Schaub 4:00
R07
THE ETHICAL CONSIDERATIONS OF EMBRYONIC STEM CELL
EXTRACTION
Jessie Liu ([email protected])
INTRODUCTION
For several years I have worked on adult stem cell
extraction and its applications in regenerative medicine,
specifically cardiac tissue regeneration. The head senior
researcher on this team has been assigned a new research
topic by his supervisor and is able to choose five researchers
from our team to work with him on this research. He
approached me yesterday to offer me a spot on his new team.
While this is a very exciting opportunity, I have to consider
the ethical implications.
Adult stem cells have incurred little ethical controversy
and have been the alternative solution to embryonic stem
cell research [1]. The new project, however, is centered
around embryonic stem cells and their extraction for use in
cardiac regenerative medicine. Never having dealt directly
with embryonic stem cell research before, I must carefully
consider whether or not to join my head senior researcher,
drawing from the codes of ethics I have pledged to follow
and recent examples of similar situations.
EXPLANATIONS OF RELEVANT
HISTORY AND MATERIAL
Before evaluating my resources and reaching a
conclusion on my decision, a brief explanation of the
historical ethical concerns regarding and the nature of
embryonic versus adult stem cells is necessary.
A Brief History of Stem Cell Ethical Issues
Stem cell research has been at the center of controversy
though treatments have been used for decades [2]. Stem
cells are a type of cells that have pluripotent differentiation
potential. This means they have the ability to be influenced
by their cellular surroundings and transform to a completely
different type of cell. There are two types of stem cells:
adult stem cells and embryonic stem cells. Adult stem cells
are stem cells that have lost some pluripotent ability and thus
can only differentiate into a few different types of cells.
Embryonic stem cells are completely pluripotent and have
vast abilities in potential tissue engineering and regenerative
medicine treatments [3]. Instrumental to experimental
research on embryonic stem cells is the extraction of the
cells from embryos. This is where the controversy between
social, ethical, and religious beliefs begins.
The main debate revolves around when human life
begins. Is it from the moment of conception? If so, is
extracting stem cells considered to be homicide? Or is there
University of Pittsburgh, Swanson School of Engineering 1
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a certain stage in pregnancy when the fetus is considered to
possess human rights [4]? These questions arise from
certain religious and political affiliations, most notably
Christianity and Republican conservatism, respectively [5].
If one considers the embryo to be a person from conception,
then extracting cells, which effectively ends the potential for
the embryo to develop into a fetus, can be thought of as an
intentional killing. The extraction of an embryo has been
compared to abortion by its opponents. This reinforces their
position that this research is unethical. For those who do not
believe that an embryo possesses human rights, this is not an
issue.
The real potential of embryonic stem cell research to
advance regenerative medicine is overshadowed by
controversy. Much of the opposition of embryonic stem
cell research comes from a religious or political standpoint.
Over the course of this text, however, I will consult the
codes of ethics laid out by official organizations, of which I
am part of, my own moral standards, and relevant
experiences of other professionals.
What Are Stem Cells?
Stem cells are a type of cells that have pluripotent
differentiation potential. Pluripotent refers to the fact that
they can become every potential cell. Differentiation is the
process by which cells (including stem cells) are influenced
by their surroundings, external and internal factors, which
causes them to progress from one stage to another. In the
case of stem cells, these “stages” are small changes that
direct it in the path of a certain type of cell.
As previously mentioned, there are two types of stem
cells, embryonic and adult. Embryonic stem cells exist only
in the pure embryo, as the name suggests. Only in the pure
embryo do they possess the total pluripotent potential. Adult
stem cells are partially differentiated embryonic stem cells.
For example, there are muscle adult stem cells. These cells
can turn into several types of muscle related cells but are
limited by this nature [1].
Treatment wise, adult stem cells are not as easy to work
with or as effective because they do not have the great
potential that embryonic cells do. One example of this
limitation is in the case of tissue engineered organ
transplants. Since there are many different types of cells in
one organ, several types of adult stem cells must be
harvested to even start the process. In addition, adult stem
cells are rare within tissues. There are only several adult
stem cells and when they multiply, most of the daughter
cells will differentiate to become regular body cells [1].
With embryonic stem cells, this process is much easier. The
Jessie Liu
advantage of an engineered organ is that the cells can be
“personalized,” in a way, to the patient. This drastically
reduces the chances for transplant rejection and infection.
In order to make progress with effective treatments,
embryonic stem cells must be extracted from the embryo.
Here is where the controversy is centered. By extracting the
cells, the embryo is halted from developing any further.
Between the Codes of Ethics for NSPE and BMES there
are several overlapping articles. One of which that is
relevant to my situation is Article 1 under Section I of the
BMES Code of Ethics. This article reads “Biomedical
engineers in the fulfillment of their professional engineering
duties shall use their knowledge, skills, and abilities to
enhance the safety, health, and welfare of the public” [7].
