Stem Cell Policies Around the World - Research Paper Example

Stem Cells Institute’s Introduction Stem cell research has been one of the most prominent developments by mankind and its discovery has been credited to two scientists, James Till and Ernest McCulloch. They also defined the two key properties of stem cells namely self—renewal and their ability to differentiate into several kinds of cells (James Till 1931, n.d). Their discovery has now led to the development of promising cure for a wide range of diseases ranging from diabetes to Parkinson’s disease. There are many sources of stem cells used in research and these include embryonic, fetal and adult stem cells. Among these, the use of embryonic stem cells has been the most debated and opposed as scientists maintain that of the many potential sources embryonic stem cells have a greater degree of pluripotency and hence could be a good source of a variety of cell types, while at the same time religious groups have vehemently opposed the use of embryos for research (Stem Cell Information, 2011). While a large community of the medical and scientific fraternity has acknowledged its importance and wide implications in treatment, religious groups seem to have a varied status with regard to stem cell research. However, considering the enormous benefits that humans stand to gain from the use of stem cells due to its inherent ability to liberate humans from mortal sufferings stem cell research needs to be avidly supported by the public and governments. What are stem cells Stem cells constitute a class of cells which are unspecialized and have the ability to divide infinitely and differentiate into many types of body cells. This totipotent ability is attributed to their inherent nature of dividing into various types of cells even after long periods of inactivity. This nature of stem cells enables it to serve as a repair system within the body and continuously replenish the cells within the body. When the stem cells remain in their unspecialized state they cannot perform any specific cells functions. However, when these cells are induced under specific experimental and physical conditions they are capable of differentiating into specific cells such as a heart cell, blood cell or nerve cell which form the specific tissues or organs. Stem cells are primarily obtained from two sources namely the embryos and the non-embryonic somatic stem cells (Stem Cell Information, 2011). The isolation of human embryonic stem cells by Dr. James A. Thomson and its potential use in treating various diseases marked the beginning of the widely debated issue about stem cell research (AAAS Policy Research, 2010). Embryonic stem cells are isolated from embryos and most of the embryos that are used for stem cell research are obtained from embryos that have been fertilized invitro and after getting the required informed consent of the donors. The somatic stem cells on the other hand are isolated from specific tissues or organs. These cells are also present in an undifferentiated state and can be induced to differentiate into certain specific cell types of the body. One of the most commonly used somatic stem cells are the hematopoietic stem cells which are isolated from the bone marrow and which differentiates into the various blood cells under suitable conditions. These cells have been widely used in transplantation processes. Apart from the bone marrow somatic stem cells have also been found in other body tissues including brain, heart, skeletal muscle, skin, teeth, liver ovarian epithelium and testis. Each type of stem cell give rise to their specific tissue cells or in some case can be induced to give rise to other types of cells. For example brain cells can be induced to differentiate into cell types other than the brain cells such as the blood cells (Stem Cell Information, 2011). Embryonic tissues are considered to be one of the best sources of stem cells and while mouse embryos were used initially, scientific advances have allowed the isolation of stem cells from human embryos. Totipotent stem cells give rise to all types of cells within the body including the extra embryonic tissues such as the placenta. Embryonic cells obtained in the first couple of divisions are examples of totipotent stem cells. All other embryonic stem cells are referred to as pluripotent stem cells which can also give rise to the different cells of the body except the extra embryonic tissues such as the placenta (Thomson et al, 1998). In addition, embryonic stem cells are also found in abundance compared to the lesser number of adult stem cells that can be isolated. However, one major disadvantage associated with embryonic stem cells is the possibility of rejection during transplantation as they are obtained from fertilized embryos. Adult stem cells which are isolated from the patient’s own body is less likely to be rejected following a transplant (Stem Cell Information, 2011). Medical Uses of Stem Cells Stem cell research has been one of the most prominent developments promising cure for a wide range of diseases ranging from diabetes to Parkinson’s disease. As they have the inherent ability to differentiate into various cell types their use could alleviate the need for organ donation. In addition to saving lives application of stem cells on human health can also reduce recurrent healthcare costs globally (Caulfield et a,2009). The human embryonic stem cells are