November 15, 2002

Stem Cells & Clones: Theological Perspectives on Biomedical Research

9:30am – 12:30pm
University of Chicago Divinity School
Chicago, Illinois

Gilbert Meilaender is the Phyllis and Richard Duesenberg Professor of Christian Ethics at Valparaiso University. His work focuses upon theological and medical ethics. In 2001 he was appointed to the President’s Council on Bioethics, which recently issued a major report entitled “Human Cloning and Human Dignity: An Ethical Inquiry.” Professor Meilaender serves as an Associate Editor of the Journal of Religious Ethics and sits on the editorial board of First Things. Recent books include Working: Its Meaning and Its Limits (2000) and Body, Soul and Bioethics (1995). He earned the Ph.D. from Princeton University.

Richard Miller is Professor and Chair of the Department of Religious Studies at Indiana University (Bloomington). His work incorporates Western religious ethics and social theory to examine issues in medical ethics, political philosophy, and the ethics of war and peace. Professor Miller has recently completed Children, Ethics and Modern Medicine, forthcoming from Indiana University Press in 2003; previous works include Interpretations of Conflict: Ethics, Pacifism, and the Just-War Tradition (1991), and Casuistry and Modern Ethics: A Poetics of Practical Reasoning (1996). He earned the Ph.D. from The University of Chicago.

Professors Meilaender and Miller requested that their talks not be posted on the web. What follows is a transcription of the question and answer period which followed their remarks.

Jean Bethke Elshtain: Well, we have just heard two very complex, and rich and intricate presentations. I am pleased to say that we have 45 minutes for discussion. Before we turn to the audience, we would like to give Professors Meilaender and Miller an opportunity to respond to one another. As I am sure you noticed, there are some very important distinctions that emerged in their presentations as well as areas of overlap. They, obviously, know what those distinctions and differences are and I will simply turn it over, first to you, Gil, to respond to Professor Miller’s presentation and then, Rich, you an opportunity, in turn, to respond to Gil and then we will open it up.

Gilbert Meilaender: Well, there is a lot there and I am not going to begin to try to respond to everything. Let me just say a couple of things. I want to say, first, since we’re here at Chicago, that I’ve never realized how Gustafsonian you were. I just didn’t know that, actually. So I’ve learned something useful. I mean, I hope that means something to at least some of you, but that was sort of a revelation to me that I did not realize it, though, of course, I did once, years ago, in religious studies, write a very long review of Ethics from a Theocentric Perspective that was not entirely positive, I think it is fair to say. I hope that reference means something to at least some of you. I just didn’t realize this about your work, though, of course, I did years ago write a long review of Ethics from a Theocentric Perspective in Religious Studies Review–and, I think it’s fair to say that it was not entirely positive. So, one thing, if we’re going to talk a long time, I think would be interesting to pursue would be exactly, whether there is more theoretical baggage than you need. You, yourself, said there was no really logical entailment between the biocentric and natural piety. And I have to say that I was not, myself, real certain, exactly, how we got from that to some of the conclusions, and it might be interesting to explore the connection..

But there are just a couple of other things, and there is one thing that I think is important. You sometimes contrast intrinsic value with absolute value, which I believe I understand. But, there were other times, when you, one very important point in particular when you were making your move, just when I thought you were going to stop with only approving research on spare embryos, all of a sudden, bingo, you know, we were making the move to producing them for research, and you equated full moral status with absolute value, there. And, we’ve got three categories. We’ve got intrinsic value, absolute value and full moral status. And I am suddenly not, I was not clear how they relate. I understand what it would mean to say that a being who has intrinsic value does not have absolute value in the sense that there might be occasions on which that being’s life could be taken. But, all of a sudden, absolute value was equated with full moral status and I take it that you and I have full moral status, but that does not necessarily mean that we have absolute value. Our lives could be taken, so I thought there was just something that needed clarifying along the way there.

And then the other thing, I guess that I would say is that, I do not know how to put it, it seems to me that in your very careful working through the possibility of research on spare embryos–and I agree with Gene Outka, who was one of my teachers after all, that it is easier to defend research on spare embryos than to defend producing embryos for research–it seems to me that you underplayed the role of human will there. In other words, surplus embryos are not natural facts. They are surplus embryos because of choices and decisions that we have made and it does seem to me that one needs to think about that and take it into account, even though, I grant, that there are differences. So, I guess I will settle for those comments, that I am still a little puzzled by the relation between the kind of theoretical baggage you developed about natural piety and the particular conclusions. I am not quite sure about the categories, full moral status, absolute value, intrinsic value and how they relate to each other. I would still like to see a little more acknowledgment that we have made some decisions about those embryos and that that enters into our moral evaluation. Those would be, those would be starters, anyway, for discussion.

Richard Miller: Do I respond to those or ask him? That’s the problem, isn’t it?

Elshtain: That’s right. Because we have a good bit of time, why don’t you respond.

Miller: That would be easier.

Elshtain: But if you have a few questions for Gil, go ahead and ask them and he can respond in turn, we have got enough time.

Miller: Why don’t I respond and let’s see what happens.

Elshtain: Sure. Sure.

