Stem Cell Research

An Interview with Kevin T. FitzGerald

Kevin T. FitzGerald, SJ, PhD, is the Dr. David Lauler Chair in Catholic Health Care Ethics at Georgetown University and a Research Associate Professor in the Department of Oncology at Georgetown University Medical Center. He received a PhD in molecular genetics and a PhD in bioethics from Georgetown University. He has published both scientific and ethical articles in peer-reviewed journals, books, and in the popular press.

Fr. FitzGerald has given presentations nationally and internationally and has often been interviewed by the news media on topics such as human genetic engineering, cloning, stem cell research, and the Human Genome Project. For the past ten years he has served as an ethics consultant for the National Society of Genetic Counselors. He is a consultant to the Juvenile Diabetes Research Foundation, the United States Catholic Conference, and is a member of the American Association for the Advancement of Science Program of Dialogue on Science, Ethics, and Religion.

The biggest controversy in stem cell research deals with the sources of the stem cells. Given each of the following sources of stem cells, what are your opinions of the ethics of each and why or why not?

• Excess embryos from in vitro fertilization at fertility clinics

• Embryonic germ cells from aborted fetuses/embryos

• What about therapeutic cloning (somatic cell nuclear transfer)

Well, what do you mean when you say embryo? Let us look at it this way – I would say right now that this is a term that nobody really and truly has a clear grip on. Oftentimes when you are talking to scientists, for instance, they might say to you that anytime sperm and egg come together, you have an embryo. The problem is that we also know from science and medical research that sperm and egg can come together and you can end up with something called a complete hydatidiform mole [the product of an egg with no maternal DNA being fertilized by a sperm], which, as far as I am concerned, is not the kind of thing that people are conceptualizing when we are having this debate about the destruction of embryos. Nobody worries about the destruction of a complete hydatidiform mole.

So, we have to be very very careful with the language here, because it often gets thrown around with great emotion and not a great deal of understanding or precision. So, when I am talking about embryos, particularly from a moral perspective, I think the easiest way to conceptualize it is: That which we all once were. In spite of the fact that some people would want to say that you can use somatic cell nuclear transfer and get something other than an embryo - a clonode or whatever they want to call it. Then you would also then figure that that means that Dolly was not a sheep.

Now, everybody agrees that Dolly was a sheep, and if Dolly was sheep then she was a fetal sheep and if she was a fetal sheep than she was an embryonic sheep. So Dolly was an embryo. Whether or not you create a human being from an egg or by cloning or some other way, it is that which we all at one point once were. Now, looking at it that way, if one considers the sorts of restrictions and protections that we build in to human subject research, and we all presume that they are human subjects, and we are to protect human subjects in research, then I would argue that anything that violates the protections that we supposedly have in place – even though we in this country have a lot of problems doing that (and doing that well) – then anything that violates that would be something not to do.

In different parts of the world one might be able to say, looking at prisoners on death row, "They are going to die, you know they are going to die, you in fact know when they are going to die, so why not take advantage of them before they die?" Similar kinds of reasons, you see, are being used. Well, if we treat these as human subjects, then what you do to an embryo is no less of a violation than what you do to a fetus, what you do to a child, what you do to an adult.

So, in that sense, it rules out all of the options that you have here. Now, that is not to say that everything that you destroy is an embryo in that sense. The problem right now is that it is not possible to tell which is which. So, using a different analogy, if you walk into a field after a battle and there are dead soldiers all over the field, and you are worried because that field is quite near a town and the people in the town might be at an increased risk for disease or other problems because of the dead bodies in the field, the quickest and easiest thing you could do would be to just bulldoze all of them into a large ditch and bury them. But, you haven't had a chance to go through the field to see if they are really all dead. Now, are you justified to bulldoze them all because it would take so much time and it might add to the risk to the living people in the town?

Now, we might say no, you have to give benefit of the doubt that there might be somebody out there, and you have to go through the whole process [to find them]. So, I would argue similarly that you have to give benefit of the doubt that even though the entities (biological embryos) that are all frozen away, many of them might not be embryos in the sense that we at one point all once were. Just because one would say "Well, this embryo will only live four weeks or eight weeks or eight months," that doesn't matter. Length of life does not matter. Just like those prisoners on death row. You have two weeks to live, so what? Just because you have two weeks to live, that makes you less of a human being? No. So, even if they only live two weeks, that does not make each one less of a human being. As I said, some of them are not embryos in that sense; they are something else. But since we cannot tell the difference, we give benefit of the doubt.

Do you think that adult stem cells hold enough potential to avoid having to worry about using embryonic stem cells?

