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Wyatt Iwanaga
Professor Cvrkel
MCDB 50
16 March 2015
Stem Cell Banking
Stem cells have incredible potential to revolutionize the medical field. Both embryonic
stem cells (ES cells) and induced pluripotent stem cells (iPS cells) may be, in the future, able to
treat or cure diseases or conditions that are currently untreatable or incurable. There are several
problems currently facing cell therapy, some of which stem cell research has the ability to
alleviate. The problems of supply of cells, immune rejection of introduced cells, and delivery of
the cells in a functional manner. The first two are hypothetically solved by stem cells: both ES
and iPS cells can be replicated indefinitely in culture, alleviating the problem of supply, and iPS
cells are derived from an adult cell and therefore share the genetic information of the donor,
alleviating the problem of HLA-immunity, the system by which the body recognizes itself and
prevents an immune response from attacking normal body cells. However, even this stillhypothetical solution has problems, particularly that of immunity. Since iPS cells must be
cultured and developed in order to be effective, they would not be immediately available for time
sensitive treatments. Unfortunately, many of the diseases that have the potential to be cured by
stem cell therapy are also of this time sensitive nature, which makes iPS cells a less than
practical solution. Therefore, in all likelihood, stem cells will have to be banked in order to treat
those with such conditions. However, due to the aforementioned HLA-immunity, not all people
can be covered by such a bank unless it could store a huge number of haplotypes. Since this is
logistically impossible, the question arises: which people should be covered by this proposed

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bank? Because HLA haplotypes are often grouped racially, minority groups having the most
diverse haplotypes, a strategy that simply maximizes coverage would favor the racial majority.
In the United States, where minority groups have been historically oppressed, this raises serious
ethical difficulties in deciding which haplotypes to bank.
In order to solve this problem, I suggest a policy of stem cell banking in which a lottery is
held. A lottery would be held in every electoral district for the House of Representatives. This
will ensure, at least to some extent, that the resources are divided equally according to
population. Each person in the electoral district will have the same chances of being selected,
and therefore roughly the same chances as anyone in the nation. The lottery will select a number
of people equivalent to the maximum number of haplotypes that can be banked using resources
equally distributed among the districts, regardless of a districts diversity or homogeneity. The
haplotypes of these people will be analyzed, and used as templates to be banked. In the event
that duplicate haplotypes, or haplotypes that are at least mutually compatible to a large degree,
are selected within the same district, one will be chosen at random to bank and the rest will be
eliminated and more drawn in their place. After haplotypes for the bank have been selected,
those haplotypes will be banked within the districts from which they were selected. As
mentioned, banking resources will be distributed equally among all districts. If, for some reason,
local laws prohibit the development, research, or use of stem cells within a district, resources
from that district will be redistributed to other districts equally. If a district has such laws in only
a portion of its area, resources will be redirected proportionally. That is, if 60% of the population
lives in an area within a district that permits stem cell research, use, and development, it will be
given 60% of the resources available to a district with no such restrictions. This will be
continually evaluated with each election in which representatives to the House are decided.

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This policy, I admit, is not perfect. It is, in my own view, neither the strongest ethically
nor politically. However, this sacrifice comes as a necessary cost of compromise. Had I
proposed the strongest ethical policy, it would have had no chance of succeeding politically,
while the strongest political option was too morally objectionable to consider seriously. Two
proposals that could be considered stronger from a moral standpoint are commonly referred to as
the equal opportunity strategy and the ethnic/ancestral representation strategy. The first, in
which a lottery of all haplotypes or compatible haplotype groups would be held, would allow
people with rare haplotypes to have the greatest chance of being banked. While this would give
those disadvantaged with a rare haplotype the greatest benefit, and therefore be preferable in
terms of Rawlsian justice, it would give unequal representation due to the uneven nature of
haplotype distribution. Those in common haplotype groups, which represent thousands, would
be given the same collective chance as those in rare haplotype groups, which may only represent
dozens, meaning the individual probability of being chosen is much lower for the former group.
While it may be just according to Rawls theory, I do not believe the average American would
find it politically palatable to have such a disparity in individual odds. In addition, the strategy,
while being completely fair, would probably save far fewer lives than other strategies, another
reason this ethically strong policy fails politically. The second strategy mentioned, the
ethnic/ancestral representation strategy, attempts to use Rawlsian justice along ancestral lines. It
proposes equal percentages of each ethnic group be represented. However, this means some
ethnic groups, specifically those with the greatest diversity in haplotype, would have far more
representation in the haplotype bank itself, in order to cover a given percentage. This would be
highly objectionable to groups with more homogenous haplotype distributions, as well as to
those with rare haplotypes within their ethnic groups, as they would stand no chance of being

