Stem Cell Research and the Affirmation of Life

By Rosemarie Tong
Autumn 2007

Whether or not they are fully informed about its intricacies, almost everyone in the United States seems to have an opinion about stem-cell research. Stem cells are either totipotent or pluripotent cells: They have the amazing ability to develop into many or even all the different types of cells that constitute the human body. Their cell lines are immortal in the sense that they can be cultivated indefinitely to produce a virtually unlimited supply of cells, testifying to the strength, resilience, and determination of life itself. Although progress in stem-cell research has been somewhat slow due to technical hurdles, political debates, and the moral controversies described below, most scientists believe stem cells will ultimately prove useful in treating damaged human cells and tissues (including major organs), testing pharmaceutical products for safety, studying embryo development, and discovering new gene-therapy techniques. Indeed, according to the Stem Cell Research Foundation, stem-cell research promises to create treatments to help millions of Americans: 58 million with heart disease, 4.3 million with arthritis, 10 million with osteoporosis, 8.2 million with cancer, 4 million with Alzheimer’s disease, 1 million with juvenile diabetes, and 250,000 with spinal-cord injuries. These are big promises and ones that excite most people, but particularly aging baby boomers looking for a medical fountain of youth—treatments and pharmaceutical products that will permit them to live vibrant, healthy lives well into their 90s and even 100s.

A limited number of stem cells is found in adults’ tissues and in umbilical-cord blood. In addition, recent studies indicate that stem cells may be present in amniotic fluid, the amniotic membrane, and the placenta. Scientists remain divided about the usefulness of these cells. Some think the cells are able to differentiate only into a relatively narrow array of cells (for example, blood stem cells producing blood elements but not nervous tissues). Others are much more enthusiastic. They point out that so far, the only successful stem cell-derived treatments have come from adult or umbilical-cord stem cells. Examples include the use of adult stem cells found in bone marrow to help victims of heart attacks and the use of umbilical-cord stem cells to treat rare enzyme malfunctions like Krabbe’s leukodystrophy, a devastating condition that destroys neurological capacities. These same scientists are enthused about recent successes in programming adult mice skin cells back to pluripotent form. The hope is that similar methods can be used to reprogram a wide variety of human cells back to pluripotent form, so that the need for totipotent stem cells is gradually eliminated.

Whatever promise adult stem cells, umbilical-cord blood cells, and amniotic fluid stem cells hold, most stem-cell researchers still think that, at present, the best source of stem cells is either in the gonadal tissue of aborted fetuses or in the inner mass of blastocysts—that is, of embryos in the early days after fertilization.

It is not surprising that both embryonic gonadal (EG) stem-cell research and embryonic stem-cell (ES) research generate moral controversy. People who believe that human life and, therefore, human personhood begins at the moment of conception will view such research as morally wrong. They will claim that to destroy an embryo, even for a good purpose such as curing Alzheimer’s disease, is as wrong as killing an adult so that his or her organs can be distributed to six or seven other adults who might otherwise die. But is the wrong done in both these cases really of the same kind and magnitude? I think not.

Opponents claim that to destroy an embryo, even for a good purpose such as
curing Alzheimer’s disease, is as wrong as killing an adult so that his or her organs
can be distributed to six or seven other adults who might otherwise die.

Consider the case of EG stem cells first. National Catholic Bioethics Center education director Tadeusz Pacholczyk, a priest and neuroscientist, calls it morallypermissible to use EG cells from miscarriages, also known as spontaneous abortions, provided the parents give informed consent. Pacholczyk adds, however, that it is morally forbidden to use EG cells from elective abortions, whether or not the parents give informed consent. But what about EG cells from therapeutic abortions—abortions that must be performed to save the mother’s life? Are not these abortions more like spontaneous abortions than elective abortions in intent? Chances are that a woman who has to undergo a therapeutic abortion does not want to terminate her pregnancy any more than a woman who has a spontaneous miscarriage. Why, then, should it not be morally permissible to use EG cells from the former’s aborted fetus?

In any event, subsequent to any of the three aforementioned kinds of abortion, is it morally worse to use the embryo for research purposes, or to discard it?Provided that a woman does not get pregnant with the deliberate intent to abort her fetus for the purpose of research, it would seem morally good to use EG cells from her aborted fetus potentially to save other human lives. Regulations can be put into place prohibiting parents from directing that EG stem cells removed from their aborted fetuses be used to develop treatments for particular persons, as was the case when a woman allegedly had an abortion so that the tissue from her aborted fetus could be used to treat her father for Parkinson’s disease.

