The Ethics of Stem Cell Research

By Danitza

Introduction

 What if your daughter, son or someone you deeply care for was diagnosed with Parkinson’s disease, would you not want the hope that a cure would be found through stem cell research?   Recently the press has been reporting arguments of pros and cons for stem cell research, mostly with embryonic stem cells.  So what is the controversy all about?  Stem cells can be contrasted with “differentiated” cells, which mean to change from a generalized to a specialized cell during development.  These cells offer tremendous hope for medical advancement because of their ability to grow into almost any kind of cell, that one day may cure debilitating diseases such as Parkinson’s, Alzheimer’s, diabetes, and therapies for spinal cord injuries, stroke, and burns.   While advocates and scientists believe the research can be the answer to some diseases, opponents believe it is unethical because it includes embryonic stems cells derived from human fetuses, which are later destroyed thereby taking a life.   The examination here will answer the question is stem cell research ethical?

What are Stem Cells?

With the rapid advances of science, for many years scientist have been researching stem cells that has given us hope to eventually find cures for terrible diseases, but not without the ethical dilemmas. So, what is a stem cell?  The definition of stem cells is unspecialized cells that have two important characteristics that are different from other cells in the body.  First, they have the ability to divide for indefinite periods in culture and then with the right chemical reactions, they become specialized cells with specific functions, such as heart or nerve cells.  An exact definition of stem cells according to the online source, Merriam-Webster's Medical Desk Dictionary:

A stem cell is a “generic” cell that can make exact copies of itself indefinitely.

In addition, a stem cell has the ability to produce specialized cells for various tissues in the body—such as heart muscle, brain tissue, and liver tissue.  Scientists are able to maintain stem cells forever, developing them into specialized cells as needed (www.healthline.com).

Of these stem cells, there are three types that cell divide: totipotent, pluripotent, and multipotent.  The first stage of the totipotent cell is a fertilized egg, which has the potential to develop in various specialized ways.  The second stage is the pluripotent cells that come from totipotent cells in the embryo.  These cells that develop after 4 days of fertilization can eventually specialize into any cell type, except for totipotent stem cells and the cells from the placenta. The last stage before permanently taking on a specific function is multipotent stem cells that derives from pluripotent stem cells like neural stem cells, which can transform into nerve cells.  According to the Stem Cell Research Foundation website, exact definitions of the three following types are as follows including what happens at the end of the cell division:

Totipotent [see figure 1] cells are considered the "master" cells of the body because they contain all the genetic information needed to create all the cells of the body plus the placenta, which nourishes the human embryo. The next stage of division results in pluripotent [see figure 1] cells, which are highly versatile and can give rise to any cell type except the cells of the placenta or other supporting tissues for the uterus. At the next stage, cells become multipotent [see figure 2], meaning they can give rise to several other cell types, but those types are limited in number.  At the end of the long chain of cell divisions that make up the embryo are "terminally differentiated" cells—cells that are considered to be permanently committed to a specific function.  (http://www.stemcellresearchfoundation.org/WhatsNew/Pluripotent.htm).

Having identified stem cells and the various types, one must also know the main sources for obtaining stem cells make up the potential to cure diseases. 

To understand in favor or against stem cell research, one must first know the source of stem cells.  The three main sources are from the adult cells, cord cells, and embryonic (fetal or germ) cells.  Adult cells or somatic stem cells as they are also known are undifferentiated cells that are found in small numbers in most adult tissues. These cells are also found in children and can be removed from umbilical cord blood. The main function of adult stem cells in the body is to maintain and repair the tissues in which they are found. They are usually thought of as multipotent cells, like hematopoietic (blood forming) stem cells, which form all the various cells in the blood. For instance, after a birth leftover blood from a placenta and umbilical cord is a fertile source of hematopoietic stem cells, meaning a stem cell from which all red and white blood cells develop. These umbilical cord stem cells show the ability to separate into bone cells, neurons and as cells lining the inside of blood vessels.  Studies shows that a possible benefit to using adult stem cells from a patient is that the patient’s own cells can be completed in culture, treated to differentiate into preferred cells, and then re-inserted into the patient. Therefore, using the patient’s own cells or an exact DNA match minimizes the immune system to reject it.  However, the detriment in using adult stem cells are that they are rare in fully developed tissues and more difficult to increase their numbers in cell culture, compared to embryonic stem cells.  Even so, the results have been intense and positive. 

