Tuesday, 9 August 2011

What Lay People Should Know about Cloning – Ethical and Legal Issues (technical) [Part 1]

by Zad Datu

Preceeding linked article (Read first!):
What Lay People Should Know about Cloning – Animal Reproductive Cloning
What Lay People Should Know about Cloning – Other Types of Cloning
What Lay People Should Know about Cloning – Fear Fuelled Objections (opinion) [Part 1] [Part 2]

Ethical Debates on Killing Embryos
As definitive as I have attempted to establish that human embryos are not humans in the previous article, I doubt that the debates would ever end. Defining what it means to be a person is very subjective and has caused many evil acts in the past. Slavery and the massacre of indigenous people were results of subjective definitions which disregards certain races as not people or not humans.

Many scientists and scientific books on embryology state that human life begins at conception. Some argues that conscious life only begins when the heartbeat develops, which is during the 5th week of pregnancy, or when the brain begins developing activity, which has been detected at 54 days after conception. One fact which I can insist on is that embryos do not and never did have conscious feelings and thoughts.

A report in the British Medical Journal states that foetuses cannot feel pain because it requires mental development that only occurs outside the womb. Also, according to Dr Stuart Derbyshire, of the University of Birmingham, a baby's subjectivity of pain is enabled by actions and relationships with carers. But interestingly and not surprisingly enough, pro-life groups say foetuses respond to stimuli from 20 weeks.

But scientist proponents of therapeutic cloning says that embryos are not equivalent to human life as they are still incapable of surviving outside the womb – that they are only potential humans. They state that more than a third of zygotes do not implant after conception, and that far more embryos are lost due to chance than are proposed to be used for embryonic stem cell research or treatments.

A rebuttal to this is that in some countries, a relatively high percentage of children die before a certain age. Should we allow killing of children? The way I see it, this is a bad analogy as these children are capable of experiencing pain and suffering, whereas embryos are not. Another rebuttal could be regarding comatose patient whom are technically described as those who cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. Since they are in such a state, should we allow the killing of comatose patients? The answer should be “no” because they have the potential of awakening just as those who are asleep where some who do not respond to pain in their sleep.

Coma can last from days to weeks and even years, where some regain consciousness to a stable condition, some to a vegetative state, and others die. Wouldn’t this mean that comatose patients are only potential consciousness, just as embryos are simply potential humans? Should we allow the killing of comatose patients? The difference between them and embryos is that the patients have already lived their lives as fully developed and conscious human beings whom had rights, ambitions and dreams. They do not just have the potential to regain consciousness, but potential to recover to the life they were living.

Babies born in a coma state are not and probably never were capable of pain and suffering. This is no different from embryos which never were capable of pain and suffering but only have the potential, and to define that babies aren’t fully developed humans is as valid of an interpretation as stating that embryos are not humans, since there isn’t a scientific fine line to define the matter. Is it then reasonable to kill babies born in such conditions? Surprisingly, I came up with this argument against my own logic by myself. Did I just defeat myself? I have a response to this, actually.

If the baby was intended to be raised as a son or daughter, which I certainly hope is the case, then of course it would be immoral to shatter the parents dream by killing the baby. But the parents should have the rights to have the baby subjected to euthanasia if all treatments to awaken the baby fail and if it’s concluded that nothing can be done. But if a comatose baby which never did and never will develop consciousness and experience suffering is produced with the intent to be killed and used for research and treatment purposes, if that is possible in the first place, as disgusting as I am going to sound, I suppose it isn’t a horrible act based on the “doing harm” logic for the baby. But it does harm the mother, so it is horrible. What kind of mother would be willing to go through the pain of labour for nothing? Neither I nor anyone would support such a procedure even if it is for research or treatment. Even if a woman is willing to be paid for such a procedure, there is a major concern – the exploitation of women’s body which may lead to a new form of human trafficking.

This is actually another interesting point made by opponents of embryonic stem cell research – that vulnerable women will be walking ovary factories exploiting their bodies, vulnerable to human trafficking. Former US president George W. Bush himself addressed this issue in his speech on April 10, 2002 to call back the senate to back the banning of human cloning where he says “This would create a massive national market for eggs and egg donors – an exploitation of women’s bodies that we cannot and must not allow.”

There already are about an estimate of 400,000 available frozen embryos in laboratories in the US alone which may never find its way into the womb as a result of in vitro fertilisation where only a selected few are implanted to successfully conceive a baby. Some of these excess embryos are implanted into adopted mothers to be born as healthy babies, some are donated to stem cell research, some are destroyed and some may not survive after long storage. So the argument is that we might as well use these embryos for stem cell research which kills them in the process rather than letting them die as waste. Some rebut this by questioning if it is then acceptable to kill those who are nearing their deaths for research purposes. The flaw in this rebuttal is that embryos do not and never did have conscious feelings and thoughts, whereas people nearing their deaths do.

