Madam, – The recent report of the National Council on Bioethics has provided a platform for further and wider debate on the future of research using stem cells. It has provided a clear outline of the nature of such research, and outlined some of the current therapeutic applications of adult stem cells.
However, the report lacks a wider perspective on challenges to those with neurological disease, particularly those major brain diseases associated with ageing, such as Alzheimer’s and stroke. Susan Sontag has written eloquently about how negative social attitudes adversely affect how we approach illness, both personally and as a society. This is especially true for these brain illnesses of later life, where services are poorly developed, and popular, professional and societal attitudes often reflect a disparity of esteem for the personhood and moral status of those affected with such illnesses.
Much of the difficulty of appreciating personhood in dementia lies in an often utilitarian, hypercognitive approach to personhood, rather than a wider sense of what constitutes our human nature. This approach has been expanded by some moral philosophers to support rationing care away from those with Alzheimer’s disease, and another has likened people with dementia to dogs.
Thankfully, original thinkers, such as the late Tom Kitwood, have helped to show not only how we disqualify people with dementia by failing to capitalise on their abilities and the full breadth of their personhood, but also how to create person-centred care.
It is ironic that those with Alzheimer’s disease and stroke are quoted as primary targets for the use of embryonic stem cell treatments, as outlined by the council’s document. For their well-being and care is threatened by a lack of appreciation of their personhood: such a qualified approach to personhood is mirrored by a qualified (or, as they term it, a gradualist) approach to personhood at the beginning of life.
It is critical that vulnerability and co-dependency do not become disqualifying criteria for personhood, as we are all vulnerable and co-dependent in our own ways.
This philosophical and moral underpinning of care is all the more important given that Alzheimer’s disease and stroke represent groups of illnesses that may have a variable response to new stem cell therapies. This means that the excellence of existing, person-centred care will still need to be developed for most people with these illnesses for the foreseeable future.
Stem cell research holds great promise for our understanding and eventual treatment for the major neuro-degenerative illnesses of later life. However, it remains important that this is not done in a way which erodes the universality of our moral status as persons at the extremes of age, vulnerability and co-dependency. – Yours, etc,
Prof DESMOND O’NEILL,
Consultant Physician in
Geriatric and
Stroke Medicine,
Trinity College,
Dublin 2;
Prof MARTIN CLYNES,
Professor of Biotechnology,
Dublin City University,
Associate Professor,
Department of Medical
Gerontology,
Adelaide and Meath Hospital,
Dublin 24.