Stem cell research

Introduction: Human embryonic stem cells (hES cells) are currently discussed not only by the biologists by whom they were discovered but also by the medical profession, media, ethicists, governments and politicians. There are several reasons for this. On the one hand, these `super cells' have a major clinical potential in tissue repair, with their proponents believing that they represent the future relief or cure of a wide range of common disabilities; replacement of defective cells in a patient by transplantation of hES cell-derived equivalents would restore normal function. On the other hand, the use of hES cells is highly controversial because they are derived from human pre-implantation embryos. To date, most embryos used for the establishment of hES cell lines have been spare embryos from IVF, but the creation of embryos specially for deriving hES cells is also under discussion. The most controversial variant of this is the transfer of a somatic cell-nucleus from a patient to an enucleated oocyte (unfertilized egg) in order to produce hES cells genetically identical to that patient for `autonomous' transplantation (so-called `therapeutic' cloning); this may prevent tissue rejection. Stem cells In 1998, James Thomson of the University of Wisconsin-Madison derived the first human embryonic stem cell line. According to the National Institutes of Health, stem cells are cells differ from other kinds of cells in the body. All stem cells regardless of their sourcehave three general properties: they are capable of dividing and renewing themselves for long periods; they are unspecialized; and they can give rise to specialized cell types. Stem cells are generally classified as either embryonic stem cells (ESC) or adult stem cells. Because of the unique nature of stem cells (as compared to other somatic cells), they have become of enormous importance in medical research, particularly as potential cures for life threatening diseases. Human stem cell research, however, is extremely controversial. Especially in the case of embryonic stem cell research, serious ethical concerns have arisen. As a result, legislation providing for the use of stem cells in medical research has faced serious opposition. The most recent legislation, introduced by the 110th session of the U.S. Congress regarding stem cell research, is S.5: Stem Cell Research Enhancement Act of 2007.
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This act was introduced on January 4, 2007, and passed by the Senate on April 11, 2007. The Act was passed by the House on June 7, 2007, but ultimately failed passage into law as a result of the June 20, 2007 presidential veto by then president, George W. Bush. (Wolf, DC., 2009) Consequences of stem cell research: Every year millions of people suffer and eventually die from serious and largely incurable degenerative diseases of the nervous system (for example, Parkinsons disease, multiple sclerosis and stroke), heart (myocardial infarction), liver (hepatitis), pancreas (diabetes) and other organs. Stem cell therapy could alleviate or even cure some of these diseases but what about the ethics, if the stem cells come from embryos? Any new, experimental medical treatment raises ethical issues for both doctors and patients, but research on embryonic stem (ES) cells raises in addition the ethical conflict between destructive human embryo research and the magnitude of the possible benefits. The huge scale of the clinical problem means those resource considerations cannot be ignored, given that equity is itself an ethical issue. These conflicts, and their social and legal implications, have stimulated discussions worldwide.
Stem cell derivation

Stem cells can be harvested not only from embryos, but also from adults (living or dead) or from fetuses. From the ethical point of view, the use of adult stem cells (Fig. 1) for therapy raises no new issues. Bone-marrow transfusion and organ transplantation are widely practiced and regulated by guidelines. The use of fetal tissue, including fetal stem cells, is also regulated by guidelines, although people who regard elective termination of pregnancy as ethically unacceptable include some who would not countenance the use of tissue from an aborted fetus for research or treatment. A fetus cannot give informed consent. In addition, although adult and fetal stem cells may be multipotent1 that is, capable of generating many different cell types they are present only in small numbers, so would not provide a realistic approach to cell therapy of common degenerative diseases unless they

Stem cell research

could be greatly amplified in culture while retaining a stable karyotype. Stem cells in the cord blood of one baby are sufficient to treat only a single patient. (Mclaren, A 2001) Controversy regarding stem cell research Experimentation with embryonic stem (ES) cells has become an important breakthrough in medical research. However, it is also a source of controversy, because it requires the destruction of the human embryos used to derive ES cells. This paper deals with some of the ethical issues concerning ES cell research. To begin with, the terms used in the debate on the ethical status of the human embryo need to be defined. Apart from the presumed benefits of ES cell research, we should also consider such issues as the strong opposition to this research by a large part of society, who argue in favor of protecting and respecting human embryos; the fragility and defenseless of human embryos; and the contradiction in terms inherent in the statement that human embryos must be treated with respect. THE ETHICAL DEBATE The main ethical issue raised by ES cell research is that it requires the destruction of human embryos. The debate on the ethical status of the human embryo is not a new one. It began 25 years ago, when in vitro fertilization (IVF) techniques were introduced. Since then, the ethical conflict has not proven susceptible to resolution, although IVF is being used in many countries. In general, since the Warnock Report was released in 1984, some arbitrary solutions have been adopted in order to allow scientists to perform research on human embryos Moreover; ES cell research generates several additional issues over and above those concerning research with human embryos: First of all, it requires new methods of research on human embryos, different from those dealing with reproductive problems. Accordingly, the British Parliament recently modified the 1990 Act to approve three new fields in which human embryo research is to be allowed: to increase knowledge about embryo development, to increase knowledge about serious diseases, and to enable any such knowledge to be applied in developing treatments for serious diseases Secondly, ES cell research demands the creation of embryos for research purposes. Research with stem cells would probably require many more embryos than those left over from IVF procedures.
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Thirdly, the effort is made in ES cell research to apply the new procedure of somatic nuclear cell transfer (SCNT), as a means to side-step immunological problems. The arguments customarily adduced to justify the destruction of human embryos in research are based upon the 'developmental view' of moral status , which holds that the human individual acquires higher moral status as he/she develops sentience, consciousness, and relationships, properties absent in early embryos. Moreover, human embryos less than 14 days old cannot yet be considered individual organisms, on account of their ability to twin. Accordingly, a merely symbolic moral value is assigned to early human embryos. This diminished moral status of the human embryo is invoked to justify their destruction in the course of research carried out on them, in exchange for potential benefits for countless patients. This is a consequentiality approach, that is to say, in order to determine the morality of actions only the presumed consequences of performing such actions are considered. There are other requirements, however, besides the presumed benefits of ES cells research, that should be taken into account before this kind of research could be regarded as morally acceptable. (Ruiz-Canela, M., 2002) What is ethically at issue with embryo research where the fertilized egg has to be destroyed? Some scientists in the international scientific community believe that stem cell research will lead to stem cell-based therapies only if scientists can derive new human embryonic stem cell lines. Embryonic stem cells are needed, since their ability to live indefinitely in tissue culture and the wide range of cell types to which they give rise make them unique. However, with the currently known techniques, fertilized human eggs at the pre-implantation (blast cyst) stage must be destroyed in order to produce new stem cell lines. However, the moral status of the embryos used to derive of an embryo and its moral status, there is at least one area of ethical agreement regarding embryonic stem cell research the aim of stem cell research (to cure diseases and relieve suffering) is universally recognized as a good aim

What moral status does the human embryo have? The moral status that the human embryo is given varies. Three different main positions with variations can be separated. Having full moral status after fertilization of the egg This point of

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view can be divided into two: considering embryos worthy of protection simply because they are human or considering them as potential persons. Philosophers differ on this question. Whereas many philosophers, particularly futilitarians, do not consider a fertilized human egg before implantation to satisfy the criteria of personhood, others take a different view. However, the criteria of personhood are notoriously unclear. Fertilized eggs as worthy of protection simply because They are human What is the opinion on embryonic stem cell research in major religions? The moral status of the early human embryo before the time of its implantation in the uterus differs depending on religion. Catholic, Orthodox, conservative Protestant Churches Since a human embryo is believed to have a status of a human individual from the moment of the fertilization of the eggs, it has the right to its own life, and every intervention not in favor of the embryo is a violation of that right. No end believed to be good (e.g. using stem cells to prepare other differentiated cells to be applied in what look to be promising therapeutic procedures) can justify the destruction of the embryo, which is believed to be a wrong action . For a comparison, killing a human being to provide organs for another human being is condemned, and the same standard should be applied to the human embryo. The Orthodox Churches, like the contemporary Roman Catholic Church, believe that the process toward authentic human personhood begins with the zygote, which is committed to a developmental course that will ultimately lead to a human person. Therefore, Orthodox Christians as well as Roman Catholics and Conservative Protestants affirm the sanctity of human life at all stages of development. However, they consider that already existing stem cell lines could be used for therapeutic purposes, since they had already been created and cannot be undone.