the master cells of the body which have the potential to develop into any cell of the human body. These cells were first isolated in the year 1998 by researchers at the University of Wisconsin, under the guidance of Dr. Thomson, from the inner cell mass of the human embryo. Ever since researchers have focused on the ability of these stem cells to treat dysfunctional tissues by generation of new cells. With these cells scientists believe that several diseases such as Alzheimer’s, Parkinson’s, Diabetes, Multiple sclerosis and other nervous and metabolic conditions can be treated (Thomson et al, 1998). This work by Dr. Thomson and his colleagues was not funded by the federal government’s primary sponsor for biomedical research, National Institute of Health (NIH) as the Congress had placed a ban on NIH- funded research on human embryo in the year 1995 and until 2001 there was no public funding for human embryo research. The ban prevented both the creation and the destruction of human embryos for research purposes. However, considering the potential of the discovery in 1998, the NIH appealed to the Department of Health and Human Services (HHS) about the funding for human embryonic stem cell (hESC) research. In 1999, the HHS concluded that public funding could be allowed for hESC research provided the derivation of these cells was carried out with private funds (Duffy, 2002). One of the most important medical applications of human stem cells is in cell-based therapies. There is an increasing demand for organs and tissues in transplantation processes. However, the demand for compatible organs and tissues for transplant is much more than the available supply. The use of stem cells which are taken from the person requiring the transplant offers an immediate and compatible source of cells. Stem cells are being used as potential sources of cure for cardiovascular diseases through regeneration of damaged heart tissues. Stem cells derived from the embryos and somatic tissues have been successfully used in animal models for the purpose of cardiac repair (Stem Cell Information, 2011). Thus stem cell research can potentially solve the problem of side effects that could arise from transplanting another person’s organs and also meet the insufficient supply for organs and in finding out new remedies for incurable diseases. Organ transplantation is being widely considered as an accepted medical treatment especially in cases involving terminal stage organ failure. According to a United State of Health and Human services Administration report about 28,953 people have received organ transplants in 2013. In general, there are about seventy-nine people who receive organ transplants in average each day. On the contrary, the data also reveals that on an average there are about eighteen people who die each day due to the considerable lack of transplantable organs. The use of stem cells can alleviate this situation and save the lives of millions of people worldwide (The Need is Real: Data, n.d) Despite the increasing demand for organ transplant, there are also several side effects to the treatment which in most cases involves immune reactions that develop in response to the newly transplanted cells. The immune system protects the human body against invading foreign organisms or antigens which it eventually attacks and destroys. In the case of whole organ transplants the individual’s immune system may recognize the new cells or organs as foreign and start an immune attack against it. The side effects from the resulting attack could lead to decreased organ function and pain or swelling in the area of transplant. Hence recipients are required to take immunosuppressive drugs as a life-long measure in order to prevent such an attack. However, these are in turn associated with very high cancer risks. The use of stem cells taken from the same patient can help to lessen the immune rejection response. Following stem cell isolation from the patient, they are cultivated under laboratory conditions and then used for the transplant process. Organ transplant using stem cells from the same individual is associated with minimum complications such as bleeding, anemia, infections and liver damage. In the case where the stem cells are obtained from a donor, graft versus host disease may occur when the compatibility is less. Symptoms of this include rashes, itchy skin, hair loss, gastric problems and liver damage (Sachs, J, n.d). Philosophical Issues related to stem cells There are many philosophical debates of the stem cell research, especially embryo stem cell research as it involves the use of fertilized embryos. Buddhism has a clear definition as to when life begins. According to their doctrine life begins once the fusion of the egg and the sperm takes place and thus embryos are considered to be a living form of an individual. When these embryos are used as a source of stem cells their life has essentially been damaged. But given the fact that stem cells are utilized for the purpose of saving lives, Buddhism takes a more pro-active stand with respect to embryonic stem cell research. Buddhist advocates focus more on the intention behind the killing of the embryos and according to them stem cell research is one of the processes of unraveling the science and mystery of life with the intention of saving millions. They hold a strong belief that destruction of life is related to karma. As how embryos are being