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<h3>Genetic Engineering</h3>
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<h1>Stem Cell Ethics and Controversy</h1>
<h2>ISSUE'S AND CONTROVERSY
</h2>
<p class="normal">
Stem Cell research is a highly controversial
and emotive subject that is, more often that
not, misunderstood, misrepresented and fraught
with 'ifs and buts'. There are fears that science
is moving too fast without giving proper consideration
to potential impacts and to ethical concerns.
The subject is a confusing and complex one that
is difficult to grasp and constantly changing.
Governments around the world struggle to develop
policies and guidelines at the same time as
individuals struggle with their conscience and
beliefs.
</p>
<h2>There are two key areas of debate:
</h2>
<p class="normal">
<b>The scientific debate;</b> what is proven,
what is debatably proven, research results that
are received with skepticism.
<br /> <br />
<b>The ethical/moral debate;</b> some people
base their objections on religious beliefs,
some on ethical grounds, others believe simply,
that changing or 'messing with' the human genome
is simply not right, against nature and a highly
dangerous path to follow. Others harbour concerns
about the directions in which stem cell research
can be taken.
<br /><br />
Significantly much of the debate is held at
an emotional level with scientific facts often
overlooked or conveniently ignored. So with
that in mind <b>lets first look at the issues
that are currently facing scientist in the field</b>.
<br /> <br />
Exciting claims are regularly reported by scientists
with their findings published in reputable science
journals with all the relevant data and background
information, the media, picking up on these
stories, repackages the findings for public
consumption and dutifully supplies the splash
headline:
<br /><br />
'<em>Brain stem cells to cure diabetes</em>'<br />
'<em>Giant leap for the 'secret of long life</em>'<br />
<br />
Unfortunately the fine detail is the thing that
is often lost leading to much misconception,
once you get to the small print you discover
that all is not as it seems. Sentences like
'hold much promise', 'seems to suggest', 'has
the exciting potential to be', 'it is reasonable
to assume' abound in reports of advances in
genetic engineering and stem cell research.
</p>
<h2>WHAT ARE SOME OF THE SCIENTIFIC HURDLES
STILL TO BE OVERCOME?
</h2>
<p class="normal">
As rapidly as the field of stem cell research
is developing new questions and problems arise,
with each new discovery another set of problems
seems to arrive. Scientist really don't fully
understand why embryonic stem cells can proliferate
successfully in the laboratory without differentiating
but adult stem cells are not so easily controlled
or proliferated. As yet there is no reliable
and reproducible way to create stem cell lines.
For experimentation to continue successfully
it is essential that results can be reproduced
repeatedly, at present this simply doesn't happen.
Scientists have yet to agree a set of test to
confirm that the fundamental properties of a
stem cell exists in a set of laboratory stem
cells. Even the test that are used are not wholly
reliable and accurate.
<br /><br />
In actuality scientist don't really know exactly
how the process of stem cell differentiation
takes place, whether the stem cell be embryonic
or adult. Differentiation occurs when a stem
cell becomes a specific cell type, this happens
when the stem cell receives signals telling
it to start to become a cell. Scientists barely
know what those signals are and how they affect
the process. Directing the differentiation of
stem cells has developed over the years but
is still not an wholly exact science. It seems
likely the process relies on a series of complex
interactions. Controlling the differentiation
is proving to be a major difficulty, how to
make a stem cell become the exact cell type
you want is not so easy and certainly not reliably
reproducible in all areas.
<br /><br />
Scientist simply don't know how many different
types of adult stem cells exist and where they
exist. They also don't know how adult stem cells
come to exist or how they know where to go to
do their repair and replacement functions. The
question of just how flexible different adult
stem cell types are is still unknown. Some scientist
claim that adult stem cells can differentiate
into many kinds of cells outside of their specialism,
others argue that this is a fluke of the laboratory.
<br /><br />
One of the major goals for scientists is to
develop a way to use stem cells to repair damaged
tissue. To do this they require a large amount
of cells. Embryonic stem cells are the easiest
to proliferate but are not a genetic match for
the patient, adult stem cells are a match but
are not easy to grow or control in large numbers.
The recent
<a href="http://news.bbc.co.uk/2/hi/health/4555023.stm" target="_blank">announcement</a>
from Seoul University is being seen as a major
step forward in this area.
<br /><br />
There are many other problems that face the
scientists; the laboratory process requires
the use of some animal products that leave residue,
how long a laboratory created cell survives
in a human is an unknown. There has been significant
progress in the field but there are still many
unanswered questions.
</p>
<h2>THE ETHICAL DEBATE
</h2>
<p class="normal">
The biggest problem with the ethical debate
is that the potential for stem cell research
to produce cures for some of the worlds most
deadly and debilitating diseases is pitted against
fervently and deeply held moral and faith based
beliefs.