Thinking that work with ES cells might be less morally controversial than with EG cells, many researchers have sought to secure ES cells in one of two basic ways, each of which has turned out to present its own moral issues.

The first source of ES cells is the process of in vitro fertilization, which combines sperm and egg ex utero with the intention of transferring the conceptus to a woman’s womb for reproductive purposes. When a couple produces more embryos than it is prudent to transfer into the woman’s womb, clinicians generally advise the couple to freeze surplus embryos for possible future use. If a couple takes the clinicians’ advice, they may sign a contract—unenforceable in most states, incidentally—that specifies their wishes for the surplus embryos, should they decide not to use them after all. Their options include keeping the embryos frozen, discarding them, putting them up for adoption, or earmarking them for research.

If the couple opts to keep their surplus embryos frozen, they will add yet more embryos to the 900,000 already frozen in U.S. embryo banks. In effect, their decision will let their surplus embryos die a slow death, for, unlike stem cells, frozen embryos are not immortal. If the couple opts instead to discard the surplus embryos, they will, in effect, be choosing to abort them. In this instance, men as well as women get to make the abortion decision; both are asked to decide whether to procreate. (On the face of it, it would seem that opponents of abortion should be more troubled about these ex utero abortions than about traditional in utero abortions; after all, frozen surplus embryos do not in any way threaten a woman’s life or health. There is no need, in their case, to weigh their right to life against a woman’s right to life or bodily integrity.) The couple’s other two options—putting the surplus
embryos up for adoption or earmarking them for research— are potentially more life-affirming. One problem with putting up surplus embryos for adoption, however, is that there are probably not enough infertile couples who want them. Another problem with adoption is that some couples would rather discard surplus embryos than have other couples bring them to term and rear them; they simply do not want to procreate and cannot come to terms with the thought that somewhere out there, their child is being reared by strangers. For couples with this mindset, as well as those who would otherwise discard their surplus embryos or freeze them, earmarking embryos for stem-cell research would seem the best moral option. At least such research has the goal of enhancing and extending human life.

The second way of obtaining ES cells is to create them specifically for research purposes. Researchers have sought in this way to avoid the personal drama of in vitro fertilization and to secure the best embryos to use for research—freezing and thawing embryos may, after all, damage or degrade them in some way. Some researchers have opted to create their own embryos by combining, in vitro, the genetic material of willing sperm and egg donors. Other researchers are working to perfect a process called somatic-cell nuclear transfer (scnt), a form of therapeutic cloning. But to date they have had success cloning only animal embryos, not human embryos. Reports that a South Korean researcher had successfully cloned multiple human embryos turned out to be false—indeed, a case of blatant scientific fraud. To create a human embryo via scnt, researchers must, as in the animal research that led to the birth of the famous cloned sheep Dolly, fuse one of a human donor’s somatic cells—say, a skin or blood cell—with a donor egg cell which has had its nucleus removed. The stem cells produced would be genetically identical to the donor’s somatic cells and could be implanted in the donor without fear of rejection.

One question that has been raised about embryos produced via SCNT is whether they are really embryos. After all, they are not the product of egg and sperm uniting; they are the product of a somatic cell and an enucleated egg fusing. Another question about scnt is whether women should be paid for their eggs and, if so, how much. Unlike sperm donation, egg donation is an arduous and risky process. Potential egg donors who would not be willing to take risks for free might be willing to take the same risks for $3,000 to $7,000, the range of money women who sell their eggs for reproductive purposes typically get. Is there any good moral reason that a woman who sells her eggs for research purposes should not be paid the same amount as a woman who sells her eggs for reproductive purposes?

In 2001, President George W. Bush’s attempt to steer a middle course between embryonic stem-cell research advocacy and opposition struck me as reasonable. Bush proclaimed that federal funds could be used for only certain types of stemcell research—namely, adultstem cell research, umbilical cord blood-stem cell research, and embryonic-stem cell research on already existing stem-cell colonies, said to be 78 in number at that time. An opponent of abortion, he reasoned that because there was no way to bring back from the dead the embryos that had been destroyed to create existing stem-cell lines, some good—in the form of treatments for devastating disease—might as well come from their evil origin. However, Bush emphasized in nearly the same breath that no federal money would be available to create additional stem-cell lines from unwanted frozen embryos or deliberately to create new embryos for research purposes. Importantly, Bush’s ruling forbade only federal funding for research on stem-cell lines derived after August 9, 2001. It did not forbid state or private funding for such research, substantial amounts of which have been provided to researchers for over a decade now.

