JCI CURRICULUM: UNIT 3: CHAPTER 1 BIO ETHICS LESSON 1: EMBRYONIC STEM CELL RESEARCH. LESSON 1: EMBRYONIC STEM CELL RESEARCH (45 mins 1 hour)

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1 (45 mins 1 hour) Goals For students to: Define what embryonic stem cells are, where they are found, and how they may be used. Understand different religious & ethical perspectives on the use of embryonic stem cells for research Apply Jewish values and perspectives to the question of stem cell research. Create a public service announcement advocating for a perspective on this issue. Materials: Poster board Markers Pens Computer with internet access (with projector, if possible) / if no internet then present a printout of the CNN Primer on Stem Cells Text handouts o Dr. Jeff Kahn-CNN article with questions o Statements from Religious Action Center of Reform Judaism Orthodox Union Eric Cohen of the Ethics and Public Policy Center (National Review Article Unorthodox Endorsement ) Procedure 1) Framing exercise #1 (10 mins) a) Put the following question on the board: What is stem cell research? b) Ask for volunteers to respond to this question, and track the answers on the board. c) Show CNN Primer & answer questions 2) Framing exercise #2 Learning the basics (10-15 mins) a) Divide students into pairs & distribute the Dr. Jeff Kahn-CNN article with question worksheet. b) Have them read the article together & answer the key questions. 3) Main Activity (15-20 mins) Divide students into 3 groups and hand out the appropriate statement to each group: 1

2 Religious Action Center of Reform Judaism Orthodox Union Ethics and Public Policy Center (see Eric Cohen s article) Instructions: Read through your organization s statement on Stem Cell research, discuss, and develop a 3-minute public service announcement (skit) to be run on Jew-TV, a cable channel. You must use Jewish values and ideas to explain why Jews should favor or oppose federal funding of embryonic stem cell research. 4) Conclusion (10 mins) Journal Questions: What are the overriding values in the debate over stem cell research? What makes a stance on a certain issue legitimately Jewish? What are the limits to these kinds of interpretations? 2

3 CNN Primer on Stem Cells 3

4 4 JCI CURRICULUM: UNIT 3: CHAPTER 1 BIO ETHICS

8 Handouts: Handout 1: Dr. Jeff Kahn: Ethics of stem cell research July 11, 2001 Posted: 1:08 PM EDT (1708 GMT) Jeffrey Kahn is the director of the Center for Bioethics at the University of Minnesota. He is a professor in the university's schools of medicine, and public health and philosophy. Kahn's recent book is "Beyond Consent: Seeking Justice in Research." He writes a bi-weekly column about ethics for CNN Interactive. CNN: Good afternoon Dr. Jeff Kahn. Welcome to CNN.com Newsroom. Stem cell research KAHN: Hi, everybody! Happy to be here. CNN: What exactly are we talking about when referring to stem cells? KAHN: Well, actually, there are two kinds of stem cells that we're talking about. There are adult stem cells, which are like in the bone marrow, which can become any other kind of cell within a particular area of the body. For example, in the bone marrow, stem cells can become any other kind of blood cell, but they can't become liver or nerve or heart, or other kinds of tissue. So, the kind of cells we're arguing about are called embryonic stem cells, which are cells that can become any other kind of cell in the body. They're more potent than other stem cells. They're much more controversial because of the source. They come from human embryos, and human embryos are destroyed in the process of collecting them. CHAT PARTICIPANT: Is there any solid progress or reason to consider continuing this research? KAHN: Yes, there is lots and lots of progress, first in animal models. There has been promising research showing that these cells can be used in lots of therapeutic applications. For instance, the likely first step would be things like Alzheimers or Parkinson's Disease, where stem cells could be implanted into the brain, and replace the diseased cells or the cells that don't work properly. And then if we look further out, people have suggested that we could actually repair spinal cord injuries in people like Christopher Reeve, or grow human organs for transplant purposes. So, the step between where we are now and getting to these applications, is taking these cells and learning how to program them to become the target cell that we want. That's what this research is all about, getting to that kind of understanding, so we could actually use these cells for therapeutic purposes. 8

