Embryonic stem cell research, which uses special cells found in three- to five-day-old human embryos to seek cures for a host of chronic diseases, has sparked a major moral and political debate in the United States. In the 10 years since University of Wisconsin scientists announced they had harvested potentially life-saving cells from surplus embryos donated by fertility clinics, the ethical dilemma presented by the studies has absorbed activists on both sides of the issue and has risen to the top of state and federal political agendas.

For patients and their families, embryonic stem cell research offers the hope of cures for chronic and debilitating conditions, such as juvenile diabetes, Alzheimer’s disease, Parkinson’s disease, spinal cord injuries and blindness. For scientists, it represents a revolutionary path to discovering the causes and cures for many more human maladies. Embryonic stem cells are pluripotent, that is, they have the unique ability to develop into any of the 220 cell types in the human body. In addition to their versatility, embryonic stem cells are easier to grow in the laboratory than adult stem cells. (See The Science Behind Stem Cell Research.¹ )

But many opponents, including some religious leaders, believe that stem cell research raises the same moral issues as abortion. Furthermore, opponents maintain that scientists have other promising ways of reaching the same goals, including non-controversial adult stem cell research. (See The Case Against Embryonic Stem Cell Research: An Interview with Yuval Levin.² ) But proponents (see The Case For Embryonic Stem Cell Research: An Interview with Jonathan Moreno.³) of the research point out that there is no substitute at this time for research using embryos. In addition, they say, the research has resulted in the destruction of only a few hundred embryos, making it fundamentally different from abortion, which results in the destruction of millions of human embryos every year.

Different religious groups hold a wide variety of opinions on embryonic stem cell research. (See Religious Groups’ Official Positions on Stem Cell Research.⁴ ) For the Catholic Church and many other Christian groups, life begins at conception, making the research tantamount to homicide because it results in the destruction of human embryos. “Human embryos obtained in vitro are human beings and are subjects with rights; their dignity and right to life must be respected from the first moment of their existence,” the late Pope John Paul II wrote in his 1995 encyclical, The Gospel of Life. Other religious groups do not take a position on the issue, and some, including many Jewish and more-liberal Christian groups, support embryonic stem cell research.

National polls indicate that a slim majority of Americans support the research. According to a 2007 national poll by the Pew Forum on Religion & Public Life and the Pew Research Center for the People & the Press, 51 percent say it is more important to conduct stem cell research that could result in new medical cures than to avoid destroying the potential life of human embryos. The same poll found that 35 percent say it is more important not to destroy embryos.⁵

As the pace of the cutting-edge research quickens and the prospect for cures moves closer to reality, advocates on both sides of the debate see the possibility that, within a few years, scientists will find a way to harvest stem cells without destroying embryos. In late 2007, researchers in Wisconsin and Tokyo announced they had transformed ordinary human skin cells into those that appeared to have the same properties as embryonic stem cells. Religious leaders hailed the discovery as proof that the destruction of embryos is unnecessary. President George W. Bush, in his 2008 State of the Union address, said the groundbreaking new research “has the potential to move us beyond the divisive debates of the past.”

But far from resolving the moral quandary, the highly publicized breakthrough has only intensified the discussion. Scientists around the world quickly cautioned that, although promising, the new research did not guarantee that adult stem cells could successfully be transformed into pluripotent cells. Many, including James Thomson, the researcher who led the team at the University of Wisconsin, publicly argued that embryonic stem cell research should continue.

In Europe, only the United Kingdom, Sweden and Belgium allow all forms of embryonic stem cell studies. On the other end of the spectrum, Austria, Ireland, Poland and Lithuania have outlawed all forms of stem cell research. Germany and Italy have criminalized the extraction of stem cells from human embryos, but scientists are permitted to conduct research on stem cells created elsewhere. Denmark, Finland, France, Greece, Spain and the Netherlands restrict scientists to producing stem cell lines from surplus embryos that fertility clinics plan to destroy. (See Stem Cell Research Around the World.⁶ )

Political Debate in the U.S.

In the United States, the primary question is whether the federal government should fund embryonic stem cell research. Unlike Japan and most European countries, no federal laws actually limit the research, although six states – Arkansas, Indiana, Louisiana, Michigan, North Dakota and South Dakota – prohibit the creation or destruction of human embryos for medical research.