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chosen. Only those with the most common haplotypes for their ethnic group would be selected
in order to maximize the percentage of all ethnic groups. This leaves obvious political
objections, though it is certainly probable that people in historically disadvantaged groups stand
to benefit, which would again be preferable according to Rawls theory. There is also the
problem of how to categorize ethnicities to consider, something which I doubt could be done
without much debate. Mixed race individuals seem to have no place in this scheme, as they both
often have extremely rare haplotypes and do not fit into ethnic or ancestral categories nicely.
Thus, this strategy, while ethically stronger than my own proposed theory, has as many or more
political obstacles as the equal opportunity strategy. With the two strongest opponents of my
policy in terms of ethics left unviable politically, I turn to the strongest political opponent, the
coverage maximization strategy. I mentioned it briefly in introducing the subject as an example
of why ethical problems are raised, and I believe it to be simple enough to restate fairly briefly: it
would simply bank as many of the most common haplotypes as possible in order to cover the
maximum number of people. The political power of this argument is undeniable. Indeed, by
nature, it stands to benefit a majority of people in a democratic society. However, as both the
equal opportunity and ethnic/ancestral representation strategies attempted to address, it leaves
both those with rare haplotypes and those in historically disadvantaged ethnic groups severely
underrepresented. If its ethical problems can be made clear to the public, this strategy becomes
much less appealing and loses its political power. Therefore, the three major policies, as it
stands, are unviable in one of the two categories. My proposed strategy, incorporating equal
individual chance, seeks to find an ethical and political middle ground between these two sides,
something which is both politically and ethically viable. Though it is not the strongest in either,
it is the strongest overall, and should therefore be adopted.

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The strongest objection to my argument lies in the balance it attempts to find between
ethical and political considerations. Simply because it is a viable political strategy and commits
fewer moral wrongs than the coverage maximization strategy, does not mean it is preferable or
even acceptable. My strategy has the potential to save fewer people than either the coverage
maximization strategy or the ethnic/ancestral representation strategy. It does nothing for the
historically underrepresented groups, unlike the latter. While it does give a chance to those with
rare haplotypes, does not do as much for them as the equal opportunities strategy. In all of these
areas, it is morally objectionable compared to the other strategies. Because of this, it can be said
that my strategy is no better than the maximization of coverage strategy, as it trades away ethical
strength for political favor. The argument can be made that it does this without proportional
return compared to the ancestral/ethnic representation strategy, which, as the only common
argument to seek a middle ground between coverage and fairness, is essentially the strongest
policy that opposes my own.
In response to these possible detractions, let me explain the reasoning behind my
compromise. I make no claims as to the perfection of this reasoning; it is up to the reader to
decide whether my compromise is one worth making or not. First, saving the maximum number
of people, while politically appealing, is not a moral imperative if the methods are immoral.
While it is true that the less morally objectionable strategy of ethnic/ancestral representation has
the potential to save more people, I believe this strategy to be more deeply flawed than my own.
The same holds for the equal opportunity strategy. It is true that the justification used for both of
those strategies is Rawlsian justice. I do not intend to debate Rawlsian theory in this context, so
to give those theories the strongest possible footing, I will assume it to be correct, though this
does put my policy at an ethical disadvantage. However, the idea of Rawlsian justice is not a

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popular one. The idea of minority groups receiving greater representation is one that those who
do not benefit will resent, whether those groups have been historically underrepresented or not.
The idea of compensating for historical underrepresentation through overrepresentation is one
that may be justified by Rawlsian justice, but the idea will seem unfair to many, especially given
the short collective memory of society, and will create resentment. The creation of more
resentment will lead to these options being politically unpopular, but I also argue that it will
result in the exact opposite of what they hope to accomplish. The resentment will lead to deeper
divides and though the minorities may benefit nominally, the core problem is not being solved.
Overrepresentation of minorities will lead to a patronizing attitude in the majority at best and
outright hostility at worst. Of course this resentment is not justified, but the fact is that it exists.
So, while it is true that overrepresentation may be justified in terms of the nominal benefits in a
Rawlsian view of the situation, the actual effects are dubious and the political effects are
certainly detrimental. Thus, I believe my policy to be the strongest combination of political
viability and ethical strength, with no chance for resentment to be created beyond what people
may already resent about population representation in the House of Representatives. Of course, I
do not believe this policy to be perfect, and it is probably not even the best possible compromise.
However, it is, I believe, the most balanced fair and practical policy of the four discussed.