<br /> <br />
The issue that gets the most attention and is
often the focus for opponents of stem cell research
is the use of embryonic stem cells. This is
because during the process of stem cell line
creation the embryo is destroyed, opponents
argue that this is the taking of human life
- murder. Opponents argue that, as every embryo
has the potential to become a human being that
each and every one is sacrosanct. Proponents
argue that even under natural conditions not
all embryos go on to form a baby, that unused
harvested embryos would anyway be destroyed
and that, ultimately the ends justify the means.
Many opponents of <i>Embryonic</i> stem cell
research put forward compelling arguments for
more vigorous experimentation and research into
the use of <i>Adult</i> stem cells. They see
this as an answer to the dilemma of the potential
for disease relief. In reality this debate is
quite clear cut, either you believe that embryonic
stem cell research is fundamentally wrong because
it destroys a potential human or you believe
embryonic stem cell research is acceptable because
the embryo will never become a human even if
it has the potential to do so.
<br /><br />
But this argument is merely a very vocal, media
fed argument that only scratches at the surface
of far deeper and potentially more impactful
debates. There are big questions regarding the
potential directions in which stem cell research
can be taken; designer babies and eugenics,
cloning, chimera. What of the rights of the
women who donate their eggs for research and
just how much attention is being paid to the
health risks? What are the potential impacts
of research on the future?
</p>
<h2>CHIMERA</h2>
<p class="normal">
A chimera is an organism constructed out of
living parts from more than one biological species.
Many scientist see the creation of chimera as
a useful tool for the observation of stem cell
behaviour.
<br /><br />
<b>The Science </b><br /><br />
The use of chimera is seen as a way to overcome
some of the hurdles outlined above. Basically
it allows the scientist to test what happens
when stem cells are introduced into a patient,
without experimenting on humans. For experimentation
purposes what happens is that human stem cells
are implanted into an animal host, either an
animal embryo or an adult animal. Most commonly
used are mice and monkeys. Some of the experiments
that have been done already involve implanting
brain cells and creating mice with entire human
immune systems. It is also worth noting that
this is not an entirely new idea and that human-animal
chimera also exist in the form of animal tissue
implanted into humans; pig heart valves are
commonly used as replacement organs for people
with heart disease. The extent to which the
implanted human stem cells affect the host animal
is dependent on the stage at which the material
is introduced. If the human stem cells are introduced
into an early stage animal embryo then they
have a much more profound effect because the
stem cells of the host are less differentiated.
If the stem cells are introduced into an adult
animal the effect, in theory is much less profound
because much less differentiation is taking
place so the stem cells are more of an addition.
But just how far should we go with the use of
chimera? Where should the boundaries be drawn?
When does the 'yuck' factor kick in?<br />
<br />
<b>The Ethics</b><br /><br />
The 'yuck factor' is the point at which our
reaction to a piece of information or something
we see makes us squirm. If we see a monkey running
around a cage, we're unlikely to squirm even
if we know that a percentage of that monkeys
brain is made up of human cells. But what if
we saw a sheep with human feet? Although there
is no proof that this has happened, it is theoretically
possible. In fact there are a lot of theoretically
possible outcomes of chimeric experimentation
and many of them may not be so evident to the
naked eye. It is the mixing of animal and human
cells that concerns the ethicists that have
bothered to notice this element of stem cell
research. For example how human would a monkey
with 20% human cells be, is it human or monkey?
Some might say that 20% human cells does not
make a monkey human but where is the line to
be drawn? These are some of the issues that
the bioethicists are fighting with.<br /><br />
For more information on the chimera debate a
good starting point is <a href="http://www.genetics-and-society.org/newsdisp.asp?id=753" target="_blank" Title="Reproduced at Genetics and Society From The New York Times, April 10, 2005, By JAMIE SHREEVE">The
Other Stem-Cell Debate</a> <br /><br />
For a Christian Perspective: <a href="http://www.beliefnet.com/story/167/story_16727_1.html" target="_blank" title="Paul Lauritzen on the ethical implications of stem-cell research, cloning, and the creation of human/nonhuman chimeras. -- Beliefnet.com">The
Stuart Little Syndrome</a> <br />
</p>
<h2>CLONING</h2>
<p class="normal">
There are two basic types of cloning <i>Reproductive</i>
cloning and <i>Research</i> cloning.
Reproductive cloning means to recreate a genetic
duplicate of a human being and in itself raise
a great many ethical issues, therefore it is
dealt with separately <a href="genetic_engineering_human_cloning.htm" target="_blank">on
this site</a>.
Research cloning is the use of cloning techniques
to create an embryo for research purposes only.
