Scientists have recently developed a safe and efficient method to create induced pluripotent stem (iPS) cells from adult skin cells. Many opponents of embryonic stem cell research hail this news as an important step away from research methods that rely on destroying embryos. Despite this advance, the future of iPS cell research involves challenging moral and legal issues.
The therapeutic promise of stem cell research rests on using pluripotent stem cells, which can be grown into many of the types of cells found in the human body. Until recently, such cells could be produced only by destroying human embryos and harvesting embryonic stem cells. Opponents of embryonic stem cell research (ESCR) sought a method of producing pluripotent cells without destroying embryos. Their goal was to show that adult cells, rather than embryos, could provide the raw material for stem-cell therapy.
In 2007, scientists demonstrated that they could transform human skin cells into iPS cells, bypassing the destruction of embryos. While opponents of ESCR hailed this announcement as a sign that iPS cells could provide the full therapeutic promise of ES cells, the methods were still in their infancy. It took about a month for the iPS cells to develop, and very few transformations were successful: 99.9% of treated cells failed to transform. Besides being slow and unreliable, the techniques were dangerous. Viruses were used to insert specific genes into the adult cells, which increased the cancer risk for the stem cells and thus for prospective patients receiving stem cell therapy. Without a safer technique, the promise of iPS cell research remained in the future.
That future is now. On September 30, researchers led by Derrick J. Rossi, Ph.D., at the Harvard Stem Cell Institute reported a novel technique for producing iPS cells from adult skin cells that is fast, reliable, and safe. Instead of viruses, Rossi’s team transformed skin cells using messenger RNA (mRNA), producing iPS cells two times faster and one hundred times more reliably than the virus techniques. Most importantly, the mRNA method does not raise the cancer risk for the iPS cells. While there is still room for improvement in the method’s efficiency, scientists in the field view Rossi’s discovery as a major breakthrough. Robert Lanza, chief scientific officer at Advanced Cell Technology, likens it to “turning lead into gold.”
Opponents of ESCR have applauded the discovery as well, citing its potential to render obsolete research methods that destroy embryos. Richard Doerflinger, Deputy Director of the Secretariat for Pro-Life Activities at the United States Conference of Catholic Bishops, commented: “With each new study it becomes more and more implausible to claim that scientists must rely on destruction of human embryos to achieve rapid progress in regenerative medicine.”
With the new mRNA method for producing iPS cells the prospects for iPS cell research are better than ever. In this respect, opponents of ESCR should welcome the news. They should be aware, however, that it is no moral panacea.
To begin with, demand for embryonic stem cells will continue in the near future. In order to determine that the transformations work properly and the cells are safe for therapeutic use, researchers need to compare the iPS cells to ES cells, which means destroying embryos. In the long run, fewer embryos may be destroyed in stem-cell research as research shifts to iPS cells; but this transition may take years.
The moral complications of the new state of the art go even deeper, due to an advance that scientists anticipate within a decade: using iPS cells to create human sperm and egg cells. Scientists will be able to create an entire embryo using ordinary skin cells or other adult cells, without ever using gametes harvested from a person. This method, which we might call gameteless reproduction, makes in vitro fertilization look like child’s play and gives us more control than ever over human reproduction. The prospect of gameteless reproduction not only makes even more pressing the ongoing debate about the morality and legality of human cloning, but also raises moral and legal questions that are not widely known and discussed, even among the staunchest opponents of ESCR.
First, there are the moral issues connected with the procedure itself. Like Somatic Cell Nuclear Transfer (SCNT), the method used to clone Dolly in 1996, gameteless reproduction raises the question of the morality of cloning and other kinds of asexual reproduction, since it allows the creation of an embryo from one or more tissue donors. However, gameteless reproduction has the potential to transform reproduction even more dramatically than SCNT. Unlike SCNT, gameteless reproduction uses easily obtainable adult tissue and does not require donated ova, which can be obtained only through a highly invasive procedure. It will thus be a dramatically cheaper and easier route to asexual reproduction, and may therefore be much more widely used than SCNT. Due to its advantage over SCNT, gameteless reproduction may over time replace IVF as the assisted reproductive technology of choice. Since it allows reproduction without donated sperm or eggs, gameteless reproduction expands the possibilities of reproduction. In principle, young children or deceased persons could become parents of embryos used in research. Moreover, gameteless reproduction may erode the link between procreation and any kind of family context: single persons, for example, could create an embryo using only their genetic material. As a result, children could be increasingly—and tragically—viewed as products, rather than the fruit of a loving relationship. Most importantly, like other non-conjugal methods of conception that sever the procreative and unitive aspects of human sexuality, gameteless reproduction is intrinsically immoral.
