological resources.3 Embryos can be created for reproductive purposes, for research towards improving assisted

reproductive technologies, to train technicians, and to test materials for toxicity. For example, when

testing a new culture medium against a gold standard, gametes are placed in the two different media and

their potential to fertilize and develop is evaluated. After embryos are scored, they are typically discarded

since they cannot be used for reproductive purposes. Our suggestion is that these surplus embryos, which

were once created for different credible intents, should be used to derive pluripotent stem cells instead of

being discarded.


123

that this represents a loss of personal integrity—a compromised morality, rather

than a moral compromise. In practical application, the specific policy problem in the

US is not compromise in a general sense but whether such a compromise can be

applied to federal public service funding, since state or private funding is allowed.

This problem entails questions of political philosophy about the use of public funds

for activities about which there is deep moral disagreement. Such questions are

beyond the scope of this paper.

The main philosophical targets of the paper are those who, like Devolder and

Harris, have rejected compromised positions (such as the use of surplus embryos) on

the claim that such positions are based upon inconsistent values and positions. We

have argued, to the contrary, that there can be great personal integrity in adopting a

moral compromise in SCR. To this extent, our paper is an exercise in the theory of

moral compromise, by applying it to moral argumentation on SCR.

Although we have presented an example of a moral compromise in SCR, we

recognize that for democratically legitimate and justified decisions to be translated

into policy, citizens must first engage in deliberation to reach a moral agreement on

contentious issues by providing reasons that can be accepted by those who are

affected by the action [30]. As reciprocity is a fundamental tenet in moral

deliberation, we imagine a policy consultation process where concerned parties

have the opportunity to extensively deliberate on the conditions of the moral

compromise and reason reciprocally while recognizing and respecting the moral

worth of opposing views. Thus, deliberation will probably be a key component in

the consultation process for achieving a moral compromise in SCR.

Conclusion

We have argued that a moral compromise offers the promise of an optimally ethical

outcome in contemporary US debates regarding the ethics of SCR. In moral

compromise, each party concedes part of their desired outcome in order to engage in

a process that respects the values of all parties equitably. We have outlined an

example of one set of possible conditions to provide moral compromise in SCR and

have applied it to US policy and scientific funding. Although the particular proposal

presented here would not fully satisfy the desires of either SCR Enthusiasts or

Interdictionists, it does offer several distinct and compelling advantages to both

parties. First, there is value in achieving the benefits of SCR for society and to

develop techniques that reduce or eliminate other moral harms, including the

creation of embryos for destruction and the procurement of ova from women.

Second, there is benevolence when citizens participate in a democratic process of

policy-making for the overall good in society. Lastly, there is virtue when citizens

engage in debate, but not with the intent of convincing the opposition of the

rightness of one’s principles and policy choices, but to facilitate a reciprocal

understanding and appreciation for opposing views and in attempting to accom-

modate the desires of the opposition [30]. Bioethicists concerned with the morality

of SCR need to further consider the value of a moral compromise as a practical and

reasonable solution to address the diverse moral perspectives in SCR.


123

Acknowledgments We would like to thank Dr. Francoise Baylis and the Novel Tech Ethics research

team, Dr. David B. Resnik, Dr. Andrew Fenton, and Ms. Sasha Kontic for valuable feedback. We are also

grateful to the anonymous reviewers of the manuscript for thoughtful feedback. This work was supported

in part by a grant from the Stem Cell Network. ZM was affiliated with the Sprott Centre for Stem Cell

Research and the Ottawa Hospital Research Institute, University of Ottawa when initially writing this

manuscript. GKD Crozier was affiliated with the Department of Philosophy, Loyola University Chicago

when first drafting the manuscript. The views expressed here are those of the authors and do not reflect the

positions of their academic institutions, Health Canada, or the Government of Canada.

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The Ethics of Moral Compromise for Stem Cell Research Policy