Ethics of Stem Cell Research
Stem cells are central to newly developed therapies for curing degenerative diseases in humans. This is attributed to a very attractive feature of stem cells: their ability to produce a wide variety of other types of cells. Starting from stem cells, it is possible therefore to produce blood, brain, liver, muscle or essentially any type of specialized cell in a process called differentiation. Accordingly, with these therapies is now possible to aspire to find solutions to conditions that require organ or tissue replacement with a reduced rejection probability or even immune response (Juengst E). Patients with conditions like cirrhosis, muscle paralysis, corneal deterioration, Parkinson’s, Alzheimer’s, and quadriplegia may have hope that in the coming years a solution may be found for their situation. This approach is contained in what is known as regenerative medicine. Despite these tremendous potential for improving human health, stem cell-based therapies have encountered considerable opposition in some sectors of society. This is mainly due to the very origin of stem cells: although they are present in many tissues of an adult human being, their ability to replicate and differentiate is not even close to that of embryonic cells. As a result, many therapies have been developed with the aid of human embryonic stem cells (hES). The more traditional procedure for hES isolation involves the destruction of a cloned fetus or human eggs fertilized in vivo or in vitro (Juengst E). The former is also known as reproductive cloning while the latter has been termed therapeutic cloning. As expected, this approach has generated a very agitated discussion involving members of pro-life religious groups and politicians. At the core of the controversy is determining whether a life is taken away or not (Juengst E). Terminating an embryo’s existence only to produce stem cells is seen by most of the general public as an unjustifiable crime. Most opponents of hES argue that besides its biological definition, an embryo has the moral status and rights of every other human being. In this view, harvesting of cells from embryos is at the same level of slavery or mutilation (Juengst E). Fortunately, an alternative view where the whole humanity is fighting against the disease has been also contemplated. Every single day numerous patients passed away due to the absence of replacement organs or tissues. In this regard, it is evident that hES could play a major role when addressing the needs of those suffering with a degenerative or terminal disease (Juengst E). Dismissal of such conditions has been also highly debatable from the ethics stand point. No matter what side of the debate is picked, the implications of prohibition or full endorsement for hES are difficult to estimate and beyond our current legislation (Juengst E). On one hand, it could happen that hES become a profitable business and women start to sell fetuses or on the other hand, a black market could develop where pregnant women are targets for crime organizations in search of unborn children. Fortunately, not all stem cells are hES, various therapies involve the use of adult stem cells including the treatment of cancers and autoimmune disorders (Juengst E). In such a case, the debate has no real foundation but may jeopardize an important research field that could potentially finish the controversy once and for all. All the discussion has been conducted under the vigilant sight of the public through the strictest of all frames: federal funding investment. This has generated several law enactments not only in the U.S. but around the world. The legislation explicitly states that the use of hES created in a privately supported manner is authorized (Juengst E). The cells need to be derived from embryos that are going to be discarded. Additionally, donors need to be properly informed about the final use of their embryos and cannot receive any compensation for their donation. In general, these laws avoid a profound discussion about the creation and cloning of embryos which maintains the ethical debate at other instances of our society (Juengst E).
Although the article discussed in the previous paragraphs was published back in 2000, some of the major ethical issues regarding the moment where the human rights start are still profoundly debated (Jennifer McCormick and Huso). Also, major concerns about the privacy, confidentiality and future use of the donated embryos are still under the public scrutiny. Recently, an important scientific discovery has opened an avenue to use hES without all the ethical concerns: normal cells can now be reprogrammed to behave as stem cells in a process called induced pluripotency (iPS) (Jennifer McCormick and Huso). Although this approach has been considered as extremely appealing by researchers, it has been determined that induced pluripotent cells (iPS) may carry genetic abnormalities of adults that are not normally seen in hES. Despite not using embryos at all, the production of iPS has been criticized by those who believe that human cloning can be attainable through this method.
In my personal opinion, it has been demonstrated that we have to put aside our personal ethical and moral values considering that they could be a major obstacle for moving forward the research in stem cells. But putting aside some personal issues and views does not mean that research on stem cells should be conducted precariously and without following the proper safety and regulatory oversight. The therapeutic approach attainable with stem cells is unique and holds great promise: many lives could be saved and a major reduction in the economic burden associated with our aging population could be achieved. Also, it is important to notice that the discovery of iPS did not happen in the Western hemisphere, which was not a coincidence (Jennifer McCormick and Huso). Due to the restrictions and banning of research on hES in many Western countries, some talented scientists relocated to countries where these activities are legal and fully supported by the government. If these restrictive policies continue to be promoted, hES research in the Western world will lag far behind. Today’s economies in the Western world need to be strengthen considerably by regaining competitiveness in critical fields of science and engineering, hES are one of those fields. This can be evidenced in the patent filing pursued by those involved in the discovery of iPS in an attempt to maintain global intellectual property and dominance in a future changing technology like this (Jennifer McCormick and Huso). Moreover, the rate of U.S.-authored publication on stem cells during the past three years appears significantly lower when compared with countries such as Japan, South Korea, and Singapore (DeRouen et al.). Also, stem cell tourism where patients travel to distant locations for innovative treatments is becoming a more common practice every day. This represents an important revenue influx for some of the most important emerging economies and particularly in Asia.
