Is Fetal Tissue Research Justified?
As the human population increases and man learns more, his desire to deal with the afflictions that bother him increase. However, dealing with some of these afflictions has proven to be difficult as numerous cell types of the human body naturally lack an ability to divide. Almost two decades ago, the discovery that the human body has multi-potential stem cells, which scientists can harness and manipulate them to cause them to differentiate into a desired cell type increased the hope of dealing with afflictions of human tissues whose cells lacked an intrinsic ability to replicate (Vakili et al., 2015). The discovery that fetal tissues have pluripotent stem cells –those with the ability to differentiate into any adult human cells – further increased the hope (Levine et al., 2013). It is for this reason that humans became increasingly interested in fetal stem cell research. Apart from their ability to divide into numerous adult cell-lines, fetal stem cells also produce growth factors that enhance cell division and limit immune reactions. This research promised to deliver the cure to many degenerative illnesses, traumatic injuries, and chronic inflammatory conditions (Vakili et al., 2015). Numerous challenges have, however, hampered the progress of this research. Earlier studies revealed that despite their perceived benefits, fetal stem cells posed various risks to their recipients (Vakili et al., 2015). This discovery tended to encourage further research in the area rather than derail it. One key challenge that has curtailed the development of this area is the ever-continuing ethical debate. Further, this debate also has legal implications depending on the law of various countries. The fact that one has to harvest a fetus for them to acquire fetal cells for research, which is in itself abortion, is the key driver of these ethical and legal debates. Some people argue that abortion, especially when it is premeditated and done deliberately, is unethical and in some cases unlawful (Vakili et al., 2015). However, the potential benefits of fetal stem cells research including the management of neurodegenerative diseases and orthopedic cases, and the fact that many people are in full support of the research as it promises to save humanity from some of the most troublesome diseases fully justify the utilization of this technology.
The Science of Fetal Stem Cell Research
Stem cells are cells that can divide and replace other cells of particular tissues. Most human tissues, for example, the liver and the retina have their stem cells which usually divide to replace aged and lost cells of these organs and tissues (Jones et al., 2012). These stem cells are unipotent; they can divide into cells of only one cell line. However, stem cells in the human fetus have a greater potency; this means that they are able to divide into a greater range of cells (Jones et al., 2012). Most fetal stem cells are multipotent – they can divide into various related cells. Some adult stem cells are multipotent too. This unique feature of fetal stem cells that makes them theoretically advantageous over adult stem cells is their pluripotency – their ability to divide into numerous cells lines that form whole tissues or even organs. Such cells offer the advantage of having an ability to replace cells of tissues that lack stem cells and lack an intrinsic inability to divide (Jones et al., 2012). The potency of fetal stem cells is highest during the earlier stages of pregnancy. In fact, at the blastocyst stage, fetal cells are totipotent; totipotency means that these cells can divide and form entire organisms with the placenta.
The placenta itself is an important source of multipotent stem cells. Clinicians have applied placental stem cells of humans and other mammals in the management of traumatic injuries and other surgical problems in orthopedics (Jones et al., 2012). Placental stem, however, have one limitation – they have a limited ability to divide hence they are majorly used in the management of musculoskeletal system disorders or disorders that affect human tissues that are derivatives of the mesenchymal germ cell layer.
The higher potency of earlier fetal stem cells explains the preference of earlier and more primitive fetuses for fetal stem cell research. Moreover, scientists always attempt to use the safest stem cells for transplant into humans (Piroth et al. 2014). As such, fetal cells derived from elective abortions are the safest source of fetal stem cells for research. Some people have proposed that it would be more ethical to utilize fetal stem cells from fetuses expelled spontaneously. However, fetuses from spontaneous abortions are likely to have higher concentrations of microbial organisms hence posing a greater risk of infectious complications in the recipient of the stem cells. Additionally, spontaneous abortions have various causes including infections and chromosomal abnormalities (Piroth et al. 2014). Transplantation of cells with chromosomal abnormalities is likely to cause more complications than help to the recipient. Therefore, fetal cells derived from elective abortions are, by far, the safest.
