Pro-lifers fumed during the 2004 presidential race when John Kerry attacked opponents of embryonic stem-cell (ESC) research as "anti-science" ideologues who sought to block life-saving cures "right at our fingertips."
"This is not the way we do things in America. Here in America, we don’t sacrifice science for ideology," Kerry argued in an August 2004 radio address. "And that’s why we must lift the ban on stem-cell research…. Every day that we wait, more than 3,000 Americans lose their lives to diseases that may someday be treatable because of stem-cell research."
Never mind that embryo-destructive research has never been banned in this country—nor has it actually produced any cures for disease. Kerry’s dismissal of ethical objections to ESC research reflects the position of the biotechnology industry, whose campaign for public support has benefited from abortion politics fueled by media hype. Yet unbeknownst to Kerry, a group of pro-life scientists and ethicists saw the curative potential of embryonic stem cells not as a reason to tolerate death-dealing in the laboratory, but as a challenge to discover morally licit means of obtaining cells with the same applicability as human embryonic stem cells.
William Hurlbut, a physician and bioethicist at Stanford University and a member of the President’s Council on Bioethics, pondered this issue as the council conducted its hearings and deliberations. In the fall of 2004, as leading researchers bombarded the council with demands that President Bush lift his restrictions on federal funding, Hurlbut presented his own solution: altered nuclear transfer (ANT)—an approach that might permit researchers to use "embryo-like stem cells" without creating or destroying actual embryos. Within six months, the broad concept proposed by Hurlbut had rallied a dream team of pro-life scientists and bioethicists, led by Robert George, McCormick professor of jurisprudence at Princeton University and a member of the President’s Council on Bioethics, and Markus Grompe, professor of genetics at the Oregon Health and Science University and director of the Oregon Stem Cell Center.
The centerpiece of this carefully orchestrated campaign is oocyte-assisted reprogramming (OAR)—a variation of Hurlbut’s original proposal—put forward by Grompe. Introduced at an April 2005 conference, the approach has received backing from 35 signers, including Protestant, Jewish, and influential Catholic moral theologians. On Capitol Hill, Hurlbut’s well-publicized mission has provided cover for President Bush and other pro-life political leaders who have resisted an expansion of federal funding for embryo-destructive research.
The campaign ignited by Hurlbut may well emerge as a brilliant strategy for strengthening the intellectual credibility of the pro-life movement—and for forcing a re-appraisal of anti-life research methods. Much still needs to be understood about the workings of these cells and whether reprogramming them will offer "different ethical ways of getting the same kind of cells now taken from embryos without violating human life or dignity," as President Bush explains it.
Heading Down a Slippery Slope?
But the mission to reshape the national debate on stem-cell research also carries considerable risk. There are dangers inherent in a pro-life effort that acknowledges the potential curative role of embryonic stem cells while insisting that the vital tissue can only be extracted through morally licit means. Last spring, the pro-life movement stood united in its opposition to ESC research while heralding the already significant achievements of adult stem-cell therapies.
Yet despite the breakthroughs in adult stem-cell research, the pro-life position never held much sway with top researchers or Democrats on Capitol Hill. Hurlbut’s proposal acknowledges this fact by putting something new on the table. But his initiative also generates concerns that a pro-life shift might forge divisions within the movement and sow confusion among the general public.
Jessica Echard, executive director of Phyllis Schlafly’s Eagle Forum, has described stem-cell alternatives as a problematic, "middle-ground" position. "Most scientists will say it’s never enough," Echard explained in a published interview. "We will be giving ground to more and more unethical research." A handful of Catholic theologians like David Schindler echo these concerns. They contend that Hurlbut and his colleagues have succumbed to the over-hyped ESC juggernaut and that the plan betrays a "mechanistic" approach to nascent human life that does the pro-life movement no credit.
For some wary activists, such concerns appeared justified in October 2005 with the announcement that scientists had successfully tested two alternative methods of producing the coveted stem cells. The front-page news prompted Christian groups to break ranks. Pro-life ethicists had already rejected one approach as morally unacceptable; the second was Hurlbut’s ANT method. While ANT defenders expressed cautious optimism, some pro-lifers attacked Hurlbut’s procedure. "Just because scientists have created a genetic time bomb in the embryo does not change its essential human nature," argued Dr. David Stevens, executive director of the Christian Medical Association. Hurlbut’s backers questioned whether Stevens really understood ANT. But they also acknowledged that confusion regarding cutting-edge research in biotechnology would hamstring efforts to establish an effective dialogue between scientists and the pro-life community.
