NotaBene е електронно списание за философски и политически науки. Повече за нас
Kalina Kamenova
Notwithstanding the divergent assessments of the respect owed to the human embryo that emanate from major religious traditions, the stem cell controversy has often been framed in terms of the inevitable conflict between theology and modern science in contemporary pluralistic societies. There are different considerations and analytical approaches deployed to tackle the intricate and complicated relationship between religious traditions and embryo science. Habermas (2003) has argued that value conflicts between science and religion are unavoidable in a post-secular society, in which strong religious communities continue to exist in the context of ongoing secularization. The dilemma we face is to ensure effective reciprocity between sides and that neither position ought to be dismissive of the contributions of the other. However, some scholars have argued that a harmonious relationship is contingent on the extent to which religions allow input from contemporary scientific viewpoints and are open to dialogue with rival religious traditions (Zivotovsky & Jotkowitz, 2009; Jones & Whitaker, 2009). If religious citizens are to contribute meaningfully to bioethical debates on hESC research, they should consider how our knowledge of embryonic development and human biology has evolved.
In a response to the new bioethical directives in Dignitas Personae, Zivotovsky and Jotkowitz (2009) argue that new technology and scientific knowledge often requires different application of fundamental theological principles that had remained unchanged in the long history of religious traditions. While the teachings of both Catholicism and Orthodox halakha (Jewish Law) strive to incorporate contemporary scientific knowledge, recent bioethical issues in human reproduction have caused tensions between religious authorities and modern science, especially in religious rulings based on erroneous science, such as the Vatican’s position on emergency contraception. By contrast, Orthodox halakha has demonstrated greater openness to modern scientific views on zygotic personhood, no-conjugal procreation, and producing benefits through illicit means. The divergences stem from the different authority paradigms adopted by the two traditions. Unlike the pyramidal, hierarchical structure of the Catholic Church, which delegates uncontested authority to the Pope and the Vatican in developing a single, uniform position on ethical issues, Judaism has developed as a more diffusive system of dispersed communities around the globe, with no central authority or judicial center and rulings largely based on precedent of specific laws, principles, and values. In addition to the Hebrew Bible and the Talmud, three other genres have become indispensable for the development of halakha - the Commentaries on the Talmud, Codes of law, and Responsa literature, which has allowed more than one acceptable position on moral dilemmas:
“While all three genres are ongoing, it is this final genre that is the primary means of development, refinement, and clarification of halakha today and exemplifies an important aspect of the nature of halakha—it is dynamic yet precedent oriented. A contemporary rabbi will typically examine earlier sources in search of analogous circumstances before deciding a point of law. No one will rule without citing the relevant passages from the Talmud, and usually from the early commentaries on the Talmud, and almost always the major codes. Many modern rabbis will often also heavily rely upon the responsa literature of the last few hundred years” (Zivotovsky & Jotkowitz, 2009, p. 27).
This requirement for openness to scientific input is consistent with calls that religious traditions based on outdated scientist concepts need to be modified and reaffirmed in contemporary terms (Jones & Whitaker, 2009). In many ways, this is easier said than done. For Judaism, the adaptation is greatly facilitated by their fundamental theological tenet that personhood does not begin until the 40th day after conception which does not contradict contemporary scientific assessments. It is unlikely, however, that most Christians will ever dispense with the notion of the inviolability of the human embryo and the need to protect embryonic life. The assertion that all human life is sacred from conception is so central to their belief systems that any different scientifically-based assessment is likely be interpreted as an assault on the dignity of human life (Jones & Whitaker, 2009). The dialogue between science and religion, therefore, seems to be contingent on how compatible modern scientific views are with the major theological principles of the respective religious tradition.
