Cloning in Medicine: The Ethical Debate that Can Never Heal

Think of a time you’ve ever needed a hand. No, not just a helpful friend who’s willing to feed your cat when you’re on holiday. A real hand- those five fingered things at the end of your arms! It’s not common to need a new body part, but the probability of someone needing a replacement organ on this planet is higher than you may think. On 31 March 2015, 6,943 patients were registered for an organ transplant in the UK alone.

Currently, organ donors are not meeting demand; between April 2014 and March 2015, 429 patients died while suspended on the UK’s waiting list alone, waiting for a compatible match. In the UK, those waiting for kidneys may be on the list for 3-4 years.

The problems associated with organ donation make the idea of growing organs in a lab (a process called regenerative medicine) seem ideal. Many scientists are excited at the prospect of doing so using embryonic stem cell research and therapeutic cloning techniques.

Should we be using embryos?

In order to grow organs in a lab, we use stem cells; which are cells that are undifferentiated. This means that they have the potential to become many different types of cells and therefore, organs. Stem cells sourced from adults are already used to effectively treat certain diseases- such as the use of blood stem cells to treat leukaemia.

  • However, as specified by Dan Kaufman of the University of Minnesota Stem Cell Institute, adult stem cells are ‘limited to treating only a narrow range of diseases’ unlike embryonic stem cells as they don’t have the same pluripotency. This means that they can’t become any type of cell like embryonic stem cells and are therefore less useful for the purpose of creating organs. Embryonic stem cells are also safer to use because they are 100% free from genetic diseases. But the fact that these procedures entail the destruction of embryos, with the potential to become a human child, means many are wary to support this cause.

Religious views:

  • Below are some religious views dependent on the use of embryos and the beginning of life. The ethical and moral views sustained by their arguments can be held by anyone.

Christianity

  • Many conservative Christians, especially Roman Catholics, are against the destruction of embryos since this would count as the murder of a full human being- as they state that life starts at conception. Christians also believe that we do not have the right to ‘play God’, and God must remain the sole Creator.

Islam

  • Whilst many Muslims contest the use of embryos, some Islamic scholars believe that cloning certain parts of the human body for medical reasons should not be prohibited. They would allow cloning using embryonic stem cells by God’s instruction to respect the sanctity of life and preserve it.

Judaism

  • Jewish scholars also maintain mixed views on the start of life and their position on cloning. Intriguingly, some have sought scientific understanding of the cloning process to base their moral decisions, some look to Jewish scriptures. Orthodox rabbis and many Jews appreciate the possible medical benefits of cloning and so often hold middle-ground views on the topic.

Buddhism 

  • Buddhist practice allows the individual to come to individual views but also demands respecting the sanctity of life. Many Buddhists do not see human cells, so far removed from a whole organism, as ‘living’. Therefore, the destruction of embryos (made up of a few human cells) and part of the human cloning process are not seen as morally intolerable. Intention and purpose is vital. Cloning for medical benefit is seen as ethical but commercial aims are not.
Irish Christian pro-life protest against cloning research

Irish Christian pro-life protest against cloning research

Sourcing embryos- which way is better?

Existing embryonic stem cell lines

  • Embryonic stem cells have the power to divide and multiply themselves. These cells created are called embryonic stem cell lines. Although they are originally sourced from destroyed embryos, it can be argued that we might as well use existing cells.

Leftover embryos from IVF

  • Many people take the view that these leftover embryos from IVF (In Vitro Fertilization) should be used in research as they would be otherwise be destroyed- ‘thousands of IVF embryos could be used which are effectively wasted’.
  • However, we need consent of the parents of leftover IVF embryos; therefore it would be difficult to enforce the systemisation of leftover IVF embryo The Eurobarometer “Biotechnology” in 2010 suggests that 80% of EU citizens supported embryonic stem cell research. This has gone up dramatically from 53% in 2005. While this portrays an increase in support for use of embryos for research purposes- it does not eradicate the issue of seeking individual consent.

Therapeutic Cloning

In therapeutic cloning, the embryo is created by taking a nucleus from a patient’s cell and putting it into a donated egg cell, then letting it grow into an early stage embryo. This technique creates genetically compatible stem cells which are more likely to be accepted by patients.

