The Use of Human Embryonic Stem Cells Derived From Human Embryos is Unnecessary Considering The Other Alternatives Available.

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1 The Use of Human Embryonic Stem Cells Derived From Human Embryos is Unnecessary Considering The Other Alternatives Available By Ciaran Barlow Pass with Merit RESEARCH PAPER BASED ON PATHOLOGY LECTURES AT MEDLINK

2 ABSTRACT Since the derivation of the first human embryonic stem (ES) cell lines by Thomson in 1998 many pro-life activists have protested about the source of such stem cells labelling them as unethical. This has caused the world to become in part sceptical of the use of these cells in research and practically in modern medicine. Such doubts have lead scientists to research and develop other techniques such as somatic cell nuclear transfer or a technique involving pre-implantation genetic diagnosis. These techniques avoid the general potential life and personhood debate and whilst not completely without their own ethical flaws seem to be a good alternative. Yet the money invested in this research seems to tip the scale in terms of the debate as essentially the research is attempting to achieve what we have already achieved although via a different route. It seems logical that human ES cells collected as a result of IVF should be permitted considering they are sourced from embryos that will inevitably be discarded and will never develop to become a foetus. INTRODUCTION In what Scott describes as an experiment that shook the world (Scott, 2006) Thomson tells us in the journal Science how he managed to develop a single line of human embryonic stem cells. This was first reported in the journal Science on the 6th of November 1998 where he describes just how he achieved his goal. This achievement whilst seeming relatively straight-forward if you listen to Thomson s modesty was a huge step in the long road towards stem cells becoming a dominant part of modern medicine. Whether deliberate or not Thomson in the publication s abstract seems to not be fully aware and underestimates the potential uses of his cell lines. He writes in the abstract These cell lines should be useful in human developmental biology, drug discovery and transplantation medicine. (Thomson, 1998). To me this seems to be Thomson wanting to seem modest and play down the importance of his discovery rather than his ignorance towards its capabilities. But nevertheless he had just set the foundation for what seems to be becoming the greatest hope in 21 st Century medicine. Yet despite the initial enthusiasm there were those that became sceptical about whether it was in practice ethical or not. Perhaps the most famous of these sceptics was the US President George W. Bush who on the August 9 th 2001 prohibited Federal Funding on Human Embryonic Research where the derivation process began after 9:00 P.M. EDT on August 9, The stem cells that were still eligible for funding must have been derived from an embryo that had been created for reproductive purposes no longer needed and must have been donated with informed consent. These restrictions led other researchers to investigate alternative procedures to obtain identical or similar ES cells. Such processes developed involved Somatic Cell Nuclear Transfer (SCNT), Altered Nuclear Transfer, Pathogenesis, a technique involved with Pre Implantation Genetic Diagnosis (PGD) as well as other methods involving things such as engineering stem cells from skin biopsies. The debate was once again reignited in the wake of Obama s statement on the 9 th March 2009 which read: 2

3 For the past 8 years, the authority of the Department of Health and Human Services, including the National Institutes of Health (NIH), to fund and conduct human embryonic stem cell research has been limited by Presidential actions. The purpose of this order is to remove these limitations on scientific inquiry, to expand NIH support for the exploration of human stem cell research, and in so doing to enhance the contribution of America s scientists to important new discoveries and new therapies for the benefit of humankind. The stance showed that unlike Bush Obama saw that the future capabilities of stem cells outweighed the ethical issues involved and in fact these alternatives were not seen to swing the President s decision. This stance is of course widely controversial and the debate continues to this day with the future of human ES stem cells relatively ambiguous. DISCUSSION On the one hand there are some that would argue that the ethical issues involved with ES cells are relatively unimportant in comparison to the inherent future medical capabilities they have. One of the major issues involved with the stem cell debate is the whole preventing a potential life debate. Yet frankly whilst it seems that to call this ball of cells a potential life is scientifically correct but yet when assessed practically it seems this view is a bit farfetched considering every embryo requires a mother to carry the blastocyst in order for it to develop into a foetus. Therefore considering that most if not all of the embryos donated to ES cell research are provided as a result of In-Vitro Fertilisation (IVF) fertility treatment where the embryos are unwanted and consequently only going to be discarded due to the number of embryos produced in IVF treatments it seems that using them for ES cell research would be a wise use of resources considering in some way they are in some ways a bi-product of such treatment. It would be an idealistic viewpoint to consider that these embryos have some sort of right to life when in fact practically even if they did have some kind of right they would practically have no way of exercising this right. It is a fact of IVF treatment that more embryos are created than are actually required in order to achieve the best results as in this procedure embryos are assessed to predict which of these have the greatest chance of survival in the womb and will consequently be implanted. Subsequently this means there are embryos left over with relatively no purpose and to use them for significant scientific research which could in effect help to save millions of lives as currently the ability of stem cells seems never-ending would be a wise choice. Another ethical dilemma that comes as a package with the potential life debate is the debate involving personhood where ethicists try to determine when does a pre-embryo, an embryo or a foetus become a person. In his book the Ethics: An Introduction to Moral Philosophy ethicist Noel Stewart assesses five possible solutions or points at which personhood begins. The first stage considered is at conception where the sperm meets the egg to form a zygote. This is a point of view held by the Catholic Church who released a statement in 2008 called Dignitas Personae on Certain Bioethical Questions where they stated that: 3

