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ETHICS IN THE USE OF STEM CELLS IN MODERN MEDICINE
Peter Shilowich (pes44@pitt.edu)
INTRODUCTION: A POSSIBLE
ETHICAL SCENARIO
In the field of engineering one of the most
important things to pay attention to is the ethics of a
situation. Engineers in all fields have to pay attention,
legally and morally, to a specific code of ethics. Whether
it’s a medical engineer developing new car technology or a
bioengineer researching and implementing stem cells. In
the following scenario, the head engineer in a stem cell
research lab must come to decision that is within the
bioengineering code of ethics. To further understand the
reasons behind the engineer’s solution to this scenario, you
must be informed about the basics of stem cell research and
use.
WHAT ARE STEM CELLS AND
HOW ARE THEY USED?
The research that is currently being conducted on
stem cells is future of modern medicine. “Stem cells have
the remarkable potential to develop into many different cell
types in the body during early life and growth” [1]. A stem
cell divides and when this occurs it has the option to
continuing being a stem cell or it can change itself into
another type of cell with a specific function, for instance a
red blood cell or brain cell. Also stem cells do not have a
limit to how many times they can divide so they can also
serve as an internal repair system but only as long as the
organism is living.
In the realm of stem cells there are two different
types: adult stem cells and embryonic stem cells. An adult
stem cell are stem cells that exist in already developed
tissue, but it can also be found in infants and children.
“These stem cells can act like a repair system, dividing
regularly to provide new specialized cells to take the place
of those that die or are lost” [2]. But research with adult
cells has been limited because scientists have found
difficulty growing and differentiating the cells in the
conditions of a lab. Embryonic stem cells on the hand are
produced when a newly fertilized egg begins to divide,
which is usually about three to five days into the
development of the zygote. In the following scenario, the
embryonic stem cell is one that is being used.
Obtaining the stem cells can both a simple and
nearly harmless process as well as a more in-depth process.
The collection of adult stem cell is the easier of the two.
They can be removed from adult tissues with little harmful
effect on the patient meanwhile embryonic stem cells are
University of Pittsburgh, Swanson School of Engineering
2014-10-26
created from multicellular embryos that have been cultured
in the a lab [2]. There are also other ways that scientists
produce stem cells because there is limited about of them
from research. Some of the current and potential sources
are early embryos created by in vitro fertilization, germ
cells or organs from an aborted fetus, early embryos
created by somatic (body) cell nuclear transfer (SCNT),
and reprogramming mature adult tissue cells to behave like
stem cells [2].
In today’s medicine stem cells have been used to
provide life-saving treatments to patients with lymphoma,
leukemia, other blood disorders, as well as solid tumors.
Also stem cells have been used in bone marrow transplants,
where healthy, matching donor cells replace the patient’s
bone marrow. “While most blood stem cells reside in the
bone marrow, a small number are present in the
bloodstream. Peripheral blood stem cells can be obtained
from drawn blood, making them easier to collect than bone
marrow stem cells. However, PBSCs are sparse in the
bloodstream, so collecting enough to perform a transplant
can pose a challenge” [2]. Scientists have recently
discovered another place to find stem-cell-rich blood,
umbilical cords. The blood found in the umbilical cord can
be used to treat patients with the same health problems as
those treated using bone marrow cells and PBSCs.
Another use of stem cells is in the field of
therapeutic cloning. Therapeutic cloning is a procedure to
create versatile stem cells independent of fertilized eggs.
The nucleus is removed from the unfertilized egg as well
as the nucleus of the somatic cell of a donor. The donor
nucleus is then injected into the egg, creating a line of stem
cells that is genetically identical to the donor’s, a clone [3].
THE SCENARIO
The head engineer in an embryonic stem cell
research lab in UPMC has been working on the most
efficient way to create large quantities of embryonic stem
cells. In order to create even a single embryonic stem cell,
a human embryo is required and must be at the blastocyst
stage which is about three to five days post fertilization at
which time they consisted of about fifty to one hundred and
fifty cells, and the inner cell mass must be removed. But
with this process moral and ethically issues arise which
raises a red flag in the engineer’s research. These moral
issues that our engineer faces are the duty to prevent or
alleviate suffering and the duty to respect the value of
human life. In order for our hypothetical engineer to make
a decision and plan a course of action, he must consult the
WMA Declaration of Helsinki- Ethical Principles for
Peter Shilowich
Medical Research Involving Human Subjects along with
the Biomedical Engineering Society Code of Ethics.
