The Provenance of Stem Cells Does Source Matter

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In spite of the fact that good scientific reasons can be supplied to support the claim that adult, ES and EG cell research should be carried out in parallel, ethical concerns over the provenance of the latter two cell types has resulted in outright bans or policy restrictions on their use, in many nations. Does the source of stem cells matter morally quite as much as people tend to think?

Embryonic germ (EG) cells are obtained by laboratory cultivation of primordial germ cells found in the fetal gonadal ridge.12 These can be isolated from fetuses following pregnancy termination (artificially induced in cases of unwanted pregnancy or the product of miscarriage). The source of EG cells, immature reproductive organs of aborted fetuses, may repel some, but it seems right that some good come of the frustration of life. Indeed, given sensitivities about the destruction of early human life in ES cell research, studies on EG cells ought to be more ethically palatable for the obvious reason that the fetal source is moribund. Some anti-abortion activists have argued that research involving EG cells will create demand for fetal tissue, and this in turn will lead to the offering of financial incentives to women to terminate pregnancies that might otherwise be carried to term. This objection is effete: like it or not, there is an ample, ongoing supply of fetal tissue. The worry tabled, however, points to the need for strict prohibitions against paying donors for fetal tissue to avoid the merest hint of any financial inducement to abortion (see below). Although I omit dedicated discussion of EG cell research below, certain of the arguments advanced provide further defence of it.

Adult stem cells can be isolated from tissues in an adult organism, or from fetal tissue (excluding primordial germ cells). Mammals appear to contain some 20 major types of somatic stem cells, including brain, liver, bone, blood, cartilage, and arguably corneal.

In ES cell research embryos are sourced in two main ways: from fertility clinics, and by creating them specifically for research purposes. Either way the entity is sacrificed at some point prior to gastrulation. The creation of embryos in the laboratory setting can be performed either by inseminating an unfertilized egg, or by splitting a fertilized egg, or by the technique of SCNT — misleadingly dubbed therapeutic cloning. SCNT consists in the removal of the nucleus from an unfertilized egg, substituting it with the nucleus of a somatic cell, and then prompting the egg to undergo embryogenesis. As with embryo splitting, SCNT skirts the process of fertilization. The major benefit and driving force behind ES cells so generated is to provide an immunological match to the patient's tissues as any replacement tissue formed from ES cells would not elicit a hostile immune response.

Where research on gametes, embryos, or fetal tissue for research purposes, is permitted by law, uncoerced and informed consent of the donors is usually sought. Many institutions, national and pan national ethics boards have devised consent guidelines to ensure consent is faithfully solicited and given. A full review of these is beyond the scope of the present inquiry. I confine myself instead to making one point about written consent. A great deal has been published about the difficulty of eliciting truly informed consent in the clinical context. However, it strikes me that most of the standardly cited problems either do not obtain, or can be circumvented in cases of consent for use of biological materials in research. A cursory glance at a representative consent form gives quite the opposite impression. I judge there to be strong reasons supporting a move away from increasingly detailed, research-specific consent forms, to blanket consent or at least to forms which stipulate in only broad terms the area of intended research. The main reason behind this recommendation is that not all specific research or clinical uses of donated materials are likely to be envisaged in advance, especially in the case of fledgling technologies like ES cell research. Researchers have already been, and clinicians may be placed in the position of having to re-solicit consent to use the materials for purposes not originally specified (e.g. the creation of chimeras using the line, or a therapeutic application). Soliciting consent anew is not always logistically possible, and when it is, there is no guarantee that consent will be granted the second time around. Consequently, research can be slowed or significant expenditure on the production of a therapeutic product can be wasted. The abandonment of detailed forms may not be a suggestion popular with lawyers, but, the fact is, continued usage of them in inappropriate circumstances invites more problems than they solve.

Whether individuals might reasonably expect payment for the materials is a matter of some controversy, and is the second pervasive problem connected to consent. Financial incentives, it is argued, constitute a form of coercion or exploitation. Whatever the force of this objection is in relation to body parts like kidneys, it lacks punch in the case of gametes, which are replaceable, and non-essential to health. It is true that egg harvesting carries some risk to the woman (e.g. perforation of the ovary), and so that risk should be spelled out. However, it is not true that the magnitude of risk is such as to warrant state interference in the form of a ban on either donation or trade. And, we should note that risk cannot consistently be used as an objection to sale, in those countries where donation is permitted. The notion that someone might abort a foetus because they had been offered payment for fetal tissue, is rightly appalling. Abortion is defensible if good reasons for it can be supplied (when carrying the pregnancy to term would have special and grave consequences for the mother, when the life of the resulting child would be profoundly compromised or not worth living). The frustration of a life for monetary gain, under ordinary circumstances, does not constitute a morally defensible reason. With respect to the sale of embryos, the claim that individuals whose fertility treatment has resulted in embryos surplus to requirements are justified in seeking remuneration from researchers, invites the objection that this would be to commodity life, to treat life as a mere piece of property.

