The Independent Newsweekly
Issue Date: June 18, 2004
Stem cell dilemma
Do potential benefits of research outweigh ethical risks?
By PATRICK DOBSON
Missouri State Sen. Anita Yeckel was surprised and pleased to get a call from her pastor, St. Louis Archbishop Raymond Leo Burke, the evening of Jan. 12.
The strongly pro-life Catholic and Republican was in her office in the state Capitol in Jefferson City preparing to attend a hearing on a bill prohibiting human cloning before the Judiciary and Civil and Criminal Jurisprudence Committee. The bills author was Sen. Matt Bartle of Lees Summit, Mo., a suburb of Kansas City.
The purpose of Burkes call, she thought, was courtesy.
I couldnt figure out why he was calling, she said. I thought it was nice, though. He was very charming. But then, I was saying what he wanted to hear. I thought I was going to vote for the bill.
Bartles bill, also known as the anti-cloning bill, would make it a felony offense to for a person to participate in or use state funds or facilities in the cloning of a human being. According to the definitions included in the bill, Clone a human being or cloning a human being, shall mean the creation of a human being by any means other than by the fertilization of a naturally intact oocyte of a human female by a naturally intact sperm of a human male.
As such, in vitro fertilization, a useful method of producing embryos (joining egg and sperm) for implantation into women who have been unable or have had difficulty getting pregnant, would not be prohibited under the bill.
On its face, the bill would outlaw an act morally distasteful to many Americans. But it would also criminalize a biomedical research procedure called somatic cell nuclear transfer that some geneticists and doctors believe holds promise as a way to produce stem cells for tissue repair and therapy. It is a much easier method than using todays existing stem cell lines or harvesting adult stem cells, which can be a painful and invasive procedure. To many, the procedure skirts ethical and moral difficulties in creating new life from fertilizing an egg to harvest stem cells.
Burke has decided to take a stand in Missouri that could have serious national implications. If successful, his campaign would essentially shut down any human genetic bioscience research efforts in Missouri. If his view prevails, one of the most ambitious research efforts in the Midwest may be forced to move elsewhere, and university work on human genetics could be in jeopardy. The debate in Missouri contains the elements of the battle over certain areas of bioscience that is going on in varying degrees nationally. And the debate is not confined to cloning of cells, but also includes concerns over health care, how resources are used, who has access to the latest developments and how the health care system is going to pay for making new applications broadly available.
Somatic cell nuclear transfer involves removing the nucleus of an egg cell. That nucleus is then replaced with the nucleus from a donors skin, liver, brain or any other cell in the body.
With the somatic, or adult cell nucleus, the egg begins to develop into a blastocyst, essentially a sphere containing a cluster of unspecialized stem cells. Scientists can then extract these stem cells from the growing blastocyst and grow them in vitro, in other words, in an artificial environment. Since they contain the donors own DNA, stem cells generated in somatic cell nuclear transfer theoretically can be used to repair damaged or defective organ tissue in the donors body without rejection or immune reactions related to organ transplant or injection from existing stem cell lines.
Yeckel was the swing vote on the bill on the committee of nine senators. She had been the subject of heavy lobbying by the Missouri Catholic Conference and Missouri Right to Life in the weeks previous to the hearing.
And while the Missouri Catholic Conference is the lobbying agency for the bishops, the archbishop said he is acting on his conviction that, as a teacher and leader, it is his duty to make sure Catholic legislators within his diocese know the churchs position on Bartles legislation. Since Yeckel was a member of his flock, his obligation was to inform her of the churchs position on human cloning, he said.
His call to Yeckel marked Burkes first personal foray into Missouri politics and signaled his preference for taking an activist leadership role.
Burke joins an increasingly powerful pro-life lobby in Missouri. Since he has come to Missouri, Archbishop Burke has weighed in decisively and forcefully on Catholic moral and social justice teachings, said Larry Weber, a permanent deacon and head lobbyist for the Missouri Catholic Conference. I look at him willing to be involved. He will be frequently weighing in on issues in Jefferson City and in Washington.
Burkes installment in the heavily Catholic St. Louis area may give him a strong platform as a church leader. St. Louis has one of the largest Catholic school systems in the nation, a large and faithful Catholic community and a Catholic tradition dating to its establishment as a French colonial outpost. Anything he does and says will be watched and heard around the state and the nation.