Going back to my original point, if we are talking about human subject research protection, it does not much matter what the potential is - there are certain things that you cannot do. But, I understand that for other people, it is an important issue to wrestle with. The problem that I see here is that it is an incorrect analysis when one compares embryonic stem cells to adult stem cells. The point is oftentimes to do this research in order to get to certain therapeutic goals - to help people back to health, to treat disease, bring healing, all those sorts of things. If those are indeed the goals, then one has to include not just adult stem cells, but every other type of research that is going on right now – genetic research, pharmacological research, genomic research, proteomic research, all that other research has to be included in weighing that balance if indeed they are going to do it accurately.

What they are talking about is whether you can justify doing this controversial and contentious research, destroying embryos or fetuses, by arguing that you have to have this in order to get to those goals. The only way to argue that is by measuring it against everything else that we can do, not just adult stem cells. Otherwise, I would say that it is just not a logical comparison. People can say, "Well, we're talking about developmental biology, and stem cells are the only way to do that developmental biology." True, but human [stem cells] are not [the only way]; you've got animal research in there, too. And really, the developmental biology research is to understand what the mechanisms are behind all of this - the molecular mechanisms - because cellular research is much more black box research, and we want to figure out the details. Again, you are talking about molecules and things like that and that might be able to be done in some other way.

So, looking at it that way, sure, with all the other research that one could combine, one could say that [adult stem cells] certainly has the potential to get to these goals. One might argue, "Yes, but it wouldn't get there as quickly." But there are a lot of things that we do already, choices that we make that mean we aren't getting some place as quickly. In fact, if one looks at the amount of money and time and energy that are being spent on the diseases that kill most of the people in the world, including just diseases that are a result of inadequate sanitation, you don't have to do research there, we have the technology for adequate sanitation. So, if the goal is to cure people and to help people who are in need, then we have already chosen not to do that. So do not tell me that we cannot choose to not go forward as fast as possible, because we have already done that, and maybe in ways that we can't even justify.

Regarding President Bush's 2001 regulations regarding stem cell research that was available for federal funding, do you feel that his decision was appropriate, too strict, or too lenient?

I thought his decision was politically very clever and astute, and in a sense, a stopgap which will not work. It cannot work. On the one hand, it does not give the one side what they want, which is as much research as possible. On the other side, it does not give them what they want, which is to stop this kind of research. Even if you limit the research with federally funded moneys to [those stem cell lines] that happened before the decision, you are still exacerbating the situation because the information that can be gained from doing that research can be used with private funds to do embryo research. So, it really does not work either way. That is, if indeed the goal was to find a solution to this problem. If the goal was to find a politically astute stopgap measure, then yeah, it was successful.

Will his decision to restrict federal funding for only existing cell lines push a lot of research into the private sector?

I do not know if that is necessarily the case. My guess would be that if the government had allowed federal funding for this research, then the private money would have been put elsewhere. In fact, there probably would have been more private moneys because the federally-funded research would have supported more privately-funded research, would have provided the bedrock for that, so I would say that it did not make more private money go into this research, it probably reduced it.

What direction should President Bush have taken? What regulations would you have imposed?

My area is not public policy, and I am not a legal expert, and I do not deal with regulations from that perspective. But from an ethical presentation, I think we should choose as a society, and not just as a society but as a global village, voluntarily not to do this research until we understand better what it is that we are doing. So, what is an embryo, and are there ways of getting to the goals that we want that do not rely upon research that is contentious and controversial in society? Now the problem here is that we have a variety of different religious traditions, ethical traditions, cultural traditions and political traditions, and we must deal with the power and the pace of research, the advancing wave of research.

So, with that incredible, diverse mix coming together, there is, I would argue, even from a moral point of view, there is a great deal of need to be careful, to be sensitive, and to try and do this in a constructive way that does not necessarily do a great deal of damage to any particular groups' interests or values or justifications; yet we must still try our best to get to those therapeutic goals and answers that everybody wants, including the answers that we already have but are just not distributing well.

We have to acknowledge that, we have to take that into consideration, because that argument keeps getting brought up time and time again: "How can you deny my patient this research?" Well, that raises a very interesting question – who counts? For [that doctor], it is [his or her] patients. But there are many, many doctors out there and they work all over the world. U.S. patients get represented in Congress or the media, but who is representing this other doctor's patients who happen to be in Ethiopia and are facing much, much different health care concerns? The concerns are all crying out for research distribution when we have scarce resource distribution. Are reproductive technology needs the same as life and death starvation needs or needs of avoiding pathogens in inadequately sanitized water? These are the kinds of things that we are not balancing. We are not taking the time to sort these out as well as we should. Instead, there is a kind of yelling match that is going on.

Well, [Student Pugwash] is in the media, in a sense, so what sells? Balanced, careful analysis, trying to weigh a variety of things, careful listening to various groups, trying to integrate and put together a great deal of this information with age-old traditions and values, and valuing people? Or yelling and screaming matches where people say incendiary things? Of course, we know what sells in the media. One has to take that into consideration, too. I am not saying that media is evil, I am just saying that that is what the media does, and it is not necessarily going to facilitate this other thing that I think needs to be done. In fact, I think it facilitates the opposite.

