INSTITUTE Q&A

Q&A: Bioethics at the Institute June 2010

Bioethics at the Institute: Ethical Issues in the Stem Cell Debate

An Interview with James W. Fossett and Michelle N. Meyer

James W. Fossett and Michelle N. Meyer

Q: Why is there such interest among researchers in embryonic stem cells?



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The Institute occasionally posts Q&As that are lightly edited transcripts of conversations with our researchers. This is the second part in a Question-and-Answer series with the Institute’s experts on bioethics. A previous Q&A offered background on bioethics topics being examined at the Institute. Future bioethics Q&As will look at the political issues surrounding stem cell research and at assisted reproductive technologies.

James W. Fossett directs the Institute’s research program in bioethics and federalism, and is associate professor of public administration and public health at the Rockefeller College of Public Affairs and Policy, University at Albany. Institute Fellow Michelle N. Meyer is a Greenwall Fellow in bioethics and health policy at the Johns Hopkins Bloomberg School of Public Health and the Georgetown University Law Center, and associate faculty in the Union Graduate College–Mt. Sinai School of Medicine bioethics program.

Jim Fossett: The advantage of embryonic stem cells is that they can, at least in theory, be turned into any kind of cell in the body. There are these other kinds of stem cells, much further downstream, that can turn into a more limited range of specialized cells. The most common ones in medical practice are hematopoietic blood cells that get used to replace individuals’ immune systems that have been compromised or destroyed, usually by chemotherapy. But it’s proven to be very, very difficult thing to isolate these more specialized stem cells. They’re far less than 1 percent of your total blood cells, so isolating them is hard.

Embryonic stem cells are much easier to isolate. They’re also much more totipotent or pluripotent — they can be turned into a much wider range of different types of cells — in theory, every type of cell in the human body.

Q: What are the overarching ethical concerns regarding embryonic stem cell research?

Michelle Meyer: The most important ethical and political issue is really the source of embryonic stem cells. As the name suggests, embryonic stem cells come from human embryos — specifically they come from very early embryos known as blastocysts. These are maybe four-five days old. You have a fertilized egg, it begins its natural cell-division process, at about four or five days into that process you have what’s known as a blastocyst, with anywhere from 50-150 cells. It’s that entity that is the source of embryonic stem cells, or is one of the primary sources.

Deriving the stem cells from the blastocyst necessarily kills that blastocyst; it can no longer develop further. So many, but not all, pro-life people are opposed to embryonic stem cell research precisely because it requires that scientists destroy the blastocyst. In some theological and philosophical views of moral status, a blastocyst is as much of a person as you or I. And no amount of life-saving medical potential can possibly justify killing completely innocent beings, even to serve that good end. That’s where you get very tied up with abortion politics — the two are very intertwined.

Q: Where do the embryos come from that researchers use?

Michelle Meyer: They can come from a few different sources. For example, when people use in vitro fertilization (IVF) to try to have a baby, they often end up with more embryos than they want or need. Fertility patients typically have several options for dealing with these so-called “spare IVF embryos”:

  • They can cryopreserve them indefinitely, or for use in a later attempt at pregnancy;
  • They can destroy them;
  • They can donate them to another couple for reproductive purposes — so-called “embryo adoption”; or
  • They can donate them to research, including stem cell research.

The only embryonic stem cell research acceptable for federal funding under both the Bush and Obama administrations are these spare IVF embryos. There are a couple of reasons for this.

First, some find it morally significant that the intention behind the initial creation of these embryos is good — that is, individuals who are creating them are creating them to create life, to create a person. Arguably this differs from embryos created (using donated eggs and sperm) solely for the purpose of subjecting them to research. Such “research embryos” are a second source of embryonic stem cells, and raise an additional set of issues about how to ethically obtain the eggs needed to create such embryos.

Second, even some who regard the blastocyst as having considerable moral status find it justifiable to use spare IVF embryos in stem cell research, given the alternatives. Very few people donate their embryos to another couple, to produce another child that that couple would then raise. So practically speaking, the major alternative to donating embryos to research is either indefinite suspension in a freezer or destruction. So if the alternative is destruction of the embryo, arguably it would be wasteful, and maybe even disrespectful of human life, not to instead use them in research that has the potential to be lifesaving for many people.

Another source of human embryonic stem cells is somatic cell nuclear transfer, or SCNT, where the nucleus of both an adult somatic cell and an egg cell are removed and then the adult cell nucleus is placed into the enucleated egg, which is then prompted to divide until it reaches the blastocyst stage, at which point the stem cells are derived. This method of deriving stem cell lines is potentially useful because it allows researchers to create stem cell lines tailored to specific diseases and even specific patients — by using the nucleus of, say, a skin cell from someone with Parkinson’s, we might be able to learn more about that disease and in the event of a stem cell-based therapy, create a therapy that the patient’s immune system won’t reject. Unfortunately, SCNT is also the technique you would use to “clone” someone — you would do the same thing, but then allow the blastocyst to continue to develop and implant it in a human uterus. Most people — not all, but most people — are opposed to reproductive cloning. Pretty much everybody is opposed to it in the short term because of the incredible safety concerns. Dolly the sheep (the first cloned mammal) was the result of almost 30 embryos which produced only three lambs born, only one of which — Dolly — lived. So people imagine what would happen in a human experiment. Just about everybody, at least until we can get those things ironed out, is opposed to that.

Even if we’re only engaged in “therapeutic cloning” (or “research cloning”), where the “clone” isn’t allowed to develop beyond the blastocyst stage, there’s concern that this source of stem cells just makes it too likely that somebody will engage in reproductive cloning. The other concern about reproductive cloning is — again — that you’re creating a human entity solely for the purpose of destroying it and using it for research.

Stem cells are also derived from the tissue of aborted embryos and fetuses, which raises similar issues. The argument in favor of it is that the fetus is aborted and whatever you feel about it, it’s legal and it’s the woman’s choice and it’s done. So again, we may as well make something out of what some people view as a tragedy. The argument against it is that:

  • One: To the extent that we as taxpayers, we as a society, support research that comes from aborted fetal tissue, we may be encouraging a woman who would otherwise be on the fence about whether to get an abortion. Maybe she has relatives with Parkinson’s or Alzheimer’s, maybe she feels that stem cell research could really help her, and she’s on the fence about it, and maybe this would just push her over. So it might actually have an incentive that some people would consider bad.
  • Two: The other issue is, even if it has no actual effect in terms of increasing the rate of abortion, some people say it makes us — us the researchers, us the taxpayers, us the government, whoever is condoning it — symbolically complicit with abortion. Particularly when you’re talking about the government using tax dollars to support this kind of research, that can be problematic.

Jim Fossett: So we’ve drawn this line. There’s an amendment, known as Dickey-Wicker after the two members of Congress who initially sponsored it, that’s been attached to every U.S. Department of Health and Human Services appropriation since ’95. Dickey-Wicker says that you can’t use federal money to produce stem cells. You can use federal money to do research on the lines (of stem cells) that result from it, but you can’t actually use federal money to do the dirty deed and destroy the embryo to get the stem cells.

That’s been forbidden for quite some time. The Obama administration has made no attempt to change that.


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