The Use of Human Embryonic Stem Cells Derived From Human Embryos is
Unnecessary Considering The Other Alternatives Available
By
Ciaran Barlow
Pass with Merit
RESEARCH PAPER
BASED ON
PATHOLOGY LECTURES
AT MEDLINK 2011
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ABSTRACT
Since the derivation of the first human embryonic stem (ES) cell lines by Thomson in 1998 many pro-life
activists have protested about the source of such stem cells labelling them as unethical. This has caused
the world to become in part sceptical of the use of these cells in research and practically in modern
medicine. Such doubts have lead scientists to research and develop other techniques such as somatic
cell nuclear transfer or a technique involving pre-implantation genetic diagnosis. These techniques avoid
the general ‘potential life’ and ‘personhood’ debate and whilst not completely without their own ethical
flaws seem to be a good alternative. Yet the money invested in this research seems to tip the scale in
terms of the debate as essentially the research is attempting to achieve what we have already achieved
although via a different route. It seems logical that human ES cells collected as a result of IVF should be
permitted considering they are sourced from embryos that will inevitably be discarded and will never
develop to become a foetus.
INTRODUCTION
In what Scott describes as “an experiment that shook the world” (Scott, 2006) Thomson tells us in the journal
Science how he managed to develop a single line of human embryonic stem cells. This was first reported in the
journal Science on the 6th of November 1998 where he describes just how he achieved his goal. This
achievement whilst seeming relatively straight-forward if you listen to Thomson’s modesty was a huge step in
the long road towards stem cells becoming a dominant part of modern medicine. Whether deliberate or not
Thomson in the publication’s abstract seems to not be fully aware and underestimates the potential uses of his
cell lines. He writes in the abstract “These cell lines should be useful in human developmental biology, drug
discovery and transplantation medicine.”(Thomson, 1998). To me this seems to be Thomson wanting to seem
modest and play down the importance of his discovery rather than his ignorance towards its capabilities. But
nevertheless he had just set the foundation for what seems to be becoming the greatest hope in 21 st Century
medicine.
Yet despite the initial enthusiasm there were those that became sceptical about whether it was in practice
ethical or not. Perhaps the most famous of these sceptics was the US President George W. Bush who on the
August 9th 2001 prohibited Federal Funding on Human Embryonic Research where the derivation process
began after 9:00 P.M. EDT on August 9, 2001. The stem cells that were still eligible for funding must have been
derived from an embryo that had been created for reproductive purposes no longer needed and must have
been donated with informed consent.
These restrictions led other researchers to investigate alternative procedures to obtain identical or similar ES
cells. Such processes developed involved Somatic Cell Nuclear Transfer (SCNT), Altered Nuclear Transfer,
Pathogenesis, a technique involved with Pre Implantation Genetic Diagnosis (PGD) as well as other methods
involving things such as engineering stem cells from skin biopsies.
The debate was once again reignited in the wake of Obama’s statement on the 9th March 2009 which read:
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‘For the past 8 years, the authority of the Department of Health and Human Services, including the National
Institutes of Health (NIH), to fund and conduct human embryonic stem cell research has been limited by
Presidential actions. The purpose of this order is to remove these limitations on scientific inquiry, to expand
NIH support for the exploration of human stem cell research, and in so doing to enhance the contribution of
America’s scientists to important new discoveries and new therapies for the benefit of humankind.’
The stance showed that unlike Bush Obama saw that the future capabilities of stem cells outweighed the
ethical issues involved and in fact these alternatives were not seen to swing the President’s decision. This
stance is of course widely controversial and the debate continues to this day with the future of human ES stem
cells relatively ambiguous.
