ABORTION AND EMBRYONIC STERM CELL RESEARCH

CHAPTER 5 ABORTION AND EMBRYONIC STERM CELL RESEARCH

On January 20, 1973, the United States Supreme Court decided the landmark Roe v. Wade case that legalized abortion. For pro-choice advocates, the decision amounted to the emancipation of women from having to carry unwanted pregnancies to term. For pro-life supporters, on the other hand, the decision was tantamount to an assault on the most vulnerable segment of society, the unborn. Since that decision, the abortion debate has intensified, and it shows no signs of being resolved. It is still the debate that defines the current cultural conflict in America and will likely remain so in the foreseeable future. The long-standing abortion debate has expanded into other areas as well. For example, there is controversy about abortions that occur late in pregnancy, known as partial-birth abortions. Pro-life advocates cite these as particularly egregious examples of callousness toward life and the unborn, and pro-choice advocates resist any restriction on the constitutional right of women to procure abortions. As medical technology develops, there is increasing interest in research on embryos, mainly to harvest their stem cells, which scientists envision for numerous useful treatments for a variety of debilitating diseases. There is also debate about abortion and public policy—that is, whether abortion should be illegal if one considers it immoral. Most pro-life advocates are encouraging changes in the law, but some suggest that though they view abortion as immoral, the coercive force of the law should not be imposed on women seeking abortions. The literature on the subject of abortion is vast, from both pro-life and pro-choice perspectives, and on both popular and scholarly levels. It would

take some time to become familiar with all of it. Many philosophers, lawyers, theologians, and ethicists have devoted much of their professional lives to pursuing the abortion issue. This chapter is structured in such a way as to help you get at the heart of the problem by looking at four aspects of the abortion issue. The first aspect of the abortion issue concerns the legal background that has developed since the Roe v. Wade decision in 1973. Four more key Supreme Court cases will be presented, with special emphasis on the two most recent cases, which restrict abortion rights while affirming the basic direction of Roe v. Wade. The second aspect is the biblical background. We will review the contribution of the Bible to the issue. The third aspect is an analysis of pro-choice arguments for abortion rights. The fourth aspect of the problem deals with the issue of personhood and asks the question, At what point in the process of gestation does the unborn become a person? Finally, we will look at some of the related issues, such as embryonic stem cell research. You will notice that the material on the moral status of fetuses and embryos is also relevant to the discussion of reproductive technologies, addressed in chapter 6. The Legal Background of Abortion Although numerous legal battles have been carried out in the courts over different aspects of the abortion issue, the cases that have reached the Supreme Court are the most influential in setting the terms of the debate and the general direction of its outcome. Five specific cases have been particularly important both in establishing the legal right of a woman to obtain an abortion and in limiting that right. Beginning with the Roe v. Wade decision that initially legalized abortion and continuing through to the Planned Parenthood v. Casey decision that affirmed but limited the right to abortion, the abortion debate has continued to focus on the courts rather than on the U.S. Congress or state legislatures. Roe v. Wade (1973)1 In this landmark case, Norma McCorvey* (Jane Roe) claimed she had been raped and that Texas law was forcing her to continue her pregnancy, even though she had been impregnated against her will. Although she later

admitted that she had not been raped but had become pregnant due to birth control failure, the Court ruled that Texas laws prohibiting abortion except to save the mother’s life were unconstitutional. Such laws were claimed to violate the due process clause of the Fourteenth Amendment of the Constitution, which protects a person’s right to privacy. The idea of privacy was extended to a woman’s womb, allowing her the right to end her pregnancy. The Court ruled that although a woman does have a constitutional right to an abortion, the state also has an interest in protecting the woman’s health and the potential life of the fetus. The Court saw this as growing and becoming compelling as the pregnancy progresses. They therefore divided pregnancy into three trimesters and held that the state has different interests during each of the trimesters. The justices affirmed a woman’s unquestioned right to abortion on demand during the first trimester of pregnancy. After the first trimester, however, the state may regulate abortion in ways that are reasonably related to the health of the mother, for example, by requiring that abortions be done in licensed medical facilities by licensed medical personnel. Thus, after the first trimester, abortion is available but not entirely on demand. After viability (i.e., the point at which the fetus can live on its own outside its mother’s womb), due to the state’s interest in the potential life of the fetus, the state may regulate and prohibit abortion, except in cases necessary to preserve the life or health of the mother. Although the decision did not technically legalize abortion on demand, Roe v. Wade along with its companion case, Doe v. Bolton, would eventually make abortion on demand legal throughout pregnancy. Doe v. Bolton (1973)2 In a companion case decided on the same day as Roe v. Wade, the Court struck down a Georgia law that limited abortions to accredited hospitals, required the approval of the hospital abortion committee and confirmation by two other physicians, and limited access to abortion in Georgia to state residents. Again citing the woman’s right to privacy, and for the first time, the physician’s right to conduct medical practice, the Court declared the statute unconstitutional. Any attempts to limit the woman’s right to obtain an abortion must be consistent with what the Court called “a compelling state

interest,” of which there was none in this case. The “Jane Roe” in Roe v. Wade Norma McCorvey was the plaintiff in the landmark 1973 case of Roe v. Wade, which legalized abortion. Her remarkable transformation from Roe supporter to pro-life activist is well documented and is a touching story of her own personal redemption. One little-known fact about her is that, contrary to her testimony in Roe, she was not raped, and thus her abortion was not due to the fact that she was pregnant as a result of sexual assault. She became pregnant due to consensual sex. However, she did come from a very rough family background and was pregnant with a very unwanted pregnancy. Following her success as a Roe plaintiff, she was active in pro-choice advocacy and clashed repeatedly with pro-life supporters in her hometown of Dallas. Then, as fate would have it, or as some would say, in the providence of God, pro-life pastor and Operation Rescue leader Flip Benham moved into the house next door to her. Over time Benham and other leaders reached out to her, bringing her to faith in Christ. One of the most significant changes in her life was her move from pro-choice to prolife activist. She started her own ministry, Roe No More, and has a special passion for crisis pregnancy clinics.*

An exception in the Georgia law allowed for abortion in the case that a continued pregnancy would either endanger the pregnant woman’s life or threaten her health. The decision about a threat to the woman’s life or health was made according to the “best clinical judgment” of the physician. The right of the physician to exercise judgment in this way constituted a significant broadening of the Roe v. Wade decision and made abortion on demand available throughout a woman’s pregnancy. The Roe v. Wade decision allowed states to prohibit abortion after viability, except when continuing the pregnancy threatened the life or health of the mother. The decision in Doe v. Bolton expanded what was meant by the life and health of the mother. The Court interpreted the health of the mother to include much more than

