When Maureen Kass entered the in vitro fertilization program at a Long Island hospital, she took fertility drugs to increase the number of eggs she produced. Using a long needle guided by ultrasound, her doctor removed her eggs and fertilized them in a plastic dish with her husband's sperm. In eight attempts, she became pregnant twice. The first one ended in a miscarriage; the other resulted in an ectopic pregnancy that had to be surgically removed. Already the Kasses had spent nearly $75,000 on their fertility treatments, but still no baby.
On the ninth attempt, Maureen's doctors removed 16 eggs. Nine were fertilized -- too many to be safely implanted into Maureen. So five embryos were frozen for later use. Like most IVF clinics, the hospital insisted that the couple sign an advance directive regarding the fate of the frozen embryos in case the Kasses no longer wished to use them. The choices were to terminate the embryos, donate them to another couple or cede them to research. The Kasses chose research.
Now their private decision is at the heart of a public controversy. In the next few months, Congress will decide whether a ban on research that destroys embryos should be lifted altogether. At fertility clinics across the country, over 150,000 human embryos lie suspended in liquid nitrogen tanks resembling three-foot-tall thermoses. Scientists and biotech companies want access to these embryos, not to create a baby for an infertile couple, but to use the embryos' stem cells to produce medical treatments. These primitive cells can grow into every type of tissue, including nerves, bones and muscles. But turning human embryos into biological factories raises enormous ethical concerns, converting potential people into products and launching us on a slippery slope toward genetic enhancement and the cloning of human beings.
I've spent the last 20 years studying the ever-growing monster of reproductive technology and have followed the debate about embryo research with increasing alarm. What seems to be a simple issue of medical progress -- Can we save lives with tissue that would never otherwise be used? -- has the potential to turn into a sci-fi nightmare that many would not imagine possible.
Each step along the way, from sperm donation to in vitro fertilization to surrogate mothers to embryo research, we have gradually yet inexorably moved closer and closer toward engineering human life to fulfill individual desire. The compelling tales of infertile couples moved us to endorse creating the potential test-tube babies. And the hopeful pleas of the sick and injured are making us consider the idea of medical research on the leftover embryos. Now a British panel of doctors has suggested that their government allow cloned embryos for research purposes.
This week, Great Britain's chief medical officer, Liam Donaldson, urged Parliament to allow doctors to begin "therapeutic cloning." This involves creating an embryo that is a clone of the patient and using that embryo as the source of stem cells, which would guarantee that the resulting tissue is not rejected. Yet perfecting a technique to clone human embryos would pave the way for any such embryo to actually be implanted in a woman to create a living, breathing human clone.
Stakes are high on both sides. At congressional hearings last April, the former Man of Steel, Christopher Reeve, urged the use of embryo stem cells on spinal cord injury victims. Reeve, rendered quadriplegic after a fall from a horse, is confined to a wheelchair which he directs with his breath (a hard breath turns it right, a soft one, left). To speak, he must wait for his respirator to swish air over his vocal chords.
"Why has the use of discarded embryos for research become such an issue?" Reeve asked. "Is it more ethical for a woman to donate unused embryos that will never become human beings, or let them be tossed away as so much garbage when they could help save thousands of lives?"
But critics of embryo research hold no truck with such rhetoric. David Prentice, an embryologist at Indiana State University, likens Reeve's argument "to the one in Nazi Germany saying we're going to have these Jews killed, so why not experiment on them?"
A little inflammatory? Perhaps, but Prentice is articulating the concerns of many who are dismayed by the headlong rush towards embryo stem cell research and what it signals about medicine's increasingly cavalier attitude toward human life. Since removal of the cells destroys the embryo itself, some women have also voiced their concern that embryos will become nothing more than research fodder.
"It's not like I left a toenail cell at the clinic," says Risa York, an in vitro fertilization patient with seven frozen embryos. "Each embryo is a potential child. We have to be very careful -- and respectful -- about how we make decisions about them."
Despite such dissenting views, embryo research now seems inevitable. This month, the National Institutes of Health (NIH) plans to give the go-ahead for embryo stem cell research -- a slap in the face to legislators who believe that it violates an existing federal law banning research which destroys embryos. NIH claims to have found a loophole: federally-funded researchers will not remove the cells themselves (which would terminate the embryos), but will perform research on cells that have already been removed.
Douglas Johnson, legislative director of the National Right to Life Committee, responds bluntly: "If we had a law that barred research in which porpoises were killed, no one would entertain for five seconds that a federal agency could arrange for someone else to kill the porpoises and then proceed to use them in research."
The upcoming congressional bill, sponsored by Sen. Arlen Specter, R-Pa., will to allow federally funded embryo stem cell research on leftover in vitro embryos, like the ones the Kasses stored at the Long Island clinic. This bill, which has overwhelming support due to the compelling testimony of patients like Reeve, would lead to massive experiments on embryos by researchers at the NIH and at university labs and medical centers that receive federal funding. Already, on the NIH Web site, every institute has posted a plan for what it will do if it can use embryo stem cells. The Heart, Blood and Lung Institute wants to repair failing hearts and grow new heart chambers. General Medical Sciences wants to develop artificial skin. Even Environmental Sciences wants to get into the act, proposing to use embryo stem cells to test "the toxic effects of biologicals, chemicals and drugs."
Yet if this sounds like an issue that will divide pro-lifers with their strict life-is-sacred values against liberal humanists with their let's-control-fate-through-science convictions, think again. While staunch pro-lifers, such as Sen. Gordon Smith, R-Ore., have embraced the research because of its potential medical benefit, some pro-choice Protestant groups are lobbying against the bill.
Protestant theologian Gilbert Meilander of Valparaiso University in Indiana argues that while abortion is justified because of the claims of the pregnant women, "there is no such direct conflict of lives involved in embryo research." The 8.5 million member United Methodist Church opposes embryo stem cell research on the grounds that it turns human life into a commercial product.
A far-fetched fear? Not for the West Coast infertility clinic director who recently called me for advice about the unclaimed embryos in his care. Recognizing that human embryos are now a treasure trove of potential medical cures, he queried: "We have lots of embryos that couples haven't asked about for a while. Can we sell them to a biotech company?"
But imagine the heartache of the couple who comes back to the clinic a few years later to get pregnant only to learn that their future child has been turned into a kidney. Even couples like the Kasses, who checked off "research" on the forms, might have expected that the clinic would be doing the sort of research that was most important to the couple -- infertility research. They might be appalled by the idea that their embryo was converted into a set of nerve cells that was for sale to the highest bidder.
And what if the couple now disagree on the fate of the embryo? After their ninth attempt at in vitro fertilization failed, Maureen and Steve Kass divorced. She then wanted to use her frozen embryos to create a child, but Steve disagreed. After five years of litigation, the highest New York court decreed that the fate of the embryo was governed by the form the couple had initially filled out, saying leftover embryos could be used for research. Although Mrs. Kass desperately wants a baby from the embryos created with her eggs, those embryos are now fodder for research.
What's perhaps more disturbing is that there's no guarantee that embryo stem cells will be used to cure serious diseases. Indeed, biotech companies can make more money by offering to use them for the burgeoning market of "enhancement" medicine. Where cardiac patients might need new heart cells to repair a damaged chamber, athletes may use these same cells to increase stamina. Geron Corp., which holds the exclusive U.S. license on embryo stem cell technology, touts the artificial skin it is developing as a treatment not just for burn victims but for people with sun damage and other age-related conditions. Indeed, 70-year-old Specter let slip his real interest in embryonic stem cells when he referred to them as "a veritable fountain of youth."
"You could use embryo stem cells for genetic engineering and enhancement," says Prentice, who predicts that doctors will say: "If you want to be a marathon runner, we'll fix that for you."
Across the world, government policymakers are eyeing the United States to see how the laws around embryo research will develop. Many countries have national bans on embryo research that forbid even privately funded companies like Geron from undertaking such work. A member of the French Parliament is concerned that medical products made from human embryo cells will become so routine that Europeans will inadvertently use them, despite their own laws. He advocates an "ethical" label, like the European labels that indicate which foods are genetically engineered and which clothes were not made with child labor, to give people a choice not to partake of the products of human embryos.
Specter is trying to head off criticism by including two restrictions in his bill. The proposed law bans the creation of embryos for research (relying only on "excess" embryos from infertility clinics) and forbids the implantation of cloned embryos to create humans. But neither limit is likely to last. As Dr. Edmund Pellegrino of Georgetown University, a Roman Catholic physician and ethicist, puts it: "How is it possible to separate 'spare' embryos from embryos intentionally produced as stem cell sources? The temptation to make 'spares' is obvious."
And eventually, even the bright line against cloning whole humans will grow blurry. Specter's co-sponsor on the bill, Sen. Tom Harkin, D-Iowa, has already gone on record as favoring human cloning. When President Clinton previously urged Congress to ban cloning, Harkin said there should be no limits to scientific research. He told Clinton, "Take your ranks alongside Pope Paul V who in 1616 tried to stop Galileo."
Does opposing embryo stem cell research really mean throwing in one's towel with the Pope Pauls of history? Or is there something to be said for restraining the technologies that control life?
Ironically, despite charges that this ban will block promising medical research, it may be having just the opposite effect. The legal restrictions on embryo stem cell research (including flat-out bans on embryo research in eight states -- Florida, Maine, Massachusetts, Michigan, Minnesota, North Dakota, Pennsylvania and Rhode Island) have sent scientists scurrying to find other body cells with similar properties. Over the past year, a series of scientific breakthroughs occurred that challenged the traditional idea that adult cells were permanently wedded to their specialized roles in the body.
"Everyone thought that adult cells had gone past the point of no return," says geneticist Eugene Pergament of Northwestern School of Medicine. "But now we know that, from a genetic perspective, any cell with a nucleus can be made into a stem cell."
In research on mice, Italian and Canadian scientists found that adult stem cells from the brain can shed their identities and reinvent themselves as blood cells. Researchers at the University of Toronto discovered retinal stem cells in adults that could be used to regenerate damaged eyes. Pancreatic stem cells -- including those taken from cadavers -- can be persuaded to create insulin-producing cells. And, just this week, researchers announced that adult stem cells from bone marrow can create nerve cells to potentially treat Alzheimer's, Parkinson's or spinal cord injuries.
The latest findings suggest that adult stem cells have a developmental repertoire close to that of embryo stem cells. They retain their potential after long-term culture, and can be frozen for later use. If adult stem cells live up to their potential, there may be less reason to disturb those souls-on-ice in infertility clinics.
"The issue is bigger than the fate of some embryos," says Risa York. "It's possible to be pro-choice and still respect human embryos as life." She worries that commercializing embryos -- seeing them as just the raw material for medical products -- is a trend that could diminish us all. Yet in an era when reproductive medicine is changing faster than a baby grows, York's vision may soon seem quaintly antiquated.