The Ethics of Stem Cell Research

Dr. Gene Outka
Department of Religious Studies
PO Box 208287
Yale University
New Haven, CT 06520-8287

ABSTRACT. The medical and clinical promise of stem cell research is widely heralded, but moral judgments about it widely collide. This article takes general stock of such judgments, and offers one specific resolution. It canvasses first a spectrum of value judgments on sources, complicity, adult stem cells, and public and private contexts. It examines next how debates about abortion and stem cell research converge and diverge. It proposes finally to extend the principle of nothing is lost to current debates. This extension links historic discussions of the ethics of direct killing with unprecedented possibilities that in vitro fertilization procedures yield. A definite normative region to inhabit is located, within a larger range of rival value judgments. We should resist the creation of embryos for research purposes only, yet we may engage in research on "excess" embryos by virtue of an appeal to the nothing is lost principle.

Hype tempts us all. It would be naive to exempt scientists from sometimes overstating the promise of their research. Early claims about what gene therapy would accomplish, for example, were arguably exaggerated and eroded public confidence. Yet claims about what stem cell research may accomplish belong in a class by themselves. The general public is now convinced that something momentous is occurring (for one early, engaging indication, see Easterbrook 1999). Both professional and popular publications register the excitement scientists evidence. This research, it is routinely said, will not only expand significantly what we know about cellular life, but it will bring dazzling clinical benefits. Those who suffer from Alzheimer's disease, Parkinson's disease, et. al., are regularly identified as eventual beneficiaries. The cumulative effect is to raise expectations generally to a high pitch.

Whether these claims too will prove exaggerated awaits research efforts that have only begun.¹ We long for such benefits of course, and most of us sense a genuinely other-regarding motive at work among those who make these claims. That is, the prospect such research affords for bringing concrete benefits to numerous human sufferers motivates scientists to engage in it. We may discern and admire this motive even when we recognize that less altruistic considerations, e.g., a search for windfall financial profits, sometimes operate as well.

Yet concern about profits figures only marginally in the ethical controversies that this research has so far generated. The controversies show rather how a single other-regarding motive that accents benefits to human sufferers cannot and should not go through untrammeled. Even as we praise the motive, we confront a host of complicating questions. May research that accents benefits to human sufferers trump all other considerations as it seeks to secure these benefits? What of embryos and aborted fetuses? Should we reduce their value totally to their importance for relieving the suffering of third parties? Can a readiness to do anything that we please with and to embryos and aborted fetuses be acceptably other-regarding after all? What other moral considerations count and how much should they count?

I approach these questions with lenses through which I see a more encompassing diagnosis of ourselves that sets the terms for appraising even novel developments. Two basic generalizations about us that derive from this diagnosis influence my reflections in what follows.

First, we are morally capable creatures, accountable beings. We should assume responsibility for what we are doing, and we go wrong when we seek to deny our agency. Not every outcome in stem cell research is foregone; we may shape as well as be shaped by developments, and much may depend on initiatives we take that accord with our own convictions. Second, we are creatures who can exalt ourselves inordinately, i.e., in ways that flout God and manipulate others. This condition is called sin and moral evil in many religious communities. Reinhold Niebuhr takes sin to extend in two directions: "The Bible defines sin in both religious and moral terms. The religious dimension of sin is [our] rebellion against God, [our] effort to usurp the place of God. The moral and social dimension of sin is injustice. The ego which falsely makes itself the center of existence in its pride and will-to-power inevitably subordinates other life to its will and thus does injustice to other life" (Niebuhr 1949). To be tempted to usurp and to do injustice is endemic to human life as we know it. In my own identity as an Augustinian Christian (Outka 1992), I take it that we are continually in danger, and that everything is corruptible. If this is right, we should expect that stem cell research is itself not immune to pressures that may usurp and do injustice. In short, we are contending in the case of stem cell research with novel opportunities and challenges, and with permanent capabilities and dangers, and we should try to hold them together as we deliberate. As I try to hold them together here, I concentrate on specifically ethical controversies that surround such research. I characterize these controversies in section I; I assess them for myself in section II; and I offer concluding remarks in section III.

1. RECURRING ETHICAL CONTROVERSIES

The fourth point shifts to political and legal contexts in which this research proceeds, and specifically to proposals about how such research should be organized, financed, and overseen. Value judgments are in contention here as well. They do not yet receive, however, the rigorous examination that characterize debates about "sources." Still their importance is obvious. They impel us to mesh what is ethically desirable with what is politically viable. I can only touch on such an immense subject now. But to ignore institutional realities altogether, including institutional lacunae, amounts to a certain kind of ethical failure, one that holds largely at bay questions about which institutional arrangements conduce to the "common good."

The three points I take up initially are, then, the status of the fetus and of the embryo; the question of complicity, where research depends on someone destroying a fetus or an embryo; and the alternative of concentrating on stem cells found in adults. I review a spectrum of rival value judgments that pertain to each of the three.

1. Views on the "Right"

   Here I refer most of the time to Richard M. Doerflinger, who defends in lucid prose Vatican instruction on human procreation. Yet we should not suppose that only Roman Catholics reach the judgments I am about to describe; many evangelical Protestants and (Eastern) Orthodox Christians, for example, do as well (Meilaender 1999; Demopulos 1999).

   First, the status of fetuses and embryos. Doerflinger considers the moral status of the human embryo in light of the historic conviction that each human individual has basic and equal human worth. No differences in talents or other conditions should overturn this evaluation. If we take the evaluation to heart, we infer that no one should be treated, exhaustively and without remainder, as a means or instrument. "The human individual, called into existence by God and made in the divine image and likeness,...must always be treated as an end in himself or herself, not merely as a means to other ends...." (Doerflinger 1999). And it is cogent to infer inviolability too. To kill the innocent deliberately and directly is the prime instance of going against such inviolability. Fetuses and embryos are assuredly innocent. Doerflinger sees both abortion and the destruction of embryos as treating fetuses and embryos merely as means to other ends, and as going against inviolability.

   Since the moral status of fetuses and embryos is decisively similar, he combats a view that certain liberal Catholics (among others) espouse, in which "conception" differs from "individuation." For this view, the early embryo is relevantly formless until the "primitive streak" appears at around 14 days. Otherwise we cannot account for the possibilities of "twinning" and "fusion" that occur after conception.² This view allows moral room for maneuver, therefore, up to 14 days. Doerflinger replies that the most recent studies show that the early embryo is not simply formless, that the capacity for twinning is established very early indeed, and in any event, that the overwhelming majority of embryos lack the property of spontaneously producing twins. A more general concern surfaces too. Some hold that even if the argument from "twinning" allows for nontherapeutic experimentation, it remains the case that this experimentation induces a kind of attention to early life that regards it as "manipulable stuff," and not as a child, but as an entity that merely serves other, perhaps laudable ends. And such attention jeopardizes our ability to welcome children into the world and to care for them (Werpehowski 1997). We thus fall victim to incompatible attitudes, and are at war with ourselves.

   Second, complicity. Doerflinger reviews and assesses various arguments about complicity. Here certain differences between abortion and the destruction of embryos do appear, but they give no comfort to the advocates of research on embryos.

   1. He considers efforts that Congress has made since 1993 to distinguish the actions and intentions of those who decide to abort from the actions and intentions of federally funded researchers who use the fetal tissue from induced abortions in human transplantation, under certain conditions (Doerflinger 1999). While he does not altogether approve of these efforts, or of some of the arguments urged on their behalf, he grants that a researcher who uses fetal tissue is not necessarily a supporter of the decision to request or perform an abortion.

   2. He refuses to say the same, however, about the derivation and use of stem cells from embryos. "Here those who harvest and use the cells are necessarily complicit in the destruction of the embryo. This is illustrated by the fact that, if embryonic stem cell research were governed by the same legal conditions that now govern the use of fetal tissue from abortions in federally funded research -- e.g., harvesting to be done only after death, researchers' needs may not determine the timing and manner of the destruction of the fetus -- the research could not be done at all. These stem cells are taken from embryos while they are still living. In effect, the harvesting of cells is itself the abortion -- i.e., it is the act that directly destroys a live embryo -- and the method of destruction, using microsurgery to extract the embryo's inner cells from the outer trophoblast, is determined entirely by the needs of the stem cell researcher" (Doerflinger 1999).

   3. He rejects as incoherent any claim that governmental funding of research on embryonic stem cells does not involve complicity in the destruction of embryos as long as researchers did not participate directly in such destruction. For this distinction strikes him as little more than a "bookkeeping exercise," since the act of destruction is not only presumed as with research on aborted fetuses, but is directly undertaken as part of the research protocol.

   4. He also criticizes the argument that derivation of stem cells from "spare" embryos donated by fertility clinics differs morally from using embryos created solely for research purposes, and that only the latter uses embryos as a mere means to other peoples' ends. For one thing, to destroy an entity for body parts because that entity will die in any case is not the same as using cells from an entity already dead. For another thing, "a policy that permits research only on 'spare' embryos is virtually impossible to maintain in practice. Fertility clinics easily can produce a few more embryos from each couple, ostensibly for reproductive purposes, to ensure that there will be 'spares' for research at the end of the process" (Doerflinger 1999).

   Third, the alternative of adult stem cells. Doerflinger accents the advances that researchers have made in their work on adult stem cells. One major advantage of using adult stem cells on which everyone agrees is that we avoid the problems of possible tissue rejection when we treat a patient with his or her own cells. That we cannot say with certainty whether research on embryonic cells has clinical usefulness otherwise unavailable, strengthens the case on practical grounds for limiting research attention to adult stem cells. We thereby stand clear of putting morally contestable practices subject to challenge firmly and probably irrevocably into place.

