This past fall I took a course on stem cell biology, ethics, and politics. This was one of the pieces of writing I put together for the course. Enjoy.
---------------------------------
THE PROBLEM. Today in the United States there are divergent forces keeping stem cell policy from taking a firm and permanent stance. The nation is built upon the premises of freedom, which has drawn people from around the world seeking citizenship. With variegated ancestry and nationality these people brought with them vastly different religious and ethical backgrounds. These backgrounds are protected by our first amendment right of freedom includes religious independence. Legal framework on policy, which is influenced by our religion and subsequently our morals, is the same for everyone. Compromising one group’s ethical and moral guidelines with those of another has caused much standstill in stem cell politics.
I am going to suggest a policy for stem cell research and its related fields with the target population of the United States of America and justify the proposal with logical, moral, ethical, religious, and scientific reasoning.
History of Artificial Human Reproduction, Biological Cloning, and Stem Cell Research. Scientific manipulation of human gametes began to be addressed in the United States in 1975 when the Department of Health, Education, and Welfare (DHEW) declared no federal funds were to go toward such reproductive research, unless reviewed by the Ethics Advisory Board (EAB). The EAB quickly acknowledged in vitro fertilization (IVF) “acceptable from an ethical standpoint” in 1979, one year after the first successful human birth via IVF in the United Kingdom. This was only permissive if the parents gave informed consent regarding the scientific use. Another string attached was that no fertilized embryo was maintained in vitro beyond 14 days after fertilization – the time normally associated with implantation in the uterus in a natural pregnancy cycle. This was quickly overturned in 1980 when the DHEW dissolved the EAB. But do note this did now outlaw or create any restriction on IVF or research on human embryos – it was merely a ban on federal funding for couples to undergo IVF. Less the occasional exception of privately funded research, lack of governmental funding barricades that type of research. The restriction goes so far as to state that the equipment purchased with government monies cannot be used to conduct research on human embryos or IVF even if private funds cover operational costs. This funding restriction continued until 1993, when Bill Clinton and the National Institutes of Health Revitalization Act allowed full funding for human embryo research. The NIH quickly gathered a panel of scientists, ethicists, public policy experts, and other advocates to consider the moral and ethical issues involved with human embryo research and to which projects the federal dollars should be allocated, but President William Clinton was discontent and prohibited embryo creation for the sole reason of research. However, he was in favor of the destruction of leftover IVF embryos for research purposes. This recommendation did not pass in congress because Dickey-Wicker Amendment banned the use of federal funds for any experiment that created or destroyed a human embryo for scientific purposes. But in 1998, privately funded research at the University of Wisconsin derived the first human embryonic stem cell line after destroying viable human embryos. One year later, Harriet Rabb, the top lawyer at the Department for Human and Health Services issued a legal interpretation of the Dickey-Wicker Amendment. She claimed federal money should be allowed to fund stem cell lines developed by private research, as the research on the lines does not specifically include embryo destruction. From here, the Clinton Administration quickly developed criteria for allocation of funding in two areas (1) research on privately developed hESC lines and (2) research on developing hESC lines from leftover embryos marked for destruction in IVF clinics. Scientists and research groups halted their current projects to compile funding proposals. However, these proposals were disregarded when our current president George W. Bush cut federal funding for these programs. In order to preserve the sanctity of human life, he restricted funding to hESC lines created before August 9, 2001. At this point there were 22 stem cell lines that were developed.
The current political situation. As of December 4, 2008 in the United States, all stem cell research, including human embryo creation and destruction for research as well as IVF, is permitted under the law. The formation of chimeras (combining human gametes and/or DNA with a animal gametes and/or DNA), and reproductive cloning of human beings, is illegal. These means somatic cell nuclear transfer (SCNT), and altered nuclear transfer (ANT) are currently illegal using human embryos. Bush’s restriction on federal funds for hESC research is written in the United States Code. However, state funding is decided on a state-by-state basis. The tenth constitutional amendment grants the states power to decide individually among ethical and moral standards. California, Massachusetts, Connecticut, New Jersey, Missouri, and Illinois are leading the way with “permissive” policies in stem cell research. We are amid a “lame duck” president term, and the president elect Barrack Obama made a statement showing interest to uplift the ban on research on hESC lines developed after August 9, 2001.