Islam The majority of Muslim thinkers through the ages have accepted the morality of abortion through either the fortieth day or the fourth month
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of pregnancy. It is believed that the soul is breathed in to the human embryo on the 40th day after fertilization and this is when life becomes sacred. All schools of thought in Islam accept that the fetus is accorded the status of a legal person only at later stages of its development, when perceptible form and voluntary movements appear. The Koran provides no criteria for when the breathing-in of the soul occurs in the fetus and the thinkers make a distinction between a biological and a moral person, placing the stage of the moral person after the first trimester of pregnancy. However, Muslim jurists differ over whether breathing-in of the soul takes place in 40 or 120 days. Also, it is believed that there is no disease that does not have a cure, and therefore the cure should be sought. Just like in Judaism, medical progress is a strong value and stem cell research is acceptable due to its therapeutic benefits. According to the Muslim faith, the supernumerary embryos cannot be donated to other couples, as the lineage must be respected. These embryos can either be preserved or destroyed since they are still below the threshold of 40 days pregnancy. In this view, conducting research on supernumerary embryos that will no longer be used for in vitro fertilization purposes rather than destroying them is choosing the lesser of two evils. Buddhism and Hinduism Buddhism is a religion based on intelligence, science, and knowledge, and its purpose is the elimination or reduction of suffering as well as the source of suffering. It is a religion, which is not grounded in the belief in God: Buddhists are taught to think and contemplate rationally before they should believe something. Buddhism prohibits harm to any sentient beings, which presents possible restrictions on embryo and animal research. Also, every action (e.g. killing) that treats human beings as non-humans is considered immoral. For Buddhists, however, not all areas of medical biotechnology lead to ethical problems: more advanced medical biotechnology (where research is conducted on molecular level) is likely to be acceptable. Molecular human parts, such as cells, are hardly seen as human beings, thus their destruction in the process of research is not likely to be seen as morally wrong. Regarding the research on human stem cells, the intention is important. If the intention of the research is to help and benefit humankind, such research is considered ethical. On the contrary, if the research is done just for the sake of making money out of it, it is considered as unethical. But since Buddhism
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places great importance on the principle of non-harming, it has grave reservations about any scientific technique or procedure that involves the destruction of life, whether human or animal. However, the principle of non-harming can be interpreted as prohibiting only the harm on sentient beings that is those who are able to feel. Therefore, under some circumstances Buddhism could accept research on non-sentient embryos before the day 14 of their development. Hinduism, like Buddhism prohibits injuring sentient beings. The Hindu tradition rejects both animal research and the destruction of embryos. (Hug, K ., 2006) Conflicts of interest: Science vs. Ethics or Money vs. Science In ES cell research, as in any other bioethical debate, it is important to pay some attention to possible conflicts of interest. It is widely known that funding for biotechnology research is frequently a source of such conflicts. In some instances it can be reduced to a mere formality. When science is driven by profit maximization, ethics is pushed into the background in the interest of economy: for instance, the ethics advisory board of Geron Corporation drafted its first ethical statement about ES cell research only after the research was completed and accepted for publication. Ethical problems should be discussed before the research is actually conducted; afterwards, we are dealing with a fait accompli . One of the manifestations of the conflict of interests is the fight for priority and its immediate consequence: premature publication of research. Competition among biotech companies or research groups leads to the publication of half-baked reports, which occasionally serve not as vehicles of scientific information, but only to attract investors. This was the case with the announcement of the cloning of human embryos by Advanced Cell Technology. Many scientists criticized this scoop, because it showed very little experimental progress and advanced no new ideas. In fact, one of the members of the advisory board of the e-journal that published this piece of research decided to step down due to grave concerns over openness and editorial integrity. The publication of the report submitted by the ACT scientists was considered more a political and ethical milestone than a scientific one.

