Book Review: Stem Cell Century: Law and Policy for a Breakthrough Technology
July 14, 2008
Well-researched and current to the fast-moving field of stem cell research — using both embryonic and “adult” cells — Russell Korobkin navigates the complex interaction of laws, legal precedents, patents, and public policy. However, this book comes up short of its promise to adequately address the ethical concerns raised by the new field of regenerative medicine, especially in the area of embryonic stem cell research. Click on the “more” link below to read my complete review of Stem Cell Century.
A lawyer friend once told me that good lawyers always know the legal precedents that apply to their case. In the United States, precedents are established when a court makes a decision that influences similar cases down the road. While the sprawling legal system in this country issues hundreds of decisions every day, the highest courts carry the most weight in setting precedent. This is a why every move of the U.S. Supreme Court is scrutinized by students, legal professionals, the news media, and concerned citizens alike.
A “landmark decision” is when a high court issues a decision that either establishes or changes a legal principle — thus setting the stage for a new way to interpret or apply the laws made in this country. The 1954 Supreme Court case, Brown v. Board of Education of Topeka, illustrates this situation perfectly: the segregation of black from white students in Kansas was ruled fundamentally unconstitutional, opening a new chapter for civil rights in the United States. This decision actually reversed earlier rulings that institutionalized “separate but equal” segregation, including the now-infamous 1896 Supreme Court case Plessy v. Ferguson.
In his book, Stem Cell Century: Law and Policy for a Breakthrough Technology, Russell Korobkin does a thorough review of the current legislation and legal precedents that are influencing the direction and progress of stem cell research in America. (As an aside, though Stephen Munzer is credited as an author, Korobkin notes that Munzer only co-wrote the fourth chapter, and that all of the views expressed in the book are Korobkin’s own.) This review includes everything from the patenting and profiting off of living organisms (chapters 4 and 5) to the need for informed consent and default rules with gamete and tissue donation (chapters 6, 7, and 8).
Korobkin believes that stem cell research may one day revolutionize the field of medicine and cure many diseases that are currently untreatable. Accordingly, he focuses on two main questions in this book:
How do we maximize the likelihood that stem cell research and regenerative medicine will achieve their full therapeutic potential, and how do we balance that worthy goal against other moral and ethical values with which it might come into conflict? (p. 258)
As a lawyer by training, Korobkin provides well-researched insights into the policies, laws, and legal cases that are shaping the development of stem cell-based medicine. He examines and takes issue with several laws and policies that have discouraged an environment conducive to the advancement of stem cell research, including the Bush administration’s moratorium on federal funding for creating new embryonic stem cell lines (pp. 26-38) and the present state of the U.S. patent system (pp. 92-125).
Korobkin also demonstrates a strong grasp on the science of stem cell-based medicine, and he fairly presents the state and currently known limitations of both adult and embryonic stem cell research. Anyone interested in gaining a clearer understanding of the legal landscape for such important bioethical issues would gain much from reading this book.
Laws and legal precedent, however, are a poor guide for morality. This is obvious when we see the inconsistency of even the highest court in our land, which has, for example, reversed decisions like Plessy v. Ferguson in less than two generations. Legal precedent is important for determining how future laws should be written and applied, but it cannot and should not be equated with what is ethical. Ethics — which seeks to determine the good that we should pursue as a society and also weigh competing goods — should instead direct the laws that we make. In some cases, our ethical evaluation may agree with the legal precedents that have been set, and at other times it will override them.
If Korobkin has one blind spot in this book, it is that he focuses on his strength (law) and glosses over the importance of finding a common ethics to inform stem cell policy. For instance, in considering the creation of cloned human embryos for stem cell research, Korobkin concludes that “a congressional cloning ban would undermine the constitutional principles of limited federal power and individual liberty rights” (pp. 73-74). Korobkin bases this on the present lack of government regulation for in-vitro fertilization (IVF) as well as previous court decisions that upheld a right to reproductive privacy. Yet, some would argue that cloning of any kind is morally equivalent to slavery — making one human life merely the property of another. Rather than seriously weighing the purported evils of cloning, Korobkin simply dismisses the idea that embryos or blastocysts have any moral value as persons (p. 47) and he goes on to contend that government does not have the right to interfere in the search for medical cures through this technique (p. 82).
This, of course, raises all sorts of ethical issues, some of which Korobkin acknowledges and others that he does not. If medical researchers are allowed to search for cures unhindered, it may well endanger more than embryonic life in the process. One poignant example of this is the risk that female egg donors undergo in order to extract their ova, which are necessary raw materials for embryonic stem cell research. While studies indicate that as many as one in ten suffers complications from the procedure, Korobkin argues that as long as egg donors are compensated financially, the ethics are no different than paying coal miners to risk their health for the sake of energy production (p. 188). What Korobkin fails to realize is that medical practice is founded on the solemn promise to “do no harm.” Permitting practitioners to endanger the health of women for the flimsy promise of future cures is nothing less than an attack on the very heart of medical ethics. It is difficult to see here how the ends can justify the means.
While Korobkin offers a thoughtful and well-researched explanation of the legal and political factors impinging on the future of stem cell-based medicine, the book falls short of its goal to weigh the ethical issues that are truly at stake, which are particularly thorny for stem cell research that involves human eggs and embryos. Since courts and legislatures can be fickle, determining whether and what kinds of stem cell-based medicine are worth pursuing should be the focus of the debate, regardless of what legal precedents do or do not apply. Considering that human life itself hangs in the balance, the beginning of the stem cell century should be marked by a concerted effort to weigh out the benefits of curing the sick with the ethics of producing those cures.
