Will our legacy be one of holding back from the destruction of innocent human life? Or, shall we do evil that good may come?
This piece was written by G. Steven Suits, MD, former Executive Director of Palmetto Family.
Bob, a 70 year-old resident of Atlanta, Georgia, had been through two open heart operations because of heart problems. His condition deteriorated again, but his doctors told him he could not have a third procedure. Rather than give in to the “there is nothing that can be done” mentality, he sought help outside the United States and received stem cell injections into his heart tissue. Now, he can go for 30-minute walks, and has vacationed in Florida and Antigua. The stem cell injections generated new blood vessels and heart muscle in his heart. Stories such as this one are becoming more common, and centers in the United States, such as the well-renown Texas Heart Institute, are using stem cell technology to offer hope in previously little hope situations.
Stem cell therapies are not limited to heart disease, however. Now, more than 70 disease and injury conditions have been treated with some degree of success using stem cells. In addition to heart diseases such as congestive heart failure and coronary artery disease (the cause of heart attacks), stem cells are used for replacement of heart valves even in children, where they offer the hope of valves that will grow with the patient, alleviating the need to have repeated surgery as the child develops. Cardiomyopathy, characterized by abnormal and ineffective heart muscle, has responded to stem cell therapy. Poor circulation to the lower extremities is a disease that stem cells show promise to alleviate.
The cardiovascular system is only one for which stem cell therapy holds promise. Another body system where there is much-needed progress for diseases and injuries is the central nervous system. Here, stem cells show potential treating spinal cord injuries, stroke, cerebral palsy, Parkinson’s Disease, traumatic brain injury (including injury after hemorrhagic strokes), and anoxic brain injury (most frequently seen in premature infants who suffer oxygen deprivation). In South Korea, stem cell transplants resulted in the return of sensation and mobility in a patient who suffered a spinal cord injury 19 years earlier!
The success of stem cell treatments for some bone marrow and cancer problems, such as multiple myeloma, is so commonplace today that it can be considered standard treatment. Cancers that have been treated using stem cells include leukemias, lymphomas, neuroblastoma, and breast cancer. Scientists have even been able to grow small “breasts” from stem cells, offering post-mastectomy patients a chance to have restored breast tissue. Now, sickle cell disease, which causes severe anemia, pain and heart problems, responds to stem cell transfusions. Stem cells provide insulin-secreting cells that can treat (cure?) diabetes mellitus Type I.
Dialysis may become a medical historical anecdote if the early success with stem cell treatment of kidney disease progresses. Stem cells have been used to replace a damaged windpipe (trachea) and to overcome pulmonary hypertension that limits blood oxygenation and now requires lung transplantation in advanced cases. In cirrhosis of the liver, whether from alcohol abuse or infectious hepatitis, stem cells can provide new, healthy liver cells. Rare diseases that destroy the lining of the gut and require long-term intravenous nutrition with its many complications are now the subject of stem cell therapy.
Broken bones that do not heal have mended shortly after stem cell injections. Stem cells have been used to “grow” and replace a jaw bone that was destroyed by cancer. Recalcitrant tennis elbow has responded to stem cell injections and new cartilage can be grown to replace injured cartilage, or torn cartilage pieces may be united using stem cells. Stem cells have corrected chronic, non-healing skin sores. They have even shown success in epidermolysis bullosa, a condition in which the skin blisters from the slightest trauma and is prone to recurrent infections. An autoimmune form of the disease affects internal organs as well.
Autoimmune disorders, some of the most difficult problems in medicine, seem to show response to stem cell therapy. These include multiple sclerosis, lupus and Crohn’s disease. Combined immunodeficiency disease, which causes frequent infections that are life-threatening and leads to early death, responds to stem cell transfusions. Other immunological conditions stem cells may treat incldeu conditions related to therapies for cancer. One particularly devastating process is graft-versus-host reaction. In this situation, the tissue or organ transplanted into a patient attacks the patient’s own tissue because it recognizes it as “foreign.” Stem cell transfusions alleviate the reaction in many cases. Stem cells are also used in other transplantation scenarios to “trick” the host tissues into accepting the donor tissue, making immunosuppression with its deleterious effects unnecessary.
