Abstract
In this project I intend to explore to what extent ethical arguments about the research on Embryonic stem cells (ESC’s) and induced pluripotent stem cells (IPSC’s) have changed over the last 20 years and how factors such as, breakthroughs in research, socioeconomic and government involvement and widening access to media have contributed to these changes. I intend to look at 3 points in the last 20 years ranging from 2000 to the present day. I aim to find out how these ethical opinions have affected the progress in stem cell research in terms of how they are cultivated and harvested and also in terms of how soon its uses are available to the masses. This project will explore how justified these opinions are when compared with the science behind it and whether or not there are cases that have been overlooked which could have resulted in a different outcome or if there are arguments that can directly contradict previous ones.
Introduction
Stem cells are undifferentiated cells that can be found in the embryonic, fetal and adult stages of life which result in the production of differentiated cells that play big roles in the growth of tissue and organs. Three major characteristics of stem cells include the ability to self repair its specific tissue or organ, its ability to clone from a single cell [1] and its potency, which gives the cell the ability to differentiate into different cell types. The potency of a stem cell is what determines the range of which it can differentiate into different cells and tissue types. As an indirect result of these findings, potency is also what determines the value of stem cells in terms of research purposes. The three main ranks of potency starting from the most potent are: totipotent, pluripotent and multipotent stem cells. Totipotent stem cells have the ability to differentiate into all human tissue types and potentially become an entire organism. They are very difficult to find, however, as they can only be found in the very early stages of fertilisation and the formation of a zygote. It is so early on in fact that they can only be found within 4 days of development [2 ]. Pluripotent stem cells are able to form all three germ layers which allow them to also differentiate into any tissue type however they will not be able to form an organism.
Multi-potent stem cells are found to be able to differentiate into cells of a specific tissue type.
The controversy regarding the research on stem cells was prompted by announcements in 1998 [3] where Dr. James Thomson was able to isolate human embryonic stem cells and where Dr. John Gearhart isolated human embryonic germ cells. The stem cells that would be harvested from the sources stated are pluripotent. Because of this, scientists believed that stem cell research will eventually lead therapies to help treat; stroke, diabetes, Alzheimers and a host of currently degenerative and incurable diseases. However because these embryonic stem cells could not be harvested without destroying embryos, this caused many ethical and religious objections. This then caused president Clinton in 1999 to call for the National Bioethics Advisory Commission (NBAC) to hold public hearings regarding the issues raised from stem cell research. Following these hearings, a comprehensive report was published. The report covered; scientific, legal, ethical, religious and public policy perspectives on stem cell research. These reports lead to the introduction of a funding policy for stem cell research that would stick around for many years to come, with the main point being that scientists must not create or destroy embryos that aren’t in excess in order to research stem cells.
Research into stem cell has received large amounts of global interest due to its potential to drastically change the lives of sufferers of various diseases in the future. With this in mind, it would be safe to assume that people and governments would be all for the use of stem cells, however once presented with the fact that certain stem cells require embryos to be destroyed for example it causes people to question if the cost is worth the potential outcome of the research. The main question I wish to answer explores the extent in which ethical opinions have been influenced not just by scientific advancements in research, but also in how modern influences in media and government have influenced opinions as well.
I intend to explore my answer by having two main sections for my essay ranging from the years 2000 – 2018 these sections being: embryonic stem cells and induced pluripotent stem cells looking at the main opinions and how they were influenced and if there is any other reason that this may have occurred. I will be analysing a number of academic journals and books along with a few articles.
Key arguments affecting opinions of stem cell research
Embryonic stem cells:
Ethical controversies surrounding research into embryonic stem cells have begun initially from 1998 when the first discovery or embryonic stem cells was made. These controversies split into two main directions: firstly, regarding the motive to benefit human sufferers of diseases we intend to treat and secondly, the moral status of using an embryo as a source of these stem cells. The argument regarding benefits to human sufferers suggests that ‘research that accents benefits to human sufferers’ trumps all other considerations as it would intend to achieve these benefits. However, in response to this, the question of embryos is raised and whether or not as humans should we ‘reduce their value totally to their importance’ to relieve the suffering of third parties.
