Ethics in the trenches: a multifaceted analysis of the stem cell debate.

The increasing understanding of stem cell biology has opened up the possibility of using cell transplantation to treat a large variety of diseases. The medical need to identify optimal therapies is being challenged, however, by some members of society who seek to impose on this scientific quest their views--generally associated with particular religious beliefs--of what constitutes allowable research. This conflict mirrors earlier battles, extending over 150 years, between those implementing inoculation and vaccination to protect against smallpox and those who felt this to be unethical for religious reasons. For the many individuals who might benefit from the potential of stem cell medicine, such prolonged debate is unacceptable. In this review, conflicts in this debate are examined by holding opponents of embryonic stem cell (ESC) research to the standards applied to the science. The challenge of identifying optimal cells for tissue repair is juxtaposed with misrepresentations of stem cell science by those opposed to ESC research. Absolutist views on ethics are juxtaposed with examples of the bad science and unethical acts that occur when dogmatic religious filters and definitions of human-ness are forced upon scientific discussions. Finally, after considering how opponents of ESC research may, ironically, enhance commercial demand for cells derived from fetuses aborted for personal reasons of the mother, 10 proposals are offered that would--if followed by all participants in this debate--produce more ethically balanced discussions and a more comprehensive body of data from which evidence-based conclusions can be drawn.