Again, there is the statement of acting to maintain and
advance the safety, health, and welfare of the public.
Embryonic stem cell research does not harm and can only
advance the public’s safety, health, or welfare. This seems
to point in the direction of accepting the research position.
The second relevant article is Article 1 under Section 3
which states “Biomedical engineers involved in research
shall comply fully with legal, ethical, institutional,
governmental, and other applicable research guidelines,
respecting the rights of and exercising the responsibilities to
colleagues, human and animal subjects, and the scientific
and general public” [7]. Similar to Section III Article 2 of
the NSPE Code of Ethics, this article provides a catch to the
conclusion the other article pointed to. If I define life as
starting at conception, then stem cell extraction from the
embryo is clearly not “respecting human…subjects” [7]. If I
do not define human life as starting at conception, then I am
complying with this article and there is no issue with
continuing embryonic stem cell research.
THE CODES OF ETHICS
As a professional biomedical engineer I am a member of
both the National Society of Professional Engineers (NSPE)
and the Biomedical Engineering Society (BMES). As a
pledged member, I must adhere to both codes of ethics.
NSPE Code of Ethics
Article 2 of Section III “Professional Obligations” of the
NSPE Code of Ethics states “Engineers shall at all times
strive to serve the public interest” [6]. More specifically the
positive image of engineering to the public, encouraging the
education of the public about engineering, participating in
civic affairs, career guidance for youths, and work for the
advancement of safety of the public. Most useful is the
phrase “work for the advancement of the safety, health, and
well-being of their community” [6].
As previously
mentioned, the development of embryonic stem cell research
holds immense potential for a wide variety of regenerative
treatments. The potential is virtually limitless as compared
to previously available treatments and clinical trials. To me,
it is clear that embryonic stem cell research should be
encouraged and continued. By only considering the health
and welfare of the public, it is easily said that advancement
of embryonic stem cell research does not violate the NSPE
Code of Ethics. However, if one only considers the general
statement of Article 2, a much different conclusion will be
drawn. Given the great amount of public concern and
opposition to the extraction of embryonic stem cells, the
interest of “the public” would not be served if this research
was pursued against their beliefs.
Next, I will consider Article 5 of Section III which reads
“Engineers shall not be influenced in their professional
duties by conflicting interests” [6]. I personally believe in
the great potential of embryonic stem cell research and have
no religious issues with the research myself. I do not believe
an embryo is a person at conception and thus do not have
any concerns with the effective end to the embryo’s potential.
As a professional engineer and researcher I am able to
closely and tangibly see this potential and the great
possibility of its applications. I realize, though, that this
research will not only affect me but millions of others. As a
result, I must remove my own personal interests and greatly
consider the public over myself.
Conclusion Based On Codes of Ethics
If I was to make a conclusion based solely on these two
codes of ethics, I would, in short, refuse the offer from my
head senior researcher. There is only a slight margin
between joining the research team and not joining the team,
though, and several conditions which could lead to a
different decision.
I would love to partake in the research and the concepts
excite me greatly. I know it would have a great and positive
impact in the world of regenerative medicine and it would
pain me to not be able to partake in the project. However, it
is necessary to consider the public and put the public as one
of the highest priorities in making this decision. In my
opinion, taking part in this research would not be unethical.
But if I made the choice to do the research, I would be also
devastating a great deal of the population who have
legitimate religious, moral, and political concerns.
Therefore, based solely upon these codes of ethics, I
would not join the research team as it is.
RELEVANT CASES AND STUDIES
However, my final decision must also draw from the
experiences of other professionals.
Alternative Options to Human Embryonic Stem Cells
BMES Code of Ethics
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Jessie Liu
The main issue that several widespread religions, notably
Christianity, have with embryonic stem cell research is that
an embryo is believed to possess human rights from
conception. This means that any intentional harm to come to
an embryo is religiously reprehensible. Most will describe
this as homicide or relate it to abortion [3]. As pro-life
versus pro-choice is already quite an issue in the United
States, this relationship and the similarities between the two
topics has only further rooted non supporters to this belief.