2. Views in the "Middle"

   First, the status of fetuses and embryos. A more liberal case is made within the Catholic tradition that favors human embryo stem cell research. It requires us to distinguish, as I mentioned earlier, between conception and individuation. Margaret Farley accepts this case. For her and a number of other Catholic moral theologians, the human embryo is not considered "in its earliest stages (prior to the development of the primitive streak or to implantation) to constitute an individualized human entity with the settled inherent potential to become a human person. The moral status of the embryo is, therefore (in this view), not that of a person; and its use for certain kinds of research can be justified. (Since it is, however, a form of human life, some respect is due it -- for example, it should not be bought and sold.)" (Farley 1999).³ She commends certain safeguards, e.g., donors may not specify who is to receive stem cells for therapeutic treatment, and an "absolute barrier" should be maintained between therapeutic and reproductive cloning.

   Second, complicity. While those who occupy positions in the middle may disagree in their evaluation of the moral standing of fetuses, they tend to agree that one distinction respecting embryos has moral relevance. They refuse to equate the destruction of embryos who already exist but who will either be frozen in perpetuity or discarded, with the creation of embryos in order to destroy them solely to benefit third parties. Complicity in the former instance looks morally less ominous. For the decisive role here is played by those responsible for the existence of embryos in the first place and for electing subsequently to freeze them or discard them. Researchers react rather than initiate, after those responsible have reached their fateful determinations. And the numbers of embryos effectively bereft of prospects are vast. Some estimate that approximately 100,000 frozen spare embyros now languish in in vitro fertilization clinics. The majority are no longer wanted or claimed. They will never be implanted. Judging complicity should reckon with this datum.

   Third, the alternative of adult stem cells. Those who occupy middle places across the spectrum are disposed generally to accept (though sometimes reluctantly) a verdict that many scientists have reached. It is that stem cell therapies deriving from adults are necessary but not sufficient -- if we want to maximize the data available and hence the possibility of break-throughs -- for obtaining the various cell types that clinically important areas of research require. Research on each of the "sources" should go forward, for each has its own advantages and disadvantages. But in any event, embryonic stem cell research embryos holds promise for which at present there is no adequate substitute.

3. Views on the "Left"

   Here I refer most of the time to John C. Robertson (much as I did with Richard M. Doerflinger on the other side).

   First, the status of fetuses and embryos. Those who stand on the left side of the spectrum characteristically deny that the value accorded to pre-viable fetuses should ever override pregnant women's choices (for whatever reason) to terminate their pregnancies. To attribute basic and equal human worth to each human individual requires more than the presence of cells that have the potential to develop into a person. Robertson extends this value judgment to embryos in the following way: Those "holding this view about pre-viable fetuses view preimplantation embryos, which are much less developed than fetuses, as too rudimentary in structure or development to have moral status or interests in their own right.... No moral duties are owed to embryos by virtue of their present status and...they are not harmed by research or destruction when no transfer to the uterus is planned" (Robertson 1999).

   Robertson refuses to say, however, that because embryos lack moral status in their own right we may do anything at all with them (they are not "means" in this sense or to this extent), e.g., we may not use them "for toxicology testing of cosmetics or buying and selling them." One should deny intrinsic value to embryos and still accord them "symbolic" value and "'special respect' because of their potential, when placed in a uterus, to become fetuses and eventually to be born" (Robertson 1999). This symbolic value should nevertheless be trumped when we pursue a good scientific or medical end that we cannot pursue by other means.

   Second, complicity. Robertson thinks that any distinction between the derivation and the use of embryonic stem cells does not survive critical scrutiny. Researchers who use stem cells derived from embryos are complicit in their destruction, whether or not they actually participate in the act of destruction itself. Moreover, those who support obtaining cells from spare embryos from in vitro fertilization clinics should also support creating embryos for the purpose of research. For in both cases embryos do become a means to address the needs of others, once we decide to use them in research. Robertson displays an ironic affinity with Doerflinger here. Both insist on an either/or, though of course each draws the opposite normative conclusion from the other. Either we should stop opposing the creation and destruction of embryos for research purposes only (when we accept Robertson's view of the status of the embryo), or we should oppose not only the creation and destruction of embryos for research purposes, but the research on spare embryos from in vitro fertilization clinics too, (when we accept Doerflinger's's view of the status of the embryo). Pressures come to those in the "middle" from the "left" as well as from the "right."

   Third, the alternative of adult stem cells. Those who take the position Robertson does can only prefer limiting research to adult stem cells if such a limit will in fact yield superior therapeutic benefits for members of society generally. And their criteria for determining this are, it seems, empirical and consequentialist: what research on which sources will produce the greatest benefit overall? Thus Robertson insists that at this juncture we have not established definitively any empirical-consequentialist case for limiting research to adult stem cells. The most promising course is to engage in research that is free to employ any one of the three "sources."

4. Political and Legal Contexts

   I turn finally to the fourth point where controversies recur. Here we should demarcate two levels. The first concerns controversies about federal funding of stem cell research. These consume the bulk of disputants' energies so far. Passions rise highest where taxpayer dollars figure centrally. Disputants perceive expenditures on this level to attest to society-wide convictions. Those who occupy particular positions along the spectrum I characterized battle on behalf of criteria for federal funding that support their respective normative conclusions about "sources." A pastiche results. The second level concerns controversies about the absence of coordination between research permitted in the public and private sectors. I find it disquieting that research possibilities lack any sort of society-wide oversight. Yet many either welcome the status quo, or appear resigned to it. Some judge the current arrangements to be desirable on the whole. Or at least they prefer to leave well enough alone, so long as researchers are free somewhere to pursue various research possibilities. To enjoy liberty from scrutiny allows those in the private sector to conduct research that holds promise of achieving major breakthroughs, and that societal scrutiny might well forestall (for in light of societal pluralism, such scrutiny is likely to be constraining, reflecting compromises). Others judge the present situation to be ad hoc to a fault. They accept that publically and privately funded research should be somehow coordinated. Yet they view the practical chances of coordination to be distressingly slight.

2. NORMATIVE ASSESSMENTS

I commend as a normative point of departure the conviction that Doerflinger cites: "the human individual, called into existence by God and made in the divine image and likeness,...must always be treated as an end in himself or herself, not merely as a means to other ends...." Many hold this conviction, not only those on the "right." To regard each person for his or her own sake, as one who is irreducibly valuable, authorizes a sphere of inviolability, as I noted. And it heightens sensitivity to multiple ways we may go wrong, e.g., when we dominate, manipulate, and self-aggrandize. To affirm inviolability and to abjure domination capture deeply important commitments. They direct moral attention along lines I take to be permanently valid.

Many likewise draw on the language of ends and means to evaluate cases of "killing and saving" (Reeder 1996). To commit murder is arguably the quintessential instance of going wrong. Those who murder arrogate to themselves a position of false superiority. They usurp or perversely imitate God who alone is the "Author of life and death." Yet they possess the power to accomplish this. That is, in the case of murder, they can do what they ought not to do. They also effectively claim that they are better than their victims, so much better that they are prepared to "instrumentalize" them through and through. Murderers do their victims incommensurable harm; in depriving them of life, they reduce them to "mere means" to their own aims and projects. Those who save life do the opposite. They pay homage on their own level to what they take the character of God's love to be, by attesting that the one saved is not a mere means, but someone for whom they should care, whose well-being they should protect and promote.

To mix theological and Kantain ingredients in this way deserves examination that I must waive.⁴ I focus now on how far this evaluation extends. Is it cogent to claim that abortion and embryonic stem cell research are morally indistinguishable from murder?

Posing so blunt a question concentrates our thoughts. Yet it also encourages an unfortunate tendency to restrict evaluative possibilities to a single either/or. Either we judge abortion and the destruction of embryos to be transparent instances of treating fetuses and embryos as mere means to other ends. Or we judge the case for transparency to omit too many morally relevant considerations, but then rush to the other end, where we judge abortion and embryoic stem cell research as morally indifferent actions in themselves, to be evaluated solely in terms of the benefits they bring to others. I reject this simplifying restriction. That formidable arguments come from the "right" and the "left" ends of the spectrum, I do not deny. Still, the most fitting place to inhabit is, I think, a particular region in the "middle." Here one engages such formidable arguments and appropriates as much as one consistently can, but one retains a distinctive vantage point. From this point, one finds a position less cogent than many conservatives do that extends simpliciter (morally, if not legally) the prohibition of murder to the prohibition of abortion and embryonic stem cell research. But one ascribes greater importance to fetuses and embryos than many liberals do, an importance not reduced to the benefits that research on them may bring to third parties. Let me say more about this region as the most fitting place to be, but also acknowledge dangers in locating ourselves there.

1. From the "Right": Specificity and Stringency

   The tradition of moral reflection that shapes conclusions on the "right" elevates two considerations that those in the "middle" should heed as well.

   1. One consideration is moral specificity. I am drawn to the strand in the tradition that endeavors to identify certain actions -- which persistently affect our weal and woe -- in a definite and non-tautological way. To consider the action that concerns us most: murder is prohibited, but not all killing is murder. How shall we discriminate? We should not do so by writing morally evaluative references into the characterization of what murder is. For then we make this characterization morally decisive by definition. So for example murder is defined as "wrongful" or "unjust" or "irresponsible" killing. But resorting to tautology forecloses debate. The tradition favors instead specification that leaves the wrongfulness of the action open, to be "settled only by a further nondefinitional judgment" (Finnis 1991). Here the prohibition of killing in the Decalogue is construed more precisely to mean that we should not intentionally kill innocent human life. This construal specifies what "murder" is. It is a delimited action-kind. The judgment that murder in this sense is wrong purports to be true, yet is not a tautology. (I accept that who is requisitely "innocent" is sometimes difficult to ascertain and deeply controversial, but not in the cases before us here.) It is the judgment under scrutiny and it remains possible to dispute it.

