Ethical questions of stem cell research
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Ethical questions of stem cell research. Jozsef Kovacs MD. PhD Semmelweis University-Budapest Institute of Behavioral Sciences Department of Bioethics. Historical remarks. 1978—The first infant (Louise Brown) was born following in vitro fertilization (IVF)

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Ethical questions of stem cell research

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Ethical questions of stem cell research

Ethical questions of stem cell research

Jozsef Kovacs MD. PhD

Semmelweis University-Budapest

Institute of Behavioral Sciences

Department of Bioethics


Historical remarks

Historical remarks

1978—The first infant (Louise Brown) was born following in vitro fertilization (IVF)

1997—First successful Somatic Cell Nuclear Transfer (SCNT) (cloning) in a mammal

1998—Isolation and culturing of the first human pluripotent embryonic stem cell lines

To drive stem cells to differentiate into a desired cell type is still not a solved problem


The types of stem cells

The types of stem cells

Human Embryonic Stem Cells (hESC) (pluripotent)

Pluripotent stem cells: they cannot form a whole organism, but they can specialize into almost all forms of adult cell types

Umbilical cord stem cells (multipotent)

Adult-derived stem cells (multipotent)

Multipotent stem cells: can give rise only to some specialized cells


The source of human embryonic stem cells hesc s

The source of human embryonic stem cells (hESC-s)

1. They can be isolated from the inner cell mass of human embryos (blastocyst)—these embryos can be found in IVF (in vitro fertilization) clinics

2.Primordial germ cells retrieved from first-trimester aborted fetuses

3. To use somatic cell nuclear transfer (SCNT)=cloning to produce embryos, and then the same as 1. (therapeutic cloning)

4. To transform multipotent adult stem cells?


The promise of stem cells

The promise of stem cells

To cure diseases like

Diabetes

Heart disease

Parkinson disease

Alzheimer disease

Neurodegenerative disorders

Spinal cord injury

Replace cells injured by trauma


The advent of regenerative medicine

The advent of regenerative medicine

Therapeutic cloning

Regenerative medicine will transform our conception of

Aging

Personal identity


The ethical dilemma of hesc therapy

The ethical dilemma of hESC-therapy

Extracting the stem cells kills the embryo (which is in the blastocyst stage of development)

Is destroying the embryo killing a human person?

If a 4-5 days old embryo is a person, then healing a person with stem cells is performed by killing an other one


The moral status of the blastocyst

The moral status of the blastocyst

The basic question

At what stage of embryonic development does the life of the embryo deserve the same respect and protection due a newborn infant?

The main answers

Conservative: at conception

Liberal: at birth

Moderate: at some stage during embryonic development


The conservative position

The conservative position

All human beings have the same value

Human life begins at conception

Killing an embryo is just as bad as killing adults

Problems:

Theoretical:

It uses the term „human life” in two different meanings: (human life at a cellular level and human life as the life of an organism)

„But the zygote is a potential human being”—then it only potentially has a right to life

The potentiality argument leads too far—it would prohibit contraception as well


The liberal position

The liberal position

It takes into account women’s right to self-determination over their bodies, which is relevant in case of abortion

It is, however, irrelevant, when the status of the embryo, outside the woman’s body is considered


The moderate positions

The moderate positions

Common in them: development is relevant to attain full moral status

The gradualist position: human life is valuable at all stages of its development, but it becomes more and more valuable during development until it reaches full moral status

At what point is personhood reached?


The symmetry between brain death and brain birth i

The symmetry between brain death and brain birth I.

  • Human life (morally and legally) comes to an end by brain death

  • The brain dead is biological still alive (its organs can be used for transplantation purposes)

  • The end of biological life and the end of personal life do not coincide—personal human life ends earlier, than biological life


The symmetry between brain death and brain birth ii

The symmetry between brain death and brain birth II.

  • Similarly: human life (morally and legally) begins by brain birth (at 10th week of gestation, at the end of embryonic development) (Goldenring, 1982)

  • Embryos (before the 10th week of gestation) are biologically humans, but are still not persons

  • Fetuses (after 10th week of gestation) have functioning brains


The symmetry between brain death and brain birth iii

The symmetry between brain death and brain birth III.