As discussed by McCormick and Huso, the scientific community for the most part coincides with my view in that major efforts should be put forward to make sure that stem cell research progresses in the right direction. This can be accomplished by creating legislation that regulates intellectual property rights, collecting experimental data to determine impacts of hES-based therapies on cells and tissues, rethinking the consent process of embryo donation, and involving different sectors of society in constructive debates that accommodate as many views as possible (McCormick and Huso). Although of a tremendous potential, hES treatments should be considered with special care considering that the mass communication media often creates expectations that go beyond reality. Additionally, infomercials and web-based propaganda about stem cell-based therapies from overseas could be misleading and potentially dangerous (McCormick and Huso). To address this issue, The International Society of Stem Cell Research provided a set of guidelines to conduct experimental therapies and trials around the world (McCormick and Huso). Finally, McCormick and Huso point out about a gap in the regulatory system that allows researchers and biomedical companies to conduct clinical trials without fully informing the participants about the real risks and origin of what are they receiving as treatment.
According to Master and Crozier, thus far, most of the scientific proposals for the deriving stem cells are not very sound and are disrespectful to moral values. They argue that the iPS strategy still requires the use of embryos if the clinical trial stage wants to be reached (Master and Crozier). This article suggests that the only avenue to overcome this obstacle is by creating patient-specific stem cells derived from non-embryonic sources. We concurred in that much research is required to assure a successful transition of hES- or iPS- based therapies to the clinical trial stage. Finally, they conclude by proposing a new moral approach to solve the ethical issues behind hES. In this approach, major points of agreement between the contending sides of the stem cell debate are indentified: hES is morally significant, is important to reduce the use of embryos, the hES research leads to important conclusions, hES need not morally objectionable, and the destruction of embryos can be justified under special circumstances. Next, based on this groundwork, the parts set a discussion where some of their expectations are conceded. In the end, an agreement could be reached where some concessions and reciprocities are conciliated.
In the work by (Longstaff et al.), the role of education in fueling the stem cell debate was analyzed. Their analyses encompassed a full revision of the available online educational resources in the ethics of stem cells, and also guided discussions where students, researchers and the general public were interrogated about their knowledge of stem cells. Some of the most important topics of discussion included the source of the stem cells, the ethics training for properly handling animals and humans, and the regulatory context. The main conclusion of their study is that there are significant misconceptions about the origin and use of stem cells, which is then translated into inadequately prepared policies and a continued debate sometimes without real foundations. This has been attributed to the lack of formal educational tools and the abundant number sources with unproved and misleading information.
Perhaps the most important ethical issue surrounding hES is the use of embryos. (Klitzman) discusses the issue in detail in an historical perspective and considering current and future impacts. His work proposes that even though scientists and policy makers should keep an open mind to different opinions, not every single point of view could be accommodated in the regulatory framework. Klitzman also realizes that education is a key aspect to move forward, especially when the general public is incorporated into the discussion. Besides the already discussed questions that have been discussed by the other articles cited here, Klitzman brings out an important issue regarding the monetary compensation that egg donors should receive considering that a profit may be generated from the corresponding research. Most conservative parties argue that this practice should be avoided at all cost because that is against dignity and represents a commercialization of the human body. Most scientists, however, defend this compensation arguing that it is a fair deal that responds to the inherent risks of the withdrawal procedure. Additionally, researchers that have attempted egg donations with no compensation have been quite unsuccessful. This has led to recruitment campaigns under the auspices of private funding in which, unfortunately, not every woman gets paid the same. Ethnicity, religion, phenotype, and economical background among many others have been considered as screening factors for compensation. Klitzman proposes that it is very important to develop a robust legislation that avoids discrimination among the egg donors. Moreover, he proposes that the regulations should consider international trading considering that many countries will start to require and produce a variety of hES derived products.
DeRouen, MindyC. et al. “The Race Is On: Human Embryonic Stem Cell Research Goes Global.” Stem Cell Reviews and Reports 8.4 (2012): 1043–1047.
Juengst E, Fossel M. “The Ethics of Embryonic Stem Cells—now and Forever, Cells Without End.” JAMA 284.24 (2000): 3180–3184.
Klitzman, Robert. “The Use of Eggs and Embryos in Stem Cell Research.” Semin Reprod Med 28.04 (3): 336–344.
Longstaff, Holly et al. “Scientists’ Perspectives on the Ethical Issues of Stem Cell Research.” Stem Cell Reviews and Reports 5.2 (2009): 89–95.
Master, Zubin, and G.K.D. Crozier. “The Ethics of Moral Compromise for Stem Cell Research Policy.” Health Care Analysis 20.1 (2012): 50–65.
McCormick, Jennifer, and HollyA. Huso. “Stem Cells and Ethics: Current Issues.” Journal of Cardiovascular Translational Research 3.2 (2010): 122–127.