Without any sort of open mindset, progress cannot
expect to be made. Slowly, some religious supporters are
beginning to look at embryonic stem cell research from a
new perspective. Dr. Richard Whittington of the University
of Pennsylvania discusses the controversy of this research
from a Roman Catholic’s point of view in his publication
“Embryonic Stem Cell Research: A Pragmatic Roman
Catholic’s Defense” [5]. Dr. Whittington begins “The
potential benefits of embryonic stem cell research have been
clarified by the last ten years of research so that it is
necessary to re-examine the foundations for the restrictions
imposed on this research” [5]. Acknowledging the change
in circumstances over the last decade, Dr. Whittington
knows that it is realistic to have to reconsider and clarify
previous notions as well. Ten years ago, not nearly as much
was known about the process of embryonic stem cell
extraction or the possibilities that stem cells have in
regenerative medicine. Although no compromise can be
made regarding religious standpoints, as there are too many
conflicting points of view, and it is a personal matter, open
mindedness is essential. Dr. Whittington expands upon his
ideas of reforming embryonic stem cell research by
explaining that the embryos experimented upon did not have
to be “alive” [5]. He writes “Children and adults may be
organ donors after expiration…The ethical issues
surrounding these donations have been resolved, and the
issues are no different for an embryo that is no longer
viable…this act is considered…a way to honor the life of the
deceased” [5]. Instead of experimenting upon live embryos
that could potentially develop into a child, he proposes that
embryos that can no longer develop into life can be used
without issue.
Despite this seems like a promising
alternative, very little work has been done with tangible
results. Most researchers have instead turned to adult stem
cells for new treatments instead of this alternative.
In addition to this alternative, there have been recent
findings on Induced Pluripotent Stem Cells (iPSCs).
Although most stem cell researchers and scientists agree that
embryonic stem cells cannot be fully replaced by iPSCs, the
ability of iPSCs to mimic pluripotency in nature is promising
[8]. iPSCs are the closest that scientists have been able to
get to finding an alternative to human embryonic stem cells,
seemingly only having a difference in their genetic makeup
which limits them slightly (although not as much as adult
stem cells). Despite this fact, iPSCs cannot compare to
embryonic stem cells and are currently being studied to see
if the only difference is at the genomic level [8]. At the
moment, iPSCs would be very difficult to introduce to a
clinical setting as a result of their genetic differences from
embryonic stem cells. Current iPSC development is not
feasible for useful treatments resulting from the lack of
knowledge on their longitudinal effects [9]. This poses
another issue in attempting to implement iPSCs in place of
human embryonic stem cells because it is unknown how
well iPSCs can maintain their embryonic stem cell-like
identity.
Judicial Decisions Affecting Stem Cell Patents
Additionally, there have been judicial decisions
regarding the attempt to use and patent embryonic stem cell
therapies, for example, regenerating nerve cells for nervous
and spinal injuries. Stem cell researcher Oliver Brustle’s
patent for such treatments was challenged by an
environmental group from Amsterdam. Germany’s federal
patent court ruled in favor of the environmental group on the
basis that “even if they do not involve the direct destruction
of embryos, techniques involving human embryonic stem
cell lines are tantamount to making industrial use of human
embryos, which would be contrary to ethics and public
policy” [10]. While many researchers are fuming, even
more are worried that stem cell research could be severely
limited and/or banned forever with the amount of
controversy it is now being swept up in. The consequence
of the unresolved opposition threatens the advancement of
any sort of stem cell research. Resolving the opposition to
embryonic stem cell research is the only way for it to
continue without major legal and binding backlash.
Embryonic Stem Cell Identity Ethics
At the heart of the public’s ethical concerns with
embryonic stem cell research is the question of whether an
embryo is a human, and thus has fundamental human rights,
at conception. Phillip Montague of the Department of
Philosophy of Western Washington University presents an
argument to why no human was ever an embryo, thus
eliminating the concerns that the loss of potential of an
embryo is the killing of a human being. He presents several
key ideas including the scientific fact that an embryo’s
identity is changed in later developmental states [11].
Secondly, he presents the example that twin siblings
originate from the same embryo. If each person is
numerically identical with the embryo from which they
developed, then that implies the twins are the same person.
This is easily denied since the twins are two different people.
Therefore, Montague argues that no person existed as one
embryo that could have been destroyed by embryonic stem
cell research [11]. These ideas, then, point to the conclusion
that embryos do not possess fundamental human rights since
they cannot be directly linked to an individual adult human.
Moreover, philosophically speaking, one must possess
rationality and consciousness to be considered a human
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Jessie Liu
being [12]. Embryos possess neither of these qualities and
thus do not possess fundamental human rights.
http://muse.jhu.edu/journals/asian_bioethics_review/v005/5.
1.bridge.html
[9] D. G. Zacharias, T. J. Nelson, et al. (2011). “The
Science and Ethics of Induced Pluripotency: What Will
Become of Embryonic Stem Cells?” Mayo Clinic
Proceedings. (Online article). DOI: 10.4065/mcp.2011.0054
[10] A. Abbott. (2011). “Europe rules against stem-cell
patents: work with human embryonic stem cells is ‘contrary
to
ethics.’”
Nature.