4 The originality of every person is a consequence of the particular relationship that exists between God and a human being from the first moment of his existence and carries with it the obligation to respect the singularity and integrity of each person, even on the biological and genetic levels. Yet this comes with its problems as something such as a sardine at this point is a higher functioning being than a foetus yet we do not call it a person. Some would then argue that this is down to the zygote having the potential to become a higher functioning being and implying that at this point we can call it a potential person. This consequently almost indirectly admits that the zygote at this point is not yet a person as it is in fact a potential person. The second point considered is the point at which the foetus possesses a shape that resembles a human being as we know it. This again has its flaws as it seems that we can call anything that looks slightly like a human a person. Would we call a chimpanzee a person? I highly doubt it. This point also fails to address the idea the mental qualities that a person holds with the ability to reason and make informed decisions. The third looks at when we become a sentient being at just after 8 weeks. This means that the foetus is able to feel pleasure and pain as the result of developing a nervous system. To me, this seems to be a decent attempt at answering this almost unanswerable question as it seems to encompass the main ideas that we consider to make up a person. Firstly as of 8 weeks we do resemble to some extent the shell of a human being as well as more importantly developing a nervous system so consequently having the ability to not only feel pleasure and pain but to also to a point be rational and self-aware which in philosophical terms seems to define a person. Other alternatives considered by Stewart involve personhood at the point at which a foetus can independently survive outside the womb or finally at birth yet in terms of looking at an ethical issue involving stem cells these points seem irrelevant. We can see from these ideas that personhood does seem to begin until the point at which he/she is sentient at around the 8 week mark. Therefore it seems that such ES cell research from a personhood point of view should be permitted considering that the cells are removed from the Blastocyst at Day 8 of the pregnancy or development weeks before the formation of a sentient foetus. Another relatively large stakeholder in the debate were those involved with the Report of the Committee of Inquiry into Human Fertilisation and Embryology of 1984 which was headed by Dame Mary Warnock DBE and was subsequently known by many in the British public as the Warnock Committee. This whilst before the time of research directly on Human ES cells is directly relevant as it assesses the main ethical dilemmas in researching upon human embryos, perhaps the main ethical dilemma connected with ES cells. They debated amongst the idea in order to provide recommendations for legislations on topics such as embryo research and IVF treatment. Up until this time there were no laws directly linked to acts of embryo research, with such acts only being affected by relatively vague laws created way before the modern scientific era. The group formulated an argument that then provided the basis for the Human Fertilisation and Embryology Act They like Stewart attempted to first answer the idea of Personhood and came up with a completely new idea not even assessed by the ethicist. Their debate came to the conclusion that the an embryo becomes a human at the tender age of 14 days in the womb which is the point at which the first recognisable features of the embryo will appear. Warnock writes, 4

