Stem cell research: The problem and the solution

Lessons from barrenness about a controversial issue, part III
Published in Christian Renewal magazine, 30 January 2007

The first article in this series recounted how infertility gave my wife and me a crash-course education on the difficult issues surrounding in-vitro fertilization, embryo adoption, stem cell research, and the beginning point of human life. This article will apply the things we learned to one of the most controversial and politically charged issues of our time: stem cell research.

The reason for the controversy surrounding stem cell research is straightforward: if human life begins at conception, and if human life is intrinsically valuable and therefore to be preserved whenever possible—which were the two conclusions of the previous article in this series—then the procedures common to embryonic stem cell research, which involve the termination of human life, are inherently wrong.

Does this mean that a person who believes that life begins at conception should oppose stem cell research and its potential for treating serious diseases? Although it is rarely mentioned in the public discourse on the subject, there is a solution to this controversy that both promotes research and protects human life.

The problem

By the fifth day after conception, a fertilized egg will have multiplied into about 200 cells. An embryo at this stage is called a blastocyst and is made up of two main parts: the outer cell mass and the inner cell mass. A blastocyst’s outer cell mass expands into the placenta, while all the various components of a fetal body will grow from the inner cell mass.

It is these inner cells that are the embryonic stem cells. They intrigue medical researchers—from this one kind of cell comes all the diverse parts in the human body, from muscle and bone to brain and skin cells. The hope is that embryonic stem cells can be manipulated into any kind of tissue, making them able to treat disease by replacing diseased or damaged tissue anywhere in the body. For example, stem cells could be injected into a heart that has been damaged by a heart attack in order to increase healthy tissue and strengthen the heart.

The controversy concerning embryonic stem cell research is the method used for collecting the stem cells, which involves removing the inner cell mass from a blastocyst. If the collection is done properly, these stem cells will repeatedly divide and researchers will have a successful stem cell line that will supply them with cells indefinitely. However, the removal of the inner cell mass essentially destroys the blastocyst. Consequently, if human life begins at conception, then the method for collecting embryonic stem cells destroys human life.

Whenever such an opinion is expressed, however, the counter argument is quickly raised: if you care so much about human life, what about the lives of the sick and dying who could be cured by embryonic stem cell research? Unfortunately, this is a very misguided question. Not only does it pit the life of an embryo against an ill person’s life, far too often the promise of embryonic stem cell research is overstated and its inherent problems are unduly minimized.

The hope of stem cell research is a cure for some of the most serious diseases known to man. This hope, however, is still only a theoretical possibility. Perhaps stem cells can be manipulated into any number of cell types, but perhaps not—there is no guarantee that this can be accomplished. Even if stem cells are introduced into an ill person’s body, they might not improve its condition at all. A January 2004 report on stem cell research by the President’s Council on Bioethics (http://www.bioethics.gov/reports/stemcell/chapter1.html), states,

"There are also sensitive issues regarding premature claims of cures for diseases that are not scientifically substantiated and the potential exploitation of sick people and their families. Some advocates of stem cell research have made bold claims about the number of people who will be helped should the research go forward, hoping to generate sympathy for increased research funding among legislators and the public. A few advocates have gone so far as to blame (in advance) opponents of embryonic stem cell research for those who will die unless the research goes forward today. At the same time, other scientists have cautioned that the pace of progress will be very slow, and that no cures can be guaranteed in advance. Which of these claims and counterclaims is closer to the truth cannot be known ahead of time. Only once the proper scientific studies are conducted will we discover the potential therapeutic value of stem cells from any source. How, then, in the meantime should we discuss these matters, offering encouragement but without misleading or exploiting the fears and hopes of the desperately ill?"

While uncertainty concerning the potential benefits of stem cell treatment is in itself is no reason to stop research, overstating the potential benefits is grossly unethical by any standard as it deals cruelly with two sets of human beings, the unborn and the ill.

