Showing posts with label ethics. Show all posts
Showing posts with label ethics. Show all posts

Saturday, December 6, 2008

Individuality and Stem Cell Research

Individuality and Stem Cell Research

Stem cell research has a great potential to save lives, as these cells can potentially transform into any tissue in the body, possibly providing a cure for many diseases. It is an extremely controversial issue in medicine, however, because in order to obtain the best kind of stem cells, human embryos must be destroyed. Another controversial source of stem cells comes from the germ cells of an aborted fetus. Adult stem cells, which involve no destruction of life, do exist, but they have some limitations that scientists believe only embryonic and fetal stem cells can overcome. While many argue that embryonic stem cell research is wrong because it destroys a human individual, this cannot be so as the embryo at this stage has the potential to become multiple individuals. So individuality cannot yet exist. Fetal stem cells are more objectionable, on the other hand, since the fetus is a definite individual. However, it is not a person, and so if virtuous reasoning is used on all sides, it can be morally acceptable. Using the doctrine of double effect, one can see that a fetus may be aborted, if virtues, such as compassion, are used. Then stem cells can then be derived from these fetuses. Regulations must be in place, however, since a potential person does deserve respect and should not be aborted for reasons of money or for research alone.

Embryonic stem cells are cells that can be derived from very young embryos, about five days after fertilization, called a blastocyst. These cells have the ability to become (or differentiate) into nearly any type of cell in the body. They are therefore pluripotent. (NIH, 2000) Since they can develop into so many types of cells, they could serve to treat many diseases. For example, if a person’s heart is damaged, scientists hope to one day be able to implant pluripotent stem cells into that patient’s heart and coax them into becoming healthy heart cells. This might also be possible for diabetics, where the pancreas is not making insulin properly. Pluripotent cells can also be derived from fetuses, but they are a little more differentiated. They are further on their way to becoming particular types of cells. This can actually be beneficial, as they are more predictable. There is the potential problem, for example, that one might implant embryonic stem cells into a heart and have liver cells form, especially since the science is not completely understood. Both have their advantages and disadvantages.

Many people find this troubling, because these stem cells involve killing an embryo, which some people attribute human dignity to. An alternative that has been suggested is adult stem cells. These cells are only multipotent, in that they can only give rise to the types of tissue that they are derived from. They still can divide into many cells, but only into the type of cell they already are. Adult stem cells have not been found for every tissue type, and they cannot divide infinitely as embryonic stem cells can. They have been shown in some cases to even have pluripotent capabilities, however, but only for a few tissues and only in animals (NIH, 2000).

Some opponents argue that embryonic stem cell research is only a futuristic hope that may never be realized. Fetal stem cells have been shown in animals to be able to proliferate in a damaged spinal cord region, which would help treat Lou Gehrig's disease. (Devitt, 2007) Retinal disease has also been shown in rats to be treatable, and it is likely that this could extend to humans. (Devitt, 2007)

Arguments against embryonic stem cell research pertain to the fact that a human life is being destroyed. Admittedly, a human life is being destroyed. The cell is alive, and it is human. But what about destroying a human life is intrinsically wrong? Why is killing a human life worse than killing, say, an insect? Personhood is the main reason killing a human life is wrong. We value the unique person a human is – the fact that we can experience the world, reason, be self-aware, etc. Warren (1973) defines personhood as having at least one of the following: “consciousness, reasoning, self-motivated activity, communication, and self-concepts”. It seems consciousness is a reasonable requisite for personhood, and since most would consider a conscious insect not a person, probably another criterion as well. Even with this minimal requirement, the embryo certainly cannot be a person, since it is not even conscious.

Marquis (1989) would argue against this, because it has a “future of value”. Even if the embryo is not a person, according to Marquis, we should value it for its future. We value adult human life for the capacity it has to feel emotions, experience the world, and so forth. Therefore, we should value such a future to do so as well. However, the embryo could have two, or possibly even three or more futures of value in the case of identical twins/triplets, etc., as embryonic stem cell research uses embryos before the stage of possible twinning (14 days) (Oduncu, 2003). Ford (1991) argues that the embryo is not even an individual yet, for this very reason. Since the embryo may be either one individual or two individuals, it is nonsensical to claim that an embryo is both a potential person and potentially two persons. It could be either, so it has the potential to be both. It therefore could have two or more futures of value. Since this does not make sense, Ford claims that the embryo is not an individual yet at all. This is logical, and the embryo therefore has no moral status, as it is so far removed from personhood (it cannot even have that potential yet), that it is equivalent to a sperm or egg. Individuality is an essential characteristic of a human being, a characteristic that cannot be removed from any human being, and so the embryo is not yet even a human being. This is not to say that it is not a human cell, but it is not an actual human individual, just as an egg is a human cell, but not a human being. Therefore, if contraception is not wrong, embryonic stem cell research is not wrong either, and Marqui’s argument cannot apply to embryos.