      To construe more precisely the prohibition of killing introduces on the one hand a certain flexibility. It helps to make sense of society's organized efforts to provide security for its citizens against arbitrary, unprovoked, or otherwise unjust assaults on life and limb, and to accommodate policing, courts of law, and soldiering. We should by no means idealize here; activities that fall under these organized efforts are always corruptible, and in some measure, distinctively so. To recognize general and particular corruptibility, however, need not consign the efforts to a godforsaken realm. Yet on the other hand, this construal limits flexibility. When we meet cases that fall within its range of applicability, as we surely do, we may not then go roaming around, redescribing at will. Instead, we acknowledge the moral features of the case we confront, and either condemn or seek special justification or mitigation.

   2. A second consideration is moral stringency. To reiterate an ancient question: may we (ever) do evil to achieve good? (McCormick and Ramsey 1978). When we meet cases that fall within the prohibition's range of applicability, we face two choices: the prohibition against killing as precisely construed possesses either absolute or prima facie authority in any circumstance to which it applies.

   A familiar historical example brings out the difference between the two kinds of authority. President Truman reasoned that to drop atomic bombs on Hiroshima and Nagasaki served to hasten the end of the war and it cost fewer lives than a full scale invasion of Japan would have.⁵ We cannot ascertain whether he was empirically correct, but we can ask whether he was morally right that the criterion of "fewer lives lost" should trump. Those who adhere to the prohibition against killing as precisely construed normally extend it in circumstances of war to forbid the direct and intentional killing of noncombatants (as "material innocents"). To accord absolute authority to the prohibition thus extended means that Truman erred morally when he calculated total outcomes in the fashion he did. No argument from outcomes (that included his readiness to pursue a "countercity" rather than "counterforce" strategy to shorten the war and kill fewer persons) can override what by prior determination is judged to be wrong in itself to do, whoever does it. In this sense, we may never do evil to achieve good. To accord prima facie authority but not invariably actual bindingness to the prohibition thus extended means that noncombatant immunity has presumptive validity. This is strong enough to query Truman's decision. For we assume in advance that there is a presumption in the prohibition's favor, that any violation has the burden of proof. And the prohibition retains authority in that it may never be disregarded in any circumstance to which it applies, but only overridden, and always with compunction. Still, we may consider in tragic cases whether we should do something morally repellent (something we would not do for its own sake), to prevent something far worse.

   Unless we understand how the prohibition against killing is construed, and that it may be accorded absolute authority, we fail to grasp where and why many on the "right" judge abortion and embryonic stem cell research as they do, and where and why many on the "left" demur.

   Those on the "right" judge that the prohibition extends to fetuses and embryos. Both are innocent, and aborting a fetus and disaggregating an embryo are direct actions that kill. Whether death is strictly intended is a more complicated question in the case of abortion. Certain defenders of abortion claim that a pregnant woman may justly withdraw her bodily life support from the fetus, but that she may not thereby have a "right" to the fetus' death, if the fetus can survive outside her womb (Thomson 1971). Before 20 weeks of the pregnancy, however, this distinction has strictly theoretical interest. Death accompanies withdrawal of bodily life support, whatever hypothetical speculations we append. Death also accompanies the disaggregation of embryos, and affords no room for distinguishing between intending withdrawal but not death. As for "human life," the last part of the specified prohibition, those on the "right" maintain that each human entity, from the time of conception, is irreducibly valuable. Indeed, each is judged to have an equally protectible status. If embryos are currently genderless and removed from the naked eye, they differ from the rest of us in that they await implantation, growth, and subsequent entry into the world of social interaction (Sullivan 2001). But they contain the requisite genetic information that renders each unique. And all of us began at this stage. Why then discriminate? Does our self-absorption blind us to injustices we may commit because at present we enjoy superior power? Assuredly, fetuses and embryos cannot now fight back on their own behalf. Yet none of us could at the point of our origins. We transcend our self-absorption when we revere human entities by doing nothing that would jeopardize their inviolable status, just as our parents earlier revered ours (and fought for our survival, when we needed it). To intervene and destroy fetuses and embryos, palpably instrumentalizes them, for the sake of those who are presently stronger. We do well to remember what our parents did, and that we are grateful for what they did, when we evaluate abortion and embryonic stem cell research.

   Those on the "right" go next from specificity to stringency. We should make others' ends our own, provided that these ends are morally permissible. Violating the prohibition against killing as precisely construed is an impermissible end. We may not do or approve this evil, even when it achieves good. For we should always relate any benefits we aim to secure to what we are prepared to do to obtain them. We do best to consider first what we do and forbear, and not simply what will happen, and to live within the absolute limits that the prohibition against murder sets for us.

2. In the "Middle": Potentiality, and When "Nothing is Lost"

   I have identified arguments from the "right" that I find formidable. Why do I not simply accept them without further ado? I take no pleasure in objecting, yet I judge certain extensions less cogent than their defenders assume. Two lines of argument prevent my saying that abortion and embryonic stem cell research are morally indistinguishable from murder, and permit my occupying a particular region in the "middle."

   1. One line of argument concerns "potentiality," as applied to fetuses and embryos. This word recurs in the literature, yet is a red flag to many on the "right" and the "left." Conservatives think it nullifies a serious commitment to fetuses and embryos; liberals deride it as "mere" potentiality, a referent too indeterminate ever to be permitted to trump decisions to abort and to conduct research on embryos. The truth seems to me complicated in ways these contrary evaluations neglect.

      I claim the following about "potentiality." It has a two-sidedness that leads me to draw back from unqualified extensions, but to draw back a lesser distance than those on the "left" do. It yields appraisals that show how debates about abortion and debates about embryonic stem cell research are sometimes allied and sometimes not. How they diverge needs especially to be recognized. I consider these claims in turn, and attend first to fetuses.

      "Potentiality" on one of its sides registers what fetuses are not yet. They are entities who at least during the first 20 weeks of their existence (or until their lungs are sufficiently developed) cannot live except in total physical dependence on one and only one person in all the world. Talk of artificial placentas and hypothetical preferences should not divert us. Assuming the medical technology available now and in all the future we can empirically foresee, pregnancy involves unique physical dependence. Here and now, every pregnant woman is non-interchangeable. No one else can take her place. This state of affairs is not at all odd (not numerically uncommon), yet it is distinctive (though numerically common). The distinctiveness means that in certain respects pregnancy is sui generis. Analogies that are entirely satisfactory elude us.

      Consider two sorts of cases where this total dependence allows us to ascribe to the fetus a status less than that of equally protectible human life when weighed against the pregnant woman who is as well an end in herself.

      The first sort involves parity-conflicts where one physical life collides with another physical life, and we cannot save both. Such cases include conflicts between the pregnant woman and her fetus, where the pregnant woman will die, unless we end the life of the fetus (though thankfully these are now rare). A random lottery solution lacks advocates in this set of circumstances. In brief, such a case differs from lifeboat scenarios, because unlike the latter, we do not propose drawing straws. Rather, we unhesitatingly save the pregnant woman. "Potentiality" captures accordingly the sense that commitment to fetal life here is prima facie but not absolute. We override when the fetus imperils the pregnant woman's physical life. We abort when the fetus stands fatally in the way of actions intended to save the woman's life. Parity-conflicts of this sort are resolved in one way.

      The second sort involves encounters with evil, where a woman is pregnant because she is raped or the victim of incest. It is at this juncture that the absence of satisfactory analogies asserts itself most forcefully. No one except the pregnant woman can carry in her body someone conceived in rape but non-transferable just the same, who combines her own genes with those of her violator. She is uniquely near the fetus, yet is alienated from it by virtue of the crime that affects her intimately and in which she is not complicit. This evil case brings three factors together. The first concerns unique dependency. The woman can help in a way no one else can. The second concerns agency. She is not responsible for being pregnant. The third concerns cost. She carries the offspring of violence. The first holds for all pregnancies. The second and third do not, and they go together. How far these three factors are severally necessary as well as jointly sufficient to set this case apart points to the intricacies of debates about abortion as such that I cannot address here.⁶ But at least in this case, to judge that she is obliged to bring the fetus to term exceeds what the conditions of her own inviolability accommodate. Potentiality again stops short of equal protectibility that would prohibit termination in every such instance.

      "Potentiality" on the other of its sides registers what fetuses are. Here I take potentiality to be something more than mere possibility. The "more" refers to an entity actually in motion, a force that is there, a power underway (after the primitive streak and implantation). This power includes existent capacities to acquire in future various characteristics we attribute to those who "bear the human countenance," e.g., self-awareness, personal accountability, and conscious relations with other human beings. Since fetuses possess these capacities to acquire, traditional appraisals are correct that fetuses have a value greater than zero, a value separate and independent from their parents (Noonan 1970). In short, they are irreducibly valuable. I take their real value to mean that from conception forward, a presumption holds that they should come to term. Overriding this presumption carries the burden of proof.

      Such commitment to fetal life makes theological sense to many for whom bibilical passages count in weighing matters of life and death. Believers adduce passages that trace the working of providence back to the womb, for example (Isaiah 44:2; Psalm 138:13, for Jews and Christians; Luke 1:31-39, 42-44, for Christians). We should not dismiss citations like these as mere "proof-texting." For they cohere with a conviction that God's covenant love stands as our alpha and omega. In this case, our own love should correspond to far-reaching providential action. To err on the side of inclusiveness looks fitting. That a biblical depiction of providence encompasses potentiality implies that our love should start before recipients become self-aware.

