Let's start with stem cells. That may seem a strange place to begin thinking about torture, but many bioethical issues are at least as controversial and disputed as torture. Among the most controversial in recent years has been research that destroys embryos in order to procure stem cells for use in regenerative medicine. Those who oppose embryonic stem cell research have, in my view, made the right moral choice. The logic of that choice is worth examining, however, before we turn more directly to the issue of torture, for it is a choice that comes with certain costs.

It is still much too soon to say for sure whether the promise for regenerative medicine that some see in embryo-destructive research will be fulfilled or will lead to a dead end. Perhaps other approaches--using induced pluripotent stem cells or altered nuclear transfer--will make better scientific progress without the destruction of embryos, demonstrating that at least sometimes we can have our cake and eat it too. But perhaps not. Maybe these other approaches will fail to cure or ameliorate suffering from serious degenerative diseases, and embryo-destructive research will, in fact, turn out to be the "gold standard" its defenders often call it.

Even if things were to turn out that way, it would not mean that opponents of embryonic stem cell research had been wrong. It would simply mean that they had accepted the cost to which their moral beliefs committed them. They do not think that good results are the only--or even the most important--factor in determining how we ought to live. However fervently and sincerely they may hope that we find ways to relieve the condition of those who suffer, they do not take the further moral step of concluding that any and every avenue to that good end may be used. If this means that some suffering which could be relieved is not, then that is the cost, however regrettable, that a commitment to act rightly will sometimes exact.

This distinction, between what we do and what we accomplish, marks one of the fault lines in moral reasoning, and it reemerges time and again in bioethical argument. This was seen clearly and stated directly and forcefully when in the late 1960s bioethics first burst upon the scene in this country. Thus, in The Patient as Person (1973), one of the classic early works in bioethics, Paul Ramsey underscored the fundamental moral point: "There may be valuable scientific knowledge which it is morally impossible to obtain. There may be truths which would be of great and lasting benefit to mankind if they could be discovered, but which cannot be discovered without systematic and sustained violations of legitimate moral imperatives."

Embryonic stem cell research itself could not at that time have been on Ramsey's radar, prescient though he was in many ways. However, the ethics of medical research more generally surely was. A subject that received sustained attention in those early years of bioethics, it was the topic of a long and complicated chapter in Patient as Person. The thread that holds together the chapter's complications is the moral stance I have noted. The fact that both researchers and subjects are human persons "places an independent moral limit [independent, that is, of all possible good results flowing out of the research] upon the fashion in which the rest of mankind can be made the ultimate beneficiary of these procedures." That independent limit is the requirement that research subjects be able to give and actually do give a free and informed consent to their participation. If they cannot, the research ought not be done, however beneficial for others it might be--or so Ramsey, at any rate, believed.