Thursday, July 20, 2006

Stem cells

Predictably, there has been much hostile reaction to President Bush's vetoing of federal funds for embryonic stem cells. However, he has some surprising support.

This is a quote from Andrew Sullivan's blog. Andrew is a Sunday Times columnist who has been critical of the President's handing of Iraq since the war. He has been particularly critical of the 'Christianists', his name for the American right-wing evangelicals.

"I feel obliged to come to the president's defense on his embryonic stem cell research veto. I find the absolutism of those who view a blastocyst as a human person to be morally unpersuasive, but I cannot see how it can be seen as anything other than human life. I know also that many of these superfluous blastocysts and embryos will be discarded anyway and so not using them for research does not protect them from extinction. Nevertheless, it is hard not to be troubled by the line this crosses. Human life is created and then experimented on to save other human lives. I think the argument for the benefits of such research is compelling; there's little doubt that this avenue could be extremely fruitful. I live with one of the diseases, HIV, it might help cure or treat. For those reasons, I don't believe such research should be banned - or even that individual states shouldn't, if their citizens support it, directly finance such research from the public purse. I'm a federalist. But when a very significant number of Americans feel deeply that this really is morally unconscionable, and when the research is taking place anyway under other auspices, I see no reason why the feds should actively finance this research as well. I don't think that Bush's compromise is so unreasonable, in other words. This isn't a ban on such research; it's a decision not to throw the weight of federal financing behind it. I respect the case of those who favor it; but, when push comes to shove, I'm with Bush on this. It took political courage to take this stand. And the morality it reflects - a refusal to treat human life as a means rather than as an end - deserves respect even from its opponents."

Andrew is, of course, a Roman Catholic, and even though he is at odds with much of that Church's teaching - he is a practicing gay, for example - he is not apt to dismiss Catholic dogma willy nilly.

I realize that stem cells are one of the most polarizing issues around. People from either side of the argument are calling each other names and seem unable to understand each other's viewpoint. I think this is because they have very different philosophical presumptions. Jeremy Bentham was the founder of utilitarianism. This is the idea of the greatest good for the greatest number. It seems apparent to those who espouse this philosophy that when you weigh up the future of a blastocyst, created as a spare that will be discarded when not needed against the possibility of using these cells to find a cure for diseases like diabetes, Parkinson's disease and dementia.

On the other side of the debate are people who stress that the end does not justify the means. They reach this conclusion because in their view the means involves the destruction of a human life. No-one, for example would countenance conceiving a baby to produce a heart donor for a child a congenital heart defect. It would involve allowing the baby to be born, then removing its heart to give it to its sibling, and allowing the donor then to perish. How about killing the fetus two weeks before birth and harvesting an organ? Or four weeks? Or at 24 weeks gestation, the legal limit for an abortion?

Society in its wisdom has set a limit after which the embryo cannot be destroyed for this purpose. Baroness Warnock's committee set a limit at the formation of the neural streak, the first indication of organized nervous tissue. I have always thought this a sort of committee decision; a limit that gives some scope to researchers, but one that could be defended on quasi-logical grounds against religious people. After all, why should a few nerve cells make a difference? It is not as though a 14 day embryo has any consciousness of personhood.

On scientific grounds I have always believed that the fusion of egg and sperm to form a fertilized ovum was the beginning of a life. I know that it has been argued that at this stage the fertilized egg might give rise to twins or triplets, but i hardly see that this is an argument for destroying it. Indeed it makes the act more wicked, if wicked it be, because it would result in the destruction of two or three lives.

It is of course true that the fertilization of an egg does not guarantee the development of a baby; indeed it has been demonstrated a fairly large proportion of fertilized eggs never make it (I have seen figures suggesting 20% to 50%). There is no way of knowing which embryos are going to make it, however, and any act of destruction might kill not just a potential child, but a future Beethoven. The normal reaction of a physician is to try and save a human life not to destroy it.

It must be conceded that as a society we do not hold a fetus of a few weeks of gestation in the same regard as a young child; nor do we hold a wake for a miscarriage in the same way that we would for an old friend. But I do know that a miscarriage is a time of great sadness for an expectant mother. The loss of a potential life still leads to grieving.

The embryology regulators in the UK, while taking a liberal approach to IVF and the creation of spare embryos, still found it hard to swallow the idea of producing a baby solely or mainly for the purpose of donating its bone marrow to a sibling, even though they were assured that the baby would be a loved and welcome member of the family. They didn’t like the idea of creating another human being to use in this way. It could of course not give consent, and the parents acting for it could not give unbiased consent.

In the past the beginning of life has been taken to be at various levels of gestation by different religions, but these were set out of ignorance. They did not understand about the fertilization of gametes. Government commissions set up to advise on these matters in the UK usually have religious representation among their number, but they usually find a tame priest of liberal persuasion who could be relied upon not to rock the boat. The Bishop of Oxford, Richard Harris, got on a lot of advisory boards.

Christians who tend to follow the Bible have difficulties in taking a low view of the status of the fetus. Both David (in Psalm 139) and Jeremiah (chapter 1 verse 5) give evidence of being known by God while still in the womb, and then there is the remarkable story in Luke Chapter 1 of the fetal John the Baptist leaping with joy within his mother’s womb when his mother encountered Mary carrying the embryological Jesus.

It could be said that these passages refer to people specifically chosen by God and not to all fetuses, or you could interpret it generally.

Similarly, with the only passage in the Bible that specifically mentions a miscarriage, Exodus 21:22, different beliefs determine how the Hebrew is translated. It refers to a fight in which a woman standing nearby is stuck and forced to deliver prematurely and no harm comes, then the perpetrator is forced to pay a fine. Does this mean no harm comes to the mother or no harm to the baby? It is not clear and certainly not convincing enough to build a doctrine on.