      These evaluations of the status of the fetus locate me on the right side of the tortured "middle," within the vast territory of debates about abortion. It is essential to make these evaluations explicit, if one hopes to add anything useful to the widely-voiced opinion that debates about stem cell research chiefly reprise debates about abortion. This opinion captures something right. Given what I say above about two-sidedness, both fetuses and embryos are irreducibly valuable in that both have a value greater than zero, a value separate and independent from their parents; and both cannot live and develop except in total physical dependence for a certain time on one and only one person in all the world.

      Yet we should not stop here. The opinion misses divergences that I find important to notice in staking out a particular region in the "middle," within the smaller but rapidly expanding territory of debates about stem cell research. I allude to three such divergences now. The first concerns the kinds of conflict that are at issue. The second concerns the parameters of cost. The third concerns the range of choices that present themselves. I take them in turn.

      First, we miss in debates about embryos the characteristic tensions resident in the two sorts of cases I reviewed, where total dependence allows us to ascribe to the fetus a status that is less than equally protectible human life when weighed directly against the pregnant woman. For these cases focus on conflicts between two parties where a one-to-one correspondence obtains. While the stakes differ -- saving one physical life by ending another physical life, deciding whether a fetus conceived by the act of rape that transgresses the inviolability of one party should be brought to term and parented with all of the deep and permanent commitments this carries -- the correspondence does not. It is otherwise with embryos. In typical circumstances, no similar conflicts exist. While we take an active step by implanting the embryo, something that the two conflict cases do not require and have in any event passed beyond, the decision to implant is not a conflicted one. The circumstances here center on infertile couples who want a child and who embrace emphatically the deep and permanent commitments parenting brings. If a conflict emerges, it is neither immediate nor one-to-one, between the fetus and the woman. Rather, it is between those embryos who are not implanted and are to be frozen in perpetuity or discarded, and the needs of third parties who suffer from various maladies that research on embryos may eventually alleviate.

      Second, the cost to affected parties is constant in the case of fetuses and embryos, but diverges notably in the cases of pregnant women and third parties suffering from maladies mentioned earlier. Fetuses aborted and embryos disaggregated undergo incommensurable physical harm, i.e., lethal harm beyond our powers to reverse or compensate. I argue elsewhere that it is this incommensurable harm that constitutes a decisive similarity between abortion and infanticide, and one may extend this argument to embryos. Conservatives judge this similarity to fall under the prohibition against murder, and accord the prohibition absolute priority, as we have seen. I do not go so far, as we have also seen. But we should not shrink from soberly acknowledging the similarity itself. On the other hand, we encounter important divergences when we turn to the cases of pregnant women and third parties suffering from maladies. Let us recall the instance of pregnancy following rape, and the three factors that go together here (unique dependency, agency, and cost). The woman is not obliged to carry the fetus to term who is conceived in these circumstances. Yet the sphere of discretion she enjoys includes the possibility that out of extreme generosity and despite excruciating personal cost, she may elect to bring the fetus to term. The sacrifices she makes are hers, though after the fact. That is, the rapist deprives her of the exercise of her agency, and yet she exercises it post eventum; she may choose voluntarily to bear the cost. This sort of personally incurred cost disappears in cases of third parties suffering from maladies that stem cell research may alleviate. That they suffer excruciatingly as well, from maladies over which they exercise no agential control and yet which may eventually obliterate their agency, and that alleviating their suffering is something to be lauded, I would be the last to deny. Still, their standing as possible beneficiaries of embryonic stem cell research is initially unrelated to the circumstances of conception. They are not themselves actors within these circumstances. Unlike a pregnant woman, they cannot connect the plight they face with what they do, at voluntary cost to themselves. Moreover, no researcher of stem cells currently suffers, or faces permanent changes to his or her future life, that compare at all with the suffering a woman knows whose pregnancy is due to rape, and who elects to bear and parent a child.

      Third, the choices a woman confronts whose pregnancy is due to rape are stark. Either she elects to terminate or she does not, and if she does not, she may either bear and place the child for adoption, or she may parent. Her reasons for deciding as she does may vary, from honoring her own inviolability to honoring the well-being of the fetus who is another innocent. Yet some reason must trump. And the time to decide is short: if she does not terminate, she will bear, by affirmation or default. Whatever she decides, she will live with a host of physical and emotional effects, from a single point of origin. Once more, the circumstances surrounding stem cell research diverge markedly from her case. The reasons to conduct such research include the alleviation of suffering and the advancement of scientific knowledge. Neither reason must trump; they may reinforce each other. And our choices in how we pursue such research are several, as the debates about "sources" make clear. No one source is the narrow gate through which all promising lines of research must pass. We debate relative advantages and disadvantages, as well as the place of moral constraints. Finally, we are not bound by fixed and knowable temporal limits. And these are early days for such research.

      The respects in which debates about abortion and debates about stem cell research converge and diverge pressure those in the "middle" in contrary directions, as I observed earlier. Some are disposed to be more permissive about embryonic stem cell research than about abortion for these reasons: (a) Prior to implantation, we may distinguish conception from individuation. (b) After implantation, the fetus is indeed a "power underway," who left to self-elaborating processes is likely to become "one of us." Abortion actively intervenes to terminate "a force that is there," and has the burden of proof, whereas an embryo must still be implanted, and until it is, we cannot describe it as now a self-elaborating power underway. Others are disposed to be less permissive about embryonic stem cell research than about abortion, for this reason: abortion may involve bona fide conflicts between two entities who are both ends in themselves, whereas embryonic stem cell research is morally simpler. It concerns only one such entity about whom we can say with certainty, here and now, that the action we take, disaggregation, causes incommensurable harm. That third parties may benefit from the research subsequently done, is an outcome for which we fervently hope. But such benefit lies in the future. It does not lend itself to similarly determinate judgment. And we cannot gainsay the possibility that it may be attained without taking any lethal step, e.g., through research on other, morally unambiguous sources of stem cells (from adults, umbilical cord blood, and the like).

      The two-sidedness of potentiality supports the less permissive side, it seems, yet we should weigh a further argument that furnishes some room for maneuver and nuances the distinctiveness of debates about embryonic stem cell research.

   2. A second line of argument prevents my saying that abortion and embryonic stem cell research are morally indistinguishable from murder, and permits me to occupy the particular region in the "middle" I do: nothing is lost.

      I propose to invoke and extend the nothing is lost principle. I first learned of this principle from Paul Ramsey. While he was committed to an absolute prohibition against murder as the intentional killing of innocent life, he was prepared to attach two exempting conditions to it. One may directly kill when two conditions obtain: (a) the innocent will die in any case; and (b) other innocent life will be saved (Ramsey 1961). These two conditions stipulate what nothing is lost means. They originally extend to parity-conflicts, where one physical life collides directly and immediately with another physical life, and we cannot save both. (Ramsey may not have continued to uphold the principle in later writings, and I doubt in any case that he would have accepted the further extension I now offer.) I will argue that it is correct to view embryos in reproductive clinics who are bound either to be discarded or frozen in perpetuity as innocent lives who will die in any case, and those third parties with Alzheimer's, Parkinson's, et. al., as other innocent life who will be saved by virtue of research on such embryos.

      I grant that this extension at best stretches the nothing is lost principle nearly to the breaking point. For I defend the extension (and perhaps the original principle) as a move to the effect that (a) nothing more is lost, and (b) less is lost, or at least, someone is saved. One reason it is worth considering is because we face a particular instance of a general phenomenon, namely, that novel developments arise, for which no clear precedents suffice to guide us. We should seek both to extend traditional moral commitments and incorporate new developments as cogently as we can. To labor the obvious: some of the controversies we are examining only make sense after the age of in vitro fertilization dawned. It stands behind them, amplifying questions about "end" and "means" that our forebears could not foresee. Unless we are prepared to repudiate in vitro fertilization as such, so that we sympathize with infertile couples but refuse them a right to overcome their condition by any means that science and their financial resources make available, we must take the moral measure of these new possibilities.

      In the instance before us, I sympathize with the plight of infertility, but am disquieted by the way in vitro fertilization is practiced in our culture. I will return to this disquiet. But rightly or wrongly, "excess" embryos are a tenacious datum, for they are a result of the practice as it currently exists. I welcome the day when such necessity vanishes, and welcome in the meantime "adopting" mothers willing to implant embryos, when the genetic couple consents.⁷ Not to welcome these things belies the claim that embryos as well as fetuses are irreducibly valuable. Nevertheless, it looks as if embryos in appreciable numbers will continue to be discarded or frozen in perpetuity. They will die, unimplanted, in any case. (Nothing more will be lost by their becoming subjects of research.) Again, it is the absence of prospects of these innocents that partly extends the first exempting condition. It is the enhancement of prospects to other innocent life that partly extends the second exempting condition. (Less will be lost, or at least, someone may benefit.) These judgments taken together summarize the case I wish to make.

      I say "partly." I do not say "wholly" and certainly not "transparently." The case for extension I put forward shows both continuities and discontinuities with prior judgments on the ethics of direct killing. I take the prior judgments seriously and extend them to novel possibilities as far as I can. But I acknowledge that the present debates attest to a moral space embryonic stem cell research occupies that is to a degree unprecedented. Let me give two examples of continuities and discontinuities.

      First, consider this point of continuity. My extension goes so far, and no further. It includes embryos conceived to enhance fertility, but who will never be implanted. It excludes embryos created exclusively for research, where we intentionally create them, in order to disaggregate them. This limited extension accords with the "timbre" of nothing is lost in that we encounter circumstances we did not initiate and that we wish were otherwise. That we contemplate doing repellent things, things that again we would not do for their own sake, indicates how intentional killing was not "part of our plan" from the start. This timbre matters, yet a difference presents itself even here. The parity-conflict cases assume a contingent disaster that no one intends or foresees, nor is it made part of any established procedure. The circumstance of in vitro fertilization includes a recognition that "excess" embryos are endemic to the procedure to date. At a minimum, we foresee this. Still, we intend in the procedure to alleviate infertility, not to create embryos for research. Thus a significant continuity holds, despite this difference.