Talk about the 4 questions before looking at the arguments
Three main arguments responding to the use of embryonic stem cells include:
Specificity and stringency [4]. This argument evaluates two considerations: moral specificity and moral stringency. Moral specificity refers to the fact that while murder is prohibited, not all killing is murder and this consideration questions how we should discriminate between them. With regards to embryonic stem cells, this is where many arguments lie, as the prohibition of killing in the decalogue is constructed more precisely to state that we ‘should not intentionally kill innocent human life’. This brings up the question about using embryonic stem cells and whether we can count them as fully human. On one hand, at the point at which scientists would harvest these stem cells, the embryo would be completely genderless and lack any physiological features so the argument would suggest that the would not actually be human at that point and using these cells for stem cells may not be seen as killing in some perspectives and therefore some may see this as morally acceptable. On the other hand, these embryos do contain the requisite genetic information in which we are characterised as being unique so in some perspectives, they can be seen as being close enough to be human and therefore not support uses of embryonic stem cells. Some can also argue that as humans we all begin in this pretender cellular state so to an extent these embryos would be seen as human.
The second consideration of this argument refers to moral stringency, and this asks the question of ‘may we (ever) do evil to achieve good?’[5] Those who believe in this argument mention that the prohibition of murder extends to foetuses and embryos as both are seen as ‘innocent’ and disaggregating an embryo are direct actions that kill. Regarding the point of prohibition discussing ‘human life’ people in favour of this argument believe that each human ‘from conception are irreducibly valuable, judging that embryos have an equally protectable status.
Nothing is lost: This principle was suggested by Paul Ramsey back in 1961, it is not directly to do with stem cells but gives conditions that are relevant to the use of embryonic stem cells. This argument states that ‘one may direct kill’ when two conditions are met; the ‘innocent will die in any case’ and ‘other innocents life will be saved. These two conditions outline how ‘nothing is lost’. The idea of innocent lives can be interpreted as embryonic stem cells in this case and how we can view embryos in clinics who are set to either be discarded or frozen. In this case, some would say that ‘innocent lives would die in any case’ from this process. And third parties such as people with Alzheimer’s, Parkinson’s and other diseases, these ‘innocent lives’ may be saved or at leased helped as a result of the research on such embryos. In this respect this argument is valid as ‘nothing more is lost’ and nothing less is lost or there is someone that at least may be saved or helped. One reason that people may think that it is worth considering the use of embryos in stem cell research with regards to this argument can be found in the process of In Vitro Fertilisation (IVF). The reason that this is brought up is that with the process of IVF there is an unavoidable excess of embryos that are produced. As seen in former president Bill Clintons justification of supporting stem cell research to an extent and mentions that the use of surplus embryos is morally acceptable . To justify this with regards to the argument it is true that these excess embryos will die ‘in any case’ thus supporting the first condition and secondly ‘nothing more will be lost by their becoming subjects of research’ furthermore fulfilling the second condition and the fact that there is the possibility of enhancing more innocent lives as a result of the potential research further fulfills the condition. This argument about using embryos that are in excess has been talked about numerous times especially in the USA and Germany. To conclude this argument I do believe that this argument is valid especially with regards to the use of surplus embryos to derive stem cells as the conditions of ‘nothing is lost is fulfilled’ and also has great potential to benefit others in the long run.
Derivation and use, and Ends and Means. There are two main claims made by John A. Robertson (2006) in this argument. Firstly, that researchers are complicit in destroying embryos when using stem cells from them, whether they actually engage in the destruction in the embryos themselves. And secondly that if one supports the research on embryos obtained as ‘spares’ from IVF, then one should be support creating and destroying embryos for the sole purpose of research. As by definition embryos do become a ‘mere means’ one we decide to research on them. However referring back to the argument of ‘nothing is lost’ it is safe to agree with Robertson’s first statement but disagree with the second. With the second statement about the creation of embryos just to be destroyed for research the condition of ‘the innocent will die in any case’ is contradicted as you are creating this ‘innocent’ just to kill it which would be seen as avoidable. So the argument of if one agrees with the research into surplus stem cells they should support the creation and destruction of embryos for research is somewhat false or easily countered in that respect. Disallowing the intentional creation and destruction of embryos for research draws more closely the considerations that are brought in when judging whether it is ok to research on fatal cadavers and ‘excess’ embryos. For a long time in both cases, the genetic parents decide whether to donate them for research.