Embryonic Stem Cells vs. Adult Stem Cells
Criticisms on the killing of embryos do not hold only for therapeutic cloning, but embryonic stem cell research as a whole. Besides criticising the field for the ending one life for the benefit of another, opponents of therapeutic cloning also criticise on the possibilities of therapeutic cloning, that they are just possibilities and has not produced any results of success, whereas the alternative technology of adult stem cells therapy has its successes in curing patients.

Human embryonic stem cells were first derived in 1998 by James Alexander Thomson from the University of Wisconsin-Madison who received patents related to a method of “isolating embryonic stem cells of humans and primates”, although there is an earlier documentation on the isolation of inner cell mass from a human blasocyst in 1994 by Ariff Bongso and colleagues from the Department of Obstetrics and Gynaecology, National University Hospital.

Even the first human cloned embryo by Robert Lanza of Advanced Cell Technology in Worcester, Massachusetts in 2001 only produced 3 embryos out of 9 Somati Cell Nuclear Transfers (SCNT) in which none reached the blastocyst stage. The largest stopped developing only after splitting into 6 cells after three days and the other two spitted to only 4 cells. The team also performed induced parthenogenesis (a form of asexual reproduction in females where development of embryos occur without fertilisation by a male which occurs naturally in plants, common in insects and few vertebrates but not humans) on 22 human ova which succeeded in developing 6 blastocyst, but none contained the inner cell mass of which stem cells are located. Induced parthogenesis is artificial asexual reproduction hence technically is cloning, but scientists often refer to “cloning” primarily to the SCNT method, and artificial parthenogenesis of ova as “induced pathogenesis” which can only produce females.

The first successful human cloned blastocyst via SCNT was announced only in February 2004 by Hwang Woo-Suk, a South Korean established as an expert in animal cloning of celebrity status after his well received claims of successes in creating a cloned dairy cow in February 1999, another cow later on April that year, and also a BSE-resistant cow as well as the intention to clone a Siberian tiger. This human cloned blastocyst success was published in March 12th Issue of Science. Later in May 2005, Hwang’s team announced to have created 11 human embryonic stem cells which was then published in June 17th issue of Science. Parallel to these successes, in the same month of the same year, Miodrag Stojkovic, professor of embryology and stem cell biology at Newcastle, and his colleagues succeeded in producing 3 cloned embryos which survived up to the blastcyst stage, but these were clones from human embryonic stem cells of discarded embryos and yet they failed to produce a stem cell line. Deceivingly, it turns out that all Hwang’s claims were fraudulent. There are still no stem cells from cloned embryos to date.

It was four years after the fraud, 17th January 2008, when the first matured human embryos were cloned via SCNT by Stemagen, a privately held embryonic stem cell research company in Carlifonia, as announced by the Chief Scientific Officer, Andrew French. Stemagen’s founder and CEO, Samuel H. Wood, one of the country’s most highly respected fertility specialists, used his own skin cells and 25 donated mature oocytes (the germ cells (mother cells) of ova) to produce five blastocyst. French said that “No other scientific group has documented the cloning of an adult human cell, much less been able to grow it to the blastocyst stage, the stage at which it is the adult donor cell that is driving embryonic development, the stage that yields the cells (the inner cell mass) from which embryonic stem cell lines are made.”

Apparently, this achievement had mixed reviews by the embryonic stem cell research community. President of California’s Stem Cell Institute, Alan Trounson said “(This) is a very challenging area, and there are not many players in it because of its difficulty,” adding “This is some of the best work I've read about in this area.” Director of the Human Embryo and Embryonic Stem Cell Center at Stanford University, Renee Reijo Pera, wasn’t impressed with the quantity or quality of the embryos as and called it “a reasonably small step forward.” Robert Lanza of ACT said that the report did not show the result of molecular tests scientists normally do to prove the completion of the cloning process and said “I'd really like to believe it, but I'm not sold yet.” Miodrag Stojkovic on the other hand defended the research by saying “Stemagen's work is the first time anyone has documented that this could be done with adult skin cells,” and that the work was important enough to be published in a scientific journal.

On top of these, embryonic stem cell research has still yet to overcome problems and challenges before shifting its theoretical potentials into reality. Scientists are most concerned about the development of tumours in the transplanted tissue, which has bee proven as an occurring setback in experiments with histocompatible animals. Scientists are yet determine an appropriate state and conditions of and for differentiation of embryonic stem cells into specialised cells before transplantation, and to establish protocols for these states and conditions. This is a difficult feat due to the speed at which embryonic stem cells grow which may be uncontrollable resulting in tumours. Targeting the differentiated cells to the appropriate part of the organ also proves as a hurdle.