simply her physical health. It also included her psychological and emotional health. Thus, if she would be significantly harmed emotionally by continuing the pregnancy, the physician could authorize an abortion. The Court put it this way: “That statute [the Georgia law in question] has been construed to bear upon the psychological as well as physical well-being…. We agree that the medical judgment [of the woman’s physician] may be exercised in light of all factors—physical, emotional, psychological, familial and the woman’s age—relevant to the well-being of the patient. All these factors may relate to health [of the pregnant woman].”3 Thus the Court ruled that if the physician sees the pregnancy as a threat to the woman’s health in virtually any way, he or she can authorize an abortion at any stage of the pregnancy. If continuing the pregnancy would affect the emotional health of her family (the familial factors cited by the Court), an abortion could also be justified. The way in which the Court expanded the idea of the woman’s health and how the fetus can threaten it opened the door to abortion for virtually any reason. This decision, along with the Roe decision, established a constitutional right to abortion on demand. Planned Parenthood v. Danforth (1977)4 The case of Planned Parenthood v. Danforth struck down limits on the freedom to obtain an abortion according to the standards set down in Roe v. Wade. At issue was a Missouri law that required that a woman’s husband also consent to the abortion, and that the parents of a minor child consent to her abortion. The Court ruled that a woman’s right to abortion cannot be limited by the requirement that a spouse or parent of a minor child must grant prior consent. The Court ruled that the decision to abort must be left to the pregnant woman and the best medical judgment of her attending physician, and that blanket provisions of consent were overreaching and therefore unconstitutional. For many opponents of abortion, it was inconceivable that a pregnant teenager could obtain an abortion without either her parents’ consent or even their knowledge. Accordingly, this decision created substantial controversy. Webster v. Reproductive Health Services (1989)5 Webster v. Reproduction Health Services marked one of the first significant

limits to the right to abortion. The Court reversed decisions by the District Court and the Court of Appeals and upheld a Missouri law that prohibited the use of public funds or medical facilities for “nontherapeutic” abortions (i.e., abortions not necessary to safeguard the life of the mother). The Court held that the right to abortion established in Roe v. Wade does not obligate the state to pay for abortions for women who cannot afford them. The denial of public funds to secure an abortion does not violate Roe v. Wade, since it places no governmental obstacle in the path of a woman seeking an abortion. It simply leaves her the same choices as if the government had decided not to operate any public hospitals at all. In addition, the use of public funds for childbirth, which is constitutional, and not for abortion does not violate Roe v. Wade, since states are allowed to make value judgments in their allocation of public funds. Whereas the Hyde Amendment prohibited the use of federal funds for abortions, Webster v. Reproductive Health Services concerned the right of states to prohibit the use of their tax dollars to pay for abortions. Proponents of abortion argued that the right to obtain an abortion is an empty right if a woman cannot afford it and if the state refuses to help her pay for it. The Court ruled that the responsibility of government, at any level, to pay for abortions does not follow from the woman’s right to obtain an abortion free from state interference. The Court rightly distinguished between a negative and a positive right. Negative rights are the rights to be left alone, to be free from governmental interference (in this case, in procuring an abortion). In other words, the state cannot place deliberate obstacles in the way of a woman who desires an abortion. A positive right is a right that also obligates someone to provide it for you (in this case the state that provides the funds to pay for the abortion). As outlined in Roe v. Wade, the right to an abortion is a negative right, a right to be left alone and free from interference in pursuing an abortion. That negative right does not obligate the state to provide a way for a woman to obtain the abortion. Planned Parenthood v. Casey (1992)6 The most recent challenge to Roe v. Wade concerned a Pennsylvania law and was considered by abortion opponents to be the best opportunity for the Court to actually overturn Roe v. Wade. At issue in the case were the

provisions of the law that required a twenty-four-hour waiting period before the abortion (during which time a woman must be given information about the procedure and risks of abortion and about the probable gestational age of the fetus), parental consent for a minor seeking an abortion (although the law provided a way to bypass that requirement by getting a judge’s consent, called the judicial bypass), and notification of the woman’s husband of her decision to obtain an abortion. A woman could be exempt from all of these requirements in cases of “medical emergency.” Sensing that this case was a challenge to the basic tenets of Roe v. Wade, the Court went to great lengths to reaffirm the basic direction of that decision and to continue to safeguard a woman’s right to choose an abortion, much to the disappointment of pro-life advocates. The Court reasoned that abortion rights are consistent with the notion of the right to privacy that emerges out of the idea of liberty in the Constitution. They further reasoned that abortion rights are consistent with the ideas of personal autonomy (the right to make one’s major life decisions for oneself) and bodily integrity (the right to have one’s body left alone), parallel to the right to refuse medical treatment. These arguments constitute a significant part of the pro-choice position that will be examined more closely in the next section. However, the Court did uphold some of the provisions of the Pennsylvania law, much to the dismay of pro-choice advocates. First, the Court upheld the twenty-four-hour waiting period in which the woman would be provided information about the risks of abortion (both to the woman and the fetus) and the probable age of the fetus. Even if the information presented (which had to be presented fairly and in a way that was not misleading) resulted in the woman choosing childbirth over abortion, it did not constitute an undue burden to a woman seeking an abortion. Second, the Court also upheld the parental consent with judicial bypass provision of the law as reasonable. Third, the Court declared the spousal notification provision of the law invalid because of the risk that it could pose to a woman and because it would be a significant obstacle for some women in obtaining an abortion. Thus both pro-life and pro-choice advocates were disappointed with the ruling. Pro-life supporters felt as if the best chance to overturn Roe v. Wade had been lost and vowed to continue the fight in state legislatures across the country. Pro-choice supporters were disappointed at the restrictions the Court

upheld, believing them to be undue burdens on women seeking abortions. The legality of abortion appears to be safe for the time being, however, with Roe v. Wade having survived the challenges to its constitutionality. That makes the place of moral debate and persuasion even more important and underscores the significance of the biblical data and the moral arguments used in the debate. The Biblical Background of Abortion Although the Bible never specifically states that “the fetus is a person” and “Thou shalt not have an abortion,” it is misleading to insist that the Bible has nothing to say about the moral status of the unborn. The general tenor of Scripture is resoundingly pro-life. Although some texts on the surface appear to support a pro-choice position, such support is not borne out by further examination of the texts in their context. The Bible clearly prohibits the taking of innocent life in the Fifth Commandment: “You shall not murder” (Ex. 20:13). Applying this directly to the unborn involves begging the question about the moral and ontological status of the unborn. That is, to apply this to the unborn involves a further argument that the embryo/fetus in the womb constitutes a person who possesses the right to life. It is indisputable that God is deeply involved in fashioning the unborn in the womb and thus deeply cares about the unborn. From the Bible’s perspective, abortion is thus seen as an unjustified interference in God’s sacred role in the womb. When abortion occurs, it involves not only the termination of a pregnancy, but also the termination of the very work of God in the womb. However, that is not the same thing as claiming that the unborn are persons and that abortion is ending the life of an innocent person. Given his role as Creator of the entire universe, God is involved in the creation of animals and cares deeply for them as well. But from that alone, it does not follow that animals have the same rights as people, since God also gave people dominion over the animal kingdom7 and since only human beings are made in God’s image. The important part of the argument is to show that God attributes the same characteristics to the unborn in the womb as to a person out of the womb. In other words, Scripture must indicate a continuity of personal identity when describing the unborn.

