Barriers to Bumps
By David Stevens, MD, MA (Ethics) | May 25, 2017
by David Stevens, MD, MA (Ethics)
I vividly remember appearing live on CNN to be interviewed about the embryonic stem cell debate waging across the country early in the new millennium. I was looking at a camera in our studio in Bristol, Tennessee, connected by satellite to Atlanta, Georgia. I couldn’t see the broadcast but could hear the “setup” to my interview through my earpiece. It touted that embryonic stem cells would cure Parkinson’s disease, stroke, diabetes, multiple sclerosis and a host of other diseases. Cures were just around the corner if the government would simply put funds into embryonic stem cell research.
The camera went live and the CNN host said in my ear, “Dr. Stevens, you have children. If they were sick and could be cured with stem cell therapy, wouldn’t you want to help them?” The Bible promises God will give us the right words to say when we are called before “authorities.” The words that came out of my mouth validated that promise as I without pre-thought said, “Oh, I’m not opposed to stem cell research. We are entering an era of regenerative medicine that will have as much impact on our health as the discovery of antibiotics. The question is not whether we should do stem cell research. The question is where do we get the stem cells?”
As you may remember, the promise of miracle cures broke through the barrier of doing destructive research on human beings. It became morally acceptable to sacrifice small human beings on the altar of science for the “greater good.” Looking back, the barrier was smashed into a mere bump as science accelerated onward to their hope of new discoveries, fame and fortune.
Of course, more than 15 years later we have yet to see a disease treated or cured with embryonic stem cells. Most researchers are using induced pluripotent stem cells (IPS cells) for their research. They can take any cell from the body, but most often use skin cells, and then genetically modify them so they act like embryonic stem cells that can become any tissue in the body. Embryos aren’t sacrificed with this new technology, but that wasn’t most scientists’ motivation. IPS cells could be created in unlimited numbers and they could genetically match the person they originated from so the tissue created would not be rejected by that patient.
Other barriers were busted as well around this time. Human cloning was allowed as long as the embryos created were destroyed and not implanted in a woman’s womb.
Bump! … Bump!
Oregon legalized physician-assisted suicide, allowing doctors to assist their patients in killing themselves, and also destroying the ethical and professional barrier of “doing no harm.” Through linguistic gymnastics, suicide was redefined to be “aid in dying,” “compassion” and “choice.” Other states have followed suit and the speed of legalization now has great momentum. A total of 38 states considered legalizing physician-assisted suicide last year, and two more approved it. The latest was Washington, D.C., so now it is legal in six states.
Bump! … Bump! … Bump!
Another very large barrier has been bulldozed. The ethical line in the sand was that it was wrong to tamper with the human “germ line.” In other words, scientists shouldn’t genetically modify human embryos, sperm or eggs because any ill effects would be passed on to every subsequent generation. How do you get informed consent from a grandchild who is yet to be born? Such genetic modification doesn’t help those suffering now with diseases, but it could only possibly benefit future generations. This wall was inviolable since it was thought there was no way to do the research ethically.
But what if you could maybe cure a very rare genetic mitochondrial disease passed from mother to child? This cloning technique takes the nucleus out of an egg with mitochondrial abnormalities and then places it in an enucleated egg from a woman without the disease and then fertilizes the egg to obtain and embryo for implantation. That is legal in the United Kingdom now, and a U.S. doctor did it but made sure the baby was born in Mexico since it is illegal here in the U.S. The parents took the child back to New York and they have refused any testing. So much for the careful follow-up promised to ensure the child is “normal!”
Bump! … Bump! … Bump! … Bump!
Creating human organs in pigs would give an unlimited supply of kidneys, livers and other organs for transplant, a laudable goal. Scientists frequently modify mice with a few human genes to create disease models for study. The big barrier in this scientific arena was risking changing the animal’s nature by genetically modifying the animal’s brain. That barrier was shattered in the last few months as scientists at the Salk Institute in Paris reported they had inserted embryonic human stem cells into pig embryos. Those pluripotent cells can become human tissue in any organ in that pig, including its brain, eggs or sperm. They reported success in finding human cells in pig tissue, though not nearly as many as they hoped to discover. They are going to modify their protocol and keep trying. The silence of any criticism of their shotgun technique was deafening as this barrier crumbled.
Bump! … Bump! … Bump! … Bump! … Bump!
Last week there was a report of another broken barrier. The New York Times article, “Babies From Skin Cells? Prospect Is Unsettling to Some Experts,” reported a group of Japanese researches have accomplished “in vitro gametogenesis,” or I.V.G. They manufactured sperm and eggs from mouse skin cells derived from induced pluripotent stem cells, used them to create a mouse embryo and then implanted it. A normal appearing mouse was born. One academic reported he had an “unsettled feeling” when he heard the news. Many more postulated that in five years or a couple of decades, two men or two women could create a child, or that you could create an egg and a sperm from your own skin, use them to conceive an embryo and clone yourself. A lawyer (though I’m not sure why he is in the discussion) postulated that two pairs of people could create embryos and then take cells from each embryo to create sperm and eggs and use those to create a baby with four parents. A few scientists interviewed were a little concerned this could lead to designer babies and embryo farming.
Bump! … Bump! … Bump! … Bump! … Bump! … Bump!
Scientists recently reported the first successful use of an “artificial womb.” They placed a premature lamb in a large clear sack full of artificial amniotic fluid. They hooked the fetus’ umbilical cord to a box that could oxygenate and provide nutrition to its blood. The lamb’s heart served as the pump as it lay in a darkened room with a recording of an ewe’s heartbeat playing in the background. The lamb grew and developed for over a month without apparent harm. This technology holds great hope to save premature babies, but the scientists came under criticism from abortion advocates who are afraid this technology could be used on human fetuses earlier than 22 weeks gestation, thus humanizing babies that are now being aborted.
This technology could save premature babies and minimize the high rate of disabilities they have if they survive. But the other side of that coin is that it could someday be used along with I.V.G to create baby farms. Why have the discomfort of carrying a baby? Why should a woman lose her girlish figure to have a child? Wouldn’t it be safer to have your baby grow where it can be continually monitored and receive ideal nutrition to give it the best chance of a healthy life? I can imagine the justifications already.
Bump! … Bump! … Bump! … Bump! … Bump! … Bump! … Bump!
Our technological abilities are growing at an exponential and uncontrollable rate. Our government and society can’t even ponder much less place the ethical fences needed around science before a hypothesis becomes a reality. Historical barriers are decimated at an alarming rate.
No matter the dangers or moral and ethical issues a new technology raises, as long as the endeavor is done with the intent of doing something good, these days it is accepted. That is the new mantra governing science.
Often the only reason to consult an ethicist is to have them create a logic framework that justifies what the scientist is already doing.
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