      Second, consider this point of discontinuity. The nothing is lost principle, as originally formulated, is narrower and more exact than an extension to the novel case of unimplanted embryos can be. In parity-conflict cases that goad us to articulate the nothing is lost principle in the first place, unless we directly kill one, we cannot save the other, and this allows us to claim that we would save both if we could. In cases of unimplanted embryos, we face no similar temporal and causal limits. No other party will directly and immediately die if we elect to save embryos by freezing them. Any "conflict," as I said earlier, is much further removed and comparatively indeterminate, plainly from parity-conflict cases, and arguably from abortion decisions more generally.

3. From the "Left": Derivation and Use, and Ends and Means

   While a particular location in the "middle" that I seek to inhabit has led me so far to pursue boundary questions with the "right" side, what I have said anticipates as well how I pursue boundary questions with the "left" side. I noticed previously that Doerflinger and Robertson as representatives of each side sometimes concur that our moral choices are less complicated than I take them to be. They hold respectively, we recall, that either we should oppose not only the creation and destruction of embryos for research purposes, but the research on spare embryos from in vitro fertilization clinics too, or we should stop opposing the creation and destruction of embryos for research purposes only. I have sought to show morally relevant differences between the creation and destruction of embryos for research purposes, and the research on spare embryos from in vitro fertilization clinics. To the degree these differences make sense, they suggest how those in the "middle" differ from those on the "left" and not only from those on the "right." I examine these boundary questions now more closely.

   Robertson makes two claims under my earlier "complicity" heading that we should not conflate. He contends first that the distinction between derivation and use is chimerical. Researchers are complicit in destroying embryos when they use stem cells derived from them, whether or not they engage in the actual destroying themselves. So far, I agree. The earlier NIH Guidelines promulgated during the Clinton Administration⁸ split the difference, perhaps for political reasons, to promote civil peace by not ignoring conservatives' concerns altogether, but funding research all the same. Robertson contends secondly that if one supports research on embryos obtained as "spares" from in vitro fertilization clinics, one should also support creating and destroying embryos for the purpose of research. For embryos do become a "mere means," once we decide to use them in research. I think we may compatibly accept his first contention and reject his second. And if I am right to extend in a qualified way the nothing is lost principle, we have important reasons to reject the second.

   To recount the reasons clarifies where boundaries lie. Such reasons focus on what status we ascribe to embryos, and on how we interpret the injunction to treat persons as ends in themselves.

   Regarding status, we remember that Robertson holds, along with many others, that embryos are too rudimentary to have moral status in their own right. He ascribes "symbolic" value to them, and this means for example that they may not be bought and sold, but they lack "intrinsic" value. The account of potentiality and irreducible value that I offered does ascribe status to them in their own right. And this account warrants resistance to so thin a view of their value that virtually any reason (excepting qualms about commercialization) trumps it. I intend potentiality to be robust enough, in the case of both fetuses and embryos, to resist the view that fetal life and embryonic life lack any weight that might ever be determinative, as soon as they conflict with other interests. Without such resistance, we reduce concern for such life to a platitude, a mere expression of good will, that never has efficacy, that can always be trumped.

   Regarding the injunction, Robertson insists that once we decide to use embryos in research, they do become a "mere means." This announces moral equivalence between two circumstances that I have argued differ relevantly. It is one thing to say that innocent life "will die" in any case, when we refer to a condition that we did not, by our own that embryos are too rudimentary to have moral status in their own right. He ascribes "symbolic" value to them, and this means for example that they may not be bought and sold, but they lack "intrinsic" value. The account of potentiality and irreducible value that I offered does ascribe status to them in their own right. And this account warrants resistance to so thin a view of their value that virtually any reason (excepting qualms about commercialization) trumps it. I intend potentiality to be robust enough, in the case of both fetuses and embryos, to resist the view that fetal life and embryonic life lack any weight that might ever be determinative, as soon as they conflict with other interests. Without such resistance, we reduce concern for such life to a platitude, a mere expression of good will, that never has efficacy, that can always be trumped.

   Regarding the injunction, Robertson insists that once we decide to use embryos in research, they do become a "mere means." This announces moral equivalence between two circumstances that I have argued differ relevantly. It is one thing to say that innocent life "will die" in any case, when we refer to a condition that we did not, by our own hands, bring about, and in most instances cannot alter. It is another thing to say that innocent life will die at our own hands, a condition that we plan and bring about from the beginning, and where we could have done otherwise. This latter procedure does reduce embryos to a menial status through and through. We would distort the nothing is lost principle beyond recognition if we proposed to "extend" it to say that nothing is lost when we create an entity whose prospects are nil because of what we intend from the start. For in that case, we see to this.

   The difference is there, yet I must still ask, and Robertson's insistence valuably presses me to ask: how much remains of the injunction to treat persons as ends in themselves when we allow research on frozen and eventually-to-be-discarded embryos? I reply that the normative force of the injunction diminishes significantly when we take to heart their prospects. It diminishes for everyone, and not only for those who allow research. Some seek to witness to the dignity of embryos by refusing to do anything to them other than to freeze them. They adhere to the norm I mentioned when canvassing conservative views, that we do best to consider first what we do and forbear, and not simply what will happen. While this norm counts for me across a range of other circumstances, I find in the present circumstance that such a witness threatens to idle in relation to what the injunction paradigmatically summons us to undertake. It is difficult to specify what interests we protect and promote, for example, when freezing and discarding are all that we can seriously envisage. To honor potentiality, where there is no hope of implantation, is to honor perpetual potentiality.⁹ It diminishes action-guiding content, either present or future, from the injunction to treat as an end. It even affects what we say in the theological context to which I alluded earlier concerning providence and our corresponding love. For we cannot precisely equate the affirmation that our love should start before recipients become self-aware with an affirmation that we should love recipients who will never become self-aware. To deny equation is emphatically not to disbelieve in providence in both cases. And it is not to withhold corresponding love in both cases. It aims only to acknowledge that our room for exercising fidelity in action over time may differ. What we can and cannot do in treating persons as ends will be affected by their prospects. Our love for an anencephalic infant destined to live a few days without self-awareness and our love for an embryo who will live at most in a perpetually frozen state without self-awareness, has less prospective room than our love for a fetus who is a power underway and who will acquire self-awareness by virtue of his or her self-development. What we can envisage and do, now and later, has greater scope in the latter instance, which is why termination obliterates a future that the fetus now has in prospect, a future that an embryo frozen in perpetuity itself still lacks.

   This severely diminished force bears on the second exempting condition, that other innocent life will be saved. The case to extend this condition is imperfect as well, indeed more so, for reasons already given. I observe, however, that as we disallow the intentional creation and destruction of embryos for research purposes only, we draw more closely together the moral considerations we weigh in judging the permissibility of research on fetal cadavers and certain-to-be-discarded embryos. In both cases, the genetic parents decide whether to donate them for research. Researchers play a lesser role (they lack a voice in the decision to abort or to attempt in vitro fertilization) than when they guide the intentional creation and destruction of embryos.

   Political and Legal Contexts I ask next how the normative orientation that locating ourselves in the "middle" yields, affects our engagements in political and legal contexts in which stem cell research proceeds. Four broad observations must do for the present.

   First, the range of applicability of such an orientation needs itself to be clarified. Do I take it to be relevant to the entire body politic, at least in the United States, or only to certain segments of it? I divide this question into two parts.

   1. Since I referred to Augustinian Christian convictions at the start, do I address persons in the church only, or persons in the wider society also? The answer is that in this instance I address neither audience exclusively. On the one side, particular convictions influence how I depict the orientation in various ways. For example, I have in view certain Christian accounts of agape-love as I interpret the notion of persons as ends in themselves (Outka 1972); I extend a principle from Ramsey, a Christian writer who claimed that his own formulation of nothing is lost came from a Christian understanding of charity; I dwell on the prohibition against murder as precisely construed, and my senses of "intentional," and "innocent" are influenced by my own tradition. On the other side, the subject of stem cell research demonstrably engages the wider society, and much of the literature on moral issues and scientific developments that I have read and incorporated focuses on no religious tradition. Moreover, to cite examples again, the prohibition against murder is one on which Jews, Muslims, and secularists likewise have innumerable things to say, from which I have learned; to protect citizens from murder is a "rock-bottom" duty of any political government, and this partly explains the urgency of debates about whether abortion and/or embryonic stem cell research are morally indistinguishable from murder; the maladies from which stem cell research may rescue us fall within the range of common human woes (Alzheimer's strikes members of many faiths and of no faith).

   2. Does the orientation apply with equivalent normative force in the public and the private sectors? It does, "in principle," but insofar as "ought implies can," the prospects in American society for de facto adherence differ greatly. I alluded to some of the reasons much earlier. Disputants from all parts of the spectrum have concentrated chiefly on what federally funded research should include. Comparatively little has been said about conduct in the private sector, where currently a thousand research flowers bloom. Some liberals especially look nowadays to the private sector for much of the most promising and innovative research. As they see it, for the government to issue and enforce definite rules that apply not only to the research it funds, but to all research, including privately funded research, would be a poison gift. To implement such a step would curtail substantially the kinds of research presently allowed in the private sector. They prefer to rely instead on ethical standards that professional bodies most directly involved propound, and on ethics advisory committees that Geron and the Advanced Cell Technology group, for instance have established. These matters are beyond the scope of our inquiry. I add only that one need not attack indiscriminately all free market undertakings in this area, to entertain certain justified worries. The results of privately funded research may not be immediately or universally available to the general public, in the fashion that federally funded research is. And "commercial organizations" are after all designed to make money. Neither in their objectives nor in their management are they designed to balance conflicting interests or to pay homage to the distinctive non-commercial qualities of medical research and medical care. The government should not, at a minimum, ignore the paucity of coordination I mentioned previously, or permit so many decisions to be made by default.

