Justice Considerations
The
therapeutic potential of stem cells for treating and possibly curing many
serious diseases constitutes a major rationale for large-scale investments of
public and private resources in human stem cell research. To justify doing so, however, requires some
assurance that people in need will have access to the therapies as they become
available. Principles of justice are
based on treating persons with fairness and equity and distributing the
benefits and burdens of health care as fairly as possible in society. This would require equitable access to the
benefits of stem cell research, without regard to the ability to pay.
Several factors make it
unlikely, however, that there will be equitable access to the benefits of this
research in this country. Unlike other
western democracies, the United States does not have a commitment to universal
health care. Currently the trends are
in the opposite direction. 44.3 million
people (16.3% of the United States population) lack health insurance and
therefore do not have reliable access even to basic health care. Others are under-insured. Moreover, if stem cell research results in
highly technological and expensive therapies, health insurers may be reluctant
to fund such treatments.
Another factor complicating the
commitment to just access is the central role of the private sector in stem
cell development. The private sector
makes determinations about investments on the basis of potential
profitability. This has several
implications. The private sector will
not invest resources in potential applications that they consider lacking in
commercial value, but that may have considerable therapeutic promise. Commercial considerations will also affect
the pricing of stem cell products. Here
again, market concerns could raise prices, making stem cell therapies more expensive. Unless the federal government assumes a central role in setting
priorities and investing in stem cell research, some of the most needed
therapies may not be developed. These
justice considerations are a further reason for encouraging federal support for
stem cell research.
Problems of access and equity
are even greater on a global level.
Vastly unequal resources, differential standards of public health, and
uneven opportunities for health care within and between countries comprise
barriers to achieving even a semblance of distributive justice. The World Health Organization has reminded
member states that “justice demands equitable access to genetic services.” WHO
has also stated that “Genetic services for the prevention, diagnosis and
treatment of disease should be available to all, without regard to ability to
pay, and should be provided first to those whose needs are greatest.” It will be difficult to achieve these norms
in a global economy in which transnational corporations play a dominant role
and disparities of all types are ever growing greater.
Overcoming these hurdles and
assuring equitable access to the benefits of stem cell research in this country
will be a politically and financially challenging task. It is therefore appropriate to begin
considering how to do so now in advance of the development of
applications. Therefore, the federal
government should consider ways to achieve equitable access to the benefits
derived from stem cell research.
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| Contributed by: AAAS DoSER and the Institute for
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