In fact, the law is conceptually confused over ownership titles in gametes and embryos. They are plausibly regarded in law as species of property. The problem that arises is that the corpus of law in most countries contains conflicting legal attitudes on which species of property, they are. Control ownership of gametes is recognized in relation to, for example, procreation, placement of gametes in banks prior to chemotherapy, non-procreative sexual acts, and directives stipulating the fate of a couple's supernumerary IVF embryos in the event of divorce. At the same time, in countries where control in these circumstances is recognized, the right to alienate our control over gametes/embryos through donation, is not always permitted. And, in many nations where donation is allowed, the right to alienate control of sperm, eggs, and embryos, through sale is disallowed. Are such apparently conflicting legal attitudes defensible?

What justifications are there for proscribing commercial trade in gametes, and embryos, especially in those nations where donation of all three is legal? It has been argued that if we own our gametes, and embryos then it follows that we also own our children. However, this objection (of the slippery slope variety, a style of argument about which we shall say more in another context, below), can be dodged by insisting that we cannot own human entities which possess interests of a morally relevant kind: infants, children, and adults indisputably have morally protectable interests. Gametes have no interests let alone such interests, and therefore I see no problem with unfettered property rights in them. As to whether embryos have interests, the ensuing discussion makes clear this a matter of deep disagreement about the sacred, the kind of disagreement over which government may only legitimately take a stand, if it has strong reasons for doing so, and it is most unclear that such reasons are available. The same discussion also makes clear that even if we accept that embryos have interests, these interests are permissibly overridden in many circumstances. In advance of that discussion, to round off our reply to the view that property rights in embryos entails property rights in fully formed persons, the point here, to repeat, is that there is no such entailment. Furthermore, recognition of some property rights in embryos does not amount to free license; consistent with the norms of property law, is that not all property rights can be exercised with impunity.13

The final objection we shall consider to donation or sale in gametes and embryos, is the woolly objection from reverence and respect for the human body.14 It does not, however, seem to me, that we either do or should revere/respect all bodily materials. As is obvious, we hold rather cavalier attitudes to many "bits" of the body — hair, for example. And, alienation of control over some body materials is widely practiced (donation/sale of blood). Thus the objection from respect and reverence stands or falls not on our attitudes to the human body but on our attitudes to gametes and embryos. People typically, and permissibly, do not regard gametes as objects of reverence, hence any objection to unfettered property rights in them, on the basis that they do, is a non-objection. There are compelling reasons to think that embryos merit respect when the intention is that they shall become persons. When this is not the intention, the respect requirement does not necessarily figure as a moral demand. The question of whether embryos are the property of individuals, and can, on that basis, be donated, bought and sold, hinges on what interests they might plausibly be said to have. This is the subject to which we now turn, first by way a challenge to the claim that the source of embryos for ES cell research matters morally.

Emphasis has been placed on the merits of using embryos in research which would otherwise remain in deep freeze and ultimately perish, in preference to those deliberately created for research. On the face of it this makes sense — if the entity is to expire anyway it seems better that benefit be derived. But, people who oppose the destruction of any and all human life are not persuaded that the source makes any moral difference whatsoever. Nor should they, given that they believe that as soon as human life begins, it should be afforded the same protection of security of the person as adult individuals. They therefore regard the sacrifice of supernumerary embryos for research purposes to be worse than simply allowing the entity to degrade gradually in its frozen-down state, just as they would regard it as being morally worse to sacrifice an adult in failing health who was destined to die, to serve the greater good. This position is consistent although, as I shall shortly show, I strongly doubt that anyone is wholly wedded to it.

For others who subscribe to the view that human life assumes value incrementally, hence early life has little value or is less valuable than adult lives, the source of the embryos does not much matter either. If no early life has value, then why trouble over the source of that early life? And, people who think that early life has only marginal value, then, again, it is of little import to them what the source of early life is. These positions are also consistent.

There is one concern about source that people holding any of the views just described, might harbor, which is not, on the face of it, underpinned by any story of moral status. The argument is that had we not had IVF, and if we did not have SCNT to generate ES cells from research embryos, then it would be less likely that SCNT could be refined as a procreative method (i.e. to produce cloned children). This can be conceded. It is worth stressing, however, that it is definitely not the case that there is hard and fast causal relationship between a technology and all of its possible uses. Slippery slope arguments are ever current though easily discredited. There are many technologies which might be abused, but which regulation and/or legislation manages to keep in check. And, there are many technologies which are abused but which nonetheless we would not want to disinvent. Consider an analogy with information technology (IT). The Internet makes possible global distribution and commerce in child pornography. Yet, few lament the invention of IT. Thus the power of the objection that IVF and ES cell research using SCNT make reproductive cloning more likely, rests heavily on whether one can substantiate the view that IVF and deriving embryos by SCNT are themselves immoral. If this is the argument, the objector is smuggling in the notion either that early life has morally protectable interests or that any non-natural manipulation of gametes is immoral because naturalness in sex and procreation are fundamental to being human. This constitutes, quite clearly, a conception of what is sacred about life. How the state should respond when citizens hold divergent deep seated conceptions of the sacred, is the issue in the controversy surrounding research involving embryos, and merits sustained discussion. This we shall proffer following scrutiny of different positions held on the moral status of early life.

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