2 Goals for today’s conversation Review the ScienceReview President’s CommissionExplore challenges for Catholic health care
3 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?
5 Doctor’s Use Teen’s Stem Cells In Procedure To Repair His Heart Public FramingMatters of Life and DeathAdult stem cells restore feeling in paraplegic19 Years as a ParaplegicKorea ReportWorldNetDaily.ComDoctor’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
6 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."
7 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)
8 What are stem cells? 2 kinds Embryonic—occurring in early fetal development and produce multiple specialized cellsAdult—occurring in adult organisms in bone marrow, muscle, and brain and generate replacement cells
9 Embryonic Stem CellsAfter fertilization, the zygote (fertilized egg) divides several times.Any of these first cell divisions could give rise to cells need for an adult organismThese cells are totipotent
10 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
14 Embryonic Stem CellsThe cells that form the inner cell mass of the blastocyst are called pluripotentThey 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.
15 Adult Stem CellsThey 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.
16 Embryonic Germ CellsGerm cells share some but not all the characteristics of stem cellsThey are primordial germ cells which occur in embryoThey normally develop into mature gametes (eggs and sperm)They do differentiate into specialized cells.
18 Alternative Sources Micro gravity primitive umbilical cells Dead embryosPreviously frozen embryos that fail to divide within 24-hour period“Organismically dead”Discarded human embryos (IVF)Alternative Sources
19 Alternative SourcesBiopsy 1 cell—blastomere extractions remove 1 or a few cells from 6-8 cellDe-differentiationUse somatic cells and restore them to pluripotencyE.g., Lop of newt’s tail or leg & it regeneratesProtein from newts regenerated mice muscles
20 Alternative Sources Altered Nuclear Transfer Use existing lines Creating biological artifacts resembling embryos but incapable of developing into humansRemove nucleus from oocyteReplace with somatic cell that has been altered so new entity would not be able to developReprogram the trophectoderm (outer sheath) so not to form properlyOocyte-assisted reprogramming (OAR)Fusing cellsUse existing lines
21 Ethical issuesAccurate and fair terminologyCloning for ChildrenCloning for Biomedical ResearchObligations of Catholic institutionsPublic Policy issues
22 The Language Activity Cloning Asexual reproduction Reproductive cloningNon-reproductive cloningResearch cloningTherapeutic cloningSomatic cell transfer (SCNT)Nuclear transfer for stem cell researchRegenerative medicine
23 Entity: potential human being human clone human SCNT cell egg activated eggtotipotent cellreconstituted eggclump of cellsblastocystclonecystembryo
25 Language What’s at stake is whether SCNT should be considered cloning. Using the term cloning prejudices the activityUsing many terms obscures the public debateAlso 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 researchClone=replica, not a zygote
26 Cloning for Children Purposes Allow infertile couples to have genetically related childrenPermit couples at risk for genetic disorders to avoid having an afflicted childAllow bearing of child who could become an ideal transplant donorAllow parents to keep connection with dying or dead childReplicate persons of talent or beauty
27 Objections Violates ethics or research Identity and Individuality High rates of morbidity and morality/ unsafe and unethicalIdentity and Individualityidentical to someone else who has already livedConcerns regarding manufacturing1st children to be totally designed in advancemore like a product than a gift and accepted as they arePromote commercialization and industrialization of human procreationProspects of new eugenicsServe as individualized eugenic enhancements, avoid defects
28 Objections Troubled family relationships Strain between generationsFathers as twin brothers to their sonMothers give birth to genetic twinsOne parent reproduction could strain family lifeEffects on societyEffect the way society looks at childrenNovel control of the next generation
29 Cloning for biomedical research OpportunitiesImportant knowledge on embryological developmentTreatments for dreaded diseasesViewA. Non-moral status of embryoB. Intermediate moral status of embryoC. Moral status of embryo
30 Moral status of cloned embryo Continuous history of human individuals from fetal life of infantSpecial respect for nascent human lifeExploitation of developing human lifeBy permitting this, nascent life is a toolCoarsen our moral sensibilitiesMoral harm to societyApprove of control of nascent lifeOpen door to reproductive cloningFederal government mandating the destruction of human lifeWhat we owe the suffering
31 Obligations of Catholic institutions 1. KnowledgeDrug development & ToxicityCell developmentCooperation, toleration & complicityMainly opaque to user2. Applications
33 Obligations of Catholic institutions AmbiguousDead embryos & IVF extrasIs 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 prohibitionBiopsyPre-implantation genetic diagnosis (PGD)Biopsy totipotent or pluripotent?
34 Obligations of Catholic institutions Existing 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 destructionsIs this moral cooperation, toleration, or complicity?No one can cooperate in doing what has already been done—did not cooperate with the destruction
35 Obligations of Catholic institutions Existing linesIs this moral cooperation, toleration, or complicity?One tolerates only what one might preventThey did more than tolerate by allowing the research on already dead embryosComplicity: they have excluded on going relationships by setting a date after which no use. Thus, no encouragement
36 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”?
37 Practical considerations What about partnerships and joint operating agreements?What about institutions with teaching programs?Proactive partnerships for alternativesStaff and community education?
38 Public Policy issues Morally acceptable compromises? Compromises not to facilitate destruction but to stop or limit regulationProtect embryos as well as they canMaterially implicated, materially cooperating
39 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
40 Conclusions Framing No rush to judgment Proactive, not reactive Clarity of languageNo rush to judgmentExamine scientific alternativesProactive, not reactiveNo need for train wreckPartnershipsEducation