5 The first of these features is the primitive streak, which appears as a heaping-up of cells at one end of the embryonic disc on the fourteenth or fifteenth day after fertilisation. Two primitive streaks may form in a single embryonic disc. This is the latest stage at which identical twins can occur. This quite clearly takes up the point that personhood begins at 14 days which is scientifically the point at which an embryo will no longer divide to leave two identical embryos which can subsequently develop into identical twins. Therefore the scientific argument is that the embryo becomes an individual and consequently a potential person at this stage. This idea would essentially imply that the harvesting of stem cells should be given the go ahead when you consider that these ES cells are only ever harvested from an blastocyst that is between three to five days old, which means that these cells will never be extracted after the point of 13 days after conception, at least a day before its development of the primitive streak (a thickening line that eventually gives rise to the nervous system). The report also seemed to find that the majority seemed to back human embryo research and it was in fact the minority that were against its use. The report used the example of Down s syndrome which seemed directly related to fertilisation and was a condition that was only found in human beings. The report wrote that: We found that the more generally held position, however, is that though the human embryo is entitled to some added measure of respect beyond that accorded to other animal subjects, that respect cannot be absolute, and may be weighed against the benefits arising from research. In certain situations there is no substitute for the use of human embryos. Another point that could be considered relating to the idea that there is no substitute to human embryos is the concept of whether an embryo created via the fusing of a human ovum and sperm has the exact same composition as an embryo developed as a result of Somatic Cell Nuclear Transfer (SCNT). Evidence for this statement could come in the form of undoubtedly the most famous product of SCNT, Dolly the Sheep. Some cloned mammals, including Dolly, have been shown to have shorter telomeres than other animals of the same age. These Telomeres are small fragments of DNA that shield the ends of chromosomes. They shorten as cells divide and are therefore considered a feature of ageing in cells. This idea of premature ageing concurs with Dolly s death where she was diagnosed with a progressive lung disease and severe arthritis, a condition usually found in sheep much older than Dolly who died at the age of 6, only achieving 50% of her life expectancy (New Scientist, 2005). Another study of cloned mammals that have lived long enough to determine any effect on lifespan yielded similar results where the mice involved died prematurely. The research was conducted at the National Institute of Infectious Diseases in Tokyo, Japan, and published in February So surely it would only be logical to perform research on embryos which we are sure are identical to those created as a result of human sexual reproduction which we can obtain via In Vitro Fertilisation (IVF). 5

6 It seems crucial, ethically that these embryos are obtained via IVF to avoid any other ethical concerns as is once again an issue covered by the Warnock report. This is down to the fact that any embryos not implanted into the mother s uterus will inevitably be discarded as a result so why not use them for research in a way that may benefit humanity in helping to save other s lives. Why should we divert to other techniques in developing stem cells when we could perhaps more easily use these embryos which would continue to be created and destroyed in the absence of embryo research. So isn t using them for valuable medical advances only logical in attempt to make up for the potential lives lost in the process? Dame Warnock writes of this importance in her report stating that: Nevertheless, the argument runs, research on embryos may be justified, provided that the embryos used as subjects of research were brought into being, not primarily for research, but in order to alleviate a particular case of infertility. An embryo obtained via extraction from a woman s uterus would be seen as preventing life from thriving and could be seen by many as murder if it were to be viewed on the same level as human life. Furthermore the idea of generating the required embryos solely the purpose of testing is a contentious issue. Some believe that such acts can be justified whereas others believe that it exploits the concept of creation. Many even believe that the use of such embryos as a result of IVF treatment can only be justified in context of the philosophical principle of double effect which states that an act which would be wrong if chosen for its own sake may be justified if it occurs as a bi-product of some other. being matched to patient, a feat that clearly could not be achieved by those cells derived from embryos However on the other hand there are others who would argue that seems logical to use other viable, less ethically controversial techniques to require the stem cells needed for medical experimentation. There are many different arguments ranging from the ideas of alternative techniques such as SCNT or the use of less pluripotent stem cells in Adult or Cord Blood stem cells which all even have the added bonus of the possibility of the consequent stem cells One fairly viable alternative technique could come in the form of the somatic cell nuclear transfer which would provide us with ES cells without the need for sexual reproduction. In the process the nucleus of an unfertilized egg is replaced with the nucleus from a somatic cell, such as a skin cell, from the patient who will ultimately be transplanted with the appropriate cells. The generated cell becomes a structure that looks similar to but is very different from a blastocyst produced by a sperm and an egg. Within it are embryonic stem cells however they are 6

7 unable to undergo the genetic reprogramming that, after sexual reproduction, permits the development of a healthy baby. Therefore the generation of life becomes impossible (Teitelbaum, 2005). The fact that there is no hope of any generation of life is extremely important because it eradicates many of the ethical dilemmas associated with ES cell research. For example the whole Personhood debate is immediately eliminated. However it is important to realise that the technique does have its flaws. It is perhaps not as ethically controversial as there remains to be ethical concerns about the misapplication for reproductive SCNT, a highly controversial issue that has seen bans throughout the majority of the world connected with its application, but in terms of a practical sense it seems to be disadvantaged. The application of SCNT is entirely theoretical as so far no scientist has prevailed in actualising such ES cells. However scientists have succeeded in generating a SCNT blastocyst. Practical difficulties can also be seen in relevance to the practicality of requiring the number of ova required for its application. The process requires women actually donating their eggs, but can the supply really meet the demand? So it poses the question: Should money be injected into researching techniques to produce a product we can already generate? Or would it really be worth pursuing techniques so that the controversy surrounding ES cells can be dismissed? It could then be argued by those against embryo cultivation that the future of stem cells lies with the recently developed technique of engineering stem cells by reprogramming mature adult cells so that they can revert to their original pluripotent state. The technique was developed in 2006 by a scientist named Shinya Yamanaka who found that if you were to place four specific genes into cells from a skin biopsy the resulting cells would seem to become pluripotent and in bluntly seemingly undifferentiate. These cells were called an induced pluripotent stem cell, or ips cell. This was a remarkable discovery because to date scientists had found that only ES cells, derived from a human embryo, are naturally pluripotent. Yamanaka s discovery means that any cell of the body except a sperm or egg can now be turned into a pluripotent stem cell. Research into this area is fairly primitive with scientists exploring the relatively unknown. But surely if Yamanaka s results are accurate and we can in fact develop pluripotent cells from adult cells, from a Pro-Life perspective it would be foolish not to abrogate the experimentation on embryos for stem cell research. This technique finally presents us with a method without the political, scientific and ethical roadblock of using human eggs or embryos we have become accustomed to. (Goldstein, 2010) 7

