Article for Jewish Chaplains Association Newsletter
By David A. Teutsch
In recent years new scientific methods and understandings have led to an explosion of interest in stem-cell research. This is so because stem cells can generate a huge variety of cells vitally important for the blood, brain, various organs, and neurological system. These potentialities raise the possibility of intervention or cure in the treatment of cancer, Parkinson’s Disease, Alzheimer’s, ALS, other neurodegenerative diseases, cardiovascular disease, diabetes, auto-immune syndromes, spinal-cord injury, burns, arthritis and other medical problems.
There are two kinds of stem cells. Adult stem cells are multi-potent. They travel from the bone marrow to a variety of sites where they can replace damaged tissue. A recent experiment in Japan, for example, showed that stem cells sprayed into damaged heart chambers had the capacity to lead to the heart tissues repairing themselves in a way that no other treatment has been able to accomplish. These adult stem cells are somewhat differentiated, with at least three kinds of stem cells to be found in bone marrow. When they are separated from the rest of the marrow, they can be used more effectively and safely in bone marrow replacement as part of cancer treatment. The research done on adult stem cells has been relatively free of serious ethical issues. The adult stem cells can be harvested with patient consent and more commonly can be taken from bodies donated for medical research. Because of the absence of ethical problems, most of the current research is being done on adult stem cells. When an adult’s stem cells are used as an aid to healing for that person’s own body, this avoids the issues of tissue rejection that may still need to be overcome in the use of stem cells in the treatment of other people.
The second category of stem cells is embryonic cells. They are pluri-potent (many-potentialed) in that they can become any cell in the body. If embryonic cells were used in the treatment of another human being, the issue of fusion and tissue match with the host would need to be overcome, but embryonic cells are very attractive as a basis for research because of their capacity to produce any kind of tissue that a body needs.
There are several sources of embryonic cells. They can be taken from umbilical cords and uterine baby water. The advantage of this method is that there are no moral issues regarding the source of the cells. Because the cells can provide a tissue match for the infant with which they are associated, some people are actually freezing the cords in order to make it possible to obtain genetically matching embryonic cells later if research should become sufficiently sophisticated to make that useful and the child or adult should ever need those cells.
A second source of embryonic cells is fetuses. When a fetus is aborted, stem cells can be harvested without difficulty. The only ethical danger here is the somewhat hard to imagine possibility that a woman might become convinced to become pregnant so that her fetus could be aborted for the sake of harvesting stem cells. While this would raise serious moral problems, it is rather difficult to imagine that this would become a common problem.
By far the most common source of embryonic stem cells is embryos that have been created as part of an assisted reproduction program. Currently when couples are attempting to become pregnant through assisted implantation of an embryo, eggs are harvested and fertilized, a group of embryos is created, and only a few of them are implanted. The rest are frozen and retained by the clinic for use at a later time in order to avoid having to do unnecessary additional harvesting. Once it is certain that these embryos will not be needed, they are usually unceremoniously discarded. That being the case, there is no moral reason why they cannot be used for research.
It is possible that at some point in the future, scientists may wish to engineer new embryos with particular genetic characteristics. This raises some complicated ethical questions. While an embryo that is external to the womb has no moral status in inherited Jewish ethics, it nonetheless is a potential life that has some holiness attached to it. This raises questions about its creation with no intent of creating a human life. There may be compelling reasons at some point in the future to allow this type of research in order to achieve breakthroughs in the treatment of disease, but the research on stem cells has not yet reached the point that would justify this.
When a united sperm and ovum are placed into a suitable growth medium, they begin to divide. After nine divisions, they form a ball of cells known as a blastocyst. This grows to 150 cells in five days – roughly the size of a very small grain of sand. This cluster becomes a fetus if it is implanted in the womb. If it instead is allowed to grow in a suitable medium, it becomes a cell line that can continue to grow almost indefinitely in vitro. This cell line can produce stem cells that can be utilized in many kinds of research regarding the diseases mentioned above. This process is known as research cloning, which is morally distinguished from reproductive cloning in that the cells never are allowed to develop into a fetus.
Research cloning that begins from what would otherwise have been discarded embryos is a morally worthy undertaking not only because of its potential to save lives (pikuah nefesh) but also because of its potential for healing (refua) in general. Thus this research can be understood as a derivative of both the duty to heal and the commitment to pursuing knowledge. Given that, there is no sensible reason to limit the number of cell lines on which research can be based as current federal funding policy does. The presidential position of refusing funding for other lines raises serious questions because some of the existing cell lines are contaminated and because they are genetically limited to a very small pool of donors. The $5 billion California bond issue to fund cloning research in that state partially alleviates the problem, but it does not completely do so. In other states, research is very likely to be funded privately, which would make their results proprietary. This might mean that important results would only be available by buying uses of patents. This raises serious moral questions regarding potential future access for lifesaving purposes.
One of the reasons for the federal position is the concern about creating new embryos. From a Jewish perspective, the embryo does not have the status of a soul in the way that the embryo does in Catholic thought. Even in the womb Jews consider a developing fetus to be “like water” at the very beginning of fetal development. Later on it is regarded as “a limb” of the mother. Outside the womb, an embryo has no status of that type. Since the alternative to this research is simple destruction or disposal of embryos from fertility clinics, from a Jewish perspective there is no reason to avoid this kind of research.
Some are concerned that the expertise developed from research cloning might later be applied to reproductive cloning. In turn, the opposition to reproductive cloning comes from concern about our “playing God.” It is true that such cloning may be stimulated by the ego of a person who wishes to be genetically duplicated, and it is true also that we do not yet know about long-term effects. Dolly, the cloned sheep, had a shortened life perhaps because of genetic weaknesses, and we have not yet been able at this writing to clone dogs. It is unreasonable to ban something that has as many potential salutary effects as research cloning in order to avoid something that might later turn out to provide data that has the potential for unethical use.
Currently limits placed on stem-cell research vary in every country. In some places this research is not sufficiently regulated or supervised, and this raises moral issues of its own. However, these issues are similar to those of other forms of medical and psychological research.
All such research is open to abuse both in the way it is done and in the way its future results can be utilized. We as Jews have a commitment both to pursuing knowledge and to the disciplined use of that knowledge. We ought to support the research, and we ought to support international regulation of that research as well.
Rabbi David Teutsch is the director of the Levin-Lieber program in Jewish ethics at the Reconstructionist Rabbinical College. The Center has recently published the bioethics volume of its multi-volume guide to Jewish practice. It has also published Behoref Hayamim, a values-based Jewish guide to decision-making at the end of life. Information about the Center and an order form for the books is available through the website of the Reconstructionist Rabbinical College, http://www.rrc.edu/ethics-center/publications/publications.