The Ethics of Human Embryonic, Fetal Stem Cell and Fetal Tissue Research

Recently, the issue of conducting research on human embryonic stem cells (hESC), human fetal stem cells (hFSC), and human fetal tissue has been coming up more frequently in the media and in politics. The issue is two-fold: is research using such human material ethical, and should government funds be allocated to such research?

People on one side of this issue argue this practice is necessary for scientific advancement, will benefit vast numbers of people by developing treatments for various diseases, and is ethical because no valuable human is being harmed in this research. Therefore, federal and/or state funds should be allocated for such research (i.e., through grants or awards).

On the other side of the spectrum, people argue that similar research can be carried out with adult stem cells or fetal stem cells from cord blood, that many people are already benefiting from treatments resulting from adult stem cells, that human embryonic and fetal stem cell and tissue research is unethical because it requires the killing of a living human being, and that such research should be completely illegal and/or unfunded by the government.

Which side is right? How can we, as a society, conduct research which is both ethical and has the opportunity to help many people?

Let’s start with some scientific and research basics in order to explore this issue.

Stem cells are cells which can give rise to many different types of cells and are able to replicate infinitely (or for a very long time). Besides being labeled according to which stage of life they are present in— embryonic, fetal, or adult— they can also be labeled according to how flexible their ability is to give rise to different cells.

Embryonic stem cells can be totipotent or pluripotent, depending on the specific embryonic stage of development. Totipotent stem cells are those which can give rise to a whole human organism. A zygote is the first of the embryonic stages of human development and is formed from the union of a sperm and an egg cell. The human zygote consists of totipotent stem cells. After approximately four days, the totipotent stem cells differentiate into two cell layers, inner and outer. A human at this stage of embryonic development is referred to as a blastocyst. A human blastocyst’s inner layer of cells are pluripotent. Each pluripotent stem cell can go on to form any cell type in the developing human body. The main difference between pluripotent and totipotent stem cells is that pluripotent cells can give rise to any cell type, but they cannot give rise to a whole human organism.

Compared to hESCs, hFSCs are relative newcomers to the scene of stem cells. A human fetus has large numbers of stem cells in all major body organs. However, fetal stem cells are also found in extra-fetal tissue, such as amniotic fluid, the placenta, umbilical cord, and other tissues. Depending on where the fetal stem cells are taken from, they may be multipotent or pluripotent. The problem with research using hFSCs is that they may come from a dead human fetus. Some research requires whole organs or parts of organs from human fetuses instead of only the stem cells.

Adult stem cells are in most, if not all, organs of the body and are considered multipotent stem cells. These stem cells can differentiate into many different specialized cells but only within a certain type, like blood cells (white, red, etc.) or brain cells (neurons, glia, etc.). However, adult stem cells can be induced back into a state of pluripotency (human induced pluripotent stem cells, hIPSCs) and can be directly manipulated to convert to another cell type (known as transdifferentiation).

For hESCs to be used in research, a human embryo is grown to the blastocyst stage in the lab (usually from IVF embryos donated or no longer wanted), and the pluripotent cells from the inner layer of a human blastocyst must be taken and essentially spread out and grown into colonies of cells, spread out and grown again, with the process repeating until the cell colonies can be screened for stem cells. To date, no hESC has been made which did not first come from a living human embryo. Therefore, all hESC research necessarily kills a human in the first few days of their life, which is why pro-life people generally oppose hESC research.

hFSCs can be procured from the umbilical cord, amniotic fluid, placenta, etc. of miscarried, stillborn, live born, or aborted human fetuses. Closely related, human fetal tissue can also be used from miscarried, stillborn, or aborted human fetuses. Abortion is generally the greatest contribution to human fetal tissue research, since abortion is planned ahead of time, and once donation is consented to, the abortionist can have the proper equipment ready at the time of the abortion to preserve the fetal body or organs until they reach the researcher. In fact, in a letter to the U.S. Department of Health and Human Services (HHS) Secretary Alex Azar, the composers made the statement,

“Tissue from spontaneous abortions cannot replace tissue from elective abortions.

Tissue from spontaneous abortions is not a suitable or reliable substitute for tissue from elective abortions. Spontaneous abortions, commonly called miscarriages, often result from profound genetic defects, developmental abnormalities, or other conditions that undermine the usefulness of the tissue for research. Additionally, spontaneous abortions generally do not occur in settings where the tissue can be adequately preserved for research.”