Partial-Birth Abortion Opponents of abortion cite one particular method of terminating a pregnancy as an example of the “right to choose” taken to an extreme. Abortion rights advocates argue that the procedure is used only in emergency late-term abortions and should remain legal. The procedure involves partially delivering the fetus breech (legs and torso first) but leaving the skull in the womb—then the physician makes an incision at the base of the skull and removes by suction the brain tissue of the fetus, instantly causing its death. Abortion opponents routinely refer to this as a form of infanticide, even though some (admittedly a small part) of the fetus is still technically in the womb. How frequently and for what reasons these types of abortion occur is a matter of debate. President George W. Bush signed a bill into law in 2003 prohibiting the procedure, though it does contain an exception in the case of a threat to the mother’s life. The U.S. Supreme Court upheld the law in a 2007 decision. The ban on partial-birth abortions does not mean that all late-term abortions are illegal—just the specific procedure known as the partial-birth abortion.

The passages cited below are not an exhaustive list of texts that could refer to abortion, but they represent the clearest indications of a continuity of personal identity that begins at the earliest point of pregnancy and continues into adulthood. Some of the relevant passages use conception and birth interchangeably. Others suggest that the same characteristics of adults are applied to the unborn. Examples of where the Bible uses conception and birth interchangeably include Job 3:3, which states, “Let the day perish on which I was to be born, and the night which said, ‘A boy is conceived’ “ (NASB). This poetic passage employs what is called synonymous parallelism, in which the second line of poetry restates the first one, essentially saying the same thing in different language. This type of parallelism suggests that the child who was “born” and the child who was “conceived” are considered the same person. In fact, the terms “born” and “conceived” are used interchangeably here, suggesting that a person is in view at both conception and birth. What was present at birth was considered equivalent to what was present at conception.

This is strengthened by the use of the term “boy” in the second half of the verse, which speaks of conception. The woman did not conceive a thing or a piece of tissue, but a “boy,” a person. The Hebrew term for “boy,” geber, is also used in other parts of the Old Testament to refer to a man (Ex. 10:11; Deut. 22:5; Judg. 5:30). Thus, in the same sense that an adult man is a person, the individual conceived in Job 3:3 is a person. Other passages that seem to use conception and birth interchangeably include Jeremiah 1:5, where God says, “Before I formed you in the womb I knew you, before you were born I set you apart; I appointed you as a prophet to the nations.” Here it seems clear that God had a relationship with and an intimate knowledge of Jeremiah in the same way he did when Jeremiah was an adult and engaged in his prophetic ministry. In the womb he was called to be a prophet, something that was commonly done with other prophets when they were adults. That is, there is more to this text than the simple parallel between conception and birth. It also describes God knowing the unborn in the same way he knows a child or an adult, thereby attributing something characteristic of adults to the unborn. However, one should be careful not to take the parallelism too far in this text, since it would extend the argument for personhood farther than one might want and suggest preexistence. A similar text occurs in Isaiah 49:1, which states, “Before I was born the LORD called me [literally, “from the womb the LORD called me”]; from my birth he has made mention of my name.” Again the parallel suggests that conception and birth are used interchangeably, but the text adds to this the idea that the person in question was both called and named prior to birth, indicative of a personal interest that parallels the interest God takes in adults. Since the person in view in Isaiah 49:1 is the Suffering Servant, Jesus Christ, this passage may be a reference to the preexistence of Jesus. Perhaps the clearest indication that the unborn are objects of God’s knowledge may be found in Psalm 139:13–16, which clearly shows that God is intimately involved in forming the unborn child and cultivating an intimate knowledge of that child. Some people may object to the use of these texts, suggesting that all of these refer only to God’s foreknowledge of a person prior to birth. However, in passages such as Job 3:3, the person who eventually grows into an adult is the same person who is in view in the womb. Although it is true that these passages use poetic devices to make their point, one cannot dismiss such texts

simply because they are using figurative language. Poetry is difficult to interpret in many places, but just because it uses figures of speech is no reason to minimize their contribution. Figurative language always is making some kind of literal point, and though it is not appropriate to take figures of speech in a woodenly literal way, they do have an underlying literal point that is being made, which, in the above texts, is the parallel between conception and birth. Psalm 139:13–16 describes the intimate involvement of God in the formation of the unborn. From a Christian worldview, this should be sufficient to discourage abortion, since it interrupts the sovereign work of God in the womb. However, the psalm further teaches a continuity of personal identity from the earliest points of pregnancy forward. The psalmist who is intimately known by God in the first few verses is the same person who was described as intricately formed in the womb by God later in the psalm. And he is the same person who at the end of the psalm, requests God to search him and know his heart. Some raise the objection that Psalm 139 speaks only of the development of a person in the womb, not of the fact that what is in the womb is indeed a person. However, these texts suggest that in the womb from conception is a person with potential for development, not merely some being that will develop into a person at some point in the gestational process. These texts, particularly Psalm 139, strongly suggest a continuity of personal identity that runs from conception to adulthood. Two other passages highlight this continuity of personal identity. Psalm 51:5 says, “Surely I was sinful at birth, sinful from the time my mother conceived me.” Here David is confessing not only his sins of adultery with Bathsheba and premeditated murder of her husband, Uriah the Hittite (see 2 Sam. 11–12), but also his innate inclination to sin. This is a characteristic shared by all people, and David’s claim is that he possessed it from the point of conception. Thus the inherent inclination to sin is attributed both to adult persons and the unborn. Using synonymous parallelism similar to that in Job 3:3, David appears to treat birth and conception as practically interchangeable terms. Finally, the Greek term for “baby,” bréphos, is applied to a child still in the womb in Luke 1:41–44 as well as to the newborn baby Jesus in Luke 2:16. Perhaps a more explicit reference to the significance of the birth of the

baby (bréphos) Jesus comes from the visitation of Mary to Elizabeth in the early days of her pregnancy. Mary visits Elizabeth (Luke 1:39–56) only a few days after she has found out that she is pregnant with Jesus. The account of the angel’s announcement (vv. 26–38) indicates that Mary left in haste to visit Elizabeth and share this news with her. Allowing for travel time of roughly two weeks, we perceive that when she arrives at Elizabeth’s home, Mary is in the very earliest stages of her pregnancy, with a fetus that is less than three weeks old. Upon arrival at Elizabeth’s home, Mary is immediately recognized as “the mother of my Lord” (v. 43). Even though she is carrying a very early stage fetus (in fact, at this point in the pregnancy, most expectant women do not even know they are pregnant), she is clearly recognized as a mother, and by implication, Jesus is recognized as her son, a baby. Further, John the Baptist leaps in Elizabeth’s womb, perhaps signifying his recognition of the significance of Jesus’ conception and in utero development. What is clear is that all of the parties involved in this narrative—Mary, John, and Elizabeth—recognize that something very significant is occurring that is bound up with Mary being pregnant with the Messiah. The significance of the incarnation, though likely not grasped in its fullness, is nonetheless recognized, not at Jesus’ birth, but far earlier, in the earliest stages following conception. That is, the incarnation is recognized as having begun months prior to Jesus’ actual birth. From the earliest points of life in the womb, Mary and Elizabeth realize that the incarnation has begun. This lends support to the notion that the incarnation began with Jesus’ conception and that the Messiah took on human form in all of its stages, embryonic life included. The general tenor of Scripture appears to support the idea that the unborn is considered a person by God, being described with many of the same characteristics that apply to children and adults. However, a handful of passages seem to indicate that the unborn is less than a full person, and that the Bible does not consider the unborn to be the equivalent of an adult in terms of its essential personhood. The primary text that calls this into question is Exodus 21:22–25, which records a specific law designed to arbitrate a very specific case. “If men who are fighting hit a pregnant woman and she gives birth prematurely [has a miscarriage] but there is no serious

