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Ethical Debate of Stem Cell Research Annotated Bibliography

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Updated: Oct 1st, 2021

Timothy Caulfield researched at Health Law Institute, Alberta, while heading Canada Research Chair in Health Law and Policy, and documented National and International legal guidelines for persons volunteering egg donation (Caulfield, Ogbogu and Isasi, 2007). In this paper, the authors addressed two issues: who should obtain consent and what is the right for donors to withdraw consent. Normally, infertility clinics’ eggs donated for reproduction are stored frozen, and clinicians take consent from donors to deliver cells to infertile patients. According to Canadian guidelines, clinicians providing care for infertile patients may unduly influence the donor’s choice and should not be involved in taking the donor’s consent. In order not to jeopardize the research interest and to protect research material, the right to withdraw consent also limits to “any time before cell line is created.” It was argued that if stem cell lines are truly made anonymous, then withdrawal of consent would not be possible, and donors should be made aware of this condition.

The authors of the article Cogle et al. (2003) researched under the auspices of Stem Cell Biology and Regenerative Medicine Program of the University of Florida Shands Cancer Center. The authors overviewed the developmental stages and differentiation abilities of human embryonic stem (hES) cells and stressed therapeutic research to understand gestation problems, birth defects, regeneration and remodeling of human tissues, transplantation of damaged tissue, etc. The authors, however, discounted the application of somatic cell nuclear transfer (SCNT), by which technique Dolly was cloned, for human trials and provided evidence that medical problems like a tumor, developmental abnormalities, early aging, and atypical joint distribution-related complications may emerge in such practices. Although bone marrow stem cells were used to regenerate blood cells, due to abnormal plasticity, an ability to differentiate to the target tissue, authors claimed that such stem cells might differentiate to even brain cells, and caution note was given for such transplantation. The paper stressed patient consent because there are risks associated with the application of both types of stem cells.

H-W Denker researched at the Institute of Anatomy & Developmental Biology, University Clinic at Essen, and published this article (Denker, 2006) to highlight which stage of embryo growth is ethically acceptable to carry out stem cell therapeutic application. The author claimed that undifferentiated totipotent (able to produce an entire being) blastomere cells (morulae or inner cell mass) before they develop to pluripotent (able to differentiate to any tissue) blastocysts are the most suitable cell lines as they are ethically considered as being “non-living.” This article also raised the issue of teratoma (tumor) formation upon ectopic application of hES. The extent of such overgrowth is found with totipotent rather than pluripotent cell lines. Evidence was provided to show that heterogeneous abnormal growth of otherwise acceptable totipotent cell lines is a matter of concern in stem cell application.

Kristina Hug worked at the Department of Social Medicine at the Kansas University of Medicine. In a paper (Hug, 2005), ethical issues using different sources of hES, particularly the embryos left unused after in vitro fertilization called “spare” embryos, were raised. It was claimed that even though “spare,” using such embryos is disrespectful to human life and may lead to dehumanizing practices such as embryo farms and the use of fetuses as spare parts. The issue was further debated, and as a counter-argument, it was emphasized that “spare” embryos are neither implanted nor donated to other couples and are anyway eventually destroyed. Then why not use them to tackle serious human diseases? Application of SCNT or “therapeutic cloning” using his was counter-argued as it is not a tested and validated process for human benefit and may lead to problems like disrespectful commercial use of embryos, exploitation of women to donate eggs, and illegal global trade of stem cells. Evidence was provided that morulae culture can still be ethically acceptable for the application. Even one cell can be removed, and the rest can be allowed to develop to blastocyst so that technically embryo is not killed.

Philip H. Schwartz, affiliated to National Human Neural Stem Cell Resource, Children’s Hospital, Biola University, La Mirada, published a paper (Schwartz, 2006) in which human embryos were graded for fertilization purposes. It was claimed that all embryos are not physiologically equal, and low-grade embryos from in vitro fertilization clinics should never be chosen for the implant, as it will lead to miscarriage or birth defects. Removal of organs for transplantation from brain dead person is not ethically incorrect, and the same argument is given for the donation of low-grade embryos. It was claimed that pre-implantation genetic diagnosis at the blastomere stage had reduced chances of abnormal conceptions and abortions, and since cell differentiation is normal in such defective reproductive embryos, they can be used for harnessing hES without ethical problems.

Robert Steinbrook, researched at the Department of Medicine at Dartmouth Medical School, and in this paper (Steinbrook, 2006) narrated an account of the first SCNT scandal by W. S. Hwang of South Korea. Human egg donation is an uncomfortable, time-consuming, and potentially risky affair and is allowed only for reproductive purposes. He claimed that Hwang used over 2000 eggs from his associates and colleagues by forceful retrieval using unsound medical methods for a fraud SCNT research that led to severe health complications in donors. Compensation to volunteered donors was prohibited by law in many countries except in the US, and it was argued that this had resulted in such kind of undercover practice. In the aftermath of the Korean scandal, compensation issues depending on donors’ complications again came into the limelight.

Reference

Caulfield, Timothy, Ubaka Ogbogu, and Rosario M. Isasi. “Informed consent in embryonic stem cell research: Are we following basic principles?” Canadian Medical Association Journal 176.12 (2007): 1722-1725.

Cogle, Christopher R., Steven M. Guthrie, Ronald C. Sanders, William L. Allen, Edward W. Scott, and Bryon E. Peterson. “An overview of stem cell research and regulatory issues.” Mayo Clinical Proceedings 78 (2003): 993-1003.

Denker, H-W. “Potentiality of embryonic stem cells: an ethical problem even with alternative stem cell sources.” Journal of Medical Ethics 32 (2006): 665-671.

Hug, Kristina. “Sources of human embryos for stem cell research: ethical problems and their possible solutions. Medicina (Kaunas) 41 (2005): 1002-1010.

Schwartz, Philip H. “An approach to the ethical donation of human embryos for harvest of stem cells.” Reproductive BioMedicine 12 (2006): 771–775.

Steinbrook, R. “Egg donation and human embryonic stem-cell research.” The New England Journal of Medicine 354 (2006): 324-326.

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