So, all those things have to be taken into consideration when you say how should we go forward. I do not think we can unilaterally say we are just going to have these regulations, because what happens in other parts of the world? This technology affects everyone, no matter what your beliefs are, where you are form, what your cultural background is - this technology works on you. In fact, the beauty of it is, in one sense, it works on all living things. If there is anything that is going to pull us together, I would think that that would be the one thing. Now, we can use it for different ends, but it does affect everyone, so that is why I say we still need that international deliberation. And yes, that will slow things down, but let us make sure that, in the process of slowing things down, people who might get hurt get the extra needed attention.

That brings us to another whole issue: What is healing? Too much, particularly in our society, we look for technological solutions to healing. In part, medicine is a science, but in part, medicine is an art, and healing requires more than just technological intervention. It requires a relationship, it requires trust, it requires care, it requires love, commitment, all those things. Those are not technical solutions, but there are many ways in which our pursuit, of technical solutions is actually undermining those other aspects of healing. And when people do not get those, they scream for what they think will be the answers – more technical solutions. So, I would say that even in that regard, we are somewhat out of balance, and that skews this debate.

Would you say that discussions regarding the ethics of using/obtaining stem cells have a lot of interplay with cloning and genetic engineering? Will trying to determine the proper ways to conduct stem cell research affect how we go about research in those other areas?

Absolutely. In fact, all of that stuff is really only the tip of the iceberg. Another aspect of this that does not get enough emphasis is that these are big issues, they are big challenges, and people kind of look at these and think, "Oh, it's too big, let's break it down into smaller pieces." The problem is, the way that you deal or attempt to deal with the smaller pieces sets precedents for the future. What we are talking about now is really just the tip of the iceberg, because really, these things represent all the different sorts of manipulations that will be available at a physiological level to manipulate ourselves as human beings, and to manipulate nature.

All these powerful, powerful tools are going to be more and more available to us, and how we deal with these so-called "isolated issues" directly affects how we will continue to do things in the future, because we set precedents, we set trajectories along which we start to move. So, I think that just raises the importance of doing this now, and taking into consideration these greater global concerns now. If we suddenly decide down the road, twenty years from now, that was not a very good trajectory to take, that means we have to turn around, we have to backtrack, perhaps, or at least make up some of that ground, and that means there are costs, and costs in human lives. People talk about the cost in human lives; absolutely, I am concerned about the cost in human lives. I think that is critical.

Given the precedents that we are starting to set today, what do you think of the future of stem cell research will be? Will the world see much benefit from it, or is there going to be so much controversy around it that we will never get anything useful out of it? Will we end up overstepping long-held beliefs about protecting human lives and do something awful in the process? What can we do to move along what you consider to be the right path?

Well, to move along the right path, we have to do what I have already said about having the international deliberations and getting these different groups together in a way where people feel like they are heard. Everybody has got to feel like they are heard, and I do not believe that is [happening now]. Everybody is screaming to be heard, so that you just have a cacophony and hopefully your voice gets singled out somehow. [It would be better to have] a more structured approach to try to listen to everyone. In addition, stem cell research, depending on how you define it, what exactly you're talking about, is where certain research trajectories are at this point in time. Things are moving very fast, so, I think the move right now is to get away from the cellular level down to the molecular level, where the interventions would be much less drastic in a sense. More elegant, more possibility of finer tuning, all that sort of thing.

So, again, will stem cell research be successful? Well, what is the success one is looking for? If stem cell research, particularly with adult stem cells or animal research or something like that, leads us to a greater understanding of these molecular mechanisms, then we could say scientifically that has been successful. If stem cell research leads us to a more sensitive, balanced, sane, inclusive discussion on these issues, then I would say that is very successful, maybe not from a scientific point of view, but certainly from a societal point of view. These are the things that we have to hope for and work for. Right now, I would say that the difficulty is that things are very fractured. You have a variety of groups that are working at cross-purposes in part, coming out of different sorts of traditions and beliefs, with different goals.

Some say the big goal is to cure all of these people, or the big goal is to make money or become famous or whatever. So, there are different goals, different interests. You hear people saying, "You cannot restrict scientific investigation and the advancement of scientific knowledge." What do you mean we cannot? We already do. We do it, in part, because we claim it is for societal good to do it. So, that dichotomy gets set up – scientific advancement versus societal good. But whose societal good? That is the big question. Who counts in this discussion, and how much voice do they have. This is another conflict. First world versus third world if you want to be cruel about it. So you have all of these fracture lines, and it is important to be aware of them and it is important to try and come up with a process, a system, a methodology that helps us cross these fracture lines. We cannot deny them - they are there - but we can build superstructures across them that are stable and help us, build for the future, because this stuff is not going to slow down; it is only going to speed up.

Submitted by: Kyle Gracey, Rensselaer Polytechnic Institute, 2003 Fall Intern