Stem Cells

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• Stem Cells
• Implications for
• Catholic Health Care
• Philip Boyle, Ph.D.
• Vice President, Mission Ethics
• www.CHE.ORG/ETHICS

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Goals for todays conversation

• Review the Science
• Review Presidents Commission
• Explore challenges for Catholic health care

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Moral Considerations

• Catholic health care
• What if embryonic stems cells become standard of
  care?
• How much oversight
• MDs staff privileges for those who utilize?
• MDs prescription in privacy of doc-pt
  relationship?
• How to provide staff and community education?
• Restraining the worst alternatives?

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• Review science
• Embryonic adult stem cells
• Alternatives
• Dead embryos
• IVF
• Micro gravity primitive umbilical cells
• Biopsy
• Dedifferentiation
• Altered Nuclear Transfer
• Use existing lines

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Public Framing

• Matters of Life and Death
• Adult stem cells restore feeling in paraplegic
• 19 Years as a Paraplegic
• Korea Report
• WorldNetDaily.Com
• Doctors Use Teens Stem Cells In Procedure To
  Repair His Heart
• A 16-year-old shot in the chest with a nail gun
  has undergone the nations first procedure to
  repair dying heart muscles using his own stem
  cells.
• The Wall Street Journal

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Public Framing

• Patient's Own Stem Cells Provide a Tailor-Made
  Jawbone
•  
• Scientists in Finland have replaced a 65-year-old
  patient's upper jaw with a bone transplant
  cultivated from stem cells isolated from his own
  fatty tissue and grown inside his abdomen,
  Reuters reported.
• Researchers said the breakthrough opens up new
  ways to treat severe tissue damage and makes the
  prospect of custom-made spare parts for humans a
  step closer to reality.
• "The use of a patient's own stem cells to grow a
  new jaw is a great example of how personalized
  medicine is becoming a reality," said Dawn Vargo,
  associate bioethics analyst for Focus on the
  Family Action. "Despite all the talk about using
  embryonic stem cells to create personalized
  therapies, this displays the practical and timely
  advantages of adult stem cells."

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• Advance Made in Stem-Cell Debate (Washington
  Times)
• You would barely know adult stem cells exist
• (Times Higher Education)
• Building a New Prostate
• (Science)
• Stem Cell Breakthrough Mass-Production Of
  Embryonic Stem Cells From A Human Hair
• (ScienceDaily)
• A breakthrough, then a surge, in stem cell
  research
• (PhysOrg)
• Stem cell generation from ordinary cells now safe
• (Reuters)
• Adult Stem Cell Trial The First of Its Kind
• (KCPW)
• Stem cells from testicles an option to embryos
• (AP)
• Scientists Find Way to Regress Adult Cells to
  Embryonic State
• (Washington Post)

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What are stem cells?

• 2 kinds
• Embryonicoccurring in early fetal development
  and produce multiple specialized cells
• Adultoccurring in adult organisms in bone
  marrow, muscle, and brain and generate
  replacement cells

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Embryonic Stem Cells

• After fertilization, the zygote (fertilized egg)
  divides several times.
• Any of these first cell divisions could give rise
  to cells need for an adult organism
• These cells are totipotent

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Sources of embryos

• In vitro fertilization
• Somatic cell nuclear transfer (SCNT)
• Embryos can be created by transferring the
  nucleus of a donor cell into an enucleated oocyte

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Embryonic Stem Cells

• The cells that form the inner cell mass of the
  blastocyst are called pluripotent
• They have lost the ability to differentiate into
  all types of cells needed for a complete embryo,
  but they still have the ability to differentiate
  into other types of cells up to 14 days post
  fertilization.
• Adult stem cells mainly produce the cells type
  tissue they reside in.

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Adult Stem Cells

• They give the body ability to repair and replace
  the cells of some organs.
• It is supposed they are set aside during fetal
  development and restrained from differentiating.
• They are rare and their origin in tissue is not
  known.
• They behave differently depending on local
  environment.

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Embryonic Germ Cells

• Germ cells share some but not all the
  characteristics of stem cells
• They are primordial germ cells which occur in
  embryo
• They normally develop into mature gametes (eggs
  and sperm)
• They do differentiate into specialized cells.

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Alternative Sources

• Micro gravity primitive umbilical cells
• Dead embryos
• Previously frozen embryos that fail to divide
  within 24-hour period
• Organismically dead
• Discarded human embryos (IVF)

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Alternative Sources

• Biopsy 1 cellblastomere extractions remove 1 or
  a few cells from 6-8 cell
• De-differentiation
• Use somatic cells and restore them to
  pluripotency
• E.g., Lop of newts tail or leg it regenerates
• Protein from newts regenerated mice muscles

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Alternative Sources

• Altered Nuclear Transfer
• Creating biological artifacts resembling embryos
  but incapable of developing into humans
• Remove nucleus from oocyte
• Replace with somatic cell that has been altered
  so new entity would not be able to develop
• Reprogram the trophectoderm (outer sheath) so not
  to form properly
• Oocyte-assisted reprogramming (OAR)
• Fusing cells
• Use existing lines

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Ethical issues

• Accurate and fair terminology
• Cloning for Children
• Cloning for Biomedical Research
• Obligations of Catholic institutions
• Public Policy issues