Miller: On the connections between theology to ethics, I by no means want to suggest that there is a clear or logical entailment of biomedical ideas from theological ideas, or that theological sentiments do the main conceptual work. Nor do I want to say that the biomedical aspects of my argument just make explicit ideas that are implicit in the theology. In fact, I know very little theology that has clear bridges from more general claims to detailed analyses and verdicts about medical questions. What I sought to do in the theological part of my paper was to articulate what I think are some general sentiments that religious and non-religious people tend to have about the generation of life. The theological ideas I developed can serve as a kind of module that joins a variety of religious traditions. The theology is meant to capture a sense of awe and reverence that I think researchers ought to have and, typically, do have about research in the life sciences. I think that, not only on my account but, in general, theological discussions need to be informed by facts and distinctions and categories and analogies. And that is what I sought to do in the second part of my paper, in the biomedical section. And it is about those distinctions and analogies that Gil and I have some differences. Still, I don’t see how those specific biomedical points I raise are compromised or deficient because they are not tightly linked with theological claims that I developed. So, I will grant there is a gap, but I don’t see that as a weakness in the argument.

On the issue of intrinsic versus absolute values, the question of when embryos have full moral status: What I was trying to do was to lay out a set of distinctions that help us think about human embryo research, keeping in mind that the issue of abortion lies in the background. And what I want to say is that once we arrive at the threshold of 14 days, we have crossed a critical threshold. I would say at that point we have an embryo with absolute value I would assign that full human status. I do not want to say that then all taking of that life is unjustified. I will say that those justifications turn on other considerations. Questions typically involve conflict cases.

Meilaender: So, the distinction between intrinsic and absolute value is not between a life that has value but, which may nevertheless be taken and a life that will simply not be taken?

Miller: Right, that’s right. But I think in the latter case, what I want to say is, in the taking of that life, there have to be cases of clear conflicts. In the case of the embryo research, there is no conflict of life and life. I think embryo research thus poses a different kind of moral case from abortion. So, for example, if we were to assign full moral status to the pre-fourteen day embryo, I think research on human embryos would not be justified, except on utilitarian terms.

The third point: I think we probably do agree that there are some worrisome features of IVF; and that is one reason I approach embryo research as a regrettable practice. A regrettable practice is not one that I think is wrong. I think that it involves conflicts and tradeoffs and, I think, actually we are both talking about where the weight goes and we think about how to resolve conflicts and tradeoffs. But I do not want to say we ought to celebrate or sit neutral to the fact that this industry exists, and that under better, more ideal arrangements, there would be limits on the production of surplus embryos.

Elshtain: Let me put a question, or an observation, and if either of you or both of you want to respond, fine. It really struck me, listening to the presentations, that Professor Miller, Rich, you were far more optimistic about the possibility of drawing certain lines and maintaining certain safeguards to just a-run-a-muck, profit-making industry and Professor Meilaender, you Gil, were far less optimistic, indeed, you have no optimism at all about the possibility of doing that.

Meilaender: Apart from the grace of God.

Elshtain: Apart from the grace of God…that that would really be possible and that in light of the danger of what is to come if certain things are opened up as possibilities, given the confluence of forces currently at work in our society, that the line really has to be held in a far more restrictive way, that you could not rely on safeguards of the temptations to keep taking it a step further, and a step further, and a step further would be too great. So, again, if either of you wants to respond to this observation, fine. If not, we will immediately go to the audience, but let me give both of you an opportunity.

Meilaender: Well, I do not think there is anything peculiar for someone who believes firmly in original sin to be, you know, fairly pessimistic about what we are likely to do. But I guess I would say two things. I do not think the case or the argument rests solely or even necessarily chiefly on slippery slope kinds of considerations. So I want to make clear, I think there are other sorts of issues at work there as well. But having said that, yes, I think the momentum is enormous here. The pressure is enormous and I must say…For the most part I do not like to talk precisely about what I have learned from the work of the President’s Council, but I will say one thing that I have come to realize that I was actually still carrying around a certain kind of naïve belief that scientists had no agenda, that they just followed the facts. I’ve been sort of stunned to realize that about myself. I thought I was a little, you know, I would not have thought that true of myself. But, for instance, and I will give the details if somebody wants to talk about it, but in February of this year, a Committee of the National Academy of the Sciences, as prestigious a body as you could possibly find, in the scientific world in this country, brought out a report on cloning, which I simply regard as duplicitous, and I do not mind saying that. It simply wanted to distinguish between what it called human cloning, by which it meant reproductive cloning, and what it called the entirely different procedure of nuclear transfer to produce stem cells. These are not entirely different procedures at all. It is exactly the same procedure for a different purpose. So when you begin to take note of such things, you realize that the moment is extraordinarily powerful. I am, I admit, used to losing votes. I have lost hundreds of votes in my life right down to departmental levels, so it does not bother me, exactly. I would probably worry if things were otherwise, by now. But yes, I think that the pressures to do research, unlike the Hans Jonas sentence that I quoted where he says, there is nothing sacred about progress, I think we do think there is something sacred about progress and it is very hard to resist. But I do not think it is impossible. I would not want to say that, but I think there are great, powerful forces here and they are not easy to constrain.

Miller: I think there are really two issues, though, that your question poses, and they can come together into this question: Does one’s moral stance on an issue clearly lead to public policy that reflects that moral stance? There are ethical issues surrounding policy making are different from the ethics of morality. So one question is: would a legal ban be the appropriate response to a practice that one considers morally impermissible? That is a second order question, concerning the purposes and aims of a policy, as opposed to moral questions around a practice. Complicating these points is the idea that it is better to regulate an arguable procedure than impose an absolute ban. One problem with a ban is that when you put it up, people typically find a way around it. A more finely grained set of expectations, procedures, and regulations can involve policy makers more in the practice, allowing for more direct oversight.

