Keeping with my attempt to actually do book reviews, I have the first of what will hopefully be a continuing series. I am reviewing Stem Cell Century by UCLA Law Professor and Volokh Conspiracy contributor Russell Korobkin -- with Stephen Munzer in some chapters.
This book examines the legal, ethical and policy-related issues in stem cell research. Stem cells as a technology are nearly universally acknowledged as possessing huge potential to improve human life and limit human suffering; however, in many cases this potential has not yet been realized. Further, the legal and ethical ramifications of stem cells have yet to be worked out. For example, who owns stem cell lines? Under what circumstances should stem cell lines be extracted from abandoned embryos at IVF clinics? These are the issues that Prof. Korobkin attempts to address in this book.
And how does he do?
I can summarize my opinion of this book in one sentence: if every policy-maker and politician responsible for stem cell law were forced to read this book the world would be noticeably better.
Just to begin, one of the core requirements in a good book on science policy is that the author -- if not technically inclined -- has a good grasp of the technologies involved. Korobkin succeeds in this in spades, producing one of the most cogent, up-to-date, and accurate summaries of stem cell research that I have read in a long time. He even includes very recent breaking research such as using cell extracted for Pre-implantation Genetic Diagnosis (PGD) to create stem cell lines and efforts to transdifferentiate adult cells into stem cells. (I didn't get a chance to talk about that, but it is a very good paper.) His first chapter is devoted to summarizing the techniques that he will be discussing later, and what he wrote is to the best of my knowledge accurate. Korobkin is clearly on his game with the science, particularly in that he emphasizes that a lot of this research is in-progress. Both adult and embryonic stem cells have failed to materialize real treatments yet, though most of us think they someday will.
Korobkin then proceeds to discuss all aspects of stem cell research both ethical and legal. His comments are insightful. He discusses some of the ethical aspects that I hadn't even considered. For example, the big, ethical elephant in the room with stem cells is the destruction of embryos to create them. People who object to the creation of stem cells from embryos argue that such destruction is tantamount to murder because the embryo has the potential to become a human being. Korobkin argues that such a standard is absurd: potential for humanity is not equivalent to the moral value of a person.
The intuition that a blastocyst lacks the moral value of a person is vividly demonstrated with the following hypothetical: Imagine that a fire starts in a fertility clinic and you must choose between saving a Petri dish containing two blastocysts and a five-year-old child. Is there any question that you should (and would) save the child? The appropriate answer to the question is just as obvious if the blastocysts would be destroyed by the fire and the child only injured. The reason is that the child possesses not only human DNA but also such qualities as sentience, consciousness, emotions, the ability to interact with the environment, and the capacity to experience pain. (p. 31)
He argues that the core argument of the defenders of embryo viability -- their potential to become human beings -- takes the concept of potentiality to an irrational degree. In theory, DNA from every cell of your body could become a person. (Assuming that reproductive cloning becomes possible for people.) Should we assume therefore that all cells possess human value? Obviously not. "In short, [the blastocyst] lacks every trait that could plausibly be considered a characteristic of human moral value except one: it has human DNA." (p. 30)
This is not to suggest that human tissues and embryos possess moral value greater than other classes of objects. Embryos are not inanimate; they are clearly a special and morally privileged group of things. However, in the comparison between the value of a human being who can be saved by a treatment and the value of an class of objects recognized as not equivalent in value, the human being always wins.
Korobkin applies his insight into the ethics of stem cell research to identify several internal inconsistencies in policy both by the Bush Administration and in existing Federal law. Take this excellent phrasing:
If the central premise of the Bush policy is the moral equivalence of blastocysts and persons, the finer distinctions incorporated in that policy are based on the philosophical principle that benefiting from a moral transgression is acceptable as long as causal complicity in the transgression is absent. According to this principle, the government should do nothing to cause the alleged moral wrong -- in this case, embryo destruction -- but neither need it refuse to benefit from the fruits of bad acts perpetrated by others. (p.34-35)
The sad fact of the matter is that Korobkin may have identified the moral premise underlying Bush Administration policy generally, not just for stem cell research. A similar moral premise seems to be at work to justify CIA rendition.
But Korobkin does not pull punches from the Congressional alternative: the Stem Cell Research Enhancement Act (SCREA). (The Act has been vetoed twice by President Bush.) This Act also has some internal inconsistencies because it attempts to limit stem cell research to the destruction of embryos that are produced for the purpose of creating life, i.e. not for explicitly research purposes.
To suggest that all of these embryos are produced for the purpose of "creating life," however, is to use rhetoric to promulgate a blatant falsehood. If the nation's governing moral principle were to be that embryos should be created only for the purpose of creating life, IVF clinics would be permitted to create at any one time only the number of embryos that they were planning to implant immediately, and they would be required to wait to create more embryos until another treatment became necessary. (p. 46)
Korobkin's underlying goal is to identify those policies that will best promote this emerging research while limiting the ethical concerns, and he suggests some very reasonable compromises. For example in his chapter on stem cells and patents, he discusses the history of the Wisconsin Alumni Research Foundation (WARF) which holds three patents-related to stem cell research technology, although those patents are being contested and it looks like they may be overturned or amended. The question of the patents is whether just the procedure created by Dr. James Thomson -- a stem cell pioneer -- should be patentable only or whether the patents should apply to the production of all stem cell lines by similar methods. After summarizing patent law and the issues involved, Korobkin offers the following compromise:
Regardless of which side ultimately prevails in his extremely technical dispute, the nature of the disagreement reinforces the notion that any hESC (human embryonic stem cell) patents should be issued for a particular method or elements thereof or for a particular culture medium that renders a cell line uniquely useful for research. It is these items that are potentially inventive and thus deserving of patent protection, not the hESCs themselves. (p. 122)
There are two important notes that I would like to make about this book.
