How Have Ethical Concerns Affected the Progress of Stem Cell Research?

Lise Murrell

How effective can the use of stem cells be without an agreement as to the origin of the cells?  Many of the policies made in the United States to help protect the rights of human embryonic stem cells have brought this kind of research to a standstill. Various countries and states have made an effort to allow this research to progress in a positive direction.  A recent study has found a new source for the stem cells that seem to be a promising discovery.  However, there are still many stipulations on just how effective the use of this new source for stem cells will be, without the research used on embryonic cells.  Thus, moral and ethical concerns by various nations have temporarily stalled the progression of stem cell research throughout many countries.

Sources of Stem Cells

There are many different types of donor cells that can be used for the transplantation of stem cells for the treatment of diseases.  Brundin, Li and Morizane cited Gage (2000) who defined stem cells “as the undifferentiated cells that are capable of self-renewal and then can differentiate into different cell types, i.e., they are multipotent” (p. 331).  There are stem cells located throughout an individual’s body.  Embryonic cells are the most commonly used source of cells for stem cell therapy.  Some cells are taken from the midbrain of the fetus; however, neural stem cells, which can be derived from mature adult brains or fetal brains, are also used.  Neural stem cells are much less constrained to differentiation in a purely neural recipient.  Another possible source of stem cells can be taken from the blastocyst of embryonic stem cells.  The blastocyst is an inner cell mass that is multipotent and is capable of constructing all types of tissues throughout the body (p. 331).  There are also various mature somatic cells, cells of the body, which can be used as a source of stem cell differentiation.  Somatic cells that can be used are cells located in bone marrow, skin, even the umbilical cord (Brundin et al 2007).

Taylor (2005) states that the use of the embryonic blastocysts is the main ethical issue debated by ethicists and scientists.  Many people believe that a blastocyst is so immature that it does not deserve the same kind of legal security that a second or third trimester fetus is permitted.  However, others argue that because a blastocyst has every capability of becoming a human being, it is in fact entitled to the same ethical and legal rights as a fetus in any trimester. 

Many scientists and ethicists’ opinions deviate on stem cells that seem to be “independent of their physical environment,” such as a blastocyst (Taylor, p. 592).  Scientists attempt to validate the use of stem cells grown in Petri dishes because they have no chance of becoming a self-sustaining human being without the presence of a uterus.  However, Taylor cited McGee (1999) who argued that some scientists believe that the blastocysts taken from the uterus “take on different meanings depending on the institutional context” (p. 592).  While a difference between the potential of the two blastocysts is quite evident, it is difficult to find validity in this argument because the major discussion is a result of the disagreement of whether or not embryos should be created in Petri dishes, or for the sole purpose of research, period.

Therefore, one must beg the question whether or not the embryos that are grown in dishes and have no chance of becoming full-grown fetuses, have any rights.  Only if this blastocyst is implanted in a uterus is it able to develop into a mature embryo, so many believe that its moral rights are stricken.  Those who argue in favor of stem cell research often discuss the potentially staggering effects that it may possibly have for various therapies.  However, because the question of just how astonishing the effects will be can only be answered with the continuation of the stem cell research itself, there is an invisible barrier resting upon its development.  People who support stem cell research often challenge those opposed of discrediting its therapeutic potential.  However, because there is much more research that needs to be done, the arguments for its potential effects are somewhat based upon speculation.  Because the cost of this research is prohibitive, it will be extremely difficult for the resulting therapy to be available in clinics across the United States, or even the world.  This dilemma underlines the fact that this type of treatment will be extremely expensive and therefore, not attainable by most citizens.

During their research, Roberts and Throsby (2007) found that due to the ever-increasing scarcity of eggs available for stem cell research, the Newcastle Stem Cell Institute was granted authorization to use eggs that had failed to fertilize during the process of in vitro fertilization.  In 2005, researchers made a huge breakthrough by using research on such an egg to discover a way to create “an early-stage clone human embryo” (p. 2).  This was the first one of its kind.  However, shortly after this discovery it became evident that the process would be much more effective and successful with the use of novel eggs.  In 2006, Newcastle University was given permission to ask patients undergoing in vitro fertilization to donate some of the eggs gathered during the standard fertilization procedure in exchange for a reduced price for the treatment by the Human Fertilization and Embryology Authority (HFEA) of the United Kingdom.  These eggs were to be used in a process called “somatic cell nuclear transfer – which is a technique also known as therapeutic cloning, in which the nucleus of a bodily cell is transferred into an egg which has had its nucleus removed and is [then] chemically stimulated to initiate embryonic cell development” (p. 2).  However, because of the previous study, which proved that newer cells were much more effective for this process, a problem arose.  Patients would have to be willing to forfeit some of the eggs that would have otherwise been used for their IVF treatment.  This is how the idea of monetary compensation for egg cells arose. 

