On March 4, 2002, the Canadian Institutes of Health Research (CIHR) released guidelines on the public federal funding of research using human pluripotent stem cells. While there are many practical aspects of the final report, Human Pluripotent Stem Cell Research: Recommendations for CIHR-Funded Research, that deserve commendation, the guidelines prepared by the ad hoc Working Group on Stem Cell Research are missing a key component: a sustained, reasoned argument explaining why particular areas of stem cell research will receive funding by CIHR, while other research avenues will not.

Thoughtful, credible policymaking that can withstand criticism and garner public support needs to be buttressed by argumentation. Canadian citizens need to be given understandable, sensible reasons that collectively provide a rationale for why particular forms of research will be funded with taxpayer dollars while other areas of research will not be eligible for public funding. The difficult exercise of reason giving, argumentation and rebuttal of competing moral claims and policy alternatives is particularly important in an area where contentious ethical issues exist and about which Canadian citizens have markedly divergent views.

Pluripotent stem cell research is an area of biomedical research marked by public disagreement not just in Canada but also in countries such as the United States, Great Britain, Germany, Belgium, France and Switzerland. Many countries are currently attempting to craft guidelines and legislation that address ethical, legal, scientific and economic dimensions of pluripotent stem cell research. In most of these countries, the major area of disagreement centers on the use of stem cells obtained from embryonic and fetal sources. The disputes are not surprising because in these countries people have disparate understandings of the moral status and meaning of embryos, human biological development and notions of “personhood,” the meaning of human dignity and the manner in which medical research should respect human dignity, and the ethical and legal limitations that ought to be imposed upon controversial areas of biomedical research.

While it might be expedient to dismiss or ignore public disagreements about the morality of various aspects of pluripotent stem cell research, publicly funded agencies cannot evade the challenge of providing well-reasoned, well-argued public policies that acknowledge and address ethical disputes in a candid, thoughtful manner.

The controversy over stem cells research is complex and multifaceted; it is not enough to simply assume that opponents to this type of research are necessarily “right to lifers” or members of what one Globe and Mail reporter refers to as “the anti-abortion forces” and “the anti-abortion religious right.” The current debate involves more than a clash of religious voices versus the claims of science and progress. Indeed, one of the more interesting dimensions of the current debate in the United States is the way in which many individuals, often labeled “pro-life,” opposed to all forms of research involving embryos, have recognized the potentially enormous health benefits that could flow from stem cell therapies and have publicly supported some forms of embryonic stem cell research. In fact, Orrin Hatch, John McCain, Strom Thurmond, the Reverend Jerry Falwell and the National Right to Life Committee all supported President George W. Bush’s August 9, 2001 announcement permitting stem cell research using 64 stem cell lines established before 9:00 p.m. on August 9, 2001.

Acknowledging the complexity of labeling and categorizing different interpretations of the morality of pluripotent stem cell research is to recognize that there are a number of conflicting views that vie for control of public debate and public policy.

The opponents commonly draw upon a number of argumentative strategies to buttress their position. Some opponents rely upon a sanctity of life doctrine that insists that personhood, or humanity, begins at conception. Some commentators argue it is a matter of human dignity that human embryos should not be utilized even if considerable health benefits could flow from embryonic stem cell research. Other opponents of embryonic stem cell research argue that embryos are “vulnerable” and that members of society have special obligations to protect “the vulnerable.” Recently, some opponents of embryonic stem cell research have combined their opposition to the use of human embryos with the argument that pluripotent stem cell research using stem cells derived from adult tissues holds enormous and unexpected promise. They argue that on the basis of the “precautionary principle,” every effort should be made to determine what therapies can be established using stem cells derived from adults before even considering making use of stem cells derived from embryos.

Many of the argumentative strategies of opponents of embryonic stem cell research are open to rebuttal. For example, anyone defending a “sanctity of life” doctrine should consider how much weight should be given to the suffering of individuals who will die because they are not given access to potentially life-preserving or life-extending stem cell-based therapies. Proponents of a sanctity of life doctrine have some genuine dilemmas to face, as a number of pro-life Republican politicians in the United States recognize. Furthermore, defenders of the precautionary principle need to be more candid about whether they are urging caution and further research before utilizing pluripotent stem cells derived from embryos, or have no intention of ever recognizing that embryonic stem cell research might be warranted.