Questions about the conditions, under which religious persons may participate in science policy debates, have become central to the stem cell controversy. If the conflict between moral discourse derived from religious traditions and scientific claims about embryonic development is irresolvable, how are people of faith to engage bioethical debates that require a certain distance from tradition and theology? In such debates, proponents of hESC research have not hesitated to dismiss any beliefs in the ontological status of the human embryo as a narrow, highly contested religious worldview that stands at odds with the society’s public political culture. Moreover, scholarly analyses that have shown significant variations between different cultures and religions on the moral respect and legal protection owed to prenatal human life-forms and the types of embryo research deemed ethical (Ruse and Pynes, 2003; Waters & Cole-Turner, 2003). All past philosophical debates on the moral status of the blastocyst (the pre-implantation human embryo) have led to an impasse, and the issue is presently considered irresolvable. As Finlay (2004) points out in an article on stem cells and cloning, “in a postmodern society there are no knock-down arguments by which Christians can compel others to adopt their ethical positions” given that their ethical perspective is not derived by “rationally defensible proposition, but from the stories by which we are formed” (p. 21). Similarly, Dworkin (2000) argues in his book Sovereign Virtue: The Theory and Practice of Equality that the issue of respect and protection owed embryonic life is a question of detached not derivative value, and that “opinions of such values are notoriously varied, even within a particular democratic culture, in large part because they are sensitive to the very different religious convictions that coexist in such cultures” (p. 431). While some believe that the embryo is a human person even in the very early stages of development and should be granted legal protection, others see it simply as a collection of cells, which is yet to develop human potential. Nonetheless, support for beliefs in the ontological significance of embryos is provided not only by religious faith, but also by Kantian deontological ethics. Sandel (2005) claims that our reluctance to objectify the blastocysts used in hESC research has much to do with “the Kantian assumption that the moral universe is divided in binary terms: everything is either a person, worthy of respect, or a thing, open to use” (p. 245). Even some opponents of hESC research reluctantly admit that the debate on the human status of the early embryo is complicated by fundamental differences in our theological traditions, which cannot be resolved with rational arguments (Lawler, 2007). Intercultural perspectives on the ethics of hESC research have clearly illustrated that although all religious traditions are deeply concerned with the question of the beginning of life, they significantly differ on the issue of respect and legal protection owed to pre-natal human life.
The prominence of religious arguments in stem cell debates in North America and Europe is by no means accidental; rather, it is indicative of the increasing influence of religious orthodoxies in contemporary pluralistic democracies. The influence of religious communities in the secular West is becoming manifested through the value conflicts of post-secular society on scientific and social issues such as abortion, voluntary euthanasia, genetic engineering, reproductive medicine, animal protection, and environmental activism (Habermas, 2008b). There are still highly ambivalent feelings towards secularization, not only worldwide, but also in the Western world, a phenomenon that incites critical assessments of the secularization paradigm and further self-reflection on the unfinished dialectic of our own occidental secularization (Habermas, 2003). In a secular society, religious communities are required to undertake the difficult task of accepting and adapting to religious pluralism, the authority of scientific knowledge, and the secular values of the liberal state. Habermas (2003) has suggested that the post-secular society demands a similar effort from secular citizen, who are yet to conform to the ethical expectations of democratic citizenship. This need to accept the input of religious traditions in the informal public sphere, provided that their contributions are translated into generally accessible terms consistent with the principles of democratic political culture (i.e., the “institutional translation proviso”), is arising from the secular society’s overreliance on the crude naturalism of science. The problem, he claims, is that secular epistemologies and scientific doctrines often undermine our self-understanding as moral persons by abstracting nature from the social frame of reference of persons freely engaged in communicative interactions in the public sphere.
In response to contrasting evaluations of secularization, Habermas (2003) has developed as a critique of the replacement and expropriation models in secularization theory. Both perspectives have construed the process as a zero-sum game which entails the inevitable clash between religious and scientific worldviews. While the former asserts progressivist interpretations in the context of “disenchanted modernity” which have envisioned the replacement of religious ways of life and thinking by the rational, the latter proposes a theory of decline in the context of “unsheltered modernity” in which modern ways of life and thinking are discredited as illegitimately appropriated goods. Although Habermas (2003) advocates a distance from both strong religious traditions and comprehensive doctrines, such as naturalism, he attempts to avoid narrow, secularist perspectives on the political role of religion developed within political liberalism. In an article published in the European Journal of Philosophy, Habermas (2006) considers two critical questions: (1) “Is all religious discourse just a pre-modern residue?”, and (2) “Do secular citizens also have a duty to rise above their narrowly secularist consciousness in order to engage with religion in terms of ‘reasonably expected disagreement’?” In some sense, it seems that this revised concept of citizenship in the post-secular society may have imposed an asymmetrical cognitive burden on religious communities to develop specific epistemic attitudes and stances towards: (1) other religions and world views, (2) the independence of secular epistemologies from religious knowledge, and (3) the priority of secular reasons in the public arena. Nevertheless, he argues that the arduous work of hermeneutic self-reflection should also be undertaken by secular citizens, who are presently expected to engage in reflexive self-understanding and a meaningful dialogue with religious persons. This act of cognitive adaptation is different from mere tolerance and respect for the existential value that religion may have for some persons; rather, it constitutes “a self-reflective transcending of a secularist self-understanding of Modernity” (Habermas, 2006, p. 15). Essentially, what he suggests is a change of epistemic attitudes in the secularized Western societies that would simultaneously accelerate the process of modernization and the adaptation of religious consciousness to the ethics of citizenship and help out secular citizens become epistemically adjusted to the continued existence of religious communities. This would require that in their conflicts with religious traditions secular citizens do not deny any cognitive substance to religious arguments from the onset, but rather perceive these differences as reasonably expected disagreements. Religious perspectives on moral issues can greatly enrich the public discourse, but only if citizens are willing to change their epistemic attitudes and embark on “complimentary learning processes” to ensure that religious consciousness becomes reflexive, while secular consciousness transcends its limitations.
