In 1997 I wrote a paper about fetal tissue use and delivered
it at the PAN forum that year. It was presented with a title
that was designed to cause people on both sides of the issue
to think hard about their respective views. The title was
Pro-Life and Pro-Udall. I have prepared this draft on the
current stem cell debate and may forward it to the NIH. I
would appreciate comments from the list members. It is about
two pages long. For purposes of paper submission I would
consider all comments to be anonomous unless I have
specicific approval to encorporate your thoughts as a
co-contributor.

 Response to NIH Stem Cell Guide lines

Life is much to precious to terminate or abandon

The basic tenet was and still is that human life is much to
precious to terminate. The gift of life is something that
should be treasured and protected at almost all cost.
Decisions that involve living cells, that are completely
dependent on other's cells to provide life of course get
more complicated. When one set of cells threatens the other
set of cells some tough decisions must be made. If both sets
will be lost without intervention, life is lost.
Intervention at this point seems to be morally and ethically
acceptable and perhaps even mandated by the base premise
that life is too precious to terminate or abandon. The
decision to terminate one set versus the other set has
evolved and will continue to evolve with life saving
capabilities that exist at the time the decision is made.
This I would define as a fluid life saving state.

In the next situation the cells again are linked through a
dependency and one set threatens the other set. The
understanding of the threat has evolved and will continue to
evolve with life saving capabilities that exist at the time.
The understanding this time is that one life can be saved
with intervention. Intervention at this point is more
complicated than the first case where both would be lost
with out intervention.  The moral and ethical dimension here
is expanded now because one set of cells is threatening the
other and one will survive. In fully matured adult cells,
when one set of cells threatens the other we remove the
threat through incarceration, isolation and in some instance
termination. The rights of the threatener are restricted and
limited by our understanding of the seriousness of the
threat. The ultimate penalty for this threat may be and
today can be the elimination of the threatener.

In a third situation the cells are frozen and can through
some period of codependency become independent. Today the
cells require codependent care to survive and potentially
get subjected to cases one and two. Tomorrow they require
only some form of incubation not yet available today. These
cells can be born, cloned, reengineered in a mutually
exclusive way or perhaps at some future point in a
completely compatible way. Would the guidelines and laws be
the same in either scenario?  I.e. the mutually exclusive
scenario versus the complete compatibility with synergistic
benefits scenario.

In the first two cases the life saving efforts could end
when the decision is made to terminate one set of cells. The
decisions about the two sets of cells  that were directly
involved in these cases could be viewed as final. No doubt
this was the case at some point in our level of
understanding. The third case takes a two dimensional
playing field and makes it theoretical and  multidimensional
beyond this first drafts focus.

But for now we have discovered and proven or are trying to
prove that an opportunity for another life to be saved may
exist by redeploying the cells that otherwise were
considered terminated in the first to cases. There is belief
that the cells have life giving potential. What potential,
how many potentials how will we resolve the issues of these
potentials. Some can be used to make a heart, some can be
used for a lung, and some can be used to repair a sick
sustantia nigra. And yes some might be used to clone and
restore the very life that we thought was terminated thereby
actually giving it life. Would ethics and morality forbid
these life saving overtures? Well maybe yes and maybe no.

 If the choices are mutually exclusive, the complexity of
deciding which path to follow will demand that a set of
guidelines be deployed that takes into account the moral,
ethical, and practical issues at the time the decision is
made. Perhaps this can be called the fluid law.

Today organ donations and transplants are a generally
accepted practice. The source of the donation and the
distribution of the donation are determined by a set of
guidelines and laws that take into account our understanding
of the issues at the time the decision must be made. In
general the source can be legal an ethical or illegal and
unethical. Ditto for the use.  The guidelines and the law
have evolved to protect us all from inappropriate behaviors
in both the source and disposition issues.  The heart
transfer that is sourced from a naturally caused death is
preferred over one that is sourced from a murder victim. The
law makes that very clear. The disposition of the heart has
a set of guidelines and laws that govern that transfer yet
the laws are separate apart and distinct from the laws that
deal with murder and death from natural causes.

The same will be needed in the stem cell controversy.  The
cells can be obtained from aborted fetuses, umbilical cords,
petri dish embryo's, genetically similar humans,  porcine
cells, and perhaps our own cells.

The guidelines and laws that pertain to the various sources
must necessarily address the very different issues that
emerge from these very different sources.
Likewise the disposition of these cells will require a set
of guidelines and laws that address the different issues
that could emerge based on the source on the cells. These
could involve anything from cross species diseases to same
species diseases to simple cell rejections.

How the cells are obtained clearly makes a difference.
Saving a life normally doesn't justify causing a death. Yet
we saw in case one (the second paragraph) where one could
argue that the decision was not to take a life but to save
one even though cells were terminated. Since there may be
instances where cell availability can be morally and
ethically justified preparation for the proper use of these
cells must proceed on the tenant that al life is precious
and should be protected.

There should be a separation of the sourcing and the
dispositioning guidelines and laws and further within these
two categories laws will have to evolve that recognize the
circumstances that create the issues to begin with.

The notion that one size fits all is clearly not appropriate
here. To say that all methods of obtaining cells are legal
is as inappropriate as saying no method of obtaining cells
is legal.


Respectfully,


Bob Martone
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http://www.kingwoodcable.com/martone/