9 CHAT PARTICIPANT: Thank you Dr. Kahn for being here - can you please discuss the types of ways embryonic stem cells are collected currently? KAHN: Embryonic stem cells all come from human embryos. What happens is that they're very early stage after fertilization. Most have come from leftover embryos from invitro fertilizations. Those embryos are just a few days old, just a few hundred cells total. They have embryonic stem cells within those cells, and they're harvested from the embryos, which destroys the embryo in the process. You can't just take the cells, and then have the embryo normally develop. CHAT PARTICIPANT: Please clarify - are we talking about the embryos from abortions or those artificially inseminated that go unused? KAHN: The latter. There aren't such things as embryos from abortions, because an abortion happens much further along in gestation. Two years ago, when embryonic stem cells were first identified, the two sources were human embryos and tissue from aborted fetuses. An area called the neural ridge in a developing fetus has cells that are very similar to embryonic stem cells, but most scientists now believe that stem cells from embryos are of superior quality, so that's become the focus of the source of stem cells, rather than aborted fetal tissue. CHAT PARTICIPANT: Why is everybody asking if this is ethical? Who exactly is getting hurt since we do still allow abortions? KAHN: The concern is that it violates the moral status of human embryos to destroy them for research purposes. It's not exactly like abortion, because it's not inside a woman's body. Much of the abortion debate revolves around the right of women to choose what happens to their body, but these are embryos in a test tube. The question is who has the right to decide what will happen to these leftover embryos. CHAT PARTICIPANT: What normally happens to these used embryos if they are not used for research? KAHN: Great question. Here's a list: They can remain frozen. They can be donated to another couple. They can be donated for research purposes. They can be discarded. Or they can be used by the couple that created them in the first place. CHAT PARTICIPANT: Would "parents" of the frozen embryos need to give permission for their product to be used? KAHN: Yes. Every clinic requires the consent of the couple for any disposition of the embryos. CHAT PARTICIPANT: Is there any chance that these stem cells embryos would become human beings if not used for the research? KAHN: Yes, if they were implanted into a woman's uterus, and things went right, then they would become a baby. That requires a willingness to use them if they're their owned, or donate them if they're created for the purpose of having a child. But for the vast majority of those leftover embryos, that will never happen. CNN: Are any biotech companies or researchers soliciting donors to create these embryos? 9

10 KAHN: Certainly researchers. That's the story out today about the Jones Institute. Researchers at the Jones Institute recruited women to donate eggs, and men to donate sperm for the purpose of mixing them together to create embryos for the purpose of doing stem cell research on them. Not for the purpose of reproduction. It's created controversy, because the intention was not to have a child, as in the case of IVF, but for the express purpose of destroying them in the process of research. There's a question about whether we need to do that. It's not clear, even after they published their paper, whether there's any need to do this, given we have an estimate of 200,000 embryos left over from IVF worldwide. CHAT PARTICIPANT: Is this the first instance of embryos being created solely for the purpose of stem cell research? KAHN: As far as we know, yes. CNN: What kind of procedure must female egg donors go through? KAHN: You have to take injections of hormones to stimulate what we call hyper-ovulation, so the woman would produce many more eggs than usual under normal ovulation. Then those eggs are collected by a long needle being inserted into the ovary, and removing them. There are risks from the drugs you take before hand, and risks to the procedure itself. There's some evidence that there's an increased risk of cancer in women who take the drugs for hyperstimulation of their ovaries. CHAT PARTICIPANT: How many embryonic stem cells would have to be transplanted into a human to replace an organ or to cure their disease? KAHN: It turns out that embryonic stem cells are immortal. That is, they'll divide forever. So, in theory, you would grow an organ in a laboratory and then transplant it into a person's body. You wouldn't put the cells into a body and have them grow in the right place. That's all very prospective, and there's a lot of research to be done. This could all change. CHAT PARTICIPANT: Dr Kahn, do you need federal money to continue the research? KAHN: That's a great question. People should understand that the U.S. government is the single largest funder of biomedical research in the world. It's not just a question for stem cell research in the U.S., but on the international scene. Without federal funding, it's very hard to exert federal control over this or any other area of research. It would be much easier to control this research if the federal government funds it. So those are two strong reasons why we should consider federal funding. CNN: Do you have any final thoughts for us today? KAHN: I think what's interesting to watch in the debate in Washington is how much this policy decision is being influenced by political considerations, rather than by issues of science and ethics. It's not the best way to make science policy. I hope that voices from the scientific community and the bioethics community have a say before the Bush administration makes their final decision about whether to fund this research. CNN: Thank you for joining us, Dr. Kahn. KAHN: It's been fun, as always. Thanks for having me. 10