At the national level, most Democratic politicians favor federal funding of embryonic stem cell research, including Democratic presidential candidate Sen. Barack Obama of Illinois. In 2005, Obama voted for legislation that would have allowed federal funding for stem cell research using embryos slated to be discarded from fertility clinics. Bush vetoed the bill.

The issue has split Republican lawmakers. Some oppose any research that involves the destruction of human embryos. Kansas Sen. Sam Brownback and former Pennsylvania Sen. Rick Santorum, for example, are vocal opponents of the research. Others, including Republican presidential candidate Sen. John McCain of Arizona, favor certain aspects of the research. For example, McCain supports federal funding not only for adult stem cell research but also for research using embryos slated for destruction by fertility clinics. Still other high-profile Republicans are vocal supporters. Former first lady Nancy Reagan, who watched her husband, President Ronald Reagan, succumb to the devastating effects of Alzheimer’s disease, has joined other patient advocates in seeking federal funding for embryonic stem cell research. Even staunch abortion opponent Sen. Orrin Hatch of Utah has proposed legislation to support this research.

Still, powerful forces on both sides of the issue have created a deadlock in Washington, D.C., over the funding issue. In 2006 and 2007, for instance, Bush vetoed bipartisan bills that would have unlocked federal funding for the research. Meanwhile, attempts in the U.S. Congress to ban any research involving human embryos have repeatedly failed.

With a stalemate in Washington, much of the debate has shifted to state capitals. At least seven states saw the shortage of federal funding as an opportunity: By investing in the nascent science, they hoped to attract top scientists and incubate what experts predict will be a new multi-billion-dollar biotechnology industry.

In early 2004, New Jersey became the first state to invest in stem cell research. California followed in November of the same year, when voters approved a $3 billion bond measure to fund the research. Over the next two years, Connecticut, Illinois, Maryland, New York and Wisconsin joined the list of states making a commitment to fund stem cell research. Three states – Iowa, Massachusetts and Missouri – made the research legal but did not offer state funding; Massachusetts lawmakers are currently considering an investment in the science.

While these states have taken action to move forward on stem cell research, the issue is unsettled in much of the country. Because the U.S. government allows the research as long as no federal money is spent, state universities and private, nonprofit and corporate laboratories are free to pursue it, except in states that prohibit it.

History of the Debate

Embryonic stem cell research first drew widespread media attention in 2001 when Bush, under pressure from both opponents and supporters, attempted to forge a compromise. That compromise entailed allowing the nation’s medical research underwriters, the National Institutes of Health (NIH), to begin funding these studies using stem cells harvested from surplus embryos before Aug. 9, 2001, the date of his decision.

Religious opponents, who had argued for a federal ban, were disappointed, while scientists complained that most existing stem cell lines (cultured embryonic stem cells grown in a Petri dish) were either contaminated or dying.

Although most Americans became aware of the issue once Bush made his controversial funding decision, the ethical debate over research involving human embryos began much earlier. In the mid-1970s, for example, federal policymakers prohibited funding for so-called test tube babies, laying the groundwork for future discussions of whether the U.S. government should fund research that many people consider immoral.

Around the same time, the U.S. Supreme Court handed down its 1973 Roe v. Wade decision legalizing abortion. That historic decision mobilized abortion opponents, many of whom would later oppose stem cell research because of what they consider to be the destruction of human life.

Some two decades later, President Bill Clinton approved, for the first time, funding of stem cell research involving surplus embryos from fertility clinics. At the same time, he placed a moratorium on support for research involving human cloning, a restriction Bush extended in 2000.

In 1995, Congress overrode Clinton’s decision to fund some types of stem cell research, enacting an appropriations rider, still on the books today, that prevents NIH from funding any research that harms or destroys human embryos. Bush sidestepped this law in 2001 when he allowed funding for stem cell lines that already had been created, also assuring many of his supporters that no new embryos would be destroyed.

Opponents of embryonic stem cell research object to two basic techniques: harvesting stem cells from human embryos, and creating cloned human embryos from a human egg and an adult donor cell – a technique called somatic cell nuclear transfer. In both cases, the embryo is ultimately destroyed.

Although many abortion opponents oppose both techniques, some supporters say harvesting potentially life-saving cells from embryos that otherwise would be destroyed is justified. But some supporters of the research also argue against the creation of embryos for the sole purpose of harvesting cells and then destroying them.