Application of Fetal Stem Cells in Management of Neurodegenerative Diseases
Neurons are the basic cells and the most important cells of the nervous system. Neurons lack an intrinsic ability to divide (Clarkson, 2001). This feature of neurons poses a major challenge in the management of neurodegenerative diseases including Parkinson’s disease and Huntington disease. Degeneration of dopaminergic neurons in the pars compacta part of the substantia nigra is what causes Parkinson’s disease (Clarkson, 2001). The destruction of these neurons, which are a major source of dopamine, decreases the availability of dopamine in the central nervous system. Dopamine is an inhibitory neurotransmitter in the basal ganglia, which control motor activities. The neurotransmitter is, however, excitatory in other areas of the central nervous system (CNS) including the limbic system. The deficiency of an inhibitory neurotransmitter in the basal ganglia makes it difficult for the brain to control unnecessary motor signals (Clarkson, 2001). These signals are thus transmitted through various nerves to the motor end plates of muscles hence causing muscle contraction. These uncoordinated and largely unnecessary muscle contraction causes the clinical features of Parkinsonism including dyskinesia, rigidity, drooling, and incoordination (Clarkson, 2001).
Throughout history, clinicians have used various strategies to manage Parkinson’s disease. The most important of these strategies include the inhibition of muscle contraction that causes the major clinical features of the disease. However, this strategy only offers symptomatic relief; Parkinsonism continues to progress as more dopaminergic neurons are lost and the amount of dopamine keeps decreasing (Clarkson, 2001). In later years, scientists discovered the use of dopamine precursors which can cross the blood-brain-barrier and access the CNS. In the CNS, these dopamine precursors, including levodopa, are converted to dopamine. Levodopa is combined with carbidopa to prevent its conversion to dopamine peripherally; dopamine cannot cross the blood-brain-barrier (Clarkson, 2001). However, this strategy also does not alter the progression of the disease and the drugs used have various side effects.
The use of fetal dopamine stem cells, which scientists derive from the CNS areas of primitive fetuses and transplant into a recipient’s CNS with the hope that this can differentiate into dopamine cells promises to be curative for Parkinsonism. Clarkson (2001) reports that between 1988 and 2001, 300 American patients had received fetal stem cell transplants. The author also reveals that most of these patients showed improvements in their motor skills and coordination. Moreover, these patients were using lesser amounts of levodopa and their dependency on levodopa decreased. Moreover, the study revealed that the most significant effects of the transplantation occur in the first six months post-transplant (Clarkson, 2001). Further, the number of years of since disease onset do not predict the outcome of transplantation.
However, the transplantation of fetal stem cells poses various risks to the recipient. Piroth et al. (2014) posit that the most important of these risk is the possibility of bacterial and fungal infections. Fetuses and their stem cells are often contaminated; in the study, prospective testing revealed that 47.7% of all fetuses revealed bacterial growth. The practice of immunosuppression in transplant recipients further increases the risk of debilitating bacterial and fungal infections. However, Piroth et al. (2014) propose an elaborate strategy for stringent decontamination of the fetuses hence reducing or even completely dealing with the risk of infectious complications. As such, fetal stem cell research is relatively safe and promises to be curative for Parkinsonism.
Currently, fetal stem cell research is also focusing on the management of other neurological diseases like Huntington disease and multiple sclerosis. Huntington’s disease is a poorly understood neurodegenerative disease with a genetic basis (Piroth et al., 2014). For this reason, fetal stem cell research is highly justified as it looks to solve the problems of humanity and not to destroy fetuses.
Application of Fetal Stem Cell Research in Orthopedics
Apart from their potential to divide rapidly into cells of various cell lines, fetal stem cells also produce numerous growth factors and cytokines (Hanselman et al., 2015). These growth factors induce the growth and regeneration of other tissues wherever the fetal cells are transplanted. Moreover, the cytokines that the fetal stem cells produce mainly limit rather than encourage inflammation. The inhibition of inflammation prevents scarring thus enhance better tissue function after healing.
The ability of fetal stem cells to produce growth factors and various cytokines confer their usefulness in various fields of surgery, especially trauma and orthopedic surgery. Most connective and muscle tissues including bones, tendons, and ligaments lack an intrinsic ability to divide and lack stem cells (Hanselman et al., 2015). Consequently, in orthopedics, surgeons can apply fetal stem cells to heal difficult tendon and ligament tears, and non-healing fractures. Moreover, the cytokines produced by the fetal stem cells inhibit chronic inflammation and healing by fibrosis and hence enhance the function of the healed connective tissues. These attributes of fetal stem cells explain their application in foot and ankle surgery, especially in athletes where both the patients and their physicians desire quick and complete recovery of the affected tissues without derangement of function (Hanselman et al., 2015).
