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June 20, 2013 | Posted By Zubin Master, PhD

Last month, I covered in Part I of this blog the ethical debates surrounding the moral status of human embryos and the potential harms to women as egg providers for cloning research. I also described how the technique of research cloning (a.k.a. somatic cell nuclear transfer) works. For today’s blog post, I want to argue that bioethicists should not leave moral debates behind because the science of stem cell research has moved on in a different direction as it is likely to leave people uneasy and frustrated because no clear way to move forward has been resolved and the debate has almost ceased to continue.

Bioethical discourse surrounding the moral status of human embryos and payment of women for eggs became stagnant upon the discovery of induced pluripotent stem cells (iPSCs). iPSCs were heralded as free of ethical concern because this technique creates hESC-like cells without the creation and destruction of human embryos and it doesn’t require eggs from women. The technique aims to dedifferentiate specialized cells (e.g., skin cells) into a more pluripotent state prior to directing their differentiation into specific cell types needed for repair or regeneration. Even George W. Bush in his Eight State of the Union address stated that the iPSC breakthrough can expand the frontiers of medicine without destroying life. Although iPSCs may obviate ethical concerns surrounding moral status and harms to women, they haven’t served to replace hESC research. In fact, one study shows that hESCs and iPSCs are being used together which makes sense because hESC research serves as a control for iPSC research. In addition, there are also many other ethical challenges to iPSC research including moral complicity as well as research ethics issues including informed consent, privacy and withdrawal. I have argued along with Gillian Crozier that perhaps an ethical and political compromise in stem cell research is needed in order to permit stem cell research to be performed using eggs and embryos for a certain period until such time that non-egg and non-embryo sources for the derivation of stem cells can be used. But because iPSCs have received such hype, ethics discourse around research cloning and deriving hESCs has received far less attention in the past 4-5 years.

Yet every time a new cloning-like technique is discovered, the same ethical concerns resurface. In 2011, a research team derived hESC-like cells from a similar SCNT technique except the ovum’s nucleus had not been removed. This triploid embryo was morally ambiguous and although it would not fully develop, it might have raised moral confusion. Those that consider the embryo to be sacred or have significant moral worth, irrespective of its potential to become you or me, would be morally troubled by this research. What happened is that this research raised several media headlines such as “Don’t fear the cloned stem cells: they’re not people” or “Control the bonanza for research eggs” as the researchers did pay women for providing eggs. What I suspect will happen in the near future is that the debates surrounding moral status of human embryos, whether they can be used for stem cell research, and the potential physical and social harms to women will momentarily be revisited. For example, in this most recent SCNT effort, a cloned embryo was created and theoretically could be brought to term. Moreover, young women were paid $3000-$7000 for their eggs and some may comment that such amounts may be coercive to women.

These unsettled debates are likely to surface and it is troubling to see that bioethics discourse follows scientific trends. Let’s take on a hypothetical scenario where iPSCs are not going to meet our clinical needs for the regeneration of disease or damaged cells and tissue. This is not completely unlikely as there have been several papers demonstrating that iPSCs differ than their hESC counterparts in many ways including a greater number of genetic mutations, an inability to fully differentiate into every adult cell type, and epigenetic differences. The ethical issues of moral status and harms to women might come back with full force if iPSC research declines and more efforts are made towards hESC research. Again, the same debates will be resurrected.

Bioethics should not be at the whim of the prevailing science. It remains problematic to leave even the most intractable of debates aside as it is likely to frustrate one or more parties morally engaged in the debate because no reasonable solution, compromise, or path forward has been concluded. Thus bioethicists should continue to debate these ethical issues irrespective of the direction scientific research takes. Ethical concerns surrounding stem cell research should not focus strictly on research ethics questions or the hot topic of stem cell tourism, but all of the ethical concerns should be examined.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

1 comments | Topics: Cloning, Ethics and Morality, Health and the Internet, Stem Cell Research, Women's Reproductive Rights

Comments

William Fisk

William Fisk wrote on 05/05/14 6:51 PM

This is intolerably poorly written.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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