Stem cell research

One of the negative consequences of conflicts of interest is that ethical requirements are pushed to a secondary place; they are regarded not as guidelines for good research, but rather as an obstacle to be overcome in the search for profit. Moreover, financial considerations impoverish the ethical discussion about SCNT, as is clearly apparent when one compares the richness of argument in the 1966 debate on the ethics of nuclear transfer between Paul Ramsey and Joseph Fletcher, two of the founders of American bioethics, with the penury of reasoning shown in 2001 by the scientists from ACT. Only the prior ethical assessment of research projects can guarantee that a basic clause of the Helsinki Declaration is respected, which affirms that 'considerations related to the well-being of the human subject should take precedence over the interests of science and society'. When, in contrast, financial interests take precedence, the debate about ethical issues becomes a heartless pantomime. SOCIAL AND POLITIC AL IMPLICATIONS The ethical debate about ES cell research does not concern only scientists. It must be exposed to public discussion, and all the more so, since the issue of the use of human embryos for research has generated so much interest, due to its profound ethical, social, religious and political implications . Supporters and detractors of SCNT are faced off in the battle over whether to legalize or ban ES cell research. In fact, the political reaction varies greatly in different countries. These differences in fact constitute an impediment to an international agreement on cloning. In Europe there are important differences regarding the authorization of research with human embryos. Some European countries, such as Austria, Poland, the Czech Republic, Switzerland or Norway, have no national law governing ES cell research. In other countries, such as Sweden, research with ES cells is Allowed, but therapeutic cloning is not. Germany alone has approved restricted imports of ES cells from other countries, while the most permissive approach is found in the UK, where the first human embryo research licenses have been granted and therapeutic cloning has been approved by the Parliament. Nevertheless, the European Parliament and Commission have put forward a proposal to establish the ethical principles that should guide any research funded by the European Union. Under the next Framework Program (2002-06) research will be authorized only on spare

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embryos, while research on embryos produced for research purposes, including cloned embryos, will not be financed.

European Court of Justice rejects stem-cell patents The European Court of Justice 10 march 2011 issued a Preliminary opinion that procedures involving established human embryonic stem (hES) cell lines are not patentable. The opinion has wrong footed stem-cell researchers, who had been expecting a less conservative judgment. "It's the worst possible outcome," says Oliver Brstle, director of the Institute of Reconstructive Neurobiology at the University of Bonn in Germany, whose 1991 patent of a technique to generate nerve cells from established hES cell lines sparked the legal debate. (Nature news, 2011) Europe rules against stem-cell patents Stem-cell researchers in Europe are reeling after the Court of Justice of the European Communities issued an opinion questioning the ethics of their work and threatening to ban them from patenting procedures that involve human embryonic stem- cell lines. Some scientists fear that the opinion could also prompt European countries to tighten their legislation on such research, or ban it altogether. . (Nature news, 2011)