The growth factors produced by fetal stem cells confer their application in the management of diabetic and other chronic ulcers (Hanselman et al., 2015). After debridement of the ulcers, the application of fetal stem cells causes the surrounding cells to regenerate and tends to suppress extreme inflammation which can interfere with tissue regeneration. This practice enhances the healing of diabetic ulcers. Diabetic ulcers have been an important clinical problem in the past (Hanselman et al., 2015). Thus fetal stem cell research is highly justified as it promises to offer curative measures to surgical conditions that have troubled man in the past.
Fetal Stem Cell Research is Ethically Justified
Since fetal stem cell research promises to have great benefits to humanity, many people are in full support of it. Despite the various controversies, there are more humans in the developed world who feel that fetal stem cell research is justified. Allum et al. (2017) found that majority of people in Europe, the USA, and Canada are in full support of fetal stem cell research. In Europe, the perceived benefits of fetal stem cell research are key drivers of its high popularity. By the rules of democracy, the higher acceptability of stem cell research, despite its various controversies, justifies it (Allum et al., 2017).
`Allum et al. (2017) accept that in America, religious convictions are at the heart of either acceptability or unacceptability of fetal stem cell research. However, the study also found that unlike common expectations, most religious people in both Europe and North America are in full support of fetal stem cell research. Burgins (2009) further found that the members of the congress who opposed fetal stem cell research mainly did so because of inaccurate ideologies rather than factual realities. Some of these members were initially negative towards abortion and simply allowed this negativity to influence their vote. However, even for those who supported fetal stem cell research, their link or close relationship to potential beneficiaries of the technology such as patients with Parkinson’s disease tended to encourage the legislator’s support. Religious convictions were the most important reason cited by those who were against the technology; subscribers of Abrahamic religions like Christianity, Islam, and Judaism view abortion as close to murder and thus unacceptable (Burgins, 2009; Thomas, 2013). The fact that fetal stem cells pose greater risks to recipients compared to any other stem cells fuel traditional Christians’ opposition to fetal stem cell research. However, post-traditional Christianity, which targets to incorporate contemporary principles into the basics of religion, does not oppose the destruction of human embryos to research purposes in that aim at bettering man’s life in future (Thomas, 2013). Burgins (2009) tends to suggest that the moral debate over the legitimacy of fetal stem cell research tend to undermine a good thing rather than add value to it.
In his attempt to address this ethical dilemma, Green (2002) exposes the wrongfulness of abortion versus the potential benefits of the technology. The author exposes the beneficiaries of fetal stem cell research as accomplices in the unethical practice of abortion. This aspect is particularly true where the elective abortion is conducted specifically to provide stem cells for managing the condition of the potential beneficiary. Moreover, the author questions the possibility of the unethical practice of abortion increasing on the basis that it is potentially beneficial to the human race. However, the author dehumanizes the process of fetal cell division to form the pluripotential stem cells to conclude that it is ethical for opponents of abortion to benefit from fetal stem cell transplant since it is just one of the therapeutic options available to them (Green, 2002). As such, since the application of the technology even in its opponents is ethical, the whole practice is ethical and justified.
Gimbel (2017) also addresses this issue with a mirror of mutual benefit. The author asserts that most feminists, who fully support the birth by choice rhetoric, support abortion. Thus, fetal stem cell research is something that, in itself, justifies abortion. In other words, fetal stem cells not only benefit the practitioners and the patient benefactors but also the mothers to the embryos used as they are able to procure an abortion to a good cause. Even though it is unethical to pay the mothers for their embryos, provision of safe medical abortion to mothers who give their fetuses to this course massively benefits. However, Gimbel (2017) concluded that the fetal stem cell research is exploitative of poor young women from minority groups; a conclusion that is, in itself, biased. The author did not address the reason why the participants in their study wanted to procure abortions hence allowing it to be a confounding factor.