DISCUSSION
On the one hand there are some that would argue that the ethical issues involved with ES cells are relatively
unimportant in comparison to the inherent future medical capabilities they have. One of the major issues
involved with the stem cell debate is the whole preventing a potential life debate. Yet frankly whilst it seems
that to call this ‘ball of cells’ a potential life is scientifically correct but yet when assessed practically it seems
this view is a bit farfetched considering every embryo requires a mother to carry the blastocyst in order for it to
develop into a foetus. Therefore considering that most if not
all of the embryos donated to ES cell research are provided
as a result of In-Vitro Fertilisation (IVF) fertility treatment
where the embryos are unwanted and consequently only
going to be discarded due to the number of embryos
produced in IVF treatments it seems that using them for ES
cell research would be a wise use of resources considering in
some way they are in some ways a ‘bi-product’ of such
treatment. It would be an idealistic viewpoint to consider
that these embryos have some sort of ‘right to life’ when in
fact practically even if they did have some kind of ‘right’ they
would practically have no way of exercising this right. It is a fact of IVF treatment that more embryos are
created than are actually required in order to achieve the best results as in this procedure embryos are
assessed to predict which of these have the greatest chance of survival in the womb and will consequently be
implanted. Subsequently this means there are embryos left over with relatively no purpose and to use them for
significant scientific research which could in effect help to save millions of lives as currently the ability of stem
cells seems never-ending would be a wise choice.
Another ethical dilemma that comes as a package with the ‘potential life’ debate is the debate involving
‘personhood’ where ethicists try to determine when does a pre-embryo, an embryo or a foetus become a
person. In his book the Ethics: An Introduction to Moral Philosophy ethicist Noel Stewart assesses five possible
solutions or points at which personhood begins. The first stage considered is ‘at conception’ where the sperm
meets the egg to form a zygote. This is a point of view held by the Catholic Church who released a statement in
2008 called Dignitas Personae on Certain Bioethical Questions where they stated that:
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‘The originality of every person is a consequence of the particular relationship that exists between God and a
human being from the first moment of his existence and carries with it the obligation to respect the singularity
and integrity of each person, even on the biological and genetic levels.’
Yet this comes with its problems as something such as a sardine at this point is a higher functioning being than
a foetus yet we do not call it a person. Some would then argue that this is down to the zygote having the
potential to become a higher functioning being and implying that at this point we can call it a potential person.
This consequently almost indirectly admits that the zygote at this point is not yet a person as it is in fact a
potential person. The second point considered is the point at which the foetus possesses a shape that
resembles a human being as we know it. This again has its flaws as it seems that we can call anything that
looks slightly like a human a person. Would we call a chimpanzee a person? I highly doubt it. This point also
fails to address the idea the mental qualities that a person holds with the ability to reason and make informed
decisions. The third looks at when we become a sentient being at just after 8 weeks. This means that the foetus
is able to feel pleasure and pain as the result of developing a nervous system. To me, this seems to be a decent
attempt at answering this almost unanswerable question as it seems to encompass the main ideas that we
consider to make up a person. Firstly as of 8 weeks we do resemble to some extent the ‘shell’ of a human being
as well as more importantly developing a nervous system so consequently
having the ability to not only feel pleasure and pain but to also to a point be
rational and self-aware which in philosophical terms seems to define a person.
Other alternatives considered by Stewart involve personhood at the point at
which a foetus can independently survive outside the womb or finally at birth
yet in terms of looking at an ethical issue involving stem cells these points seem
irrelevant. We can see from these ideas that personhood does seem to begin
until the point at which he/she is sentient at around the 8 week mark. Therefore
it seems that such ES cell research from a personhood point of view should be
permitted considering that the cells are removed from the Blastocyst at Day 8 of
the pregnancy or development weeks before the formation of a sentient foetus.
Another relatively large stakeholder in the debate were those involved with the ‘Report of the Committee of
Inquiry into Human Fertilisation and Embryology’ of 1984 which was headed by Dame Mary Warnock DBE and
was subsequently known by many in the British public as the Warnock Committee. This whilst before the time
of research directly on Human ES cells is directly relevant as it assesses the main ethical dilemmas in
researching upon human embryos, perhaps the main ethical dilemma connected with ES cells. They debated
amongst the idea in order to provide recommendations for legislations on topics such as embryo research and
IVF treatment. Up until this time there were no laws directly linked to acts of embryo research, with such acts
only being affected by relatively vague laws created way before the modern scientific era. The group
formulated an argument that then provided the basis for the Human Fertilisation and Embryology Act 1990.
