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Between Public Opinion and Public Policy: Human Embryonic Stem-Cell Research and Path-Dependency

Published online by Cambridge University Press:  01 January 2021

Extract

My aim in this paper is simply to show that, in bioethics no less than in other areas of health care, policy in democracies is shaped not only by principles and values, but also — and to some extent independently — by the shape and history of particular political institutions and past policies. “Path dependency,” or what one scholar has called the “accidental logics” of already-existing institutions, condition and guide national policy choices. These institutional and historical pressures can even create substantial policy divergences between quite likeminded nations. I shall illustrate the point using some comparative data about national policies regarding research on human embryonic stem cells. The fact that gaps can develop between values and policies is readily visible to anyone who compares national stemcell research policies to the expressed attitudes of the citizens of various democratic countries regarding human embryonic stem-cell research. The role of path dependency and the accidental logics of institutional structure in creating those gaps can be illustrated by tracking down the details of the development of human embryonic stem cell policies in a few different countries.

Type
Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2009

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References

Tuohy, C., Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain and Canada (New York: Oxford University Press, 1999). For a similar argument about path-dependency resulting in a dissociation between national values and health policy, see Marmor, T., Okma, K. and Latham, S., “Values, Institutions and Health Politics: Comparative Perspectives,” Kölner Zeitschrift für Soziologie und Sozialpsychologie 46 (2006): 383-405.Google Scholar
National Institutes of Health, Stem Cell Basics, at 14, available at <http://stemcells.nih.gov/staticresources/info/basics/SCprimer2009.pdf> (last visited October 26, 2009).+(last+visited+October+26,+2009).>Google Scholar
This sketch is extremely “thumbnail.” I am making an effort to limit my rehearsal of the (already well-rehearsed) facts of stem-cell science to those that are strictly relevant to the menu of research policies examined later in the paper. I have therefore written nothing here about possible alternatives to embryonic stem cell research (including, e.g., induced pluripotent stem cells as a possible replacement for embryonic cells); nothing about adult stem cells; very little about the creation of stem-cell lines from parthenogenesis; and so on. For more detailed examinations of stem cell science, see Latham, S., “The Once and Future Debate on Human Embryonic Stem Cell Research,” Yale Journal of Health Policy, Law, and Ethics 2, no. IX, supplement (2009): 483494, at 483–486; Rao, R., “Alternatives to Embryonic Stem Cells and Cloning: A Brief Scientific Overview,” Yale Journal of Health Policy., Law, and Ethics 2, no. IX, supplement (2009): 603-622; and see generally National Institutes of Health, Stem Cell Basics, available at <http://stemcells.nih.gov/staticresources/info/basics/SCprimer2009.pdf> (last visited October 26, 2009).Google Scholar
National Institutes of Health, Stem Cell Basics, supra note 2, at Chapter III, “What are Embryonic Stem Cells?” available at <http://stemcells.nih.gov/info/basics/basics3.asp> (last visited October 26, 2009).+(last+visited+October+26,+2009).>Google Scholar
Id., at Chapter V, “What are the Similarities and Differences between Embryonic and Adult Stem Cells?”Google Scholar
“[E]mbryonic stem cell transplant…could be used to replace neurons damaged by spinal cord injury, stroke, Alzheimer's disease, Parkinson's disease, or other neurological problems. Cells grown to produce insulin could treat people with diabetes and heart muscle cells could repair damage after a heart attack. This list could conceivably include any tissue that is injured or diseased.” California Institute for Regenerative Medicine, “Turning Stem Cells Into Therapies,” available at <http://www.cirm.ca.gov/StemCellBasics_Therapies> (last visited October 26, 2009). (last visited October 26, 2009).' href=https://scholar.google.com/scholar?q=“[E]mbryonic+stem+cell+transplant…could+be+used+to+replace+neurons+damaged+by+spinal+cord+injury,+stroke,+Alzheimer's+disease,+Parkinson's+disease,+or+other+neurological+problems.+Cells+grown+to+produce+insulin+could+treat+people+with+diabetes+and+heart+muscle+cells+could+repair+damage+after+a+heart+attack.+This+list+could+conceivably+include+any+tissue+that+is+injured+or+diseased.”+California+Institute+for+Regenerative+Medicine,+“Turning+Stem+Cells+Into+Therapies,”+available+at++(last+visited+October+26,+2009).>Google Scholar
