5-1 medical sociology
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On August 9, 2001, President George W. Bush announced that federal government will limit funding of embryonic stem cell research to the 64 stem cell lines already in existence. This decision has escalated the embryonic stem cell debate to the political arena and, as usually happens, has obscured rather than illuminated the issues fueling the debate. This assignment focuses on highlighting these issues and framing their medical, social, religious and ethical implications. At the heart of the debate is the question, When does life begin? On one side are those who maintain that life begins at the moment of conception, when the sperm and egg meet and cell division begins. Others take the position that life begins when the embryo is considered viable – that is, when the embryo demonstrates characteristics of growth and development, usually at nine to 12 weeks of gestation. We will not answer this question, but we will hope to shed light on the scope and importance of this debate for medical science, society, and our personal and cultural values and beliefs. The tension between these three forces will shape our perception of life and how we value, enhance, and preserve it for the better part of the 21st century.
Embryonic stem cells come from embryos and are unique in one respect. They are the only cell we know of that has the capacity to become any type of human cell in the body. This characteristic cannot be found in fetal tissue or adult stem cells. The medical science implications of this unique cell characteristic are significant. Embryonic stem cells, because of their unique replication capability, can be used in treating a variety of chronic diseases, such as juvenile diabetes, Parkinson’s, Alzheimer’s, and certain neuro-degenerative diseases, such as ALS (Lou Gerig’s disease) and multiple sclerosis. Scientists believe that the manipulation and replication of stem cells can lead to therapies that will alleviate the symptoms or cure the diseases of millions of people. They, therefore, vigorously support the continued and unrestricted research on the use of embryonic stem cells until the anticipated medical breakthroughs are achieved in the treatment of these diseases.
Those who oppose embryonic stem cell research do so on moral or religious grounds. They believe that a human being is created at the moment of conception and therefore an embryo is a human life. To use the stem cells of an embryo for scientific purposes would result in its destruction and is, therefore, the killing of a human being.
A level of complexity is added to this debate by the surplus of embryos already available. Because of the increase, in vitro fertilization procedures designed to help in the reproductive process of infertile couples, thousands of embryos exist in a frozen state. In this process, eggs are fertilized with sperm outside the uterus then implanted into the uterus to be carried to term. In the in vitro fertilization process, it is common to produce a number of embryos to accommodate several implantation attempts to assure success. This process has produced many unused embryos that are stored indefinitely in a frozen state. Few of these embryos will ever be destroyed, and their numbers are growing each year. The status and use of these embryos have galvanized positions on both sides of the debate. When President Bush announced the decision to limit federal funding for stem cell research, he received criticism from some supporters, who labeled his position as inconsistent with his pro-life stand. While organizations like the National Conference of Catholic Bishops criticized the decision, the National Right to Life Organization supported the position. However, the greatest outcry came from the medical scientific community and well-known celebrities like Nancy Reagan, Christopher Reeves, and Michael J. Fox. They voiced the position that these embryos, frozen several days after conception, have the potential to advance medical research, possibly leading to the cure of many devastating diseases. Therefore, to limit research in this area would be tantamount to withholding treatment and potential cures of these debilitating and terminal diseases from patients who desperately need them.
We will examine four areas of this debate in an attempt to expand our understanding of the issues. We will consider the theological perspective, examine public opinion, present the scientific medical argument, and finally, address the ethical issues of this subject. It is important to recognize that much of one’s position on embryonic stem cell research is guided by personal conscience and not by indisputable facts. It is the pursuit of the answer to the question of whether we should allow research that uses embryonic stem cells to continue that requires us, in the last analysis, to form an opinion based on our conscience. What follows is an examination that hopefully allows us to form an informed opinion.
We begin with an examination of the current theological perspectives on the use of embryonic stem cells for research purposes. The various theological perspectives on this matter orbit around the question concerning when the embryo acquires life as a human being. The question is an important one since its answer determines the moral status of the embryo with all its rights and protections. Numerous Christian theologians vary on this question, from the most conservative position that life begins at the moment of conception to the position that life begins when a woman can feel movement of the fetus. However, most Christians are undecided on this issue. Some maintain that life begins at the time the embryo is implanted in the wall of the uterus; others have determined that the fetus is viable after fourteen days of gestation. Most Christian churches have taken a non-committal position on embryonic stem cell research. Several have taken specific positions. The Catholic Church is opposed to embryonic stem cell research on the grounds that life begins at conception, while the United Church of Christ’s General Synod approved embryonic stem cell research so long as the embryo is less than fourteen days into fetal development. Judaism discourages any interference in the natural development of life. However, recent statements by Rabbi Elliott Dorff, Chairman of the Conservative Movement’s Committee on Law and Standards, indicated that embryonic stem cell research could serve a common good in combating disease. His statements may signal a shift of the conservative Jewish position on this question. While there is no officially stated Islamic position on stem cell research, Moslem teaching holds that life does not begin until the embryo is attached to the wall of the uterus. A presumption can be made that embryonic research would not violate Islamic law so long as the embryo implantation has not occurred. The theological debate continues as religious institutions instruct their followers on the proper moral position on this issue.
