by Anton-Lewis Usala, M.D.
On August 23, 2000, the National Institutes of Health (NIH) issued final guidelines for federal funding of human embryonic stem cell research. Senate hearings quickly followed on a bill to fund the destruction of human embryos for their stem cells. On February 23, 2001, President George W. Bush received a letter urging him to support federal funding for such research. This letter was signed by eighty Nobel laureates, and came on the heels of a similar letter signed by 123 organizations sent the previous month.
What are these "stem cells" and why this enormous interest in them?
Briefly, stem cells are cells that have the potential to become many other kinds of cells, depending on the signals they receive. They theoretically provide avenues for replacing damaged or non-functioning tissue to treat many kinds of diseases. Stem cells are found from the beginning of embryonic development throughout adult life. Some researchers believe that stem cells found in the embryo provide more potential for regenerating tissue than do stem cells taken from older, adult donors.
The question arises: Since human embryonic stem cells may provide the basis for some medical miracles, shouldn't the federal government fund research utilizing "spare" embryos from in vitro fertilization (IVF) clinics? Wouldn't this be a better use for discarded embryos than destroying or freezing them as is currently done?
To address the question whether government funding should support human embryonic stem cell research, we need to consider the following:
- What is the scientific and medical rationale for considering this line of research and its alternative?
- What are the secular ethical arguments pro and con?
- What are the legal and jurisprudential considerations?
The reader will notice that religious arguments are not a part of this list. As I testified to a Senate subcommittee on this issue last September, it became very evident that while religious arguments would be politely listened to, they served as a convenient opportunity to dismiss contrary views. Many legislators take a literalist view of "separation of Church and State," hence they dismiss religious arguments as perhaps a valid personal view, but not worthy of a substantive response in a secular arena.
Catholic teaching strongly opposes any procedure that willfully terminates innocent human life, from the time of conception until natural death. Jesus Christ taught that each human being is important to God, and each is responsible for his or her own actions. Individuals will be judged not by the goodness of those around them, but by how well they personally have lived according to God's Word.
Fortunately, the essence of these points can be found in a revered document in secular law. All societies are based on the rule of law, even unjust societies. What distinguish a just from an unjust society are the legal precedents accepted as the basis for its jurisprudence. In my view, the United States is a uniquely just society, because it is the first government in the history of mankind in which the rights of the individual supersede the perceived rights of the State. The individual is the most valued entity in society. This precept is found in the first ten amendments to the United States Constitution, commonly referred to as the Bill of Rights.
This is the crux of our argument in the secular world–and one which coincides with the teachings of Jesus Christ–that the individual human being is the most sacred and inviolable entity in our society, and can never be seen simply as an object or as raw material to be used for the public good, even so demonstrable a good as another's health or life.
Scientific and Medical Rationale for Considering Human Embryonic Stem Cell Research
Medical science now provides no definitive therapy for many debilitating diseases. In fact, with the exception of antibiotics and other infectious disease therapies, medical science offers few definitive cures for human disease. Most therapies either control the disease, slow its progression, or palliate its effects.
The ability to regenerate poorly functioning or damaged tissue might provide definitive therapy for many of the above diseases. The ability to regenerate central nervous system structures may help paraplegics regain the ability to walk. Regeneration of parts of the brain that make dopamine might cure Parkinson's disease. Regeneration of the pancreatic tissue that makes insulin could conceivably cure diabetes.
Some medical researchers use cells that have not yet differentiated into specific kinds of tissue, and therefore might be induced to become the kind of tissue needed to treat a specific disease. These pluripotent stem cells are abundantly present during embryonic development (when most cells are just beginning to differentiate, or specialize), and become less abundant as the organism matures into adulthood. However, stem cells are apparently present throughout human life.
Studies in animals, and some preliminary studies in humans, have shown the ability of adult stem cells to improve various conditions associated with disease. Studies using human embryonic stem cells as a treatment do not yet exist. One misleading conclusion drawn from those favoring embryonic stem cell research is that it is a "medical breakthrough." It is not. It is an interesting idea favored by many scientists at NIH and leading universities.