destroyed by abortions or miscarriages which are considered to be due to its karma, likewise destruction of embryos is also believed to have happened due to a karmic influence. Use of stem cells is likened to the Bodhisattva doctrine which claims that in times of human suffering from sickness, a bodhisattva sacrifices his life for their benefit which is considered as an act of donation. Thus while taking a more pro-stem cell research stand Buddhism also calls for lowering the inflictions caused to the embryos through its optimal usage and providing treatment and cure for as many individuals as possible (Prompta, 2004). The Catholic Church has taken a strictly opposing stand to embryonic stem cell research while it supports research using umbilical cord and adult stem cells. Like Buddhism, the Catholic Church believes that life begins when sperm and egg fuse which is considered to be the time of infusion of the soul. According to them from the time of conception the fertilized ovum is to be considered as a complete human being as it possesses a complete set of the human genes and hence its rights as a human need to be respected (Richert, n.d). The church has argued that a good end obtained through killing of a life can only breed evil for the future. While stating that every human being is destined to die, death brought about in an unnatural and willful manner is a crime which cannot be accepted. It also prohibits the killing of spare embryos created for in vitro fertilization stating that no individual has the right to kill even such abandoned embryos (O’Brien, n.d). While use of embryos has been strongly opposed use of stem cells from other sources such as adult and fetal umbilical cord blood and tissues has been supported by the church (O’Brien, n.d). Ethical issues related to stem cells The moral and ethical issues associated with hESC research are related to the beginning of life following fertilization. While the people opposing the research believe that human life begins immediately after fertilization and not ant any specific stage of development and that the use of the human embryo is against the moral code (AAAS Policy Research, 2010). This also applies to the thousands of unused embryos in fertility clinics which are likely to be discarded. It is considered to possess an intrinsic value irrespective of whether it gives rise to a baby or not (Wertz, 2002). Those favoring the research have argued that only those embryos which implant in the uterus can be considered to be capable of giving rise to a human being. Using embryos which fail to implant or the excess embryos which are created in fertility clinics and left unused for research purposes would be morally fair rather than discarding them (AAAS Policy Research, 2010). The cultural factors that differentiate the views on embryo research between the United States and European nations includes: the government is answerable to the majority religiously fervent population as nearly 40% of the population attend church services, the politically active anti-abortion laws in the US and the inability to control the free enterprise of embryo research companies who are left to pursue their own goals (Wertz, 2002). The NIH draft guidelines released in 1999, during the Clinton presidency, allowed research on hESC from unused or leftover embryos in fertility clinics and those which were donated with the consent of the donor. The guidelines, which came into effect in 2000, faced mixed reviews from supporters and opponents of hESC research. But, the NIH received several grant applications for work with hESC and a committee was also established to review suitable proposals for approval. The encouragement for hESC research did not continue in the next government under President Bush as he vehemently opposed the use of embryonic stem cells for research. Thus after he became President, the NIH guidelines were withdrawn and ordered for a review in the issue. While several scientists, biotechnology companies and other organizations lobbied with the President to reintroduce the federal funding for hESC research, the Catholic Church and other anti-abortion groups resisted the move. In his response to federal funding on hESC research, President Bush declared in 2001, that the government would allow funding only for existing hESC cell lines thereby putting an end to all the speculation on the issue. He stated that as embryonic destruction had already occurred to create the existing cell lines, they could be used for research with federal funding but no further public funding would be allowed for creating new cell lines in the future. This decision, however, drew a mixed response with the proponents of hESC research arguing whether the existing cell lines would be sufficient to carry out enough research and those against the research both praised the president for limiting the research to existing cell lines and also criticized that no research should be allowed even with the existing cells (AAAS Policy Research, 2010). The decision by the Bush administration was based on reports that there were 64 cell lines in various laboratories across the world and it also released a report of 10 entities that created the cells lines and also announced the plan to create a stem cell registry by which information about those cell lines which were available for public funding would be provided. As a further step the President also announced the