Bioethics experts say the stem cell debate marks the first time in U.S. history that medical science has played such a prominent role in electoral politics. Indeed, the issue had a significant impact on the 2006 U.S. Senate election in Missouri, where voters debated and ultimately approved a proposed state constitutional amendment ensuring the legality of embryonic stem cell research. Missouri Democrat Claire McCaskill, who supports the research, ousted Republican incumbent and stem cell research opponent Jim Talent in part because of their differences over this issue. McCaskill backed the first-in-the-nation amendment; Talent opposed it.

If the next president decides to drop Bush’s restrictions on stem cell funding, Congress could press again for federal money. But with an economic downturn and a growing budget deficit, competition for NIH funding is expected to be stiff. Even without federal money, however, state and private investment in stem cell studies is expected to continue.

Notes

¹ The Science Behind Stem Cell Research

² The Case Against Embryonic Stem Cell Research: An Interview with Yuval Levin

³ The Case For Embryonic Stem Cell Research: An Interview with Jonathan Moreno

⁴ Religious Groups’ Official Positions on Stem Cell Research

⁵ Declining Majority of Americans Favor Embryonic Stem Cell Research

⁶ Stem Cell Research Around the World

In the 10 years since University of Wisconsin scientists announced they had harvested potentially life-saving stem cells from human embryos, the bioethical dilemma presented by the science has stymied the federal government, split the GOP and prompted debate in nearly every statehouse in the country.

Now, as the pace of new scientific discoveries in the field quickens, seven states — California, Connecticut, Illinois, Maryland, New Jersey, New York and Wisconsin — are leading the world in financial and political support for stem-cell research, and Massachusetts is poised to join them .

Three — Iowa, Massachusetts and Missouri — have made the research legal, but not offered state funding, while six — Arkansas, Indiana, Louisiana, Michigan, North Dakota and South Dakota — have taken the path of most developed countries and restricted the studies.

President Bush and other opponents argue that stem-cell research that results in the destruction of human embryos is immoral. Scientists, patients and their advocates seek the freedom and resources to conduct this embryonic research they say could cure diseases that affect millions of Americans.

With powerful forces on both sides, Washington has remained stalled.

“The lack of federal leadership leaves a vacuum that states are trying to fill on a very piecemeal basis,” said Michigan state Rep. Andy Meisner (D), who has to tried to repeal his state’s ban on the research for the past four years.

Bush said in his State of the Union Address Jan. 28 that groundbreaking new stem-cell research in which ordinary skin cells could replace the use of human embryos “has the potential to move us beyond the divisive debates of the past.”

But far from resolving the moral quandary, last November’s highly publicized breakthrough has escalated the discussion. Scientists around the world quickly cautioned that years of work remained to perfect the promising new technique, and continuing parallel work on embryonic stem cells is an essential part of that process. While they unanimously agreed the new skin-cell work is groundbreaking, scientists said many questions remain, including whether the method can be safely used for human therapies.

Even if federal funding for the new skin-cell studies is expanded, as Bush suggested in his address, scientists say they also would need money to continue embryonic studies.

Since August 2001, when Bush allowed limited federal funding of the embryonic stem-cell research, Congress has been unable to open up more federal dollars, despite pressure from the scientific community and support from a majority of Americans. Congressional attempts to ban the science also have been unsuccessful, making the research legal unless prohibited by state law.

In January 2004, New Jersey was the first to underwrite embryonic stem-cell research, appropriating $10 million and taking on a role historically held by the federal government’s esteemed National Institutes of Health (NIH). California came next with its November 2004 voter-approved fund of $3 billion and immediately outstripped all other investors.

Other states followed. In the last two years, states have distributed some $230 million in grants — more than three times as much as the federal government spent on embryonic stem-cell science in the same period — and there has been no shortage of scientists seeking the funding. Over the next decade, states are committed to spending nearly $5 billion on the science and Massachusetts may add another billion.

Since 2001, nearly every state has bitterly debated the question of whether the work should be banned for moral reasons or supported for its potential to cure many of the world’s chronic and debilitating diseases.

Also at stake in deciding whether to support the research is the nation’s longstanding leadership role in medical science and states’ eagerness to claim a piece of an exploding new field that could bring high-paying jobs and big investments in universities and businesses.

“State policies will determine which states will become magnets for high-tech research and which will become irradiated zones for the same kind of research,” said Daniel Perry of the Alliance for Aging Research, a citizen advocacy group for stem cell research.