A Technological Bombshell
Hurlbut first brought his proposal to the President’s Council on Bioethics in late 2004. His original plan encouraged the study of ANT, a concept based on the premise that "pluripotent stem cells can be obtained without destroying living human embryos. At present, there are only three confirmed sources of pluripotent stem cells: the existing lines (or colonies) of already harvested human embryonic stem cells, embryos either to be created in vitro or donated from IVF clinics for the harvesting of their stem cells (and consequent destruction), or cloning." Hurlbut offered a potentially benign solution: "No embryo produced, so no embryo destroyed," the mantra echoed by the Hurlbut camp.
Broadly speaking, ANT involves three steps.
First, a cell is removed from a patient, and the DNA in the nucleus of that cell is "altered" to control and direct the types of gene expression the nucleus is capable of supporting.
Then the nucleus is removed from a human oocyte (egg cell), to which is then fused the altered adult cell nucleus. This newly constituted cell would be neither an oocyte nor an adult cell, but a hybrid that exhibits the properties programmed into it by the alterations made to the adult cell nucleus.
The newly generated ANT cell could be used to produce pluripotent or embryonic-like stem cells. These stem cells would be genetically identical to the patient from whom the original adult cell was taken and could be used for research and therapeutic purposes.
Hurlbut’s initial proposal—established within the ANT framework—speculated that the gene that fuels the development of the embryo could be suppressed to prohibit its growth. Nuclear transfer thus would involve a cell that could not develop into a fetus, but would rather, from the very start, have the developmental trajectory akin to that of a teratoma—a naturally occurring tumor stemming from the human germ cells in the testes of males and ovaries of females. Retrieval of the stem cells would not result in the destruction of a living human embryo because it was never created.
The initial ANT proposal received immediate attention in journals like Science. But critics on both sides of the debate questioned the feasibility of Hurlbut’s hypothesis. A few scientists and politicians who had expressed no compunction about the creation and destruction of human embryos signaled their dismay that ANT might lead to the possible, if inadvertent, creation of disabled embryos. Hurlbut agreed that animal testing would be pursued first to establish clearly the nature of the entity created by the procedure. His insistence on this point underscored the fact that scientists are poised to enter still-uncharted frontiers of exploration regarding the origins of human life.
Ultimately, the president’s council issued a "white paper" on "Alternative Sources of Pluripotent Stem Cells" that noted four compelling research proposals. In a press conference, Leon Kass, chairman of the council, explained the strengths and weaknesses of each approach. The third approach was Hurlbut’s ANT plan; a fourth proposal, called cellular reprogramming, posed the possibility of taking any cell in the human body—skin or liver cells, for example—and reversing their development in order to return them to their original pluripotent condition. Ultimately, the third and fourth methods would be combined in the Grompe-Hurlbut ANT-OAR plan. Kass acknowledged the attendant issues that made ANT problematic. But he noted that both the ANT and the reprogramming proposals offered the additional scientific benefit of yielding "individualized and personalized stem cells" that could be used for therapies benefiting the original donor because there would be no "danger of immune rejection."
In fact, both ANT and the reprogramming proposal would permit scientists to control the genetic makeup of the stem cells they produce, removing the justification for "therapeutic cloning," which researchers say they need to produce stem cells for diseases they want to study and that are an exact genetic match for patients, theoretically helping them overcome the immune rejection problem. According to the latest news reports, only a Korean team of ESC researchers has successfully engaged in so-called therapeutic cloning to produce early-stage embryos for the purpose of extracting their stem cells. Most scientists have denied any plans to initiate "reproductive cloning," which would bring cloned embryos to term. But many observers expect that the perfection of cloning techniques for research purposes will inevitably lead to its use for reproductive purposes.