Therefore, a critical look at the issue of fetal stem cell research reveals that it is highly justified and a self-propagating thing. As Vakili et al. (2015) found out, even in the absence of funding from the federal government, sheer necessity and developments in other countries kept driving fetal stem cell research. Additionally, a critical look at fetal stem cell research justifies its wide acceptability; it is ethical. Many countries including the USA have laws that govern the use of human tissues and cells for research and therapeutic purposes (Vakili et al., 2016). Strict adherence to these laws and regulations renders the practice legal.
Conclusion
Fetal stem research has kept developing as it promises to enable man to achieve effective therapeutic measures for various afflictions. The technology promises to control diseases that man has struggled to control such as Parkinsonism, Huntington’s disease, and diabetic ulcers. Moreover, a critical view at the technology reveals that it is ethical and lawful. The technology is popular among many people including strict subscribers to Abrahamic religions. Moreover, since the technology promises more benefits than risks, it is ethical basing on contemporary ethics. Fetal stem cell research is highly beneficial to the recipients of the cells and the women who offer their embryos as they get a chance to have a safe and lawful medical abortion. Moreover, since the practitioners of the technology base their activities on the laws of the land, it is lawful. Thus, there is not ethical dilemma on fetal stem cell research. The ethical rhetoric that curtails the development of the technology is unnecessary. Fetal stem cell research is highly justified and is an area of science that governments should fully support.
Allum, N. A. (2017). Religion and the public ethics of stem-cell research: Attitudes in Europe, Canada and the United States. Plos One, 12(4), p1 – 14.
Abstract: We examine international public opinions toward stem cell research during the period when the issue was at its most contentious. We draw upon representative sample surveys in Europe and North America, fielded in 2005 and find that the majority of people in Europe, Canada and the United States supported stem-cell research providing it was tightly regulated, but that there were key differences between geographical regions in the relative importance of different types of ethical position. In the U.S., moral acceptability was more influential as a driver of support for stem-cell research: in Europe the perceived benefit to society carried more weight; and in Canada the two were almost equally important. We also find that public opinion on stem-cell research was more strongly associated with religious convictions in the U.S. than in Canada and Europe, although many strongly religious citizens in all regions approved of stem-cell research. We conclude that if anything public opinion or ‘public ethics’ are likely to play an increasingly important role in framing policy and regulatory regimes for sensitive technologies in the future.
Burgin, E. (2009, March). Deciding on human embryonic stem cell research. Politics & the Life Sciences., 28(1), 3-16.
Abstract: This paper examines the influences that congressional staff people viewed as important in shaping legislators’ voting decisions on the human embryonic stem (ES) cell research bill in the 109Th Congress, the first legislation voted by President George E. Bush. The analysis illuminates factors that impact congressional decision making on a salient issue with a strong moral component. Constituent concerns, ideology, and a desire to make good public policy all centrally affected members’ choices; however, moral overtones permeated considerations relevant to the human ES cell research question. In addition, at least three influences that directly reflect or relate to members moral claims- religious convictions, personal connections to potential beneficiaries of human ES cell research, and moral pressure from outside interests- were important also. The analysis draws on data gathered from interviews with congressional aides.
Clarkson, E. D. (2001). Fetal Tissue Transplantation for Patients with Parkinson Disease: A Database of Published Clinical Results. Drugs & Aging., 18(10), 773-785.
Abstract: Over the past 13 years approximately 300 patients with Parkinson’s disease have received transplants of human fetal dopamine cells in an attempt to reduce or control disease symptoms. Many of these patients have had improvements in their motor skills and a reduction in their daily levodopa administration. However, improvements are far from guaranteed and questions need to be answered before this technique can be widely applied. To help address some of these issues, a search of all the published results of patients with Parkinson’s disease transplanted with human fetal tissue was conducted. This generated a database of 70 transplant recipients who had their levodopa administration and clinical benefit reported both prior to transplant and at least 6 months post-transplant. Futhermore, the number of years of disease onset prior to transplant was available for all recipients. This database was examined for motor improvement and reduction in levodopa dosage for up to 2 years post-transplant to determine the effects of time on transplant outcome. The database showed that most recipients had significant improvements in motor skills and levodopa administration, and that most benefits were observed in the first 6 months post-transplant. In addition, the database demonstrated that the number of years of disease onset prior to transplantation was not a predictor of patient outcome 1 year post-transplant. Current and future directions in fetal tissue transplantation research and replacements for fetal tissue are discussed.