What started to change my mind about the reasonableness of Bush’s ruling was that, as it turned out, only 23 of the 78 stemcell lines were available for research purposes. Of the original 78 lines, 7 were duplicates, 31 were in overseas laboratories that were unwilling or unable to transfer them to the National Institutes of Health for safekeeping and distribution, 16 died after being thawed, and one was withdrawn because the embryo donors withheld consent. Of the remaining 23 lines, none was entirely safe. They had been grown in mouse culture or feeders, exposing them to possible contamination. Therefore, federally funded researchers would not have enough stem-cell colonies with which to work. To produce new colonies for cutting-edge research, they would have to seek funding from states, charitable private foundations such as the Juvenile Diabetes Research Foundation and the Howard Hughes Medical Institute, profit-making corporations such as Geron, or foreign nations with little or nothing in the way of restrictions on stem-cell research.

Although the exodus of scientists from the public domain into the private domain may not strike terror in Americans’ hearts, it concerns many members of the bioethics community. To give one example, Dr. Joshua M. Hare, who has conducted stemcell research funded by the Maryland biotechnology company Osiris Therapeutics, recently commented, “In Ecuador, fetal stem cells, obtained in the Ukraine, are being used to treat patients from the U.S. There are cowboys who want to do this, and are going to do it.” Research done in the private realm is far less regulated and ethically disciplined than research done in the public realm.

Adding to what became my entire dissatisfaction with Bush’s 2001 ruling was the fact that a majority of Americans do not share the president’s view of the morality of the situation. Polling data indicate that close to 70 percent of Americans favor stem-cell research even when it requires embryo destruction. A poll conducted in 2005 by the Genetics and Public Policy Center at Johns Hopkins University indicated that 69 percent of Roman Catholics, 74 percent of Protestants, and 50 percent of Evangelicals supported stem-cell research. To be sure, just because a majority of people favors a practice does not guarantee its moral rightness. However, a growing majoritarian moral consensus on a subject that requires weighing several moral goods and bads against each other may indicate a need to reflect on one’s own moral views. Perhaps some change is in order.

No doubt Americans’ growing moral consensus in support of stem-cell research partially explains why the U.S. Congress passed the Stem-Cell Research Enhancement Act in 2006, and a very similar bill in 2007. Both of these bills permitted federal funding for stem-cell research on frozen surplus embryos that would otherwise be discarded. Bush vetoed both bills, simply reiterating his 2001 position, in what seemed a stubborn rather than a thoughtful manner. Chances are that if Bush is still in office when Congress produces another stem-cell bill, further enhanced with a provision for scnt, the president will go ballistic before he pulls out his veto pen.

On the occasion of his veto of the 2006 Stem-Cell Research Enhancement Act, Bush surrounded himself with 24 “snowflakes”—children who had been adopted from in vitro fertilization clinics when they were still embryos. His point seemed to be that no surplus embryo need be discarded, that they can all be adopted. But, as I noted above, adoptions of surplus embryos are likely to be relatively few.

There is another, feminist point to be made about Bush’s “snowflakes.” No human embryo is going to be born unless it is implanted in a woman’s womb. Conception is a necessary but not sufficient condition for the emergence of human personhood. It merits underscoring that stem-cell researchers have tried, through processes such as altered nuclear transfer, to create pseudo-embryos that cannot implant in a woman’s womb. Pseudo-embryos, as well as bona fide embryos that no woman is willing to take into her body, are merely potential for human life—a potentiality that will never be actualized in the form of a human “snowflake,” but can nevertheless be used for the good of the human community to which they belong. We who happen to have been of woman born should also try to add to the good of our human community. We are called, for example, to serve as research subjects, to donate our tissues and organs if and when we can, and to give our cadavers to medical schools for the purposes of clinical education. If ex utero embryos’ life-giving powers should not go to waste, neither should ours.

Rosemarie Tong, PH.D., is distinguished professor of health care ethics and director of the Center for Professional and Applied Ethics in the Department of Philosophy at the University of North Carolina at Charlotte.