Meilaender: We are never going to settle differences of opinions on some questions like that. See, some people, taking Richard’s view that we should regulate more, will point to Great Britain, for instance, as an excellent example of where that kind of regulation takes place. Other people pointing to exactly the same thing will say, just look at the decisions that, whatever it is called, the human embryology and fertilization authority makes and you will see a kind of continual, relentless progress in terms of what it permits. So from one angle it is useful regulation, from another angle, it is, there is a kind of relentless progress.

Miller: But then the real question is: should we compare that to a situation when there is an absolute policy ban? And see what happens there. That seems to be another point of reference.

Meilaender: Well, you can probably think of some things you think there ought to be absolute policy bans on, right?

Miller: Yes.

Meilaender: And even if absolute policy bans have downsides to them, in terms of the kind of reaction they generate, there are probably some circumstances in which you would run those risks for the sake of a policy ban. So, the question is just whether this is a significant enough occasion to run the risks, I think. I think it is.

Elshtain: Let’s open it up and, if you would, I would like you to, and I am going to recognize my colleague, Don Browning first, but I would like you to please come to the microphone so that we can get your voice and memorialize you on a tape, and give your name and please tell us where you are from, what you are doing here, what school you are studying in, and so on, so that we can get a sense of the audience, because I know there are divinity school students and faculty here and I believe we also have some friends visiting from the medical school. So, it would be interesting to have a sense of that. Don, do you want to rise to the occasion?

Professor Don Browning, University of Chicago: Well, first let me thank you both for excellent presentations. I go to an awfully lot of public policy discussions, where there is not the slightest effort to say anything theological, and it is refreshing to get some positions that actually opened up that point of view. Nonetheless, it was not quite as robust theologically as I expected. With regard to Richard’s position, natural piety, I think, is something that does exist but it was abstracted from any discernible, historical, theological development except for that relatively thin strand of American piety that you very nicely summarize. I believe there’s a lot there. But I just kind of wondered why you bypassed these other frameworks. My question, primarily though, is to Gil, to unpack this one very potent phrase, which I did not think was located theologically, once again, and that is the embryo is an integrated self-developing whole. Could you say something more about that to contextualize that theologically?

Meilaender: You would not just accept no as a reply, would you? Implicated in this issue is an understanding of when we have another human being among us. Okay, there is a kind of a decision to be made there about when we have another human being among us and I do not, myself, think that is a theological question. I say that, subject to correction, I am happy to be instructed. I am prepared, happily, to treat as many questions as theological as possible, but, at least within my own theological framework, I don’t think there is a specifically theological answer to that question. I do think there is a certain kind of pressure, within that framework, as I said in the talk. There is a pressure toward a kind of openness and even eagerness to value the weakest and the most vulnerable–pressure not to let your decisions about when there is another one of us here be determined by capacities or qualities that only some have or that may be unevenly distributed. So I think there is some theological pressure in that direction. But I do not think, at least in theological framework out of which I work, that framework, itself, provides an answer to the question, when do we have another one of us here? I think you have to look elsewhere to try to answer as best you can that question. But if you think you have answered it and you say, here we have got another one of us, then the theological framework tells you something about how you ought to think about that one pretty much regardless of whatever capacities he does or does not display at the present moment. That is the best I can do and, as I say, I would be happy to have a better answer, but it is the only one I have got.

Miller: Following in that in a very similar spirit, my references to theology were deliberately thin because I think that theology neither answers nor provides clear directives about how to sort through these questions about the moral status of the embryo and proper action or inaction toward the embryo. What I was trying to capture was less a sense of a broad theological vision, a vision that allows us to speak about a set of virtues, or dispositions, or affections that ought to frame work in the life sciences. Admittedly, they are very amorphous. They are more character -oriented than they are rules and directions. But what I was trying to do was capture a sense of proper affections toward issues of the generation and development of life and situate some of those virtues in what I think is a broader strand of American intellectual culture.

Elshtain: Okay, we have got a little line started in the back, so you want to join the queue? Anyone who has a question just go back and join the queue and we will… Thank you, I should have mentioned that earlier. So, John.

John Carlson: I am sorry, I have another theological question. I am John Carlson with the Pew Forum and a divinity school student here, and I was quite pleased, actually, to hear echoes of Gustafson today, and I wanted to ask a follow-up question to Professor Miller about that, and understanding that some of the caveats that you have already offered about virtues and orientations and dispositions, but I want to ask if there might be something that is lost in this move…from the move from theocentrism, which is what Gustafson dealt with to biocentrism. And I am thinking if there is, perhaps, there is some added force that theocentrism has, namely, when you asked the question, how is God acting upon us in the world, what is God’s will and how are we able to discern that? That seems to me to be a pretty important added step, in part, because it forces us to stop and look and listen a bit, even before proceeding, which you talked some about. But it also seemed important to me because I take it that one of your reasons for offering a biocentric view is to open the umbrella of public reason a bit for those who consider themselves to be religious and non-religious and I am still reminded again with the theocentric point of view, which is grounded in a Calvinist kind of theology, that Calvin’s anthropology is that we are all religious, whether we, we all believe in certain things, that’s really just whether we have true beliefs or false beliefs. And so, again, it seems to me that without some of that kind of horizon above us that is calling us to look upwards that, perhaps, a biocentric view could lead us to be a little bit more relative or subjective in our scope.

