Stem Cell Rev and Rep (2009) 5:96101
DOI 10.1007/s12015-009-9062-4
Emerging Ethical, Legal and Social Issues Associated
with Stem Cell Research & and the Current Role
of the Moral Status of the Embryo
Amy Zarzeczny & Timothy Caulfield
Published online: 14 May 2009
# Humana Press 2009
Abstract Since its early days, stem cell research, particu-
larly human embryonic stem cell research, has been the
focus of intense social debate, and the question of the moral
status of the embryo has been a central issue in the
controversy. Despite this friction, and while it has yet to
obtain widespread success in clinical applications, stem cell
research remains a great hope for future advances in
healthcare. In this paper, we will discuss the results of our
systematic literature review in which we examined recent
social science, legal and biomedical discourse, as well as
Canadian print media discourse, associated with stem cell
research in order to assess the role the question of the moral
status of the embryo currently plays in these forums, and to
identify what other issues are emerging and receiving
attention. This analysis will assist with recognizing the
issues which are likely to inform future policy and will
facilitate forecasting the probable direction of the continu-
ally developing social discourse surrounding stem cell
research.
Keywords Stem cell research . Moral status . Embryo .
Discourse . Policy . Emerging themes
Introduction
Since its early days, stem cell research, particularly human
embryonic stem cell (hESC) research, has captured imag-
inations and been the subject of both excitement and social
controversy. This interest has been reflected in various
A. Zarzeczny : T. Caulfield (*)
Health Law Institute, University of Alberta,
Edmonton, AB, Canada
e-mail: tcaulfld@law.ualberta.ca
domains including the entertainment media, the popular
press, scholarly discourse and policy forumsboth national
[1, 2] and international [3]. The question of whether, and to
what degree, human embryos have a moral status requiring
protection has played a significant role in that controversy
[4, 5]. As such, issues associated with the moral status of
the embryo have received considerable attention in the
popular press as well as other areas of discourse [6, 7, 8].
The nature of the representations made in these realms,
particularly the media, is important because they have the
potential to inform and influence the publics views [9, 10,
11] and to impact the policy making process, particularly
if there is actual (or perceived) social consensus on the
issue(s) [12].
The therapeutic potential of stem cell research, while
remaining largely unrealized, continues to generate much
enthusiasm [13, 14, 15]. This enthusiasm is often rejuve-
nated by research developments including the emergence of
technologies such as induced pluripotent stem (iPS) cells
[16], interspecies somatic cell nuclear transfer [17], parthe-
nogenetic embryonic stem cells [18], and embryonic stem
cells derived from single cells of the embryo [19]. While
the majority of these technologies do not involve human
embryos and may have distinct scientific purposes and
advantages, they are nonetheless commonly linked with
hESC research in the prevalent discourse. In some cases,
they are promoted or even celebrated as more ethical or
acceptable alternatives [20, 21].
As these new technologies may not have been contem-
plated at the time Canadas legislation governing stem cell
research, the Assisted Human Reproduction Act, 2004, c. 2
(AHRA), was crafted, and are not directly addressed in the
legislation, they do not fit neatly within its parameters. As
such, the manner in which they are or are not regulated is
not entirely clear [22]. In view of these regulatory question
marks and the pending review of the AHRA mandated by
Stem Cell Rev and Rep (2009) 5:96101
the legislation (s.70), it is an ideal time to explore the
current issues associated with stem cell research, as they are
expressed in various forms of discourse. Whether directly,
indirectly, or potentially both, these issues are likely to
inform and influence the direction Canadian stem cell
policy takes.
Approach
We conducted a systematic literature review to obtain initial
impressions regarding the current state of legal, social
science and biomedical discourse surrounding stem cell
research, with a particular focus on examining the role
currently played by the moral status of the embryo in these
discourses. Our respective sources included the Legal
Periodicals Full Text Database1, the Social Sciences Full
Text Database2, and the Pub Med Database.3 We began
with a limited snapshot of timespecifically January 1,
2007September 16, 2008. The search term used for both
the legal and social science discourse was stem cell
research. For the biomedical discourse, we did a combi-
nation of more limited searches to obtain commentary-type
data rather than scientific results. Specifically, we searched
for stem cell research (with limits to editorials, com-
ments, consensus development conferences and lectures);
stem cell research & policy; stem cell research & identified as a reason to avoid hESC research; moral status
moral status; and stem cell research & controversy. of the embryo identified as a reason to pursue non-hESC
All of our results were then screened for relevance,
duplicate results were omitted and only items actually
addressing stem cell research were accepted for analysis.
