August 30, 2005

    

Dear Concerned Citizen,

  
by William B. Hurlbut

Senate Hearing: July 13, 2005
William B. Hurlbut, M.D.
Program in Human Biology
Stanford University

Thank you, it's an honor to speak to you. I want to say from the onset that I agree with Senator Specter on the moral imperative of biomedical research and the scandal of priorities in our consumer society.

It's clear to me that both sides of this difficult debate are defending important human goods. And both of these goods, opening avenues for advance in biomedical science and preserving the fundamental moral principles on which our society are based, are important to all of us.

In 1999 President Clinton's National Bioethics Advisory Commission issued a report entitled: "Ethical Issues in Human Stem Cell Research." Acknowledging that a week old human embryo is a form of human life that deserves respect, the Commission stated:

"In our judgment, the derivation of stem cells from embryos remaining following infertility treatments is justifiable only if no less morally problematic alternatives are available for advancing the research."

Two months ago the President's Council on Bioethics issued a White Paper entitled "Alternative sources of Pluripotent Stem Cells," which discusses such less morally problematic alternatives. After analyzing the scientific feasibility, practicality and moral acceptability of a range of approaches, the Council endorsed, for preliminary animal studies, three proposals for the production of pluripotent stem cells (the functional equivalent of ES cells).

One of these proposals Altered Nuclear Transfer, is a broad concept with a range of possible approaches worthy of exploration. Altered Nuclear Transfer would, draw on the basic technique of SCNT (popularly known as 'therapeutic cloning') but with an alteration such that pluripotent cells are produced without the creation and destruction of human embryos.

In standard nuclear transfer the cell nucleus is removed from an adult body cell and transferred into an egg cell that first has its own nucleus removed. The egg then has a full set of DNA and, after it's electrically stimulated, starts to divide like a naturally fertilized egg. This is how Dolly the sheep was produced.

Altered Nuclear Transfer uses the technology of nuclear transfer but with a preemptive alteration that assures that no embryo is created. The adult body cell nucleus or the enucleated egg's contents (or both) are first altered before the adult body cell nucleus is transferred into the egg. The alterations cause the adult body cell DNA to function in such a way that no embryo is generated, but pluripotent stem cells are produced.

There may be many ways ANT can be used to accomplish the same end. One recent variation of this proposal, called Oocyte Assisted Reprogramming, has been put forward by Markus Grompe, Director of the Stem Cell Center at OHSU. In this variation of ANT, alterations of the nucleus of the adult body cell and the enucleated egg's contents before nuclear transfer would force early expression of genes characteristic of a later and more specialized cell type that is capable of producing pluripotent stem cells. Such a creation, from it's very beginning, would never have the actual configuration or potential for development that characterizes a human embryo and would therefore not have the moral standing of a human being.

As described in a recent op-ed in the WSJ and documented in a joint statement posted at the Ethics and Public Policy Center website, this proposal has drawn wide endorsement from leading scientists, moral philosophers and religious authorities.

Advantages

Altered Nuclear Transfer, in its many variations, could provide a uniquely flexible tool and has many positive advantages that would help advance embryonic stem cell research.

----Unlike the use of embryos from IVF clinics, ANT would produce an unlimited range of genetic types for the study of disease, drug testing and possibly generation of therapeutically useful cells.

---- By allowing controlled and reproducible experiments, ANT would provide a uniquely flexible research tool for a wide range of useful studies of gene expression, imprinting, and intercellular communication.

---- Furthermore, the basic research essential to establishing the technique would advance our understanding of developmental biology and might serve as a bridge to transcendent technologies such as direct reprogramming of adult cells.

---- Moreover, as a direct laboratory technique, ANT would unburden embryonic stem cell research from the additional ethical concerns of the 'left over' IVF embryos, including the attendant clinical and legal complexities in this realm of great personal and social sensitivity.

I have discussed this proposal with many of the leading molecular and cell biologists and the general response is that ANT is technically feasible, might be rapidly developed (in12-24 months or maybe sooner), and would not burden stem cell research with excessive cost or inconvenience.

Conclusion

The present conflict over the moral status of the human embryo reflects deep differences in our basic convictions and is unlikely to be resolved through deliberation or debate. Yet a purely political solution will leave our country bitterly divided, eroding the social support and sense of noble purpose that is essential for the public funding of biomedical science. In offering a 'third option,' ANT defines with clarity and precision the boundaries that our moral principles are seeking to preserve while opening fully the promising possibilities of ESCR.

As described by my colleagues today, ANT is just one of a range of hopeful proposals. Specific legislation to support exploration and development of these complementary ways of obtaining pluripotent stem cells would greatly encourage this research. And I want to say, I would favor a stand alone bill, unencumbered with other political agendas----one small island of unity in our sea of controversy.