However, whatever the shortcomings of the arguments of individuals opposed to pluripotent stem cell research involving the use of stem cells derived from embryos or fetuses, their arguments deserve to be recognized, addressed, critiqued and given whatever weight they deserve when setting public policy. Tax revenues from all citizens support publicly funded agencies such as the CIHR, and publicly funded agencies should be held accountable for defending their guidelines.

Yet, the final report of the ad hoc Working Group on Stem Cell Research neither considers the arguments of individuals and organizations opposed to pluripotent stem cell research involving stem cells derived from embryonic and fetal sources nor grapples with the moral claims of individuals and organizations who insist that public funds ought to be directed toward lines of research not currently permitted by the CIHR guidelines.

The report draws upon, at least in part, utilitarian arguments about the health benefits likely to flow from funding pluripotent stem cell research. However, this utilitarian argument and its emphasis upon the potential health benefits of research on pluripotent stem cells can be extrapolated to include areas of research excluded by this very report. For example, some proponents of research involving embryonic stem cells argue that the creation of embryos for the purpose of conducting embryonic stem cell research ought to be publicly funded. In addition, some defenders of a wide-ranging health research agenda argue that somatic cell nuclear transfer (what some refer to as “therapeutic cloning” or “nuclear transplantation”) ought to be permitted. With somatic cell nuclear transfer, a human somatic cell nucleus can be transferred into a human oocyte for the purpose of developing a human embryonic stem cell line. Bert Vogelstein, Bruce Alberts and Kenneth Shine, authors of a Science policy article defending nuclear transplantation argue,

The technique shows promise to overcome the anticipated problem of immune rejection in stem cell-based therapies to replace a patient’s diseased or damaged tissue. Creating stem cells with the patient’s own nuclear genome might theoretically eliminate tissue rejection.

Drawing upon the utilitarian “health benefits” logic found in the CIHR guidelines, it is possible to argue for the public funding of areas of research that the ad hoc Working Group has excluded from receiving public funding. Given that the ad hoc Working Group accepts the guiding principles of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (the TCPS), given that the TCPS allows research involving human embryos “on a graduated approach that correlates permitted interventions with the developmental stages of the human embryo or foetus,” and recognizing that the TCPS permits research on embryos until 14 days, it is possible to argue that the regulatory framework within which the ad hoc Working Group operates should permit both the creation of human embryos for the purpose of research and the creation of embryos through somatic cell nuclear transfer.

If research on embryos is allowed to proceed until embryos reach 14 days, then it is possible to argue that the existing policy guidelines are excessively narrow, and a more consistent, coherent policy would enable public funding for the creation of human embryos for both the purpose of research and the creation of embryos through the method of somatic cell nuclear transfer. A defender of this position would not have to draw upon arcane strategies of argumentation. Rather, these policy conclusions can be reached using the moral framework implicit in the final report of the ad hoc Working Group.

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In short, individuals opposed to the use of pluripotent stem cell research involving human embryos as well as individuals supportive of the creation of human embryos for stem cell research through somatic cell nuclear transplantation are unlikely to be satisfied by the final report of the ad hoc Working Group. Indeed, even individuals who agree with the guidelines established by the group might well be dismayed at the lack of argumentation supplied in support of its policy conclusions.

Indeed, individuals concerned with the careful consideration of the many different ethical issues associated with research involving human pluripotent stem cells will be disappointed by the very narrow task that the Working Group accepted as its agenda. According to the final report,

The charge to the Working Group was to provide guidance to CIHR as to whether human ES or EG cell research should be considered eligible for CIHR funding, in the light of existing guidelines for human embryo research in Canada and the evolving international situation…the Working Group did not reconsider the range of ethical issues such as those relating to the moral status of the human embryo and the commodification of human life that had been considered previously (and in depth) in the 1993 report of the Royal Commission on New Reproductive Technologies. Rather, the Working Group accepted the findings of the Commission and the subsequent TCPS as the general ethical framework for its discussions.

In the third appendix to the report, the document states,

No attempt was made to articulate an argument regarding the moral status of the embryo, as this was not within the mandate of the Working Group. The principles governing “Human Pluripotent Stem Cell Research: Recommendations for CIHR-funded Research” are the CIHR principles for research involving humans as outlined in the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS). The Working Group accepted the TCPS guidelines for research involving human embryos. These guidelines are based on a “graduated approach that correlates permitted interventions with the develop mental stages of the human embryo or foetus” and they allow research on embryos until 14 days.