For example, results where stem cell research appeared
only in a footnote reference, or where it was listed with
other controversial topics but was not actually addressed,
were discarded. Our resulting data sets were as follows:
legal discourse: 12; social science discourse: 23, and
biomedical discourse: 33.
1
Legal Periodicals Full Text Database is a bibliographic database
containing information from legal periodicals including law reviews,
bar association journals, university publications, yearbooks, institutes,
and government publications, covering court decisions, legislation and
original scholarship and books, with international coverage
including the U.S., Canada, Great Britain, Ireland, Australia, and
New Zealand.
2
The Social Sciences Full Text Database provides access to English-
language journals covering the latest concepts, trends, opinions,
theories, and methods from both applied and theoretical aspects of
the social sciences, with international coverage including publications
from the US, Canada, Great Britain, Europe, China, Africa, and other
jurisdictions.
3 4
Pub Med provides access to approximately 5,000 biomedical
journals published in the United States and worldwide in the fields
of medicine, nursing, dentistry, veterinary medicine, health care
systems, and preclinical sciences, as well as life science journals and
biomedical articles.
97
We were also interested in identifying general trends in
popular representations about stem cell research and chose
Canadian newspapers as our initial sample. For the purpose
of this preliminary review, we limited our search to a
selection of Canadian newspapers using the Canadian
Newsstand Database4 and, to control our sample size,
confined our examination to a one year period, from
September 16, 2007September 16, 2008. Again, only
results directly addressing stem cell research were accepted
for analysis and duplicate results were omitted, with a
resulting data set of 51 articles. Examples of omitted results
included articles about the United States recent election
which merely stated a candidates position regarding stem
cell research, and articles addressing other biomedical
issues in which stem cell research was only mentioned
peripherally.
All of the data, including the legal, social science and
biomedical discourse results, as well as the print media
data, were assessed using a coding frame. The coding frame
was developed to determine whether the data referred to the
moral status of the embryo (either directly or indirectly) and
if so, whether this issue played a peripheral, intermediate or
central role in the discussion. The data were also reviewed
to determine the context in which moral status of the
embryo was raised. The categories established in the coding
frame were as follows: moral status of the embryo
research; moral status of the embryo identified as a
consideration in stem cell research (i.e. in the absence of
positive or negative connotations); moral status of the
embryo rejected as a consideration in stem cell research,
and other. Finally, the results were analyzed for other
considerations (beyond the moral status of the embryo) and
emerging themes were identified.
Discussion
In the first stage of our analysis, we examined the role
played by the moral status of the embryo in the various
types of discourse. Our results are presented in the Chart 1.
The trends revealed by these results are interesting,
particularly those relating to legal and print media dis-
course. As is evident in Chart 1, issues associated with the
moral status of the embryo played a relatively minor role in
the print media data, as compared to their more central role
Our sample included the following publications: Calgary Herald,
Edmonton Journal, Globe & Mail, National Post, Ottawa Citizen, The
Province (Vancouver), Toronto Star, Vancouver Sun, The Guardian
(Charlottetown), The Telegram (St. Johns), The Daily News (Halifax)
& The Gazette (Montreal).
98
Chart 1 The role played by the
moral status of the embryo
Percent of Relevant
Articles
in legal discourse. One potential explanation for the minimal
role played by the moral status of the embryo in this forum
may be related to the fact that, as discussed below,
representations about scientific developments were so prev-
alent in the print media discourse. It is also worthy of note that
in the social science and biomedical discourse, the signifi-
cance of the role played by the moral status of the embryo
varied fairly evenly between the different categories. In order
to highlight overall trends, we also combined the data from
each type of discourse and applied the same analysis
described above. These results are presented in Chart 2.
The trends revealed by our data suggest that while the
moral status of the embryo may not always play a central
role in the discourse surrounding stem cell research, it
continues to be widespread. As seen above, the significance
of its role varies depending on the form of discourse and
there are domains in which it remains of more primary
importance.
