The San Jose Mercury News, CA
Posted on Sun, Mar. 30, 2003

Ethics debate differs in U.S., Sweden
AT HEART OF POLICIES: WHEN DOES LIFE BEGIN?
By Dan Lee
Mercury News

GOTEBORG, Sweden -- A generation ago, scientists' ability to unite
sperm and egg outside of a woman's body to create an embryo
revolutionized the treatment of infertility worldwide.

The practice -- in vitro fertilization -- sparked widespread ethical
and medical debate but has since offered the hope of parenthood to
hundreds of thousands of couples.

Today, with those early ``test tube babies'' now adults, leftover
human embryos from IVF treatments are at the center of another
explosive medical controversy: embryonic stem cell research.

``It's almost exactly the same,'' said Dr. Lars Hamberger, a longtime
professor of obstetrics and gynecology at Sweden's Göteborg
University, comparing the debate and promise of the early days of IVF
with that of stem cells today.

While both the United States and Sweden are world leaders when it
comes to embryonic stem cells, the two nations have taken divergent
paths on ethical debate and federal policy when it comes to funding
research and the push toward potential treatments.

The opinions in each country are formed around some of the most
fundamental questions in medicine: When does life begin? At what
point of development does an embryo, or a fetus, gain full protection
of law? Is it justifiable to destroy a human embryo if that research
could eventually lead to treatments or even cures for ailments
including cancer, diabetes, Parkinson's, Alzheimer's and heart
disease? Should this research be federally funded?

In 1982, Hamberger's group was behind the first IVF baby in
Scandinavia. Now, he is focused on culturing embryos that will never
be transferred to a woman's uterus but will be destroyed to yield
embryonic stem cells. And those cells, he and others say, could lead
to treatments for some of humanity's most dreaded conditions.

``The potential for embryonic stem cells is really fantastic,'' said
Hamberger, who has ties to two Swedish companies involved with stem
cells, Cell Therapeutics Scandinavia and Vitrolife.

In 2001, President Bush ruled that U.S. funding could go toward only
previously established lines of embryonic stem cells. Those lines had
to be derived from spare embryos from fertility treatments that were
donated with the couple's consent.

That same year Sweden issued vastly different guidelines for
embryonic stem cell research. As in the United States, the embryos
would have to come from leftovers from IVF. But in Sweden federal
funds can be used on new stem cell lines.

Critics of embryonic stem cell research, including the Roman Catholic
Church and some medical professionals, say that those embryos should
be protected and that such research is immoral.

To produce stem cells, researchers culture an embryo into a
blastocyst that has an inner cell mass of about 30 cells -- those
cells that could ultimately give rise to the fetus. That stem-cell
producing inner cell mass is then removed, destroying the embryo.

One group of U.S. medical researchers opposing embryonic stem cell
research is the Washington, D.C.-based ``Do No Harm: The Coalition of
Americans for Research Ethics.'' The group, which takes its name from
Hippocrates' ``Of the Epidemics,'' maintains that the potential
treatments from the research do not justify destroying human embryos.

Life begins at fertilization, when the ``genetic code is complete and
operative,'' according to the group. That means that the embryos are
not just clusters of cells but ``are the tiniest of human beings.''

But Swedish stem cell researcher Dr. Anders Lindahl sees life as
starting more gradually.

``It was not an easy decision for us, either. We had a long ethical
debate internally,'' said Lindahl, a professor of clinical chemistry
and transfusion medicine at Göteborg University's Sahlgrenska
University Hospital, who also works with Cell Therapeutics. ``You can
argue in many, many ways. I think you should argue: When does life
start? What is life? If you have the Catholic Church that says life
starts at the time of fertilization, of course, then it's impossible
to use embryonic stem cells from that standpoint.

``I think that's the sort of common ethical ground that we have here
in Sweden, that life's value is increasing during pregnancy. To feel
something, which is life, you have to have a nervous system, which
means that the first presence of some type of nervous tissue is
around three weeks.''

Of the 78 lines worldwide that meet the Bush criteria, 25 are in
Sweden. And Swedish researchers have no plans to stop there. Boo
Edgar, chief executive of Cell Therapeutics, which grew out of
research at Sahlgrenska, said the company could gain access to a
potential of 40 new lines of embryonic stem cells a year.

``They would have been destroyed anyway,'' Edgar said of the embryos
left over from IVF. ``The decision about life or death on that embryo
has been taken.''

The view of a gradual beginning of life is widely shared by many
politicians and citizens in Sweden, according to Dr. Harriet Wallberg-
 Henriksson, secretary-general of medicine for the Swedish Research
Council, which oversees that nation's medical policy and funding.

``That's why we, I think, look upon this kind of research in maybe a
more liberal way than some others,'' she added.

By the end of 2001, all seven parties in Swedish Parliament had
reached consensus on embryonic stem cells, Wallberg-Henriksson said.

In an established embryonic stem cell line, the original inner cell
mass has yielded millions of unspecialized cells that potentially
could develop into the various cell types that make up the body, such
as heart-muscle cells.

``Do No Harm'' maintains that alternatives exist to using embryos for
stem cell research, such as taking stem cells from bone marrow, the
umbilical cord of live births or other sources.

Kevin FitzGerald, a ``Do No Harm'' co-founder, is also critical of
the premise that an embryo would receive greater protection as it
develops.

``That's an interesting sort of argument to make because we don't
always in our thinking associate further development with greater
protection,'' said FitzGerald, an associate professor of oncology at
Georgetown University. He cites that children are still developing
into adults, yet are given special legal protections.

FitzGerald, also a Jesuit priest, fears that such an approach could
have wide implications for how societies care for the weakest among
them, whether it is embryos at the beginning of life or people at the
end of life. ``Does vulnerability and in some sense less of an
ability to care for one's self mean that you should be worth less, or
does that obligate that society should care for you more?'' he asked.

Stem cell researchers and companies in Sweden are working to attract
more U.S. funding, but the controversy remains. Last December, the
Swedish consulate in Southern California co- sponsored a seminar on
stem cells in Santa Monica but closed the event to the media to avoid
potential negative publicity.

FitzGerald said a truly global dialogue is needed on embryonic stem
cell research, since research done in the United States, Sweden or
elsewhere has a potential worldwide impact.

``If you look only to science for answers, the science is going to
say `do the research,' '' he said. ``What I'm saying is this
technology and this research raises profound societal questions, and
those social questions are not necessarily strictly answered from a
scientific perspective.''

Lindahl of Göteborg University predicts that some critics would
rethink their opposition once embryonic stem cells begin to change
lives by rejuvenating and repairing human tissue.

``We started this rather early here in Sweden, and the Bush decision
was something that was totally unexpected,'' Lindahl said. ``This was
work that we initiated based on the belief that human embryonic stem
cells would be a very valuable scientific tool, and as a doctor I'm
sort of the lawyer presenting the case for my client, the patient.
And I think in this case, for the patient it's an important piece.''

SOURCE: The San Jose Mercury News, CA
http://www.bayarea.com/mld/mercurynews/business/5517522.htm

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