  • However, there is controversy surrounding the idea of creating an embryo especially for its destruction- does this undermine its value? Is this embryo worth the same as an embryo created through IVF?
  • In trying to source IVF embryos, women have been exploited for their egg cells. This occurred during the ‘Hwang Debacle’ where scientist Dr Hwang Woo Suk coerced his female lab assistants into donating eggs. Some clinics offer women free IVF treatment for their egg cells- this distorts the freedom of choice for women who would be tempted by this offer.
  • Egg cell extraction is also not a risk free procedure. Studies have shown that up to 10% of women who undergo the procedure, which includes hormonal therapy and the use of anaesthesia, develop ‘ovarian hyper-stimulation syndrome’ (OHSS). In more serious cases, OHSS can lead to hospitalization.
Dr Hwang with his cloned dog

Dr Hwang with his cloned dog

Outside the World of Science

Concern on Need for Medical Progress:

Many Liberal governments maintain that the current level of risk to human matter- intrinsic to the cloning process is unethical. Yet cloning techniques should be honed until therapeutic cloning can be done regularly and ‘ethically’.

  • The British government have relaxed policy on cloning research following researcher Donaldson’s expert group discovery of more humane methods of embryonic treatment. The Human Embryology and Fertilisation Act 2001 now extends use of cloning human matter to research in serious diseases. Even the religiously conservative Jordanian government as recently as 2014, legalised therapeutic cloning research for the sake of medical progress.
  • Harvard University privately funded therapeutic cloning research post the federal banning of funds for it in 1997.

Politicised Public Groups on Social Divide

  • The UK group Centre for Genetics and Society work alongside scientists and civil society leaders to promote ‘beneficent medical applications’ of human cloning technology. They oppose ‘applications that objectify… human life’. But also promote medical progress.
  • They also emphasise the risk of the potential ‘division [of] human society’ over this controversial issue. This group serves to mediate the debate dominated by the few, reminding them to consider the spectrum of the public’s stance, including extremes.

The Public Spectrum and Media Manipulation:

  • The Wellcome Trust’s 1998 broad report on Public Perspectives on Human Cloning demonstrates that positive portrayals of cloning events. For example, the discovery of the Crispr-9 gene editing method in 2014 which could eliminate some inherited illnesses would liberalise public views on human cloning. Therefore, public opinion can be influenced by media agendas. Should media portrayals should be monitored because they affect our views?
  • Conversely, other media sources merely reflect popular views of the time. ‘Gattaca’ portrays dangers of reproductive cloning (often thought to follow therapeutic cloning) whilst ‘Multiplicity’ shows the exciting new paths of science. These are not serious information providers but they mostly serve to start the ethical debate.
1997 Movie, Gattaca on the future of gene editing and designer babies

1997 Movie, Gattaca on the future of gene editing and designer babies

1996 film 'Multiplicity'

1996 film ‘Multiplicity’

What does this reveal about the ethical debate?

So which side are you on? It’s hard to decide and progress is piecemeal and occurs over decades. Everyone from individuals, religious peoples, scientists and the government struggle to reach decisions on the use of existing embryo stem cell lines, IVF embryos or the mere manipulation of human matter- crucial to the cloning process. These issues on opinion and their translation into policy are compounded by problems from the exploitation of women to media influence. So, even if you can’t lend a hand, lend some thought to this ethical debate!

Word Count: 1401

Disclaimer: Any opinions expressed within this blog are the opinions of the author(s) and not those of University College London. This blog does not represent or endorse the accuracy or reliability of any information, content or advertisements contained on, distributed through, or linked, downloaded or accessed from any of the services contained on this website. You hereby acknowledge that any reliance upon any materials shall be at your own risk. This blog reserves the right, at its sole discretion and without any obligation, to make improvements to, or correct any error or omissions in any portion of the service or the materials.

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Cloning in Medicine: the ethical debate that can never heal

Think of a time you’ve ever needed a hand. No, not just a helpful friend who’s willing to feed your cat when you’re on holiday. A real hand- those five fingered things at the end of your arms! It’s not common to need a new body part, but the probability of someone needing a replacement organ on this planet is higher than you may think. On 31 March 2015, 6,943 patients were registered for an organ transplant in the UK alone.

hand

Mark Cahill, after transplant of cloned hand, 2013

Currently, organ donors are not meeting demand; between April 2014 and March 2015, 429 patients died while suspended on the UK’s waiting list waiting for a compatible match. In the UK, those waiting for kidneys may be on the list for 3-4 years (nhs.uk, 2015).