   Second, the subject of stem cell research remains volatile all the way up and down. It so far resists any repetition of a pattern we sometimes see, where, when we theorize about moral matters, divergent and rival points of departure and lines of argument abound, but when we weigh political possibilities and institutional policies, agreements and points of consensus (a modus vivendi of sorts) more readily appear. We should beware of assuming here that once we turn to institutional policies, we no longer need to engage in "theoretical" debates. On this subject, we are never done with moral points of departure. These determine, in key part, what we take desirable and undesirable institutional policies to be. We make claims as I have done here, weighing arguments about where to place ourselves along a spectrum, how far judgments about abortion and stem cell research diverge, and so on. If we give these enduring moral concerns short shrift, we enter the political fray with undefended assumptions that we merely announce.

   To avoid such an outcome, we must not grow weary of moral debates. They matter, and views taken exert vast influence. Between those who evaluate embryos as equally protectible human life and those who evaluate embryos as only "clumps of cells in petri dishes," there is no peace. I have tried to suggest why neither of these evaluations is adequate. And I for my part then must continue to attempt to address conservative and liberal objections. For example, conservatives may discern a consequentialist flavor in the nothing is lost principle (the innocent will die in any event; other innocent life will be saved). I claim it is fitting to ask, in the case before us, what actual benefits we can confer, and are conferring, and on whom. Yet I hardly comment on the intricacies of consequentialist theories. I only consider actual benefits in a case that the anomalous practice of in vitro fertilization presents to us, that leaves us with entities we did not directly intend to destroy from the start. Liberals may protest my refusal to keep concern about the status of embryos in circuit with every other morally estimable consideration, without benefit of even prima facie ranking. While I extol possible benefits to third parties from embryonic stem cell research, I resist allowing concern about the status of embryos to recede again to a platitude, where it never has efficacy and can always be trumped.

   Third, I should also specify further the orientation overall that emerges from this particular location in the "middle." To extend the nothing is lost principle in the way I do sets a deontological constraint on "sources" that applies in principle to stem cell research in the public and private sectors. It draws a line between research on embryos created solely for this purpose, and research on embryos slated to be discarded or frozen in perpetuity from in vitro fertilization clinics. It disallows the first sort of research and allows the second. This constraint makes concern about embryos more than an ineffectual afterthought. We should acknowledge any costs it may incur. Some liberals worry for instance that such a limit might affect adversely the "quality" of available embryos for research, a difficulty that intentional creation for research would surmount. Researchers debate whether this worry is well-founded empirically, but if we are unwilling to risk this much, we transmute concern about the status of embryos once more into a mere expression of good will. If we hold the constraint hostage to interminable bargaining, we deprive it of normative force that makes a discernible difference. We should leave the line intact, and be content to derive as many scientific and medical benefits from research on "excess" embryos as we can.

   The constraint matters then as it marks the drawing of a line. It matters in a further way. It registers an attitude of ongoing mourning for a plight. We regard research even on excess embryos as something to which we only reluctantly acquiesce. This attitude begins in sympathy for those who view their own infertility as an affliction they seek to overcome. It continues in allowing unprecedented in vitro technology that sometimes triumphs over this affliction. But such technology brings one outcome we foresee and lament, namely, the presence of embryos to be discarded or frozen in perpetuity. The case for extension occurs, once more, in circumstances we take as diminishments. We welcome neither infertility nor excess embryos. The attitude concludes in a desire that one day we may get out and get out for good. That is, we look forward to a time when we may reprogram adult stem cells so that we no longer require embryos as a source. Once research on embryonic stem cells enables us to identify the genes responsible for pluripotency, we may develop methods to de-differentiate adult stem cells so that we will no longer need to derive from embryos. And we hope that this time comes quickly, that the establishment of cell lines will prove to make the use of donated embryos a transitional matter. In short, to destroy embryos never leaves us at ease or becomes simply unproblematic, a permanently acceptable part of routine procedures. Our research priorities should attest to such an attitude.

   Fourth, when I claimed initially that the most fitting place to inhabit is a particular region in the "middle," I said there were dangers in locating ourselves there. Let me give one example of such a danger. It suggests how moral judgments and socio- political realties display volatility. We would accordingly be wrong to anticipate a static existence when we inhabit this region.

   This example falls within my third broad observation, that the constraint draws a line and registers an attitude. The danger derives from practical undermining more than from outright repudiation. Here the over-used metaphor of "slippery slope" comes into play. We recall Doerflinger's contention that researchers and those in charge of in vitro fertilization clinics might in effect collude, to produce by the "back-door" spare embryos in accordance with research needs, and no longer plausibly internal to the procedure to alleviate infertility. The "slope" at issue here is not so much one of theoretical argument, where the "logic" of a position we take carries us inexorably to conclusions we deplore. It is more "performative." That is, the line--between research on embryos created solely for this purpose, and research on embryos slated to be discarded or frozen in perpetuity from in vitro fertilization clinics -- is accepted provisionally by some on the "left," perhaps because fewer public qualms presently accompany concentration on spare embryos. Yet they reserve their passion for the benefits to third parties this research promises. To collude occasions no crisis of conscience on their part. For their governing aim is to secure embryos for research. If the line one day evaporates, if such research actually brings demonstrable benefits for numerous sufferers, so that public pressure to obtain these benefits one way or another becomes irresistible, they will have little to lament. In the meantime, their task is to exploit a distinction as far as one can, to make the most of all the opportunities for research it can possibly yield. The pressure to go down this slope tells us something important. A line is harder to maintain when the attitude of permanent unease with research on embryos is not shared. And such an attitude derives from complex sources, some of which I have tried to delineate. It requires a set of interlocking convictions.

3. CONCLUDING REMARKS ON NOTHING IS LOST

Yet the results of canvassing and evaluation here display varying grades of moral clarity and accountability, and different kinds of usurpation and injustice. I conclude by summarizing and elaborating such results in one concrete instance, my attempt to apply the nothing is lost principle to debates about stem cell research.

I proposed to apply the principle against a background of claims about the status of human life from conception forward. I take conception and all that it alone makes possible as the point at which we ascribe a judgment of irreducible value. Once conceived, each entity is a form of primordial human life, a being in its own right, that should exert a claim upon us to be regarded as an end rather than a mere means only. We should view its potentiality as constituting a presumption in favor of its coming to term. If this presumption is not robust enough to trump other claims on some occasions, the judgment of irreducible value becomes a platitude. "Symbolic respect" stands too near the chimerical because it trumps little or nothing whenever conflicts occur.¹⁰

After conception, I find no comparable bright line, but defend some proximate discriminations. Before individuation and implantation, the entity does not yet have the full fledged moral standing that an implanted fetus has. Yet for its part, the fetus' value is not equally protectible with the pregnant woman's, for she too is an end in herself and potentiality still characterizes the fetus. Equal protectibility holds after the fetus becomes capable of independent existence outside the womb.

These claims about status indicate why I deny that abortion and embryonic stem cell research are morally indistinguishable from murder, and also why I deny that abortion and embryonic stem cell research are morally indifferent actions in themselves, to be evaluated wholly by the benefits they bring to others.

The claims indicate as well why I object to the sort of embryonic stem cell research that creates embryos in order to disaggregate them. To conduct this research clashes directly with the judgment that entities conceived have irreducible value. For it is one thing to allow that we need not yet ascribe full moral standing or equal protectibility to embryos. It is another thing to "instrumentalize" them through and through when what we intend in the actions we perform exhaustively concerns benefits to third parties. But the claims also indicate why I object to an ironic alliance that those on the "right" and "left" sometimes form, to the effect that we confront a single either/or: we should forbid all embryonic stem cell research or we should permit it all. There is, I believe, a more nuanced possibility, where we may distinguish creating for research and only employing for research. The latter allows us to consider the tangled aftermath of in vitro fertilization as a practice in our culture. Employment for research connects with the datum of discarded embryos, where the original creation of embryos possesses a non-instrumentalist rationale, namely, the promotion of fertility, so that what we intend does not exhaustively concern benefit to third parties, yet the aftermath allows us to pursue benefits to third parties when we may do so without from the start creating in order to disaggregate. These differences lead me to argue that the nothing is lost principle illumines a morally significant distinction between creation for research and employment for research.

I want to offer four concluding observations that illustrate varying grades of moral clarity and accountability available, and different kinds of usurpation and injustice.

First, consider a clear instance of a difference. An appeal to nothing is lost remains distinct from the kind of calculus President Truman favored. He elected to take certain innocent lives intentionally for the sake of saving many more. If this kind of calculus operates in stem cell debates, as it surely does in certain circles, we should not run it together with nothing is lost. The latter principle limits itself to two sorts of cases, neither of which possesses the balancing of lives lost and saved that Truman's calculus encompassed. In the first sort of case between two parties, or among a limited number of parties (e.g., a lifeboat with too many occupants), we can choose whom we save, but we cannot save both, or we cannot save all. Here we must invoke some distributive criterion, e.g., a lottery. In the second sort of case, we cannot choose whom we save. The embryos in question fall under the second case. They will be lost no matter what we do. They will die if we do nothing (we may assume that the embryos will be frozen and eventually destroyed, and not kept in limbo for all time), and we cannot save them by killing others or letting others die.¹¹

Second, consider another reasonably clear but less widely recognized distinction regarding the status of moral claims. I believe my appeal to nothing is lost reaches a moral judgment that should endure rather than one that holds only "for the time being." It is one thing to seek both to extend traditional moral commitments and to incorporate new insights as cogently as we can in the development of enduring moral judgments regarding novel moral issues. It is another thing to seek for the most judicious judgment we discern to be acceptable at the present time, where the judgment remains provisional and revisable in response to shifting social consensus. In the latter case disputants sometimes tacitly assume and hope that what is beyond the pale now may not be later. I follow the former route. Once we take the measure of combining traditional commitments and incorporating new developments, we should reach definite moral judgments. If the principle that nothing is lost rules out creating embryos for research and permits research on spare embryos, then shifts in public opinion should not cause us to change course.

