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World Stem Cell Summit 2009 explores ethical issues

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BALTIMORE -- A look at ethical issues -- from research on human embryos to patents on stem cell lines -- was the focus of the first plenary session of the World Stem Cell Summit 2009.

The summit, held at the Baltimore Convention Center Sept. 21-23, drew hundreds of participants from across the United States and 26 other countries.

Jeremy Sugarman, deputy director of the Berman Institute of Bioethics at the Johns Hopkins University in Baltimore, said at the “Ethics and Societal Issues” plenary session that besides the question of the moral status of human embryos, there is a broad spectrum of other ethical issues to be dealt with in stem cell research. He said these range from intellectual property rights of researchers to fairness of access to therapies developed from stem cells, from informed consent of stem cell donors and patients to social justice issues in the directions of research.

Erica Haimes, a professor of sociology at Newcastle University in the United Kingdom and founding executive director of the Policy, Ethics and Life Sciences Research Centre there, described studies she has been leading in two major areas dealing with the relation between in vitro fertilization clinics and stem cell laboratories in Great Britain.

One is on the attitudes and experiences of in vitro fertilization patients when asked to provide fresh “spare” embryos for human embryonic stem cell research. The other is a study of the world’s first “egg-sharing for research” study, in which patients are offered reduced fees in return for providing eggs for somatic cell nuclear transfer research.

Among ethical questions Haimes cited were “the moral status of the human embryo”; the issue of destroying human embryos and, beyond that, of creating such embryos in order to destroy them for research; the likelihood of successful strategies in such research; and the distribution of funding between research on embryonic stem cells and on adult stem cells.

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She noted those who come to fertilization clinics are there because they want a baby but have fertility problems. “They’re patients, not embryo donors,” she said, and treating them as “resources for research” raises questions of “the exploitation of providers.”

She noted that since the first hurdle women coming to clinics face is producing eggs, her studies have found that they are more reluctant to donate their eggs than to donate unused embryos that result from in vitro fertilization -- even though many ethics commentators regard the donation of unfertilized eggs as less morally problematic than the donation of embryos.

“Are eggs [used for somatic cell nuclear transfer research] more valuable than embryos [used to create pluripotent stem cell lines]?” she asked.

In the egg donation project, “does the fee reduction exploit the vulnerable, desperate, needy and poor?” she asked. “Does the fee reduction reduce the autonomy for informed consent?”

In another view, potential egg donors could be viewed as “market traders in a [human cell] tissue economy,” she said.

In Great Britain, she said, current in vitro fertilization rules permit the insertion into the womb of no more than two embryos, and consideration is being given to reducing that to one, so the likelihood of a woman having “spare” embryos fertilized in vitro has grown significantly as methods have improved.

She said potential embryo donors attach “variable status and meaning” to the embryos they are invited to donate for research. They think of “ ‘our’ embryos” -- embryos deemed suitable for implanting -- in a different way from “ ‘other’ embryos” -- those not considered suitable for implantation -- she said. She said the philosophical and ethical language using the more abstract terminology of “ ‘the’ embryo” “features very little in the debate.”

Haimes offered no solution to the ethical and moral debates and concluded her presentation with a question: whether the United Kingdom projects in human egg and embryonic stem cell policies are the route to the future in human stem cell research or “a cautionary tale.”

Other panelists at the plenary session were Jonathan Moreno, editor of Science Progress magazine and a professor of ethics, medical ethics and philosophy at the University of Pennsylvania, and Timothy Caulfield, a professor of law and public health at the University of Alberta in Canada.

Moreno said that besides the obvious “deep philosophical disagreements over the moral status of the [human] embryo,” stem cell research faces a wide variety of ethical issues, including “the social role of the life sciences ... the future of human dignity ... the commodification of parts of our body.”

“The status of humanness” is at the root of questions surrounding research on stem cells derived from human embryos, he said. Over the decades, gay people, people of color, people with disabilities have come to have their human rights protected, he said: “Who gets included? ... Why not human embryos?”

He said the scientific breakthrough two years ago of creating induced pluripotent stem cells from adult stem cells -- a reprogramming of adult stem cells to make them act like embryonic stem cells -- has wide ethical implications.

While opponents of research that destroys human embryos to create stem cell lines have largely hailed the newer process as a way to end ethically problematic human embryonic stem cell research, Moreno pointed to new ethical issues.

Induced pluripotent stem cells “could be programmed to become sperm or egg cells or blastomemes [an early stage of development between embryo and fetus],” he said, and those possibilities raise new ethical issues, including such things as possible children for gay or lesbian couples.

Caulfield urged critical analysis of stem cell research claims by general news media, warning that charlatan clinics offering unproven stem cell therapies, which he compared to snake oil salesmen of a previous century, are bilking people around the world of millions of dollars every year.

In his PowerPoint presentation he showed ads that claimed stem cell cures for “oncology” -- which is a field of medical study and practice, not a disease -- “aging,” and “male climax,” which Caulfield professed not to understand as a medical problem.

Caulfield said four clinics analyzed in his study offered their “cures” for an average of more than $24,000 per treatment. None of the alleged cures had a single peer-reviewed study to verify their efficacy, he said.

In his overview of ethical issues in human stem cell research, Sugarman of Johns Hopkins cited “vastly different cultural” views on everything to from the human status of the embryo to the use of the placenta -- regarded in some cultures as inviolable -- as examples of the ethical dilemmas faced by stem cell researchers in a global environment.

Jerry Filteau is NCR Washington correspondent.

Online resources
World Stem Cell Summit 2009
www.worldstemcellsummit.com

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