Obviously the Catholic Church takes a high view of the status of the embryo as do evangelical churches. An objective scholar would come to the conclusion that the Bible is not absolutely clear about the question – it was a question that was never required to be answered when the Bible was written; it doesn’t say anything about space travel either. Christians then must come to a conclusion based on the whole teaching of Scripture.

For myself I find the whole idea of using spare embryos for experimentation very uncomfortable, particularly since adult stem cells are turning out to be much more plastic than had been suspected so that the utilitarian argument is weakened. On a radio debate this morning I heard a new argument. Suppose, said the researcher, that we were able to dedifferentiate adult stem cells so that they became just as plastic as embryological stem cells. They would then be implantable in a womb and could become fetuses, so that the same ethical questions would apply.

He was quite wrong there. No ethical problems would arise because the adult stem cells would have been donate by a donor with full and informed consent, not taken from an embryo unable to consent, and since he or she would die in the process must be deemed to have been unlikely to give it.

So if you are still with me, you must make up your own mind about this question, but please do so after giving it some thought and considering the evidence, rather than making a knee jerk response based on prejudice or even political persuasion.


Anonymous said...

If I could have one wish in 2006, it would be that NO ONE would talk about stem cells WITHOUT identifying whether they are talking about embryonic stem cells or adult stem cells.

To say that someone is in favor of 'stem cell research' is like saying someone is in favor of 'medical research'. Clinical trials in the West is one type of medical research; the medical research the Nazis did was another kind altogether.

Please please please NEVER say 'stem cell research' without identifying which kind. Everyone is in favor of adult stem cell research. There is significant opposition to embryonic stem cell research.

I support the former, and oppose the latter.

Carol Kaelin said...

Interesting presentation. I find the absence of Biblcal mention (unless it is yet undiscovered) telling. There is significant evidence that from the earliest of times women have tried to induce miscarriage. The only conclusion I can draw from the absence of mention is that it was not considered notable.

That's not to say that modern ethics could not be stricter than ancient ones.

My view is that it is not ethically consistent to say we can convey the frozen embryos not used to the trash heap and then alternately say they are life. We could mandate adoption, but many would see that as infringement on a pro-family/pro life practice since some do not want to allow such adoptions.

I would see that as ethically consistent and perhaps producing a smaller surplus of the five-day embryos would eliminate at least part of quandary.

In the US though the vast majority of people favor the limited use of such embryos for research so it's not quite fair to say the decision was honoring the moral wishes of the citizens. The support crosses though political and religious divides. We make many laws that are supported by far fewer than three-quarters of the public.

We allow the death penalty, which further muddies the ethics, although there are sufficient Biblical grounds. In many cases, DNA testing that could exonerate or prove guilt of death row inmates was not allowed until recently.

Some consider the gap between the pre-birth and post-birth ethics an indication that the motivations are political not grounded in moral values. A true moral decision would have resulted in less backlash.

We're a confusing country barely out of our adolescence. Or as a gentleman in Chester told us: "See that building? It's older than your country."

Anonymous said...

"See religion? It's older than secular humanism." Besides, the United States were British colonies for far longer than before 1776. It's a meaningless statement, really.

Since birth begins at conception, then I oppose the use of techniques that result in frozen life being thrown away in the trash.

Until the recent debate on the issue, I was unaware of the process that maintained fertilized ova that could then be killed.

The notion that because a majority of people believe that something is OK makes it morally right is plainly wrong.

Slavery was supported by a majority of people up until quite recently (just over 150 years ago). Does that make it right, then suddenly wrong? No.

I disagree with the idea that 3/4 of Americans support embryonic stem cell research. Explain that the research is performed on living humans, and has resulted in no treatments, no cures, and the possibility of no advantage over adult stem cells, and that number would flip.

The liberal media loves to push the idea, and deliberately muddles the issue by calling research 'stem cell research' without explaining the difference between embryonic stem cells and adult stem cells.

In any case, it's a moot point since federal funding is dead.

Frank Holder said...

The arguments you use against embryonic stem cell research may also be used against current IVF procedures, in that it results in the destruction of embryos. Do you believe that the stored embryos should be kept forever? Wouldn’t this mean they were being unlawfully or immorally detained?

Also, you say that you see no ethical problem with the implantation of a dedifferentiated adult stem cell. Wouldn't this amount to human cloning and is this not commonly presented as the most heinous potential of stem cell research?

Terry Hamblin said...

I agree that the same ethical objections apply to IVF unless every embryo were inplanted. Remember that there was no federal funding for the evelopment of IVF which was developed in teh UK not the US.

Dedifferentiated stem cells would be used to produce a missing tissue not a person. The argument is that embryological stem cells are more plastic than adult stem cells. The suggestion is that by means of some sort of manipulation that plasticity would be restored to an adult stem cell. I suggest that this would not make them new humans, they would be an autologous cell donation that had been manipulated in the laboratory to become part of a missing or damaged organ - no different except in complexity to a skin graft fron the abdomen fashioned to become a missing nose.

Anonymous said...

Dr. Hamblin's comment just above is right on the money.

BTW, there is a new item today mentioning using adult stem cells from adipose tissue (fat) for smooth muscle cell development. The area of research is called tissue engineering, and it is progressing rapidly.

There IS federal funding for this type of research. Cures are coming, and in some cases, have already arrived.

Stem cell transplants for CLL patients use adult stem cells TODAY, and they are saving lives.

Not so with the problematical embryonic stem cells.