<br /><br />
<b>The Science</b><br /><br />
The technique can be used to produce stem cells
for research. The technique used is called Somatic
Cell Nuclear Transfer: SCNT, what happens is
that nucleus from a body cell is transplant
into an egg. Using electricity or chemicals
this entity is triggered into producing an embryo.
The resulting embryo can then be used to obtain
embryonic stem cells. This process is also know
as <i>embryo cloning</i> or <i>therapeutic cloning</i>.
Some of the uses for this technique include
producing patient specific stem cells, the genetic
material of the patient is implanted into a
donor egg thus producing stem cells that are
a genetic match for the patient. This stem cells
could then be used for therapeutic cell transplant.
Another proposed use is that stem cells could
be created with genetic disorders allowing research
of that disorder to be carried out. There are
however a few scientific problems; the cost
of therapeutic patient specific cell production
may make it a non-starter or at least only available
to the very rich; the very specificness of the
cells means that they can only be given to the
patient they were grown for, unlike conventional
drugs which can be given to almost anyone. Even
though recent research has improved the efficiency
of cell line production it still takes a lot
of time and eggs to produce very few usable
lines. Also lets be clear the technique is still
only useful for research purposes and there
are many hurdles to be overcome before any real
human use is possible.
<br /><br />
<b>The Ethics</b><br /><br />
Lets not forget that cloning in itself uses
human embryos whether created using the in vitro
fertilization method or using donated eggs,
so already we have the ethical difficulties
previously outlined. But there are yet more
ethical problems arising out of cloning cells.
There are fears that research cloning will open
the door to human cloning. With the proliferation
of cloned embryos the chances of a few hundred
embryos going astray becomes more possible.
One of the major concerns is the treatment of
the women who donate their eggs. How informed
is the consent they give?
</p>
<h2>THE DONORS</h2>
<p class="normal">
Whichever method is used to obtain stem cells
at some point or other an egg is needed. Adult
stem cells are near to impossible to proliferate
outside of an egg, embryonic stem cells are
taken from an embryo. So a donor is needed;
enter the women. Eggs are often donated by women
who seek fertility treatment, they give their
spare eggs to science. Some women are paid to
produce eggs for research. As far as it is know
all women give 'informed' consent for the eggs
to be taken. But there are big questions being
asked as to exactly how informed that consent
actually is.<br /><br />
<b>The Science</b><br /><br />
Cloning and stem cell production requires an
enormous amount of eggs. Initial attempts at
cloning needed 242 eggs to produce a single
usable embryonic line, since then that figure
has been reduced to 20 eggs for one embryonic
line. During a normal cycle a woman produces
just one egg so inevitably women are treated
with drugs to stimulate multiple egg production.
The process requires a two stage drug programme,
firstly to shut down the ovaries and then to
stimulate them to produce the eggs. A woman
treated with drugs to stimulate multiple egg
production can produce about 10 eggs.<br /><br />
<b>The Ethics</b><br /><br />
At its simplest the procedure for egg extraction
is painful and invasive. However the drugs used
to stimulate multiple egg production can produce
serious health risks. Whilst most women suffer
only minor symptoms such as headaches or nausea
some can develop much serious problems such
as <i>severe ovarian hyperstimulation syndrome</i>,
which can lead to dangerous fluid buildup, clotting
disorders, renal failure, infertility and even
death. One drug that is used in the procedure
is called Lupron (leuprolide acetate) a drug
that is not approved or tested for this purpose,
although it is being legally used because it
is approved for other purposes. Lupron has
caused many problems which have been reported
to the US Food and Drug Administration (FDA)
including chest pain, nausea, depression, emotional
instability, loss of libido (sex drive), amblyopia
(dimness of vision), syncope (fainting), asthenia
(weakness), asthenia gravis hypophyseogenea
(severe weakness due to loss of pituitary function),
amnesia (disturbance in memory), hypertension
(high arterial blood pressure).<br /><br />
A woman who donates spare eggs from fertility
treatment has a clear motive for wanting to
undertake such a procedure, she wants a baby.
However those choosing to voluntarily donate
eggs will have different motivations; possibly
they believe they are helping to find ways to
cure disease, but how many realise just how
far into the future those cures are? Maybe they
are doing it for the money, tho' laws exist
preventing excessive payments in some countries,
in other poorer countries that money can be
more than useful, but how aware are the women
of the risks they are taking ?
</p>
<h2>EUGENICS AND DESIGNER BABIES</h2>
<p class="normal">
There are issues associated with the connections
between stem cell research, eugenics and designer
babies. It is within the area of stem cell research
that information will be found that will enable
scientists to pursue eugenics, <i>the betterment
of humanity</i> and the ability for parents
to choose not only the sex but also physical
and character traits of their offspring, <i>designer
babies</i>. Because these are such big issues
they are covered <a href="genetic_engineering_eugenics.htm" target="_blank">elsewhere</a>
on this site.
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