Little Cells, Big Issues
by Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota
Recent reports of important breakthroughs in the scientific understanding of the earliest cells involved in human development have sent positive shock waves through the medical research community. At the same time as opening promising new areas of research, the news also raised concerns over the ethical implications of the findings, and prompted President Clinton to direct the National Bioethics Advisory Commission to consider them.
Then last week, National Institutes of Health Director Harold Varmus announced that federal funding and research on embryonic stem cells should be allowed and would not violate the longstanding federal ban on research involving human embryos.
While offering vast therapeutic potential, the collection and use of embryonic stem cells challenges our views about the ethics of using human embryos and tissue from fetuses for research, and the limits society should place on science. Big issues to be raised by such little cells.Cells with an unlimited future
The ability to isolate stem cells is a giant step towards the holy grail of human developmental biology: understanding how every cell in the body can start from a single egg and sperm. Somehow, as the embryo divides, cells are programmed to become heart, liver, skin, hair, eyes, and the multitude of other body parts it takes to become a fully formed human. Embryonic stem cells have the potential to become any of these so-called differentiated cells, which is why they are so special.
Their future is unlimited, and because of this ability, they are extremely valuable in understanding what makes cells become one type instead of another, and also for the therapeutic potential that could come with controlling that process. Once cell control is harnessed, we may be able to grow whole organs, treat diabetes in wholly new ways, or even reverse some neurological disorders and paralysis. But understanding will require a sufficient supply and variety of stem cells. And therein lies the rub.Does source matter?
Two different sources have been successfully used to collect these cells so far, and both carry substantial moral baggage. One technique used discarded fetal tissue, and the other used embryos created in fertility clinics and donated by couples who no longer needed or wanted to use them. Each source obviously raises ethical questions.
Fetal tissue comes from either miscarriages or therapeutic abortions, and so some activists have argued that research on embryonic stem cells will create new demand for fetal tissue and incentives for abortions. This seems unlikely given the ample ongoing supply of fetal tissue, and the important prohibition against paying donors for the tissue so as not to create financial incentives for abortion.
The use of human embryos, on the other hand, challenges us to confront their moral status, whether they are so-called "spare" embryos that were created for infertile couples who no longer need them, or are created expressly for research uses. Does the intention for which the embryos were created matter? Do embryos deserve special respect because of what they are and the potential they represent? Does the fact that stem cells have been collected and can be shared among the research community excuse all future users of the supply from considering how the cells they use were created?
Principle versus pragmatism
This last point is at the heart of the NIH position: Since the stem cells that are now available to researchers were collected legally (no federal monies for research on human embryos, and fetal tissue research only under specific criteria), then the government should be free to fund and carry out research on them.
It will be difficult to stand on principles that prevent using or creating sources of embryonic stem cells when there are real opportunities for research and treatment from their use -- especially when we need new varieties of cells (say for immune system matching, as in organ transplants.) This collision of principles and pragmatism will require us to carefully think through what principles deserve respect, and under what conditions. As the ethics surrounding embryonic stem cell research are being pushed to change, it seems ironic that it is a nearly invisible collection of cells that is creating issues that are too large to ignore.
"Ethics Matters" Archive
where you'll find other columns from Jeffrey Kahn
on a wide range of bioethics topics.
Center for Bioethics and CNN Interactive.
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