Stem Cells Implications for Catholic Health Care Philip Boyle, Ph.D.

1. Stem Cells Implicationsfor Catholic Health Care Philip Boyle, Ph.D. Vice President, Mission & Ethics www.CHE.ORG/ETHICS

2. Goals for today’s conversation • Review the Science • Review President’s Commission • Explore challenges for Catholic health care

3. Moral Considerations Catholic health care • What if embryonic stems cells become standard of care? • How much oversight: • MDs’ staff privileges for those who utilize? • MDs’ prescription in “privacy of doc-pt relationship? • How to provide staff and community education? • Restraining the worst alternatives?

4. Review science • Embryonic & adult stem cells • Alternatives • Dead embryos • IVF • Micro gravity primitive umbilical cells • Biopsy • Dedifferentiation • Altered Nuclear Transfer • Use existing lines

5. Public Framing Matters of Life and Death Adult stem cells restore feeling in paraplegic 19 Years as a Paraplegic Korea Report WorldNetDaily.Com Doctor’s Use Teen’s Stem Cells In Procedure To Repair His Heart “A 16-year-old shot in the chest with a nail gun has undergone the nation’s first procedure to repair dying heart muscles using his own stem cells.” • The Wall Street Journal

6. Public Framing Patient's Own Stem Cells Provide a Tailor-Made Jawbone Scientists in Finland have replaced a 65-year-old patient's upper jaw with a bone transplant cultivated from stem cells isolated from his own fatty tissue and grown inside his abdomen, Reuters reported. Researchers said the breakthrough opens up new ways to treat severe tissue damage and makes the prospect of custom-made spare parts for humans a step closer to reality. "The use of a patient's own stem cells to grow a new jaw is a great example of how personalized medicine is becoming a reality," said Dawn Vargo, associate bioethics analyst for Focus on the Family Action. "Despite all the talk about using embryonic stem cells to create personalized therapies, this displays the practical and timely advantages of adult stem cells."

7. Advance Made in Stem-Cell Debate (Washington Times) • ‘You would barely know adult stem cells exist’ • (Times Higher Education) • Building a New Prostate • (Science) • Stem Cell Breakthrough: Mass-Production Of ‘Embryonic’ Stem Cells From A Human Hair • (ScienceDaily) • A breakthrough, then a surge, in stem cell research • (PhysOrg) • Stem cell generation from ordinary cells now safe • (Reuters) • Adult Stem Cell Trial The First of Its Kind • (KCPW) • Stem cells from testicles an option to embryos • (AP) • Scientists Find Way to Regress Adult Cells to Embryonic State • (Washington Post)

8. What are stem cells? • 2 kinds • Embryonic—occurring in early fetal development and produce multiple specialized cells • Adult—occurring in adult organisms in bone marrow, muscle, and brain and generate replacement cells

9. Embryonic Stem Cells • After fertilization, the zygote (fertilized egg) divides several times. • Any of these first cell divisions could give rise to cells need for an adult organism • These cells are totipotent

10. Sources of embryos • In vitro fertilization • Somatic cell nuclear transfer (SCNT) • Embryos can be created by transferring the nucleus of a donor cell into an enucleated oocyte

14. Embryonic Stem Cells • The cells that form the inner cell mass of the blastocyst are called pluripotent • They have lost the ability to differentiate into all types of cells needed for a complete embryo, but they still have the ability to differentiate into other types of cells up to 14 days post fertilization. • Adult stem cells mainly produce the cells type tissue they reside in.

15. Adult Stem Cells • They give the body ability to repair and replace the cells of some organs. • It is supposed they are set aside during fetal development and restrained from differentiating. • They are rare and their origin in tissue is not known. • They behave differently depending on local environment.

16. Embryonic Germ Cells • Germ cells share some but not all the characteristics of stem cells • They are primordial germ cells which occur in embryo • They normally develop into mature gametes (eggs and sperm) • They do differentiate into specialized cells.

18. Alternative Sources • Micro gravity primitive umbilical cells • Dead embryos • Previously frozen embryos that fail to divide within 24-hour period • “Organismically dead” • Discarded human embryos (IVF)

19. Alternative Sources • Biopsy 1 cell—blastomere extractions remove 1 or a few cells from 6-8 cell • De-differentiation • Use somatic cells and restore them to pluripotency • E.g., Lop of newt’s tail or leg & it regenerates • Protein from newts regenerated mice muscles

20. Alternative Sources • Altered Nuclear Transfer • Creating biological artifacts resembling embryos but incapable of developing into humans • Remove nucleus from oocyte • Replace with somatic cell that has been altered so new entity would not be able to develop • Reprogram the trophectoderm (outer sheath) so not to form properly • Oocyte-assisted reprogramming (OAR) • Fusing cells • Use existing lines

21. Ethical issues • Accurate and fair terminology • Cloning for Children • Cloning for Biomedical Research • Obligations of Catholic institutions • Public Policy issues