Office of Science Policy Analysis, National Institutes of Health, “Cloning: Present Uses and Promises,” available at <http://ospp.od.nih.gov/policy/cloning.asp> (last visited October 26, 2009).+(last+visited+October+26,+2009).>Google Scholar
The process described here is known as “therapeutic cloning” because it aims at producing a therapy rather than at implanting and bringing the cloned offspring to term (“reproductive cloning”). See Mollard, R., “Nuclear Transfer – Stem Cells or Somatic Cell Nuclear Transfer (SCNT),” International Society for Stem Cell Research, available at <http://www.isscr.org/public/therapeutic_cloning.pdf> (last visited October 26, 2009).Google Scholar
The clone would have the patient's nuclear genetic material, but would have different mitochondrial DNA – the DNA in what we might think of as the “white” part of the egg surrounding the nuclear “yolk.” “Mitochondria are structures within cells that convert the energy from food into a form that cells can use. Although most DNA is packaged in chromosomes within the nucleus, mitochondria also have a small amount of their own DNA. This genetic material is known as mitochondrial DNA.” National Institutes of Health, Genetics Home Reference, “Mitochondrial DNA,” available at <http://ghr.nlm.nih.gov/chromosome=MT> (last visited October 26, 2009). (last visited October 26, 2009).' href=https://scholar.google.com/scholar?q=The+clone+would+have+the+patient's+nuclear+genetic+material,+but+would+have+different+mitochondrial+DNA+–+the+DNA+in+what+we+might+think+of+as+the+“white”+part+of+the+egg+surrounding+the+nuclear+“yolk.”+“Mitochondria+are+structures+within+cells+that+convert+the+energy+from+food+into+a+form+that+cells+can+use.+Although+most+DNA+is+packaged+in+chromosomes+within+the+nucleus,+mitochondria+also+have+a+small+amount+of+their+own+DNA.+This+genetic+material+is+known+as+mitochondrial+DNA.”+National+Institutes+of+Health,+Genetics+Home+Reference,+“Mitochondrial+DNA,”+available+at++(last+visited+October+26,+2009).>Google Scholar
Another technique which may reduce transplant rejection risk involves developing stem-cell lines from unfertilized human eggs (a process known as parthenogenesis). This technique does not involve the creation and destruction of a human embryo (since an unfertilized human egg can not develop into a functioning embryo), but obviously requires access to donor oocytes. For reduction of transplant risk through parthenogenesis, see Kim, K., Lerou, P., Yabuuchi, A., Lengerke, C., Ng, K., West, J., Kirby, A., Daly, M. and Daley, G., “Histocompatible Embryonic Stem cells by Parthenogenesis,” Science 315, no. 5811 (2007): 482486; see also Latham, S., “NIH Draft Guidelines on Stem Cell Research: A Work in Progress?” Hastings Center Bioethics Forum, available at <http://www.thehasting-scenter.org/Bioethicsforum/Post.aspx?id=3410> (last visited October 26, 2009).CrossRefGoogle Scholar
International Society for Stem Cell Research, Stem Cell Policies, Europe available at <http://www.isscr.org/public/regions/region.cfm?RegionID=1> (last visited October 26, 2009); and Minnesota Biomedical and Bioscience Network, World Stem Cell Map, available at <http://www.mbbnet.umn.edu/scmap.html> (last visited October 26, 2009).+(last+visited+October+26,+2009);+and+Minnesota+Biomedical+and+Bioscience+Network,+World+Stem+Cell+Map,+available+at++(last+visited+October+26,+2009).>Google Scholar
For a detailed statement of this moral argument, see Outka, G., “The Ethics of Embryonic Stem Cell Research and the Principle of “Nothing is Lost,” Yale Journal of Health Policy, Law, and Ethics 2, no. IX, supplement (2009): 585602.Google Scholar
International Society for Stem Cell Research, Stem Cell Policies, North America, available at <http://www.isscr.org/public/regions/region.cfm?RegionID=6> (last visited October 26, 2009); Minnesota Biomedical and Bioscience Network, World Stem Cell Map, supra note 11.+(last+visited+October+26,+2009);+Minnesota+Biomedical+and+Bioscience+Network,+World+Stem+Cell+Map,+supra+note+11.>Google Scholar
International Society for Stem Cell Research, Stem Cell Policies, Europe, available at <http://www.isscr.org/public/regions/region.cfm?RegionID=1> (last visited on October 26, 2009); Minnesota Biomedical and Bioscience Network, World Stem Cell Map, supra note 11.+(last+visited+on+October+26,+2009);+Minnesota+Biomedical+and+Bioscience+Network,+World+Stem+Cell+Map,+supra+note+11.>Google Scholar
