How meaningful are public attitudes towards stem cell research?

By Nick Dragojlovic

When scientists in Scotland announced the successful cloning of Dolly the Sheep in 1997, it triggered a frenzy of speculation in the global media about the possibility of human cloning, and elevated ethical questions to the fore of public discussions about biotechnology. This debate had far-reaching consequences, with citizens’ perceived moral objections to human cloning contributing to the imposition of restrictive policies on stem cell research that involves the cloning of embryos. In Canada, for example, work on “therapeutic cloning” in regenerative medicine (i.e., the use of somatic cell nuclear transfer or SCNT) was classified as a criminal offense in 2004 when the Assisted Human Reproduction Act (ARHA) came into force. This legislative action followed a debate in which opponents of the technique, which involves the harvest of stem cells from embryos cloned using a prospective patient’s nuclear DNA, pointed to an ostensible “social consensus” on the moral undesirability of any type of human cloning as an argument to ban this type of research despite its potential medical benefits.

ARHA can be thought of as a prime example of what the science policy literature refers to as “upstream” engagement — that is, a policy-making model in which public preferences are taken into account by scientists and regulators early on in the development of a new technology. This concept emerged partly as a response to the social and political controversies triggered by the Dolly announcement, the derivation of human embryonic stem cells (hESCs), and the commercialization of genetically modified crops — controversies that continue to this day. Advocates have argued that early public engagement could increase the impact of citizens’ preferences on the governance of future technologies (thereby increasing the democratic legitimacy of novel regulatory frameworks) and, indeed, prevent social controversies surrounding emerging technologies in the future.

The value of upstream engagement has, however, been questioned. As Joyce Tait argues, our limited ability to predict the way in which new technologies will develop means that public preferences for the regulation of emerging technologies are likely to evolve over time along with our technical capabilities. ARHA, for example, was enacted prior to the development of induced pluripotent stem cells (iPSC), yet may inadvertently impact the legality of iPSC research in Canada (despite the wide acceptance of iPSCs as an “ethical” alternative to hESCs by opponents of embryo research). Would Canadians have supported ARHA in 2004 even if they’d know it might prohibit iPSC research? If not, what does this say about the value of upstream engagement?

As it happens, the existence of a social consensus against human cloning in Canada – one of the principal arguments used by ARHA supporters – was itself not supported by contemporaneous public opinion evidence. Instead, opponents of therapeutic cloning who used this argument appear to have been motivated primarily by the more general concerns about inflicting harm on the embryo (whether cloned or not) that underpin moral opposition to all forms of embryonic stem cell research. Yet how many of even those who opposed SCNT in 2004 due to their moral opposition to embryo research would still oppose it knowing what we do today about the potential of stem cell research or, say, if a stem cell therapy derived from this technique was able to cure Parkinson’s?

Not surprisingly, available evidence suggests that many would change their mind if the medical benefits of the technique were demonstrated. Public opinion polling has shown that individuals who oppose hESC research on moral grounds often still view it as necessary, and while Americans tend to oppose the use of hESCs to treat less serious conditions like allergies, they view their use in the treatment of serious conditions like heart attack and cancer overwhelmingly positively. In a recent article, I found further evidence for this dynamic in the context of Proposition 71 — the 2004 ballot initiative that created the California Institute for Regenerative Medicine.

Using individual-level data from pre-election opinion polls and county-level demographic data, I explored the voting intentions of born-again Protestants, who have been identified by other work as the key US constituency opposed to hESC research (and, therefore, Proposition 71) on moral grounds. What I found is that while the typical born-again Protestant in California was more likely to indicate an intention to vote against the initiative than voters espousing other religious beliefs, this cleavage disappeared in counties with greater proportions of elderly residents and of people suffering from chronic diseases like diabetes or heart disease. My interpretation of this result is that many voters who were predisposed to oppose Proposition 71 on moral grounds were nevertheless persuaded to support the initiative when the potential benefits of future stem cell therapies — namely, the reduction in the suffering of those afflicted by chronic diseases — was made salient to them.

This finding is particularly important in the context of the rapid demographic aging of the global population. To the extent that the benefits of regenerative medicine are likely to accrue primarily to older individuals suffering from age-related chronic diseases, the aging of the population provides a compelling reason to expect that the benefits of stem cell research and therapies will be much more salient to publics in 20 years than they are today. Assuming the dynamic I observed in California is replicated, this gives us reason to believe that public preferences for the regulation of even ethically controversial areas of stem cell research and regenerative medicine will become more permissive over time – precisely the type of over-time evolution in public attitudes that critics of upstream engagement have pointed to as its underlying flaw. Given that people’s current preferences are likely not representative of those same individuals’ future preferences, then, the wisdom and, indeed, the democratic legitimacy of enshrining current ethical concerns about stem cell research into difficult-to-change laws like Canada’s ARHA is questionable.

Nick Dragojlovic is a science communication and health policy researcher interested in how public engagement with science can boost innovation in the biomedical domain. He is the author of “Voting for stem cells: How local conditions tempered moral opposition to Proposition 71” (available to read for free for a limited time) in Science and Public Policy.

Science and Public Policy is a leading international journal on public policies for science, technology and innovation. It covers all types of science and technology in both developed and developing countries.

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