With regards to experimenting with fetal cadavers, one case that I feel that was overlooked with regards to this argument was an experiment conducted in 2001 . Evan Snyder and Kurt Free conducted an experiment on a foetal monkey using neural stem cells from a human cadaver. Unexpectedly they found that the neural stem cells from the human had migrated and incorporated into the monkey’s brain. To me, this raises a question about to what extent if we continue to look into different ways of researching into embryonic stem cells will we stumble across something that is no longer human. I feel like if this experiment was more publicly aware, the opinion on how we use stem cells for research may have changed quite a bit especially in countries like the USA due to their large religious influence on certain opinions.
Furthering the point regarding religion and stem cell research, it is suggested from the first two arguments, that those with more religious commitment are less likely to approve of stem cell
research. Looking at a study from 2017 this is still the case around 10 years later.
Fig.1
Figure 1 shows that in all regions surveyed, the approval of stem cell research does correlate with a decline as religious commitment increases. However, the pattern is less pronounced in Europe compared to the USA and Canada. However, it is important to note that even among the more religious samples, around half of the public still approve of stem cell research, which is a slight from when stem cells were initially introduced. However, I think that religion will always correlate to a decline in research approval until major breakthroughs in terms of full functional treatments are introduced to the public.
To summarise the arguments about embryonic stem cells, the controversies still stand stemming from moral and religious perspectives with three moral questions being asked about embryos: ‘can we ever intentionally destroy a human embryo?’, ‘can we benefit from others’ destruction of embryos?’ And finally and most controversially, ‘can we create an embryo to destroy it?’
Induced Pluripotent Stem cells
The first introduction to pluripotent stem cells in 2006 by Takahashi and Yamanaka was a huge breakthrough in research into stem cells. It was a technique for reprogramming somatic cells, require the transfer of specific transcription factors in order to regulate gene expression. These factors of reprogramming were able to induce pluripotent in somatic cells and they could now differentiate into three primary germ layer cell types: endoderm, ectoderm, and mesoderms.
This new technology poses a huge potential for stem cell therapies, disease modelling, and drug testing. However, even though It potentially solves the ethical issues faced with embryonic stem cells ethical problems regarding the moral status of somatic cells began to rise.
Initially, when induced pluripotent stem cells were introduced, this advancement was also celebrated as a fix for the ethical problems associated with the use of embryos in order to derive embryonic stem cells. Since IPSC’s were able to produce ‘embryonic-stem-cell-like cells’ without using embryos it was thought that ethical issues would be solved. However, a problem concerning the use of somatic cells rose. The suggestion was that because it was possible to revert the somatic cells back to a pluripotent state, this IPSC’s could be assisted by a tetraploid complementation technique and theoretically be able to develop a newborn . While this suggestion is theoretical it stimulated the revisit the moral status of the use of these cells. The issue consists of three main arguments to address the ethical status of using IPSC’s: potentiality, standard view/relational properties, and the genetic basis for moral status.
The potentiality argument is based on the general agreement that ‘something that is potential is not actual but can become actual under certain conditions’ . There is a claim that IPSC’s present significant challenge to the potentiality argument . They suggest that reprogrammed skin cells have the same potential to develop as the cells of the inner mass from a blastocyst from a zygote, however, this is provided that the cells are in an appropriate environment and thus theoretically developing into a late-term, fully formed foetus.
It is also mentioned by this journal that placental structures supposedly make no lasting contribution towards the postnatal organisms. Therefore according to this journal only these IPSC’s would be required to potentially form a late-term foetus. It is suggested that by accepting the natural potentiality of IPSC’s they merit the same type of ethical protection as that of embryos and other protected cell types due to the theoretical capacity or ‘potentiality’ to form a late-term foetus. However in my opinion and most likely many others, a prohibition of this magnitude would be absurd as the reach of the cells in relation reach to almost every cell in the body. I also think that this argument seems to lack any real biological proof as this argument is very theoretical
The argument from Magill and Neaves was strongly criticised numerous times and after reading multiple journals for example by Condict et al. (2009) it seems that they do not believe that IPSC’S have the same potentiality as the inner mass of the blastocyst and they emphasise that the placenta plays a vital function in the development of the organism and thus this journal concluded that natural potency is in no way challenged by reprogramming somatic cells to become pluripotent.
In 2013 authors Marco stir and Bettina s. serifert in 2013 also argue against the potentiality argument with a journal which talks about how for an embryo to develop completely, the embryonic potential must meet its external biochemical triggers such as nutrition. There is also a consideration that pluripotent stem cells will also have specific potentials which must meet its own biochemical triggers and with no proof of this triggers being the same the argument seems to be somewhat debunked.