Cord cells, the second source, taken from the umbilical cord blood, extracted during pregnancy, also has an abundant supply of desirable stem cell qualities.  According to the Stem Cell Glossary, the description of umbilical cord stem cells is as follows: 

These stem cells are similar to hematopoietic stem cells, which have been used in the treatment of blood diseases, such as leukemia. Recent research has discovered that the outer lining of the umbilical cord contains stem cells that appear to be very similar to embryonic stem cells that may have the capacity to differentiate into many cell types. Scientists are actively exploring this finding. (http://www.stemcellresearchfoundation.org/WhatsNew/Glossary.htm).

A team of scientist from Kingston University in the UK and the University of Texas Medical Branch at Galveston, claim to have found cells inside the human umbilical cord blood that resemble and include proteins as embryonic stem cells.  But they have not confirmed to have the same possibility to become any type of cell, like a pluripotent stem cell. For the time being and because of this type of cell, the newborn or family members can benefit by banking umbilical cord blood cells for future use because it is a perfect DNA match without the risk of the immune system rejecting it.  Based on findings, the rest of the births and normal removal of cord blood is seemed to be a good source and a morally right way to get an ample supply for research to find the same DNA cell type to reinsert in the body without the common rejection.  According to researcher Dr. Colin McGuicin stated, “Cord blood is great because it is normally disposed of.  It is ethically very acceptable to most of the world.  This means you have 100 million times a chance to find cells that have the same immunology as you and won’t be rejected when they are transplanted into you” (http://news.bbc.co.uk/1/hi/health/4157362.stm).   As a result, donation of umbilical cells is highly encouraged.  Knowing these findings, it is imperative that scientists continue to explore these results, since the umbilical cord is the richest source of stem cells over adult and embryonic cells. As for embryonic cells, one must know more about these too as being the most desirable type for researchers.

Lastly, embryonic stem cells are undifferentiated cells from the embryo, a live organism that has the possibility to become all cell types found in the body.  The definition of an embryo is “an organism in its early stages of development, especially before it has reached a distinctly recognizable form” (http://dictionary.reference.com/browse/embryo).  The embryo is obtained from either aborted fetuses or fertilized eggs that are left over from in vitro fertilization, which is a specialized way to fertilize an ovum by a sperm outside of the body resulting in an embryo and later inserting the uterus for conception.  Embryonic stem cells are found in the inner mass of cells of the blastocysts, which are a very early embryo stage before they begin to differentiate, consisting of about 150 cells.  These stem cells grown in culture are called embryonic stem cells, which continue to multiply for about 3 days and with most of them they can be kept alive forever. In addition, a stem cell line is genetic material that comes from the same fertilized human egg that started reproducing a set of stem cells from a single blastocyst.  Consequently, to help stem cell research with this stem cell line, on August 2001, President George W. Bush authorized federal funding.  However, the same federal funding for research is not available with other stem cell lines.  Hence, funding is essential for stem cell research to continue to provide the potential major medical advances to become therapeutic even though it remains controversial.

The Controversy

So, what is the debate all about?  The controversy of stem cell research is with examining human embryonic (or fetus) germ cells, the best type of cells that has the potential to become all cell types found in the body.  People who believe that life if formed at the time of conception, oppose embryonic stem cell research because the extraction of stem cells from this type of embryo requires its destruction.  Opponents equate this destruction to killing a human life, murdering, or deliberately aborting.  In contrast, embryonic research advocates argue that the tiny blastocyst has no human features, and therefore can be used freely. Further, most scientists and advocates agree that by treating embryos respectfully, they can be used for research as evidence by the following:

Lawrence Nelson, adjunct associate professor of philosophy at SCU, believes the embryos can be used for research if they are treated respectfully. Some manifestations of respect might be: 1) They are used only if the goal of the research cannot be obtained by other methods, 2) The embryos have not reached gastrulation (prior to 14 to 18 days of development), 3) Those who use them avoid considering or treating them as property, 4) Their destruction is accompanied by some sense of loss or sorrow (http://www.scu.edu/ethics/publications/cloning.html).

