Research relating to the therapeutic use of cells has increased significantly in recent years. But, as with any rapid advances in technology, there are ethical worries about the potential use, abuse, and more subtle long-term impacts upon individuals and society. Here, we present some ethical concerns in this area and briefly review them.

Advances in Cell Research

Space requirements constrain a detailed discussion of some of the principal research developments in this area. Most often in the news are human stem cells, which have the potential to generate any of the body's tissues. Currently, stem cells are proving difficult to use and manipulate, and there are well-publicized objections relating to the use of human embryos. Progenitor cells, however, which can be found in adult bone marrow, have relatively less potential and appear to be easier to use. Besides producing blood cells, they have the potential to produce muscle cells, bone cells, and chondrocytes.

Along with these discoveries and their potentials, there are technologies that are useful in culturing cells, preserving tissues, and improving our understanding of cellular interaction, which now provide a basis for tissue engineering. Human skin has now been grown that will develop all of the skin's layers. And a range of other cell types has been grown in vitro and successfully transplanted into mice.

Other cell biology developments are already here or seem just around the corner: growing synovial membranes and cartilage or tendons, injecting muscle cells into muscles, engineering cells to produce more growth factors, and many others.

Should we welcome these developments or should they disquiet us?

Arguments for Continuing This Research

Two leading arguments for continuing the research and developing its applications are the therapeutic advantages and the promotion of choice for individuals.

The potential--and already existing--therapeutic advantages are undeniable. Repopulating muscle cells might help those with muscular dystrophies or diseased heart muscles. Synovial membranes might be used in reconstructive joint surgery or to restore function for those with arthritis. Microencapsulation of cells is a recent technology that is already being used successfully for pain relief in terminal illness. Depot matrices could be developed to store and slowly release growth hormones to those with deficiencies, or, alternatively, they could be used as cellular sponges to mop up unwanted hormones. Not far down the track might be the capacity to grow some external organs (such as the nose or ears) in molds that could be used in reconstructive surgery.

An additional argument supporting continued research, development, and application of these technologies is that of choice. The argument is that to restrain these developments, for example, by government legislation, would be to restrict people's freedom, making choices for individuals that they should be left to make for themselves. The underlying belief of this argument seems to be that choice is a good in itself, which seems debatable. Moreover, there is a strong motive for looking at the conditions under which such choices would become possible--that is, to consider the ethical problems of such research. We now turn to those.

Concerns Raised by the Application of Cell Technologies

A first concern is the means required to achieve the benefits of cell technologies. For instance, even though we might applaud the desire to replace a badly disfigured nose, some means to this end might be considered unacceptable. It might, for example, be thought unnatural to grow a replacement nose in a dish and then sew it on someone's face. However, this line of argument seems to rely upon an unsupported intuition or feeling that growing body parts in vitro is wrong. Such intuitions have their place, but if we do not attempt to think beyond them, we might pass up benefits that would one day be enjoyed without a second thought. We need to reflect on whether it is the unfamiliarity of an idea that turns us against it.

Turning from means to ends, there might be a number of concerns about the consequences of applying cell technologies. The first consequence is the use of these technologies to enhance rather than treat. Treatment is the use of such technologies to return those disadvantaged by pathologies or disease to a healthy state. The same technologies are abused when utilized to enhance, i.e., to move already healthy individuals beyond the norm. For example, repopulating the muscle tissue of a muscular dystrophy victim might be seen as proper, whereas repopulating the healthy muscle tissue of an athlete to improve performance might be regarded as an abuse.

But, what is the norm, and how are we to define health? The World Health Organization defines it as a 'complete state of physical, mental, and social well-being and not merely the absence of disease or infirmity.' By this account, all sorts of interventions might be legitimated in the name of treatment that a more restricted notion of health would rule out as enhancement. Furthermore, the concern about enhancement begs the question: It assumes that moving individuals beyond the norm is unacceptable, but it does not show that it is, or why.

A second concern related to the outcome of applying new cell technologies points to a more insidious consequence. Treatment to remove health-related disadvantages seems acceptable, but people might also be disadvantaged by failing to match an ideal. The new cell technologies could be utilized to remove such disadvantages. An older person could be given wrinkle-free skin, for example. The potential of cell technologies to help achieve ideals, such as youthful appearance, is evident. But is it right to make changes to an individual, thereby perpetuating--or at the very least not questioning--ageist social structures?

What if the same reasoning were used to argue for changes to a person's racial characteristics to match a dominant racially specific ideal of beauty? The argument is that these ideals might represent forms of oppression.

This is a significant concern, but it appears to assume too easily that social norms, for example of health, are not oppressive. However, those norms might also be oppressive--on the one hand, marginalizing the disabled, for example. On the other hand, ideals might be shared by some but safely ignored by most. A bodybuilder clearly works toward achieving an ideal body, but most people do not believe that a bodybuilder's ideals demand anything of them.

Another feared consequence of cell technologies is that the wrong people might use them for bad ends, for example, criminal or terrorist purposes. Where might this concern lead? First, the fact that a technology is open to abuse is not necessarily an argument against pursuing it for purposes deemed acceptable, although we should take care who acquires it. Second, this is an argument against the development of cell technology even for therapeutic purposes. That is where the possibility of being used for bad ends begins; however, it is also where the possibility of treatment begins.

It is highly unlikely that concerns about cell technologies will win the day. The rewards for commerce and the promise of therapeutic advantages will surely drive research forward. Even if this is the case, however, airing the issues is important. In doing so, safeguards might emerge, along with an awareness of the potential moral costs of advance.