Suggested Policy Regulation.What’s allowed. (1) The use of induced pluripotent cells (iPSCs) for the development of ESC lines and (2) the use of fetal tissue aborted fetuses (given informed consent from both parents) – for the development of hESC lines. These methods will be legal and be eligible for receiving federal funding.
What’s prohibited. Conducting any form of IVF, creating or destroying human embryos outside the natural reproductive process, human reproductive cloning, any use of therapeutic cloning that involves the use of a human gamete egg or sperm (which includes SCNT and ANT), birth control involving the use of the “morning after pill,” and abortion at any time during pregnancy except when the mother’s life is in danger (which limits the amount of aborted fetuses available for development of hESC lines).
How should things be done. An executive order will be issued to announce fund allocation for the creation of new hESC lines from iPSCs, fetal tissue, and for continued research on any existing hESC lines created on or before December 4, 2008. Since outlawing this research is not within the jurisdiction of the federal government (tenth constitutional amendment) but the states, this legislation will unfortunately be dealt with at the state level. Ideally a constitutional amendment would be passed indicating this policy is of utmost importance and needs to be mandated at the federal level. Given the unlikelihood of a constitutional amendment with regards to stem cell research, to start federal funding should be specifically defined to what is allowed. Later, campaigning to the individual states should be followed to ensure we are all on the same page.
Ethical and scientific justification.Research on hESC is main topic to be addressed by this policy report. Policy on hESC closely tied together on ethical, moral, and scientific bases, and hence is insensible to advocate a policy on hESC without mention of IVF or abortion. As read in “Navigating the quagmire: the regulation of human embryonic stem cell research,” consistent policy is key to upholding one’s moral standards.
There has been political stalemate in many issues regarding our morals and values due to the vast nature of our society. The values and morals we hold have to come from somewhere – usually through a combination of societal and environmental coercion, but also through the innate nature of our own conscience. The founding fathers had values that were inspired by their religious faith. Along with these values came religious and personal freedom. This freedom has allowed US citizens free will in choosing right from wrong. Many Americans have made bad decisions and not realized that it was through zealous religiosity and personal integrity of our founders that made this possible.
Life begins at the point of an egg and sperm cell fertilizing each other – a process known as conception. One may argue that there is no difference between the morning after pill and a fertilized egg not implanting in the uterus, because a woman’s uterus may reject a viable embryo. However, the morning-after pill will surely restrict any chance of implantation, whereas natural implantation allows approximately one-third of the fertilized embryos to attached. This brings back the discussion topic of “potentiality” or “potential for life.” No, two individuals of opposite gender who have no inclination to partake in sexual intercourse are not killing nor destroying the “potential for life” by abstaining from sexual intercourse with each other. The sanctity that we need to preserve is the potential for life after conception – the joining of the egg and the sperm cell – regardless of its natural biological fate beyond our control within a woman’s body.
The process of in vitro fertilization is morally violating of the human spirit and dignity for three reasons. First, it creates an excess of embryos – which are not the potential for life – but are life in its early form. There are some nations that only allow the fertilization of one egg at a time, to ensure that no extra embryos are created. This is almost sufficient reason to exclude this reasoning from deeming IVF as morally wrong. But unless it’s promised implantation in the woman’s body coincides the hypothetical situation of implantation resulting from natural sexual intercourse with her partner at the exact time that artificial implantation was artificially attempted, the procedure violates our human dignity through scientific experimentation with the reproductive process. This is somebody’s future life. What are the feelings associated with a baby that grows up to find out he or she is the result of a scientific process and/or experiment? Second, IVF violates the sanctity of human sexual intercourse for the creation of new life. This reason is weaker the previous reason as it does not apply directly to IVF. It’s already accepted that sexual intercourse out of wedlock, and/or with the use of chemical and/or mechanical birth control mechanisms already violates this principle. Lastly, IVF instills in couples’ minds that they have a right to have genetic offspring, regardless whether their bodies’ natural capability. We are combating the process of natural selection in choosing a superior race for the future. As humans we have the dignity to save and care for the disabled and less fortunate, which is the moral and just thing to do. We are unable to statistically prove that babies born to IVF are equal or lesser chance of having a physical and/or mental disability, and hence this reason stands strong.