setting up of a President Council on Bioethics which will oversee all the ethical and legal issues related to stem cells and also the federally funded research on hESC. The NIH launched the Human Embryonic Stem Cell Registry in 2001 and by the year 2002, the registry listed 78 cell lines that were eligible for publicly funded research. However, the suitability of these cell lines for research use and also the delay in their availability for distribution to research institutes resulted in many experts calling for a reform of the President’s policy which was further supported by public pleas. Letters from 206 representatives and another from 58 senators requesting for leniency on the stem cell issue were handed over to the President. With the support of nearly 189 bipartisan house members the legislation H.R 4682, the Stem Cell Research Enhancement Act of 2004 was introduced which called for the need of increasing federal funding for stem cell research and also to allow the use of embryos donated from IVF clinics for deriving stem cells. This bill was rested. As another move to promote stem cell research the NIH in 2004 announced plans for setting up a stem cell bank by which the available stem cell lines would be consolidated to one location (AAAS Policy Research, 2010). The reintroduction of the Stem Cell Research Enhancement Act H.R. 810 in the year 2005 saw favorable gains as it was passed by the house with a bipartisan vote of 238-194. Following this the bill was also passed in the Senate with a vote of 63-37 along with two other bills, S.2754 which called for research methods for obtaining cells similar to hESC and S.3504 which prohibited the establishment of fetal farms. The bills were then placed in the suspension calendar, which is a speedy voting process, in which only S. 3504 was passed and the President subsequently passed S.3504 and vetoed H.R.810. However, following this lag in hESC research several states such as Florida and California took up the cause and initiated their own funding for hESC research. The S.5 bill which was again passed in the Senate in 2007 was also vetoed by President Bush. The Obama government pledged support to increase federal funding for stem cell research and when he took office, President Obama issued an executive order by which guidelines for expanding the existing stem cells lines were to be framed within 120 days. In addition, the Stem Cell Research Enhancement Act and another new bill, Stem Cell Research Improvement Act was also introduced again. In 2009, the NIH published a new set of guidelines which allowed federal funds for the use of donated leftover embryos in fertility clinics for research but only after an informed consent was obtained from the donors. It would also continue to fund research on adult stem cells. However, it maintained that funding will not be provided for research using embryos created specifically for research purposes or stem cells obtained by cloning or parthenogenesis. In a further set of guidelines the NIH decided that the quality and use of the older stem cell lines will be evaluated by an NIH advisory panel. According to the Dickey-Wicker amendment no federal funding would be provided for research that creates or destroys a human embryo. In 2010, a preliminary injunction for the NIH funding of hESC research was issued based on two lawsuits that were filed by scientists from Boston and Seattle who claimed that such funding would cause them irreparable injury as they are likely to prevent funding for their adult stem cell research work. The injunction was later temporarily stayed in order to hear the oral arguments, following which a three-member judge panel ruled in favor of continuation of federal funds for hESC research (AAAS Policy Research, 2010). Thus as a result of several ethical and cultural views there is no specific policy or rules that govern stem cell research. Hence every country has developed their own policies and guidelines for the use of stem cells in research. Among the Asiatic countries, China prohibits human reproductive cloning while allowing the creation of human embryos for therapy. The government allows researchers to carry out stem cell therapy for chronically and terminally ill patients. In China the stem cell policies are unrestrictive as they allow leftover embryos in IVF clinics, fetal cells obtained from abortions and from blastocysts. The Japanese government allows stem cell research though no formal guidelines are followed. The Policy of the Council for Science and Technology allows stem cell research for therapeutic purposes. Singapore, which harbors more than 40 stem cell groups, has authorized the use of embryos which are less than 2 weeks old. India has created several stem cell banks which store embryonic stem cells for future therapeutic use. While it has banned reproductive cloning, therapeutic cloning is permitted. Guidelines for stem cell research have also been issued by the Indian Council for Medical Research. While Australia has banned all human cloning experiments, leftover embryos in IVF facilities can be used for research. South Africa bans reproductive cloning while therapeutic cloning is allowed and is the first African nation to start a stem cell bank. Among the European countries, Belgium has banned reproductive cloning but has allowed therapeutic cloning of embryos. France both prohibits reproductive cloning as well as the creation of