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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 * * * ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn