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Stem Cells

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Science News. Public Framing. Patient's Own Stem Cells Provide a Tailor-Made Jawbone ... Breakthrough Isolating Embryo-quality Stem Cells From Blood (Science Daily) ... – PowerPoint PPT presentation

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Title: Stem Cells


1
  • Stem Cells
  • Implications for
  • Catholic HealthCare
  • Philip Boyle, Ph.D.
  • Vice President, Mission Ethics
  • www.CHE.ORG/ETHICS

2
Etiquette
  • Press 6 to mute
  • Press 6 to unmute
  • Keep your phone on mute unless you are dialoging
    with the presenter
  • Never place phone on hold
  • If you do not want to be called on please check
    the red mood button on the lower left of screen

3
Goals for todays conversation
  • Explore challenges for Catholic health care
  • Review the Science
  • Review public policy options

4
Moral Considerations
  • Catholic health care
  • What if embryonic stems cells become standard of
    care?
  • How much oversight in use of alternatives?
  • MDs staff privileges for those who utilize?
  • MDs prescription in privacy of doc-pt
    relationship?
  • How to provide staff and community education?

5
  • Review science
  • Embryonic adult stem cells
  • Alternatives
  • Dead embryos
  • IVF
  • Micro gravity primitive umbilical cells
  • Biopsy
  • Dedifferentiation
  • Altered Nuclear Transfer
  • Use existing lines

6
Public Policy Options
  • Compromise
  • Moral pluralism
  • Restraining worst alternatives

7
Public Framing
  • Matters of Life and Death
  • Adult stem cells restore feeling in paraplegic
  • 19 Years as a Paraplegic
  • Korea Report
  • WorldNetDaily.Com
  • Fetal tissue heals burns
  • Skins cells of aborted fetus successfully healed
    severe burns in 8 children
  • Washington Post,

8
Public Framing
  • Doctors Use Teens Stem Cells In Procedure To
    Repair His Heart
  • A 16-year-old shot in the chest with a nail gun
    has undergone the nations first procedure to
    repair dying heart muscles using his own stem
    cells.
  • The Wall Street Journal
  • Stem Cell Surprise Blood Cells Form Liver,
    Nerve Cells
  • A persons blood could someday provide
    replacement cells for that individuals damaged
    brain or liver, a provocative study suggests.
    Human blood contains so-called stem cells that
    can be transformed outside the body into a
    variety of cell types, according to the
    report.
  • Science News

9
Public Framing
  • Patient's Own Stem Cells Provide a Tailor-Made
    Jawbone
  •  
  • Scientists in Finland have replaced a 65-year-old
    patient's upper jaw with a bone transplant
    cultivated from stem cells isolated from his own
    fatty tissue and grown inside his abdomen,
    Reuters reported.
  • Researchers said the breakthrough opens up new
    ways to treat severe tissue damage and makes the
    prospect of custom-made spare parts for humans a
    step closer to reality.
  • "The use of a patient's own stem cells to grow a
    new jaw is a great example of how personalized
    medicine is becoming a reality," said Dawn Vargo,
    associate bioethics analyst for Focus on the
    Family Action. "Despite all the talk about using
    embryonic stem cells to create personalized
    therapies, this displays the practical and timely
    advantages of adult stem cells."

10
  • Advance Made in Stem-Cell Debate (Washington
    Times)
  • Compound Can Hasten Harvest of Adult Stem Cells
    (Health Day)
  • New Zealand New Adult Stem Cell Surgery for
    Paraplegics Could be Done in Dunedin (NZPA)
  • Breakthrough Isolating Embryo-quality Stem Cells
    From Blood (Science Daily)
  • Paralyzed Lynn Man Has Surprising View on Stem
    Cell Debate (Daily Stem)
  • Bone Marrow Stem Cell Hope for Liver Disease
    (BBC)
  • Umbilical Cord-Blood Transplants Save Lives of
    Babies with Rare Genetic Disorder, Krabbe's
    Disease (Medical News Today)
  • www.stemcellresearch.org

11
Public Opinion
  • 63 support ESC
  • 28 oppose ESC
  • ABC Wash Post-- April
  • 12 following closely
  • 46 following somewhat closely
  • 42 not following closely at all
  • CNN/USA Today/Gallop--May
  • 52 oppose federal funding
  • USCCB

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22
Alternative Sources
  • Micro gravity primitive umbilical cells
  • Dead embryos
  • Previously frozen embryos that fail to divide
    within 24-hour period
  • Organismically dead
  • Discarded human embryos (IVF)

23
Alternative Sources
  • Biopsy 1 cellblastomere extractions remove 1 or
    a few cells from 6-8 cell
  • De-differentiation
  • Use somatic cells and restore them to
    pluripotency
  • E.g., Lop of newts tail or leg it regenerates
  • Protein from newts regenerated mice muscles

24
Alternative Sources
  • Altered Nuclear Transfer
  • Creating biological artifacts resembling embryos
    but incapable of developing into humans
  • Remove nucleus from oocyte
  • Replace with somatic cell that has been altered
    so new entity would not be able to develop
  • Reprogram the trophectoderm (outer sheath) so not
    to form properly
  • Oocyte-assisted reprogramming (OAR)
  • Fusing cells
  • Use existing lines

25
Ethical issues
  • Accurate and fair terminology
  • Cloning for Children
  • Cloning for Biomedical Research
  • Obligations of Catholic institutions
  • Public Policy issues

26
The Language
  • Activity
  • Cloning
  • Asexual reproduction
  • Reproductive cloning
  • Non-reproductive cloning
  • Research cloning
  • Therapeutic cloning
  • Somatic cell transfer (SCNT)
  • Nuclear transfer for stem cell research
  • Regenerative medicine

27
Entity
  • potential human being
  • human clone
  • human SCNT
  • cell egg
  • activated egg
  • totipotent cell
  • reconstituted egg
  • clump of cells
  • blastocyst
  • clonecyst
  • embryo

28
Relationships
  • genetic copy
  • replica
  • genetically virtually identical
  • non-contemporary twin
  • delayed genetic twin
  • clone

29
Language
  • Whats at stake is whether SCNT should be
    considered cloning.
  • Using the term cloning prejudices the activity
  • Using many terms obscures the public debate
  • Also at stake is the moral status. To call it an
    embryo, some argue, is to unfairly prejudice, but
    not to use it hides the full import of cloning
    for biomedical research
  • Clonereplica, not a zygote

30
Cloning for Children
  • Purposes
  • Allow infertile couples to have genetically
    related children
  • Permit couples at risk for genetic disorders to
    avoid having an afflicted child
  • Allow bearing of child who could become an ideal
    transplant donor
  • Allow parents to keep connection with dying or
    dead child
  • Replicate persons of talent or beauty

31
Objections
  • Violates ethics or research
  • High rates of morbidity and morality/ unsafe and
    unethical
  • Identity and Individuality
  • identical to someone else who has already lived
  • Concerns regarding manufacturing
  • 1st children to be totally designed in advance
  • more like a product than a gift and accepted as
    they are
  • Promote commercialization and industrialization
    of human procreation
  • Prospects of new eugenics
  • Serve as individualized eugenic enhancements,
    avoid defects


32
Objections
  • Troubled family relationships
  • Strain between generations
  • Fathers as twin brothers to their son
  • Mothers give birth to genetic twins
  • One parent reproduction could strain family life
  • Effects on society
  • Effect the way society looks at children
  • Novel control of the next generation

33
Cloning for biomedical research
  • Opportunities
  • Important knowledge on embryological development
  • Treatments for dreaded diseases
  • View
  • A. Non-moral status of embryo
  • B. Intermediate moral status of embryo
  • C. Moral status of embryo

34
Moral status of cloned embryo
  • Continuous history of human individuals from
    fetal life of infant
  • Special respect for nascent human life
  • Exploitation of developing human life
  • By permitting this, nascent life is a tool
  • Coarsen our moral sensibilities
  • Moral harm to society
  • Approve of control of nascent life
  • Open door to reproductive cloning
  • Federal government mandating the destruction of
    human life
  • What we owe the suffering

35
Obligations of Catholic institutions
  • 1. Knowledge
  • Drug development Toxicity
  • Cell development
  • Cooperation, toleration complicity
  • Mainly opaque to user
  • 2. Applications

36
Obligations of Catholic institutions
  • Therapies
  • Clearly unacceptable
  • Embryonic stem cells
  • Clearly acceptable
  • De-differentiation
  • Umbilical cord
  • Ambiguous
  • Dead embryos
  • Biopsy
  • Altered nucleus
  • Existing lines

37
Obligations of Catholic institutions
  • Ambiguous
  • Dead embryos IVF extras
  • Is it permissible to used doomed embryos?
  • No loss argument for those who accept the
    humanity of the embryo and absoluteness of the
    prohibition of intentional killing, the no loss
    argument does not provide an exception to the
    prohibition
  • Biopsy
  • Pre-implantation genetic diagnosis (PGD)
  • Biopsy totipotent or pluripotent?

38
Obligations of Catholic institutions
  • Existing Lines before moratorium? (Bush and
    German govt)
  • Is use of federal funding on existing lines an
    unprincipled exception?
  • Crafted to allow some research without
    encouraging destructions
  • Is this moral cooperation, toleration, or
    complicity?
  • No one can cooperate in doing what has already
    been donedid not cooperate with the destruction

39
Obligations of Catholic institutions
  • Existing lines
  • Is this moral cooperation, toleration, or
    complicity?
  • One tolerates only what one might prevent
  • They did more than tolerate by allowing the
    research on already dead embryos
  • Complicity they have excluded on going
    relationships by setting a date after which no
    use. Thus, no encouragement

40
Practical considerations
  • What if embryonic stems cells become standard of
    care?
  • How much oversight in use of alternatives?
  • MDs staff privileges for those who utilize?
  • MDs prescription in privacy of doc-pt
    relationship?

41
Practical considerations
  • What about partnerships and joint operating
    agreements?
  • What about institutions with teaching programs?
  • Proactive partnerships for alternatives
  • Staff and community education?

42
Public Policy issues
  • Morally acceptable compromises?
  • 1. Multiculturalism and moral pluralism
  • If deep moral disagreement, no ban but no funding
    either
  • 2. Compromises not to facilitate destruction but
    to stop or limit regulation
  • Protect embryos as well as they can
  • Materially implicated, materially cooperating

43
  • In a case like the one just mentioned where a
    legislative vote would be decisive for the
    passage of a more restrictive law, limiting the
    number of authorized abortions, when it is not
    possible to overturn or completely abrogate a
    pro-abortion law, an elected official whose
    opposition to abortion is well known, could
    licitly support proposals aimed at limiting the
    harm done by such a law and lessening its
    negative consequences at the level of general
    opinion and public morality. This does not in
    fact represent an illicit cooperation with an
    unjust law, but rather a legitimate and proper
    attempt to limit its evil aspects.
  • John Paul II, Evangelium Vitae

44
Conclusions
  • Framing
  • Clarity of language
  • No rush to judgment
  • Examine scientific alternatives
  • Proactive, not reactive
  • No need for train wreck
  • Partnerships
  • Education
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