8 The final alternative perhaps lies with the comparatively proven technique of using adult stem cells which whilst less powerful that their ES cell counterparts come without controversy. They have also demonstrated successful treatments in the past with Hematopoietic stem cell transplantations being used since 1959 in the treatment of Leukaemia. These cells whilst not as powerful should without a doubt also be considered considering how they have consistently produced more promising results than the use of ES cells therefore providing an argument for such cells as a better alternative. CONCLUSION There is no doubt in my mind that from a personal perspective I would consider that human life would start at either the point of a development of a primitive streak or the point at which a foetus can be seen as becoming sentient. This allows me to conclude that from my perspective human life can start at a point no earlier than 14 days after conception. This implies that the practice of embryo research should be allowed in the case of stem cells as such experimentation only ever occurs up until the 13 day point. However I realise the question of personhood is entirely philosophical in nature and will consequently never acquire a definite answer. This observance leads me to suggest that whilst I personally may condone such research the objection of others is never likely to disappear so therefore would encourage the development of certain other techniques which are less controversial so that the emphasis can turn from the ethical debate to the application towards the treatment of patients, the ultimate goal of stem cell research. When you consider the possible potential uses and impact of stem cells and by being stubborn and arguing for one side of the debate is only dooming more and more to their inevitable end it seems that a solution to any problem should be found as soon as physically possible. The Guardian attempts to explain its potential in its article on Tomorrow s Cures which read: 8 The potential of stem cell research is almost biblical in its scale. The capacity for these cells to transform into whatever the body needs to regenerate itself could, in the lifetime of the next generation, make the blind see, the crippled walk, and the deaf hear. It could cure cystic fibrosis and arrest muscular dystrophy. (The Guardian, 2009) But the list goes on and on. Possibly when you consider that worldwide there are around people who suffer from the rare condition of cystic fibrosis it can be seen just how potentially powerful these cells are. Yet I will reiterate that it is imperative that we do not go about the research in the wrong way and potentially doom a potential Medical Revolution to a Medical Disaster. I believe that whilst research and treatment using Adult stem cells should continue, research involving SCNT should be halted as to me it seems that it is attempting to answer one problem with another ethically

9 controversial technique. For me, the greatest hope comes with the development of the ips technique. With the ips technique with have something that seems practically possible with the recent development of ips cell lines, something which produces pluripotent cells as well as a something which is comparatively without ethical controversy. Perhaps with the development of such techniques the Medical Revolution can finally begin. BIBLIOGRAPHY Scott, C. T. (2006). Stem Cell Now: A Brief Introduction to the Coming Medical Revolution. Plume. Thomson, J. A. (1998). Embryonic Stem Cell Lines Derived from Human Blastocysts. Science, Human Embryonic Stem Cell Policy Under Former President Bush (Aug. 9, 2001 Mar. 9, 2009) Stewart, N (2009). Ethics: An introduction to Moral Philosophy. Polity Press Congregation for the Doctrine of the Faith (2008) INSTRUCTION DIGNITAS PERSONAE ON CERTAIN BIOETHICAL QUESTIONS Warnock, M (1984). Report of the Committee of Inquiry into Human Fertilisation and Embryology. Her Majesty s Stationary Office New Scientist, Dolly the sheep dies young (14 February 2003) Teitelbaum, S. (2005) Stem Cells Hold Great Promise Lawrence S.B Goldstein, (2010) Stem Cells for Dummies, Wiley Publishing Maggie Fox (2007) Embryonic stem cells made without embryos The Guardian (2009) Tomorrow s Cures 9

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