As a person having diabetes 41 of my 42 years, I have seen many theories espoused by the NIH and leading academics proven disastrously wrong. Until the early 1990's, the NIH and leading academic medical centers showed, in study after study, that the degree of blood sugar control made no difference in the onset of devastating circulatory complications associated with diabetes. At ten years of age, I thought this was nonsense. Nature kept blood sugar levels in a tight range for a reason, so I surreptitiously began taking injections of fast acting insulin before I ate. For that reason I am alive to tell you the story. Now, of course, everyone knows blood sugar control is the single largest determinant of whether or not someone with Type I diabetes develops circulatory complications.
There is also a huge difference between promising research and the ability to turn research into a medical product. It takes years to conduct the basic science research, and many more years to turn discoveries into a usable medical therapy. Products that are now in human clinical trials are years ahead of any new basic science effort in, for example, embryonic stem cell research, now being proposed for federal funding. I founded a company, Encelle, Inc., to fund research on potential therapies for diabetes and other diseases requiring replacement of destroyed or non-functioning tissues. As my approach was outside the NIH approach, we did not seek funding from traditional NIH or foundation sources until very late in our development. Instead, we sought private investment.
We are in our first human clinical trials with a product that we believe regenerates human tissue. Preliminary results are very exciting, and seem to confirm what we have found in animal studies—that exposure of patient tissues to our product after only a one-time injection regenerates complex tissue structures, resulting in healing of chronic skin ulcers. Our material (a co-polymer artificially synthesized to resemble connective tissue structures found during embryonic development) apparently induces de-differentiation followed by explosive differentiation to regenerate completely integrated tissue. These results have been demonstrated in four different species of animals, and we are awaiting results in our first human trial.
Along with greater understanding of cellular differentiation comes the scientific realization that defines the human being. At the Senate subcommittee hearing, I was impressed that those both for and against human embryo research said the human embryo should be treated with respect. I gave the following dispassionate definition of what was human in my testimony:
Replication of specific tissue requires cells to receive an enormous number of specific signals. What defines a human life is the cellular mass that is able to produce and integrate this enormous number of sequences, that occurs shortly after fertilization. The cascade of specific cellular differentiation begins, and continues throughout the adult life of the person. It can be argued when the reasoning of the fetal organism begins; it cannot be argued when it is human.
While embryonic stem cell research may be a popular idea, there are other exciting therapies that are much further along in development and that do not require the destruction of embryonic human beings. To cite a few recent examples: adult rat brain cells successfully generated rat muscle tissue; stems cells from umbilical cord blood became "brain tissue [when injected into rats' brains], maturing into the type of cell appropriate for that area of the brain"; cow skin tissue was reprogrammed to its stem cell state and then transformed into heart tissue; human thigh muscle from a patient has been turned into contracting heart muscle cells; and researchers have converted human fat cells obtained through liposuction into bone, muscle and cartilage cells.
Secular Ethical Arguments
There are many ethical arguments put forth both for and against the use of human embryonic stem cells for medical research. Here is one case in favor of such research, provided in the September 2000 Senate subcommittee testimony of Dr. Richard Hynes, Professor of Biology at M.I.T.:
[We] believe it would be immoral not to pursue embryonic stem cell research ... because this research has such enormous potential to save human lives and to mitigate human suffering....... Surely, we should take advantage of the enormous life-saving potential of the thousands of embryos that are currently frozen and destined for destruction. ... We owe it to all those who are suffering to explore all possible avenues that could lead to the prevention of, and remedies for, disease.
But the premise that because the need is great, the effort should be great and ALL possible avenues explored, is clearly not ethically valid. If an adult does not give consent to be an organ donor, states do not presume the right to use that person's organs for transplantation, even if the person is dead. Much less would any state instruct researchers in how to kill him by harvesting his organs while he is still alive. In this case, the developing human entity, cannot give consent to be sacrificed–hence using precepts of natural law, the State should not subsidize and promote that sacrifice. Catholics, along with Americans of many other religious backgrounds or none, believe that each individual has rights and duties, including a duty to respect the existence of other individuals. Simply to claim that the research potential is promising has not been seen as sufficient to justify funding countless other approaches to curing disease, many of which present no ethical problem. So one cannot reasonably demand funding for this research on the basis that it may have potential to one day mitigate disease, without taking into account the fact that it involves the destruction of living embryonic humans.
The ethical arguments that support fetal or embryonic research assume that the fetus and embryo do not have rights equal to individuals further along in their development (i.e., older). In short, one must define the embryo as a human cell mass that does not have the same right to life as us, more differentiated cell masses. If that assumption were correct, would it then be unethical not to have embryo farms in order to save the further differentiated human beings who we value more? And which other groups of undeveloped, underdeveloped or no longer productive humans may we apply this premise to next?
Legal and Jurisprudential Considerations
The medical and scientific basis for funding embryonic stem cell research is debatable. The ethical basis hinges on accepting a ranked valuation of humans according to how far they have developed. The most compelling secular argument against funding lies in its conflict with the Bill of Rights.
The Bill of Rights establishes a government whereby the rights of the individual supercede the perceived rights of the State. George Mason, the author of the 1776 Virginia Declaration of Rights (part of Virginia's State Constitution) on which was modeled the Bill of Rights, was a delegate to the Constitutional Convention in Philadelphia. He was one of three delegates who would not approve the U.S. Constitution unless it included such a Bill of Rights. Without this, Mason believed, the "Government would end either in monarchy, or a tyrannical aristocracy; which one, he was in doubt, but one or other he was sure." James Madison convinced Mason to support Virginia's ratification of the U.S. Constitution by assuring him that his Bill of Rights would be added as amendments. Madison kept his word.
Mason believed that unless the people retained their ability to defend the specific individual rights articulated in the first ten amendments, just government would eventually devolve into one in which the majority could inflict injustice on less favored groups. Thus the rights of the individual have been protected throughout the history of the republic. When debate on what constitutes human life reaches a flash point, as with slavery and now with abortion, the premise of one side had to be defeated. In the case of slavery, it took the Civil War to establish the precedent that all people are worthy of Constitutional protection.
In the case of abortion, an interesting paradigm has developed. Since, at the time of the Roe v. Wade decision, a majority of Supreme Court justices stated uncertainty about when life begins, they allowed the right of one individual to take precedence over the right of another. The right of the mother to terminate her pregnancy took precedence over the right of her developing child to live. But now, by proposing federal support for human embryo research, the State will be deciding the best use of an individual for the State's purposes, for the first time in American law.
Abortion is not performed for any government-assigned purpose in the United States as, for example, in China. It is performed at the request of one individual, the mother, to terminate the life of another individual, the unborn child. Federally sponsored and approved research that endorses using human embryos for social good is a cataclysmic paradigm shift. The NIH, with federal support, will for the first time determine that human individuals can be used and destroyed in medical experimentation in the interests of the State.
As I told the Senate subcommittee:
History has amply demonstrated the ghastly consequences when government arbitrarily defines what constitutes human life. I am not suggesting that those who want to use human embryonic tissue are of the same mind. However, the law is based on precedent, and once the United States allows the individual human embryo to be sacrificed for a perceived greater good, the greatest defense for the rights of individuals will have been eroded.
We are not alone in our religious conviction that God created human beings as the most precious creation on earth. Like Jesus, Mohammad also broke from standard religious thought of the time by suggesting that individuals were responsible for their own behavior, and that Allah cared for each one of us. Earlier still, the Genesis account dramatized how individuals' choices, including the choice whether to take the life of another individual, can transform our world for better or worse. The U.S. Constitution incorporated these precepts in fashioning a workable model of government that has produced the greatest civilization in history.
It is our duty as Americans to prevent the destruction of the Bill of Rights through trivializing the protection it affords all individuals, including embryos. It is our calling as Catholics to protect our smallest, most vulnerable treasures. As part of this calling, it is also our responsibility to find God's Word in secular documents such as the United States Constitution–learn it, articulate it, and live it so as to conduct our lives consistent with the teachings of Jesus Christ.
Dr. Usala, a pediatric endocrinologist, is Chief Scientific Officer and Medical Director of Encelle, Inc.