Holm (2003) contends that this research should not be permitted because it could justify the use of an embryo, fetus, or infant for any purpose, even an “anti-wrinkle cream”. He is arguing that we could become frivolous and disrespectful in our use of human life. The first point, however, is invalid, because infants may already be persons, as might be fetuses (depending upon the stage of development), as they are conscious, and therefore may be persons. It would be the same with a person who is mentally incapacitated. They are still at least conscious, so, using Warren’s criteria, they may be persons.

The point of the “anti-wrinkle cream” is also not valid, since there is no difference between an embryo and another collection of human cells. As it is not even a human individual, it would be morally equivalent to use it for such a seemingly frivolous purpose as to use a blood cell for such a purpose. So there would be no problem with the scenario he gives. Even if this was an issue, (and it is not) embryonic stem cell research is not intending to use embryos for frivolous reasons. The whole point is to produce cures that will help many actual persons. Not only is no person, and actually no individual, being killed, but one can also see that, in accordance with virtue ethics, the researcher is using good character traits such as healing and beneficence.

Holm, does however, make an interesting point regarding the arguments against stem cell research. He argues that if the embryo is equivalent to a newborn baby at conception, then not only would abortions be immoral even in cases of rape, but research should be done to save the many embryos that women miscarry before they even know they are pregnant. If all life is sacred from the moment of conception, we should be putting as much effort into saving these embryos as we do into saving infants. If a similar number of infants were succumbing to a similar physiological situation, where they died immediately before being born, scientists would be working hectically to find a cure. We do not do this, however, for embryos. Therefore even sanctity of life theorists place lesser value on the embryo than the infant.

Embryos for research generally come from embryos that will already be destroyed from the process of in vitro fertilization (IVF). When a couple is infertile, they can opt to use IVF to create an embryo from the parents’ sperm and egg outside of the womb. However, since this process is very expensive, doctors usually create several embryos to make sure the process works the first time. Then only one or a few embryos are implanted and the rest are either discarded or frozen indefinitely. So embryonic stem cell research is only trying to use embryos that are already going to be destroyed. It will benefit many others, and the embryos would die anyway. However, I will argue later that it is even permissible to create embryos that would not otherwise be created for research.

Another point of note is that many opponents of embryonic stem cell research are not opposed to IVF. America creates thousands of embryos for the purpose of treating infertility, but the same country refuses not only to create them but also to use public funding to cure diseases with already created ones. This does not make any sense. Both result in the destruction of embryos. This is a cultural phenomenon, probably associated with uneasiness regarding any new scientific research. America is fine with it if it aids in reproductive freedom, but contradicts itself in prohibiting potentially life-saving research.

Clarke (2004) argues this point and extends it that it is not consistent to maintain that surplus embryos may be used for research and to maintain that embryos may not be created for research. Some argue this, claiming we may morally use surplus embryos from IVF, but not embryos created for the sole purpose of research. He points out that even if one uses the doctrine of double effect of virtue ethics, that the act may be good since the bad effect is not intended, it can apply to both cases. The first allows IVF for the good of having a child, completely knowing the surplus embryos will be destroyed. The second allows research for the good of saving lives, also knowing that the embryo will be destroyed. Therefore, one who is opposed to embryonic stem cell research must also be opposed to IVF. And if one is not opposed to IVF, one cannot logically be opposed to creating embryos for research alone.

It is also not consistent to appeal to using only surplus embryos, as you are still killing the embryo. Under the assumption that it is wrong to kill an embryo, you are doing the act either way. For example, if someone were to capture you, and tell you that you must kill another innocent person to save your life; most people would not consider that moral. No one would ask whether or not that person would be killed anyway. It would not matter. You killing the person would be wrong whether or not the person would or would not die anyway.

It is the same with embryos. It does not matter whether the embryo would be killed anyway (you create it to be killed when it wouldn’t have been otherwise vs. it is already created and will be killed). You are still doing the act of killing. Therefore, it comes down to personhood. It is wrong to kill the person in the example because he/she has dignity and value in their personhood. Embryos, for the reasons already mentioned, are not persons, and do not even yet have a potential to become so.

So while an embryo is not even an individual with the potential for personhood, a fetus certainly is. It is a distinct individual, and it has at least has the potential for personhood. At some point, it even becomes a person, as it is considered a person at birth. So at some point, the fetus must become a person. However, a potential person, or a fetus before this point, may not have the same moral rights as an actual person. So it becomes imperative to pinpoint at which point it definitely is not a person. While the exact time an individual reaches personhood will probably remain unknown for some time, we can define at what points of development a fetus is definitely not a person.

Since consciousness seems the minimal requirement for personhood, as discussed with the embryo, a fetus at a stage before it is conscious would not be a person. Studies have shown that a fetus may form memories around 22-23 weeks, which indicates consciousness. (Hepper, 1996) However, no studies have shown much evidence of fetal consciousness prior to this point. Holm (2003) argues, however, that personhood cannot be defined at one point, as if given one definition of personhood; a being may go in and out of being a person. However, we need not define the exact moment of personhood. We need only to define when a being is absolutely not a person. And it is fairly reasonable to say that a being that is not and never has been conscious is not a person.