The problems associated with organ donation make the idea of growing organs in a lab (a process called regenerative medicine) seem ideal. Many scientists are excited at the prospect of doing so using embryonic stem cell research and therapeutic cloning techniques. Ethical considerations and the weightings given to them are dependent on the background beliefs and responsibilities of certain groups of people. Indeed, scientific institutions will outline their view pointing to factors such as medical progress and risk. This is in contrast with the views of religious peoples who base their views on spiritual factors or alongside religious doctrine. This is why the ethical points of the debate below are outlined by the groups to whom they belong. These include scientific institutions, religious groups, governments, the public and media.

Scientific Institutions and their options:

Using embryos and the goal of medical progress

  • In order to grow organs in a lab, we use stem cells; which are cells that are undifferentiated. This means that they have the potential to become many different types of cells and therefore, organs. Stem cells sourced from adults are already used to effectively treat certain diseases- such as the use of blood stem cells to treat leukaemia.
  • However, as specified by Dan Kaufman of the University of Minnesota Stem Cell Institute, adult stem cells are ‘limited to treating only a narrow range of diseases’ unlike embryonic stem cells as they don’t have the same pluripotency. This means that they can’t become any type of cell like embryonic stem cells and are therefore less useful for the purpose of creating organs. Embryonic stem cells are also safer to use because they are 100% free from genetic diseases. But the fact that these procedures entail the destruction of embryos, with the potential to become a human child, means many institutions are wary to support this cause (thesurvivaldoctor.com, 2013.)

Using existing embryonic stem cell lines

  • Embryonic stem cells have the power to divide and multiply themselves. They form stem cell lines which are not technically a part of the original embryonic source. Although they are originally sourced from destroyed embryos, it can be argued that we might as well use existing cells.

Leftover embryos from IVF and the issue of consent

  • Many people take the view that these leftover embryos from IVF (In Vitro Fertilization) should be used in research as they would otherwise be destroyed.
  • However, we need consent of the parents of leftover IVF embryos; therefore it would be difficult to enforce the systematised use of leftover IVF embryos. The Eurobarometer “Biotechnology” in 2010 suggests that 80% of EU citizens supported embryonic stem cell research (Malley, 2014). This has gone up dramatically from 53% in 2005. While this portrays an increase in support for use of embryos for research purposes- it does not eradicate the issue of seeking individual consent.

Therapeutic Cloning- the future of compatible organs and better healthcare?

In therapeutic cloning, the embryo is created by taking a nucleus from a patient’s cell and putting it into a donated egg cell, then letting it grow into an early stage embryo. This technique creates genetically compatible stem cells which are more likely to be accepted by patients.

  • However, there is controversy surrounding the idea of creating an embryo especially for its destruction- does this undermine its value? Is this embryo worth the same as an embryo created through IVF?
  • In trying to source IVF embryos, women have been exploited for their egg cells. This occurred during the ‘Hwang Debacle’ where scientist Dr Hwang coerced his female lab assistants into donating eggs for cloning research (Nature, 2005). Some clinics offer women free IVF treatment for their egg cells- this distorts the freedom of choice for women who would be tempted by this offer (George, 2007).
  • Egg cell extraction is also not a risk free procedure. Studies have shown that up to 10% of women who undergo the procedure, which includes hormonal therapy and the use of anaesthesia, develop ‘ovarian hyper-stimulation syndrome’ (OHSS). This can lead to hospitalization.
Hwang1

Dr Hwang with his cloned dog.

Religious views:

Below are some religious views dependent on the use of embryos and the beginning of life. The ethical and moral views sustained by their arguments can be held by anyone (Hug, 2006).

Christianity

  • Many conservative Christians, oppose the destruction of embryos since this would count as the murder of a full human being. They believe that life starts at conception. Christians also believe that we do not have the right to ‘play God’, and God must remain the sole Creator.