Miller: Actually, I think your second question answers your first, but I won’t do that. I self-consciously distinguished biocentrism from theocentrism. I pulled back from speaking about theocentrism. because I think as Gustafson, himself, recognizes, that it is very difficult to move from an attention to natural goods and processes to the claim that one can infer a will that orders and directs those processes. That is a category step that I think is very difficult to make. He takes that step by virtue of standing from within that Calvinist tradition and adopting, as it were, a theocentric angle of vision and that imputes to these processes and purposes an intentionality that is very difficult to sustain. I think that there is an indifference to human welfare and well being that the natural world exhibits and that many ways. This Darwinian point is one that I do not think that Gustafson’s theocentrism has really fully grappled with. Secondly, I agree with the broad theological point from Calvin that you raise, in this sense. I am trying to say that technology is not value neutral, that these practices are not just disinterested inquiry, that they both derive from and affect character and that what I am trying to do is provide some sort of language that might capture or track a set of affections and loyalties and attachments that broaden the horizon in ways that I think speak to the general drift of your second point.

Meilaender: May I just make one comment. I just want to note that your question, John, was about theocentrism, which you immediately translated into God language. And actually, I think if you look at those volumes, it is more often the powers that press down upon us and sustain us. I mean, I think one would have to think about what the significance of that language is in terms of …

Miller: Or the significance or the understanding of what God is.

Meilaender: Oh, that’s right, absolutely.

Elshtain: Okay.

Mike Kraftson-Hogue: Hi, my name is Mike [Kraftson-Hogue] and I am in the Ethics program here at the Divinity School and I wanted to thank you both, too, for your papers. And like John, I appreciate Mr. Miller’s Gustafsonianism, and I have also recognized that you are both influenced by Hans Jonas and my question is specifically for Mr. Miller and his understanding of qualified biocentrism, which, in my hearing of your paper I understand that what you mean by that is that the idea of humans or that the superior value of humans in the hierarchy of value, stems from the human moral capacities or moral responsibilities. The idea that the future of all life forms depends ultimately on human action and that is, I think, that is where the idea that Hans Jonas develops his imperative of responsibility from. And on that view, on the basis of that understanding of human value then, we have an imperative to preserve the idea of humanity. And my question is that in allowing for the qualified exploitation of spare or manufactured embryos, are we comprising the idea of humanity? You have both focused on embryos as moral subjects and not so much on ourselves as actors also being influenced by our activities and research on embryos.

Miller: Let me take a stab at your questions and if I am off-base, please let me know. I think that my views focus on the dignity of having freedom and responsibility, and especially, duties to care and steward the natural world. How successful those responsibilities are carried out is another matter. But you are right to say that I am trying to identify or join issues of dignity with obligation. Now, whether permitting research on embryos compromises the duty to preserve humanity suggests that somehow humanity is at risk in that research. I am saying that here we meet the task of sorting through clear moral conflicts, because the putative aim is to help sustain and preserve those who are either now or later will be ill. I mean, what we are talking about is where to draw the line. He and I do not disagree that a line should be drawn. He and I do not disagree that there are limits. In many ways, all the questions here have not really tried to get at where these lines are and what justifies where one line is, vis-à-vis another. But I certainly do not want to be understood as someone who is not drawing lines.

Meilaender: Just drawing the wrong ones. [Laughter] I just want to say something that will call attention to some different aspect of what Richard had to say but first a word about Jonas. I, myself, prefer earlier Jonas, to the earliest Jonas of the imperative responsibility later Jonas who emphasized the imperative of responsibility, because I am not all that pleased with the direction the moral system takes at that point. But one of the moves that Richard made, precisely with respect to the importance of certain virtues, addresses the terms of your question. It might be that in seeking to preserve humanity in one sense through this research, we would, nevertheless, turn ourselves into people of a certain sort lacking virtues. Therefore, although I don’t, myself, think Richard got it worked out quite the way I would want to see it worked out, the possibility was at least there in his appeal to virtues, and my own language about learning to shudder at certain things was in a certain sense picking up on this notion that, in addition to the question of what we ought to do to research subjects, there is always the question about what we are doing to ourselves when we do this. Although I don’t think that you can separate them. In other words, if there is really nothing wrong with doing this stuff to these subjects, then it is not quite clear how there is going to be some kind of rebound in terms of bad effects on our character. So, you do have to take up the other questions as well.

Elshtain: Okay, next question.

Ariana Wolynec-Werner: Hello. My name is Ariana Wolynec-Werner and I am a second year Master student here in the Divinity School in political ethics, and my question is for both of you and it will ever so slightly betray my ignorance of the science behind this, but please bear with me. It is also a hypothetical question. Specific to stem cell research–so cloning aside–it seems that both of your arguments deal in some capacity with the focus. There is a focus on death, in specific, the non-viability of the cells once the experiments have been conducted on them. But there is also the progression in science that you mentioned and what if science got to the point where those cells, even post experimentation, were still viable and would the death question be eliminated? Would they still have to be killed? Because, what happens with the humanity of that cell or cells, and what if they were brought to term? And I am thinking, specifically, in the past couple of weeks, there have been news articles about post menopausal women who have not been able to conceive but have had in vitro fertilization with foreign eggs and these eggs might be potentially these post experimental eggs. So, what if?

Meilaender: Well, I am not quite sure what direction your question is going. I am not sure because I am not sure what you’re referring to with the language of cells. If it were, let’s just take a couple of possibilities, if it were possible to extract the stem cells without destroying the embryo and permitting the embryo to continue to develop, then I don’t suppose that, at least, this set of problems would be raised, right? We don’t object to taking bone marrow cells from Richard. He might but we don’t, and using them to try to derive stem cells in that way. He continues to exist and carries on just fine if we do that. So, if that’s what you mean, you know, if one could somehow extract stem cells without destroying the embryo, would there be any problem? I suppose there wouldn’t be this sort of problem, although I am not a scientist either, but since the research is actually disaggregating the embryo, I don’t quite see how your description would apply. The other thing you might mean is, if there were some possibility of taking any individual stem cell and as it were turning it back into an embryo, putting it in the proper context such that it would undergo what is essentially embryonic development. I am not sure whether such a thing could be possible but then you wouldn’t be doing the research we’re discussing, since the point of it is to get the cell and use it in ways that would be different from turning it back into an embryo. So I just don’t see how it could happen. Now, again, I am subject to being instructed by somebody but I don’t quite see these, I don’t think that these hypothetical possibilities are possibilities.