As an earlier article I wrote pointed out, the federal government funds millions of dollars’ worth of research involving fetal tissue, most of which comes from aborted humans who may be as old as 24 weeks (and quite viable outside the womb) when aborted. Though with the recent HHS announcement, federal funding seems to be at a stand-still for future research involving the use of fetal tissue.

Now that those basics are out of the way, we can start exploring the ethical issues  of such research.

Questions relevant to many people for this issue are:

1. Does hESC, hFSC, and human fetal tissue research save lives?
2. Does this research have the greatest potential to find cures compared to other research methods/materials?
3. Are there any other alternative research material and methods which could be used?
4. Will scientific advancement on disease cures stall if this research is defunded or made illegal?

These are fair questions to ask. The lay citizen who is paying taxes which may be used to fund these projects, the scientist who may be invested in these projects or generally concerned with the direction the field is going, the government officials we elect to represent us who are making the budgets, the sick people who would benefit from a new treatment or cure — all these people and more have a legitimate interest in addressing the topic of using these materials in research and the methods of procuring them.

Ultimately, what these questions and others like them boil down to is this: even if we concede a young, living human being is directly and intentionally killed for this type of research, do the (potential) benefits of such research outweigh this fact?

Let’s look at some of the research being done with the different types of human stem cells and human fetal tissue.

News outlets, journals, magazines, and some scientists state there are some questions which can only be answered by using human fetal tissue or hESCs, and there are no alternatives which can be realistically used to get similar or better results. Under NIH funding, HIV/AIDS research had the most projects using humanized mice — mice which have human-like immune systems due to human fetal tissue transplants — in the 2014 fiscal year. Embryonic and fetal development and diseases or conditions affecting people starting early during in-utero development can also only be tested using hESCs or fetal tissue, some argue. Additionally, viral infection and brain or spinal cord-related injuries are being studied using hESCs. Recently, for example, hESCs from a cell line established from the stem cells of the spinal cord of an electively terminated 8-week-old human fetus have been used in a pre-clinical trial to test the effects of hESCs on spinal injuries. Other cell types from aborted embryonic and fetal humans have been procured to study brain and spinal injuries in animals and humans. Currently, however, hESCs have yielded no disease cures; even the NIH reluctantly admits this point by not listing any diseases being treated with hESCs.

On the other hand, adult stem cells and hIPSCs have already provided treatments for diseases and injuries, such as spinal injuries, multiple sclerosis, Parkinson’s, and over 70 more conditions. Adult stem cells are actually much more plastic than originally believed, with more potential for pluripotency like hESCs. Because of this, adult stem cells may be able to be used instead of hESCs. They have the added benefit of coming from the patient who needs them, reducing the chances of rejection by the body and increasing research into specific disease states. Additionally, adult cells can be forced into a state of pluripotency to function just like hESCs. In fact, research has been done to show genetically matched hESCs and hIPSCs are functionally exactly the same. This eliminates the need to destroy young living humans for research purposes.

Alternatives to fetal tissue research are also available, despite what some scientists say. The fact is, using fetal tissue has been one of the earliest ways to make humanized mouse models, and, since it has been around so long, it is the method most frequently used by scientists and the method which scientists are hesitant to get away from. It’s the status quo. Scientists can also easily procure fetal tissue from electively aborted human fetuses by going through a third-party vendor instead of having to establish “their own protocol for patient consent, tissue procurement, and storage.” In reality, humanized mice do not need to be made using fetal tissue from elective abortions. In fact, humanized mice made from other methods are easier and cheaper to use, as well as more efficient since more longer-living mice can be made with a single sample. Making humanized mice from only human blood stem cells — like from the umbilical cord — gives comparable research results to humanized mice made from both human fetal thymus and blood stem cells.

Essentially, while the alternatives to using fetal tissue from elective abortions to make humanized mice are feasible and may be more efficient and cheaper in the long run, the process to procure samples from live births, still births, or miscarriages may be difficult to set up, and specific blood and tissue samples may be harder or more inconvenient to obtain.

The ethical arguments concerning research using hESCs, hFSCs, and/or human fetal tissue hinge on whether or not a living human being is killed for research purposes. If no living human is being killed, then there is no good reason why none of these materials should be able to be used to conduct basic research or be used in treatment trials, especially since the research could be potentially life-saving. But if a living human being is being killed, then the use of these materials needs to be defunded and stopped immediately. Ending the life of an innocent human being for the possibility of good outcomes in the future is not a justifiable reason to kill humans: i.e., the end does not justify the means.