In my opinion after reading these journals I do think that the potentiality argument does not have much moral claim due to the fact that most of the argument is theoretical and also the idea that these IPSC’s should receive ethical protection is somewhat foolish as this would encompass almost the entire human body and thus not giving any moral claim.
The relational properties/standard view argument considered intrinsic and relational properties in relation to moral status. According to the standard view, moral status depends exclusively on intrinsic properties and their intrinsic value. Baertschi and Mauron (2010) proposed a change in the standard view. They suggest that the relational properties that affect the expression of intrinsic properties must be taken into account when assessing the moral status of stem cells and embryos. Using Embryos as examples one example would be an embryo created for the purpose of being used in stem cell research the other would be an embryo created in the context of things such as IVF. While both of these embryos have the same intrinsic properties, they relational properties are vastly different. And according to this argument, the later would have a higher moral status than that of an embryo produced for research. As a result, IPSC’s would have an even lower moral status as they are destined for stem cell therapy and research and there are no plans on using them to produce humans. Reading into this argument there seems to be a lack of valid moral assessment however the suggestion that IPCS’s have a lower moral status is something that can be agreed upon as they are specifically made in order to be used in research.
The genetic basis for moral agency argument was proposed by S. Matthew Liao in 2010. It is defined as ‘the capacity to act in light or moral reasons is sufficient for one to be a right-holder. I.e a being is a right holder if it has a genetic basis for moral agency. This argument rejects the ideas from the first argument that states every human cell has a genetic basis for moral agency. His justification for rejecting the first argument is summarised in three main reasons: Firstly, human cells are not beings but part of a being. They are not self-contained organisms that are ready to develop into an individual. Secondly, for a human cell to become a human being, its nature would need to be altered to the point that the cell would stop being a human cell. Third and finally, normal human cells do not have the genes for a moral agency which, according to this argument, is a requirement for this ‘being’ to qualify as having a genetic basis for a moral agency
Overall this argument is quite valid in terms of how it rejects the first argument and also how if we were to look at the moral status of these cells, IPSC’s would be far lower than that of embryonic stem cells.
Concluding the arguments regarding induced pluripotent stem cells, I feel that I can agree the most with the genetic basis for moral agency argument as I feel it contradicts the potentiality argument well, giving new ideas and perspectives to the moral status of these cells.
Evaluation
For the vast majority of my sources used, they come from both scientific and scholarly journals. Mainly because finding any primary information regarding this topic would be extremely difficult due to the somewhat small public understanding of stem cell research. Being journals, this means that these sources are very reliable as in order for these journals to be published, they must be peer-reviewed by numerous professionals in that specific field. However, due to the fact that science is ever changing and evolving, I understand that some of the scientific journals that I have read are not absolutely true.
With regards to the books I have read, the book: ‘Stem cells anew frontier’ is a collection of numerous arguments written by numerous scholars coming from professional and university backgrounds and the product must also go through publishing procedures, therefore the books that are referred too have good reliability. Some of the journals I referred too are not directly related to the topic of stem cells, however arguments such as: ‘War and the Christian Conscience:’ give links to the ethical issues facing stem cell research today.
Conclusion
From my research, I can conclude that regarding embryonic stem cell research, over time arguments have always been to do with the acceptability of using embryos to derive stem cells and also the correlation of religiousness and disapproval of stem cell research being present. However, as time has gone on and research has progressed more and more arguments surfaced which refer to the use of surplus embryos specifically for research and the ever-present principle of nothing is lost and I feel that there has been an increase in acceptance as a product of this increased awareness of the presence of these surplus embryos. However, I feel that real development can be seen with the arguments regarding induced pluripotent stem cells. I feel that it is interesting to see that even though the introduction of induced pluripotent stem cells was seen to be the solution to the moral issues of using human embryos for research, people were still able to come up with arguments against its use for example in the potentiality argument. However, I feel that the overall consensus of the arguments talking about induced pluripotent stem cells are in favour of its use with most themes revolving around whether it is valid to see induced pluripotent stem cells as moral right-holders. Over time It was clear that theoretical arguments would be quickly and easily debunked with contradicting arguments containing accurate biological evidence. As time goes on I feel that as technology and science progresses, more and more arguments will emerge, some contradicting others and some introducing new perspectives on the use of stem cell research.
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