Embryonic Stem Cells 2007

[1] Stem cells have been called “the gift that keeps on giving” and that may be true not only for biomedical researchers but also for ethicists. This is the third time the ELCA has invited me to reflect on stem cells and related matters. Back in 1995 the Department of Studies asked several people to comment on the NIH’s “Report of the Human Embryo Research Panel” (September 27, 1994) which had drawn harsh criticism in the pages of Pro Ecclesia and First Things. A bishop had asked the department for guidance, and they were soliciting advice. While I shared some of the critics’ concerns — particularly in regard to the creation of embryos for research purposes which, I worried, would corrode respect for human dignity — I thought that some experimentation on human embryos is ethically justifiable. I was even prepared to approve public funding of research on existing “surplus” embryos no longer needed for infertility treatment, embryos that would otherwise be destroyed.[1] However I was not persuaded that “embryo research warrants a very high priority in the allocation of scarce public resources for biomedical research” especially “where the objective is to improve existing infertility therapies: hardly one of our most pressing public health concerns.”[2]

[2] Then in 2001 I was asked to contribute an article to JLE on therapeutic cloning or, as the President’s council on Bioethics prefers to call it, ‘cloning for research’.[3] The use of surplus embryos was not at issue. Nor was infertility treatment the primary target of the research. Embryos were to be created using the somatic cell nuclear transfer (SCNT) technique in order to derive pluripotent embryonic stem cells that might one day lead to effective treatments for diabetes, Parkinson’s, paralyzing spinal cord injuries, stroke and brain trauma, heart disease, cancer, Alzheimer’s, multiple sclerosis, diseases of the bone and cartilage, and even the growth of transplantable organs. The list went on and on, and the number of patients suffering from these diseases and conditions was staggering. Admittedly the therapeutic benefits were hypothetical and, at best, a long way off but that is often, if not always, the case in biomedical research. How would we ever know if we don’t investigate further. In the article I confessed to being ambivalent and perplexed — no doubt some readers concluded I was simply confused — about the moral status of the early (one to two week old) embryo and whether allowing cloning for research today would make the acceptance of cloning for reproduction more likely somewhere down the slippery slope. Ultimately I found that I could neither advocate the legal prohibition of cloning for research nor wholeheartedly endorse such research without trepidation. What was it my esteemed teacher Paul Ramsey once said about “the man of frivolous conscience” who, despite much hand wringing and many words of caution, in the end always says yes?

[3] Does the slight drift of my thinking from 1995 to 2001 in the direction of permissiveness show that conservatives’ fears about the slippery slope were well justified? I would prefer to suggest that Christian ethics must strike a balance between nonmaleficence and beneficence. If the Christian moral life involves responsibility for the well-being of one’s neighbors, how could we not pursue these promising avenues of biomedical research? As Ted Peters and Gaymon Bennett provocatively observe, “To elect an unsure commitment to nonmaleficence rather than an unsure commitment to beneficence would be, as in Jesus’ parable of the Good Samaritan, passing by on the other side.”[4] That may be true but it’s too simple and one-sided. An unqualified commitment to an unsure beneficence may lead us “to do evil that good might come.” Christian ethics must hold means as well as ends in view and that requires us to resist the utilitarian imperative to achieve all the good we can no matter by what means.

[4] Of course, there is simply no escaping the perennial question of the moral status of the early embryo. Should it be regarded as the weakest and most vulnerable of neighbors deserving our protection, rather than exploitation, in the service of others? Or is it just “a clump of cells” to be manipulated, used, and discarded as we see fit? Perhaps we should accord it an intermediate status somewhere (where exactly?) in between. I suspect that most JLE readers are familiar with the arguments for and against various answers to this question, and I have nothing to say that might illuminate, much less settle, the issue. But after all the abstract philosophical and theological arguments have been made and rebutted, I can only concur with the candid statement of former Republican (and pro-life) senator and Episcopal priest John Danforth (who, incidentally, was also a student of Paul Ramsey),

No theologian, however learned; no church council, however authoritative; no bishop or archbishop, however holy, will ever persuade me that protecting a frozen embryo that will never see the light of day should take precedence over my brother Don [who died of amyotrophic lateral sclerosis]. No religious doctrine, however earnestly formulated, will ever convince me that cells in a laboratory are so significant that my brother should be denied the benefits of medical research. The very notion goes against both my reason and my deepest feelings.[5]

The results of recent pro-stem cell research referenda and legislation in various states as well as last November’s congressional elections suggest that his sentiments are widely shared.

[5] But now it’s 2007, and there are new developments that should be welcomed by all of us, not least by those who are as conflicted as I am. It may be possible to obtain embryonic stem cells without destroying viable embryos. Research is under way using parthenotes (unfertilized eggs that can be induced to start dividing but could never develop the placenta needed for gestation). Another technique which is, according to Ronald M. Green (head of the Geron Corporation’s Ethics Advisory Board in a presentation at the Annual Meetings of The Society of Christian Ethics and the Society of Jewish Ethics in January 2007), “ready for use today” is single blastomere biopsy in which embryonic stem cells are obtained by the same technique used in pre-implantation genetic diagnosis (PGD). The PGD is being performed in order to help couples produce a genetically healthy baby, and while the procedure involves risk to the embryo, there would be little, if any, additional risk if the biopsied blastomere were also used to generate stem cells.[6] Also in January, scientists reported that stem cells similar to embryonic stem cells had been found in amniotic fluid.[7] None of these procedures involves ‘creation for destruction’. Most exciting of all is the concept of altered nuclear transfer (ANT) in which,

the adult body cell nucleus or the egg cytoplasm (or both) are altered before the nucleus is transferred to the enucleated egg so that the newly constituted cell will, from the outset, lack the integrated unity and developmental potential of an embryo, yet will nevertheless possess the capacity for a certain limited subset of growth sufficient to produce pluripotent stem cells.[8]