The philosophical justification of the need for and right of religious discourse in public life was extended by Habermas (2008a) in his book Between Naturalism and Religion, which offers a revision of his invariable critique of the validity of religiously informed moral arguments in the public sphere. Religion, he argues, does not necessarily stand in the way of science and religious reasoning should not be considered adversarial to the secular rationality of modern life. More importantly, religious traditions can help people articulate moral intuitions about vulnerable life forms and encourage non-religious persons to engage in reflection on deep moral issues. Understanding religious discourse is worthwhile in the context of a prevailing naturalist worldview, which establishes modern science as an autonomous practice with its own criteria of verification and as a measurement of all truths and falsehoods. The dangers of naturalism are discernible in recent advances in genetic engineering, the reproductive technologies, and the neurosciences, which threaten to subsume moral persons under scientific descriptions and thus encroach on our normative self-understanding. In this case, the question of how science is related to religious doctrines seems to be implicated in the overarching philosophical concern about the genealogy of Modernity’s self-understanding and the recognition that modern science is a practice that is by no means separated from the history of Reason that includes the world’s religious traditions (Habermas, 2008a).
Philosophical and political debates on the relationship between faith and knowledge have thus become implicated in the stem cell controversy, particularly when the issue was debated beyond narrow bioethical concerns about the status of hESC lines or technical questions concerning public funding. Rather than adopting a simplistic “science versus religion” framework of analysis, it is worth considering the relevance of Habermas’s concept of ethical citizenship in post-secular societies to the public discourse on stem cells and what specific limitations ought to be set out for religious arguments in deliberations over contested scientific issues in both the informal public sphere and the institutional arena of decision-making of contemporary pluralistic societies. I provide further reflection in the conclusion, after a close consideration of three major bioethical issues that have become prominent in science policy debates: (1) secular defenses of the embryo’s moral status, (2) the ethics of human cloning, and (3) concerns about women’s reproductive rights and health in embryo donation. These ethical considerations have influenced specific framings of the stem cell controversy in national policy debates as I have illustrated in greater detail elsewhere (Kamenova, 2011). It is worth noting that current bioethical discourse on hESC research is not limited to these three clusters of concerns, but encompasses complex ethical dilemmas arising from the patenting of stem cell lines, access to novel therapies, clinical challenges in translational stem cell research, and the global phenomenon of stem cell tourism.
3. Secular bioethical perspectives on the moral status of the human embryo
Conflicting ethical perspectives on moral and legal status of pre-implantation embryos have been articulated in science policy debates on hESC research and related technologies. While the embryo’s moral status has remained highly contested, some scholars in the United States have strived to develop a coherent philosophical defense of the full moral respect and protection owed to the embryo from the very moment of fertilization, not grounded on theological assumptions and religious reasoning (George & Gomez-Lobo, 2005; George & Lee, 2005; George & Tollefsen, 2008). The key argument advanced by such perspectives is that the differing capabilities of early embryos to develop into human beings do not necessarily entail a different moral status and, respectively, do not warrant a lesser degree of protection owed to these entities. Subsequently, the destruction of pre-implantation embryos for stem cell derivation is deemed immoral and reasons are provided to restrict research to experimentation with stem cells from non-embryonic sources.