By publicizing ANT and other stem-cell alternatives, Kass hoped to prod a complacent scientific establishment to take a harder look at embryo-destructive stem-cell research. With the hope of breaking the stalemate between top research scientists and the Bush administration, he brought opposing parties to the table to hash out their differences. Some Republican operatives dismissed this approach as high-minded but naïve. During a press conference, Kass acknowledged both the difficulty of bringing the two sides together and the relative isolation of pro-life bioethicists. Indeed, the apparent unanimity of the scientific community on the ethics of stem-cell research, Kass suggested, was due partly to the appointment of "ethicists who in every fundamental respect don’t really differ from the scientific community whose work they’re supposed to scrutinize and to some degree restrain." Noting the consensus document on ESC research issued by the National Academy of Sciences, he wryly observed, "One should simply recognize that they have accepted the basic question as settled, that it’s not only not problematic to use the spare embryos, but it’s morally acceptable [even] to create embryos solely for research, both by cloning and by in vitro fertilization."
Around the time Kass held his press conference, Robert George and Rev. Thomas Berg, LC, executive director of the Westchester Institute for Ethics and the Human Person, organized a meeting of pro-life scientists, ethicists, and moral theologians. The conference was designed to bring the ANT proposal before a group of experts to jump-start the review process. By then, Hurlbut had already received a letter of encouragement from Archbishop William Levada of San Francisco.
"We were all united in our opposition to embryo-destructive research. We were also very aware of the dark interest in cloning, not simply for stem cells, but to bring clones along to later stages of development for further research purposes, for example, the harvesting of progenitor organs grown in laboratories," explained Father Berg. "Given the world we’re living in, we had to take seriously the proposals that were on the table pointing to alternative sources of pluripotent stem cells. That was the motivation that brought the meeting together."
Hurlbut presented his ideas to conference participants. On the second day of the meeting, Grompe, a top researcher who works solely with adult stem cells, presented his intriguing variation of Hurlbut’s original proposal—oocyte-assisted reprogramming. In the words of a published joint statement, OAR would not yield an "entity that undergoes or mimics embryonic development." Rather, it "would produce a cell with positive characteristics and a type of organization that from the beginning would be clearly and unambiguously distinct from, and incompatible with those of an embryo. Incapable of being or becoming an embryo, the cell produced would itself be a pluripotent cell that could be cultured to establish a pluripotent stem cell line."
The Grompe-Hurlbut proposal received an almost unanimous endorsement from the conference participants. "We consider this so important because you don’t have to kill embryos to get stem cells," noted moral theologian William E. May of the John Paul II Institute for Studies on Marriage and Family in Washington, D.C. Like May, most conference participants signed a "Joint Statement: Production of Pluripotent Stem Cells by Oocyte Assisted Reprogramming." The statement endorsed an OAR research program that would begin with animal cells to determine "beyond a reasonable doubt that ooctye assisted reprogramming can reliably be used to produce pluripotent stem cells without creating embryos." A slew of prominent Catholic moral theologians and ethicists also endorsed OAR, including Germain Grisez of Mount Saint Mary’s University, John Haas of the National Catholic Bioethics Center, Kevin FitzGerald, S.J., of Georgetown’s Center for Clinical Bioethics Research, Patrick Lee of the Franciscan University of Steubenville, and Kevin Flannery, S.J., of the Pontifical Gregorian University in Rome.
The Controversy Begins
But May’s enthusiasm for OAR was not shared by several of his colleagues at the John Paul II Institute. The institute’s academic dean, David Schindler, Gagnon Professor of Fundamental Theology and an invited participant in the conference, dissented from the majority’s endorsement (disclosure: I am a graduate of the John Paul II Institute and a former student of Schindler’s). Schindler and Adrian Walker, another institute professor, had already critiqued Hurlbut’s original proposal in two articles published in Communio, the international theological journal.
In part, Schindler and Walker echoed the initial concerns of other conference participants regarding the precise nature of the entity that would be created by Hurlbut’s ANT method. But there were other issues as well, some scientific, some philosophical, and some strategic. In his Communio article, "Biotechnology and the Givenness of the Good: Posing Properly the Moral Question Regarding Human Dignity," Schindler didn’t dispute Hurlbut’s good intentions, but suggested that the ANT proposal lacked the proper philosophical grounding. Instead, its preoccupation with establishing technical evidence to confirm or deny the creation of a human embryo arose from a mechanistic ethos that denied the "integrity of the human being as born not manufactured and as naturally apt in his or her bodiliness for the expression of gift." Contrary to Hurlbut’s hope that ANT might offer a "technological solution to a moral impasse," Schindler argued that "[t]here can be no unqualifiedly technological solution to the moral problem that ANT seeks to address because in fact there is no unqualifiedly technological solution to any human problem."