William Hurlbut (a Christian physician, neuroscientist and member of the President’s Council on Bioethics, who believes human life begins at conception and is the father of a handicapped child) thinks that ANT will provide the therapeutic benefit of SCNT (a genotype identical to that of the patient from whom the adult cell was taken) without “degrading the very humanity we are trying to heal.”[9]

[6] Each of these research programs has its skeptics and detractors, and the scientific and bioethical literature is full of vigorous debate about their relative merits. Obviously, I am in no position to opine which if any of them will work, but I am heartened by the prospect that one day we may be able to at least pursue embryonic stem cell cures (which is, in itself, doing good whatever the result) without doing harm to embryonic human life.[10]

[7] If one or more of these techniques succeeds and the question of the moral status of the embryo becomes moot, there will remain plenty of things for religious ethicists, bioethicists and citizens to worry about. How will the embryos for single blastomere biopsy be obtained? What inducements might compromise the informed consent of prospective donors? Would it be fair to donors (or the fetus they desire) if changes in the usual PGD procedure were to affect the accuracy of the test or diminish the likelihood of a successful pregnancy?[11] If ANT works, there will be a huge demand for eggs. Can it be met without endangering and exploiting poor women in our own country and around the world? (The international black market in kidneys should be a warning.) And who will benefit from stem cell therapies? Will the stem cell banks be set up so as to serve all of the ethnic groups in our society or just those of European ancestry? What public policy measures might insure fair “biological access,” to say nothing of economic access, to the new therapies?[12] Should we continue to provide commercial patent protection to embryonic stem cell “inventions” that may inhibit medical research and make stem cell therapies too expensive for all but the wealthy? These are the sort of emergent ethical issues that we need to address, and address quickly before exploitative and unjust practices become the norm.[13]

[8] Scientists, themselves, are being pro-active. The International Society for Stem Cell Research (ISSCR) has just issued “Guidelines for the Conduct of Human Embryonic Stem Cell Research” which call for “special scrutiny of human embryonic stem cell research and specify rigorous ethical standards for scientists working with human embryonic stem cells, seeking to promote responsible, transparent and uniform practices worldwide.”[14] The guidelines are far too technical and detailed to summarize here but interested readers may wish to examine them on the ISSCR website.[15] They represent an admirable initiative toward professional self-regulation. However, the burdens and benefits of stem cell research are far too important to be left to the scientific community alone. Religious communities should engage these issues, bringing to bear the moral convictions and critical resources of their faith traditions. We may not know much about embryology, but we do know something about justice.

End Notes

[1]. In a paper presented to the President’s Council of Bioethics, Gene Outka offers a persuasive justification for using surplus embryos despite his opposition to the creation of embryos for research. See his “The Ethics of Stem Cell Research” in the Kennedy Institute of Ethics Journal, 12:2 (2002), 175-213. It is also available in Brent Waters and Ronald Cole-Turner, eds. “God and the Embryo (Washington, DC: GeorgetownUniversity Press, 2003). 29-64.

[2]. Letter to Dr. John R. Stumme, September 1995. I seem to recall that the responses (or a summary of them) were printed by the department but I do not have a copy.

[3]. “Therapeutic Cloning and Moral Perplexity,” Journal of Lutheran Ethics, www.elca.org/jle (December 10, 2001).

[4]. Ted Peters and Gaymon Bennett, “A Plea for Beneficence” in Waters and Cole-Turner, God and the Embryo, 128.

[5]. John Danforth, Faith and Politics (New York: Viking, 2006), 94.

[6]. For a less optimistic risk assessment, see Kathy Hudson, “Embryo Biopsy for Stem Cells: Trading Old Problems for New,” Hastings Center Report, 36:5 (2006), 50-51.

[7]. Constance Holden, “Versatile Stem Cells Without the Ethical Baggage?” Science, 315 (12 January 2007), 170.

[8]. William B. Hurlbut, Robert P. George, and Markus Gompe, “Seeking Consensus: A Clarification and Defense of Altered Nuclear Transfer,” HastingsCenter Report, 36:5 (2006), 43.

[9]. William B. Hurlbut, “Stem Cells, Embryos and Ethics: Is There a Way Forward?” Canyon Institute of Advanced Studies Newsletter, 6:2 (2006), 7.

[10]. To be sure, such beneficent work is done today using non-embryonic stem cells from umbilical cord blood, bone marrow and other adult tissue. Patients with leukemia and sickle cell anemia have already benefited from adult stem cell therapies.

[11]. Kathy Hudson, “Embryo Biopsy for Stem Cells,” 51.

[12]. Ruth R. Faden, Liza Dawson, Alison S. Bateman-House, et al., “Public Stem Cell Banks: Considerations of Justice in Stem Cell Research and Therapy.” Hastings Center Report, 33:6, 13-27. It is also available in Michael Ruse and Christopher A. Pynes, The Stem Cell Controversy (Amherst, NY: Prometheus Books, 2006), 199-222.

[13]. The emergent issues identified in this paragraph were discussed by Laurie Zoloth, Sondra Wheeler and Audrey Chapman (in absentia) at the Annual Meetings of the Society of Christian Ethics and the Society of Jewish Ethics in January 2007.

[14]. http://www.isscr.org/press_releases/guidelines_release.htm (February 5, 2007).

[15]. http://www.isscr.org/guidelines/ISSCRhESCguidelines2006.pdf (February 5, 2007).