injury, the offender must be fined whatever the woman’s husband demands and the court allows. But if there is serious injury [i.e., to the woman], you are to take life for life, eye for eye, tooth for tooth, hand for hand, burn for burn, wound for wound, bruise for bruise” (emphasis added). Some suggest that since the penalty for causing the death of the fetus is only a fine, whereas the penalty for causing the death of the mother is death, the fetus must not be deserving of the same level of protection as an adult person. It must have a different status, something less than that full personhood that merits a life-for-life penalty if taken. This argument assumes that the phrase “gives birth prematurely” should be translated “has a miscarriage.” If that is the correct translation, then the argument that the unborn are viewed differently may have more merit, because of the difference in penalty. However, there is significant debate over the translation “gives birth prematurely.” The most likely translation is “she gives birth prematurely” (so NIV), implying that the birth is successful, creating serious discomfort to the pregnant woman but not killing her or her child. The normal Hebrew word for “miscarriage” is the term shakal, which is not used here. Rather, the term yasa is used. It is normally used in connection with the live birth of one’s child. The fact that the normal term for miscarriage is not used here and a term that has connotations to live birth is used suggests that the passage means a woman who gives birth prematurely.8 This would make more sense of the different penalties accruing to the guilty party. Perhaps the phrase “if there is serious injury” (v. 23) could apply to either the woman or the child, so that if the woman actually did have a miscarriage, the punishment would be life for life. The Arguments for the Pro-Choice Position The pro-life position has in effect only one argument, based on the notion that the unborn is a person, which must be answered. Throughout the past two decades, however, pro-choice proponents have put forth a number of arguments to support a woman’s right to choose abortion. In the next section, we will examine the pro-life claim that the unborn has personhood from the point of conception. Here we will examine the various pro-choice arguments that have been articulated both in popular and scholarly forums.9 Most of the arguments for abortion rights commit the logical fallacy known as “begging

the question,” or assuming the conclusion one wishes to reach without offering any evidence for its validity. For example, in order for their various arguments to work, pro-choice advocates assume that the fetus is not a full person. The pro-life advocate will rightly point out the question-begging fallacy so as to focus the debate on the central issue—the personhood of the unborn. 1. A woman has the right to do with her own body whatever she chooses. That a woman has the right to do with her own body whatever she chooses is by far the most frequently presented argument in favor of abortion rights. It is the fundamental principle of the pro-choice movement—the woman’s right to choose. This is foundational to the woman’s constitutional right to privacy and was appealed to by the Court in the Casey decision when they referred to the preservation of a woman’s bodily integrity and to her personal autonomy to choose abortion. Many people who personally oppose abortion and would never have one themselves nevertheless support a woman’s right to choose abortion on the basis that it is her body and therefore her choice. In response, I would note that a person’s right over his or her own body is not absolute. In most states, prostitution is illegal, and nowhere is it legal to pour illegal drugs into one’s body. In addition, the fetus is technically not part of the woman’s body. It is a genetically distinct entity with its own genetic code, and early on in the pregnancy it has its own heart and circulatory system. In many cases it also has a separate gender identity that is present from the moment of conception. It would be difficult to account for the presence of a differently gendered “part” of the woman if the fetus is a part of the woman’s body. This argument confuses the fetus being attached to the woman carrying it and being a part of the woman carrying it. It does not follow that just because the fetus is attached to its mother by an umbilical cord that the fetus is a part of her in a way that denies its own separate identity. To put it differently, this argument confuses the fetus living inside the woman with being a part of her. Again, these are not the same, and being a part of her does not follow necessarily from the fact that the fetus lives inside of her. This argument further begs the question of the nature of the fetus by

assuming that it is less than fully human. If pro-choice advocates did not assume this, this argument could not stand. Historically in Western society, when life and freedom (choice) have been in conflict, life always has taken precedence. Only if the fetus is not a person does a woman have a right to make a choice that would result in its death. But if the fetus is a person, then very few freedoms would take precedence over its right to life. The prochoice advocate may respond that I am also begging the question by assuming that the fetus is indeed a person. That is true, but it is done only in order to show the question-begging nature of this argument. That is, only if one assumes that the fetus is not a person will the argument work. But that is the heart of the debate, and any argument that assumes what is central to the issue cannot be considered valid. 2. If abortion becomes illegal, we will return to the dangerous days of the “back alley” abortion providers. The argument that if abortion becomes illegal we will return to the days of the “back alley” abortion providers takes one back to the days prior to the Roe v. Wad e decision, when most abortions were illegal and women had to go to less than ideal settings to obtain them, thereby putting their health at significantly greater risk. Unlicensed physicians allegedly performed these abortions in “back alley” clinics with varying degrees of safety. Desperate to be relieved of an unwanted pregnancy, women would thus endanger themselves in the process of obtaining an abortion. No one, the argument goes, would want to go back to those days, and if the pro-life movement has its way, that is exactly where society will be heading. In response, this argument also begs the question, since one must assume that the fetus is not a person. Otherwise, the person advancing this argument would be arguing that society has the responsibility to make it safe to kill people who have the right to life. Unless the fetus is a person, this argument has little force, for if it is a person and abortion amounts to killing a person, the issue of making it safe for a person to do so is not only irrelevant, but it is absurd. The only way that the safety of the mother can be a legitimate concern is if the fetus is not a person and if abortion is comparable to any

other type of surgery in which a part of the woman’s body is removed. This argument also seems to overstate the potential danger to women receiving illegal “back alley” abortions. The statistics on the number of women who died procuring illegal abortions are clearly inflated, at times even by the admission of pro-choice advocates.10 For example, according to numbers available from the Bureau of Vital Statistics, roughly forty women died from such abortions in 1972, the year prior to Roe v. Wade. In fact, the number of deaths from abortion-related consequences has decreased consistently since 1942.11 It is misleading to insist that the majority of illegal abortions were performed by unqualified physicians, since prior to 1973 roughly 90 percent of illegal abortions were performed by licensed physicians in good standing with their state medical boards.12 Closely related to this argument is the argument that any substantial prohibition of abortion is unenforceable. To enforce any such law would likely involve intolerable invasions of privacy and would force physicians to break their covenant of confidentiality with their patients. But again, this argument begs the question by assuming that the fetus is not a person, for if it is, then making it safe and legal to abort a fetus does not follow at all. In addition, it can be shown that prior to 1973, restrictive abortion laws were quite enforceable and were effective in limiting abortions. Since 1973 roughly 1.5 million abortions have been performed annually. Prior to 1973 roughly 100,000 abortions were performed annually. This does not mean that enforcement would be free of all difficulties, but it does not follow that abortion should not be limited because of these difficulties. 3. Forcing women, especially poor ones, to continue their pregnancies will create overwhelming financial hardship. The argument that forcing women to continue their pregnancies will create overwhelming financial hardship is based on the idea that economic hardship will likely result from women being without the option of abortion to control the size of their families. Without safe and legal abortion, these women will be condemned to a life of poverty and financial burden, which is also unfair to the children that they bring into the world.