Miller: Let’s consider the hypothetical to be real. I think that sharpens a couple of points. First: it would sharpen the point about this research and then we would be able to ask more carefully–does this research impose justifiable risks to the human embryo? It would certainly take the abortion issue off the table. It would clarify the issue in that regard. It would be more focused on the legitimate risks that can be imposed on a research subject. In fact we have federal regulations in place that restrict what may be done on children for non-therapeutic purposes. What is interesting to me in the current debate, and I was talking to Gil about this earlier, is that those regulations don’t seem to have been wielded out to help frame this discussion in the national debate. That strikes me as odd because if, in fact, the embryo is human life at conception, then we have a set of regulations in place that ought to prohibit research on that subject for non-therapeutic reasons, that is to say, non-therapeutic to the research subject. The fact that we don’t have those regulations wielded out suggests to me that there is some kind of ambiguity in the public’s mind about this item we call the human embryo. The absence of these regulations being argued for suggests that we are looking at this in a way that is quite different from research on children.

Meilaender: Or that it simply clearly wouldn’t be therapeutic to the subject.

Elshtain: Right.

Meilaender: I mean it’s not, it’s more the minimal risk of harm since destruction is inevitably in order. I mean that’s another reason why you wouldn’t wield those criteria out here.

Miller: No, it would be the very reason because the research imposes risks that are unacceptable.

Meilaender: Right, but we don’t need to bring out the restrictions on research on children to know that we are not supposed to do research that kills the research subject. I mean, we don’t need the special set of protections that the Federal Code has for children’s research subjects in order to know that we are not supposed to do research in which the research subject is destroyed.

Elshtain: And that you know is going to be destroyed in advance of doing the research which is the case with embryos and stem cells.

Miller: Right, but the fact is, we’re really not talking about the kinds of risks that are being imposed on the embryo. All of those federal regulations, whatever they are about, are not being deployed.

Meilaender: Right, because there is only one risk.

Miller: But the idea here is that we nonetheless have kept open the question of the ethics of human embryo research. We know they are going to be destroyed. But we’re nonetheless keeping open the argument. That fact suggests that this entity is something other than a human research subject.

Meilaender: I’m missing it. I’m sorry.

Meilaender: Well, of course, we may disagree about whether it is, in fact, such a subject, but my point is simply that on no set of research subjects, just kind of ordinary competent adults, or those who, like children, who need special protections, for no set do we contemplate in the federal regulations what the criteria ought to be that would govern research in which the research subject would be destroyed.

Miller: It would be forbidden.

Meilaender: That’s right. It’s just forbidden. So, in other words, since such research is simply not permitted, I don’t see why we would need to talk about special protections.

Miller: Well, because one would say that the risks are excessive. They are disproportionate on any standard and, therefore, are unacceptable.

Meilaender: The kind of thing the federal regulations say is if there are excessive risks, then rather than just going through the standard kinds of procedures, you need a special ethics review board, or something like that. It would be peculiar to say, you know, we need a special ethics review board to determine whether research that will involve the destruction of all of these vulnerable subjects is permitted. so that, again, it seems to me it is beyond the range of possible risks that the standard kind of regulations protecting vulnerable subjects envision. So when the public mind doesn’t think of embryo research in terms of these standard categories, I don’t think that tells us much about what we think the human value of these subjects is or is not. Granting, of course, that the public mind certainly is not of one mind. I have no disagreement with you on that.

Elshtain: The difference has been clarified. Right. You understand the differences at stake here? Okay, next question.

Nachama Soloveichik: Hi. My name is Nachama Soloveichik. I am a first year Master student at the Harris School of Public Policy, and my question is for both of you. I want to talk about this very popular justification that the embryos can be used for stem cell research because they are going to be discarded anyway, and that sounds to me like, in an ideal moral world, we wouldn’t want to be discarding these embryos. This is a very unfortunate incident, but since they are going to be tossed out anyway, we may as use them to gain something from them. So, that leads me to ask about in vitro fertilization where these embryos are coming from and I realize that in vitro fertilization has a reproductive aspect, which does not apply to stem cell research, which is used for, you know, therapeutic aspects but, to me, I still see a similar moral problem in that you have all these embryos that are not being used and are… [TAPE FLIPS HERE]

Meilaender: Actually, I think yes to the last question but let me kind of tickle it out a little bit. Among the most under examined at and under-regulated industries in this country is the IVF industry and there are several things connected with your question. One is, suppose that we said we are only going to do research on spare embryos left over from IVF procedures. Now, as I say, actually I think that is not all the researchers want. They can’t get the disease models that they want by cloning embryos and so forth. But the truth is, we would miraculously produce all the spare embryos that we needed through the IVF industry to keep the research going. So, there is more than just meeting the needs of infertile couples that is potentially there. But, yes, I do think that in some respects, you pick your arguments, you see. Michael Sandel’s argument that Richard was outlining is basically designed to get a person like me to say, if you object to research to embryos, you must also take on the IVF industry tomorrow, assuming thereby that I’ll look like a fool, you know, and get run out of court. My answer to that is that the fact that you’ve made six mistakes so far doesn’t mean you must make the seventh. Not making the seventh is progress, even if you don’t turn things around. So, yes, I think it’s one of those areas that could use some regulation. That’s a place where regulation really is needed, but it’s a political quagmire that you get yourself caught in.