Third, consider a possible difficulty internal to the nothing is lost principle itself. Here clarity is harder to attain. The difficulty is that "nothing is lost" may permit more extensions than I seek. Recall the difference Doerflinger cites, that I noted much earlier: to destroy an entity for body parts because that entity will die in any case is not the same as using cells from an entity already dead. Some may worry that the principle may also allow the general "harvesting" of organs or tissues from the living who are, e.g., terminally ill, or comatose, or condemned to die by authorities of the state as criminals. The specter of Nazi doctors may well appear before us: if certain people were slated for death anyway, why not experiment on them to the point of ending their lives to acquire knowledge?¹² These possible extensions differ from the one I propose here because the embryos in question are in physical limbo, without history or prospects. I judge that the general difference Doerflinger cites should otherwise continue to claim allegiance. It is impermissible to destroy any entity for body parts who has an agential history even if he or she does not now have any considerable future, entities for instance whose maturity (their "potentiality" has long since been realized) deprives their genetic parents of authority to end their existence or to elect to donate them for research. But the "perpetual potentiality" of the embryos in question distinguishes them markedly enough from these other entities. "Perpetual potentiality," assuming the claims I made about the two-sidedness of potentiality as we focus on embryos and fetuses, leads us intelligibly to find more affinities than differences between fetal cadavers and the embryos in question. Whatever other extensions nothing is lost may warrant then, in cases of tragic forced choices (I have not considered these at any length), the extension I offer here pertains to a peculiar case by virtue of what the embryos in question currently are and are not. John Reeder observes in quoting Baruch Brody that "the basic point of nothing is lost is that, as Brody puts it, the one to be killed does not 'suffer any significant losses...in unrealized potential'" (Reeder 1996; Brody 1976). I claim that "unrealized potential" carries for the embryos in question distinctive finality that resists generalization.¹³

Fourth, consider another difficulty for nothing is lost that derives from the very features that render this case peculiar. I ask now whether these features may complicate my proposed extension beyond what I have so far allowed. I only touched on what complicates when I registered "disquiet" over the way in vitro fertilization is practiced in our culture (and I now return to this, as promised). It is the practice itself that gives possible trouble for my proposed extension.

I want however to begin far enough back to acknowledge the original conflict, and locate my disquiet in this larger setting. This original conflict, as I noted earlier, is that we welcome neither infertility nor excess embryos. Those of us who are spared infertility should show "epistemic humility" toward those not spared, and try to understand from a respectful distance their sense of deprivation. We rejoice in what is hardly a trivial gain: in vitro fertilization has overcome a condition that would have otherwise consigned many to having no genetic children of their own. We should remember this and feel the force of the conflict that has ensued.

Yet excess embryos remain a tenacious datum too, and it is here that disquiet centers. It persists on three levels. The first I noticed as I contended that we should never regard as simply unproblematic our destruction of embryos or our leaving them in perpetual storage; and we should extend the attitude of permanent unease to research on them as well. Something inestimably valuable is at stake and at risk. A second level pertains to current practices in American society. Approximately 10,000 embryos are added each year, within arrangements free of much society-wide oversight (a general circumstance I lamented previously), where the profit motive plays a large but ill-considered role. We do know that many more embryos are generated than we can hope to implant, to maximize success rates particularly in cases (e.g., maternal age) where implantation prospects are meager. A third level concerns the moral diagnosis that accompanies these practices. We also know that such practices are a human achievement, not a contingent natural disaster. Matters could have been otherwise.¹⁴

That such disquiet complicates my proposed extension, it would be idle to deny. At a minimum, the permanent unease and the mourning for a plight that I defended should not end in passive resignation to these status quo practices. (We should not exhaust our energies in mourning, that might, ironically, assuage us in our resignation.) Such unease should prompt instead far more critical and skeptical appraisals of the practices presently in place. Again, in this area the government is permitting too many decisions to be made by default.

Yet I continue to uphold the extension, albeit in a chastened mood, rather than jettison any distinction between creation and employment, as those on the "right" and "left" propose. My reasons are also three.

Above all, we should not avoid the brute fact of the 100,000 embryos who are languishing in vats and whose prospects for implantation are nil (and many are unviable). Even if in vitro fertilization stopped from now altogether, this phenomenon confronts us. Accounts of nothing is lost do allow for circumstances where the fact that innocents will die is seen as a moral evil and not a natural accident (e.g., situations a tyrant creates). The reasoning is this. We need not approve of how the situation was created to judge that it is better to save some than none when those who die would die anyway. I regard employment of discarded embryos for research as morally tolerable, and no more. It remains difficult for me to see what treating them as ends leads us to do, how freezing or flushing respects them more, or is less evil, than employing them for research.

Second, I grant that the recognition of human construction of the in vitro fertilization industry puts pressure on my earlier distinction between a condition we did not, by our own hands, bring about, and in most instances cannot alter; and a condition where we plan and bring about the death of an innocent life at our hands, and we could have done otherwise. Yet I draw back from any grand use of the societal "we" in this prior account of human construction. We may now become complicit if we do not criticize, yet the circumstances of the original construction attest to the realities of our social pluralism. Those most deeply affected -- the infertile -- and those prepared to respond -- the organizers of the industry -- were the driving forces behind such construction. So it continues to matter whether one creates these particular embryos in order to disaggregate them, or whether one only knowingly foresees that unspecified excess embryos form part of the practice.

Third, the particular region of the "middle" I extol averts the excesses of a debate that engages those on the "right" and the "left" concerning the necessity of embryonic stem cell research. The former denies such necessity (there are alternative ways, even if slower ones, e.g., research on adult stem cells, that will bring the desired benefits), and the latter insists on it in order to alleviate immediate mass suffering as quickly as we can. I opt for something less sweeping. Let us bracket the debate about necessity. Instead, let us not elide the difference between creation and employment, but rather draw this line for good, and permit the kinds of research in accordance with it.¹⁵

The performative dangers to which I alluded will endure. Yet we may nevertheless defend certain commitments as always in force, such as the injunction to treat persons as ends in themselves. And I think that the constraint I identified that follows from this injunction continues to do important normative work in calling attention to a limit and in lauding research within it. For there is still lasting value in seeking moral integrity, after we engage -- with critical respect -- points on a spectrum.

REFERENCES

Brody, Baruch. 1975. Abortion and the Sanctity of Human Life: A Philosophical View. Cambridge, MA: The MIT Press: 151.

Condic, Maureen L. 2002. The Basics About Stem Cells. First Things, January: 119: 30-39.

Demopulos, Demetrios. 1999. An Eastern Orthodox View of Embryonic Stem Cell Research. Paper presented to the National Bioethics Advisory Commission.

Doerflinger, Richard M. 1999. The Ethics of Funding Embryonic Stem Cell Research: A Catholic Viewpoint. Kennedy Institute of Ethics Journal, 9/2:137-150.

Dominguez, Alex. 2002. Two Studies Cast Doubt on Stem Cells. The New York Times, March 13.

Dorff, Elliot N. 1999. Stem Cell Research. Paper presented to the National Bioethics Advisory Commission.

Easterbrook, Gregg. 1999. Medical Evolution. The New Republic, March 1: 18-26.

Farley, Margaret. 1999. Roman Catholic Views on Research Involving Human Embryonic Stem Cells. Paper presented to the National Bioethics Advisory Commission.

Finnis, John. 1991. Moral Absolutes: Tradition, Revision, and Truth. Washington, DC: The Catholic University Press of America: 37.

Glover, Jonathan. 2000. Humanity: A Moral History of the Twentieth Century. New Haven: Yale University Press: 89-112.

McCormick, Richard and Paul Ramsey, eds. 1978. Doing Evil to Achieve Good. Chicago: Loyola University Press.

Meilaender, Gilbert. 1999. Remarks on Human Embryonic Stem-Cell Research. Paper presented to the National Bioethics Advisory Commission.

---------. 2001. The Point of a Ban: Or, How to Think about Stem Cell Research. Hastings Center Report, 31/1: 9-16.

Meyer, Michael J. and Nelson, Lawrence J. 2001. Respecting What We Destroy: Reflections on Human Embryo Research. Hastings Center Report, 31/1: 16-23.

NBAC, National Bioethics Advisory Commission. 1999. Ethical Issues in Human Stem Cell Research, vol. 1. Report and Recommendations (September, 1999). Rockville, MD: NBAC.

The New York Times. 2002. Canada Takes Middle Path on Stem-Cell Study. March 5.

Niebuhr, Reinhold. 1949. The Nature and Destiny of Man, I. New York: Charles Scribner's Sons:179.

NIH. National Institutes of Health. 2001. NIH Human Embryonic Stem Cell Registry. Bethesda, MD: NIH.

Noonan, John T., Jr. 1970 An Almost Absolute Value in History. The Morality of Abortion: Legal and Historical Perspectives, ed. John T. Noonan, Jr. Cambridge, MA: Harvard University Press: 58.

Outka, Gene. 1972. Agape: An Ethical Analysis. New Haven: Yale University Press.

--------. 1986. Respect for Persons. The Westminster Dictionary of Christian Ethics, eds. James F. Childress and John Macquarrie. Philadelphia: Westminster Press: 541-45.