There are four problems with the manner in which the ad hoc Working Group regarded its responsibilities.

First, the 1993 report of the Royal Commission on New Reproductive Technologies (RRC) was written before many of the recent scientific developments that the ad hoc Working Group had to face occurred. For example, the RRC was written before the derivation of pluripotent stem cells from human embryonic and fetal sources in 1998. In addition, the RRC was written before the development of the cloning technologies involving somatic cell nuclear transfer in 1997. Furthermore, the RRC could not, of course, take into account changes in public perceptions and scientific understandings of the potential health benefits of somatic cell nuclear transfer and pluripotent stem cell research involving cells from human embryos. The findings from the Royal Commission cannot simply be dropped into current debates, as though all of the difficult ethical issues had already been resolved and as if the legalistic elaboration of guidelines were the only task remaining.

Second, the final report of the ad hoc Working Group makes frequent reference to the TCPS. But when one turns to this document for a full and frank discussion of the ethical issues concerning research involving human gametes, embryos or fetuses, one finds a text as peremptory and lacking in argumentation as the final report of the ad hoc Working Group. The entire section on this topic is no more than four widely spaced pages.

With regard to the subject of the creation of human embryos for the purpose of conducting research, the document simply states, “It is not ethically acceptable to create human embryos specifically for research purposes.” No moral justification is provided in support of this statement. Similarly, the prohibition of somatic cell nuclear transfer is buttressed by a total of three sentences, one of which admits that “while some research involving human reproduction is inherently objectionable to some schools of ethical and religious thought, it may not be so for others.” Those who find the final report of the CIHR ad hoc Working Group overly restrictive will be dissatisfied with the lack of careful reasoning and argumentation in both the TCPS and the final report, and those skeptical of the claim that funding should be provided in support of research involving pluripotent stem cells derived from human embryos and fetuses will be unimpressed by the four lines dedicated to defending research on human embryos in the TCPS. Important moral judgments and policy guidelines are elaborated without reasoned justification.

In short, while the final report of the ad hoc Working Group simply accepts the guidelines of the TCPS, the TCPS text does not provide the reasoned argumentation that could provide an adequate basis for the articulation of policy guidelines. On the subject of research involving human embryos and pluripotent stem cells, both the final report and the TCPS are long on declarative sentences and short on reasoned argumentation.

Third, policy-making is not simply about setting guidelines through the elaboration of various declarative statements. Policy-making, especially in such an ethically charged area as pluripotent stem cell research, plays an important role in shaping public understanding of topics that are complex, significant and worthy of careful deliberation. Policy documents produced by an agency such as the CIHR receive considerable media scrutiny and can play an important role in shaping future legislation and public perception. Given the importance of crafting considered, well-reasoned guidelines supported by argumentation and the careful exploration of competing arguments and policy models, the final report of the ad hoc Working Group should have included detailed justification of particular policies and not simply accepted poorly reasoned, previously published documents. It is not sufficient to write a report as though all of the difficult ethical issues and principles were already addressed and need not be reconsidered in light of competing moral frameworks and regulatory models.

Fourth, the consideration of ethical issues related to human pluripotent stem cells requires much more than the legalistic elaboration of procedures and guidelines. The final report states: “While the Working Group respects the diverse viewpoints of respondents on this issue, no attempt was made to articulate an argument regarding the moral status of the embryo, as this was not within the mandate of the Working Group.” However, in a document intended to set policy guidelines concerning the public funding of research involving human pluripotent stem cells, including stem cells derived from embryos and fetuses, it is not possible to avoid questions about the moral status of such entities as gametes, embryos, fetuses, embryos formed through somatic cell nuclear transplantation and adult pluripotent stem cells.

Either the status of these entities is addressed squarely and considered through careful reasoning intended to inform and persuade individuals who examine the policy, or it is tacitly accepted by the authors of the report and left undefended. The failure to engage in substantive moral deliberation means that the CIHR fumbled an important opportunity to make an informed contribution to public democratic deliberation concerning the use of pluripotent stem cells. Publicly funded agencies in Canada need to learn to link declarative statements to reasoned deliberation when crafting policy guidelines that are intended to address topics of considerable public controversy.

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