In response, this argument also begs the question by assuming that unborn poor are not persons. This argument can work only by making such an assumption. Otherwise, this argument could be used as a basis for exterminating all those people who are financially burdensome to society. Obviously the reason that society does not do this is that the financially burdensome are persons with the right to life, and their burden to society is irrelevant to their continuing right to life. Only if the fetus is not a person can we say that financial burdensomeness is a criteria for elimination. This argument also confuses finding a solution with eliminating the problem. The solution to unwanted pregnancies is not to eliminate them; by comparison, we could easily solve the problem of poverty by exterminating all the poor. It is better to view adoption as one of the solutions to the problem and recognize that hardship, no matter how severe, cannot justify intentionally killing someone. 4. Society should not force women to bring unwanted children into the world. Closely related to the economic hardship argument is the argument of the unwanted child. This argument is broader, encompassing pregnancies that are unwanted for more than reasons of financial hardship. Abortion helps society prevent bringing unwanted children into the world, and thus prevents child abuse and child neglect. In response, this argument also begs the question by assuming that the fetus is not a person, because if it is, then surely abortion is the worst imaginable form of child abuse. In addition, one cannot determine the value of a child based on the degree to which he or she is desired. If anything, the fact that a child is unwanted is more of a commentary on the parents than the child, and if the fetus is a person, whether it is wanted or not is irrelevant to its right to life. Perhaps the issue of the homeless offers a parallel. They are not wanted in many communities, but the reason they are not eliminated has nothing to do with that. They are persons with the right to life, and one cannot solve a problem by eliminating it. Therefore, this argument hinges on the pro-choice advocate’s ability to demonstrate that the fetus is not a person, not on the fact that the pregnancy is unwanted. Statistics show that since 1973 child abuse has increased substantially,

even with the termination of approximately 1.5 million unwanted pregnancies annually. It may be that the incidence of child abuse is unrelated to liberal abortion laws. If anything, it could be that the callousness toward the fetus engendered by liberal abortion laws has carried over into a greater societal tendency toward child abuse. No evidence shows that being unwanted is necessarily linked with being abused. In fact, some studies have shown that the great majority of abused children were wanted by their parents, and adopted children experience a higher incidence of child abuse than nonadopted children.13 5. Society should not force women to bring severely handicapped children into the world. That society should not force women to bring severely handicapped children into the world is the argument from the deformity of the fetus, which can be detected in utero through the process of amniocentesis. This is becoming more routine in prenatal care, and frequently genetic counselors assume that a woman will have an abortion if tests reveal a deformed fetus. Pro-choice advocates consider it unfair and insensitive to force a woman to carry a pregnancy that she knows will result in a severely deformed child. In response, abortions in the case of deformity are a relatively small percentage of the overall number of abortions performed annually. These are clearly some of the most difficult cases in the abortion scenario. At best, they only support the right of a woman to have an abortion in these difficult cases, but they do not support the right of a woman to choose abortion as a fundamental right. In general, difficult cases do not make the general rule— that is, they do not support the right of a woman to choose abortion on demand. This argument also begs the question of the personhood of the fetus, since this argument can only be valid if we assume that the fetus is not a person. But if the fetus is a person, then this argument can be used to justify killing all the handicapped. There is no moral difference between aborting a handicapped fetus and executing handicapped children. Yet no one accepts the right of parents to kill their handicapped children, precisely because they are persons. Unless the assumption that the fetus is not a person is true, the argument collapses. Thus this argument must rest on whether the fetus is a

person, not on the handicapped status of the fetus. In addition, it is presumptuous to say that a handicapped life is not worth living and should be aborted. This may be true in rare and very extreme cases, such as anencephaly, where the child is born with only a brain stem and no other part of the brain. But this extreme case cannot be used to justify abortion in cases of more moderate deformities, such as mild Down syndrome. No evidence supports the notion that unhappiness necessarily accompanies disability. 6. Society should not force women who are pregnant from rape or incest to continue their pregnancies. The argument that society should not force women who are pregnant from rape or incest to continue their pregnancies is related to the previous one and is one of the most emotionally compelling arguments for a woman’s right to choose abortion. Since the woman had sex forced on her against her will, it is argued that she should not be forced to continue a potential pregnancy. This is not a case of carelessness, but rather a lack of consent to sex that made her pregnant. Thus society would be punishing the victim of a violent crime by making her a victim again. At the heart of this argument is the premise that a woman should not be held responsible for sex that is forced upon her, and thus should have the right to end a pregnancy that came about through rape or incest. Peter Singer and Infanticide Australian philosopher Peter Singer, who holds an endowed chair in ethics at Princeton University, has some of the more controversial ideas about abortion and infanticide. He holds a common position in the philosophical community that an important determinant of whether someone is a person is his or her ability to experience a continuing self with an interest in continued life. This presumes a level of consciousness and self-awareness that no fetuses or newborns have and even applies to some severely impaired infants. He and Helga Kuhse put it this way: “When we kill a newborn infant (particularly one that is severely handicapped) there is not a person whose life has

begun (or will ever begin). It is the beginning of the life of the person, rather than the physical organism, that is crucial as far as the right to life is concerned.” Singer maintains that newborns, up to roughly the first thirty days of life, do not meet the criteria for being a person and that infanticide is justified during that time. He further insists that certain classes of handicapped newborns never will meet the criteria for being a person, and that infanticide is justified in their cases. Singer has had numerous critics, who insist that there is an important difference between being a person and functioning as a person. That is, you can be a person and have those critical functions that Singer describes be latent or temporarily unexpressed.*

In response, the number of pregnancies that result from rape or incest is very small—roughly 1 in 100,000 cases. Yet how the pregnancy was conceived is irrelevant to the central question of the personhood of the fetus. This is because the child should not be penalized for the sin of his or her father. This argument can only work if one assumes that the fetus is not a person, since you cannot justify the homicide of another person just to relieve the mental distress of a trauma such as rape. Many people argue that the pro-life advocate should not victimize the woman a second time by forcing her to continue the pregnancy against her will. Although they hold that the fetus is just as much a person as if conceived through consensual sex, they maintain that the law should allow an exception to permit abortion in cases of rape and incest. The reason for this is not moral but prudential. They believe that unless a proposed law contains this exception, it will have little chance of being enacted into law by any state legislature. Arguing that it is better to save more unborn children than less, one can make a good case that the exception should be adopted. Of course, an inherent problem with this is how to enforce such a law, since it might be difficult to verify the claim of a woman seeking an abortion that she has been raped. 7. Restrictive abortion laws discriminate against poor women. The argument that restrictive abortion laws discriminate against poor women

