Society, Religion and Technology Project - Church & Society Council
(Scottish Charity Number SC011353)

Embryonic and Adult Stem Cells:
Ethical Dilemmas

Dolly the cloned sheep has become an icon for biotechnology, representing both the hopes and the fears about where embryology and genetics might lead. To most people’s relief, fears of cloned humans have not yet materialised, despite a number of attempts. In our view, cloning humans would be unacceptable both on ethical principle and the high risk of producing deformed babies. Now the focus is on the use of human stem cells, derived either from adult tissue or from a “spare” IVF embryo or perhaps even an embryo specifically made for the purpose. The Church of Scotland Society, Religion and Technology (SRT) project has been at the forefront of this ethical debate since 1998. So what are the issues?

What are Embryonic Stem Cells?
These are special cells in the early embryo before it begins to differentiate. At this point, they can turn into any type of cell in the human body. In 1998 US scientists found a way to isolate them. Using special chemical treatments, scientists believe they can direct these cells to become any type of cell they choose - skin, heart muscle, nerve cells, etc. This opens up a possibility to create replacement cells to inject into patients suffering from a wide range of diseases which cause irreversible cell degeneration, like Parkinson’s, some heart conditions and diabetes. Creation of these so called “embryonic stem” (ES) cells is not cloning, but it raises deep ethical concern whether it changes our view and ethical evaluation of the human embryo.

What is the Status of the Embryo?
There are three positions on this. One extreme sees the early embryo as a ball of cells and nothing more. According to this view, because it is undeveloped and would not survive out of the womb, any research is permissible, including proposals to create embryos specifically to make stem cells from them. The medical benefits, however remote, wholly justify the action. At the opposite pole, the Roman Catholic Church and many individual Christians of other denominations, believe that from conception onwards the embryo has the full status of humanity. On principle, this allows no research or use not for the benefit of that particular embryo, including both present and the new potential uses. In 2006 the General Assembly of the Church of Scotland took a middle position, which affirms the special status as created by God but also recognises potential benefits of embryo research under limited circumstances.

Would Embryo Stem Cells Cross a New Ethical Barrier?
The UK Human Fertilisation and Embryology Act (HFE) of 1990 allowed research on embryos up to 14 days, mainly for research into infertility. The embryo was seen as a reproductive entity, researched for the eventual benefit of other embryos. Thus, the use of an embryo as a source of stem cells is a different notion, scientifically and ethically. It treats the embryo more functionally, simply as a resource and no longer as a whole. The HFE Act gave the human embryo a ‘special status’, an ethical compromise which restricted the conditions under which embryos can be created or used. Any special status is lost if embryos are created just to be a routine resource for replacement cells. They are reduced to a ball of cells which no one respects. A 1998 Ministry of Agriculture report into animal cloning cautioned against seeing animals ‘merely as means to an end’. Unless we regard human embryos of less intrinsic worth than animals, there should be ethical limits of what we may do to them, just as there are for animals. For some this is a strong argument against creating embryos just for stem cell use.

Using Spare Embryos?
When in vitro fertilization (IVF) techniques were first being developed, it wasn’t possible to store unfertilised eggs, so eggs were fertilised to create early embryos, which were then stored for possible future IVF cycles. Technology has moved on in the subsequent decades, so it is now possible to freeze unfertilised eggs, so many fewer “spare” IVF embryos are now being generated. However, many such “spare embryos” exist, no longer wanted after IVF treatments. These are, in many cases, destined to be destroyed. Many feel that while we should not create embryos for stem cells, it would be better to use spare embryos for research into stem cells which seeks to find cures for incurable diseases than simply destroying them. For others, even this would compromise the status of the embryo. Due to the fact that fewer “excess” embryos are being created, alternative sources of stem cells are now being sought.

Are there Viable Alternatives to Embryo Stem Cells?
There have been many statements claiming that there is a complete alternative by deriving stem cells from adult tissue or umbilical cord blood. A number of recent experiments suggest that these cells are indeed much more adaptable to producing different cell types than had been previously assumed. But this research is in its early days, and no one knows whether adult cells would prove sufficient to address the full range of diseases. Many researchers consider that embryonic stem cells would allow treatments for a wider range of diseases than adult cells, but advocate pursuing both paths in parallel. We have much sympathy for avoiding the use of embryonic stem cells, but it is recognized that, if on ethical grounds a decision was made to only use non- embryonic stem cells, we would have to face the possibility that the range of treatable diseases might then be limited. Each approach therefore poses scientific and ethical problems.

Where does Cloning come into it?
The main source for embryo stem cells until now has been so-called “spare” embryos left over after IVF treatments. If these stem cells were used in treating diseases, by definition these cells would be of a different genetic type from the patient. For some diseases like Parkinson’s this may not be a problem, but for others immune rejection might occur. To reduce this risk, cloning might be used to make replacement cells of the same genetic type as the patient. A skin or blood sample would be taken from the patient. The Dolly technique would be used to create a temporary cloned embryo, but instead of implanting it to make a cloned baby, it would be used to create genetically matched stem cells. This “therapeutic” cloning may not be practicable on a large scale, however, and it raises ethical objections. The European Parliament and the influential EC ethical advisory panel have drawn an ethical line at cloning human embryos. They argue that it was “instrumental” to create embryos just to destroy them to make stem cells. It would also make reproductive human cloning more likely to be attempted by unscrupulous scientists. Some scientists say cloned embryos are unnecessary. Establishing a wide range of cell lines from using IVF embryos would achieve a close enough match without cloning. Another avenue being pursued by some researchers has been to reprogramme ordinary adult cells directly into the desired type of cell, without intermediate embryos; the generation of stem cells from umbilical cord blood is also being investigated.

Need for New Legislation on Embryology
The UK HFE Act 1990 allowed embryo research for limited purposes mainly for infertility, but in 2000, MPs voted to allow research on human embryos as sources of stem cells for treating degenerative diseases. Parliament did not vote specifically on cloned embryos even though they raise special issues. The change in regulation to allow embryo research into stem cells automatically allowed the cloning of embryos by the back door, because of the wording of the old Act. This was not a satisfactory way to address such an important ethical issue. The new regulations simply allow any use of the human embryo for “increasing knowledge about serious disease.” This is too open ended for so sensitive a public issue. It puts too much at the discretion of the Human Fertilisation and Embryology Authority. The government has recognized that the time has come to revise the whole legislation to regulate this rapidly developing field of human embryo research, and has brought forward the HFE (2008) Bill currently going through Parliament. Past experience has shown that it is essential that a strict vigilance of embryo research is maintained.
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For more information about these or other ethical issues in technology: - SRT Project, Church and Society Council, 121 George Street, Edinburgh EH2 4YN Tel: 0131 225 5722. Fax: 0131 240 2239, 
eMAIL: srtp@cofscotland.org.uk Website: www.churchofscotland.org.uk/councils/churchsociety/cssrtp.htm					                                                                         Revised May 2008