As we enter the coming era of rapid advance in biotechnology, this kind of legislation would set a positive precedent for maintaining constructive ethical dialogue and encouraging creative use of our scientific knowledge. In recognizing the important values being defended by both sides of our difficult national debate over embryonic stem cell research, this approach could open positive prospects for scientific advance while honoring the diversity of opinion concerning our most fundamental moral principles. Such a solution is in keeping with the American spirit and would be a triumph for our nation as a whole.

Responses to "Right to Die or Duty to Die" :

I remember Dr. James Dobson’s (Focus on the Family) comments years ago regarding the Roe V. Wade decision and its negative impact on the value of life. His comments provided me an image of a slippery slope on the value human life. It appears Dr. Dobson’s words were prophetic. The generation that conducted a holocaust against a pre-born generation will perhaps personally experience the consequences when they are old and vulnerable. Many of us will not fully understand how slippery a slope we started down until we see it coming through the syringe in our arm at the hand of someone we may have never met. - K. R.

How times have changed! We now have the capability of keeping alive people who would have died as recently as 50 years ago, or perhaps even more recently. That has been a mixed blessing. While we are able to care for those with "curable" diseases and conditions, we are not as able to reverse all the physical effects resulting from lack of oxygen to the brain. Yet we believe that all life must go on. For those of us who claim to be Christians, my question would be whether it is better to "live" in the circumstances in which Terri Schiavo lived or release Terri to eternal life with God? For whom was Terri kept alive--and I used the term "kept alive" purposefully. A friend of us is now in a similar state, following an 18-minute time during which her brain was deprived of oxygen. Her family is doing everything to keep her "alive." God's love is so great, we believe in eternal life. Why isn't it ok to release her from man's care into God's care? - M. R.

Hey, P.S.! Have you heard of this new "Futile Care Theory"? Very interesting/frightening stuff. - B. B.

Yes indeed. And that's just the tip of the iceberg. And just as the ob/gyn community has formally redefined "conception" to start with implantation instead of fertilization (so they can call the morning after pill a "contraceptive") - so too, the euthanasia folks want to define death as loss of cognitive function (so they can harvest organs from people in coma's who are currently defined as alive, but would be "dead" since they lack cognitive function). - P. S.

What About " The Right to Live?" or do like "Bad Seed?" - M. J.

Good article. Thankfully, as I'm realizing that Isaiah 53 tells us that Jesus took on Himself our sicknesses and diseases. And as God has healed me from my fibromyalgia and hypothyroidism, I'm turning my healthcare more and more over to Him. I believe we must learn to TRUST HIM FULLY with our healthcare decisions. I am seeing people healed by the power of prayer, delivered from the symptoms Satan puts on them, and lives changed...by the grace of God and the blood of Jesus! Praise the Lord. Thank you for making us aware more fully of what is behind the scenes here. - E. P.

I think it would be nice if all the ethicists, religious nuts and protesters would just butt out and let the patients handle it. If the patient of his family continues to pay for the life sustaining treatment, it should be continued. If the patient stops paying for it, it should be withdrawn. Case closed. - J. L.

Makes it even more critical to put your life in God's hands, doesn't it! - L. G.

When I first heard the idea about "Futile Care Theory" I thought it was a terribly callous anti-Christian idea made up by secular ethecists. So, I did a search on the Internet and it seemed that every reference to this "theory" came from articles by Wesley J. Smith. I narrowed the search to educational institutions, thinking that there was must some unbiased information about this "theory." Only 6 results that came up, and they are were all discussing articles by Wesley J. Smith. Then I searched for "Futile care theory" at PubMed to see what articles were in the medical literature. There aren't ANY! So, it seems that "Futile Care Theory" is not really a theory, but just a way to rile up us Christians against the bad guys. - R. D.

Wesley J. Smith Responds:

Your correspondent (R. D.) is in error.  Futile Care Theory is what I call it.  Secular bioethicists and other supporters usually refer to it as medical futility, futile care, etc.

The following articles are about quality of life, and who decides whether it is worth living.

This next link describes the Texas law giving families ten days to find another institution once a hospital ethics committee permits withdrawal of life-sustaining treatment over patient/family objection. 

A few pro-life views:

There are TONS of articles.

Here is the point: Futile Care Theory states that extending life when that is what the patient or family wants is no longer necessarily one of the primary purposes of medicine.  The issue has been turned on its head to be "extending dying" which is deemed a poor use of resources and violative of doctors' autonomy if they don't believe the quality of life is worth living. - Wesley J. Smith

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