is based on what happened prior to abortion being legalized in 1973. When women of means wanted abortions, they simply traveled to countries where abortion was legal and paid for them. Obviously, poor women did not have such an option. Thus restrictive abortion laws have the practical effect of discriminating against poor women, who are often the ones who need abortion services the most due to their difficult economic circumstances. In response, this argument begs the question by assuming that an abortion is somehow a moral good that would be denied to poor women if restrictive abortion laws were enacted. But whether abortion is a moral good is precisely the point being debated. If the fetus is a person, then denying someone an abortion is irrelevant. Society has no obligation to provide equally to all people the freedom to kill innocent others. This argument can therefore be valid only if it assumes that the fetus is not a person. All of the above arguments for abortion rights commit the fallacy of question begging. This illustrates how important it is to debate the central issue in the abortion question—the issue of the personhood of the fetus. If the fetus is not a person at the point in the pregnancy at which the abortion is being considered, then most of the arguments for abortion rights are valid. But if the fetus is a person, then none of the arguments for abortion rights hold. If the premise that the fetus is a person is applied consistently, it would lead to morally preposterous implications. We now turn to the critical question of the personhood of the fetus. The Personhood of the Fetus Most philosophers agree that the fetus either has personhood from the point of conception or it acquires it at some point during the process of gestation. A small minority of thinkers hold that not even the newborn baby possesses personhood, thus making infanticide theoretically justifiable in some cases. But most thinkers agree that once the fetus emerges from the womb as a newborn child, it is a person with full human rights. Thus the question under debate is, At what point in the process of gestation does the fetus possess personhood? A wide variety of different points has been suggested. These are called “decisive moments,” referring to a “moment” at which the fetus can be said to be a person. In this section we will discuss these different decisive moments.14

Often a distinction is made between the fetus being a human being and the fetus being a person. Such a distinction is highly arbitrary, since the essence of the fetus is unchanged throughout the process of gestation. None of the different decisive moments suggests any relevant change in the essence of the fetus. Thus a constant process of growth and development continues from conception to adulthood. In the abortion debate one commonly hears voices suggest that no one has a way to determine for sure when personhood begins. Taking an agnostic approach to the issue, these people argue that science has provided no clear answer to the question. They maintain that since it is essentially a religious or philosophical issue and cannot be proven conclusively, it should be left to individual choice. In response to this, the same can be said of the pro-choice view that allows for abortion. By permitting abortion throughout almost the entire nine months of pregnancy, pro-choice advocates are actually making a strong statement that person-hood doesn’t begin until birth. We will examine birth as a decisive moment below. In addition, if one is admittedly agnostic about when personhood is acquired, then surely it is preferable to err on the side of life. If we are not sure that the fetus is a person, then society should not permit the taking of the life of the fetus through abortion. For example, if I am hunting with a friend who enters the woods and I then hear what sounds like the rustling of a deer at the same spot where my friend entered, I had better not shoot. After all, I cannot be sure whether the rustling sound was made by my friend or the deer. If in doubt, one should not shoot into the trees. Likewise, if in doubt about the personhood of the fetus, one should not risk the life of the fetus, since it may be a person whose life is being ended by abortion. Uncertainty about the status of the fetus justifies caution, not abortion. The most commonly proposed decisive moment, and the one currently endorsed by the Supreme Court is viability, which is the point at which the fetus is able to live on its own outside the womb. At this point of about twenty-four to twenty-six weeks of gestation, the fetus is able to live on its own, a fact that is deemed significant enough to grant it the status of a person. Although it may still depend on medical technology, it no longer depends on its uterine environment.

One problem with viability as a determinant of personhood is that it cannot be measured precisely. It varies from fetus to fetus, and medical technology is continually pushing viability back to earlier stages of pregnancy. Thus viability keeps changing, which raises questions about its reliability as an indicator of personhood. Viability also varies widely from place to place, as a function of the available medical technology. That is, viability is quite different in a high-technology New York City hospital than it is in rural Nigeria. So what does viability actually measure? Viability has more to do with the ability of medical technology to sustain life outside the womb than it has to do with the essence of the fetus. Viability relates more to the fetus’s location and dependency than to its essence or its personhood. Hence no inherent connection exists between the fetus’s ability to survive outside the womb and its essence. Rather, viability measures the progress of medical technology in helping the fetus to survive in a different location. Perhaps the next most commonly proposed decisive moment is brain development, or the point at which the brain of the fetus begins to function, which is about forty-five days into the pregnancy. The appeal of this decisive moment is the parallel with the definition of death, which is the cessation of all brain activity. Since brain activity is what measures death, or the loss of personhood, it is reasonable to take the beginning of brain activity as the indication of personhood. The problem with the analogy to brain death is that the dead brain is in an irreversible condition, unable to be revived. The brain of the developing fetus is only temporarily nonfunctional. Its electroencephalogram (EEG) is only temporarily flat, whereas the EEG of a dead person’s brain is permanently flat. Also, the embryo from the point of conception has all the necessary capacities to develop full brain activity. Until about forty-five days gestation, those capacities are not yet realized but are latent in the embryo. Just because a capacity is not exercised is not a necessary comment on the essence of the fetus, since that capacity is only temporarily latent, not irreversibly lost. Thus a fetus without brain activity for the first four to five weeks of pregnancy is significantly different from the dead person who is without brain activity. Therefore, using brain activity as the decisive moment for person-hood raises serious questions about its usefulness in determining viability. A third proposal for a decisive moment is sentience, that is, the point at

which the fetus is capable of experiencing sensations, particularly pain.15 The appeal of this point for the determination of personhood is that if the fetus cannot feel pain, then there is less of a problem with abortion, and it disarms many of the pro-life arguments that abortion is cruel to the fetus. As is the case with the other decisive moments, however, sentience has little inherent connection to the personhood of the fetus. This decisive moment confuses the experience of harm with the reality of harm. It does not follow that the fetus cannot be harmed simply because the fetus cannot feel pain or otherwise experience harm. Even if I am paralyzed from the waist down and cannot feel pain in my legs, I am still harmed if someone amputates my leg. In addition, to take sentience as the determinant of personhood, one would also have to admit that the person in a persistent vegetative state (i.e., irreversibly comatose), the momentarily unconscious person, and even the sleeping person are not persons. One might object that these people once did function with sentience and that the loss of sentience is only temporary. But once that objection is made, the objector is admitting that something besides sentience determines personhood, and thus sentience as a decisive moment cannot be sustained. This counterargument applies to other functional criteria for personhood, such as self-consciousness, awareness of one’s environment, and relationality, which are used by abortion rights proponents such as Mary Ann Warren and Peter Singer. Another idea suggested as a decisive moment is quickening, that is, the first time that the mother feels the fetus move inside her womb. Before the advent of sophisticated medical technology such as ultrasound, which can see the fetus from the early stages of pregnancy, quickening was considered the first indication of the presence of life within the mother’s womb. Yet quickening as a determinant of personhood cannot be maintained, because the essence of the fetus does not depend on someone’s awareness of it. This criteria confuses the nature of the fetus with what one can know about the fetus. Philosophically speaking, this decisive moment confuses epistemology (knowledge or awareness of the fetus) with ontology (the nature or essence of the fetus). A similar confusion is involved in the use of the appearance of humanness of the fetus as a decisive moment for personhood. The appeal of this is that as the fetus begins to resemble a baby, it makes it at least emotionally more difficult to consider abortion. But the appearance of the