Solution to the Ethical Dilemma: The dilemma: should the destruction of human embryos continue in the name of science or it should be abandoned in the name of science. The consequentiality ethical framework will look for the greatest good in this situation. As we view children and adults with diseases, we are compelled to heal. Embryonic stem cells are taken from discarded embryos and are not human like visually or physiologically. They have no arms or legs, brain, heart, or consciousness.
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Non-consequentiality argue that is it unethical to use human organs or cells if they were obtained in an immoral way. It is never ethical to kill one person in order to save another. However, I think if the stem cells were already taken from the embryo, society would allow research if the result would spare the life of misery for a child or adult. The dilemma will be solved using the following theories:
1. Utilitarian theory: Cost- benefit analysis taking in to consideration the various actors

involved and how they are affected; the measure of their pain versus pleasure from continuing the research or abandoning it. Option 1: Continue the research, Option 2: Abandon the research and use of embryos. Actors involved 1. Research scientists 2. Investors in research Pleasure Option 1 Option 2 Medical discovery No pleasure and advancement Development of No pleasure advanced medicine A potential human life saved on moral grounds Retaining the embryo which can be used to give new life Pain Option 1 No pain No pain Option 2 Loss of potential for medical advancement Loss of revenue from development and sale of new advancements in medicine Is deprived from the potential medical advancements and thus cure to many diseases No pain

3. Humanity in general Benefits from the medical discovery

4. Couples in the IVF program

Helping humanity by donating the embryo and the self satisfaction thus derived

Moral obligation towards life in the formation Loss of a potential child

As can be seen from the utilitarian perspective that after weighing the costs against benefits, continuing the research seems more advantageous for most actors and humanity in general and therefore option 1 should be taken. Criticism of the theory:
a. It is not at all evident why human happiness or pleasure for the greatest number of people should be regarded as the defining end of moral action. b. This approach to ethics argues that the sought end (happiness or pleasure for the greatest number of people) justifies the means of achieving that end.

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c. Utilitarianism has to make some difficult factual judgments when it comes to calculating the greatest good for the greatest number. It assumes objectivity in making this assessment.

2. Virtue ethics The virtue ethicist would compare virtue and vice. If an individual believed that human life began at conception, then a virtue could be saving innocent preborn life. This would influence one to argue against embryonic stem cell research. It would be a vice to destroy embryo cells in the pursuit of medical treatments for others. Contrarily, if the embryonic cells are not fully human, the ethicist could determine that healing lives of children and adults is the virtuous act. It would be wrong not to develop our knowledge and abilities in the pursuit of healing. This theory is doubtful for some of the contemporary issues resulting from our new technology for individuals, and societal definitions of virtuous character traits can change. Virtue ethics tends to focus less on moral actions and more on the virtuous character, from which actions naturally flow. Good actions come from good person. The virtue of compassion: the virtue ethics also supports the use of embryonic stem cells towards the advancement in medical science and hence the solution to many medical conditions that plague humankind. Humanity as a whole feels compassion for the ones in society suffering from diseases that might be cured through the use of research from embryonic stem cells. According to virtue compassion it would be a waste to leave this opportunity to aid in medical development and alleviate suffering in the society. Humanity as a major actor is therefore responsible for determining the ethical ground of this research and their compassion towards others have left the decision in favor of the research. According to this theory it is really a simple to take the decision of saving a mass of cell in a glass tube or a man dying from a disease. Compassion supports the man. Criticism of the theory: Ethics cannot be based on emotions - In his book, Begotton or Made, professor Oliver ODonovan of Oxford University rightly reminds us that the virtue of compassion can never stand alone. Compassion is the virtue of being moved to action by the sight of suffering. It is a virtue
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that circumvents thought, since it prompts us immediately to action. It is a virtue that presupposes that an answer has already been found to the question, What needs to be done? When taking compassion into consideration all else moral or immoral is poised as secondary since the entire focus is on emotions and human emotions seek to reduce suffering at the current moment. Egoism An action is morally right if the decision maker freely decides in order to pursue either their (short-term) desires or their (long-term) interests Solution is derived from the process of pursuing ones self interest. It would then produce a morally acceptable outcome. Actors involved 1. Research scientists 2. Investors in research 3. Humanity in general 4. Couples in the IVF program Self interest Option 1 Advancing the medical science for saving humanity from suffering Advancement in medical field and therefore more revenue from selling the new technology Benefits from the advancements in medical field in curing major diseases and reducing suffering. It could be that they are happy from contributing to removing human suffering.