Miller: No, I think we’re close to being on the same page there. I mean, certainly it is unregulated. There are some issues about that.

Elshtain: Okay.

Cynthia Dunafon: My name is Cynthia Dunafon and I am a doctoral student in the Committee of Social Thought and I have two related questions, primarily directed to Mr. Meilaender about your comment that in our society, we have a tendency or a certain sense of sacredness about our duty to relieve the sufferings of others. And to the extent that certain kinds of research like we’ve been discussing today can relieve the sufferings of others, therefore, it should be justified. This is one stance which you were speaking against and you were saying no, if we step back and look at a broader ethical context, there are situations in which certain kinds of suffering do not need to be alleviated in order to live in a moral world, in order to persist in a moral world. And I wanted to follow-up with a couple of questions about that remark. Number one is, if we as a society deny certain avenues of research that will relieve suffering, does that increase our ethical imperative to further other avenues of research that will relieve different aspects of that suffering? For example, if we are going to give up a certain line of research that involves stem cell research, do we have a greater ethical imperative to make changes in the healthcare industry such that other ways of alleviating suffering for these individuals can be alleviated based upon access to healthcare or different financial arrangements? Do you feel that that is a part of this issue? And then my second question, which is related to that is how can we educate the broader public to understand this difference that our duty to relieve the suffering of others has limitations and that those limitations apply to ourselves as well as how we treat others? It seems that we have a society which makes very simplistic distinctions and it doesn’t take that step. How do you suggest that we actually teach society to start thinking along those lines?

Meilaender: Well, the second question is a real corker. I am just a humble college professor. Let me say a word about the first and then a word about the second but I can’t do justice to it by any means. I think what I want to say to your first question is yes. Suppose we regard this avenue as an unacceptable avenue down which to go, even though it might relieve suffering of some sort. I mean, it’s hypothetical that it might, but we can grant the possibility. Then, that certainly doesn’t relieve us of the obligation to look for other morally unobjectionable ways to relieve it, and it might even put pressure on us. I would be willing to allow that, to look for those others ways, as long,–and this is a significant qualification–as long as we keep in mind that a society has to do a whole bunch of things. You know, we don’t only do medical research. You’ve got to have schools and fire stations and all sorts of stuff. Given that, then, yes, we should try to relieve suffering. I certainly don’t mean that there is no obligation to relieve suffering, there is an obligation to try to relieve suffering, but not necessarily by any means possible. Now, with respect to your second question, the reason I don’t know how to answer it is that I was quite serious when I said at one point in my talk that I believe we’ve thinned out our public moral discourse to just two principles, one of which “be compassionate” or “relieve suffering” or something like that, the other, which is “expand choice.” And the way we talk about these things is, I mean…suppose that the Today Show wants to have me on for a six minute segment where Katie is going to interview us about stem cell research, actually, I would just probably say no, but suppose this happens and there will be another person on it. We know who it will be. It’s someone suffering from Parkinson’s. Okay? I lose. I mean, you know, compassion carries the day. So I think we need to recapture a distinction between compassion alone, which still keeps the sufferer at arm’s length and might even get rid of the sufferer in order to relieve the suffering–we need a distinction between that and something else, some other form of compassion, call it sympathy, or call it something else, which actually enters into the suffering and tries to share it, which I think religious people, Christian people, at their best, have often tried to do. So that we need to try and inculcate practices and habits in ways of thinking that encourage that. But that doesn’t mean that I’m able to sketch out a plan for doing it.

Cynthia Dunafon: If I can make one response to your example, I mean, it seems to be part of the problem. You’re saying that in a scenario of a television interview, there would be a diseased person on one side and there would be you on the other side, and the other person would win.

Elshtain: The main emphasis on the suffering.

Cynthia Dunafon: It seems to me that that is a part of the problem in our media is that we have this automatic assumption that the person who is suffering can’t think about this issue and that they will only have one way of thinking and I want my own suffering to go away. I cannot really participate in a real ethical discussion with an ethicist about broader human concerns and it seems to me that that seems to be a part of the over-simplification that we see again and again in our media. I mean, I have a genetic disease and I have participated in gene therapy trials and I stand to benefit from certain kinds of research but I also believe that I am a rational thinking individual and I am capable of looking at these ethical decisions and the kinds of issues that we are talking about today and speaking competently about them, not for my own ends or my own benefit. The media doesn’t give someone like me a chance to speak. It just says a person who is sick has one way of looking at the world and ethicists have another way of looking at the world and it seems to me that there are ways of bridging those two things. So, that is a part of what I am speaking to. Where is there a place in the media for that level of discourse?

Meilaender: Except I just want to add, you can only ask so much of a society in terms of what the nature of public debate and argument will be. I’m not saying ours couldn’t be better but, you know, there are limits. And I, although I spent my life, more or less, teaching ethics, I am not all that confident about what rational argument does on these matters and I think if we want people to begin to think in what I would regard as better ways about the meaning of suffering in human life, and our obligations with respect to it, and so forth, we’ve probably got to start a little sooner. In other words, it’s what happens to children, churches, families and so forth. Aristotle said, you know, that only the young man who has been well brought up can usefully study ethics…by the time they get to me, it’s pretty late sometimes. So, I think the formation has to take place in earlier stages.

