Embryonic stem (ES) cell research has garnered almost unprecedented attention. Debate over the boundaries of such research is ongoing, and the regulation of the field varies widely between countries. This article identifies and evaluates the four major positions that emanate from current international regulations. ES cell policies may ultimately impact on public health, and hence they must be both rigorous and transparent. We contend that these goals will only be achieved if policy is both ethically consistent and clinically realistic with regard to the ability to achieve therapeutic goals. We conclude that policies allowing the ongoing extraction of stem cells from spare in vitro fertilization embryos and the creation of embryos for research (within set limitations) cope most adequately with the tension between varying views on the moral status of the human embryo and the therapeutic potential inherent within ES cell research.