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The Language

• Activity
• Cloning
• Asexual reproduction
• Reproductive cloning
• Non-reproductive cloning
• Research cloning
• Therapeutic cloning
• Somatic cell transfer (SCNT)
• Nuclear transfer for stem cell research
• Regenerative medicine

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Entity

• potential human being
• human clone
• human SCNT
• cell egg
• activated egg
• totipotent cell
• reconstituted egg
• clump of cells
• blastocyst
• clonecyst
• embryo

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Relationships

• genetic copy
• replica
• genetically virtually identical
• non-contemporary twin
• delayed genetic twin
• clone

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Language

• Whats at stake is whether SCNT should be
  considered cloning.
• Using the term cloning prejudices the activity
• Using many terms obscures the public debate
• Also at stake is the moral status. To call it an
  embryo, some argue, is to unfairly prejudice, but
  not to use it hides the full import of cloning
  for biomedical research
• Clonereplica, not a zygote

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Cloning for Children

• Purposes
• Allow infertile couples to have genetically
  related children
• Permit couples at risk for genetic disorders to
  avoid having an afflicted child
• Allow bearing of child who could become an ideal
  transplant donor
• Allow parents to keep connection with dying or
  dead child
• Replicate persons of talent or beauty

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Objections

• Violates ethics or research
• High rates of morbidity and morality/ unsafe and
  unethical
• Identity and Individuality
• identical to someone else who has already lived
• Concerns regarding manufacturing
• 1st children to be totally designed in advance
• more like a product than a gift and accepted as
  they are
• Promote commercialization and industrialization
  of human procreation
• Prospects of new eugenics
• Serve as individualized eugenic enhancements,
  avoid defects

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Objections

• Troubled family relationships
• Strain between generations
• Fathers as twin brothers to their son
• Mothers give birth to genetic twins
• One parent reproduction could strain family life
• Effects on society
• Effect the way society looks at children
• Novel control of the next generation

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Cloning for biomedical research

• Opportunities
• Important knowledge on embryological development
• Treatments for dreaded diseases
• View
• A. Non-moral status of embryo
• B. Intermediate moral status of embryo
• C. Moral status of embryo

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Moral status of cloned embryo

• Continuous history of human individuals from
  fetal life of infant
• Special respect for nascent human life
• Exploitation of developing human life
• By permitting this, nascent life is a tool
• Coarsen our moral sensibilities
• Moral harm to society
• Approve of control of nascent life
• Open door to reproductive cloning
• Federal government mandating the destruction of
  human life
• What we owe the suffering

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Obligations of Catholic institutions

• 1. Knowledge
• Drug development Toxicity
• Cell development
• Cooperation, toleration complicity
• Mainly opaque to user
• 2. Applications

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Obligations of Catholic institutions

• Therapies
• Clearly unacceptable
• Embryonic stem cells
• Clearly acceptable
• De-differentiation
• Umbilical cord
• Ambiguous
• Dead embryos
• Biopsy
• Altered nucleus
• Existing lines

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Obligations of Catholic institutions

• Ambiguous
• Dead embryos IVF extras
• Is it permissible to used doomed embryos?
• No loss argument for those who accept the
  humanity of the embryo and absoluteness of the
  prohibition of intentional killing, the no loss
  argument does not provide an exception to the
  prohibition
• Biopsy
• Pre-implantation genetic diagnosis (PGD)
• Biopsy totipotent or pluripotent?

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Obligations of Catholic institutions

• Existing Lines before moratorium? (Bush and
  German govt)
• Is use of federal funding on existing lines an
  unprincipled exception?
• Crafted to allow some research without
  encouraging destructions
• Is this moral cooperation, toleration, or
  complicity?
• No one can cooperate in doing what has already
  been donedid not cooperate with the destruction

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Obligations of Catholic institutions

• Existing lines
• Is this moral cooperation, toleration, or
  complicity?
• One tolerates only what one might prevent
• They did more than tolerate by allowing the
  research on already dead embryos
• Complicity they have excluded on going
  relationships by setting a date after which no
  use. Thus, no encouragement

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Practical considerations

• What if embryonic stems cells become standard of
  care?
• How much oversight in use of alternatives?
• MDs staff privileges for those who utilize?
• MDs prescription in privacy of doc-pt
  relationship?

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Practical considerations

• What about partnerships and joint operating
  agreements?
• What about institutions with teaching programs?
• Proactive partnerships for alternatives
• Staff and community education?

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Public Policy issues

• Morally acceptable compromises?
• Compromises not to facilitate destruction but to
  stop or limit regulation
• Protect embryos as well as they can
• Materially implicated, materially cooperating

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• In a case like the one just mentioned where a
  legislative vote would be decisive for the
  passage of a more restrictive law, limiting the
  number of authorized abortions, when it is not
  possible to overturn or completely abrogate a
  pro-abortion law, an elected official whose
  opposition to abortion is well known, could
  licitly support proposals aimed at limiting the
  harm done by such a law and lessening its
  negative consequences at the level of general
  opinion and public morality. This does not in
  fact represent an illicit cooperation with an
  unjust law, but rather a legitimate and proper
  attempt to limit its evil aspects.
• John Paul II, Evangelium Vitae

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Conclusions

• Framing
• Clarity of language
• No rush to judgment
• Examine scientific alternatives
• Proactive, not reactive
• No need for train wreck
• Partnerships
• Education