National polls indicate a majority of Americans approve of the research, which uses cells found in four-day old human embryos that can transform into cells that form tissue from any organ of the body. Scientists say these so-called pluripotent stem cells hold the key to discovering the causes and cures for conditions such as juvenile diabetes, blindness, spinal paralysis, Lou Gherig’s, Alzheimer’s and Parkinson’s disease.

Read the complete backgrounder, including a time line of happenings in the stem cell debate, a glossary of stem-cell related scientific terms, a summary of ethical questions raised by advances in stem cell research and a detailed description of the evolution and current state of stem-cell related state policies.

Far from resolving an epic moral quandary, last year’s groundbreaking discovery that ordinary skin cells eventually could replace the use of human embryos in stem-cell research actually stoked the fiery debate over the cutting-edge science.¹

Much of that battle is being waged in state capitals.

At the forefront, seven big states are leading the world in political and financial support for embryonic stem-cell research.

Their goal: Attract the best stem-cell scientists from around the globe and become a hub for a multi-billion-dollar bioscience industry. So far, their plan appears to be working.

In the past two years, California, Connecticut, Illinois, Maryland, New Jersey, New York and Wisconsin have awarded some $230 million in grants — more than three times as much as the federal government spent on embryonic stem-cell studies in that time — and there has been no shortage of scientists seeking the money.

Three more states — Iowa, Massachusetts and Missouri — have affirmed the legality of the research in hopes of keeping or encouraging scientists to work within their borders.

But six others — Arkansas, Indiana, Louisiana, Michigan, North Dakota and South Dakota — now ban studies that result in the destruction of human embryos, and Arizona bars state funding for embryonic studies. These states have positions closer to those of Japan and most European countries.

Except in these states, work on embryonic stem cells is free to go on in the United States at places such as universities and private, nonprofit and corporate laboratories — as long as no federal money is involved. But states that want to be players in the nascent stem-cell arena are finding they must ante up with state financing and a science- friendly environment.

Polls indicate a majority of Americans approve of embryonic stem-cell research, which explores special cells in 5-day-old embryos that have the unique ability to transform into cells from any organ tissue in the body. Scientists say these so-called pluripotent cells hold the keys to discovering the causes and cures for many human ailments, including Alzheimer’s, Parkinson’s and Lou Gehrig’s disease, juvenile diabetes, blindness and spinal-cord and brain injuries.

But President George W. Bush, the Catholic Church and right-to-life groups have cited the same moral objections they raise to abortion in demanding that human embryos — which they regard as the beginning of life — not be sacrificed, even in a search for cures to save human lives. Instead, they pressed for research into non-controversial adult stem cells.

The latest discovery satisfies those with moral objections and dramatically tips the balance toward more work on skin cells. But for scientific reasons, embryonic studies won’t be abandoned just yet.

Embryonic stem-cell research is still the “gold standard” for scientists, said Jonathan Moreno at the University of Pennsylvania’s Center for Bioethics. “Everyone is saying the future is with the new cells. But we’re not in the future yet. It’s going to take several years to get there.”

Scramble for scientists

Among states seeding the fledgling science, California is the bellwether with a $3 billion fund of taxpayer dollars being spent to build world-class research labs and lure leading stem-cell scientists to the sunny West Coast. When all seven states’ investments are totaled, the commitment comes to nearly $5 billion over the next 10 years. Massachusetts could add another $1 billion.

States with a financial and political climate that welcomes embryonic stem-cell work may shift more emphasis to the new techniques, but existing investments in embryonic studies will continue as well. “States that have chosen to fund the research are in an ideal position,” said Bernard Siegel, founder of the Genetics Policy Institute, a nonprofit stem-cell advocacy group. “Scientists are energized by the new developments, and many of the best and brightest already are flocking to California and other states with generous grants and friendly science policies.”

Read the complete story at stateline.org.

This article was excerpted from “State of the States 2008,” Stateline.org’s annual report on significant state policy developments and trends. The 72-page report will be published Jan. 16. You can order a print copy, while supplies last. Or register for a PDF version.

Notes

¹Religious opponents hailed the skin-cell breakthrough as proof that research involving the destruction of embryos is unnecessary and must end. Scientists countered that studies on stem cells harvested from human embryos must continue for at least several more years while the new technique is perfected. A subsequent report, published in a scientific journal Jan. 11, revealed that stem cells had been produced from human embryos in a private U.S. lab without destroying the embryos, adding to already mounting enthusiasm for the science although that technique may not hold as much promise as the skin cell method, because it is more difficult to perform, scientists say. In addition, religious leaders strongly objected to early reports of the research in 2006, and administration officials so far have said the federal government is not likely to approve it for funding.

