Sweden, Stem Cell Research and Ethics: Two Weaknesses of the Debate

[1] Stem cell research and somatic cell nuclear transfer (i.e. therapeutic cloning) were hotly debated in Sweden during autumn of 2001. Two years earlier, in 1999, the Swedish Medical Research Council had initiated an internal discussion, which resulted in a proposal for policy guidelines on the topic of stem cell research. In the year 2000, a new research organization called the Swedish Research Council (Vetenskapsrådet) took over the policy preparations. When asked about national guidelines for stem cell research, the Swedish Minister for Education referred to the preparations by the Swedish Research Council. No national guidelines were to be provided before the Swedish Research Council had published its view, which it did 3 December 2001. Meanwhile, the debate was intense, especially in one of the major daily newspapers in Sweden, Dagens Nyheter (www.dn.se). In January 2002, the Swedish government approved the view of the Swedish Research Council. It was considered ethically acceptable to gather stem cells from so-called "spare embryos" (embryos created but not implanted in the woman's uterus during in vitro fertilisation) until day 14. Therapeutic cloning was regarded as ethically acceptable, given that the Swedish law-which until then had banned such interventions-was changed. Creation of embryos solely for the purpose of research was not regarded as ethically acceptable. Thanks to this process, Sweden has one of the most permissive views of stem cell research and therapeutic cloning in the Western world.

[2] The extent to which medical experts were allowed to express their views in the major daily newspaper in Sweden and thus to set the agenda (despite the explicit statement that this was a question not only for experts, but also for the general public) has been investigated elsewhere. The possible bias present in the Dagens Nyheter, where stem cell researchers were interviewed concerning the possible benefit of the research, has also been analyzed. It has been argued that these interviews (and the lack of criticism) resulted in views of the possibilities of these interventions (Ideland 2002) that were too optimistic. This could be understood as one weakness of the Swedish debate. However, this article focuses on two other weaknesses of the debate.

[3] Medical technologies, such as stem cell research and therapeutic cloning, create medical possibilities. They open the door to new therapeutic applications. The controversial embryonic stem cells can be gathered from spare embryos, as described above. Therapeutic cloning-the transfer of a cell nucleus into another cell or embryo-can be performed on an embryo as well as on an egg cell. With therapeutic cloning, large gains in terms of decreased risk of rejection of implants are possible. Stem cell research and therapeutic cloning also evoke several ethical questions. Nevertheless, a careful analysis of the latter from a Swedish Lutheran perspective was not performed. The reasons for this are, of course, manifold. The Swedish Church may take a stand on bioethical questions, but the authority of such a stand is not altogether clear. The variety of perspectives within Lutheran ethics, in substantive as well as methodological questions, complicates the matter. Furthermore, as phrased by Anselm et al (May 22, 2002), "the freedom to have your own opinion is a characteristic of Protestantism. Only in rare cases has the Protestant tradition required a consensus in interpretations or unanimity except in fundamental questions of beliefs on which the Church stands and falls. Questions about lifestyle and ethics normally do not fall in this category." Whilst this is accurate, it can hardly be understood as a valid reason for not entering into the discussion. The lack of theological bioethical discussion is thus a first weakness of the Swedish debate. Second, some of the ethical questions concerning stem cell research are evident, such as the question of the status of the embryo. Unfortunately, within the Swedish debate, much, if not most, ethical discussion has centred on this question. If embryos were not seen as morally and ontologically equivalent to born individuals, or at least not understood as having consciousness, no or hardly any other ethical questions were regarded as present (see e.g. Lagercrantz 2002). If embryos were ontologically and morally equivalent to human individuals, this was understood as the ethical barrier to medical research. This, I will argue, is an oversimplification of the ethical debate, which hides other crucial ethical questions.

[4] The question of whether stem cell research on embryos is morally acceptable does not receive a simple "yes" or "no" depending on how we look upon the status of the embryo. Even if embryos are morally and ontologically understood as equal to human beings, this need not entail an absolute "no" to stem cell research. We might argue that once spare embryos exist, they should not be allowed to perish. With respect for the value of human life, we might hold that embryos should be used for the sake of other human beings, in order to mitigate their suffering. This would give the idea of sacrifice-the giving of life for my fellow being-a new meaning. Of course, contra-arguments are also present. Use of embryos may lead to an instrumental view of human life, it may lead us to a slippery slope, resulting in undesirable future scenarios. The accuracy of these kinds of arguments-for and against stem cell research-is not the heart of the matter here, but rather the idea that ethical question marks are not erased through a certain understanding of the embryo.

[5] The complexity of the ethical questions can be highlighted through use of notions such as "broad" and "narrow" ethics. A narrow ethic, as I will use the notion, focuses on the concrete clinical intervention. In the concrete clinical context, the question of the status of embryos becomes important. A broad ethic, as I use the notion, focuses not only on the concrete clinical intervention, but also on the surrounding culture and social structures in which the intervention is discussed and, eventually, performed. In a broad ethical analysis, questions of a changed understanding of the conditions of human life as well as of values in contemporary society become important.

[6] Is it ethically acceptable to use embryos in stem cell research? This narrow ethical question has broad undertones. What happens to our understanding of humankind if embryos are allowed to be used for the purpose of mitigating others' suffering? The distinction between narrow and broad ethics can also be exemplified in the discussion of therapeutic cloning. Therapeutic cloning can be used on egg cells. If so, it may seem as if the major ethical question of the status of embryos is evaded. An egg cell is not an embryo. However, broad ethical questions remain. Egg cells can be retrieved through donation, but such donations are not without risks for the women concerned. Furthermore, whereas trade with egg cells is forbidden in Sweden (but voluntary donation is not), this is not the case everywhere. Internationally, we may risk ending up in a situation where egg cells become a global market item in an intricate play between south-east and north-west. It may become poor women's source of income. These fears may be exaggerated or unfounded. Nevertheless, it is important to discuss them, and they highlight the need for a broad ethical analysis.

[7] Stem cell research and therapeutic cloning evoke questions of how we, as human beings, understand ourselves. Suddenly, bioethics finds itself at the core of contemporary culture. Bioethics uncovers cultural values. It becomes as important to analyse what values use of the technologies presupposes, enhances or diminishes, as it is to analyse possible consequences for humankind's self understanding. In the light of this, it is serious that many debates have been "narrowly" performed. It is also serious that Lutheran bioethical discussions are not heard. Stem cell research and therapeutic cloning provide us with new possibilities. It is high time that these possibilities be analysed, broadly and from secular as well as theological perspectives.