Essentially, Schindler advocates what he believes to be a more integrated treatment of the moral challenges posed by innovations in biotechnology. In his view, the ANT proposal approaches the human body as merely "physical" or "pre-moral"—a "main feature" of the "dominant practices of modern science and technology." He wants modern science to develop a renewed appreciation for a "pre-modern" path that "approached science and technology in the spirit of imitation of…a nature or cosmological order given by God." Our modern struggle for "power and domination" over nature reveals an alienated view of the natural order as neither "good" nor "naturally given." The natural order thus "no longer provides an inner reference point for morality," Schindler writes. What has filled the vacuum is a "mechanistic" philosophy arising from an "absent God."
Schindler published his judgment before Grompe formulated the OAR approach at the April meeting. But the revised proposal didn’t shake Schindler’s core objections, now shared by several faculty members at the John Paul II Institute. In his subsequent "Response to the Joint Statement: Production of Pluripotent Stem Cells by Oocyte Assisted Reprogramming," Schindler repeated his philosophical arguments. He also asserted that the "signatories have failed to show conclusively that OAR does not present us equally with a species of the evil of homicide; that OAR is not the cloning of defective humans." But even if animal research establishes that OAR will not yield an embryo, Schindler won’t withdraw his opposition because he rejects the use of human eggs for curative therapies. He further charges that OAR proponents ignore the "special significance of the finality of the human body’s sexual/reproductive organs, by virtue of their being bound up so directly with the origins of life."
Supporters of the technology were frustrated with Schindler’s arguments, particularly his open-ended discussion on establishing the proper philosophical framework for studying the moral challenges posed by innovations in biotechnology. Schindler has been accused of misunderstanding the science, while others don’t share his concern regarding the therapeutic use of human eggs and feel the debate provokes unnecessary divisions within the pro-life community.
The skirmish hasn’t derailed the OAR campaign. "Our primary concern continues to be: Would this procedure, if pursued with human cells, produce a human embryo? Would that entity have the necessary biological foundation to support a rational human nature? You don’t have potential persons or embryos," argues Father Berg. "There is no in between." But he stresses, "If the application of OAR in animal models came anywhere near suggesting that the resultant entity could be an embryo, then the proposal comes off the table."
The Road Ahead
Grompe accepts the possibility that the Vatican may ultimately rule against his proposal. But he is eager to engage the scientific establishment and reshape the debate on Capitol Hill. He feels that the "anti-science" label Kerry affixed to stem-cell opponents was partly justified. "Some people were saying that embryonic stem cells can do anything adult stem cells can do," he said. "The fact is that nobody knows. It became a debate about whether adult cells are as good as embryonic stem cells. It was actually a utilitarian argument. Unfortunately, there are a lot of things that we object to on a moral basis that still work. IVF is an example. Cures from embryonic stem cells could happen even though we object to them."
As a top stem-cell researcher and a practicing Catholic, Grompe hopes his proposal offers something to both sides in the debate. "Creative science can help us find a way forward and thus put pluripotent stem-cell research on a footing that all citizens can enthusiastically support," he wrote in a Wall Street Journal opinion piece with George.
OAR proponents have brought this message to Capitol Hill, and their campaign has benefited from a succession of recent scientific breakthroughs achieved with several alternatives to embryo-destructive therapies. This summer, though Congress had passed legislation expanding federal support for ESC research, the Washington Post reported that lobbying by Hurlbut and his supporters put Senate backing at risk. Moderate senators had begun to rethink their position on stem cells. Meanwhile, Representative Roscoe Bartlett (R-Maryland) has drafted legislation to provide $15 million for research into alternative sources of stem cells, including umbilical cord blood and bone marrow. Along the way, Hurlbut, George, and Grompe have strengthened the hand of President Bush. "With the right policies and the right techniques, we can pursue scientific progress while still fulfilling our moral duties," said the president.
None of this activity has gone unnoticed by ESC researchers and activists who have waged a relentless effort to loosen controls on federal funding. "Stem Cell ‘Alternatives’ Fog the Debate" was the title of one Washington Post opinion piece by heavyweight scientists seeking to neutralize Hurlbut’s mission. The article called the stem-cell alternatives a "laundry list of…speculative scientific approaches that serve only to confuse the issue." The op-ed suggested that the campaign for morally licit stem-cell research was more about advancing political agendas than scientific inquiry.