Fundación BBVA, Second BBVA Foundation International Study on Biotechnology, “Attitudes to Stem Cell Research and Hybrid Embryos,” (May 2008), available at <http://www.fbbva.es/TLFU/dat/international_study_biotechnology_08.pdf> (last visited October 26, 2009) (hereinafter, “Fundación BBVA survey”). Populations surveyed were those of Austria, the Czech Republic, Germany, Denmark, Spain, France, Israel, Ireland, Italy, Japan, the Netherlands, Poland, the United Kingdom, Sweden, and the United States. Fundación BBVA survey, at 2.+(last+visited+October+26,+2009)+(hereinafter,+“Fundación+BBVA+survey”).+Populations+surveyed+were+those+of+Austria,+the+Czech+Republic,+Germany,+Denmark,+Spain,+France,+Israel,+Ireland,+Italy,+Japan,+the+Netherlands,+Poland,+the+United+Kingdom,+Sweden,+and+the+United+States.+Fundación+BBVA+survey,+at+2.>Google Scholar
Id., at 2.Google Scholar
Id., at 5.Google Scholar
Id., at 8.Google Scholar
Id., at 9.Google Scholar
Id., at 10.Google Scholar
Id., at 14, 15.Google Scholar
Id., at 20,21.Google Scholar
Id., at 36.Google Scholar
International Society for Stem Cell Research, Stem Cell Policies, Europe, available at <http://www.isscr.org/public/regions/region.cfm?RegionID=1> (last visited October 26, 2009); Minnesota Biomedical and Bioscience Network, World Stem Cell Map, supra note 11.+(last+visited+October+26,+2009);+Minnesota+Biomedical+and+Bioscience+Network,+World+Stem+Cell+Map,+supra+note+11.>Google Scholar
International Society for Stem Cell Research, Stem Cell Policies, Middle East available at <http://www.isscr.org/public/regions/region.cfm?RegionID=3> (last visited on October 26, 2009); Minnesota Biomedical and Bioscience Network, World Stem Cell Map, supra note 11.+(last+visited+on+October+26,+2009);+Minnesota+Biomedical+and+Bioscience+Network,+World+Stem+Cell+Map,+supra+note+11.>Google Scholar
International Society for Stem Cell Research, Stem Cell Policies, Europe, available at <http://www.isscr.org/public/regions/region.cfm?RegionID=1> (visited on October 26, 2009); Minnesota Biomedical and Bioscience Network, World Stem Cell Map, supra note 11.+(visited+on+October+26,+2009);+Minnesota+Biomedical+and+Bioscience+Network,+World+Stem+Cell+Map,+supra+note+11.>Google Scholar
International Society for Stem Cell Research, Stem Cell Policies, Asia/Oceania, available at <http://www.isscr.org/public/regions/region.cfm?RegionID=2> (last visited on October 26, 2009); Minnesota Biomedical and Bioscience Network, World Stem Cell Map, supra note 11.+(last+visited+on+October+26,+2009);+Minnesota+Biomedical+and+Bioscience+Network,+World+Stem+Cell+Map,+supra+note+11.>Google Scholar
Banchoff, T., “Path Dependence and Value-Driven Issues: The Comparative Politics of Stem Cell Research,” World Politics 57 (2005): 200230, at 204–6.CrossRefGoogle Scholar
Irish respondents averaged 5.1 when asked to rate their agreement, on a scale of 0 to 10, with the statement that embryonic stem-cell research is immoral. They also averaged 5.1 in agreeing with the statement that research on leftover IVF embryos is morally acceptable. Fundación BBVA survey, supra note 16, at 8 and 20.Google Scholar
Irish Council for Bioethics, “Bioethics Research, September 2005,” available at <http://www.bioethics.ie/uploads/docs/129171-Bioethics%20Research.pdf> (last visited October 26, 2009), at pp. 3436.+(last+visited+October+26,+2009),+at+pp.+34–36.>Google Scholar
Irish Council for Bioethics, “Ethical, Scientific and Legal Issues Concerning Stem Cell Research,” 2008, at 63, available at <http://www.bioethics.ie/uploads/docs/StemCellReport.pdf> (last visited October 26, 2009).+(last+visited+October+26,+2009).>Google Scholar
For overviews of the history of the development of German embryonic stem-cell research policy, see Banchoff, , supra note 37, at 219–26; Richardt, N., “A Comparative Analysis of the Embryological Research Debate in Great Britain and Germany, Social Politics (2003): 86-128; Halliday, S., “A Comparative Approach to the Regulation of Human Embryonic Stem Cell Research in Europe,” Medical Law Review 12, no. 1 (2004): 4069, at 57–65; Campbell, A., “Ethos and Economics: Examining the Rationale Underlying Stem Cell and Cloning Research Policies in the United States, Germany and Japan,” American Journal of Law and Medicine 31, no. 1 (2005): 47-86, at 60-63; and Gottweis, H., “Stem Cell Policies in the United States and in Germany: Between Bioethics and Regulation,” Policy Studies Journal 30, no. 4 (2002): 444-469.Google Scholar
See Gottweis, , supra note 42, at 451.Google Scholar
See Campbell, , supra note 42, at 80 (“Japanese law and policy regarding stem cell and cloning research are largely grounded in a desire to cultivate the country's biotechnology sector.”)Google Scholar
See Banchoff, , supra note 37, at 215.Google Scholar
See sources at note 34.Google Scholar
See Campbell, , supra note 42, at 70–71.Google Scholar