Bioethics and the Stem Cell Research Debate

Article excerpt

Since its birth in the 1970s, bioethics--the study of ethical issues in science and medicine--has grown to become a significant academic and service-oriented discipline with its own research centers, conferences, journals, and degree programs. As these issues have moved to the center of public debate, the law has assumed an increasingly important place in the discipline of bioethics.

The growing importance of the law as a forum for the debate and mediation of bioethical issues is apparent on several fronts. In the United States Supreme Court, bioethical issues have been central to key reproductive privacy cases, from the Court's 1973 decision in Roe v. Wade, 410 U.S. 113, to its 2000 decision in Stenberg v. Carkart, 530 U.S. 914, which struck down a controversial Nebraska partial-birth abortion law. In state courts, bioethical considerations inform judges' balancing of patient health care confidentiality with a "duty to warn" of potentially dangerous patient behavior (see, for example, the California Supreme Court's landmark 1976 decision, Tarasoff v. Regents of the University of California, 17 Cal. 3d 425). At both the state and federal levels, bioethical debates help shape end-of life statutes and court cases, including Cruzan v. Missouri Dept. of Health, 497 U.S. 261 (1990), in which the U.S. Supreme Court upheld the State of Missouri's requirement for clear and convincing evidence that a person in a persistent vegetative state had expressed a wish not to be kept alive by life-sustaining equipment.

Today, embryonic stem cell research stands out as a critically important issue about which we have neither ethical consensus nor clear, comprehensive regulation. The ethical debate centers on the fact that stem cell research involves the destruction of very early human embryos. On the federal level, funding for stem cell research has been limited to research using stem cells derived from a limited number of stem cell "lines"' On the state level, approaches range from legislative restrictions on stem cell research to the State of California's plan to provide $3 billion in stem cell research funding through the voter-approved California Institute for Regenerative Medicine.

In order for potentially revolutionary stem cell research to progress, scientists' long-term needs must be effectively coordinated with appropriate and effective ethical and legal guidance. This article provides brief scientific background and then discussion of key ethical and legal/regulatory issues that surround embryonic stem cell research.

Background

Embryonic stem cells are precursor cells that have the capacity to divide for indefinite periods of time in culture and to give rise to virtually any type of specialized cells in the body They are derived from the inner cell mass of a l00-cell blastocyst--a very early embryo, usually only 3-4 days old--long before the cells have started to specialize to create a nervous system, spine and other features that, with further development, would transform the embryo into a fetus. Typically, these cells are derived from embryos that originally were created for infertility treatment purposes through in vitro fertilization, but that are no longer desired or needed by the infertile couple for treatment. The extraction of the stem cells from the blastocyst necessarily requires the destruction of that blastocyst.

Because embryonic stern cells are capable of self-renewal and can differentiate into a wide variety of cell types, potential applications of embryonic stem cell research are far-reaching. For example, embryonic stem cell research holds out great promise to those suffering from Type I diabetes. Type I diabetes is an autoimmune disease characterized by destruction of insulin-producing cells in the pancreas. Some of the current efforts to treat these patients use donated human pancreases for transplantation of islets-clusters of cells on the pancreas that produce insulin-in an effort to restore the insulin-secreting function. …