22. The Language Activity • Cloning • Asexual reproduction • Reproductive cloning • Non-reproductive cloning • Research cloning • Therapeutic cloning • Somatic cell transfer (SCNT) • Nuclear transfer for stem cell research • Regenerative medicine

23. Entity: • potential human being • human clone • human SCNT • cell egg • activated egg • totipotent cell • reconstituted egg • clump of cells • blastocyst • clonecyst • embryo

24. Relationships: • genetic copy • replica • genetically virtually identical • non-contemporary twin • delayed genetic twin • clone

25. Language • What’s at stake is whether SCNT should be considered cloning. • Using the term cloning prejudices the activity • Using many terms obscures the public debate • Also at stake is the moral status. To call it an embryo, some argue, is to unfairly prejudice, but not to use it hides the full import of cloning for biomedical research • Clone=replica, not a zygote

26. Cloning for Children Purposes • Allow infertile couples to have genetically related children • Permit couples at risk for genetic disorders to avoid having an afflicted child • Allow bearing of child who could become an ideal transplant donor • Allow parents to keep connection with dying or dead child • Replicate persons of talent or beauty

27. Objections Violates ethics or research • High rates of morbidity and morality/ unsafe and unethical • Identity andIndividuality • identical to someone else who has already lived • Concerns regarding manufacturing • 1st children to be totally designed in advance • more like a product than a gift and accepted as they are • Promote commercialization and industrialization of human procreation • Prospects of new eugenics • Serve as individualized eugenic enhancements, avoid defects

28. Objections • Troubled family relationships • Strain between generations • Fathers as twin brothers to their son • Mothers give birth to genetic twins • One parent reproduction could strain family life • Effects on society • Effect the way society looks at children • Novel control of the next generation

29. Cloning for biomedical research Opportunities • Important knowledge on embryological development • Treatments for dreaded diseases • View A. Non-moral status of embryo B. Intermediate moral status of embryo C. Moral status of embryo

30. Moral status of cloned embryo • Continuous history of human individuals from fetal life of infant • Special respect for nascent human life • Exploitation of developing human life • By permitting this, nascent life is a tool • Coarsen our moral sensibilities • Moral harm to society • Approve of control of nascent life • Open door to reproductive cloning • Federal government mandating the destruction of human life • What we owe the suffering

31. Obligations of Catholic institutions 1. Knowledge • Drug development & Toxicity • Cell development Cooperation, toleration & complicity Mainly opaque to user 2. Applications

32. Obligations of Catholic institutions Therapies • Clearly unacceptable • Embryonic stem cells • Clearly acceptable • De-differentiation • Umbilical cord • Ambiguous • Dead embryos • Biopsy • Altered nucleus • Existing lines

33. Obligations of Catholic institutions Ambiguous • Dead embryos & IVF extras • Is it permissible to used doomed embryos? • “No loss argument” for those who accept the humanity of the embryo and absoluteness of the prohibition of intentional killing, the no loss argument does not provide an exception to the prohibition • Biopsy • Pre-implantation genetic diagnosis (PGD) • Biopsy totipotent or pluripotent?

34. Obligations of Catholic institutions Existing Lines before moratorium? (Bush and German gov’t) • Is use of federal funding on existing lines an unprincipled exception? • Crafted to allow some research without encouraging destructions Is this moral cooperation, toleration, or complicity? • No one can cooperate in doing what has already been done—did not cooperate with the destruction

35. Obligations of Catholic institutions Existing lines Is this moral cooperation, toleration, or complicity? • One tolerates only what one might prevent • They did more than tolerate by allowing the research on already dead embryos • Complicity: they have excluded on going relationships by setting a date after which no use. Thus, no encouragement

36. Practical considerations • What if embryonic stems cells become standard of care? • How much oversight in use of alternatives? • MDs’ staff privileges for those who utilize? • MDs’ prescription in “privacy of doc-pt relationship”?

37. Practical considerations • What about partnerships and joint operating agreements? • What about institutions with teaching programs? • Proactive partnerships for alternatives • Staff and community education?

38. Public Policy issues Morally acceptable compromises? Compromises not to facilitate destruction but to stop or limit regulation • Protect embryos as well as they can • Materially implicated, materially cooperating

39. In a case like the one just mentioned [where a legislative vote would be decisive for the passage of a more restrictive law, limiting the number of authorized abortions], when it is not possible to overturn or completely abrogate a pro-abortion law, an elected official whose opposition to abortion is well known, could licitly support proposals aimed at limiting the harm done by such a law and lessening its negative consequences at the level of general opinion and public morality. This does not in fact represent an illicit cooperation with an unjust law, but rather a legitimate and proper attempt to limit its evil aspects.” • John Paul II, Evangelium Vitae

40. Conclusions • Framing • Clarity of language • No rush to judgment • Examine scientific alternatives • Proactive, not reactive • No need for train wreck • Partnerships • Education