Roberts and Throsby cited Franklin (2007) explaining that although this method seems to be an effective way to extract stem cells, many questions have arisen about this kind of removal.  Most, if not all of the patients undergoing IVF treatment are infertile, and asking them to donate some of the cells that could have been used for their treatment is bold.  This issue seems to place many constraints on the effectiveness of this removal process.

Effects on Various Therapies

One of the most important issues to focus on when trying to understand all of the attention being placed on this kind of research is the potential effect it will have on the quality of human life around the world.  According to Allison, Burra, Conconi, Costa, Cozzi, and Farinati (2007), studies show that this research has the potential to provide therapy for many different areas of the body.  Stem cells can offer therapeutic answers for many organs such as the heart, kidneys, liver, and pancreas.  In addition, positive effects for the healing of liver disease, liver cancer and neural repair for diseases such as Parkinson’s disease have been proven (p.2).

Taylor (2005) described the use of human embryonic cells and its effects on stem cell research as the following:

            Human embryonic cells are described by scientific proponents and many

            patient advocacy groups as leading to a revolution in health care, with

            careful research promising new insights into how human beings, organs and

            tissues develop; detailed knowledge of the factors that affect growth and

            differentiation and how they interact and dramatic new research and clinical

            applications. (p. 590) 

A new important alternative source for the production of stem cells has recently been presented.  The discovery is a treatment called “induced pluripotent stem cells” (Scroggs, p. 17). These stem cells are somatic cells, which are the same as skin cells.  This type of research seems to satisfy many pro-life supporters. However, many scientists explain that although this type of research is moving in a direction that may appease a majority of the population’s moral dilemma about stem cell research, “we still need to study embryonic stem cells to further understand how stem cells function” (p. 17).  Scroggs argues that this type of research also eliminates a majority of the wasted stem cells that are usually produced in the nuclear transfer – which is a practice commonly used today.  She explains that the innovation of this research will help bring the ethical concerns of various groups closer to an agreement.

The United States government has taken different stances on the issue of stem cell research throughout the years of its development.  Taylor (2005) discusses that during the Clinton administration, the controversy over the process of cloning a human being arose.  A report that proposed the delay of the payment of this research was issued.  Later, the General Counsel of the Department of Health and Human Services printed a report that recommended that the research not be banned, “as long as the destruction of the embryos involved in obtaining the cells was privately funded” (p. 592).  This article implied that the U.S. government should fund the research, as long as the cells used had been gathered from surplus embryos that were made for reproductive purposes provided that certain conditions were met.  The rules to be followed were somewhat complicated.  Buying or selling such embryonic cells was prohibited.  Permission from the donor to use these excess embryos was a necessary requirement.

During President Bush’s first term, the moratorium placed on stem cell research ended, and once again, the American government was forced to make a decision.  In 2002, the “President’s Bioethics Council” came to the conclusion that placing another suspension on stem cell research was in order, and funding for cloning was again a low priority. 

The different laws in most of the states also illustrate America’s division on the issue.  Taylor found that California and New Jersey provide government funding to support stem cell research. California has even created the California Institute for Regenerative Medicine in order to speed up its progression.  However, more than ten states have placed restrictions on research involving embryos, and some states have even made it illegal.  Because the United States does not have one single policy to support or limit stem cell research, states are forced to make a decision on their own, creating an even bigger division.

In an effort to create a united solution to the ethical issues of stem cell research, the National Academies published rules for the review of the use of embryos.  This committee plays different roles in various countries around the world.  In some countries, it controls the funding of all scientific research, while in others it manages the research and funding of other subjects as well.  Turkey, Poland, Greece, Germany, France, the United Kingdom and the United States are some of the countries that abide by the rulings of their National Academies. 

The National Academies’ guidelines stated that a committee must be established within various institutions, in order to be able to continue with stem cell research.  The National Academies proposed that these institutions, whether a state government or country, create Embryonic Stem Cell Research Oversight (ESCRO) committees.  Although it was understood that different institutions would create rules based on their different needs, Taylor confirmed that the rules were stated clearly by saying:

            The ESCRO committees were to enforce the following: 1) to provide local

            oversight of all issues related to derivation and research use of human

            embryonic stem cell lines; 2) to review and approve the scientific merit of

            research protocols; 3) to review compliance of in-house human embryonic

            stem cell research with “all relevant regulation”; 4) to act as a clearinghouse

            for research proposals, identifying the form of required review and assisting

            investigators in understanding that government and other regulations apply;

            5) to ensure that the provenance of such cell lines, and its approval by an

            institutional review board as appropriate, is documented; 6) to facilitate

            education of investigators involved in human embryonic stem cell research;

            7) to maintain a registry of banked human embryonic stem cell lines and

            associated genetic and medical information, with identifiers appropriately

            protected; 8) to act as the institution’s oversight committee on banking of

            such cells and; 9) to “ensure that all applicable regulatory requirements are

            met” (p. 606).