Common rejections of transplanted tissues occur because all cells carry antigens by which immune systems recognise. There are countless numbers of possible combinations of antigens, and if the combinations do not match, the tissue is likely to be rejected. Due to this it seems that countless numbers of embryonic cell lines is required in a bank. The best solution for this is to create an embryonic stem cell line from the patient’s own genetic material for him or herself through therapeutic cloning. But experiments in mice results in rejection of tissues derived from the specimen’s own cloned embryos.

Even if each of these problems were solved, it is estimated that the cost for the procedure is over 200,000 USD in the US, as the budget for the human oocyte material alone, which is needed to generate a customised set of nuclear transfer embryonic stem cell lines for one patient, is estimated to cost form 100,000 and 200,000 USD. Only the very wealthy could afford this, making the technology impractical and expensive to ever become widely available. On the other hand, adult stem cells require little of no manipulation, and although relatively rare, they are readily available in the patients, making the cost far more reasonable than that of embryonic stem cells.

In contrast to the development human embryonic stem cell research, human adult stem cell research first began as early as the 60’s which even succeeded in treating a patient with severe combined immunodeficiency disorder in 1968. Types of adult stem cells range from blood-forming stem cells (hematopoietic stem cell) found in bone marrows, to mesenchymal stem cell which has the ability to differentiate into various types of cells and is also found in bone marrows (as well as placenta, adipose tissue, lung, umbilical cord, and even teeth), blood vessel lining stem cells (endothelial stem cells) which is also found in the bone marrow, mammary stem cell from mammary gland (milk producing organ), and to neural stem cell found in brain tissues, and more. Since the early 70’s, hematopoietic stem cells have been treating cancer conditions such as leukaemia and lymphoma – to recover the hematopoietic cells which were killed during chemotherapy.

Hematopoietic and stromal stem cell differentiation
[image from http://stemcells.nih.gov] (© 2001 Terese Winslow)

Scientists have also discovered that adult stem cells have more plasticity then once thought. It was discovered that multipotent (capable to differentiate to a limited number of cell fates) adult progenitor cells (MAPC) found in bone marrows seem to have ploripotent (capable of differentiating into all types of cell) potentials both in vivo and in vitro as they are said to be able to develop into all of the 210 different tissue types in the human body. This has been suggested as an alternative to embryonic stem cells.

Despite the facts of “embryonic stem cell vs. adult stem cell” presented by opponents of embryonic stem cell research and therapeutic cloning, there have been a small light of success in India. Dr. Geeta Shroff, an infertility expert became the first person to develop pure human embryonic stem cell lines developed from just one donated embryo from an IVF donor. She has been treating over 700 patients from all over the world including from the United States with conditions such as autoimmune disorders, cardiac disorders, Alzhimer’s disease, multiple sclerosis, renal failure, cerebral palsy, diabetes and mainly spinal cord injury, where many of those unable to walk for years find themselves taking their first steps after undergoing weeks of injections along with intense physical therapies since 2002 at the Nu Tech Mediworld hospital in New Delhi. The procedure costs around 20,000 to 30,000 USD and none of which showed any signs of side-effects. In India, there never were controversial issues and fusses made on the destruction of human embryo, and the Indian Council of Medical Research (ICMR) allows the use of embryonic stem cells only on conditions considered to be incurable and terminal.

Nevertheless, some scientists and stem cell researchers in the West consider that these patients flocking to Shroff are placing themselves at huge risk to undergo experimental treatments, as there is a lack of legislation governing the use of stem cell in India as well as other developing nations. As controversial fields are bound to have controversial issues, there are also criticisms mainly from the west on the legitimacy of her claims. This is mainly because instead of publishing her research to be submitted to peer-review, which is a common practice for good science, she patented her technology with the World Intellectual Property Organisation, covering over 126 countries. Criticisms have been worded as “patients could be injected with anything without knowing” and “taking advantage of desperate patients.”

But as in all cases, where there are opponents, there are proponents. The first American physician who visited the hospital, Dr. Laurance Johnston, director of the Spinal Cord Research and Education Foundations, Paralyzed Veterans of America and was a person of high credentials. He was impressed by Shroff’s treatment and was convinced that she is sincere and conscientious in her endeavors and also said “I think India is at the forefront of emerging stem-cell treatments in many ways.”

[Continue to [Part 2 (of 3)]
Sections in the part 2:
  • World Cloning Laws
  • Reactions on Animal Reproductive Cloning
Sections in the part 3:
  • Human Cloning Attempts
  • Human Cloning Debates
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