Despite the anticipated development of gameteless reproduction and the serious moral questions it raises, this technique (like SCNT) is permitted under federal law. Only six states (Arkansas, Indiana, Iowa, Michigan, North Dakota, and South Dakota) have laws against therapeutic cloning, but only the Indiana law is broad enough to cover gameteless reproduction. We should expand existing prohibitions on cloning to cover gameteless reproduction as well.
Apart from these issues with the procedure itself, gameteless reproduction will also give parents an extraordinary level of control over the genetic makeup of their children. What moral principles govern these choices? Are parents morally required to create the “best” possible children? And should the law prevent parents from choosing to create children with disabilities?
Every human life is worth living, even a life beset by extraordinary hardship or disability. This is the foundation for protecting all human life, including the very young, the very old, and the physically and mentally disabled. It is therefore never wrong, in and of itself, to choose to bring a new human life into existence, though it may be wrong to do so with certain intentions, in certain circumstances, and through certain means. As I said earlier, non-conjugal reproduction is intrinsically immoral, and this is so because it involves an impermissible means of conception. In itself, however, choosing to conceive a child is a fundamentally good act. I therefore reject the view held by Joseph Spoerl (Professor of Philosophy at St. Anselm College), who has argued that choosing to conceive a child is to treat the future child as a means to the parents’ ends, since the child does not yet exist and therefore cannot be benefitted by the choice. On the contrary, in choosing to conceive, parents are taking the necessary first steps for their child to come into existence; provided they are not making these choices for selfish reasons, they are not treating their child as a means only and are acting permissibly. This is a delicate issue, and I firmly agree with Ryan T. Anderson that we need to devote more attention to the intrinsic moral status of reproduction.
In recognition of the goodness of conception in itself, we should protect the choices of parents to have children who share their disabilities. If deaf parents foresee that conceiving a child through a conjugal act would result in a congenitally deaf child, that choice is morally permissible and should be legally protected. It does not follow that deliberately choosing a deaf child through embryonic selection is permissible.
There’s another argument in favor of protecting the reproductive choices of the disabled. The law not only governs our behavior but also expresses our values. Prohibiting parents from knowingly conceiving a severely disabled child, on the grounds that their doing so would lead the child to have a life not worth living, expresses profound disrespect for the value of each human life. Importantly, even if it’s controversial that every life is worth living, it’s arguable that the law should proceed as though it were true because not doing so would dishonor those who live with disabilities. How can society claim to value the deaf, or those with other disabilities, if it requires that their children not resemble them in these respects?
Though it is seldom discussed among opponents of ESCR, there is a further set of issues that gameteless reproduction raises: how should we regulate tissue donation in light of future advances in reproductive technology? Donating tissue for scientific research will soon mean donating tissue that can be used to grow a sperm or egg; tissue donors could then become parents at the whim of the researchers possessing their tissue. While it has always been important for tissue donors to have some control over what procedures are done with their samples—some donors might be comfortable with certain kinds of research, and others might not—informed consent will be more important than ever once a simple cheek swab provides the raw material for someone to be a mother or father. There is disagreement in the courts and legal academy about whether there is a constitutional right not to be a parent; there should be no dispute that it is gravely immoral to make someone a parent (even of the most nascent form of human life, the embryo) without their informed consent.
The current law governing informed consent for tissue donation is woefully inadequate for protecting tissue donors in light of anticipated progress with iPS cell research. Informed consent is required when donating tissue for therapeutic research, in which the patient stands to benefit from the treatment being tested; violating the informed consent requirement is a tort. However, when donors give tissue to non-therapeutic research, in which they will not benefit from experimental treatment, violating informed consent is punished through administrative measures, like denial of federal funding. This minor response is clearly inadequate for the moral gravity of using someone’s tissue to make them a parent without their consent.
Moreover, once the tissue has been donated, there is no further risk of harm to the donor. This means that there is no legal informed consent requirement whenever obtaining a consent waiver is impractical and the tissue can no longer be linked back to the donor. If these two conditions are met, which is not uncommon, there are no restrictions related to informed consent for how researchers can use a donor’s tissue. In the absence of a sufficiently wide ban on human cloning and gameteless reproduction, or a legally protected right not to be a parent, researchers in these scenarios have a legal green light to make tissue donors parents without any kind of consent; this is profoundly immoral and should be a legally actionable tort.
As new advances alter the possibilities of human reproduction, we must develop a morally sound body of law governing stem cell research and tissue donation. Science studies momentum and other physical quantities but it also has its own momentum, which we must harness to promote the common good.