The derivation of hESC lines from embryos cannot be permissive for the same reasoning used with IVF. In order derive these lines, it requires the destruction of the human embryo, which is not the potential, but life in its primitive forms. Even if these embryos are formed via SCNT, we are still dealing with reproductive cells (eggs) and biologically altering them to combine them with another human’s DNA to promote reproduction. Human gamete cells are sacred and we must not scientifically alter them. ANT still involves the alteration of human gametes, and hence is morally unacceptable by the same standards as SCNT.
In the case of a medical emergency and the mother’s life has to be saved by the termination of her pregnancy, once the fetus has no potential to life on its own, upon informed consent of both parents, the fetus may be used for development of hESC lines. No more life can be created out of the developing human, which was naturally terminated – so there is no ethical or moral compromise associated. There is no ethical dilemma associated with the use of already terminated human life. This is the rationale for the embryos created up to December 4, 2008 – the date this policy is made public. Spatial destruction of embryos – whether in the United States or abroad – has no relevance to the moral dilemma, as future destruction abroad is just as ethically violating as future destruction domestically. However, temporal destruction of embryos is different. We can stop the future termination of development of embryos for research within the United States, regardless of funding.
However, stem cell research does provide a promising future for degenerative diseases and acute physical trauma. But this is no promise if we kill millions, billions, or trillions of human lives to allow famous actors with spinal chord injuries can retain their mobility. Therefore, we must seek a solution that does not involve destroying life for creating life. Once a human is fully developed and able to continue to live freely and has physical, cognitive, and spiritual capabilities, we are free to use all except the gamete cells to produce stem cell lines. Induced pluripotent stem cells (iPS cells) have been created from somatic cells by reversing the process of differentiation. No life destruction nor potential to create new life is involved.
Testing pluripotentcy of these induced stem cell lines by chimera formation prior to therapeutic use has no moral conflict. These cells have no potential to form human life, nor any associated abilities. There is no “being” in the experimental growth of a somatic cell. There is exactly one mentality and being in a developed human, and unless executed through reproductive processes of gametes, there is no way to duplicate a human being. Therefore, using chimeras to guarantee pluripotentcy of stem cell lines prior to placement in patients is crucial. One may argue the neural tissues are the only requirements for cognition at the human level that one is placed in the body of a rat. I discredit this argument because rats and other animals such as dogs and cats have cognitive ability otherwise. We must still respect the feelings of animals – hence development of animal cruelty legislation. Instead, we owe respect to the human enterprise, which is absent in a chimera.
Once a natural pregnancy is carried to term, and a baby is living independently, we are sure there is one and only one human life in that conception-period of the couples’ lives. This means there is only one human life being developed in the woman’s body at this time period. Unless she is pregnant with twins, there is no second miniature life floating around in her uterus. Therefore, the fetal tissue, that of which includes the umbilical chord, has no potential to develop into an additional spirited human life, and hence can be used upon the consent of both parents of the child, for the development of stem cell lines.
Now you can understand my reasoning behind policy, so you will be able to understand my questioning of inconsistent practice. What is the difference between the unregulated operation of IVF clinics and destroying embryos for the creation of new hESC lines? What is the difference between destroying a human embryo for reproductive versus scientific purposes? The common end result is that the embryo is destroyed. Consistent policy would be preferred. If a society holds specific moral values, make all laws reflecting that moral equivalent. I am not advocating the free destruction of human embryos for hESC research and IVF. If the best a governing body can do is only regulation of half of the destructive processes, it is preferred over no regulation. My assumption is that this leads to compromise of two dissenting opinions. This is the case in the United States with the system of checks and balances among the three powers of government – one branch of government is unable to implement policy that will affect everyone.
Weighing consequences for target and broader population. The United States of America is a nation at the frontier of science, a military superpower, and a prominent economic center of the world. The programs and choices that we implement serve as a role model (positive and negative) for the world’s nations. I cannot name the president, emperor, king or queen of France, England, China, nor Egypt, but I can assure you most of the world knows George W. Bush. With the US taking this brave scientific step toward the advancement of medicine while owing due respect to dignity of our existence and personhood, this would only inspire other nations to do the same: advance science but only to the extent that our self-respect allows us. It may take longer to find the medical solutions to these problems we face to day. Many will oppose this legislation. Researchers may seek residence in other nations to continue their studies. One nation at a time we can begin to make change to restore our values and respect for our dignity.
