Stem CellsImplications for

Catholic Health Care

Philip Boyle, Ph.D.Vice President, Mission & Ethics

www.CHE.ORG/ETHICS

Goals for today’s conversation

• Review the Science

• Review President’s Commission

• Explore challenges for Catholic health care

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?

• Review science– Embryonic & adult stem cells

– Alternatives• Dead embryos• IVF• Micro gravity primitive umbilical cells• Biopsy• Dedifferentiation• Altered Nuclear Transfer• Use existing lines

Public Framing

Matters of Life and DeathAdult stem cells restore feeling in paraplegic

19 Years as a ParaplegicKorea Report

WorldNetDaily.Com

Doctor’s Use Teen’s Stem Cells In Procedure To Repair His Heart

“A 16-year-old shot in the chest with a nail gun has undergone the nation’s first procedure to repair dying heart muscles using his own stem cells.”

• The Wall Street Journal

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."

• 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)

What are stem cells?

• 2 kinds– Embryonic—occurring in early fetal

development and produce multiple specialized cells

– Adult—occurring in adult organisms in bone marrow, muscle, and brain and generate replacement cells

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

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

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.

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.

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.

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)

Alternative Sources

– Biopsy 1 cell—blastomere 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 newt’s tail or leg & it regenerates• Protein from newts regenerated mice muscles

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

Ethical issues

• Accurate and fair terminology

• Cloning for Children

• Cloning for Biomedical Research

• Obligations of Catholic institutions

• Public Policy issues

The LanguageActivity

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

Entity:

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

Relationships:

• genetic copy

• replica

• genetically virtually identical

• non-contemporary twin

• delayed genetic twin

• clone

Language– What’s at stake is whether SCNT should be

considered cloning. – Using the term cloning prejudices the activity– Using many terms obscures the public debate

o 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

o Clone=replica, not a zygote

Cloning for ChildrenPurposes• 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

ObjectionsViolates 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

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

Cloning for biomedical research

Opportunities

• Important knowledge on embryological development

• Treatments for dreaded diseases

• ViewA. Non-moral status of embryo

B. Intermediate moral status of embryo

C. Moral status of embryo

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

Obligations of Catholic institutions1. Knowledge

– Drug development & Toxicity– Cell development

Cooperation, toleration & complicity

Mainly opaque to user

2. Applications

Obligations of Catholic institutionsTherapies

– Clearly unacceptable• Embryonic stem cells

– Clearly acceptable• De-differentiation• Umbilical cord

– Ambiguous• Dead embryos• Biopsy• Altered nucleus• Existing lines

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?

Obligations of Catholic institutionsExisting Lines before moratorium? (Bush and

German gov’t)

– 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 done—did not cooperate with the destruction

Obligations of Catholic institutionsExisting 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

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”?

Practical considerations• What about partnerships and joint

operating agreements?

• What about institutions with teaching programs?

• Proactive partnerships for alternatives

• Staff and community education?

Public Policy issuesMorally acceptable compromises?Compromises not to facilitate destruction but to stop or

limit regulation• Protect embryos as well as they can• Materially implicated, materially cooperating

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

Conclusions • Framing

– Clarity of language

• No rush to judgment– Examine scientific alternatives

• Proactive, not reactive– No need for train wreck– Partnerships– Education