3.1 The equal moral status view
Non-religious justification of the equal moral standing of the human embryo is provided by George and Tollefsen’s book Embryo: A Defense of Human Life (2008), which claims that a full moral status can be defended with secular arguments drawn from moral philosophy and the science of human embryology. Four major arguments are presented in defense of this proposition. First, the underlying assumption is that “human embryos are, from the very beginning, human beings, sharing an identity with, though younger than, the older human beings they will grow up to become” (George & Tollefsen, 2008, p. 3). Second, the authors claim that facts of embryology allow to extend the concept of moral personhood to human embryos at all stages of development. They suggests that “the embryonic, fetal, child, and adolescent are just stages - stages in the development of a determinate and enduring entity - a human being - who comes into existence as a single-celled organism (a zygote) and develops, if all goes well, into adulthood many years later” (George & Tollefsen, 2008, p. 51). Arguments about a human being present from the very moment of conception are grounded on their critique of the metaphysical notion of body-self dualism. This form of dualism is characterized as “inherently irrational”, as a doctrine that is premised on problematic metaphysical claims about the organic and the personal substances in the human, and, finally, as “a lost philosophical cause, although it is perennially attractive” (George & Tollefsen, 2008, p. 69). Instead, the authors adopt the philosophical principle, asserted by Thomas Aquinas, that the soul constitutes not only the organizational life-principle of the human body, but it is also the vehicle that enables the human being to think and will. Body and consciousness are considered parts of one unified entity, an animal organism bearing a rational nature, and that entity is present from the very moment of fertilization of the human zygote. The third major tenet of the “equal moral status view” is that full moral respect and protection is owed not only to persons, but also to entities in the pre-personal and post-personal stages of development. Embryos are, therefore, considered to be intrinsically valuable by the virtue of what they are, and not because of what they will become in the latter stages. Finally, the moral dualism of philosophical perspectives that accord different status, rights and attributes to embryos and persons is subjected to criticism, especially developmental theories of moral personhood (Sandel 2007) and attribution views of personhood (Green 2001; Strong 1997). Both theories, George and Tollefsen (2008) claim, are arbitrary in their assessment of when moral status should be bestowed upon human beings, and fail to provide convincing arguments that “each human being throughout his or her life has inherent dignity and is the subject of moral rights and deserving of moral respect” (p. 132).
Interestingly, George and Tollefsen’s claim that the zygote’s full human status can be proven with scientific facts and a purely philosophical reasoning stands at odds with their emotionally-laden rhetoric and politically expedient arguments. Throughout the book, hESC research is consistently labeled as “embryo-killing for research”, “embryo-destructive research”, and as “wrongful killings” comparable to the murder of retarded children in order to obtain their organs, whereas blastocysts are characterized as “embryonic human beings”, “embryonic persons”, “the youngest and most vulnerable members of the human family”. The philosophical arguments of Embryo undoubtedly seem questionable to anyone who does not share the underlying assumptions of its authors about extending the concept of personhood to the embryo from the moment of conception and treating embryos in the pre-personal stages of development as full members of the moral community of persons. Not less problematic is the imperative that human embryo ethics should be no different from the ethical treatment of minorities or dependents. Despite the authors’ well-rounded critiques of some shortcomings of moral theories and philosophies in addressing the ethics of scientific research, their argumentation in debating the moral status of the human embryo is dismissive of the role of deeply embedded cultural values and religious convictions that underlie our understanding of embryo science, embryo ethics and embryo technologies. While George and Tollefsen (2008) assert that their analysis is informed by the best scientific knowledge in embryology, it is worth asking the question whether their conclusion that full potential for personhood originates with the formation of a new diploid genome in the fertilized oocyte (zygote) is indeed supported by robust science, rather than based on certain theological assumptions and moral intuitions. It may be right to assume that the fusion of spermatozoon and ova is the point of origin of a new, genomic identity. It is problematic to assert, however, that the point of origin of a new individual identity with full potential for personhood can be traced to the moment of formation of a new genome in the zygote. It is well known that the zygote’s haploid genome may develop into more than one unique entity due to the possibility of monozygotic twinning, i.e. when a single embryo splits into two, in the early weeks of development. Given this possibility, it is widely believed that the conditions for personhood are clearly present around the 14th day, when there is a genetically complete individual entity and appearance of a primitive streak, a crumpled, rod-shaped thickening in the middle embryonic disc which indicates the beginning of neural tissues and the mesoderm. Based on this particular understanding of human embryonic development, policy makers in the United Kingdom have enforced the rule that all embryos used for stem cell derivation and other types of biomedical research are destroyed after the 14th day.