Concerning public opinion, there is wide support in our society for continued medical research using embryonic stem cells. Over the last decade, polls taken on this subject have consistently shown increasing support, even among Roman Catholics and members of other traditionally “conservative” Christian congregations. There is no evidence that our society, as diverse and pluralistic as it is, will resolve the fundamental question concerning the human status of the embryo at any stage of development. The issue as to when life begins cannot be resolved on scientific, religious or ethical grounds. Therefore, we are left with the issue to be resolved based on individual conscience.
It is this very dilemma that has drawn such a strong outcry from the medical scientific community to the President’s announcement in August 2001. In that announcement, he limited federal funding of embryonic stem cell research to the existing 64 lines already approved for research. The scientific community’s position is that the federal government should not be in the role of imposing ethical or moral standards on this research in the absence of a compelling social, legal, or constitutional need to do so. In the face of growing public opinion in support of embryonic stem cell research for medical purposes, it is difficult to see how the current federal fund limitations can be a sustainable public policy.
We can now turn our attention to the medical and scientific justification for embryonic stem cell research. The major breakthrough in stem cell research came in 1998 when the Wisconsin Alumni Research Foundation (WARF) announced that they were able to separate undifferentiated stem cells during the blastocyst stage of embryonic development. It is during this stage that stem cells have not yet taken on differentiated characteristics or qualities that identify them as cells that will form bone, muscle, brain tissue etc. Undifferentiated stem cells, under carefully defined research methods, can theoretically reproduce to form any cell in the body and therefore be eventually employed to replace diseased cells and organs of patients under specific treatment protocols. While stem cells can be extracted from placenta, bone marrow, and fat, they have begun the differentiation process and are not as valuable for research purposes. The stem cells from the blastocyst stage of an embryo are ideal because they are completely undifferentiated and have the potential to develop into approximately 260 different cell lines in the human body. The therapeutic implications of embryonic stem cell research are difficult to measure or project because the research exploration is contained, at least as far as federal funding and public policy is concerned. Research is continuing in other venues and in other countries, and as breakthroughs occur in this science, the barriers to expanded research in the United States are likely to break down.
The final considerations we will examine are the ethical issues involved with embryonic stem cell research. We will not address the overarching question as to when life begins. Since the theological and scientific arguments fall short of adequately answering this question as discussed above, the ethical implications of this question remain unclear. We will, however, concern ourselves with two ethical questions: 1) Are the established research protocols and oversight review procedures adequate to provide society and the individual patient sufficient protections against potential abuses of this research? and 2) How should society address the management and disposition of the growing number of unused embryos resulting from in vitro fertilization procedures?
First, we must examine the issue of whether we can establish sufficient controls over the research programs themselves. Traditionally the application of scientific research standards to formal studies and inquiry has relied on the peer review process to assure quality work and adequate protection of subjects. The peer review system, along with its investigational review boards, has evolved over decades of scientific research to protect society and research subjects from inappropriate, unethical, and harmful uses of the research protocols or results. For the most part, this system has worked well, not only because of stringent controls applied to the research, but also because most scientific research operates in an insulated scientific subculture that spans geographic boundaries. The nature of the scientific inquiry and clinical research and their potential applications are known and understood by a very small circle of scientists until they are published. Peer review under these circumstances works very well. However, the social and medical implications of embryonic stem cell research for economic gain are so great that the scientific insulation surrounding clinical stem cell research will probably be penetrated, in which case the potential for abuse will exceed the capacity of the peer review system to control it. What controls should be applied to embryonic stem cell research to safeguard the public, assure ethical application of the science, and realize the potential benefits to patients? Does this question suggest a different partnership among the scientific community, ethicists, and government to achieve the necessary protections and allow society to reap the benefits of this research? These questions remain unanswered as the risks continue to grow.
Finally, we need to consider the ethical implications of the growing number of embryos in a permanent frozen state. The status of unused embryos remains in a state of ethical limbo. It is difficult to reconcile the morality of storing embryos based on their potential to develop into a human being and relegating the embryo to an indefinite frozen state subject to gradual deterioration over time. This amounts to social abandonment. Clearly, society cannot ignore its obligation to address the disposition of unused embryos that are growing in numbers each year. Doctors could require couples undergoing in vitro fertilization to specify how they want to dispose of their unused embryos as part of the informed consent process. They can direct the use of the embryos for adoption by others, to be used in stem cell research, or to be stored for future pregnancies. Until a more definitive social and moral standard emerges, the decision for embryo disposition should remain within the domain of the couple’s individual conscience and their social and ethical responsibility.
Lecture and Research Update Bibliography
Begley, S. (2001, July 9). Cellular Divide. Newsweek, 138(2,) 22.
Garrett, T. M., & Baillie, H. W. (2000). Health Care Ethics: Principles and Problems (4th ed.) Upper Saddle River, NJ: Prentice Hall.
Kondrache, M. (2004, October 24). Adult vs. Embryonic Stem Cell Claims. The Washington Times, p. B14.
Lindberg, T. (2001, August 14). The Politics of Stem Cell Research. The Washington Times, p. B2.