Another option that our engineer has is that he can
continue to perform the normal process without worrying
about the value of life and thoughts of those people who
care if the embryo is considered a human or not because
the production of stem cells with prevent and alleviate
suffering.
With these two options a problem does come with
the process and how it’s conducted. Researchers are
seeking out eggs from young woman at an increasing rate.
But the process that is used to harvest multiple eggs often
involves the administration of drugs that have not been
approved for this purpose. As well as the drugs used have
not been adequately studied for their long-term effects on
women despite research providing some evidence of
significant harm to women in both short and long term [6].
So an easy solution to that issue is to remove the
use of those drugs from the process but that would increase
the difficulty of the process in addition to possibly
increasing the pain that the women would endure during
the process. But for the decision of whether to choose to
respect the value of human life or prevent and alleviate
suffering our engineer needs to refer to specific codes of
ethics.
POSSIBLE SOLUTIONS TO
THE SCENARIO
Our hypothetical engineer’s possible solutions
when it comes to facing these red flags in his research is to
try and decided which moral issue is more important to
satisfy. The research lab will continue to create embryonic
stem cells by destroying an early embryo. But this
continues to bring up a moral dilemma that has two moral
principles to it: the duty to prevent or alleviate suffering
and the duty to respect the value of human life. But our
engineer can only satisfy one of the two principles.
The first option is to attempt to satisfy the moral
principle of respecting the value of life. This is a big issue
because almost anyone can have an option on this topic.
But the main discussion is over what moral status does a
human embryo have. Some believe that the embryo has full
moral status from the instant it is fertilized while others
believe that it has no moral status at all. There also others
in the middle that believe that around the 14 th day after
fertilization is when the embryo gains moral status and
finally some believe that the embryo’s moral status
increases as it develops. The main question that needs to be
answered in order for this solution to be acceptable is to
determine when a human being begins to exist.
It is nearly impossible to please the people that
believe that an embryo has a moral status upon fertilization.
The only way to satisfy them is to not perform the
procedure. So our engineer’s best option is to destroy the
embryo before the 14th day after fertilization occurs. Before
day 14, the embryo has no central nervous system and
therefore has no sense. The argument that arises is that if
we can remove organs from a patient who is pronounced
brain dead then why can’t we take hundred-cell embryos
that have no nervous system. Fertilization is a process and
an embryo in the earliest stages is not defined as an
individual so in that case it couldn’t possibly have a moral
status [4].
“An individual who is an identical twin cannot be
numerically identical to the one-cell zygote, since both
twins bear the same relationship to the zygote, and
numerical identity must satisfy transitivity. That is, if the
zygote, A, divides into two genetically identical cell groups
that give rise to identical twins B and C, B and C cannot be
the same individual as A because they are not numerically
identical with each other. This shows that not all persons
can correctly assert that they began their life as a zygote.
However, it does not follow that the zygote is not a human
being, or that it has not individuated.”[5]. Another
argument that would provide strength to the side of
continuing research and the current procedure.
CODES OF ETHICS
The codes of ethics provide a guideline to people
in certain fields to make decisions that will be the moral
and ethical ones. In the case of our engineer and his stem
cell research, he’ll use the Biomedical Engineering Society
Code of Ethics and WMA Declaration of Helsinki- Ethical
Principles for Medical Research Involving Human
Subjects.
According
to
Biomedical
Engineering
Professional Obligations it states that biomedical engineers
should “Use their knowledge, skills, and abilities to
enhance the safety, health, and welfare of the public” [7].
Which in this case would mean to continue with process as
is because the creation of stem cells with in turn save lives
by curing health problems. But it also states that engineers
should “Regard responsibility toward and rights of
patients, including those of confidentiality and privacy, as
their primary concern” [7]. And with that the patient could
be explained the process with full detail and allow them to
make the decision if they believe the process is morally
sound or not.
The WMA states that “In medical practice and in
medical research, most interventions involve risks and
burdens. Medical research involving human subjects may
only be conducted if the importance of the objective
outweighs the risks and burdens to the research subjects”
[8]. In this scenario clearly the importance of the objective
carries a lot of weight because it would save lives but there
are always risks and burdens with each and every patient.
And similarly the WMA also states that “Participation by
individuals capable of giving informed consent as subjects
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Peter Shilowich
in medical research must be voluntary. Although it may be
appropriate to consult family members or community
leaders, no individual capable of giving informed consent
may be enrolled in a research study unless he or she freely
agrees” [8].