Overstatement of the promise of embryonic stem cell research is often a case of political propaganda. This was seen clearly in a recent television ad in which Michael J. Fox advocated Claire McCaskill for US Senate. Mr. Fox says that Ms. McCaskill “shares my hope for cures,” but her opponent, Jim Talent, wants “to criminalize the science that gives us a chance for hope.” In the world of politics, a conviction to defend human life (that is, opposition to stem cell research) can equal a disregard for human life both physically (opposing cures) and emotionally (opposing hope). As is too often the case, those who are most vulnerable—in this case, the seriously ill and the tiniest humans—have become fodder for a broader political struggle. The next article in this series will examine more thoroughly the politics of stem cell research.

Even more frequently, the potential problems stem cell treatment might cause are understated. Instead of a cure, it might cause even more problems for the patient. For example, researchers fear that the introduction of stem cells into a human body might cause a tumor or that the body might reject them. Caution must temper optimism when it is yet unknown whether research will produce a cure or cause an even greater problem.

One final problem with embryonic stem cell research is the inefficiency with which embryonic stem cells are collected. If the collection is done properly, a new line of stem cells is created which can multiply indefinitely. However, according to a May 2003 report by the Ethics Committee of the American Society for Reproductive Medicine, 11,283 embryos had been donated to research, but it is estimated that only about 275 stem cell lines could be created from that number (http://www.asrm.org/Professionals/Fertility&Sterility/cryoembryos_may2003.pdf). This success rate of about 2.5% means that 97.5% of embryos used in research are destroyed without producing any stem cells at all.

Where do these facts leave us? Do these problems mean that we must abandon stem cell research if we believe that embryos are human beings and therefore should be preserved? By supporting the tiniest form of human life, are we forsaking the seriously ill who are looking to stem cell research for cures?

Fortunately, there is a solution to the ethical problems regarding embryonic stem cell research. Unfortunately, few people even know this solution exists.

The solution

Embryonic stem cells are not the only kind of stem cells. There are other kinds, and they are collected in such a way that does not destroy human life. Consequently, a distinction must be made between embryonic stem cell research and its alternatives.

The first alternative to embryonic stem cells is adult stem cells. Scientists have been researching adult stem cells for about 40 years; they have already been identified in bone marrow, the mammary gland, fat, and nasal tissue. Research concerning sources of adult stem cells is ongoing. For example, Medical News Today reported on December 24, 2006, the discovery of adult stem cells in hair follicles that “demonstrated several desirable characteristics” of being able to repair damage to nerve pathways and sheaths.

Adult stem cells have been successfully differentiated into bone, cartilage, fat, muscle, and other tissue, and have already been successfully used to treat leukemia, heart attack victims, cancer, multiple sclerosis, Crohn’s disease, stroke, anemia, immunodeficiency, liver disorder, and Parkinson’s disease. Since adult stem cells can be harvested from the patient, the immune system will not reject them.

Researchers consider adult stem cells to be inferior to embryonic stem cells for three reasons. First, there are a number of different kinds of adult stem cells; each is found in a different area of the body and is only able to develop into certain kinds of tissue. Because embryonic stem cells have the potential to become any kind of cell and adult stem cells require extra research to locate each kind, adult stem cells are potentially more expensive and less useful for treating disease than embryonic stem cells. However, scientists continue to discover more kinds of adult stem cells, and as stated previously, the collection of a useful embryonic stem cell line is not an efficient process.

Second, embryonic stem cells are capable of reproducing indefinitely, but researchers have found the reproductive ability of adult stem cells to be both slower and more limited in duration.

Third, adult stem cells might contain more DNA abnormalities than embryonic stem cells due to sunlight exposure and toxins absorbed into the body.

Despite these drawbacks, the usefulness of adult stem cells is universally recognized. Researchers have already had tremendous success using adult stem cells—significantly more, in fact, than embryonic stem cells. For an excellent list of how adult stem cells are already being used to treat serious illness, see http://www.lifeissues.org/cloningstemcell/adultstemsuccess.htm.