11 Key Questions: What are the main differences between adult and embryonic stem cells? What kids of breakthroughs are scientists hoping will result from this research? Where do the embryonic stem cells come from? What are ethical concerns do some people have about this research? Is there an ethical difference between creating human embryos specifically for stem cell extraction versus extraction from embryos left over from fertility treatments or abortion? 11

12 Handout 2: 67th General Assembly November 2003 Minneapolis, Minnesota RESOLUTION ON STEM CELL RESEARCH BACKGROUND Jewish tradition teaches us that preserving life and promoting health are among the most precious of values. These values have informed our affirmative commitment to medical science throughout the ages. Judaism has always encouraged scientific and medical advances. As Nachmanides taught, the practice of healing is not merely a profession, it is a mitzvah, a righteous obligation. A recent CCAR responsum applies this principle to human stem cell research: "If we define the administration of lifesaving medical therapy as pikuach nefesh, we should not forget that physicians could not save lives were it not for the extensive scientific research upon which our contemporary practice of medicine is based. Since research into human stem cells partakes of the mitzvah of healing, surely our society ought to support it" (CCAR Responsum , Human Stem Cell Research, Rabbi Mark Washofsky). Continuing developments in biological science have opened the door to life-enhancing and life-saving technologies. The sequencing and mapping of the human genome, in particular, have profound implications for medical technologies. At the forefront of these possibilities is the opportunity for treating or preventing diseases through gene manipulation, often called "gene therapy." Somatic gene therapy attempts to correct a genetic defect in the cells or tissues of an individual in order to prevent or treat disease and may help heal or prevent debilitating afflictions. Somatic gene therapy should not be confused with germline therapy, which is more controversial and involves changes to an individual's genetic makeup that can then be passed on to future generations, with unknown implications and potential complications. Stem cell research involves cells that can potentially develop into any kind of cell, tissue, or organ in the body ("totipotent stem cells") and that may one day soon be able to replace damaged or sick cells in a patient with an injury or degenerative disease. For example, scientific research into stem cell regeneration holds the promise of finding new and effective treatments for Alzheimer's, Parkinson's, spinal cord injuries, and certain types of cancers. The moral imperative to pursue stem cell research is clear; it is an embodiment of the mitzvah of healing. Our tradition requires that we use all available knowledge to heal the ill, and "when one delays in doing so, it is as if he has shed blood" (Shulchan Aruch, Yorei De`ah 336:1). Totipotent stem cells are commonly obtained by using somatic cell nuclear transfer (SCNT) technology. This technique, commonly referred to as cloning, involves the removal of the nucleus of an unfertilized, mature egg and its replacement with a genetically complete nucleus obtained from another adult or fetal organism. Since almost 12

13 all of the hereditary genetic material of a cell is contained within its nucleus, the entity into which this egg develops is genetically identical to the organism that was the source of the transferred nucleus. While some argue that stem cells harvested from adults and the existing stem cell lines are sufficient for research, most in the scientific community maintain that the use of SCNT technology to develop new stem cell lines ("embryonic stem cells") is critical to further development of the medical research. It is important to note that there are ample sources of embryos for research that are currently being discarded and that research using embryonic tissue would not require the creation of new embryos for the purpose of such research. "Therapeutic cloning" uses SCNT technology to create cells that develop only until the pre-embryo stage, at which point the stem cells are removed. These stem cells are then used to research possible cures for serious medical diseases and conditions. In contrast, "reproductive cloning" attempts to use this technology to produce a living, breathing human being. This resolution deals with therapeutic cloning; it does not address the issue of reproductive cloning of humans. SCNT technology can play a vital role in exploring the causes and treatment of genetic diseases; it may help to develop therapies for the afflictions mentioned above, and it may also help develop stem cells to regenerate human tissues, nerve cells, and skin cells. Some opponents of SCNT technology argue that every fertilized egg could be allowed to develop into a fetus. Halting the process to harvest the stem cells seems to them like killing a fetus-a perspective the URJ has never accepted. Numerous URJ, CCAR and WRJ resolutions and CCAR Responsa about when life begins clarify our views in this area. (See, for example, the 1985 and 2000 CCAR Responsa related to abortion, found on-line at To other opponents, the possibility for abuse of SCNT technology seems overwhelming, and for this reason, they would prohibit the entire field of research and therapy. While we recognize the potential abuses that could arise from SCNT technology, these concerns can be met by taking measured, cautious steps and are far outweighed by the potential benefit of medical procedures that promise to cure so many. JEWISH TRADITION TEACHES THE VALUE OF SAVING EVEN A SINGLE LIFE, AND THE CALLOUSNESS OF FAILING TO SAVE A LIFE WHEN POSSIBLE. AS WE LEARN IN THE TALMUD, "WHOEVER CAUSES THE LOSS OF A SINGLE SOUL IS AS THOUGH HE CAUSED THE LOSS OF A WORLD ENTIRE; AND WHOEVER SAVES A SINGLE LIFE IS AS THOUGH HE SAVED A UNIVERSE" (TALMUD, SANHEDRIN 37a). Clearly, there is a need for moral and ethical deliberation, yet we know that millions of God's children are plagued by diseases and injuries that we have the potential to heal. The ethical choice must be to advance our research into lifesaving technologies, not abandon it. THEREFORE, the Union for Reform Judaism resolves to: 1. Support: a. Research using both adult and embryonic stem cells, in addition to the existing lines currently approved for funding by the United States and Canadian governments; b. Research using somatic gene therapy; c. Research using somatic cell nuclear transfer (SCNT) technology for therapeutic cloning; and d. Government funding for all such research; 13