Fetal Tissue Research. Laws Governing the Use of Fetal Tissue in Medicine. (2015, October). Congressional Digest., pp. 5-32. Retrieved from http://www.congressionaldigest.com.mcneese.idm.oclc.org
Abstract: The author discusses the discusses the issues related to laws on fetal tissue research and abortion in the U.S. It mentions several laws and acts introduced in the country related to the issue including the National Institutes of Health Revitalization Act of 1993 (NIH Act), National Organ Transplant Act, and Health Research Extension Act of 1985.
Gimbel, V. N. (2017). FETAL TISSUE RESEARCH 7 ABORTION; CONSCRIPTION, COMMODIFICATION, AND THE FUTURE OF CHOICE. Harvard Jounal of Law & Gender., 40(1), 229-299.
Abstract: The use of fetal tissue in medical research has emerged from obscurity to the center of the abortion debate. So far, the political positions taken on either side of the fetal tissue research debate have mirrored those of the prochoice/pro-life camps, with self -described feminists largely coming out in support of the use of aborted fetuses in medical research. this Article reopens the question of whether fetal tissue research is actually good for women. Surely the right to abortion, and women who exercise it, are necessary for the continuation of fetal tissue research. But is the benefit mutual? Do the practitioners and beneficiaries of fetal tissue research give anything back to the women who supply their raw materials and support those women’s right to access safe abortion services? Or is the relationship between fetal tissue research and abortion somehow exploitive of women’s reproduction. While aborting women are barred from receiving any form of remuneration for fetal tissue donations, that does not apply to the upstream medical companies that process the tissue into usable clinical and pharmaceutical products. In this Article, I will discuss data on the demographic characteristics of women who have abortions and on the industrial process by which the aborted fetus becomes a commodity. Ultimately, I conclude that cutting women out of the industrial proceeds of fetal tissue research constitutes exploitation of their sexual and reproductive capacities– and disproportionately so for poor women and women of color. To make meaning of this conclusion, I argue that the policy discussion between fetal tissue research and abortion should be re-framed in terms of reproductive justice. I will examine feminist and critical race jurisprudential and bioethical theories to develop a critique of the fetal tissue economy, and imagine what policy interventions, if any, might mobilize that economy towards reproductive justice.
Green, R. M. (2002, Nov). Benefiting from “Evil”: An Incipient Moral Problem in Human StemCell Research. Bioethics, 16(6), 544-556.
Abstract: When does benefiting from others’ wrongdoing effectively make one a moral accomplice in their evil deeds? If stem cell research lives up to its therapeutic promise, this question (which has previously cropped up in debates over fetal tissue research or the use of Nazi research data) is likely to become a central one for opponents of embryo destruction. I argue that benefiting from wrongdoing is prima facie morally wrong under any of three conditions: (1) when the wrongdoer is one’s agent; (2) when acceptance of benefit directly encourages the repetition of the wrongful deed (even though no agency relationship is involved); and (3) when acceptance of a benefit legitimates a wrongful practice. I conclude by showing that, because of the ways in which most embryonic stem cell lines come into being, people who oppose embryo destruction may use human embryonic stem cells without incurring moral blame.
Hanselman, A. (2015). Topical Review: Use of Fetal Tissue in Foot and Ankle Surgery. Foot & Ankle Specialists, 297-304.
Abstract: Fetal tissues are well known for their therapeutic potential. They contain numerous growth factors, cytokines and matrix components that promote regeneration of tissues while downregulating inflammation and scar formation. As a result, use of these treatments has expanded over the previous 20 years throughout various surgical specialties, including orthropedics. With improved methods of sterilization, processing, and storage, surgeons need to be informed about the potential benefits of fetal tissue in foot and ankle surgery. The aim of this review is to provide a brief historical background, basic anatomy and physiology, and a current review of the literature in regard to chronic wounds, diabetic foot ulcerations, plantar fasciitis, tendon repair, adhesion prevention, nerve repair, and bone healing.
Jones, G. N.-I.-M. (2012). Ontological Differences inFirst Compared to Third Trimester Human Fetal Placental Chorionic Stem Cells. Plos One., 7(9), 1-15.