Several other alternatives to embryonic stem cells exist; they are less researched than adult stem cells, but they are considered to have perhaps an even greater potential. One such alternative is cord blood stem cells, which can be collected from a baby’s umbilical cord after birth. According to a NewScientist.com news report on August 18, 2005, cord blood stem cells have “clinical potential matching that of the far more controversial embryonic stem cells.” Another alternative was only recently discovered. On January 8, 2007, the Associated Press reported the discovery of stem cells in amniotic fluid that “hold much the same promise as embryonic stem cells."

Some of the same problems for research exist among alternatives to embryonic stem cells, and again, it is important to not overstate their promise. But none of them involves destroying embryos.

A person who believes that life begins at conception does not have to—indeed, should not—oppose stem cell research. That person can, however, insist that it is done in a way that protects human life and does not take one life in the hope of saving another. Those who are ill and hoping for a cure do not have to choose between losing hope and taking life. Opponents of embryonic stem cell research should never be accused of criminalizing cures and hope. In fact, the truly blamable are those who push embryonic stem cell research at any cost; though they could promote research that is equally effective while preserving human life, they insist on doing otherwise.

Although stem cell research is an often controversial, convoluted, and politically and emotionally driven issue, its solution is straightforward: in the interest of preserving all varieties of human life, embryonic stem cell research should be abandoned, and all the resources that have been expended to advocate it in the scientific, political, and public arenas should be applied instead to researching cures for diseases using the several equally promising alternatives to embryonic stem cells.

When does human life begin?

Lessons from barrenness on a controversial issue, part II
Published in Christian Renewal magazine, 17 Jan 2007

In the previous article in this series, I described my own experience with infertility and the consequent choices my wife and I had to face concerning in-vitro fertilization and embryo adoption. The key question we had to answer was, when does human life begin? We were already committed to the idea that human life is to be valued and preserved above all else, so if one of the options before us somehow jeopardized what we considered to be human beings, even those in the earliest and tiniest state, we could not do it.

However, the question of when human life begins is a very difficult one to answer. We had certain preconceived ideas on the subject that came, no doubt, from being raised in Christian homes—specifically, that human life begins at conception, and therefore anything that would unnecessarily jeopardize even the smallest embryo was wrong.

But what if our assumptions were wrong? What if embryos were not humans, but instead humanness is conferred upon that organism at some later stage of development? Were we acting reasonably and biblically, or were we needlessly splitting hairs when we should be joyfully proceeding with the incredible technological opportunities that God had opened to us?

We went to several of our most trusted and mature Christian friends and asked for some help in thinking through our dilemma. Despite the sympathy and good intentions of those we asked, the advice we received was contradictory and much of it was simplistic and unhelpful. We soon realized that the issues we were facing are rarely considered in Christian circles and that we were going to have to start at square one and think through these problems for ourselves.

It seemed clear enough that anything pre-fertilization was not a human being, and it seemed even more obvious that a newborn baby was certainly a human being. The beginning of a new human life had to fall somewhere between those two points.

Does human life begin at birth—that is, does a child take on humanness only once it has successfully completed the birthing process? Most legal definitions tend toward this view, in many ways thanks to the pro-abortion movement, but medical advances over that last forty years have made it a difficult position to defend. A full-term pregnancy is roughly 40 weeks, and any birth before 38 weeks is considered premature. However, the current “age of viability,” which is defined as the earliest age at an infant has at least a 50% chance of survival, is an incredible and ever-decreasing 24 weeks. Some infants born after as few as 22 weeks gestation—just over half of a full pregnancy!—weighing just over pound and fitting snugly into a teacup are now living normal lives.