With all this exciting success using stem cell therapy, why do we hear so much controversy about it? There really is not controversy over the stem cell treatment I have described. All of the above successes came from utilizing adult and umbilical cord stem cells, which all recognize as being ethically appropriate treatment. As a corollary to this, none of these successes involved the ethically-abhorrent destruction of human embryos to harvest embryonic stem cells.
Many people do not differentiate between embryonic stem cells and adult stem cells (I will include umbilical cord stem cells along with adult stem cells). This is because they do not have the scientific background to know the difference. But it is a crucial differentiation to make. Embryonic stem cell research is problematic on at least two fronts. First and most importantly, on the moral front, embryonic stem cell research necessitates the destruction of living human beings in order to obtain the stem cells for research or treatment. It does not matter how much “good” comes if what is needed to get it is wrong. Of course this understanding raises the fundamental question: Is an embryo a human being?
A simple answer is that no one questions that it is a human thing, and that it is a thing – a being. There is no question, in other words, that it is. The question is, what it is. That it is human is not debated. But those who support embryo destruction see a further refinement of the question as necessary: When does the human being become a person? The advantage with this question is that “person” can be defined however one wishes to support one’s desires. When does a living human being have inherent dignity and “rights”? The common suggestion today is that this requires some level of neurological function. In other words, personhood is a functional thing, not an essential or ontological thing. Of course, there is no non-arbitrary level of function that establishes personhood, and some (e.g., Princeton professor Peter Singer) have argued that personhood does not inhere until some time after birth.
One argument for holding that an embryo is not a person is based upon an analogy with brain death. In brain death, there is no function of the brain tissues including the brain stem (some today argue to liberalize brain death to include higher brain death wherein the brain stem still functions, providing for continued respirations and heart function). Since the brain-dead patient is no longer a person, they reason, because they have lost self-directed integral organic function, then an embryo, which does not have brain function, is not a person. The analogy does not hold, in either the premise or the conclusion. For the “brain-dead” patient, if he still has heart function, for example, does still have self-directed integral organic function. If he did not, then there would be no need for the category of brain dead (a category that, by the way, was created in order to provide more organs for transplantation) – he would simply be dead. On the other hand, an embryo is a unique, self-integrating human organism that controls his own development, implantation, and maturation. The embryo is a human person with potential, not a potential human being. There is no ontological difference between an embryo, a fetus, an infant, or a child.
Another argument for recognizing the non-personhood of the embryo is based on a presumed analogy from cloning of somatic cells (all the non-germ [non-sex] cells). Since all somatic cells contain the entire DNA code with some of the genes “turned off,” and since these genes might be re-activated through cloning techniques such as somatic cell nuclear transfer, then every cell in our body is a potential human. If all the cells could become persons, nothing differentiates the embryo from the living hair cell, for example. Since we understand that there is no moral problem with shedding skin cells, and since embryos are analogous to these tissues, then there is no moral problem with destroying embryos for the good of others.
This argument fails to differentiate, however, between active and passive potentiality. Active potential inheres in a being that has intrinsic drive to direct and unfold its own potential. Passive potential involves external manipulation. An embryo has active potential to mature as a human person. Somatic cells only “possess” passive potential to develop into a human being: the scientist must manipulate it through complex laboratory procedures for it to become a self-integrating organism. Once it does (as would be the case with human cloning), it would be a human organism, and as such, a human person. A somatic cell such as a bone marrow stem cell is not analogous to an embryo; it has the active potential to become a leukocyte (white blood cell) and a passive potential to become a human clone. It is analogous to an acorn which has an active potential to become an oak tree and a passive potential to become a desk. The real human analogy of a somatic cell would be a gamete (egg or sperm). As the male gamete must join a female gamete in order to become a self-integrating human person, so the somatic cell must have its nucleus removed, spliced into an egg cell with its nucleus removed, and then stimulated with an electrical shock to begin dividing. Only then, might the somatic cell be the source (partial) of a living human being.
Finally, those pushing for acceptance (and tax-payer funding) of embryonic stem cell research argue that only “spare” or “left-over” embryos from in vitro fertilization procedures need be used and that they are doomed for destruction anyway. Though this conclusion is not necessary and though the idea of “left-over” embryos raises another host of ethical inquiry, even if the argument was granted (which I do not) there is a moral problem. Can we really ever draw a line that would permit experimentation only on clinically “left-over” embryos that would stand for even a short time in the face of mounting clinical (and commercial!) opportunity for advance? The hype of those who support embryo destruction as well as their media bed-partners shows the naiveté of such a proposal.