Abstract: Human mesenchymal stromal/stem cells isolated from fetal tissues hold promise for use in tissue engineering applications and cell-based therapies, but their collection is restricted ethically and technically. in contrast, the placenta is a potential source of readily-obtainable stem cells throughout pregnancy. In fetal tissues, early gestational stem cells are known to have advantageous characteristics over neonatal and adult stem cells. Our results provide insight into the ontogeny of the stemness phenotype during fetal development and suggest that the more primitive characteristics of early compared to late gestation fetal chorionic stem cells may be translationally advantageous.
Levine, A. L. (2013). The orrigins of human embryonic stem cell research policies in the US states. Science & Public Policy (SSP)., 40(4), 544-558.
Abstract: Stem cell research has emerged as a state-level science and technology policy issue in recent years in the USA, with some states supporting research in the field and others choosing to restrict it. In this paper, we systematically explore the factors that are associated with US states’ adoptions of both supportive and restrictive stem cell policies. Our analysis identifies several factors, including partisan politics, existing morality policies, the strength of a state’s scientific community and the policy environment in neighboring states, which influence the adoption of state stem cell policies. Our paper aims to advance the science and technology policy literature by providing insight into the factors that push states to adopt science policies when economic development goals conflict with ethical concerns.
Piroth, T. P. (2014). Transplantation of Human Fetal Tissue for Neurodegenerative Diseases: Validation of a New Prorocol for Microbiological Analysis and Bacterial Decontamination. Cell Tranplantation, 995-1007.
Abstract: Restorative cell therapy in neurodegenerative diseases are aimed at replacing lost neurons. Despite advances in pluripotent stem cells, fetal tissue from routine elective abortions is still regarded as the only safe cell source. Progenitor cells isolated from distinct first-trimester fetal CNS regions have already been used in clinical trials and will be used again in a new multicenter trial funded by the European Union (TRANSEURO). Bacterial contamination of human fetal tissue poses a potential risk of causing infections in the brain of recipients. Thus, effective methods of microbial decontamination and validation of these methods are required prior to approval of a neurorestorative cell therapy trial. We have developed a protocol consisting of subsequent washing steps at different stages of tissue processing. Efficacy of microbial decontamination was assessed on rat embryonic tissue incubated with high concentrations of defined microbe solutions including representative bacterial and fungal species. Experimental microbial contamination was reduced by several log ranks. Subsequently, we have analyzed the spectrum of microbial contamination and the effect of subsequent washing steps on aborted human fetal tissue; 47.7% of the samples taken during human fetal tissue processing were positive for a microbial contamination, but after washing, no samples exhibited bacterial growth. our data suggests that human fetal tissue for neural repair can carry microbes of various species, highlighting the need for decontamination procedures. The decontamination protocol described in this report has shown to be effective as no microbes could be detected at the end of the procedure.
Thomas (Joseph), B. (2013). Human Embryonic Stem Cell Research: Its Importance in the Culture Wars. 19(1), 60-71.
Abstract: The debate surrounding human embryonic stem cell research plays a crucial role in the culture wars. Those who embrace post-traditional morality not only see no ethical problem with the destruction of human embryos for research and therapies, but press fot their use despite the greater potential for risk from the totipotent cells that are harvested from the destruction of human embryos as opposed to other kinds of stem cells. Indeed, there have been foreseeable negative consequences from such attempts at treatment. Nonetheless, from the standpoint of traditional Christianity, the destruction of human embryos is expressly forbidden regardless of any potential positive outcomes. There is a fundamental cleft within the culture on such issues.
Vakilil, K. M. (2015). progress in human Embryonic Stem CellResearch in the United States between 2001 and 2010. PLoS ONE, 10(3), 1-8.
Abstract: On August 9th, 2001, the federal government of the United States announced a policy restricting federal funds available for research on human embryonic stem cell out of concern for the “vast ethical minefields” associated with the creation of embryos for research purposes. Until the policy was replaced on March 9th, 2009, no U.S. federal funds were available for research on hESCs extracted after August 9, 2001, and only limited federal funds were available for research on a subset of hESC lines that had previously been extracted. This paper analyzes how the 2001 U.S. federal funding restrictions influenced the quantity and geography of peer-reviewed journal publications on hESC. The primary finding is that the 2001 policy did not have a significant aggregate effect on hESC research in the U.S. After a brief lag in early 2000s, U.S. research maintained pace with other areas of stem cell and genetic research.