In light of these facts, it seemed to me that the idea that human life begins at birth was too arbitrary. One child is born at 38 weeks, another at 30, and another at 43—does that mean that they each acquired humanness at different points? In fact, the gestational period itself is frequently altered by induction or caesarian birth, most often for health concerns for either the baby or the mother. And while the birthing process unquestionably changes an infant’s relationship to its surroundings, the infant itself has not fundamentally changed between the moment before it was born and the moment after. Birth is an entirely arbitrary point at which to ascribe humanness to a person and should therefore be rejected.

Does human life begin at some point between conception and birth? There are many stages of development to choose from: implantation (considered week 3 of the pregnancy); the first heartbeats (week 6, about the time a mother learns that she is pregnant); the development of a circulatory system separate from the mothers (week 7); the first brainwaves and the formation of lungs, fingers, and toes (week 8); the first limb movement and hair growth (week 9); the development of facial features and the ability to feel pain (week 10); the growth of tooth buds and a complete set of organs (weeks 11-14); the first sucking (weeks 15-18); the growth of fingernails and the first movements that can be felt by mom (week 20); and the development of unique fingerprints (week 24). In fact, everything that constitutes an adult human has developed in rudimentary form in an embryo by the end of week 8.

I thought through each of these stages of development and concluded that none of them can reasonably be considered to be the starting point for human life. Nothing changes in the embryo itself between the moment before implantation and the moment after—just as with birth, its relationship to its surroundings has changed, but the embryo itself has not. The same is true concerning the other stages of development listed above, with the possible exceptions of the heartbeat and brain waves. After all, are not the usual signs of the end of human life the cessation of the heartbeat and brain waves? If human life ceases with a loss of these things, perhaps human life does not begin until they are present.

This line of reasoning is deceptive, for death is not intrinsically connected to heartbeat and brain waves. The loss of heartbeat and brain waves is simply an indication that death has occurred; in fact, both of these biological functions can sometimes be sustained by medical technology past the point of death. Consequently, the presence or absence of life is not determined by the presence or absence of these or any other particular biological functions.

If human life does not begin at birth or at any point between conception and birth, it must begin at conception. Not only is this the only option left, but it is also the most reasonable. Conception is the point in the entire process at which the most radical change occurs: two cells, one from each parent, merge together into one new, radically different cell and form a new entity. This new entity has a new and distinct set of DNA, which will determine that person’s gender; his skin, hair, and eye color; and even to some degree his height, weight, build, and personality. All the things that physically constitute a human being are established at conception, and even in its earliest stage, that new person is entirely distinct from any other in history. It must be at conception that humanness is conferred, regardless of whether it is ever fully realized in the form of a fully grown adult.

It took my wife and me much troubled thought to reach that conclusion, but once we did, certain decisions before us were easily made. Subsequent articles in this series will more closely examine how these conclusions can be applied to some social, political, and ethical controversies, but first let us remind ourselves of what we as Christians are to think of these tiniest of human beings.

The Scriptures make very plain God’s view of man. After comparing man to the majestic heavenly bodies, David asks in Psalm 8, “What is man that you are mindful of him, and the son of man that you care for him?” Although this passage certainly points out the smallness of man compared to the moon and stars, the emphasis is on the fact that despite their seeming insignificance, God is indeed mindful of and cares for men: “Yet you have made him a little lower than the heavenly beings and crowned him with glory and honor. You have given him dominion over the works of your hands; you have put all things under his feet . . .” (ESV). The psalm begins and ends by declaring the majesty of the Lord’s name because of the way he relates to man.

Why would the infinite, all-sufficient God care at all for such an insignificant thing as a human being? There is a sense in which we will be asking that question in awe and wonder for all eternity. However, the Scriptures have a great deal to teach us on this subject.

The climactic final act of the very first narrative in the Bible is the creation of man. Notice the distinctive way in which the text presents the creation of man: whereas the formula for every other act of creation is, “And God said,” the phrasing changes with the creation of man to, “Let us make.” Every created thing outside of man reveals God’s power: he speaks, and a universe is formed. But the creation of man reveals God’s person: God’s mindfulness of man and care for him is evident before he is even created.