Therefore according to the egoism theory option 1 should be selected which is continuation of the embryonic stem cell research in advancing medical science. Criticism of the theory: The egoism of self interest of the couples in the IVF program is questionable. Their self interest is only an assumption. There might be conflicting egos. The pursuit of selfish pleasures/goals eventually leads to chaos, in which everyone does what is right in his own eyes Where is morality in self interest? The egoist theorist cant be trusted when offering moral advice to others since it will be to his own advantage rather than to that of the one seeking his advice.
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Ethics of duties According to German philosopher Immanuel Kant (1724-1804), morality and the decision about right and wrong is a question of certain eternal, abstract and unchangeable principles (maxims) that humans should apply to all ethical problems. Categorical imperative: Test 1. Whether a certain action could be performed by everyone. Destroying embryos in the process of obtaining stem cells is in some cases compared to murder. And as it is pertaining in the society the action of murder is undesired and is not expected from any individual in society. Result: Negative Test 2. Whether human dignity has been ignored In some cases human embryo at the 14th day of development is considered to have gained status as a human being. Destroying them is the same as denying the basic right of living and hence ignoring its dignity. Result: Negative Test 3. Whether the principles of certain action is acceptable to every human being. To most individuals the action of saving one human life is acceptable by means of destroying an embryo in a glass jar. Result: Positive As two of the results have come negative therefore the research on embryonic stem cells should be abandoned.

Conclusion: There is no unanimous position regarding all the above-discussed questions among both scientists and ethicists, except the general agreement about the laudability of the aims of embryonic stem cell research and the necessity of precautionary approach when introducing stem cell-based therapies The status of the pre-implantation embryo is the most sensitive and disputed point in the debate on isolation of hES cells for research.

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The dominant view in ethics, however, is that the moral status of the pre-implantation embryo is relatively low and that the instrumental use of these embryos can be morally justified under some conditions. Both the principle of proportionality and a permissive interpretation of the principle of subsidiary, make a moratorium on the isolation of hES cells unjustified. A categorical ban on research on human therapeutic cloning is not justified, although the creation of embryos by cloning for the isolation of hES cells is, at the present time, premature. The necessary research can currently be carried out using animal embryos and surplus human IVF embryos.

Dealing with human life is a very sensitive matter and the power to save and destroy lives is a divine right. Dealing with such an ethical issue which penetrates to the depth of the human society culture and religions is a monumental task. Yet through our research we have scratched the surface to such an issue and have attempted to come to terms with it. With authority comes responsibility. Humans thus have the authority both to give and destroy life and they must use it responsibly. We are obliged to save-guard the human race through our technological advancements as is our responsibility to protect the very core of human life; the human embryo. It is a controversy that will continue to plague us choosing between a handful of lab creations of miniature humans and the rest of the human race. The solution to this dilemma is thus indistinct. The solution is out there into the future.

REFERENCES

Hug, K 2006, Therapeutic perspectives of human embryonic stem cell research, [online retrieved on August 2, 2011], available at :< http://www.eurostemcell.org/files>

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Nature news, (2011), 'Europe rules against stem-cell patents,, [online retrieved on August 2, 2011], available at :< http://www.nature.com/news/2011/110316/full/471280a.html> Mclaren, A 2001, 'Ethical and Social considerations of stem cell research', Research file, CRC Institute, University of Cambridge, Macmillan Magazines Ltd , [ online retrieved on August 3,2011], available at :< http://www.coloradodjlabs.org/research/antiintellectualism> Ruiz-Canela, M 2002, 'Embryonic stem cell research: the relevance', Department of Biomedical Humanities, University of Navarra, Spain, [ online retrieved on august 5, 2011[, available at < http://www.unav.es/adi/UserFiles/CvFiles/Files/68209> Wolf, DC 2009, 'Case Study on Stem cell research', Case, Bioethics Program, Iowa State University, Iowa State University, Iowa, [online retrieved on 4th august 2011], availbale at :< http://www.public.iastate.edu/~ethics>

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