embryos for research. But a legislation passed in 2004 has allowed the use of excess embryos from fertility clinics for research and another guideline in 2006 allowed scientists to create their own cell lines from these embryos. The German law is restrictive towards stem cell research and bans the creation of embryonic stem cells. Only imported stem cells lines can be used for stem cell research and therapy purposes. Italy also has strict embryonic stem cell research limitations as the law prohibits donation of sperms and eggs and also the freezing of embryos. However, research on imported stem cell lines is permitted. Spain has legalized therapeutic cloning and also has established a stem cell bank and centers that are involved in stem cell research. Therapeutic cloning is supported by the Swedish government, in addition to setting up a stem cell bank. According to the Human Fertilization and Embryology Act in the UK embryos can be destroyed for deriving embryonic stem cells provided the research proposes to use the stem cells for developing potential treatments for diseases or uses it to study the development of embryos. Embryos remaining after assisted reproductive facilities are allowed for research in Switzerland. The Brazilian government allows the use of excess embryos in fertility clinics that have been stored for more than 3 years despite the Catholic Church challenging the law. The stem cell laws in Mexico are not subject to any regulations and doctors have been using stem cells to treat ailments such as cerebral palsy and autism. Canada allows the use of discarded embryos from fertility clinics for use in research but prohibits the creation of embryos (Dhar & John Hsi-en Ho, 2009; Ralston, 2008). Middle Eastern countries such as Israel have also made several important contributions to stem cell research beginning with the extraction of stem cells from blood. Stem cell research in this country focuses on its use in regenerative medicine and treatment for diseases such as diabetes. Even in Saudi Arabia a fatwa issued in 2003 allows the use of embryos for therapeutic and research purposes (Ralston, 2008). From the utilitarian view point right actions are those that result in the most beneficial balance of good over bad consequences for everyone involved in the process. In their view, utilitarian advocates the stem cell research because of the tremendous benefits that it would provide to millions of people afflicted with diseases worldwide. One of the strong advocates of stem cell research and more specifically the use of embryonic stem cells has been actor Michel, J Fox. He was diagnosed with young-onset Parkinson’s disease and later started a foundation to aid people affected by this disease. The Foundation actively supports embryonic and the more recent induced pluripotent stem cells for the treatment of Parkinson’s disease. Fox’s argument has primarily centered on the use of leftover embryos from in vitro fertilization clinics as a potential source of stem cells. He argued that instead of discarding these embryos they could be used to save lives. The Foundation had also supported the initial work on the development of dopamine neurons from embryonic stem cells which served as the proof of principle for the use of embryonic stem cells in Parkinson’s disease. This was followed by several state and federal funding towards stem cell research for Parkinson’s disease (Stem Cells and Parkinson’s Disease, n.d). Another avid supporter of embryonic stem cell research was Christopher Reeve who immortalized the fictitious character of superman on the silver screen. The actor was left paralyzed following an injury to the spinal cord which he suffered during a horse riding accident in 1995. He strongly believed that stem cells which were obtained from embryos had the potential to cure several life threatening diseases and injuries including spinal cord injuries. He also dismissed the need for debate on the use of stem cells in medical treatments and urged researchers and governments to carry out research and provide sufficient funds required for the studies. While he understood that the use of adult stem cells had lesser chances of rejection, he urged scientists to work simultaneously on embryonic stem cells which he believed could provide quicker benefits to people like him with spinal cord injuries as well as other who would stand to gain from the treatment. Comparing the present battle for embryonic stem cell research funding to that of the 1980s struggle to get federal support for AIDS research, Reeves stressed that a similar grassroots movement was needed to promote embryonic stem cell research. He was confident that with cities such as California allowing stem cell research from all sources, the potential of embryonic stem cells as a cure for spinal injuries and several other diseases and conditions could definitely be tapped in the near future (Goodenough, 2008). References AAAS Policy Research: Stem Cell Research. (2010). Aaas.org. Retrieved 9 June, 2011, from http://www.aaas.org/spp/cstc/briefs/stemcells/ Caulfield, T et al. (2009). International stem cell environments: a world of difference. Nature Reports Stem Cells, doi: 10.1038/stemcells.2009.61 http://www.nature.com/stemcells/2009/0904/090416/full/stemcells.2009.61.html Dhar. D & John Hsi-en Ho. (2009). Stem Cell Research Policies around the world. 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