Both codes of ethics provide similar and
knowledgeable information about what is required to make
a decision in the field of bioengineering. But before our
engineer can make a final decision he needs to take a look
at some case studies that explain hypothetical situations
with solutions.
an embryonic stem cell. Possibly using an egg cell from
another animal so people would not be up in arms about the
destruction of a human embryo and the value of life.
RESOURCES
[1] (2002). “Stem Cell Basics: Introduction.” Stem Cell
Information (Website). National Institutes of Health, U.S.
Department of Health and Human Services.
http://stemcells.nih.gov/info/basics/pages/basics1.aspx
[2] “Basics of Stem Cell Research.” American Medical
Association.
(Website).
http://www.amaassn.org/ama/pub/physician-resources/medicalscience/genetics-molecular-medicine/related-policytopics/stem-cell-research/basics-stem-cellresearch.page?#
CASE STUDIES
Jim and the Forgotten Embryos
This case study comes from the State University
of New York at Buffalo. The goal of this study is to expose
students to the basics of embryonic stem cell and their
therapeutic use, and they do this through the story of a
college student, Jim Allison. Jim is paralyzed in a car
accident and Jim is approached by doctors to participate in
a study where patients are injected with embryonic cells in
the hope that these cells will regenerate damaged nerve
cells. The purpose of the study is to show how a family and
patient decided to participate in the destruction of embryos
or not. They have to decide what the moral status of an
embryo is and whether they are ok with destroying the
possibility of life. [9]
[3] Mayo Clinic Staff. (2013). “Stem Cell Transplant.”
Mayo Clinic. (Website). http://www.mayoclinic.org/testsprocedures/stem-cell-transplant/in-depth/stem-cells/art20048117?pg=1
[4] K. Hug. (2011). “Embryonic Stem Cell Research: An
Ethical Dilemma.” Euro Stem Cell. (Online Article).
http://www.eurostemcell.org/factsheet/embyronic-stemcell-research-ethical-dilemma
[5] Siegel. A. (2013). “Ethics of Stem Cell Research.” In
Stanford
Encyclopedia
of
Philosophy.
http://plato.stanford.edu/entries/stemcells/#WheDoeHumBeiBegExi
CONCLUSION AND FINAL
DECISION
[6] D. Beeson, A. Lippman. (2006). “Egg Harvesting for
Stem Cell Research: Medical Risks and Ethical Problems.”
RBM Online. (Online Article).
Along with all the of the information that was
presented throughout with paper, our engineer decided to
take a poll around his place of work of people who were
not involved in the research. He asked them to answer with
the morals in mind. And what he found was that majority
of the people he polled believed that the process of
destroying an embryo in order to make embryonic stem
cells was morally ok because of the power and usefulness
of these embryonic stem cells.
When our engineer puts all of the facts and
information together the best solution to the scenario at
hand is for our engineer to continue research as is but when
a procedure is to occur the patient must have full disclosure
of what occurs. And at that point if the patient is accepting
with how the stem cells were produced then the process can
happen but if don’t then the patient needs to seek other
treatment.
For future engineers a way to fix this entire
scenario would be to discover a way to genetically create
[7] “Biomedical Engineering Society Code of Ethics.”
(2004). Biomedical Engineering Society. (Website).
http://bmes.org/files/2004%20Approved%20%20Code%2
0of%20Ethics(2).pdf
[8] “WMA Declaration of Helsinki - Ethical Principles for
Medical Research Involving Human Subjects.” (2002).
World
Medical
Association.
(Website).
http://www.wma.net/en/30publications/10policies/b3/inde
x.html
[9] Segura-Totten, M. (2012). Jim and the Forgotten
Embryos. National Center for Case Study Teaching in
Science: SUNY Buffalo. [Case Study].
ADDITIONAL SOURCES
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Peter Shilowich
YouTube. (2012, October 18). The Ethical Questions of
Stem Cell Research [Video file]. Retrieved from
http://www.youtube.com/watch?v=f5d0ieWfKlI
Members of Forbes Floor 3 (personal communication,
October 27, 2014)
Zenios, S., Denend, L., Boeing, W., Majumdar. R.,
Riskin, D. A Problem of Understanding. Stanford
Biodesign. [Case Study].
Honesty’s Always the Best Policy. Web Guru: Guide for
Undergraduate Research. [Case Study].
ACKNOWLEDGEMENTS
I would like to thank Nicole Faina for coming into our
class and explaining in great detail how this paper should
go.
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