3.2 Developmental theories of personhood
Not everyone finds the twinning argument satisfactory and accepts that the time of formation of a primitive streak is an indication for full human potential. In his book The Morality of Embryo Use, Guenin (2008) claims that monozygotic twinning by itself does not disqualify an embryo from being a person, “nor does there obtain any reason to deny that an early embryo satisfies any condition of human individuality requisite for personhood” (p. 98). Rather, he believes that the threshold to personhood is intrauterine implantation. Therefore, the case for embryo research is argued strictly in relation to embryos (usually created and stored at IVF clinics) that will never be implanted in either a woman or in an artificial uterus because no more transfers are requested by the mother and they had already been donated by their progenitors for research purposes. This category of embryos is defined as an epidosembryo (from the Greek word epidosis meaning “for a beneficence to the common weal” or for the common good). In cases when the patients have already decided against the transfer of these embryos, their developmental potential “fails of enablement”:
“Thus one cannot accomplish anything, for anyone, by asserting that an embryo, as to which progenitors refuse intrauterine transfer, and that they wish to give to medicine, is a person for purposes of the duty not to harm or not to kill. Once progenitors have barred an embryo from the womb, its developmental potential is bounded such that the foregoing situation will not change”. (Guenin, 2008, p. 46)
This developmentalist perspective clearly indicates the event of intrauterine implantation as the crucial moment when the case for moral status can be made, and can be contrasted to attempts to establish the personhood of human zygote or conceptus through a rather metaphysical notion of potentiality based on the genetic evidence. Instead of asserting zygotic personhood and its deontic consequences, Guenin (2008) justifies the destruction of pre-implantation embryos for the humanitarian purpose of developing life-saving treatments with the argument that “permissibility of epidosembryo use follows from the embryo’s presently bounded developmental potential and the end to be served by using the embryo (p. 53).
The developmentalist position of moral personhood was shared by some members on the U.S. President’s Council on Bioethics (PBCE) during the contentious policy debate on expanding federal funding for hESC research (2001-2008). These scholars have advocated a middle-ground position between the two extreme views, claiming that pre-implantation embryos neither have full human status, or no particular moral status (Fukuyama, 2003, 2005; Sandel, 2005). Fukuyama (2005) has claimed that contrary to the common belief that the PCBE has served a conservative, pro-life agenda, its deliberations has demonstrated a “healthy balance of views on the tortured “moral status of the embryo” question” (p. 195). He has suggested that human beings develop full moral status only gradually during the prenatal development and this gradual acquisition continues during the postnatal development. This proposition is supported by the fact that full political rights are granted only to adults, and not to children. While the intermediate status of the human embryo justifies its instrumental use for serious scientific research, it also entails a certain level of respect owed to these entities and social control to ensure their ethical treatment. Therefore, we need to develop an appropriate regulatory system differentiating between legitimate use of embryos in research and potential unethical applications (e.g., cloning human embryos for reproductive purposes).
Michael Sandel provides similar arguments in an article on the ethical implications of human cloning (2005) and later on in his book The Case against Perfection (2009). He claims that we cannot simply regard the human embryo as a mere thing that is open to all kind of use and interventions. At the same time, we do not necessarily need to assume that it is a full human being in order to assert the significance of nascent human life. The major problem with attributing full personhood to the human embryo is that the “equal moral status” view has certain far-reaching implications that render it implausible. For example, proponents of this view have maintained that the extraction of stem cells from six-day-old blastocysts is as morally wrong as the harvesting organs from babies. This proposition seems very problematic in the context of the proposed U.S. anti-cloning legislation which would impose the penalty of a $1 million dollar fine and 10 years in prison, a hardly adequate punishment for such a gruesome act. If the destruction of pre-implantation embryos is indeed equal to murdering babies, then the legislation should have provided a more severe form of punishment for the scientists extracting stem cells from embryos, such as life imprisonment or the death penalty. Another problem for the equal moral status view is the high rate of embryo loss in natural pregnancies, with more than half of the embryos failing to implant. The way people respond to the natural loss of embryos (which often goes unnoticed) and early miscarriages indicates that they do not perceive embryos as morally equivalent to children. If the equal moral view holds validity, Sandel (2005) asks, wouldn’t it make sense to carry out the same burial rituals for each lost pre-implantation embryo that we observe for the death of children? In other words, this perspective clearly stands at odds with people’s moral intuitions about the significance of pre-personal human life and its implications defy the established legal and socio-cultural practices in pluralistic societies. Sandel (2005) warns that we should be wary of an ethical doctrine which “risks turning every moral question into a battle over the bounds of personhood” and advocates a middle ground approach that will help us better “cultivate a more expansive appreciation of life as a gift that commands our reverence and restricts our use” (p. 246). Similarly to Fukuyama, Sandel (2005) distinguishes between legitimate and illegitimate uses of human embryos in biomedical research. While he believes that the use of cloning technology for the creation of designer babies is unethical and constitutes “the ultimate expression of the hubris that marks the loss of reverence for life,” he commends hESC research, including the use of cloned blastocysts in it, as “a noble exercise of our human ingenuity to promote healing and to play our part in repairing the given world” (p. 246).