The original Hebrew text of Genesis 1-2 also focuses especially on the creation of man. The Hebrew word translated “create” is bara’. It is used only 20 times in the Old Testament and is usually reserved for divine acts of creation. Men are usually said to “make” (`asah) things, but it is God who “creates” (bara’).

There is an unusual concentration of this word in Genesis 1-2. The first instance is 1:1, when God creates the heavens and the earth; the last is in 2:3, when God concludes creation by blessing the seventh day. By bracketing the text with bara’, the whole of creation is shown to be manifesting the creative power of God. But bara’ is used especially in relation to the creation of man as it occurs twice in 1:27: “So God created man in his own image, in the image of God he created him; male and female he created them” (ESV). In this way, the text is identifying man as the supreme act of divine creation, the bara’ within the bara’.

As Genesis 1:27 says, man is created in God’s own image. Perhaps this is why God extends such mindfulness and care toward men. God has breathed his spirit into man, given him a measure of the divine reason and a consciousness of his law, given him dominion over creation, and enabled him to have a personal relationship with God unlike any other creature. Most importantly, God entered into a covenant with man, eternally binding himself to them. In these ways God has ennobled and honored man above all else in creation—indeed, man is above all else but God himself.

Perhaps God shows so much care toward men because they reflect the unique nature of his Son: man’s constitution of both body and spirit is a reflection of Jesus’ divine and human natures. It is interesting to note that man was created body and spirit before the fall, thus reflecting the image of the future Savior before sin had even necessitated his becoming human.

Perhaps we will never fully understand why God has so favored man, for God delights in using mysterious and awe-inspiring means to achieve his ends. He has chosen what is foolish over what is wise; what is weak over what is strong; what is low and despised and nothing over the things that are. This is exactly what David marvels about in Psalm 8 when he thinks about the smallness of man and how he nonetheless receives the favor of the God of the universe.

The biblical view of man is plain: God cares for man more than anything else in the universe. No matter how foolish, weak, low, despised, or insignificant a person might appear by human standards, God is mindful of him and cares for him even more than he cares for all the rest of the created realm. And even in the case of a person who is so small that we cannot see him without a microscope, so should we.

Stem Cells, the Miracles of Science, and the Joy of Parenting

Lessons from barrenness about a controversial issue, part I
Published in Christian Renewal magazine, 13 Dec 2006

As I begin writing this article, I am in the hospital after the birth of my first child, a boy. This is, of course, an exciting time for us, especially since we never anticipated how difficult it would be for us to have a child. We had been married for just over two years when my wife underwent a serious emergency surgery. The verdict: endometriosis had rendered her infertile.

This was a massive blow to us. Both of us had been eager to have a big family even before we had met. We wholeheartedly believed that raising a family is among the highest callings on a Christian’s life—indeed, one of the most important ministries that God has given his people. Which is the better investment, we asked: building earthly kingdoms and acquiring temporal widgets, or shaping eternal souls? We took seriously the Scripture’s testimony that children are a blessing from the Lord, and we had planned to fill our quiver with arrows. What a powerful weapon the family could be, we believed, for the kingdom of Christ!

But we would not be having any children. It was as if all our plans and priorities had been wiped out. The pain was almost overwhelming.

Many people have gone through infertility. We were very open about our situation, and it was surprising how many people we knew had gone through similar struggles. It seemed to us that struggles with infertility were perhaps especially common among Christians—maybe it somehow relates to the repeated biblical image of childlessness. Many people were very encouraging to us, and by God’s grace our openness about circumstance seemed to help several people, but we had no idea what God was about to do with us.