14 2. Oppose efforts to restrict or penalize scientists, clinicians, or patients for participating in stem cell research and SCNT technology for therapeutic purposes; 3. Support appropriate legislative and executive actions consistent with the above objectives; 4. Support efforts by the scientific community to develop regulations and monitor those using SCNT technology; and 5. Call upon congregations, in conjunction with the URJ Department of Jewish Family Concerns and the Commission on Social Action, to create educational programs that explore the issues raised by genetic technology within a framework of Jewish values. 14

17 May 24, 2005 Unorthodox Endorsement Why Judaism is wrong on stem cells. By Eric Cohen With all the disagreements within modern Judaism, embryonic-stem-cell research is an area of remarkable moral and theological consensus. Judaism is pro-medicine; there are no clear grounds in Jewish law for treating human embryos as inviolable; therefore the moral duty to advance potentially life-saving research trumps any moral concerns about the exploitation and destruction of human embryos in the laboratory. On this question, Reform Jews who never feel bound by Jewish law and Orthodox Jews who always live in strict accordance with Jewish law entirely agree: Full speed ahead. It is in this context that the Union of Orthodox Jewish Congregations, one of the most important Jewish organizations in America, has circulated a letter in support of the Castle-DeGette bill (H.R. 810), legislation that would provide federal funding for research using embryos created initially for reproductive purposes but left-over in fertility clinics. The letter is worth quoting at some length: The Jewish tradition places great value upon human life and its preservation. The Torah commands us to treat and cure the ill and to defeat disease wherever possible; to do this is to be the Creator s partner in safeguarding the created. The traditional Jewish perspective thus emphasizes that the potential to save and heal human lives is an integral part of valuing human life. Moreover, the traditional Jewish perspective does not accord an embryo outside of the womb the full status of humanhood and its attendant protections. Thus, stem cell research may be consistent with and serve these moral and noble goals; however, such research must not be pursued indiscriminately. H.R. 810 strikes this careful balance. By insisting that publicly funded stem cell research be conducted on cells derived from embryos donated to IVF clinics and were in excess of the clinical need of the individuals seeking IVF treatment, and by requiring the prior consultation with and consent of the donors, the Stem Cell Research Enhancement Act serves to value and venerate the sanctity of life and our responsibilities to our fellow man and woman. In the end, the argument that such embryos are available for our use because they are leftover ( donated to IVF clinics ), because they are unwanted ( in excess of clinical need ), and because they are likely to die anyway is morally unconvincing. Human dignity does not depend on being wanted by others; and being doomed to death does not make human beings into things otherwise, the terminally ill would be in danger of being turned into ready sources of organs. In the end, the moral question hinges on the moral standing of human embryos themselves on what human embryos are and what we owe them. And it seems irresponsible for Judaism to seek the fruits of modern science without confronting the facts modern biology which demonstrates, beyond reasonable doubt, that the embryo is a complete human organism from the moment of conception, with purposeful division and development from the very beginning, and with primordial limbs, organs, and beating 17