University of Michigan stem cell scientist Sean Morrison recently got a telephone call from a woman offering to donate her leftover embryos from a fertilization procedure for his studies on Parkinson’s disease. What she didn’t know was that Michigan law prohibits research on human embryos. Morrison suggested that the woman contact a lab in another state.

Next door in Illinois, Gov. Rod Blagojevich (D) is promoting embryonic stem cell research in an effort to lure scientists and investors, in some cases from neighboring states. In 2005, Blagojevich sent a letter urging Missouri’s top scientists to move to Illinois rather than work under a cloud created by Missouri legislators’ ultimately unsuccessful efforts to ban research on human embryos.

“The lack of federal leadership leaves a vacuum that states are trying to fill on a very piecemeal basis,” said Michigan state Rep. Andy Meisner (D). He is trying for the third year in a row to amend 1978 and 1998 Michigan statutes so that the nascent research can go forward in the job-hungry state’s acclaimed medical research institutions.

Some religious leaders and social conservatives see things differently. Instead of seeking cures for chronic and debilitating diseases by pursuing research that destroys human embryos, they maintain scientists should conduct equally promising research such as non-controversial adult stem-cell studies.

President Bush’s decision Wednesday (June 20) to again veto legislation that would allow federal funding of embryonic stem cell research puts the issue squarely in states’ hands.

In response to Bush’s 2001 decision to curtail federal funding of stem cell research and his first veto in July 2006 of a bill that would permit federal funding of the studies, states have taken widely diverging positions on the issue.

Seven states — California, Connecticut, Illinois, Maryland, New Jersey, New York and Wisconsin — are providing seed money for the fledgling science, and Massachusetts Gov. Deval Patrick (D) in May called on lawmakers in his state to follow suit. Six other states — Arkansas, Indiana, Louisiana, Michigan, North Dakota and South Dakota — ban the research. Three states — Iowa, Massachusetts and Missouri — have affirmed its legality but do not offer funding. In Florida and Texas, lawmakers are deadlocked on the issue. Most states have steered clear of it altogether.

Recent national polls indicate a majority of the American public favors federal support of embryonic stem cell research and in last year’s elections both Democratic and Republican political candidates consistently beat back their anti-stem cell competitors.

Read the full report, including a detailed rundown of where states stand on the issue, at stateline.org.

The 2008 presidential election is still more than a year-and-a-half away, but some issues, such as the war in Iraq and health care, have already begun to define the contest. Others will emerge in the months ahead to catch the attention of candidates and the electorate, and at least some of these will likely belong to the clutch of issues that fuel the nation’s so-called “culture war.”

Culture war issues tend to transcend mere public policy questions, aiming instead at voters’ core ethical and religious values. Spanning a host of policy areas, they include abortion, homosexuality, certain kinds of biomedical research, physician-assisted suicide, church-state separation and the death penalty. While these and other issues will all receive some attention during the coming campaign, most will probably not have a significant impact on the outcome of the election.

Indeed, a survey conducted last year by the Pew Research Center for the People & the Press found that the biggest such issues, abortion and gay marriage, were not priorities for voters, ranking at the very bottom of a list of 19 issues that voters deemed important. Education, the economy and national security issues were among those at the top.

On the other hand, culture war issues can vault to a much higher place on voters’ priority lists, particularly during presidential contests, when events bring them to the fore. For instance, the same-sex marriage debate rose to prominence in March 2003, when the highest court in Massachusetts stunned the nation by mandating the legalization of same-sex marriage, making that state the first to grant homosexuals the right to marry. The Massachusetts decision was subsequently amplified by events in cities and towns like San Francisco, Portland, Ore., and New Paltz, N.Y., where officials began granting marriage licenses to gay couples even though, as it turned out, they had no authority to do so. All of this produced a reaction from religious and social conservatives, leading in 2004 to an unsuccessful drive in Congress to constitutionally ban gay marriage. That same year, voters in 13 states (11 on Election Day) approved state constitutional amendments banning same-sex marriage.