So using tissue from an aborted fetus before the end of the second trimester would not involve aborting a person. But it does still involve killing a potential person. Potential persons do not have the same rights as persons because they only have the potential to become so. For instance, a twelve-year old, who has excellent athletic skills, has the potential to become a professional baseball player. But he is not treated as if he is an actual baseball player. So killing a potential person is not the same as killing an actual person.

Even if it is less problematic, killing a potential person is still a serious matter, due to the respect for the potential person it will become. Virtue ethics becomes important here. Virtue ethics regards the character traits of a person, and takes those good (or bad) traits into consideration when determining whether an act is right or wrong. In virtue ethics, the act may be right if the intentions are right. This can apply to abortions, and therefore, it is the intentions of the woman that matters. Potential persons still have rights, as they do have a future of value, as Marquis argues (unlike an embryo).

Abortions should not be taken lightly, and, in accordance with virtue ethics, should only be done when intentions are good. Aborting fetuses for research purposes is probably not the best solution, as this could lead to women aborting because a researcher has offered her money for the stem cells of her fetus. Money is certainly not a good reason to abort, as greed is definitely not a virtue. It could also lead to the idea that any life should be sacrificed for the greater good, as fetuses, even before the third trimester, are so close to being persons. Embryos, on the other hand, are simply a collection of cells and not even a human individual with the potential to be a person. Therefore, their use would not lead to such a distortion of thinking. So abortions should never be done for research purposes alone.

However, abortions, which have already taken place for other reasons, could offer life-saving stem cells. It would not be immoral to use these stem cells, as the researcher is intending good out of stem cell research, and there is no monetary interest involved. It is impossible to know if the woman aborted for virtuous reasons, so this should be left up to her, since the fetus is not yet a person. There is simply no way to know if she used virtuous reasons, and there may be instances when an abortion is virtuous. An example is when the fetus will have an extreme birth defect that will highly compromise its quality of life. So these fetuses could be used in research, as the researcher is using the virtue of trying to help the sick. The researcher would neither be using the fetus with bad motives, nor would he/she be encouraging the mother to do so.

One can use the doctrine of double effect of virtue theory here, stating that an act may be good if the good is intended and the evil is not. The intention may be good on the part of the mother, using compassion, etc., and another intention is to help cure the ailing, which is also good. The evil effect, of the aborted fetus being killed, is not necessarily intended. It is a necessary side effect of obtaining the good. (saving a child from a bad type of life, healing the sick, etc.) So in some cases, abortions, and fetal stem cell research, can be justified.

However, if embryonic stem cells can be used, they should be, as they are less morally troublesome. On the other hand, fetal stem cells have differentiated more, and are therefore more predictable. It is less likely that they will grow the wrong type of stem cells when implanted. So in cases where embryonic stem cells may be dangerous to the patient, since exactly how they will act is not known, fetal stem cells may be permissible. Research on them would probably also be necessary, as this problem may not be overcome for some time, and we would need to know how to use fetal stem cells in the meantime. It again depends on the intentions and virtues involved, particularly on the part of the researcher. However, research should also be focused on making embryonic stem cells more predictable to eventually avoid using aborted fetuses at all.

Embryonic stem cell research is a promising advance in medical technology. It has the capability to save many lives, and has already proven its value in some cases. Adult stem cells do have uses, but they do not match embryonic stem cells in their capabilities. Despite the conflict surrounding it, embryonic stem cells are not morally problematic. They are not yet human individuals, and they have no moral status. However, stem cells derived from fetuses should not be used if embryonic stem cells can be, as fetuses still are potential persons. In some cases, however, their use may be required, and virtue ethics would need to be used in their derivation. The intentions of both the mother and the doctor must be moral, and the abortion should not be done for research or monetary purposes to avoid a slippery slope problem. Embryonic stem cells are completely moral to use for research, and they have the potential to save many lives.

Literature Cited

Clarke, Simon. (2004) Ethical Consistency in Embryonic Stem Cell Research. New Zealand Bioethics Journal. Vol. 5, no. 1, pp. pp. 343-346.

Devitt, Terri. (2007) Stem cell therapy rescues motor neurons in ALS model. 20 November 2007 <http://www.news.wisc.edu/packages/stemcells/13974>

Ford, Norman. (1991) When Did I Begin? University Press, Cambridge, Great Britain.

Hepper, PG. (1996) Fetal memory: Does it exist? What does it do?. Acta Paediatrica Supplement, Vol. 416, pp. 16-20.

Holm, Soren. (2003) The Ethical Case Against Stem Cell Research. Cambridge Quarterly of Healthcare Ethics. Vol. 12, pp. 372-383.

Marquis, Don. (1989) Why Abortion is Immoral. Journal of Philosophy, Vol. 86, no. 4, pp. 183-202.

NIH. (2000). Stem Cells: A Primer.

Oduncu, Fuat, S. (2003) Stem cell research in Germany: Ethics of healing vs. human dignity. Medicine, Health Care and Philosophy. Vol. 6, pp. 5-16.

Warren, Mary. (1973) On the Moral and Legal Status of Abortion. The Monist, Vol. 57, no. 1, pp. 43-61.