Our doctors (we had visited well over a dozen during my wife’s illness) told us that we were excellent candidates for in-vitro fertilization (IVF), but some of the details associated with the IVF procedure made us uncomfortable. Among other things, if we tried to have a baby through IVF, we would almost certainly have extra embryos. We learned that there are more than 400,000 embryos in the United States alone that are left over from IVF procedures and have been preserved by cryogenic freezing. Some of these embryos will be used by their parents in future IVF procedures, but most will be eventually discarded or donated to research. Even if parents decided to use their frozen embryos for an in-vitro fertilization procedure, only about half would survive the thawing process.

Knowing what we did about IVF, would it be right for us to undergo the procedure? The promise of having our very own children made us want to do so desperately, but our consciences were troubled by what we had learned. Our dilemma caused us to go back numerous times and rethink many of our assumptions about human life, the practice of science, and the biblical perspective on our situation.

We read anything we could about IVF—everything from medical journals, articles, and legislation to sermons. We repeatedly reasoned through the implications of what we read and sought guidance from the Scriptures. When exactly does human life begin? That was the most important question to us, for we were committed to the idea that human life is to be valued and preserved above all else. If these tiny embryos produced by the IVF procedure were human beings, our decision would be clear, though not necessarily easy.

But what if our assumption about the humanness of embryos was wrong? Were we needlessly splitting hairs? Should we instead joyfully proceed with the incredible technological assistance that God had made possible to us?

After much deliberation, many tears, and more than one sleepless night, we concluded that human life does indeed begin at conception and that although IVF is not intrinsically wrong, we could not in good conscience do it. There were several aspects of the procedure that seemed to deal carelessly with human life, but since most doctors viewed them as simply standard procedure, we could not trust that it would be done in a way that respects the embryos as human beings. We began the paperwork for an adoption instead.

Before we were matched with a child to adopt, however, a friend told us about a television special she had seen about embryo adoption. A handful of families scattered across the United States, we learned, had adopted embryos left over from another couple’s IVF procedure, carried them as if they were their own, and given birth to children. This struck us as a rather strange idea at first. How would we feel about giving birth to an adopted child, and how do you explain to people that you have given birth to a genetically unrelated child?

The more we thought about embryo adoption, however, the more we leaned toward trying it. If we have committed ourselves to the idea that life begins at conception, we asked, should we not view these frozen embryos as human beings? And if they are human beings, should they not have a chance at life instead of being eventually discarded or used as microscopic guinea pigs? We began to see that these tiny babies might be a tremendous testimony to the value of human life even at its earliest stage.

With a simultaneous feeling of both joy and anxiety, we proceeded to adopt three embryos. Despite a probability of less than 15%, all three survived the thawing process and were transferred. After a few weeks, a simple pregnancy test confirmed that my wife was pregnant, and a later ultrasound informed us that just one embryo had successfully transferred. I will never forget the mixture of delight and sadness that came with that news. It is not often that a parent learns in one moment that he has gained one child and lost two, but they were all three in God’s hands. He gives and takes away, and in both cases we bless his name.

And now our beautiful son is born—he is even now in the next room crying instead of sleeping, which is why I am up writing an article in the middle of the night. I thank God for this experience as it taught us many things that we would have otherwise never considered.

This article is the first of a series born out of the things we learned through this process. Subsequent articles will discuss the origin and value of human life and the implications of those ideas for one of the more controversial issues of our day: embryonic stem cell research and its social, political, and ethical consequences.

We chose our son’s name based on its meaning: Iain Zechariah means, “The LORD is gracious; he has remembered me.” The name is true of this barren couple, who have been given a child by the Lord. It is true of our son, who was once in a freezer, but was given renewed life. And now our prayer is that it will be true of him in a spiritual sense as well.

We are often asked if we plan to adopt more embryos. Our desire is still for a full quiver, so we would not mind doing so. For reasons financial and otherwise, however, we will probably not be able to do an embryo or traditional adoption in the near future. But regardless of God’s future plans for us, this one child alone is enough to bring us before the throne of heaven in praise.

A source of helpful information on embryo adoption is the Snowflake program at Nightlight Adoptions.