We were also interested in assessing the contexts in
which the moral status of the embryo was raised. In doing
so, we found that the most common context was as a reason
to avoid hESC research. However, it is important to note
that in the majority of these cases, the author in question
was not necessarily expressing his or her own view or
advocating for that position, but rather was identifying the
Percent of Relevant
50
40
Articles
30
20
10
0 stem cell research. However, in many cases they do not
Not Raised Peripheral Intermediate
Role of Moral Status of the Embryo
Combined Data
Chart 2 The role played by the moral status of the embryo all data
combined
Stem Cell Rev and Rep (2009) 5:96101
70
60
50
40
30
20
10
0
Not Raised Peripheral Intermediate Central
Role of Moral Status in the Discussion
Legal Discourse Social Science Biomedical Discourse
Discourse
Canadian Print Media
belief(s) of others, most commonly, President Bush or
members of the Roman Catholic Church. The second most
common context was the other category. In order of
frequency, the three most prevalent other categories
included the following: (i) moral status identified as being
an issue of debate or controversy, often with the author
either implying or directly stating that it is one which is
unlikely to be resolved; (ii) moral status identified as the
reason underlying the federal funding restrictions against
hESC research in the United States, and (iii) one of the
benefits of non-embryonic stem cell research techniques,
specifically iPS cells, identified as being that they avoid the
moral status issue. Each of the other contextual categories
outlined above were represented, reflecting a diverse range
of contexts in which the moral status issue is being framed.
Finally, we examined what other issues were raised in
the data. We found that other considerations (besides the
moral status of the embryo) were raised in the majority of
our data (i.e. in 83.3% of the legal discourse, in 86.9% of
the social science discourse, in 41.1% of the biomedical
discourse and in 86.3% of the print media discourse). We
grouped these other considerations according to similarity
and a number of themes emerged, as outlined in Table 1:
Emerging Themes.
Conclusions
Our results indicate, perhaps unsurprisingly, that issues
associated with the moral status of the embryo continue to
have an undisputable presence in the literature surrounding
Central
appear to play a central role and the focus they receive and
the contexts in which they arise vary widely both between
and within different realms. Interestingly, in the data we
reviewed, there appeared to be a relative lack of heat or
contention surrounding questions about the moral status of
Stem Cell Rev and Rep (2009) 5:96101
Table 1 Emerging themes
Theme
Theories/Views on
Policy Development
Focus on Science & Health
Issues Relating to the
Supply of Embryos
Debates re: Novel Technologies
(hybrids, cloning and saviour
siblings)a
Non-embryonic Sources of
Stem Cells (iPS cells)
Jurisdictional Competition/
Forum Shopping
Intellectual Property Issues
Need for Clear and Consistent
Research Guidelines and
Standards
99
Frequency Types of discourse Examples:
14% All whether religious and/or moral views should
have a role in policy making
the nature and degree of the interaction between
politics and science
the place of moral repugnance and the yuck
factor in science policy
matters of public engagement and its appropriate role
14% Print Media scientific success in research development
stem cell researchs healthcare potential - i.e. cures
for serious and high profile conditions
(e.g. diabetes, Parkinsons, Down Syndrome and cancer)
13% Legal, Biomedical whether donors should be compensated
& Social Science how the risks incurred by donors should be
framed and addressed
the importance and meaning of informed
consent for gamete and embryo donation
creation of embryos for research
egg sharing arrangements
ethical issues associated with asking for donation
of fresh embryos for research
12.6% Print Media fears related to reproductive cloning
confirmations of the Roman Catholic Churchs
views regarding hESC research
concerns related to hybrids and issues of humanness
moral concerns re: saviour siblings
10.9% All celebrating fact that iPS cells do not involve
human embryo destruction
addressing potential anti-rejection and anticipated
personalized medicine benefits of iPS cells
ethical challenges associated with iPS cells -
including concerns about informed consent and
controlling their possible uses (e.g. the generation of
gametes and other cloning mechanisms).
