Although Gene Outka’s The Ethics of Human Stem Cell Research first appeared in the Kennedy Institute of Ethics Journal, it serves as the centerpiece for the valuable collection God and the Embryo. While size alone might indicate its strategic place (it is at least two-thirds longer than the other entries), Outka’s article also raises the central issue at stake in the embryonic stem cell debate and investigates the evidence mustered to support opposing positions.
The central question is this: What is the human fetus and embryo? This question can be posed from the viewpoint of moral status, a relatively new phrase open to a variety of judgments, or from the viewpoint of ontological status, a much more foundational approach that has a profound impact on any attendant moral status question. If from the moment of conception, we have a living organism that is specifically human, and if one holds that any living human organism is a personal being with personal endowments, that makes all the difference in the way we may treat it.
From here flows much of the ethical debate concerning research on embryonic stem cells, the political conflicts arising from the debate and the religious response to the political realities. To a large extent this is the structure of God and the Embryo.
Outka contrasts the predominantly genetic account that a human personal life begins at conception (most of us realize that Louise Brown, the first test-tube baby, was once a single-cell fertilized egg in vitro, a test-tube embryo, but she never was a sperm or ovum) with the implantation account, based upon the toti-potential nature of the early stage cells, the possibility of twinning and the high rate of embryo loss during the first few days after conception. While he seems to find the conception argument more persuasive, Outka concentrates on a problem particularly germane to the stem cell debate: what is to be done with the stem cells of embryos conceived in the laboratory?
His answer involves what for him is a crucial distinction. Human embryos must not be created solely for the use of cellular exploitation. Embryos created for reproductive assistance, however, and which are left over for indeterminate freezing or mere discarding, may ethically be used for stem cell research. Although something of a moral compromise in the face of present political, social and scientific realities, the use of such stem cells may bring about great therapeutic good; and since they are fated for destruction anyway, in a sense nothing is lost by such a compromise. The fact that Outka acknowledges the significant moral challenges to such a position indicates the care and nuance of his article. His is a delicate juggling of public policy, philosophy and theology, and scientific data.
As the conclusion of God and the Embryo’s first section, Frameworks, Outka’s article tackles the personal, collaborative and political issues suggested by Ronald Cole-Turner and Brent Waters. His investigation of the scientific data and ontological reality also makes the four contributions in the Embryos section far more effective than they would have been without his discussion. The essays by James Peterson and Brent Waters almost require Outka’s nuanced observations on the meaning of potentiality and the tools of philosophical anthropology. Similarly, Outka gives some robustness to the issues discussed in the section on Research and public policy, which might otherwise have seemed somewhat thin and abstract.
The one exception to this observation is the contribution Ethics in the Face of Uncertainty, by Kevin FitzGerald, S.J. (who may be the only extensively trained scientist featured in the collection). The uncertainty of the title refers not to some sort of moral skepticism, but rather to a sense of humility before the data of science and the realities of the world. It is refreshing to be warned about excessive claims often made on behalf of progress. It is also challenging to hear a call for a revitalized and convincing philosophical anthropology. And it is truly impressive to have an American scientist remind us of the great health care inequities in the world, as well as in our own culture, that might reduce the moral scale of our presumed imperatives for genetic therapy and enhancement.
The last section of God and the Embryo is a valuable collection of appendices. These include statements of various religious groups about the stem cell debate as well as the summary paper, Human Cloning and Human Dignity, issued by the 2002 President’s Council on Bioethics. (The entire President’s Council report, with its quite valuable position papers, is now available in paperback.)
Few readers are drawn to pick up a book of collected essays. Such volumes often seem to be spotty and only loosely integrated. But God and the Embryo is an exception. It especially merits inclusion in any library concerned with the interface of stem cell research, medical ethics and religious traditions.