BioEdge 234 -- Tuesday, 9 January 2007
More competition for embryonic stem cells
Abundant cells in amniotic fluid
"Pillow angel" at centre of ethical storm
Mentally retarded girl's growth radically stunted
We need hybrid embryos, say UK scientists
But UK government will probably ban them
Ali G rips into bioethics
What was Edmund Pellegrino doing there?
Is suffering necessarily linked to euthanasia?
Nope, says Finnish ethicist
IN BRIEF: stem cells, Korea, three parents
Since amniotic fluid-derived stem (AFS) cells are not derived from dissected embryos, they carry little ethical baggage. It would also be easy to create thousands of cell lines which could be used to create tissues for regenerative medicine. "If you banked 100,000 specimens, you'd be able to provide cells for 99% of the US population with a perfect match for genetic transplantation," says the lead researcher, Dr Anthony Atala.
Other researchers welcomed the discovery. "If the cells can be extracted from the placenta, it's a very convenient way of getting large numbers of cell lines that repair all types of cells," says Ian Wilmut, one of Britain's leading stem cell and cloning experts. And Lyle Armstrong, of the University of Newcastle-upon-Tyne, in the UK, told New Scientist: "It's likely that therapies will arise from cells like these way before they're available from ESCs."
In an accompanying commentary, the leading Australian stem cell researcher, Alan Trounson, acknowledges the potential of this development. If confirmed, he says, AFS cells "may become an important source of cells for regenerative medicine given their apparent advantages of accessibility and multipotentiality over embryonic and adult stem cells, respectively... [This] could lead to a new wave of research to demonstrate the cells' utility in regenerative medicine and in other potential applications such as drug screening, tissue engineering and gene therapy."
Although ethical alternatives to embryonic stem cells appear to be proliferating, stem cell researchers are not about to back away from their insistence on the need to clone human embryos to understand diseases and to test new drugs. Harvard researcher George Daly, who is working on therapeutic cloning, told AP: "While they are fascinating subjects of study in their own right, they are not a substitute for human embryonic stem cells, which allow scientists to address a host of other interesting questions in early human development." ~ Nature Biotechnology, January; New Scientist, Jan 7; USA Today, Jan 7; AP, Jan 8
There is no doubt that caring for Ashley is challenging. She has static encephalopathy, a severe brain impairment. She cannot walk, talk or swallow food. Her mental age is measured in months rather than years. Her parents, who have two other children, want to care for her as long as possible and fear that the larger she grows, the more difficult it will become for them. Furthermore, preventing her sexual development will prevent her from being abused in an institution, they say. As a smaller person, it will be easier to make her comfortable and to keep her from getting bored.
Her parents also borrowed an argument from the transhumanist George Dvorsky -- that "she will retain more dignity in a body that is healthier, more of a comfort to her, and more suited to her state of development". People feel disconcerted by the sight of an adult with the mind of an infant, but Ashley will still be a doll when she is 60.
Reaction to the parents' defence of "the Ashley treatment" was mixed, both by the public and bioethicists. Those in favour stressed the love of the parents for their "pillow angel". Those opposed saw the real problem as lack of social support. "Keeping Ashley small is a pharmacological solution for a social failure -- the fact that American society does not do what it should to help severely disabled children and their families," declared Arthur Caplan, of the University of Pennsylvania.
Two paediatricians who commented on the case in the Journal raised other objections as well. Will administering high-dose estrogen give profoundly disabled children a better quality of life? There is no certainty about this. And given America's past history of sterilising children with disabilities, could such treatment be misused in the future? They, too, call for "more funds for home- based services, not more medications".
One interesting feature of the case was its secrecy. This was a radical solution -- the first of its kind in the world, according to Ashley's parents -- and all those involved knew that it would be highly controversial and could create a precedent for other parents. However, discussions were kept within the 40-member ethics committee at Seattle Children's Hospital and consequently there were no legal challenges. ~ Seattle Times, Jan 4; Archives of Paediatrics & Adolescent Medicine, Oct; MSNBC.com, Jan 5
The Blair government, which has generally taken the permissive option in bioethical matters, seems to be responding to a collective "yuk" from the public. A Department of Health consultation on changes to the UK's fertility legislation received 535 responses, of which 340 focused on hybrid embryos, even though only one of 30 questions dealt with this topic. About 80% were opposed. Scientists are muttering that conservative pressure groups hijacked the poll. Dr Evan Harris, an outspoken MP who normally takes a progressive stand on bioethical issues,supported them, saying that "queasiness is not a good reason to prevent research going ahead that is strictly regulated."
In its lead editorial Nature declared that hybrid embryos were clearly needed, but that scientists had to present a more nuanced case to assuage public concerns. After all, there are similar lines of research which carry even more risks, such as transferring human brain cells into primates, or human embryonic stem cells into primate embryos. The public needs a comprehensive proposal for regulating all such research, or the doors may slam shut even on experiments with "minimal safety risk". ~ Nature, Jan 4; BBC, Jan 5; London Telegraph, Jan 5
And speaking of Edmund Pellegrino: this month's issue of Nature Biotechnology contains an interesting profile of the distinguished 86-year-old ethicist. A committed Catholic, and a former president of Catholic University of America, Dr Pellegrino has managed not to antagonise American scientists and bioethicists, as his predecessor, Leon Kass, did. He appeals to "natural law" and does not invoke religious arguments. "On the questions of assisted suicide or embryonic stem cell research, Pellegrino can give you reasons why they are morally wrong without necessarily mentioning any religious concept," says the journal admiringly. ~ Nature Biotechnology, January.
The crux of his argument rests upon a definition of medicine. There are two main approaches to this. The traditional one says that medicine's job is objective -- to maximise health and relieve pain and suffering. But more recently bioethicists have argued that "the proper goals of medicine are ultimately determined by the autonomous decisions of patients". One implication of this is that if a patient wants to die, a doctor has no business stopping him.
So, concludes Dr Varelius, "if one accepts voluntary euthanasia in the case of a person who is suffering, one should also accept it in the case of a person who is, for example, tired of living, considers her existence as meaningless, and autonomously wants to die.". ~ Bioethics, February 2007
Korea: With a birth rate of 1.08 children per woman, babies are now so scarce in South Korea that medical students are using robots to practice deliveries. The US product can also be used to simulate breech births and Caesarean sections. ~ Reuters, Jan 4
Three parents: Ontario's highest court has ruled that a Canadian child can have three legal parents. In a landmark case, the Court of Appeal overturned an earlier judgement which had denied a lesbian partner status as legal guardian of a boy they had been raising together. The boy's biological father sees the child twice a week. The judges found that the law governing the case failed to foresee social changes which would make three-parent families a reality. ~ CanWest News Service, Jan 3