Islam

  • Whilst many Muslims contest the use of embryos, some Islamic scholars re-interpret religious text and conclude that cloning certain parts of the human body for medical reasons should not be prohibited. They would allow cloning using embryonic stem cells by God’s instruction to respect the sanctity of life and preserve it.

Judaism

  • Jewish scholars maintain mixed views on the start of life and their position on cloning. Intriguingly, some have sought scientific understanding of the cloning process to base their moral decisions, some look to Jewish scriptures. Orthodox rabbis and many Jews appreciate the possible medical benefits of cloning and so often hold middle-ground views on the topic.

Buddhism 

  • Buddhist practice allows the individual to come to their own view but also demands respecting the sanctity of life. Many Buddhists do not see human cells, so far removed from a whole organism, as ‘living’. Therefore, the destruction of embryos (made up of a few human cells) and part of the human cloning process are not seen as morally intolerable. Intention and purpose is vital. Cloning for medical benefit is seen as ethical but commercial aims are not.
Reuters-pro-life-protest-protect-the-unborn-Belfast-Ireland-photog-Cathal-McNaughton

Irish Christian pro-life protest against cloning research.

Governments:

Concern on Need for Medical Progress

Many Liberal governments wait on scientific progress to advance the cloning process until it is more ethically acceptable, then subsequently change their laws because they prioritise medical progress.

  • The Human Embryology and Fertilisation Act 2001 extended use of cloning human matter to research into serious diseases after cloning methods were developed which involve less manipulation of human matter. Even the religiously conservative Jordanian government as recently as 2014, legalised therapeutic cloning research for the sake of medical progress.
  • To read on split MP opinions, see: http://news.bbc.co.uk/1/hi/uk_politics/882616.stm

Public and Media:

Politicised Public Groups on Social Divide

  • The UK group Centre for Genetics and Society work alongside scientists and civil society leaders to promote ‘beneficent medical applications’ of human cloning technology. They oppose ‘applications that objectify… human life’ (CGS, 2015).
  • They also emphasise the risk of the potential ‘division [of] human society’ over this controversial issue. This group serves to mediate the debate dominated by the few, reminding them to consider the spectrum of the public’s stance, including extremes.

The Public Spectrum and Media Manipulation:

  • The Wellcome Trust’s 1998 broad report on Public Perspectives on Human Cloning demonstrates that media slants on cloning events can influence public opinion (King & Muchamore, 1998). For example, the BBC’s article on the ‘revolutionary’ discovery of the Crispr-9 gene editing method in 2014 which could eliminate some inherited illnesses could liberalise public views on human cloning (BBC, 2015)
  • Conversely, other media sources merely reflect popular views of the time. ‘Gattaca’ portrays dangers of reproductive cloning (often thought to follow therapeutic cloning) whilst ‘Multiplicity’ shows the exciting new paths of science. These are not serious information providers but they mostly serve to start the ethical debate.
    1997 Movie, Gattaca on the future of gene editing and designer babies

    1997 film ‘Gattaca’ on the future of gene editing and designer babies

    1996 film 'Multiplicity'

    1996 film ‘Multiplicity’

What does this reveal about the ethical debate?

So which side are you on? It’s hard to decide and progress is piecemeal and occurs over decades. Everyone from individuals, religious peoples, scientists and the government struggle to reach decisions on the broader options presented by human cloning- from existing embryo stem cell lines to IVF embryos or the mere manipulation of human matter- crucial to the cloning process. These present a deeper range of ethical issues and widen the spectrum of views with it. Furthermore, issues on opinion and their translation into policy (for both governments and institutions) are compounded by problems from the exploitation of women to media influence. As the debate rages on- lend some thought to this ethical debate… even if you can’t lend a hand!

Word Count: 1484

Disclaimer: Any opinions expressed within this blog are the opinions of the author(s) and not those of University College London. This blog does not represent or endorse the accuracy or reliability of any information, content or advertisements contained on, distributed through, or linked, downloaded or accessed from any of the services contained on this website. You hereby acknowledge that any reliance upon any materials shall be at your own risk. This blog reserves the right, at its sole discretion and without any obligation, to make improvements to, or correct any error or omissions in any portion of the service or the materials.

Bibliography: