Topping and Tailing

Embryonic stem cells and assisted dying terminate opposite ends of life, but have common themes

Cosmos Science

Last summer, a remarkable scientific paper was published. You probably won’t have heard of it. It appeared in perhaps the most prestigious medical journal in the world, the New England Journal of Medicine. It reported what could ultimately be a cure for a previously incurable disease, beginning in infancy, characterised by excruciatingly painful skin blistering so severe as to be often fatal. The treatment was a form of stem-cell therapy. 

How could this not dominate the mainstream media? There were other stem-cell stories — the first patient treated in a clinical trial of embryonic stem cells for spinal cord injury (though the results are a year or more away), for example. Or a stroke patient in Scotland treated with stem cells derived from an aborted foetus. Again, the results must take  a year or more to appear. In neither case do the scientists and clinicians anticipate a “cure”: these are just preliminary clinical safety studies. And yet, in contrast to the “stem cells defeat fatal disease of infancy” story, these were both front-page news. But they involved embryonic cells, while the infant stem-cell treatment used adult cells from bone marrow. 

Do most of the public care about the cells’ origin? Unlikely — it’s the results that matter. But mainstream media science correspondents, who choose which stories to feature, almost without exception bought into the prevailing orthodoxy that embryonic stem cells were exciting and potential cure-alls, while adult stem cells were not. Any nay-saying was left to assorted ideologues — pro-lifers, Catholics and other flat-earthers. Ten years on, embryonic stem cells have delivered nothing, their innate propensity to form tumours having prevented even preliminary responsible clinical testing until this year (and many proponents of embryonic stem cell research have argued vehemently that even now is too soon). There is then an air of increasing desperation therefore in these media reports. No cure is required, just testing a single patient is enough to gain blanket coverage, as science writers strain to justify their commitment to the ESC cause. 

On the ethics of embryonic and adult cells, however, the journalists are probably far more in accord with their public. The great majority takes the utilitarian, relativist view that the ends justify the means. The death of human embryos is hardly a good thing, but any “wrongness” is more than countered by the possibility of therapeutic dividend. And if the majority of scientists and the great science institutions broadcast their confidence that cures will emerge, who are the public to question them? (When has scientific orthodoxy ever been wrong?)

But pause for a moment to reconsider. Is the great majority of the scientific community and the general public truly so coldly utilitarian in outlook? It seems doubtful. We remain revolted by Nazi medical experiments on Untermenschen, absolutely regardless of potential beneficial knowledge gained. We are revolted by stories of 1950s infectious diseases experiments  performed by US scientists on prisoners or foreigners, or by the suggestion of past biohazard or radiation testing by Britain on unwitting workers. Moreover, harmful utilitarian experiments on children would provoke more outrage, not less, and with babies more still. Smaller is more vulnerable and so more deserving of protection. 

Well, up to a point, Lord Copper. “Small but not too small” seems to be the rule. Deliberately destroying a human being outside the uterus, no matter what benefit (for others) could conceivably be wrought from the experiment, is pretty much universally considered beyond the pale — even, say, a premature infant. But destroying a human being of precisely the same age if it remains inside the uterus bothers us — as a society — a thousand times less. Hence the (general) acceptability of abortion, and of embryonic stem cell research — there being no means of conducting such research without destroying the embryonic cell donor. Put crudely, we empathise with suffering patients, but also with prisoners or others involuntarily experimented upon, or even with babies, and so come to a rightful conclusion. We cannot do the same for the unborn infant, too small and too hidden from view. We imagine, if we think about it at all, that it cannot suffer. So the balance tips in favour of the visibly suffering patient. 

The dispassionate, objective argument, that the human embryo, though small, is still human, and individual, and alive — a living human being — gains little traction. So why is this the case now, when generation upon generation of doctors and scientists, acting wholly with the consent of society, have previously rejected any thought of the expendability or utility of the human embryo? (The World Medical Association’s first Declaration of Geneva, intended to update the Hippocratic Oath, stipulated: “I will maintain the utmost respect for human life, from the time of its conception” [emphasis added].) The answer lies in part in a growing, uncontrolled fear of suffering, a loathing that sweeps aside other considerations, a pathological perception of suffering that was not shared to the same extent by our forebears. Wrapped up in this is an equally increasing sense that it is quite wrong for anyone to suffer — this is the 21st century. 

Which leads us to the other end of life and the subject of assisted dying and euthanasia, another area where “progressive” forces are gaining ground. Again, there applies a conventional and very long standing moral prohibition — any act, by any person, on any innocent person including himself, that has as its primary intention the death of that individual is always wrong. But now, in Holland, Belgium, Oregon and soon probably other US states, this prohibition too is being revoked, as assisted suicide is legalised. In Britain, too, there are repeated and apparently inexhaustible efforts to change the law. 

And again, a core argument extended in favour of changing the status quo is the prevention of suffering. Proud and brave suffering individuals make heart-rending and self-evidently compelling pleas for our support in changing a law that denies them mercy and potentially prolongs suffering. 

But people — patients — have always suffered. Surely, the “need” now for assisted suicide is far smaller than at any time before a century ago, when doctors could do nothing for almost anything? Never has medicine been better able to deal with disease, either at a mechanistic or a symptomatic level. The implication, then, is that it is our threshold for suffering that has changed — or more subtly, our perception of our threshold for suffering. 

We may well be no feebler than previous generations when we actually suffer and heroism has not died. But we are less prepared to accept the possibility of suffering. Neither does one need to argue that there is a positive good in suffering — a dispassionate position too easily caricatured as arrogant, complacent, out-of-touch, even faintly ridiculous. For whatever reason, there is an increasing perception that suffering must be avoidable.

So in both questions, at either end of life, suffering sits on one side of the scales, and apparent means of avoiding suffering — assisted dying or harvesting stem cells from an embryo to develop treatments — on the other. And in both cases, the proposed means of avoiding suffering are historically proscribed. But our collective wish to avoid suffering, or belief that it is no longer at all appropriate or acceptable, has contributed increased weight to this side of the balance, and the scales are radically tilting.