The first is that it is not entirely disinterested; Korobkin offers his own substantive opinions on manners of policy. However, I argue that this makes the book a better read for several reasons. First, science policy and law is a pretty dry subject without the invigorating addition of personal opinion. He is at points hilarious. He comments as an aside in the chapter on reproductive cloning that, "If the government has a compelling interest in maximizing the expected health and lifespan of children that justifies its interference with reproductive choice, it would seem to follow that it would have the power to ban sexual reproduction, a 'technology' that does not screen either gametes or embryos. It is scarcely imaginable that the Supreme Court would adopt a position that would suggest that Congress may ban sexual reproduction." (p. 88, Emphasis mine)
Second, while he states his opinion Korobkin is more than willing to state when it looks like the law is going to go in the opposite direction. While he discusses a variety Constitutional interpretations that could be construed positively with respect to cloning, he acknowledges that "Given the Supreme Court's reluctance to recognize substantive due process rights, it seems unlikely that it would read its jurisprudence on reproduction to require recognition of a right to pursue cloning technology." (p. 91)
The second point that I would like to make is that this book is useful for bench scientists in addition to policy-makers. I believe that it was the historian J.M. Roberts who once compared history to a garden rake: if left lying about it has the tendency to strike one in the face. (If someone could help me find that quote, I would appreciate it!) From working on this blog, I have learned that controversial scientific and legal issues are often very similar. Scientists are often oblivious too them, and that can have very negative consequences.
This book is helpful to bench scientists because it makes you aware of legal issues that could affect your work. For example, in his analysis of who owns the rights to stem cell lines -- the person from whom they were derived or the scientist who manufactures them -- he indicates the law is hardly settled with respect to this issue. In fact, there is considerable debate about the "default rule" (what you assume happens in a contract between two parties when they don't talk about who owns the product). In spite of this controversy, Korobkin has what I consider a very common sense suggestion: when in doubt, talk about it. Stem cell researchers -- in addition to getting informed consent in compliance with the common rule -- need to discuss with participants in studies about possible financial rewards. He argues -- and I agree -- that in most cases subjects will still be willing to participate.
In closing, I don't read many law books, but it gives me great comfort to notice that good law is a lot like good science. Good law and good science are both presented in clear terms, not in jargon. They both go regularly to the well of experience, avoiding castles in the sky. I think that many scientists will find this book both intriguing in its subject matter and comfortably familiar in its approach. It is also certainly going on the reading list if I ever teach a course in science policy.
You can purchase Stem Cell Century here.
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"He argues that the core argument of the defenders of embryo viability -- their potential to become human beings -- takes the concept of potentiality to an irrational degree."
If that is indeed what he argues, then I'm inclined to think it is a very poor book. Very few of them say that embryos have the potential to become human beings. Rather, they say that embryos are human beings. The least I ask of an author is that he state people's positions correctly.
bradm,
I'd say he's giving them the benefit of the doubt, lest they look even more moronic.
Nevertheless, he's wrong.
And, I guess I should point out, that it is rather uncontroversial that after the process of fertilization, a new human organism does exist. There is nothing really moronic about that - it's basic embryology. The debate is over what rights that organism has.
"human organism" != "human being".
To clarify: you're concluding the book is "very poor" over a semantical quibble. I've always seen discussions about the rights of an embryo/fetus/whatever framed in terms of its potential to become a "human being", where "human being" implies a human with all of the rights we typically grant to human organism that doesn't exist in an uterus or test tube.
"Pro-life" people argue that embryos have a right to life. They don't argue that embryos have a "potential" right to life. Their argument is not based on embryo's "potential to become human beings." It is based on their belief that an embryo already has a right to life.
I haven't concluded that the book is very poor. I've left open the possibility that Jake has misunderstood Korobkin. But if Jake has accurately described Korobkin's book, then I stand by what I said.
In addition to bradm's point:
> He argues that the core argument of the defenders of embryo viability -- their potential to become human beings -- takes the concept of potentiality to an irrational degree. In theory, DNA from every cell of your body could become a person.
If this is indeed his argument, then he is the one taking this concept to an irrational degree. A random cell taken from my body will not naturally develop into a person. Under natural circumstances (as opposed to having its development artificially suspended) an embryo *will* develop into what even you would grant is a human.
(The fact that an embryo may die by natural miscarriage before term does not make it OK to kill him/her, any more than the fact that I might die of a heart attack tomorrow makes it OK to kill me today.)
Two pages, two gross errors of logic -- guess I'll skip this one. Thanks for the helpful review!
The sad fact of the matter is that Korobkin may have identified the moral premise underlying Bush Administration policy generally, not just for stem cell research. A similar moral premise seems to be at work to justify CIA rendition.
Hmm, does that mean that it was also a moral premise underlying Clinton Administration policy, since the Clinton Administration also performed CIA rendition?
More generally, the philosophical principle that one need not "refuse to benefit from the fruits of bad acts perpetrated by others" is one that certainly has been debated and can continue to be debated. Suppose that the Tuskegee Syphilis experiments had produced useful data about syphilis that could save other lives. Would it be acceptable to incorporate that data into treatments for syphilis, or must one completely "refuse to benefit from the fruits" of those bad acts? NASA in particular and space research in general benefited from Wernher von Braun and the experiences of the V-2 combat rocket-- and certainly there was criticism of the US for benefiting from the fruits of the Nazi war machine. How much knowledge or complicity of the bad acts is enough until it is too much, and one becomes an accomplice?