Additionally, due to in vitro fertilization new stem cell lines already exist and banked, but research supporters claim that they are not available for research.  A main reason for this as noted in many sources is that the same advocates of embryonic stem cell research are aware and worried that this type of research has the potential to also clone humans.  Within that same statement, they announced that no cloning of human lives would be done just for the idea of experimentation.   In weighing both sides of the argument, the facts still remain, there is potential to discovering cures that can save lives as long as it is done acceptably.

Stem cell research would be unethical if researchers do not continue with their investigations, take advantage of science, and technology to be able to help lives, given that there are other types of cells that can be just as effective as embryonic stem cells.  As previously mentioned, there are also adult cells, cord cells and the recent discovery that involves stem cells from amniotic fluid of pregnant women.  In an article of a Stem Cell Update, the Institute for Regenerative Medicine at Wake Forest University School of Medicine in Winston-Salem, N.C. reported the following: 

Cells easily and harmlessly derived from the amniotic fluid of pregnant women have much the same potential for growing into tissues that could be used for medical treatments as do embryonic stem cells.  [According to Richard Doerflinger, deputy director of pro-life programs for the U.S. Catholic Conference said,] “This is wonderful news…It doesn’t require harming anyone or destroying life at any stage (“Stem Cell Update”). 

In conjunction with this issue there has been concern about the handling of any type of research. Therefore, researchers should abide by moral principles and continue to find other ways to ethically discover the required stem cells to save lives.  Moreover, because of past unethical practices, scientists have made great progress to ensure that human subjects participating in any research are not hurt and are well informed about the consequences of the research.  Society has even implemented institutional review boards, ethic committees, or other similar groups, which have authorized supervision on research conducted in their institutions, including the assurance that individuals enrolled in research are fully informed and have obtained consent.  This too has extended into the research for experimental animals, so that they are not kept in inhuman conditions and their suffering is at a minimum.  Unfortunately, this type of control is needed on human and animal subjects, due to past history when medical researchers become so focused on their research that they may overlook basic principles.  Nevertheless, it is imperative that stem cell research continues and we find other acceptable and ethical types of stem cell research for the sake of humanity. 

In the midst of the controversy, many institutions in the U.S. and other countries are investing in continuing their efforts with stem cell research by providing facilities, education, and researchers to speed up discoveries that ultimately could cure diseases and instill hope.  Locally, the University of Connecticut has purchased a research building near the Health Center in Farmington to accommodate a Stem Cell Institute.  Their plan is to turn in into a research center that will include the latest technology tools, equipment, cell biology and genetics research.  According to the following statement by Dr. Marc Lalande, chair of the Department of Genetics and Developmental Biology, his intention is to bring stem cell research to the Health Center for future observation and treatment of diseases in patients:

Our goal is to maximize the state’s investment in stem cell research and establish an internationally recognized program focused on human embryonic stem cells and regenerative medicine.  The Center of Innovation will also allow us to bring together our best researchers to

drive research aimed at bringing human stem cell therapies across the street to the Health Center, where someday they can be applied clinically to patients (University of Conn. Advance, pg. 1). 