--------. 1992. Universal Love and Impartiality. The Love Commandments: Essays in Christian Ethics and Moral Philosophy, eds. Edmund S. Santurri and William Werpehowski. Washington, DC: Georgetown University Press: 1-103.

--------. 1993. Augustinianism and Common Morality. Prospects for a Common Morality, eds. Gene Outka and John P. Reeder, Jr. Princeton: Princeton University Press: 114-148.

--------. 1999. The Ethics of Love and the Problem of Abortion. Second Annual James C. Spalding Memorial Lecture, printed in booklet form by the School of Religion, University of Iowa.

Pellegrino, Edmund D. 1999. Testimony Regarding Human Stem Cell Research. Paper presented to the National Bioethics Advisory Commission.

Ramsey, Paul. 1961. War and the Christian Conscience: How Shall Modern War Be Conducted Justly? Durham, NC: Duke University Press: 171-191.

Reeder, John P., Jr. 1996. Killing and Saving: Abortion, Hunger, and War. University Park: Pennsylvania State University Press: 58-66, 164-168.

Robertson, John A. 1999. Ethics and Policy in Embryonic Stem Cell Research. Kennedy Institute of Ethics Journal, 9/2:109-136.

Sachedina, Abdulaziz. 1999. Islamic Perspectives on Research with Human Embryonic Stem Cells. Paper presented to the National Bioethics Advisory Commission.

Shannon, Thomas A. 1998. Remaking Ourselves? The Ethics of Stem-Cell Research. Commonweal 125/21: 2-3.

Sullivan, Andrew. 2001. Only Human. The New Republic. July 30: 8.

Tendler, Moshe David. 1999. Stem Cell Research and Therapy: A Judeo-Biblical Perspective. Paper presented to the National Bioethics Advisory Commission.

Thomson, Judith Jarvis. 1971. A Defense of Abortion. Philosophy and Public Affairs, 1/1: 47-66.

Walzer, Michael, 1977. Just and Unjust Wars. New York: Basic Books: 263-268.

Werpehowski, William. 1997. Persons, Practices, and the Conception Argument. The Journal of Medicine and Philosophy, 22: 479-494.

Zoloth, Laurie. 1999. The Ethics of the Eighth Day: Jewish Bioethics and Genetic Medicine. Paper presented to the National Bioethics Advisory Commission.

____________________

Some of these pages began as the Wofford Lecture in Religion, Society, and Ethics, given at Wofford College in Spartanburg, South Carolina, on September 26, 2000. I am grateful to John Bullard, who issued the original invitation and kindly hosted me there. I thank Margaret Farley, Richard Fern, Wayne Meeks, Gilbert Meilaender, Paul Outka, John Reeder, Brian Sorrells, and Sondra Wheeler, for their reading of an earlier draft in its entirety. I also owe thanks to Ronald M. Green, who introduced me to important literature and with whom I had several stimulating conversations. Finally, monthly meetings over a two year period with the Yale Faculty Working Group on the Ethics of Stem Cell Research were indispensable. It was my good fortune to chair this Group. We disagreed among ourselves on many occasions (sometimes vigorously but never rancorously), and the others should not be held accountable for the views I articulate here. Still, my debts to these discussions are incalculable. The members for one or both years included John Booss, Robert Burt, Thomas Duffy, Margaret Farley, Arthur Galston, Myron Genel, Albert Jonsen, Robert J. Levine, Maurice J. Mahoney, Theodore Marmor, William F. May, Carol Pollard, Pasko Rakic, Dennis Spencer, Michael Weber, and John L. Young.

1. Scientific uncertainties may go deeper than the public now largely supposes. Maureen L. Condic queries whether the merit of embryonic stem cell research is as widely accepted by researchers as it is routinely alleged to be (Condic 2002). She dwells on the scientific and medical disadvantages of using embryonic stem cells and their derivatives in treating disease and injury, and the scientific and medical advantages of using adult stem cells, even though the latter field is not as far advanced. That her article appears in a "conservative" journal should not afford grounds for briskly dismissing or upholding the scientific case she offers. One report testifies at any rate to the volatility of current scientific judgments on the respective merits of adult stem cell and embyronic stem cell research (Dominguez 2002).

2. This view holds that embryos up to 14 days are preindividual and prepersonal (e.g., Shannon, 1998). He sees a distinction between cells drawn from a preimplantation embryo and cells drawn from an aborted fetus. I compare ahead stem cell research on embryos and fetal cadavers.

3. In addition to the papers already cited by Farley, Meilaender, and Demopulos, others given on that occasion (May 7, 1999) display the diversity of views within religious traditions. (See, e.g.,Dorff, 1999; Pellegrino, 1999; Sachedina, 1999; Tendler, 1999; Zoloth, 1999).

4. I try to sort out these ingredients in two places especially (Outka, 1986; Outka, 1992).

5. Moral assessments of Truman's decision are legion. (See, e.g., Anscombe, 1981; Walzer, 1977; Glover, 2000; and with reference to stem cell debates, Meilaender, 2001).

6. I gesture elsewhere to the intricacies of these debates (Outka, 1999). While I incorporate several sentences from this booklet in my own account of abortion here, I simplify now by dwelling on the case of rape, and do not consider moral responsibilities that arguably arise from requisitely voluntary sexual relations.

7. I welcome for example any changes in the future that qualify the generalization that the production of spare embryos is endemic to in vitro fertilization. One possibility pertains to the micromanipulation procedure that goes under the acronym ICSI (intracytoplasmic sperm injection). Here a single egg receives a single sperm to render fertilization more likely in couples where the sperm is of poor quality. In ICSI as currently practiced, scientists typically produce more embryos than are needed in a given cycle, since the survival of each of the eggs treated is never guaranteed. Hence with this procedure too there will be excess embryos into the foreseeable future. Still, the procedure allows us to ask not only whether there will be excess embryos, but whether there must be. Yet even if we suppose there must not be, we leave the proposal intact to extend the nothing is lost principle to the large number of excess embryos who exist already in in vitro fertilization clinics. This aspect of the "plight" at least is a fait accompli. I am indebted to Margaret Farley for drawing my attention to the slight caveat about the future in the case of ICSI. More generally, see also my last remark in section III here.

8. These NIH Guidelines have now been withdrawn. On November 20, 2001, NIH posted the Human Embryonic Stem Cell Registry. It lists the human embryonic stem cell lines that satisfy the eligibility criteria President Bush specified on August 9, 2001. These criteria are more restrictive than the position I defend in this paper requires, for they "allow Federal funds to be used for research on existing human embryonic stem cell lines as long as prior to his announcement...the derivation process...had already been initiated" (NIH, 2001). Compare the earlier comprehensive report and recommendations (NBAC, 1999).

9. Brian Sorrells suggested this phrase while reading an earlier draft and I gratefully appropriate it.

10. For my subsequent account of the nothing is lost principle, I owe a great debt to John Reeder's volume, Killing and Saving, and to his detailed comments on my earlier draft.

11. Those who endorse "symbolic respect" for embryos rarely ask directly whether this respect should ever trump when it conflicts with the welfare of third parties, except for repeating qualms about commercialization. Michael Meyer and Lawrence Nelson offer a fuller discussion, however, as they defend the claim that we may respect embryos even as we intentionally destroy them (Meyer and Nelson 2001). We may, because the moral status of embryos is "weak or modest." Although they are "alive" and "valued, in some cases very highly, by many people," they are not "agents," or "persons" (prior, at least, to "individuation" around 14 days), and they lack "ecological significance" (p. 18). Destruction should occasion, nevertheless, a sense of "regret and loss" (p. 20). My judgments differ from theirs at two points. First, I claim that the irreducible value embryos have trumps the possible welfare of third parties in that we may not create embryos in order to destroy them, for this instrumentalizes them through and through. Meyer and Nelson stress that the "gamete sources" must give voluntary and informed consent "for any disposition of their embryos" (p. 21), but neglect the distinction between creation in order to destroy, and employment where creation has another rationale. Yet nothing they say about "respect" strictly forbids taking the former step, as far as I can tell. If this is right, their case permits more than I do, at the end of the day. Second, my appeal to the two-sidedness of potentiality yields an account of how embryos and fetuses are like and unlike each other that retains the following link. Like fetuses, embyos now possess the genetic wherewithal to become "one of us." This distinguishes them decisively from sperm and eggs before conception. Unlike fetuses, they are not now a self-elaborating power underway, until they are implanted. Meyer and Nelson approach this account, but then draw back from it. They hold that embryos are not yet "effectively a stage in the early development of a person." I accept their "effectively," if it means "not now a self-elaborating power underway." But then they add: "Put differently, an extracorporeal embryo -- whether used in research, discarded, or kept frozen -- is simply not a precursor to any ongoing personal narrative. An embryo properly starts on that trajectory only when the gamete sources intentionally have it placed in a womb" p. 18). This is a distinct appraisal; it is not the same point "put differently." I take embryos to be the precursors to any ongoing personal narrative by virtue of the genetic properties they already have. Implantation does not create these properties, or start the "trajectory" that only these properties make possible. It allows them to develop "properly." Thus it seems more cogent to take conception and all that it alone makes possible as the point at which we should ascribe a judgment of irreducible value, for once conceived, each entity is a form of primordial human life.

12. This question was helpfully posed to me by Gilbert Meilaender in correspondence.

13. Conversations with Richard Fern shed light on the matter I raise in this paragraph, and on much else besides.

14. Sondra Wheeler led me to see that the normative position I defend requires a critical assessment of in vitro fertilization as currently practiced in the United States, and I thank her for perceptive counsel.

15. This position stands closer, it seems, to the regulations that the Canadian Institutes of Health Research have proposed than to the more restrictive policies of the United States and the more permissive policies of the United Kingdom.