18 heart tissue by age 40 days. To call such embryos mere water denies the biological and human reality that lies before us. It also seems irresponsible to ignore the many references in Jewish literature and Jewish law that celebrate the dignity and mystery of developing life, and that describe the violation of God s majestic creation entailed in deliberately destroying it. Even the wisest rabbi many centuries ago could not deal adequately and precisely with the moral complexity of our current biotechnology. Instead, the Jewish sages of the past can offer us moral guideposts things to revere and things to avoid that we must wisely apply in light of current knowledge and current circumstances. This means not only considering the act in itself embryo destruction but the environment in which the act will be committed, and by whom. And I think it is fair to say that most stem-cell biologists those in the laboratories destroying embryos don t revere God and Torah the way most Orthodox Jews do. This, too, the wise Jewish citizen must remember. While acting positively to save life is a great Jewish good, so is preserving a society that welcomes the weak and never kills the innocent. Even if embryos are not our ontological or moral equals though the argument for such a position is hard to make on rational grounds there are good Jewish reasons not to promote the destruction of nascent human life, precisely because it will corrode the sensibilities that make us good people and good Jews. It is simply wrong to appeal to Jewish law on abortion, which privileges the life of the mother over the life of the unborn child, as a moral justification. Jewish law does so, after all, only in cases where the unborn child is a pursuer who threatens the mother s life and health directly. With embryo research, by contrast, there is no direct conflict between an embryo and a patient, and we are not in the position of using particular embryos to save particular patients. Rather, we are proposing a speculative research project that requires the massive, ongoing destruction of human embryos. And this should make all Jews and all decent citizens shudder not only for what it is, but for where it might lead. Where is the Jewish fence around the law when you need it? But what is most remarkable about the Orthodox Union s letter is the seemingly disingenuous character of the way it endorses H.R. 810 by saying that the legislation strikes a careful balance by promoting only research on leftover IVF embryos. Anyone who has followed the Orthodox Union knows, after all, that this organization has been one of the most vigorous proponents for research cloning that is, for creating human embryos solely for research that requires their destruction. There are no leftover cloned embryos. There are no cloned embryos that are in excess of clinical need. There is no careful balance being struck in the South Korean-style research that the Orthodox Union proudly supports. And if one rereads these past endorsements of research cloning easily discovered on the Orthodox Union s website they are prefaced with the exact same moral language as the endorsement of H.R. 810 with a discussion about the Torah tradition s great value upon human life and the fact that our tradition states that an embryo in vitro does not enjoy the full status of humanhood. Perhaps the careful balance is simply political and not ethical, and perhaps we can expect a letter any day now saying that the Orthodox Union is absolutely opposed to federal funding for research cloning and absolutely opposed to federal funding for creating human embryos solely for research. But this seems rather unlikely. More likely is that the Castle-DeGette bill is just one step towards seeking or demanding federal funding for research cloning, too, since defeating disease may require creating the kind of tailor-made stem cells that cannot be created using only the spares. This is why everyone is so excited about so-called therapeutic cloning in the first place, and why many scientists say using the spares is not enough. On most issues, Orthodox Judaism is a beacon of moral wisdom. And personally, I wish I lived up to the standards of everyday holiness embodied by many Orthodox Jews. But on the stem-cell question, the conscience of Judaism has been misguided. And when it comes to the Castle-DeGette bill, Jews seem to have forgotten even the minimal liberal wisdom of tolerance the wisdom of not trampling on the moral opinions of their fellow 18

19 citizens, like pro-life Christians, who believe embryo destruction is not only evil but the gravest evil. As Jews, don t we owe our fellow citizens the minimal decency of not asking them to pay for the activity that most offends them? (The Bush policy that the Orthodox Union seeks to overturn, one must remember, does not fund embryo research or ban embryo research; its practical effect is ultimately neutral.) As Jews, don t we know what it is like to have our own deepest principles and practices trampled upon by the state? And as Jews, are we really so sure that medical progress justifies or requires the full-scale dehumanization of early human life? Have we forgotten not only the words but also the spirit of Ecclesiastes: As thou knowest not what is the way of the wind, Nor how the bones do grow in the womb of her that is with child; Even so thou knowest not the work of God Who doeth all things? Eric Cohen is editor of The New Atlantis and a resident scholar at the Ethics and Public Policy Center. 19