(Online
article).
http://go.galegroup.com/ps/i.do?action=interpret&id=GALE
%7CA252847874&v=2.1&u=upitt_main&it=r&p=AONE&
sw=w&authCount=1
[11] P. Montague. (2011). “Stem Cell Research and the
Problem of Embryonic Identity.” The Journal of Ethics: An
International Philosophical Review. (Online article). DOI:
10.1007/s10892-011-9107-1
[12] T. Mosteller.
(2011). “Teleology, embryonic
personhood, and stem cell research.” Ethics & Medicine: an
international journal of bioethics.
(Online article).
http://go.galegroup.com/ps/i.do?id=GALE%7CA297040574
&v=2.1&u=upitt_main&it=r&p=AONE&sw=w
FINAL CONCLUSIONS
Based solely on the codes of ethics, I would ultimately
refuse the offer to join a new embryonic stem cell research
team. However, after considering relevant professional
experiences, examples, and philosophical arguments, I have
decided accept my head senior researcher’s offer. Ultimately,
for a truly clear decision to be made, the debate over when
life begins needs to be resolved. Drawing from both the
scientific facts and philosophy presented, it is clear to me
that life does not begin at conception and therefore
embryonic stem cell extraction is not unethical. By
accepting the research position I will be adhering to both the
NSPE and BMES Codes of Ethics by advancing the health
and welfare of the public as I have come to the conclusion
that the ethical concerns are not scientifically or
philosophically sound.
REFERENCES
ADDITIONAL SOURCES
[1] L’ubos Danisovic, Stefan Polak, Jan Vojtassak. (2012).
“Adult Stem cells derived from skeletal muscle – biology
and potential.” Central European Jounral of Biology.
(Online article). DOI: 10.2478/s11535-013-0137-x
[2] C. Leeb, M. Jurga, C. McGuckin, et al. (2011). “New
perspectives in stem cell research: beyond embryonic stem
cells.” Cell Proliferation. (Online article). DOI:
10.1111/j.1365-2184.2010.00725.x
[3] N. Manzar, B. Manzar, N. Hussain, et al. (2013). “The
Ethical Dilemma of Embryonic Stem Cell Research.”
Science and Engineering Ethics. (Online article). DOI:
0.1007/s11948-011-9326-7
[4] Z. Master, G. K. D. Crozier. (2012). “The Ethics of
Moral Compromise for Stem Cell Research Policy.” Health
Care Analysis. (Online article). DOI: 1007/s10728-0110171-2
[5] R. Whittington. (2012). “Embryonic Stem Cell Research:
A Pragmatic Roman Catholic’s Defense.” Christian
Bioethics. (Online article). DOI: 10.1093/cb/cbs023
[6] National Society of Professional Engineers. (2007).
“Code of Ethics for Engineers.” National Society of
Professional
Engineers.
(Online
article).
http://www.nspe.org/Ethics/CodeofEthics/index.html
[7] Biomedical Engineering Society. (2004) “Biomedical
Engineering Society Code of Ethics.” Biomedical
Engineering
Society.
(Online
article).
http://bmes.org/files/2004%20Approved%20%20Code%20o
f%20Ethics(2).pdf
[8] S. Bridge. (2013). “Induced Pluripotent Stem Cells: An
Alternative to Embryonic Stem Cells?” Asian Bioethics
Review.
(Online
article)
A. Akar, M. Dastouri, G. Deniz, et al. (2012). “Stem cell
mediated cardiovascular repair.” Canadian Journal of
Physiology and Pharmacology. (Online article). DOI:
10.1139/Y2010-010
Alan Trounson, George Q. Daley, et al. (2013). “A new
route to human embryonic stem cells.” Nature Medicine.
(Online article). DOI: 10.1038/nm.3266
American Institute of Chemical Engineers. “Code of Ethics.”
American Institute of Chemical Engineers. (Online article).
http://www.aiche.org/about/code-ethics
G. Bahadur, M. Morrison, L. Machin. (2010). “Beyond the
‘embryo question’: human embryonic stem cell ethics in the
context of biomaterial donation in the UK.” Reproductive
BioMedicine
Online.
(Online
article).
DOI:
10.1016/j.rbmo.2010.10.001
R. Doerflinger. (2010). “Old and new ethics in the stem cell
debate.” Journal of Law, Medicine & Ethics. (Online article).
http://go.galegroup.com/ps/i.do?action=interpret&id=GALE
%7CA231407923&v=2.1&u=upitt_main&it=r&p=LT&sw=
w&authCount=1
ACKNOWLEDGEMENTS
I would like to acknowledge my brother, Peter Liu, who
took the time and had the patience to assist me in
proofreading this paper. I would also like to thank my
grandfather, a mechanical engineer, for his insight regarding
ethics in engineering. This research would not have been
possible without Judy Brink from the Bevier Engineering
Library and her guidance with accessing the right source
materials. Finally, I thank Dr. Schaub for this opportunity.
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