Still, Bush’s veto power over additional federal funding has fostered a more pragmatic view. An article in Wired, a business technology magazine, prodded the naysayers to soften their stance: "If stem-cell proponents succeed in vilifying these alternatives, they will have to face up to the fact that it wouldn’t just be the president who is delaying potential breakthroughs."
A Daring Initiative
It’s easy for pro-lifers to applaud alternative stem-cell proposals as an effective weapon against a powerful opponent—regardless of whether the technique becomes accepted practice. But some disinterested observers believe that Hurlbut has made a real contribution to a national debate that leaves politicians and ordinary citizens equally baffled. William Saletan, national correspondent of the online magazine Slate, wrote about the dynamics of one contentious Capitol Hill hearing and suggested that Hurlbut was on the right track. "He’s been doing what a scientist does: floats ideas, bounces them off researchers, and revises the ANT proposal constantly.… He also criticizes conventional embryonic stem-cell research scientifically, in a way that pro scientists won’t and anti nonscientists can’t," observed Saletan. "The pro witnesses complain that the alternative proposals are speculative. Hurlbut points out that conventional stem-cell research is speculative, too."
Recent headlines confirming what appears to be the successful testing of Hurlbut’s version of ANT underscore his singular contribution. Father Berg suggests that Hurlbut’s proposal prompted the breakthrough research with laboratory mice at MIT. Further, the initial conclusions, reported in the prestigious scientific journal Nature, strongly suggest that, in mice studies, ANT yields a "disorganized grouping of cells," in Father Berg’s words, not a mouse embryo.
"MIT’s Rudolf Jaenisch did exactly what Hurlbut suggested," Father Berg noted. "From what Jaenisch reports in the Nature article, there is reason to think he didn’t create an embryo. But we need to study this more carefully in many animal studies."
Some pro-lifers are unlikely to lend their support to this version of ANT. But ethicists like Father Berg believe that it has encouraged a new line of scientific inquiry that reflects a heightened awareness of moral concerns.
If OAR or other proposed alternatives prove workable, researchers will be pressured to embrace the new methods or justify a stubborn commitment to embryo-destructive research. Indeed, continued resistance might give rise to awkward questions about the unstated direction of some ESC research programs.
In recent months, pro-life ethicists have questioned why researchers still lobby for ESC funding, given that the stem cells of newly conceived embryos now in use show a tendency to mutate and form tumors. In contrast, research suggests that stem cells extracted from more developed animal fetuses do not form tumors; this fact may prompt researchers to find a way to grow human fetuses for months, possibly in artificial wombs, before retrieving stem cells or other tissues.
Some pro-lifers see disturbing signs that the marketing of "spare" fetal parts may be just around the corner. And if such plans are already afoot, researchers won’t be satisfied with techniques that yield pluripotent cells alone. They will need living human embryos or fetuses—some kept alive for months.
In a recent article for the Weekly Standard, George sought to explain why ESC advocates didn’t applaud recent breakthroughs in research on morally licit alternative techniques at Harvard and the University of Pittsburgh. "Based on the literature I have read, and the answers given by spokesmen for the biotechnology industry," George wrote, "I fear that the long-term goal is indeed to create an industry in harvesting late embryonic and fetal body parts for use in regenerative medicine and organ transplantation."
The demonstrable interest of many researchers in experimenting with early-stage fetal organs means that the pro-life movement must stay on its toes. This past fall, activists continued to lobby for passage of the Human Cloning Prohibition Act, sponsored by Senator Sam Brownback (R-Kansas). George believes we need to go a step further and pass legislation that would "ban the production of human embryos for research in which they are destroyed." Over the next year, some pro-lifers will stick with the promotion of adult stem cells. In Sydney, George Cardinal Pell has offered grants totaling $150,000 for research into adult stem cells, demonstrating the Church’s commitment to morally licit scientific innovation.
The verdict is still out on OAR. But Hurlbut, George, and Grompe offer a template for an informed, effective, and daring pro-life initiative that cannot be ignored.
Joan Frawley Desmond has written for the Wall Street Journal, First Things, and the National Catholic Register, among other publications.