fetus has no inherent relationship to its essence. Also, from the point of conception, the fetus has all the capacities necessary to look like a normal human being. Certainly one would not want to determine personhood on such a subjective criteria as the appearance of humanness. A few hold that birth is the decisive moment at which the fetus acquires personhood. But no essential difference exists between the fetus on the day before its birth and the day after its birth. The only difference is location, that is, the baby now lives outside the womb. But as is the case with viability as the determinant of personhood, the essence of personhood involves more than simply location. It does not follow that my nature as a person changes just because I change locations. Finally, implantation has been proposed as a decisive moment for a number of reasons. First, at this point the embryo establishes its presence in the womb by the “signals,” or the hormones, it produces. Second, 20 to 50 percent of the embryos spontaneously miscarry prior to implantation, which suggests that implantation is critical not only for the development of the embryo but to its essence. It would also suggest that we have the obligation to save all of the embryos, something that very few people consider. Third, twinning, or the production of twins, normally occurs prior to implantation, suggesting that individual human personhood does not begin until after implantation. Although placing personhood at implantation would not justify very many abortions, the implications of this decisive moment are significant. First, it would make any birth control methods that prevent implantation, such as many birth control pills, morally acceptable, since an unimplanted embryo is not considered a person. Further, embryos from in vitro fertilization can be either discarded or used for experimentation without any moral problem, since those embryos lack personhood. In response to the proposal of implantation as a decisive moment, it does not follow that personhood is established at implantation just because the embryo establishes its presence by the hormonal signals it produces. The essence of the fetus cannot be dependent on another’s awareness of its existence, whether it is physical awareness, as in quickening, or chemical awareness in the production of specific hormones. Second, just because up to 50 percent of conceived embryos spontaneously miscarry, it does not follow

that personhood comes at implantation, since the essential nature of the fetus is not dependent on the number of embryos that do or do not survive to implant. Even if the embryo is fully a person, we are not morally obligated to save all of them since we have no moral obligation to interfere in the embryo’s natural death. Not interfering to prevent a spontaneous miscarriage is not the same as killing an embryo, just as removing life support from a terminally ill patient is not the same as actively killing such a patient. Third, just because twinning occurs prior to implantation, it does not follow that the original embryo was not fully a person before the split. Thus the proposal of implantation as a decisive moment for personhood generates some very significant questions. In light of the above discussion, it seems most reasonable to conclude that the fetus has full personhood from the moment of conception. The argument could look something like this:16 1. An adult human being is the end result of the continuous growth of the organism from conception (this premise has hardly any debate). 2. From conception to adulthood, this development has no break that is relevant to the essential nature of the fetus (this is the debatable premise, but the above discussion shows that all the proposed breaks do not have a bearing on the nature of the fetus). 3. Therefore, one is a human person from the point of conception onward (this conclusion follows from the above two premises). Also, from conception the fetus has a unique and separate genetic identity, needing only nutrition and shelter to mature into a full newborn baby and later into an adult. From the moment of conception, it possesses all the capacities necessary to mature into a full adult. Thus it is incorrect to say that the fetus is a potential person. Rather, the fetus is a person with the full potential to develop all of its latent capacities. It is a full human being, a person that is in the process of maturing into a fully grown adult, with no breaks in the process of its maturity. Some abortion rights proponents actually concede that the fetus is a person and argue that a woman should still have the right to abortion. A classic example of this is the widely read argument by philosopher Judith Jarvis Thomson, in which she compares a woman with an unwanted pregnancy to a person who has been kidnapped in order to provide a

lifesaving blood transfusion to a world-renowned violinist.17 The violinist is dying, and the person providing the transfusion is essential to the violinist being able to live. Even though the violinist will die if the person “unplugs” from the transfusion, Thomson argues that there is no moral obligation for the kidnapped person to continue to provide this life-saving service. She then applies this to the case of an intended pregnancy and argues that the woman with an unwanted pregnancy has essentially been kidnapped by the fetus and forced to provide a life-saving service by continuing the pregnancy. She concludes that the pregnant woman has no obligation to save the fetus’s life and is morally justified in ending her pregnancy, even though it would result in the death of the fetus. Thomson’s argument would apply at most to pregnancies that result from non-consensual sex, but surely not to pregnancies in which the woman knew that pregnancy was a possible consequence of sexual activity. Further, Thomson’s depiction of pregnancy as analogous to being confined to the transfusion table is actually nothing like a normal pregnancy. During most pregnancies, women live their lives relatively normally, and it’s not unusual for women to report that in stretches of their pregnancy, they have never felt better. The difficulty with Thomson’s argument is her starting point. Once she concedes that the fetus is a person, she loses any force to her argument that grants abortion rights. In fact, if the fetus is a person, one can make the argument that the unborn child actually has a claim on the mother’s body. Take, for example, a mother with her one-year-old child. It is not difficult to argue that the child has a claim on her mother for all that the child needs to survive. In fact, if the mother did not provide those necessities of life for her child, she would be guilty of neglect or even child abuse. If this continued, the child would be taken from her due to her unfitness to be a parent. That is, the child has a claim on the mother for those necessary resources. Even if the mother does not want the child, she is still responsible for ensuring that her child is cared for, either by foster care or adoption. If this is true of a oneyear-old child who is a full person, why would the fetus not have a similar claim on the pregnant woman for the resources necessary for the fetus to survive? After all, Thomson has conceded that the fetus is a person and thus no different in moral status than the one-year-old. Thomson may argue that

the difference is that the fetus requires the mother’s body in order to live, whereas the one-year-old does not. But that difference is surely overstated, since the demands of caring for a one-year-old far outweigh the demands of caring for a fetus in the womb. If one concedes that the fetus is a person, then the only real difference between the fetus in the womb and the one-year-old is location. Embryo and Stem Cell Research Since scientists first isolated stem cells in the late 1990s, the possibilities of using stem cells for research and treatment of a variety of diseases has generated some very exciting prospects for patients suffering from illnesses ranging from diabetes to spinal cord injuries. But the use of many types of stem cells has presented a series of ethical challenges. Before I outline the ethical issues, let’s look at some background information. Stem cells are what one scientist called “the biological mother lode.” That is, they are undifferentiated cells, which can be directed in the lab to develop into any of the roughly two hundred types of cells and tissues in the body. Some stem cells are completely undifferentiated—that is, they have not begun down the developmental pathway that dictates that they become certain types of cells, for example, neurological cells or cardiac cells. These are called pluripotent stem cells and in theory can be engineered in the lab to become any of the cells in the body. They cannot become the entire organism; those are called totipotent cells, and single-cell embryos are the only cells in the body that are totipotent. Some stem cells have become slightly differentiated however. That is, they have begun down the developmental pathway but still can be directed to become cells of a specific type. For example, there are neurological stem cells, which can become any neurological cell but not blood cells or any other type of cells outside their initial developmental boundaries. These stem cells are called multipotent stem cells and are very useful in treating a variety of diseases but do not have the same plasticity, or developmental flexibility, that pluripotent stem cells have. There are two primary sources of stem cells. The first, and uncontroversial, is what has come to be known as adult stem cells. These stem cells are harvested from a variety of sources, including a person’s bone