  • Human biological life is longer, than the life of the human person

    • It begins earlier (at conception) than personal life, and ends later (at biological death, the death of the last living cell of the organism)

  • The life of the human person begins later, than biological life (at brain birth), and ends earlier (at brain death)


Conclusion

Conclusion

  • Embryos do not have a right to life, fetuses do have

  • This moderate position is reflected in some widespread practices


Some basis for convergence

Some basis for convergence

  • Few accept the full implications of the view, that the embryo is a person with full moral status (Ronald Dworkin)

  • These implications would be

    • Abortion would not be permitted

      • to save the mother’s life

      • even in case of rape or incest

        Conclusion: this in practice favors some form of the moderate positions


If the blastocyst is a person is stem cell research necessarily unethical

If the blastocyst is a person, is stem cell research necessarily unethical?

We could use organs for transplantation purposes, even if they resulted from a homicide

Similarly, if IVF technology involves discarding the surplus (spare) embryos, using their cells before discarding them could be acceptable, if the user did not contribute to the creation of the embryo?


Is discarding the embryo better than deriving es cells from it

Is discarding the embryo better than deriving ES cells from it?

IVF programs necessarily entail discarding spare embryos

Deriving ES cells from spare embryos before discarding them will lend permanence to the embryo (McGee—Caplan, 1999)

Conclusion: destructive embryo research destroys the embryo less, than discarding it

If IVF programs are permitted, it is inconsistent to prohibit derivation of ES cells from spare embryos


The relevant questions

The relevant questions

Is destructive embryo research on donated spare embryos of IVF programs ethically acceptable?

Is the creation of embryos for research purposes ethically acceptable?


The major policy positions regarding human embryo and hesc research i walters 2004

The major policy positions regarding human embryo and hESC research I. (Walters, 2004)

  • Total prohibition:

    • embryo research and research on existing hESC lines is forbidden

  • Almost total prohibition:

    • Embryo research is forbidden but research on existing hESC lines is permitted

  • Moderate view:

    • Research is permitted only on surplus (spare) embryos of IVF programs


The major policy positions regarding human embryo and hesc research ii

The major policy positions regarding human embryo and hESC research II.

  • The liberal view:

    • The creation of embryos specifically for research purposes is permitted

  • The radical view

    • Cloning of human embryos for research purposes is permitted

  • The ultra radical view

    • The transfer of human somatic cell nuclei into animal eggs is permitted


Radical and ultra radical countries from the point of view of hesc research

„Radical” and „ultra radical” countries from the point of view of hESC research

  • UK; Belgium; Sweden

  • India; China

  • Israel; South Korea; Singapore

  • USA (2 states: California and New Jersey)

    Controversial research that can be carried out there:

  • The creation of embryos specifically for research purposes

  • Cloning of human embryos for research

  • The transfer of human somatic cell nuclei into animal eggs


Evaluation of consistency in various positions

Evaluation of consistency in various positions

  • Total prohibition--consistent

  • Almost total prohibition (USA, Germany)

    • Reason: the prevention of future embryo destruction

    • But: IVF program (accepted in these countries) involve embryo destruction

    • Conclusion: this position is inconsistent

  • The moderate position—consistent


The superiority of the liberal position to the moderate one

The superiority of the liberal position to the moderate one

  • Moderate position—allows only the use of spare embryos from IVF programs

    • Implicit presumption—treating infertility is a goal that justifies the destruction of some embryos

  • Liberal position—allows to create embryos for research purposes

  • If a non-life saving treatment (treating infertility) justifies the destruction of embryos, why the promise of a life-saving treatment does not? (Clarke, 2006)

  • The answer depends on the acceptability of the principle of double effect


The separation of state and church

The separation of state and church

The difference between opponents and proponents of destructive embryo research proved to be intractable

Imputing full moral status to the embryo is mostly based on religious premises

Can the health needs of persons submitted to the religious views of others?

The constitutional principle of separation of church and state should be followed


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