Elshtain: We have four questioners still lined up and I would propose, I know that we have arrived at our time, but if the two of you are willing, I would suggest that we continue and get the questions in. But let’s do it in this way. If I could ask each of you to come forward seriatim and to pose your questions as succinctly as possible, I would ask Gil and Richard to collect the questions and then to respond. Is that fair?

Miller: May I just refine what I think Gil said, and then we can proceed. I think that you’re giving away too much when you say that we’ve got these two modes, one expanding liberty, one having compassion as the other value. I don’t see you as against compassion. I hope you’re not. I see you as against utilitarian approaches to compassion.

Meilaender: Of course, but you know, compassion has come to have a certain meaning. In our public argument, someone who says, “I know that would relieve your suffering but we should not do it,” is not ordinarily qualified as compassionate. Now, of course, we can think through a more sophisticated sense in which that is right, in which I am a very compassionate human being. But, I simply note that our immediate reaction won’t label that position as compassionate. That’s all I meant.

Elshtain: And I think the burden of your question was that there is also a way in which victims get stereotyped so that their appearance on the stage is an occasion for pathos but doesn’t lend itself to reasoned argument. That is the way public policy people, you know, depending on the issue, will trot out folks in wheelchairs or trot out this group or trot out that group and they are not called upon to give an argument but simply to, you know, to do a kind of afternoon talk show version of their suffering, which does not lend itself to the kind of formed capacities to argue that you’re talking about.

Okay, now having myself added to the burden of time pressure, let’s turn to our four questioners.

Meilaender: So, they’re all just going to state their questions?

Elshtain: They are all going to state their questions and you and Richard are going to gather the questions and respond brilliantly to all four of them in a brief few sentences.

Meilaender: He’s going to answer the hard ones.

Ross Eiler: My name is Ross Eiler. I am a first year Masters student here. Mine is a brief question of clarification for Professor Miller, actually. You brought up fetal tissue transplant as a potential moral precedent for the use of stem cell research on surplus embryos. But I know during the coffee break, my little divinity school corner was far more abuzz about Professor Meilaender’s suggestion of Auschwitz as a moral precedent. So, I wonder if you could please clarify the distinction of your understanding of the rationale if a predetermined loss has already been…an unfortunate predetermined loss has already been made, so let’s reap some benefit from this. If you could explain your rationale of that understanding in light of Mr. Meilaender’s suggestion?

Miller: He went to I.U. so I know that this was going to be a zinger.

Ed Barrett: My name is Ed Barrett, political science, with the additional handicap that I came in a little late, so I am not sure…

Meilaender: We answered your question. [Laughter]

Ed Barrett: Either it’s a bad question, or you already answered it. Just before I ask any questions, just to clarify, in regards to this 14-day rule, what you’re saying then is that at or prior to it, this being has intrinsic value and then, after that, absolute value? Is that correct?

Miller: Yes.

Ed Barrett: Okay. Then I have two questions. Why does this being have intrinsic value prior to that point, and to what does that value entitle it? Okay, so that’s the first question, two parts, and then secondly, precisely, what changes to give it this absolute value? I think that’s maybe the crux of this whole issue here. I think I heard you say that it could go from two to one or one to two, but not after that point. But I am not sure. So, could you flush that out a little more? Thanks.

Peter Moschovis: Hi. My name is Peter Moschovis and I am a second year medical student. You’ve addressed most of my question already in response to the previous question about suffering and compassion, but this is actually a question for both of you. Both of you referred to sort of the sense of mystery and awe we should have before nature and before some of the things that happen to us in our lives. I would like you to give me, as a medical student, some advice. How do I go about picking which forms of suffering I should try to relieve and, furthermore, which tools are at my disposal and why? And I would like sort of some general principles, not specific battles to choose. Thank you.

Elshtain: All right, final question. Melanie.

Melanie O’Hara: Yes. Professor Miller, my name is Melanie. I’m a doctoral student here and I was struck by your distinction between the moral status of an embryo that is implanted in the womb and one that is not and I was wondering if you could clarify what the difference is of being implanted in the womb, whether it’s something that’s a condition required to promote embryonic development or it’s something that affects it’s moral status and, if so, why?

Elshtain: Okay. Gil, do you want to start?

Meilaender: You want me to comment on all four questions, or what?

Elshtain: Yes, all four questions.

Meilaender: Okay, all four. Number one: Miller on fetal tissue transplants. I don’t actually think that’s a felicitous analogy. He will get his chance to say something, but I think the analogy is bad precisely because it’s more akin to cadaver donation. I mean, Richard recognized that, of course, in his talk but, in addition to some of the problems that have cropped up in fetal tissue transplantation research, I don’t think that starting with that as a paradigm case is all that useful since it’s closer to cadaver donation and I don’t see that it serves as a very useful paradigm for thinking about something like embryo research where we all agree that whatever exact value this thing has, it’s a living subject of research.

The 14-day thing…I’m going to let him handle the absolute value part of that question because to be honest, I am actually still puzzled by his view. I generally take absolute value to mean that you can’t kill. So I don’t actually understand his view. But I’m sure if I’d done my Ph.D. work in Chicago, I would understand it. But I will say, perhaps, just a word about the 14-day thing. For one thing, as I said, I think it is actually becoming an increasingly magical kind of moment. If you say, oh, we wouldn’t do research beyond 14 days and I ask why, the answer seems to be, “well because 14 days is the limit we set.” It’s just magic. But there are a couple of other things to say. In the first place, there is recent evidence, there was an article in Nature, back in July, that from conception polarity is already present in the embryo. There is already a top and a bottom. So, you don’t have to get farther. So, they’re sort of empirical considerations that I think are going to tell against the 14-day limit, which I, myself, once, a bit tentatively, more or less espoused and Then too, the issue is, if it can twin, if it can segment, then you can’t have an individual human being prior to that. That’s seems to be the claim. And the longer I thought about it, the more I realized that actually, metaphysically, there is a question here that science just can’t answer. For example, here we had one subject and now we have two and let’s say that this one was X. Now we have the two. Are they X and Y or are they Y and Z? Is X still there? If X is still there, we already have an individual subject, which has, as it were cloned itself. If it is Y and Z, we had something that split itself in two and human beings, human subjects don’t do that. Science, I think, just can’t tell us, can’t answer the metaphysical question and I prefer safety in answering it. There is more to say with that.

