Ethical Issues

The ethical aspects of human stem cell research raise a wide variety of important and controversial issues. Many of these issues have to do with the different sources from which stem cells may be obtained. Stem cells are at present obtained from adults, umbilical cord blood, and fetal and embryonic tissue. Although there are widely differing views regarding the ethics of sourcing stem cells in these ways, there is general consensus that embryos are the best source of stem cells for therapeutic purposes—a consensus that may of course change as the science develops. If spare embryos or aborted fetuses may be used as sources for stem cells, there is a further question: Should embryos or fetuses be deliberately produced in order to be sources of stem cells, whether or not they are also intended to survive stem cell harvesting and grow into healthy adults?

The European Group on Ethics in Science and New Technologies, which advises the European Commission, has highlighted the women's rights issues involved in stem cell research. It is particularly worth bearing in mind that women, as the most proximate sources of embryonic and fetal material and hence also of cord blood, may be under special pressures and indeed risks if these are to be the sources of stem cells.

The issue of free and informed consent, both of donors and recipients, raises special problems. Because embryos and fetuses can hardly consent to their role in sourcing stem cells, the question of who may give consent for the use of fetal or embryonic material is important, particularly because the usual basis for parental consent is hardly appropriate. This basis involves a judgment about what is in the best interests of the individual, and because, in most cases, the individual in question will not survive, the test is irrelevant (Harris, 2002a). Competent risk—benefit assessment is vital, and particular attention needs to be paid to appropriate ethical standards in the conduct of research on human subjects. Other issues concern the anonymity of the donors, the security and safety of cell banks, and the confidentiality and privacy of the genetic information and the tissue the banks contain. Finally, there are issues of remuneration for those taking part and of the transport and security of human tissue and genetic material and information across borders both within the European Union (EU) and worldwide. While these issues are important, they are well understood in biomedical ethics, and with the exception of the issue of consent, they do not raise special issues in connection with stem cell research and therapy (U.K. Human Genetics Commission).

Before considering the ethics of such use in detail, it is important to first explore the possible therapeutic and research uses of stem cells and also the imperatives for research and therapy.

WHY EMBRYONIC STEM CELLS? Embryonic stem cells were first grown in culture in February 1998 by James A. Thomson of the University of Wisconsin. In November of that year Thomson and his colleagues announced in the journal Science that such human embryonic stem cells formed a wide variety of recognizable tissues when transplanted into mice. Roger A. Pedersen, writing in 1999, noted potential applications of these stem cells:

Research on embryonic stem cells will ultimately lead to techniques for generating cells that can be employed in therapies, not just for heart attacks, but for many conditions in which tissue is damaged.

If it were possible to control the differentiation of human embryonic stem cells in culture the resulting cells could potentially help repair damage caused by congestive heart failure, Parkinson's disease, diabetes, and other afflictions. They could prove especially valuable for treating conditions affecting the heart and the islets of the pancreas, which retain few or no stem cells in an adult and so cannot renew themselves naturally.

Stem cells, then, might eventually enable us to grow tailor-made human organs. Furthermore, using cloning technology of the type that produced Dolly the sheep, these organs could be made individually compatible with their designated recipients. In addition to tailor-made organs or parts of organs, such as heart valves, it may be possible to use embryonic stem cells to colonize damaged parts of the body, including the brain, and to promote the repair and regrowth of damaged tissue. These possibilities have long been theoretically understood, but it is only now with the isolation of human embryonic stem cells that their benefits are being seriously considered.

Stem cells for therapy. It is difficult to estimate how many people might benefit from the products of stem cell research should it be permitted and prove fruitful. Most sources agree that the most proximate use of human embryonic stem cell therapy would for Parkinson's disease, a common neurological disease that has a disastrous effect on the quality of life of those afflicted with it. In the United Kingdom around 120,000 individuals have Parkinson's, and the Parkinson's Disease Foundation estimates that the disease affects between 1 million and 1.5 million Americans. Another source speculates that "the true prevalence of idiopathic Parkinson's disease in London may be around 200 per 100,000" (Schrag, Ben-Shlomo, and Quinn). Untold human misery and suffering could be stemmed if Parkinson's disease became treatable. If treatments become available for congestive heart failure and diabetes, for example, and if, as many believe, tailor-made transplant organs will eventually be possible, then literally millions of people worldwide will be treated using stem cell therapy.

When a possible new therapy holds out promise of dramatic cures, caution is of course advised, if only to dampen false hopes of an early treatment. For the sake of all those awaiting therapy, however, it is equally important to pursue the research that might lead to therapy with all vigor. To fail to do so would be to deny people who might benefit the possibility of therapy.

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