This chain of events put the same-sex marriage issue squarely on the agenda during the 2004 presidential campaign, forcing both President Bush and Sen. John Kerry to address the issue repeatedly, and ultimately aiding President Bush in his bid for re-election. To begin with, the referenda helped to mobilize the conservative, church-going vote in the 11 states where the issue was on the ballot, helping the president to win nine of these states. And although he had picked up the same nine states in 2000, he won them by an even greater margin in 2004, winning an average 2% more of the total vote in these states.

A similar dynamic seems to have unfolded throughout the country. A CNN exit poll conducted on Election Day found that the largest number of voters, 22%, cited “moral values” as the issue that most influenced their decision, more than “terrorism” or “the economy/jobs.” And among these, 80% voted for Bush. Later analysis by the Pew Research Center for the People & the Press showed that the number of values voters may have been somewhat inflated. People who participated in the exit poll could only choose from seven issues. “Moral values” was the least specific choice offered and the most likely to be a catch-all for many of the issues not listed, such as the candidates’ integrity or leadership ability. Regardless of the true number, the fact that moral values ranked high among voters’ most important concerns is significant.

Perhaps most significantly, the gay marriage issue seems to have had an important impact in Ohio, the state that ultimately swung the election for the president. Here, having same-sex marriage on the ballot may have made the difference for the president, who won Ohio by a very slim margin. In particular, Bush’s share of the state’s black vote nearly doubled, from 9% in 2000 to 16% in 2004. Much of this increase is attributable to a nearly 20% increase in the share of very religious, church-going African-Americans who voted for the president. During the campaign, a substantial number of socially conservative black pastors in Ohio were urging their congregants to consider the gay marriage issue when they voted, which may have contributed to this boost in black support for the president.

Looking to 2008

At the moment, there is no indication that culture war issues will have the electoral impact that same-sex marriage did in 2004. At the same time, it is not too soon to look at possible ways in which some issues might insert themselves into the campaign. Two obvious choices, in addition to same-sex marriage, are abortion and stem cell research, issues that have consistently been in the news during the last few election cycles.

Abortion is still the 800-pound gorilla of the culture war. Indeed, the Supreme Court’s 1973 Roe v. Wade decision, which established a constitutional right to abortion, is generally thought to be a major factor in prompting conservative Christians to become more politically active.

Yet, despite its political weight, abortion often remains quiescent, in part because many candidates seeking national office raise the issue infrequently, and shy away from taking a clear position on it when they do. For instance, President Bush has tried, during past electoral campaigns, to reach out to both social conservatives and centrists, talking about his support for a “culture of life” on one hand, while also stating that “Roe v. Wade is the law of the land.” Senator Kerry made a similar effort during the 2004 campaign, expressing his support for a woman’s right to choose an abortion, while at the same time stating that he believes that “life begins at conception.”

These efforts, at least in part, reflect the fact that no large and forceful majority resides on either side of the issue. For instance, an August 2006 poll by the Pew Research Center and the Pew Forum on Religion & Public Life showed that a bare majority of Americans, 51%, believe abortion should be available in all or most cases, compared with 46% who say it should be illegal in all or most cases. At the same time, two-thirds of Americans say that the nation needs to find a “middle ground” when it comes to abortion.

But, as with same-sex marriage, events beyond the candidates’ control could push abortion onto the 2008 agenda. Sometime in the next two months, the Supreme Court will rule on a pair of cases that challenge the constitutionality of the federal law banning what opponents call partial birth abortion. These cases offer the court an opportunity to rethink and possibly re-write a substantial piece of abortion jurisprudence. While Roe itself would not be directly overturned, the partial birth rulings could lead to the elimination of the “health exception,” the requirement, first set down in Roe, that any law restricting access to abortion, such as the partial birth ban, allow for a waiver in cases where a mother’s health is in danger.

While there is little argument that limits or restrictions on abortion should be waived if a mother’s life is in danger, the health exception is far more controversial. Anti-abortion advocates say that allowing abortion restrictions to be waived for health concerns essentially eviscerates the law because a doctor can determine that almost anything, including emotional stress, will impact a woman’s health. As a result, anti-abortion advocates in Congress did not include a health exception in their legislative ban, thereby laying the cornerstone for a constitutional challenge to the law.

If the Federal Partial Birth Abortion Ban law is upheld, except for the narrowest of reasons, and the court rules that the health exception is not necessary, it would lead to a dramatic shift in what states can and cannot do to restrict abortion. States could then pass restrictions that would be easier to enforce, and many state legislatures, especially in the more conservative South and Midwest, would most likely attempt to amend existing laws to exclude the health exception. For pro-abortion-rights forces, such a ruling would be seen as nothing short of disaster, prompting them to pull every alarm within reach in an effort to bring the issue squarely into the limelight.