The mystery and awe question. Look, I say …God bless you medical students, you don’t have to relieve all forms of human suffering. If you relieve a few, actually if you could do something about my right elbow, I’d be greatly pleased. But, I said to my wife the other day, you know, my athletic career is just over, and she says, you’re 56, you know, it doesn’t matter. But I think the trickier matter… I’m not going to answer the suffering thing so much, but I think the trickier thing is that we want you, to some extent, to distance yourself from the mystery and awe in certain ways and at certain moments. When they wheel me bleeding into the emergency room, I don’t want you to be overcome by awe, you know. I want a powerful active agent at work there, so we want you to do that and it is not clear that you can devote yourself to your vocation if you don’t and yet, we want you to retain your humanity even in the doing of that. That, to me, is the deeper question more than whether you should devote yourself to this or that. There are countless good things to which you can devote yourself and I think you can even let your own interests and aptitudes help to answer that question. But to retain your humanity, while doing this effectively, that I think, you know, is the real trick. And then finally, what was the last?…

Miller: The implantable question.

Meilaender: Oh yes, Richard should really answer that because I think he’s just got kind of a problem. I mean, this is partly to repeat myself. But see, first we decide not to implant this embryo. Then we say an unimplanted embryo has no future life prospects and cannot be further harmed and then we say, since it can’t be further harmed, we may as well use it as a research subject, acting as if, simply not being implanted is just a natural fact, wholly separate from our own choices and it’s not. As I said, I do not think that form of argument is very persuasive but…it’s yours.

Miller: To Ross’s question about the Auschwitz parallel, I don’t think that is a very instructive benchmark from which to proceed, for a variety of reasons. One is, there was no consent given by research subjects. Secondly, there was no scientific design or sophistication surrounding those procedures. So, the issue with Auschwitz was that the research subjects were fated to being killed as the parallel for thinking about human embryo research. There are all kinds of problems surrounding the Nazi research. As a parallel to use for thinking about human embryo research, this analogy skews the analysis in all kinds of wrong directions. There is no separation in timing between the verdict and then the recruitment for research and so, there are important distinctions to introduce.

Meilaender: But you don’t think the embryos consented?

Miller: No.

Meilaender: You’re just accepting the proxy consent here?

Miller: That’s right and, again, only with lines being drawn. So, I think that’s a rather specious analogy. I think the Tuskegee analogy is, likewise, specious because it’s not that they wouldn’t have had, they couldn’t have had some alternate. In fact penicillin, as Gil says, was available. You see, it wasn’t as if they were fated in any sort of way other than by virtue of a cultural decision, and a set of factors surrounding their lives, to deny them better treatment. So, once again, I think that gets us going in the wrong direction.

On the second question, from the political science student: I draw the distinction between assigning intrinsic value and absolute value at 14-days. I want to say that that enables us to think through a different set of conflicts. Once we cross the 14-day threshold, I’m saying that research on a human embryo is inadmissible. That still leaves open the question of justifiable abortion. With embryo research, we’re talking about a set of third party interests. The question we’re being asked is, Are those third party interests weighty enough to compromise the goods and interests and rights that surround an embryo? I’m arguing that before 14-days, the answer is yes and that after 14-days, the answer is no. What about after 14-days, when we’ve got an absolute moral good? Does that mean that its life can never be taken? I would say no, only that it can’t be taken for research purposes. In questions or issues of conflict between maternal well-being and fetal life, matters are different. A woman’s claims can override the claims that the post 14-day embryo has. That’s a different set of conflicts and they are much more acute than the sorts of issues that surround research on embryo, as I’ve described it. Does that help?

Elshtain: It’s going to have to help, because we’ve got to keep going.

Miller: And that picks up on the fourth question, I’m jumping over the third. I agree with Gil and I don’t know any bioethicist who disagrees, that science cannot answer the question, When does human life begin?. It’s not a scientific question. It’s a metaphysical question that’s a function of human judgment that pulls together a variety of facts, asks which ones seem to be pertinent or relevant to the status of the embryo, and passes judgment on when the line should be drawn. My argument draws on an ensemble of data, no one of which is sufficient to draw that line at 14 days. One factor, which I acknowledge is a contingent factor, is the implantability issue. But there is also the development of primitive streak and organ differentiation and the issue about either twinning or combining at or around 14 days. Taken together we have to ask ourselves is this entity one to which we can assign absolute moral respect? I think there is sufficient ambiguity surrounding those facts to say, no.

About the third question, I agree with Gil. The fact that you’ve asked the question, it seems to me is already a very promising sign, because you’re asking what sorts of human goods does one need to consider and what kind of character does one need to bring to bear on my profession? Having immersed myself in a hospital for a year, in an intensive care unit for six months, I only wish that more people were asking that question.

Elshtain: I’m going to call our proceedings to a close at this point. Thank you all for your attention and your good questions. Thanks most especially to Professors Meilaender and Miller. Let’s give them a round of applause.