The committees are required to segregate the research proposals into three separate groups.  The first is research that uses in vitro human embryonic stem cells that were previously approved for use, with documentation of their exact history.  The second is research that proposes the use of cells that must be taken from blastocysts that were provided by a donor.  The third is research that should not be allowed to progress at the present time.  This includes any research that proposes the use of culturing human embryonic cells that are unharmed, and it also must “deny approval to research that would involve “breeding” of animals into which human embryonic stem cells have been “introduced at any stage of development” (Taylor, p. 607).

Although the creation of ESCRO is a step in a positive direction, it must not be forgotten that the main disagreement between institutions is not how the research will be funded; it is the origin of the research.  The investigators on these committees will of course, be composed of various people, and consequently, differing opinions.  Therefore, ESCROs cannot be as effective as the National Academies would have hoped until a better source of stem cells is found. 

Allison et al. (2007) stated that Italy has also just recently established protocol for the advancement of stem cell research.  Because the use of cells taken from various body parts in adults has become more popular over the years, Italy’s government composed a list of Pharmaceutical Regulations.  These regulations cover one of the more popular types of therapy, called cell therapy.  This therapy involves the use of adult stem cells that are transplanted into a certain location or organ and left to regenerate growth.  Any person who is interested in using this kind of therapy must have consent from the Italian Pharmaceuticals Agency of the Higher Institute of Public Health.  Recently a document was published that showed that there were 26 factories that deal with stem cell research.  In this report, a document that would regulate the types of cell production occurring in these factories was promised in the near future.  This document would allow these factories to continue production as long as “scientific evidence of a potential therapeutic validity [was present]” (p. 7).

The Dulbecco Commission located in Italy has suggested some rules by which to abide in order to try to unite the European Nation’s policies on stem cell research.  This proposal states that “creating embryos for the sole purpose of obtaining stem cells is considered ethically unacceptable; [and] research on stem cells is considered ethically acceptable and encouraged when the cells are derived from adult tissues, umbilical cord blood or aborted fetuses (providing the abortion was not induced to retrieve the cells)” (Alison et al., p. 7).  Throughout the article, Alison et al. continuously emphasized the fact that stem cell research should be available to the public.  To conceal any procedures would simply cause frustration throughout a community.  They also argued that at this moment the most effective type of research is that which is done on “sources of cells that do not pose ethical problems, even if this means delaying research” (p. 7).  I must agree that this is the type of stem cell research that will be the most effective throughout a community or country because it is the least controversial and has the most chance of progression. 

Possible Solutions

Although the creation of ESCRO committees seems to help with the present issues that surround stem cell research, these committees cannot solve the problems of the progression of future research, nor can they create a more accessible method of therapy to the public.  Without one common federal plan in sight, the inability to create one set of laws for stem cell research will ultimately hinder its progression.

It is evident that no one can be close-minded about stem cell research.  The potential for stem cells’ therapeutic abilities are far too great to deny.  Most of the countries with the resources available to try to find an answer for this ethical battle have put them to use.  No one wants to see this extraordinary discovery go to waste.

As a firm pro-life advocate, I do not support stem cell research using human embryos – whether aborted, grown in a Petri dish, or donated.  To destroy life in the pursuit of improving the human condition is a paradox that cannot be reconciled.  That said, stem cell research, which is not destructive of human life, must proceed.  A method such as the development of induced pluripotent stem cells (iPSCs), or any other non-life-destroying source of stem cells, is the course the United States should pursue.  I hope that other countries will eventually follow close behind. 

References

Alison, M. R., Burra, P., Conconi, M.T., Costa, A.N., Cozzi, M.R., Farinati, F. (2007). Experimental hepatology applied to stem cells.  Science Direct. Retrieved January 30, 2008, from http://www.sciencedirect.com.

Baylis, F., Giacomini, M., Robert, J. (2007). Banking on it: Public policy and the ethics of stem cell research and development. Science Direct. Retrieved January 30, 2008, from http://www.sciencedirect.com.

Brundin, P., Li, J., Morizane, A. (2007). From bench to bed: the potential of stem cells for the treatment of Parkinson’s disease [Electronic version]. Cell Tissue/Research 331, 322-336.

Roberts, C., Throsby, K. (2007). Paid to share: IVF patients, eggs and stem cell research. Science Direct. Retrieved January 30 2008, from http://www.sciencedirect.com.

Scroggs, Amber (2008, February 21).  Stem cell debate nears compromise. The Daily Reveille, p. 17.

Taylor, P.L. (2005).  The gap between law and ethics in human embryonic stem cell research: overcoming the effect of U.S. federal policy on research advances and public benefit. [Electronic Version]. Science and Engineering Ethics II, 589-616.