marrow, the umbilical cord blood of a newborn baby, and various organs in the body. A second source, and very controversial, is human embryos, at the three-to five-day stage of development. These embryos are either those left over from infertility treatments (see chapter 6 for further discussion of in vitro fertilization) or they are created by a process known as therapeutic cloning. This is the process by which a person is cloned (see chapter 7 for further discussion of this), and the resulting embryos mature to the three-to five-day stage, at which point their stem cells are harvested. The reason human embryos are a controversial source is that to obtain their stem cells requires that the embryos be destroyed in the process. To date, an embryo cannot survive the harvest of its stem cells. Embryonic stem cells are pluripotent, whereas many types of adult stem cells are multipotent, though there are some indications that some types of adult stem cells may also be pluripotent. Embryonic stem cells also tend to have greater longevity when multiplied in a culture in the lab. Skin Cells Reprogrammed to Form Embryonic Stem Cells Two different teams of researchers, one in Japan and one in the United States, have successfully “reprogrammed” adult cells and coaxed them to go backward on their developmental pathway, enabling them to produce embryonic-like stem cells that have all the properties of stem cells harvested from human embryos. They have the potential to become, under the right conditions, any of the roughly two hundred cell or tissue types in the human body. This is a potentially significant breakthrough enabling researchers to use embryonic-like stem cells that can be harvested without either creating or destroying embryos. Many in the pro-life community have objected to using stem cells harvested from human embryos because they believe embryos to be fully human with the right to life. This discovery overcomes the most significant moral obstacle to using embryonic stem cells. “We are now in a position to be able to generate patient-and disease-specific stem cells without using human eggs or embryos,” said Shinya Ya-manaka from the University of Kyoto, who led the Japanese team. Yamanaka

was motivated by his view of embryos to engage in this work. He said, “When I saw the embryo, I suddenly realized there was such a small difference between it and my daughters…. I thought, We can’t keep destroying embryos for our research. There must be another way.” Although some technological obstacles still remain, this is a substantial breakthrough that, though tempered with caution, is reason for optimism. It may be that technology will resolve an ethical dilemma rather than create one.*

Stem cells are being used or are anticipated to be used to treat various cancers, blood diseases, immune system disorders, Parkinson’s disease, diabetes, and multiple sclerosis (MS). They can also be used for repair of heart tissue and growth of new blood vessels, and there is hope for using stem cells to treat spinal cord injuries. This is only a sample of the potential medical benefits that will come from using stem cells. To date, most of the progress in treating diseases has come from stem cells harvested from adult sources. The issue of stem cell research raises the question of the moral status of early-stage embryos, particularly those that exist outside the womb (ex utero embryos). Some suggest that such microscopic entities that consist of a handful of cells cannot be a person. They argue that embryos are simply clumps of cells and that destroying them is not immoral, especially when compared to the vast number of potential suffering patients who could be treated. Others insist that size and location are irrelevant to a being’s ontological and moral status, and that the continuity of personal identity that applies to fetuses extends to embryos too. Our common views of a person assume a continuity of personal identity, which, as mentioned above, is consistent with the Bible. For example, we assume that persons continue to be the same person irrespective of time and change. Our social notions of moral responsibility and criminal justice are dependent on this view of personal identity. We assume that when we bring someone to trial for a crime committed years prior, we are trying the same person who committed the crime, regardless of how that person has changed or how much time has elapsed. Philosophically this is called a “substance” view of a person. Another way to say this is that being a person is a matter of

one’s essence, or nature, not the ability to perform certain functions. If being a person is determined by our ability to perform certain functions, such as having self-awareness, relationality, and others, then personhood ends up being a degreed property, something of which one can have more or less. But if personhood is an essential property, then it is an all-or-nothing property, with the result that one either is or is not a person. Only an essential view of a person avoids the problematic idea that being a person is a matter of degree. Once it is admitted that being a person is a matter of essence, then the continuity of personal identity follows. What we saw earlier in this chapter is that once we admit to a continuity of identity, then there is no place along the continuum from conception to birth where there is a valid “decisive moment.” The result is that one is a person from conception forward. The single-cell embryo has all the information it needs to mature into a full-grown adult, needing only shelter and nutrients. If implantation does not make a morally relevant difference, as I suggested above that it does not, then whether embryos are implanted in the womb or are stored in the lab is irrelevant to their moral and ontological status. It is important to see that the moral status of embryos is not fundamentally a scientific question but a philosophical one. Science cannot conclusively determine philosophical matters by scientific observation alone. What science can tell us is what kind of a biological entity an embryo is, whether it is alive, and even whether it is human (embryos that are the sources of stem cells are both alive and human, even when stored in the lab). But whether embryos are persons is not a biological question but a philosophical one. It is not fundamentally a religious question, since one could arrive at the same conclusions apart from religious convictions. The notion that embryos are persons does seem somewhat counterintuitive. Some have suggested that preserving embryos should not be weighted as heavily as the obligation to help patients suffering from various diseases. But we should not forget not only the promise, but also the actual progress being made with adult stem cells. Those are being used today to treat numerous diseases effectively, while progress with embryonic stem cells has been much slower but is still promising. Some argue that it is immoral not to use leftover embryos to help suffering patients, since they are going to be discarded anyway. In reality the

stem cells from leftover embryos are not that helpful to patients, though they may be helpful in research. The reason is that they are not likely to be compatible with the recipient. This compatibility is critical for organ recipients and bone marrow recipients since the body is well equipped to keep incompatible tissues and organs out. A further problem is that so far embryonic stem cells have the tendency to form tumors when they are used, mostly benign, but a problem nonetheless. The compatibility problem is the reason why therapeutic cloning is necessary for embryonic stem cells to become widely used in treatments. Therapeutic cloning guarantees a match, since the embryos created by cloning are the identical genetic duplicates of the patient. But this requires a prohibitive number of women’s donated eggs in order to grow the cloned embryos (see chapter 7 for more on this), which is why some scientists are now calling for using the eggs of advanced mammals to grow the cloned embryos. Embryo Biopsy Researchers at Advanced Cell Technology, a Massachusetts biotechnology company, for the first time, harvested stem cells from human embryos without destroying the embryos. This marks a significant technological breakthrough in the ability of science to procure embryonic stem cells without harming the embryo from which they come. This technology is aimed at securing the stem cells from embryos that are going to be discarded, in order to produce cell lines both for research purposes and for potential treatments. Robert Lanza, chief scientific officer at ACT, admits that their procedure cannot tailor stem cells to each individual patient but could provide cell lines that would be helpful to some. Lanza is optimistic that once the procedure is peer-reviewed, having already been replicated in a University of California—San Francisco lab, it could dramatically increase the number of stem cells not only available for research, but also would qualify for federal funding because embryos are not destroyed in the process. Lanza said, “We could triple the number of human embryonic stem cells available within a few months.”*

There is hope for technologies that will enable researchers to harvest

embryonic stem cells without killing embryos. These involve embryo biopsy, using dead embryos, harvesting stem cells from embryo-like entities, and reengineering adult cells backward to an embryo-like state from which stem cells can be harvested (see “Embryo Biopsy”).