The fact is, for hESC research, the cells are being taken from living human beings to be used directly or to start a cell line from which cells can be grown to use over and over again. Living human embryos produced by IVF or by cloning techniques (somatic cell nuclear transfer) are killed in the process of removing the pluripotent stem cells from the inner layer of the blastocyst (a young human embryo). Over 300 embryonic stem cell lines have been established from blastocysts and are used the majority of the time in hESC research (so no killing of additional human embryos is involved). While the issue of using hESCs from an already-established cell line may be more of a gray area with pro-life people, the issue of directly killing a young, living human organism, whether for direct use in research or for the establishment of a cell line, is a human rights tragedy. Even if the embryo is leftover, unwanted, and/or unused by the couple, these are not good justifications for killing a human life.

Human fetal tissue and hFSCs from extra-fetal tissue can be procured from live birth, still births, and miscarriages instead of abortions. For the former cases, pro-life people generally would have no problem with using cells or tissues from a failed pregnancy which did not directly involve the intentional killing of the child. However, the picture gets less clear for tissue and cell procurement from abortions. The American Medical Association (AMA) guidelines state that only after the decision to have an abortion has been made can the mother sign the permission for her dead child to be used for research. Some people may argue that since the abortion has already been done, why not use the fetal parts for research? It’s not like the abortion was done for research purposes specifically, right? That way, some good can come out of something bad. This logic is the same or similar to the logic of using cells from cell lines established from the stem cells of human blastocysts.

However, we know many abortion clinics already break state and federal laws and guidelines. We cannot be sure that abortion clinics are not using the excuse of scientific research to pressure women into making a decision for abortion. The permission forms at some Planned Parenthood abortion clinic locations even give completely false information, stating treatments and cures have been found for “such diseases as diabetes, Parkinson’s disease, Alzheimer’s disease, and AIDS” using aborted fetal tissue. Additionally, although this permission form states no change to the abortion procedure will be made after deciding to donate, Planned Parenthood has admitted to changing the procedures to get more intact fetal parts. Even a Planned Parenthood spokeswoman Amanda Harrington has stated,

“[i]f minor adjustments that have no bearing on the woman’s health and safety are done when the woman has expressed a desire to donate tissue, that is entirely appropriate and ethical and legal”

— even though it clearly violates the permission form women sign beforehand.

Abortion clinics have already been proven to lie to women and break laws. Based on their history, it is highly likely they may further coerce or pressure women into getting an abortion using the excuse of scientific research.  Abortion providers have already been caught illegally profiting off of selling aborted fetal tissue. Not only is the direct and intentional killing of a human involved, but the process also further commodifies human life by putting a price tag on the organs and tissue samples of the killed human, thus further legitimizing the “need” for killing humans for research purposes.

Pro-life people are not the only ones uncomfortable with hESC research or human fetal tissue research — so are the very scientists who use such materials. Dr. Lishan Su of the University of North Carolina at Chapel Hill has said,

“Using fetal tissue is not an easy choice, but so far there is no better choice…Many, many biomedical researchers depend on fetal tissue research to really save human lives. And I think many of them feel the same way.”

At University of California San Diego, Dr. Larry Goldstein uses brain cells from aborted fetuses. He told Nature:

“We are not happy about how the material became available, but we would not be willing to see it wasted and just thrown away.”

One of the scientists who discovered how to make hIPSCs, Dr. Yamanaka, did so because he could not stand the idea of destroying tiny humans:

“When I saw the embryo, I suddenly realized there was such a small difference between it and my daughters…I thought, we can’t keep destroying embryos for our research. There must be another way.”

In this case, reverence for human life and the aversion to using stem cells actually produced a scientific breakthrough — something many people in favor of hESC and fetal tissue research are worried will not happen without being able to use those materials.

There are several serious, ethical issues with using hESCs, hFSCs, and fetal tissue from aborted fetuses in research. Enough ethical alternatives to using such materials are available, so it seems there are no longer any adequate reasons for continuing to fund and allow research that relies on killing an innocent human being. Humans do not need to be targeted and killed to further medical research. There are other alternatives which can lead to breakthroughs, and they have already been shown to save lives.