Also, as a comment from David Bauman, the reporter of this article, “The new center will unite Uconn scientists in a cross-disciplinary, collaborative setting to enhance Connecticut’s role as a leader in stem cell research and accelerate discoveries that ultimately could lead to therapies treating a broad range of diseases and disorders” (Bauman pg.1).  Finally, on an April 2 article of the University of Connecticut, Advance, some stem cell research related news were reported at this past month’s StemConn07, international conference.  The conference was held in Hartford where Governor Jodi Rell announced the award of $20 million in state funds to support the stem cell research mission.  Of this amount, a total of approximately $12 million for 15 out of 21 grants will go to help 23 investigators in the Storrs and Farmington campuses.  Also, in this same newspaper two articles informed the recent scientific breakthroughs with stem cell research.  In the first article, Michael Kirk reported that a team of scientists has produced a precision microscopic piercing device to use in stem cell research. This tool can be used to transfer the nuclear during the cloning process without damaging the cell membrane and causing most of the cells to die. As for the second article reported by David Bauman, deals with stem cell researchers studying the potential of programming cells by cell fusion.  It seems that this method does not harm the embryos, thereby creating stem cells to use in research.  These types of investments and breakthroughs are evidence that stem cell research can be handled in an ethical manner and therefore it is imperative to continue with this mission.

Ethical Perspectives

One can look at different ethical theories for stem cell research and apply different perspectives.  For instance, if you take a teleological view on the ethics of stem cell research you focus on the outcome of the research, which is to find the specialized cells that have the ability to grow into almost any other type of cell in the body in order to cure diseases.  The teleological vision is seen morally valuable due to the action determined by the level of the act to get to the end or purpose.  Thereby giving hope to all those people who need it because of their devastating diseases. 

In contrast to this view, a deontologist’s theory is obligation and therefore one determines the act as right or wrong based on the required nature of the act. Because the focus is in the act and not on the intention or the consequences, at times a right result may be the byproduct of this theory.  As in this case the ethics of stem cell research, one must observe that it is our duty to support researchers to continue their investigations and find the cells needed to save lives, even though this is the end result or a byproduct of the act.  In my opinion both these types of perspectives can still give humanity what is needed and that is the vision that someday there will be a cure for diabetes, Alzheimer’s etc.

Another standpoint on this topic, proponents of stem cell research believe that there is potential to find cures to debilitating diseases and therefore they focus on the end results of saving lives, seen as the “greater good for the greatest number,” the utilitarian perspective. I too believe in this because there are enough findings to prove that stem cell research holds the key for someday curing Parkinson’s and other types of incapacitating diseases.  Given the fact that the existing sources like cord blood, the placenta and adult bone marrow are morally accepted then why not continue the research with these cells?

As an opposing view to utilitarianism, the Kantian perspective centers on the motive and act, but not the consequences.  So in the case of the embryonic stem cell research and its destruction, this is where the debate starts.   Opponents believe that it is morally wrong to end a life and use it as a means to saving lives.  This result goes against Immanuel Kant’s fundamental principles called the categorical imperative, which says, “Always treat humanity, whether in your own person or that of another, never as a means but always at the same time as an end” (MacKinnon 71). By believing that we should respect human life and that life has moral values, then it is wrong to use embryonic stem cells if it means destroying them through the process needed.  Therefore, one must find equally effective and ethically acceptable cells without the use of embryonic cells.  For instance, since there are other types like the adult cells, cord cells and the recent discovery of stem cells from amniotic fluid of pregnant women, none that required harming anyone or at any stage, then these should be the areas of concentration for acceptable stem cell research.

My Thoughts on the Subject            

                Stem cell research has been the recent “buzz” and that is the motive this subject sparked my interest, as well as its controversy.  Before the facts, I too supported stem cell research including embryonic stem cells. In addition, I believe that if we have the technology, the tools and the knowledge, why not use it to save lives? However, as I have learned through this research, my thoughts have changed with the use of embryonic stem cells.  I believe that researchers should try to stay away from this source since the pros and cons remain the same, unless supporters without a doubt can prove that an embryo is not a life form and its destruction is not ending a life.  Concurrently, since there are other types of stem cell sources proven equally useful, researchers must continue investigating in an ethical manner in hope of finding therapeutic cures to most debilitating diseases.

Figure 1

Illustration by Bob Morreale, provided courtesy of the Stem Cell Research Foundation.

Figure 2

Illustration by Bob Morreale, provided courtesy of the Stem Cell Research Foundation.