They like Stewart attempted to first answer the idea of Personhood and came up with a completely new idea
not even assessed by the ethicist. Their debate came to the conclusion that the an embryo becomes a human
at the tender age of 14 days in the womb which is the point at which the first recognisable features of the
embryo will appear. Warnock writes,
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‘The first of these features is the primitive streak, which appears as a heaping-up of cells at one end of the
embryonic disc on the fourteenth or fifteenth day after fertilisation. Two primitive streaks may form in a single
embryonic disc. This is the latest stage at which identical twins can occur.’
This quite clearly takes up the point that
personhood begins at 14 days which is
scientifically the point at which an
embryo will no longer divide to leave two
identical
embryos
which
can
subsequently develop into identical
twins. Therefore the scientific argument
is that the embryo becomes an
‘individual’ and consequently a potential
person at this stage. This idea would
essentially imply that the harvesting of stem cells should be given the go ahead when you consider that these
ES cells are only ever harvested from an blastocyst that is between three to five days old, which means that
these cells will never be extracted after the point of 13 days after conception, at least a day before its
development of the primitive streak (a thickening line that eventually gives rise to the nervous system).
The report also seemed to find that the majority seemed to back human embryo research and it was in fact the
minority that were against its use. The report used the example of Down’s syndrome which seemed directly
related to fertilisation and was a condition that was only found in human beings. The report wrote that:
‘We found that the more generally held position, however, is that though the human embryo is entitled to
some added measure of respect beyond that accorded to other animal subjects, that respect cannot be
absolute, and may be weighed against the benefits arising from research. In certain situations there is no
substitute for the use of human embryos.’
Another point that could be considered relating to the idea that there is no substitute to human embryos is the
concept of whether an embryo created via the fusing of a human ovum and sperm has the exact same
composition as an embryo developed as a result of Somatic Cell Nuclear Transfer (SCNT). Evidence for this
statement could come in the form of undoubtedly the most famous product of SCNT, Dolly the Sheep. Some
cloned mammals, including Dolly, have been shown to have shorter telomeres than other animals of the same
age. These Telomeres are small fragments of DNA that shield the ends of chromosomes. They shorten as cells
divide and are therefore considered a feature of ageing in cells. This idea of premature ageing concurs with
Dolly’s death where she was diagnosed with a progressive lung disease and severe arthritis, a condition usually
found in sheep much older than Dolly who died at the age of 6, only achieving 50% of her life expectancy (New
Scientist, 2005).
Another study of cloned mammals that have lived long enough to determine any effect on lifespan yielded
similar results where the mice involved died prematurely. The research was conducted at the National Institute
of Infectious Diseases in Tokyo, Japan, and published in February 2002. So surely it would only be logical to
perform research on embryos which we are sure are identical to those created as a result of human sexual
reproduction which we can obtain via In Vitro Fertilisation (IVF).
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It seems crucial, ethically that these embryos are obtained via IVF to avoid any other ethical concerns as is
once again an issue covered by the Warnock report. This is down to the fact that any embryos not implanted
into the mother’s uterus will inevitably be discarded as a result so why not use them for research in a way that
may benefit humanity in helping to save other’s lives. Why should we divert to other techniques in developing
stem cells when we could perhaps more easily use these embryos which would continue to be created and
destroyed in the absence of embryo research. So isn’t using them for valuable medical advances only logical in
attempt to make up for the potential lives lost in the process? Dame Warnock writes of this importance in her
report stating that:
‘Nevertheless, the argument runs, research on embryos may be justified, provided that the embryos used as
subjects of research were brought into being, not primarily for research, but in order to alleviate a particular
case of infertility.’