These circumstances could dramatically raise abortion’s profile in the coming campaign. Some of the current crop of presidential candidates may be forced to confront the issue more directly than Bush and Kerry ever had to. For instance, Democratic Sen. Hillary Clinton, who is pro-choice, but lately has raised some liberal eyebrows by calling abortion “a tragic choice,” might feel compelled to eschew any rhetoric that might be interpreted as an effort to triangulate. Or former Massachusetts governor and GOP hopeful Mitt Romney, who recently declared that he had changed his mind on the issue and no longer supports abortion rights, might find his shift in position subject to much greater media and voter scrutiny.

On the other hand, while a candidate like Rudolph Giuliani who supports abortion rights might be hurt in the primaries, he could be helped in the general election by a pro-life victory in the Supreme Court. The former New York mayor might then be the best positioned among the GOP contenders to reach out to centrists, who despite having some moral qualms about abortion, might not want Roe to be overturned or made meaningless.

As in the case of abortion, the place of gay marriage in the coming campaign will also depend on future events. In the coming year, high courts in California, Maryland and Connecticut will determine whether their state constitutions guarantee gay people a right to marry. If one or more of these courts, especially in the nation’s most populous state, California, decide in favor of gay marriage, it could elevate the importance of the issue in 2008.

Here are some possibilities: Polls show that a majority of Americans (usually between 55% and 65%) oppose same-sex marriage. At the same time, a small majority also supports civil unions. So a decision by these state courts to follow the lead of Massachusetts and mandate gay marriage could raise the ire of a substantial portion of the electorate, especially religious voters.

If gay marriage became a bigger issue, Republican presidential candidates who are associated with opposition to same-sex marriage could benefit, especially in the GOP primaries. One possible beneficiary would be Gov. Romney, who won plaudits from social conservatives for leading the fight against gay marriage in Massachusetts after the 2003 court decision.

Other leading Republican candidates could potentially be hurt by a greater emphasis on same-sex marriage, especially in primaries in more conservative states. Although Giuliani, for instance, opposes gay marriage, he supports gay rights (including civil unions), has marched in gay pride parades and even lived with a gay couple for a time. And while Arizona Sen. John McCain also opposes gay marriage, he voted against the federal marriage amendment in Congress.

No similar legislative or legal event on the horizon appears likely to vault the stem cell issue into the spotlight, not even the current Senate debate on legislation that would relax federal regulations on federal funding of such research. However, polls show that Americans are becoming increasingly aware of the controversy and several states, including California and New York, are already funding stem cell research while others are considering loosening research restrictions. Further, a majority of the public supports stem cell research, including research employing embryos (56% in a recent PRC/Pew Forum poll), as do all major Democratic and some Republican presidential candidates. As a result, it could become an important — if not major — issue in 2008 should any of the candidates choose to highlight it.

The stem cell debate gained prominence in the political arena after President Bush issued an executive order in 2001 prohibiting federal research money from being used to experiment on new embryonic stem cell lines. By 2004, Democrats were pushing to bring the issue into the presidential campaign. Most notably, the Democratic vice presidential candidate, North Carolina Sen. John Edwards, caused a stir by claiming that if John Kerry were elected president, quadriplegic actor Christopher Reeve “would walk again.” Ronald Reagan Jr., also made news, appearing at the Democratic Party’s nominating convention to call for greater funding for embryonic stem cell research.

In the 2006 campaign, the stem cell issue gained some electoral traction and may have had an impact on races in a number of states, including Wisconsin and Missouri. The issue received greater attention during the campaign after actor and Parkinson’s sufferer Michael Jay Fox made a series of controversial ads for Democratic candidates who support stem cell research.

Still, it remains to be seen whether Democrats in 2008 will be able to make the stem cell debate a major campaign issue. Efforts to do so during the 2004 election did not produce any appreciable results. And the issue’s impact in 2006, while greater, was limited to a small number of states. Furthermore, the three major GOP candidates are all less opposed to embryonic stem cell research than is President Bush. Giuliani favors it. And while Romney and McCain oppose creating embryos for research, they support using embryos that are slated to be discarded from fertility clinics, something the president adamantly opposes.