A proposed constitutional amendment protecting stem cell research is likely to rise or fall on whether Missourians view a mass of cells in a Petri dish as a cure for disease or a human embryo worthy of protection.
But if critics of the measure have their way, voters this November also will wrestle with an entirely different ethical question.
Brochures mailed in recent weeks to more than 90,000 Missouri homes argue that research protected by the ballot measure would exploit women, luring them into the potentially dangerous practice of egg donation.
The viewpoint has made for strange bedfellows in the stem cell debate, aligning religious groups that oppose abortion with some women's health advocates.
"I can't remember the last time radical feminists lined up with me," said the Rev. Rick Scarborough, a Southern Baptist preacher who heads Vision America, a national group campaigning against the stem cell measure.
Scarborough's comment, made last week at a rally against the ballot measure, drew riotous laughter from the crowd who filled the pews of a Jefferson City church.
But supporters of the stem cell measure don't like the joke. They say religious conservatives are exaggerating feminist concerns about stem cell research. The Missouri measure addresses those concerns, they say, spelling out protections for women who donate eggs.
"This is a concocted issue by the opponents of the initiative," said Donn Rubin of Missouri Coalition for Lifesaving Cures, the lead supporter of the measure. "It's a distraction from what voters will actually be voting on in November."
The fight over egg donation and its relation to stem cell research centers on a process called somatic cell nuclear transfer, or SCNT.
During the process, the nucleus of a human egg is removed and replaced with the nucleus of another cell. The cell undergoes an electric shock, causing it to divide. The resulting mass of cells, or blastocyst, is used to produce stem cells, a key to fighting disease.
The ethical battle over SCNT has focused almost exclusively on the status of the blastocyst. Some regard the cells as human life, equating the process with human cloning. Others disagree, saying the cells would never form a viable embryo without first being implanted in a womb.
Opponents of the Missouri ballot measure say they recognize that many voters won't share their views on the definition of when human life begins. As a response, they are pushing the issue of egg donation, arguing that women face medical risks in providing the cells needed for research.
"There may be people who are morally neutral on the issue of cloning of embryos, but would have an issue with the exploitation of women," said Carrie Gordon Earll, a bioethicist for Focus on the Family, a national religious and policy group.
Earll prepared a brochure for Focus on the Family titled "Women's voices against cloning," recently mailed to more than 90,000 voters. Thousands more copies of the brochure are being handed out across the state by activists.
The brochure recounts the deaths of five women who suffered complications after egg extraction for in vitro fertilization. The same potentially dangerous process would be used to produce eggs for stem cell research.
The risks of egg extraction are tied to the use of drugs, which first shut down a woman's ovaries, then stimulate them to produce multiple eggs for harvesting. The drugs have multiple side effects, including blood clots and seizures. Though rare, the complications have resulted in death.
Criticism of brochure
Judy Norsigian is among the nearly dozen women's health advocates quoted in the brochure in opposition to somatic cell nuclear transfer. Norsigian is the head of Our Bodies Ourselves, a Boston-based women's heath care policy organization that supports abortion rights.
Norsigian said that until health concerns related to egg extraction can be addressed, somatic cell nuclear transfer should not be legal.
Nonetheless, Norsigian said she is frustrated that readers of the brochure might infer that she is against all forms of stem cell research. In fact, she supports research using eggs left over by fertilization clinics. She said religious conservatives are selective in how they represent her views, overstating her alignment with their position.
"They're using it to serve their purposes," she said.
The glossy, 16-page brochure focuses exclusively on women's health issues, making no mention of the religious questions surrounding embryos and cloning. The brochure urges voters to stand up against "scientific violence," saying "women's bodies are not biological objects for scientific use."
Emily Galpern, a bioethicist who focuses on stem cell research, said the brochure's tone is calculated to appeal to voters who aren't religious conservatives.
"One of our concerns is that conservative folks are co-opting feminist language to suit their cause," said Galpern, of the Center for Genetics and Society, based in California.
Galpern said she and many other women's health advocates have concerns about SCNT and egg extraction but would not ban the research.
Instead, Galpern calls for more regulation of egg extraction, such as providing donors full disclosure of the risks. She also would impose a ban on selling human eggs, a step many say would avoid the exploitation of impoverished women who might overlook the risks.
Rubin, who heads the Missouri campaign in favor of the ballot initiative, said the measure satisfies those concerns. The proposed constitutional amendment would ban the sale of eggs for research and require the informed consent of donors.
Those protections don't currently exist in state or federal law. Rubin said groups such as Focus on the Family are choosing to ignore that fact.
"If they cared about the problems of women and the fate of women, they would support the stem cell initiative," Rubin said.
Rubin said the brochure leaves the false impression that women's health groups are united against stem cell research.
In fact, several women's groups support the measure, including the Society for Women's Health Research, the National Women's Political Caucus of St. Louis and the Association of Reproductive Health Professionals.
Earll defends the brochure, saying it accurately quotes only those activists who want to ban somatic cell nuclear transfer. She said she recognizes that other women might support the research with proper regulation, "but this brochure isn't written for those women."
Bev Ehlen, of the group Missourians Against Human Cloning, has distributed hundreds of the brochures at events across the state. She said voters have been swayed by the concerns over women's health.
"It rates up there almost as high as human cloning when we explain it to women," she said.
Even so, Ehlen said she still believes the ballot measure will pass or fail based on voters' opinions about cloning and embryos, rather than fears over egg extraction.
"My own gut feeling is that very few people would make this the sole issue," she said.
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