An embryo obtained via extraction from a woman’s uterus would be seen as preventing life from thriving and
could be seen by many as murder if it were to be viewed on the same level as human life. Furthermore the idea
of generating the required embryos solely the purpose of testing is a contentious issue. Some believe that such
acts can be justified whereas others believe that it exploits the concept of creation. Many even believe that
the use of such embryos as a result of IVF treatment can only be justified in context of the philosophical
principle of ‘double effect’ which states that an act which would be wrong if chosen for its own sake may be
justified if it occurs as a bi-product of some other.
However on the other hand there are others who
would argue that seems logical to use other viable,
less ethically controversial techniques to require the
stem cells needed for medical experimentation.
There are many different arguments ranging from
the ideas of alternative techniques such as SCNT or
the use of less pluripotent stem cells in Adult or
Cord Blood stem cells which all even have the added
bonus of the possibility of the consequent stem cells
being matched to patient, a feat that clearly could not
be achieved by those cells derived from embryos
One fairly viable alternative technique could come in
the form of the somatic cell nuclear transfer which
would provide us with ES cells without the need for
sexual reproduction. In the process the nucleus of an
unfertilized egg is replaced with the nucleus from a
somatic cell, such as a skin cell, from the patient
who will ultimately be transplanted with the
appropriate cells. The generated cell becomes a
structure that looks similar to but is very different
from a blastocyst produced by a sperm and an egg.
Within it are embryonic stem cells however they are
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unable to undergo the genetic reprogramming that, after sexual reproduction, permits the development
of a healthy baby. Therefore the generation of life becomes impossible (Teitelbaum, 2005).
The fact that there is no hope of any generation of life is extremely important because it eradicates
many of the ethical dilemmas associated with ES cell research. For example the whole ‘Personhood’
debate is immediately eliminated. However it is important to realise that the technique does have its
flaws. It is perhaps not as ethically controversial as there remains to be ethical concerns about the
misapplication for reproductive SCNT, a highly controversial issue that has seen bans throughout the
majority of the world connected with its application, but in terms of a practical sense it seems to be
disadvantaged. The application of SCNT is entirely theoretical as so far no scientist has prevailed in
actualising such ES cells. However scientists have succeeded in generating a SCNT blastocyst. Practical
difficulties can also be seen in relevance to the practicality of requiring the number of ova required for
its application. The process requires women actually donating their eggs, but can the supply really
meet the demand? So it poses the question: Should money be injected into researching techniques to
produce a product we can already generate? Or would it really be worth pursuing techniques so that
the controversy surrounding ES cells can be dismissed?
It could then be argued by those
against embryo cultivation that the
future of stem cells lies with the
recently developed technique of
engineering
stem
cells
by
reprogramming mature adult cells
so that they can revert to their
original pluripotent state. The
technique was developed in 2006
by a scientist named Shinya
Yamanaka who found that if you
were to place four specific genes
into cells from a skin biopsy the
resulting cells would seem to
become pluripotent and in bluntly
seemingly ‘undifferentiate’. These
cells were called an induced
pluripotent stem cell, or iPS cell.
This was a remarkable discovery because to date scientists had found that only ES cells, derived from a
human embryo, are naturally pluripotent. Yamanaka’s discovery means that any cell of the body
except a sperm or egg can now be turned into a pluripotent stem cell. Research into this area is fairly
primitive with scientists exploring the relatively unknown. But surely if Yamanaka’s results are
accurate and we can in fact develop pluripotent cells from adult cells, from a Pro-Life perspective it
would be foolish not to abrogate the experimentation on embryos for stem cell research. This
technique finally presents us with a method without the
political, scientific and ethical roadblock of using human
eggs or embryos we have become accustomed to. (Goldstein,
2010)
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The final alternative perhaps lies with the comparatively proven technique of using adult stem cells
which whilst less powerful that their ES cell counterparts come without controversy. They have also
demonstrated successful treatments in the past with Hematopoietic stem cell transplantations being
used since 1959 in the treatment of Leukaemia. These cells whilst not as powerful should without a
doubt also be considered considering how they have consistently produced more promising results
than the use of ES cells therefore providing an argument for such cells as a better alternative.