The question we face in regards to embryonic stem cell research is distinctly ethical in nature and not practical. It really doesn’t matter if embryonic stem cell research holds great potential for improving the health of the masses. There are things that we should not do – should never do – even though they may bring great benefit. Some things just supersede any utilitarian calculus that seeks to justify deleterious means by a greater utilitarian benefit. When there is a thing we should not do and there is no gain from doing it, then it is easy to refuse to do it. This is true as well when only modest gain comes from the thing which ought not to be done. But when the benefit offered from breaching ethical boundaries seems great (either on a personal, aggrandizing basis or a more altruistic basis), then the challenge to personal morals and public policy lies precisely here.
Excursus on Altered Nuclear Transfer
Dr. William Hurlbut, a strong pro-life physician and scientist, proposed an approach for a possible source of “embryonic” stem cells that, he claimed, would not involve the destruction of human embryos. He called the technique “Altered Nuclear Transfer.” The basic technology of this approach is similar to somatic cell nuclear transfer. But either the nucleus of the somatic cell, or the enucleated oocyte (egg) (or both) undergoes alteration in such a way as to make it impossible for the resulting entity to develop into a full human being. Because there is an inherent inability to mature, Hurlbut says, there is no embryo. Therefore, to destroy the entity to derive stem cells holds no moral consequences. Once the entity has developed to the blastocyst stage, the blastomeres may be harvested and “embryonic” stem cells derived. The genetic alteration can then be reversed in the stem cells so that they can return to “normal.”
Others hold that what this technique does (and it has been accomplished) is produce a cloned embryo with defects. The entity does possess self-directed organization for the first several days until its defect causes it to degenerate into a disorganized entity that is more analogous to an embryo with severe genetic anomalies than a non-embryo. Of course, this debate boils down to the question, “What, essentially, is an embryo?”
Dr. Hurlbut deserves respect for his attempt to achieve “embryonic” stem cells without destroying human embryos. He does this because he recognizes the inherent dignity of the embryo. Like other critics, however, it seems to me that altered nuclear transfer only creates a defective embryo, one that cannot possibly survive to maturity, but an embryo nevertheless. To knowingly create a defective human embryo is problematic, to say the least. As long as there is any moral question that this is so, this technique suffers the same problems as embryonic stem cell research in its traditional sense.
At the beginning of this essay, I alluded to two fronts on which embryonic stem cell research was problematic. I have spent the bulk of the discussion on the front that I think really matters – the ethical one. In fact, even if the second front were alleviated, it would do nothing to legitimatize the destruction of human embryos. The second front is a pragmatic one. Embryonic stem cells were first isolated in 1981; the first human embryonic stem cells in 1998. But in the more than quarter century since the beginning of embryonic stem cell research there has been no successful animal or human treatment using embryonic stem cells.
Paired with this lack of success has been the propensity for embryonic stem cells to produce malignant (cancer) tumors, genetically-defective cells, ineffective tissue development and non-functional cells. The process of obtaining embryonic stem cells is quite inefficient. It takes the destruction of 10,000 embryos to provide 100 viable blastomeres (the embryonic cells from which embryonic stem cells are derived). It has been estimated that there are currently in infertility-industry freezers of the United States 400,000 cryopreserved embryos. Though from the perspective that these are each human beings, this is a huge number. But from the perspective of the inefficiency of embryonic stem cell methodology, this is quite limited. That is why there is a push for funding cloning technologies such as somatic cell nuclear transfer. What is needed by the embryonic stem cell researchers is a means of mass production of embryos. But to create living human beings for the purpose of destroying them and harvesting their body parts is the ultimate commodification of human life.
From a practical standpoint, the already very successful adult stem cell technologies ought to be supported. The table that follows enumerates many of these. This is the reason for the hope in stem cell research. Why has the media been almost silent as to these successes? On the other hand, why the hype of the media and many in politics and science over embryonic stem cell research with its lack of success and the detrimental outcomes? Is there something to the suggested “culture of death” that provides the title for Wesley J. Smith’s provocative book? Finally, will we say that we shall never, no matter what the benefits, experiment on our own kind? Will our legacy be one of holding back from the destruction of innocent human life? Or, shall we do evil that good may come?
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