7% All concerns about losing scientists to less restrictive
jurisdictions (i.e. experiencing brain drain)
concerns about countries falling behind other
nations in scientific prowess because of
restrictive policies
6.7% Legal & technical challenges associated with attaching
Biomedical patents to stem cell technologies
ethical issues associated with patents in this area
(e.g. moral concerns associated with linking
patents to human embryonic stem cells)
concerns that patents may impede research
problems caused by ambiguities in current IP
laws and practices
6.7% Legal, Social general calls for international regulation, consensus
Science & Biomedical and inter- (as well as intra-) jurisdictional consistency
need for an international definition of bioethics
current limitations in international regulatory and
ethical guidelines addressing consent, prevention
of commodification of human material and protection
of womens reproductive health
100
Table 1 (continued)
Theme Frequency Types of discourse
Research Funding Issues 5% Social Science,
Biomedical &
Print Media
Stem Cell Tourism 2.5% Print Media
Others All
a
It must be noted that the time frame of our sample overlapped with the period of time when the United Kingdoms Human Fertilisation and
Embryology Acts amendments were being considered. As a result, many of these discussions occurred in response to and were reflective of the
United Kingdoms shifting policy situation
the embryo and little strong position taking on the topic. In
other words, the view that human embryos have a moral
status rendering research on them morally unacceptable was
often simply recognized as one point of view, as opposed to
being vigorously put forward as the appropriate position.
In addition, our results indicate that questions about the
moral status of the embryo are currently sharing focus with
many other diverse and complex issues. These findings
echo results published in 2006 in relation to a study of
public discourse surrounding Californias Proposition 71,
wherein the investigators noted that no single issue
dominated the discourse (Lysaght, Ankeny & Kerridge,
2006 at 116). While our study has clear limitations as it
involved subjective content analysis of limited data sets, the
focus of this exercise was on getting a sense of the current
state of different forms of discourse surrounding stem cell
research and of the role currently played by the moral status
of the embryo in those discourses. We hope that the results
of this review will present a good starting point for further
exploration and discussion. In particular, an expanded
examination of different sources of media in various
Stem Cell Rev and Rep (2009) 5:96101
Examples:
need for national policy consistency, particularly re:
the sometimes conflicting/ inconsistent policies re:
IVF and research involving human embryos
debates about the appropriateness of using public
funds to support hESC research
challenges associated with obtaining research funding
general need for improved access to funding for
stem cell research
risks and responses
legal issues associated with a right to live for embryos
legal concerns regarding President Bushs federal
funding Directive re: stem cell research in the U.S.
added pressure and risks of unethical practices or
fraud associated with competition between both
companies and nations for scientific success
economic benefits associated with commercialization
of stem cell research, in particular as motivation for
state-sponsored stem cell research
issues associated with advertising and false claims,
primarily as related to stem cell treatments and therapies
current gap between research and the clinic
concerns about the hand of Satan encouraging
a culture of death
social justice and access issues associated with
the expected success of stem cell therapies.
jurisdictions, and of other relevant forms of discourse,
would facilitate potentially enlightening comparisons.
Our initial results confirm that stem cell research
continues to be a complex topic which raises diverse and
multifaceted issues in various forms of discourse including
legal, social science, biomedical and print media. Given the
plurality of issues that seem to be in play, our data also hint
that while issues regarding the moral status of embryos
remain relevant, the field is evolving and extending its
consideration to current and emerging issues including
patenting, policy approaches, procurement of embryos,
stem cell tourism and new sources of stem cells, among
others. Only time and further examination will determine
which, if any, of these issues will capture the attention of
policy makers. Ideally, commentators and decision makers
will be wary of making assumptions regarding the relative
impacts of these varied issues on the public sphere, and will
adopt a broad, flexible and informed approach to policy
making that accounts for the diversity of issues including,
but certainly not limited to, the moral status of the embryo,
reflected in current discourse. The situation revealed by this
Stem Cell Rev and Rep (2009) 5:96101
preliminary review suggests that the discourse surrounding
stem cell research is increasingly nuanced and is reflective
of a more general science policy question rather than a
debate centered on questions of morality.
Acknowledgments This work was completed as part of the
Canadian Stem Cell Network funded project, The Stem Cell
Research Environment: Drawing the Evidence and Experience
Together. Additional thanks go to all of the participants of the Lay
of the Land workshop for their invaluable comments and advice, and
to Erin Nelson and Michael McDonald for their comments on an
earlier draft of this paper.
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