CONCLUSION
There is no doubt in my mind that from a personal perspective I would consider that human life would start at
either the point of a development of a ‘primitive streak’ or the point at which a foetus can be seen as becoming
sentient. This allows me to conclude that from my perspective human life can start at a point no earlier than 14
days after conception. This implies that the practice of embryo research should be allowed in the case of stem
cells as such experimentation only ever occurs up until the 13 day point.
However I realise the question of personhood is entirely philosophical in nature and will consequently never
acquire a definite answer. This observance leads me to suggest that whilst I personally may condone such
research the objection of others is never likely to disappear so therefore would encourage the development of
certain other techniques which are less controversial so that the emphasis can turn from the ethical debate to
the application towards the treatment of patients, the ultimate goal of stem cell research.
When you consider the possible potential uses and impact of stem cells and by being stubborn and arguing for
one side of the debate is only dooming more and
more to their inevitable end it seems that a solution to
any problem should be found as soon as physically
possible. The Guardian attempts to explain its
potential in its article on ‘Tomorrow’s Cures’ which
read:
‘The potential of stem cell research is almost biblical in
its scale. The capacity for these cells to transform into
whatever the body needs to regenerate itself could, in
the lifetime of the next generation, make the blind
see, the crippled walk, and the deaf hear. It could cure
cystic fibrosis and arrest muscular dystrophy.’ (The
Guardian, 2009)– But the list goes on and on.
Possibly when you consider that worldwide there are around 70000 people who suffer from the rare condition
of cystic fibrosis it can be seen just how potentially powerful these cells are. Yet I will reiterate that it is
imperative that we do not go about the research in the wrong way and potentially doom a potential ‘Medical
Revolution’ to a ‘Medical Disaster’.
I believe that whilst research and treatment using Adult stem cells should continue, research involving SCNT
should be halted as to me it seems that it is attempting to answer one problem with another ethically
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controversial technique. For me, the greatest hope comes with the development of the iPS technique. With
the iPS technique with have something that seems practically possible with the recent development of iPS cell
lines, something which produces pluripotent cells as well as a something which is comparatively without ethical
controversy. Perhaps with the development of such techniques the ‘Medical Revolution’ can finally begin.
BIBLIOGRAPHY
Scott, C. T. (2006). Stem Cell Now: A Brief Introduction to the Coming Medical Revolution. Plume.
Thomson, J. A. (1998). Embryonic Stem Cell Lines Derived from Human Blastocysts. Science, 1145-1147.
Human Embryonic Stem Cell Policy Under Former President Bush (Aug. 9, 2001–Mar. 9, 2009)
http://stemcells.nih.gov/policy/2001policy.htm
Stewart, N (2009). Ethics: An introduction to Moral Philosophy. Polity Press
Congregation for the Doctrine of the Faith (2008) INSTRUCTION DIGNITAS PERSONAE ON CERTAIN BIOETHICAL
QUESTIONS
http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20081208_dignitaspersonae_en.html
Warnock, M (1984). Report of the Committee of Inquiry into Human Fertilisation and Embryology. Her
Majesty’s Stationary Office
New Scientist, Dolly the sheep dies young (14 February 2003)
http://www.newscientist.com/article/dn3393-dolly-the-sheep-dies-young.html
Teitelbaum, S. (2005) Stem Cells Hold Great Promise
http://magazine-archives.wustl.edu/Spring05/StevenTeitelbaum.htm
Lawrence S.B Goldstein, (2010) Stem Cells for Dummies, Wiley Publishing
Maggie Fox (2007) Embryonic stem cells made without embryos
http://www.reuters.com/article/2007/11/21/us-stemcells-idUSN2058175020071121
The Guardian (2009) Tomorrow’s Cures http://www.guardian.co.uk/commentisfree/2009/feb/02/leaderstem-cell-research
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