Moral Issues Surrounding the Sources of Stem Cells

At present, there are three possible sources of stem cells: adult stem cells derived from pediatric or adult donors; embryo germ cell stem cells (EG cells) derived from aborted fetuses; and embryonic stem cells (ES cells) derived from disaggregated preimplantation embryos. The first of these sources poses no special ethical problems for the majority of people. Adults and children can donate tissue so long as the appropriate conditions of consent are respected. Individuals who do not object to induced abortion will be less concerned about the use of EG cells than those opposed to abortion.

The least ethically problematic case would be to harvest stem cells from spontaneously aborted fetuses. There are, however, several obstacles to obtaining useful EG cells from spontaneously aborted tissue. Foremost is the problem of the harvesting healthy cells from fetuses. For the foreseeable future, extracting and culturing stem cells will be more of an art than an established technology. The amount of material that can be derived this way is limited even under the best circumstances. Results from several studies indicate that about 60% of all spontaneous abortions arise as a result of specific fetal anomalies; specific chromosomal abnormalities were identified in about 20% of those. While stem cells with damaged genetic complements may be useful for a limited number of experiments, they are unlikely to be the basis of experiments leading to useful “normal” tissue. Finally, there is the matter of timing. EG cells can only be obtained during a narrow developmental phase, within the first eight weeks after conception. Most spontaneous abortions that occur during this period do not take place in a hospital or clinic where the tissue can be readily obtained.

Those who do not accord significant moral weight to the pre-implantation embryo will probably not object to its being destroyed to be used as a source of ES cells. Some people holding this view may also accept the deliberate creation of embryos for this purpose, while others would only permit the use of so-called “spare embryos” remaining from infertility procedures.

The second and third source noted above (i.e., embryonic stem cells or embryonic germ cells obtained from elective abortions), however, raise special moral questions for those who regard either abortion or the destruction of early embryonic life as morally wrong. Can such people support or become involved in research using EG or ES cells when these cells are derived from what they regard as the morally unacceptable killing of a fetus or embryo? This raises the question of “complicity” or “cooperation” with evil. In the past, this issue has sometimes been discussed by Roman Catholic thinkers in connection with the issue of fetal tissue research.

What constitutes morally wrongful cooperation with evil deeds? It is clear that not all use of goods produced by wrongful acts is immoral. For example, medical researchers routinely employ tissues of people who are victims of murder or other wrongful acts. At what point does use become “cooperation” or “complicity”? In answer to this, philosophers have focused on four different ways that could make one guilty of cooperation with evil. First, there is actual, direct involvement in the wrongful deed, as when a researcher administers the lethal dose to an innocent victim in order to secure tissue samples. Second, there is direct encouragement to such by the researcher, as when researchers encourage others to kill prisoners or concentration camp inmates in order to ensure themselves a supply of research material. Third, there is indirect encouragement to wrongful killing by performing research whose beneficial consequences lead to wider acceptance of the wrongful practices and their perpetuation. Fourth, even when encouragement is not an issue, there is the appearance of endorsing, conferring legitimacy on, or diluting the condemnation of the wrongful deed.

It may be possible for stem cell research using embryonic tissues to be conducted in ways that many people otherwise opposed to embryo destruction would regard as morally acceptable. To some extent this is already the case in the area of fetal tissue research. Careful regulatory requirements that insulate researchers from direct involvement with abortion and the recognition that abortion decisions made by women both are and should be separated from permission to use the fetus’s tissues in research have reduced opposition to the current practice of federally funded fetal tissue research. One sign of this is the tendency by some who are concerned with ES research to believe that EG stem cell research using fetal tissue poses fewer questions than does ES cell research, where deliberate embryo destruction by the researcher is viewed as a first step in the process.

Properly conducted and regulated ES cell research may pose fewer ethical questions than EG cell research. But future ES researchers need not be involved in this way. Each year, thousands of embryos are routinely destroyed in infertility clinics around the world. In Great Britain, this is legally mandated. Procedures established there by the Human Fertilization and Embryology Authority require that frozen embryos not used within a set period time to establish a pregnancy must be destroyed. In 1996,check date over 3000 such frozen embryos were mandatorily discarded. In the United States, contractual agreements between couples using infertility services and clinics providing these services could lead to a similar outcome. Estimates as to the number of embryos that are untransferable or “abandoned” range up to 100,000. Some patients may donate their embryos to other infertile people, and some may choose to keep the embryos frozen permanently. But prior to commencing an infertility procedure, couples are generally asked to agree to the disposition of unused embryo. Many clinics specifically note in their agreements that “excess” embryos can be donated to research, can be destroyed, can be donated to other infertile couples, or can be cryopreserved permanently.

These facts make the separation of the decision to destroy an embryo and the decision to donate it for research even greater than is the case in fetal tissue research. The possible use of fetal tissue in research must be raised with a woman who is actively involved in making an abortion decision. Although there is little evidence that a woman’s decision is influenced by the beneficial prospects of research, this is enough of a possibility to trouble those who fear that such research will encourage abortion. No such proximate involvement is needed for ES cell research. At the time they are involved in an infertility procedure, individuals or couples usually make a decision about what is eventually to be done with their unused frozen embryos. A decision to destroy these embryos can thus be separated by months or years from the subsequent decision to donate such embryos for research purposes. When the clinic is at the point of destroying an embryo, the progenitors commitment to this course can be reascertained and, following that, their informed consent to its possible use in research can be secured.

Workers in clinics or others who disaggregate embryos in order to prepare immortalized ES cell lines may be accused of wrongful conduct by those who oppose embryos’ destruction. However, researchers further down the line who merely employ these tissues in beneficial research would seem to be less subject to this accusation. A further concern for these researchers and public agencies who fund their activities is whether the broad social benefits accruing from ES cell research will have the effect of endorsing, conferring legitimacy on, or diluting the condemnation of the practice of destroying embryos in infertility medicine. But there is little reason to believe that this will be the case. For the foreseeable future, many individuals and couples will use infertility procedures to have children. Until the remote point is reached when these procedures attain a level of 100 per cent efficiency (requiring the creation of only one embryo for each birth), spare frozen embryos will be in existence, some of which will eventually have to be destroyed. This will remain true regardless of the benefits of ES cell research. There is no reason to believe that the possibility of stem cell research will have any impact on the actual thinking or decisions of people seeking to have a child by these means. In view of this, the conclusion that researchers who receive ES cells produced in these ways do not cooperate with, condone or encourage embryo destruction is a reasonable one. Of course, some researchers may disagree and refuse to utilize ES cell lines as a sign of their moral opposition to anything related to the destruction of embryos. However, other researchers equally opposed to embryo destruction may conclude that the use of already existing stem cell lines is not itself morally objectionable. Indeed, in view of the probability of the eventual destruction of substantial numbers of embryos in connection with infertility procedures, it can be argued that ES cell research is a way of producing some benefit from what would otherwise be regarded as a situation of loss. In any case, the link between ES research and wrongful acts here is remote enough to permit public funding of this research.

There are several implications of these ideas relevant to the future conduct and possible public funding of ES research. In order to minimize the assault on many citizens’ moral convictions, ES cell lines should be established using embryos remaining from infertility procedures whose progenitors have independently made a decision that they do not wish to preserve them. Whenever possible, this determination should be explicitly renewed prior to securing the progenitors’ consent to use the embryos in ES cell research. As much as possible, an effort should be made to separate ES cell research - and researchers - from the manipulation or destruction of embryos, and public funds should not be directly used to support the destruction of embryos to produce ES cell lines.

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