In such a position, Burke adds additional heft to the pro-life agenda of the Missouri Catholic Conference, which already had the ear of conservative legislators, Catholic and Protestant. He is admired by many in the Missouri General Assembly, though many legislators of all faiths often differ from the churchs stance on the death penalty, the conflict in Iraq and social issues.
Rep. Mike Sager, a Democrat, has voted solidly pro-choice since entering the Missouri House in 2002, and stands by his convictions so firmly that he said, I began denying myself Communion in 1988. Now an Episcopalian, Sager said he understands the pressures on Catholic Missouri state legislators. Moreover, pressures on legislators to vote for pro-life issues across the board are enormous.
The Missouri Legislature is a place run on fear, he said. Whether youre pro-life or pro-choice, it doesnt matter. You vote pro-life because youre afraid of whats going to happen to you if you dont.
You talk to people who go to the Missouri General Assembly on the pro-choice side. They get there, and suddenly you find them lining up on the pro-life side, merely because they know this is a political football they cant handle. And when it comes to therapeutic cloning or somatic cell nuclear transfer, the rhetoric is just as steamed and difficult to surmount as with abortion.
With Burkes arrival, he said, the real challenges begin for Catholic legislators, and for all of us, really.
Somatic cell nuclear transfer
[Researchers at Washington University Medical School] in St. Louis have already been able to produce promising results in spinal cord repair in animals such as mice and cats, using stem cells generated with somatic cell nuclear transfer.
Normally, the DNA in the replacement nucleus is programmed to produce only the cell it came from -- skin cell nuclei, for example, produce and manage skin cells only. But the cytoplasm in an egg cell can turn on the DNA strand in the replacement nucleus in full. The DNA in any cell in the human body has the genetic code to produce any other cell in the body, DNA from a thumbnail cell, for instance, can, under correct circumstances, be made to produce liver cells, and vice versa.
More important to researchers today, these DNA strands also include the information necessary for cells that arent required past the very beginning of life, such as those that set the stage for gestation and the amorphous stem cells that can ultimately specialize into organs, limbs and tissues within the first weeks and months of embryonic development.
These unspecialized stem cells can be coaxed into becoming the tissues doctors mean to treat. But just as important, researchers see stem cells as the key to discovering how to turn on all or part of the DNA strand at will to build, repair and replace selected tissues, organs and cells -- all from, by and for the person from whom the genetic material comes.
Proponents of somatic cell nuclear transfer, such as Stowers president and CEO William Neaves, say the procedure is a way to produce stem cells that can take the form of any other cell in the body without creating new human life or destroying a human embryo. Since the cells produced in the procedure have the same genetic imprint of the donor, rejection problems with implantation of donor materials do not exist.
You are working entirely with the genes of a person conceived years earlier, Neaves said. You are not creating new life. You are not causing conception to occur. You are just reawakening the developmental potential that already resides in that individuals [donors] genes. Neaves holds a PhD in anatomy from Harvard.
Opponents, such as Bartle, author of the bill prohibiting human cloning, and Burke, however, argue that there is no distinction between the fertilized embryo and the organism with a full human genome derived from somatic cell nuclear transfer.
Yeckel, who considers herself a good and faithful Catholic, said when she spoke on the phone with the archbishop, she was in complete agreement with him. She is solidly pro-life, believes staunchly in outlawing abortion, and would vote against the death penalty.
Yeckels chat with the archbishop had buoyed her. Walking down the echoing marble halls of the Missouri Capitol to the hearing that evening, she had no qualms about what she was going to do. She believed she was going to vote to move Bartles anti-cloning bill out of committee. It was, after all, cloning, something morally reprehensible to begin with. Then it would be killing a human being, something she has stood against her whole career in the senate, which she began in 1996.
I got into the hearing, and thought I was going to vote for the bill, she said. But once she read the bill, she said, I couldnt. I just saw that somatic cell nuclear transfer could have ethical implications that were different. That this was different than abortion. Matts bill would have done away with all the research that, as I saw it, could have allowed a mother to help her diabetic child, or a family member to help another. I just wasnt going to vote for Matts bill, as much as I think hes got good intentions.
Another legislator, however, had put forth an amendment that would have permitted somatic cell nuclear transfer, and human cloning would have been strictly forbidden, Yeckel said. With the amendment, I could have voted for Matts bill. That made sense, to outlaw cloning but allow this research that could yield such benefits.
I wanted to go even farther and say that the product of the [somatic cell nuclear] transfer could never be implanted in a human uterus and the therapy could never be done for a profit, merely because the cost of the procedure itself would keep it out of the hands of a vast number of people it would help.
The committee, however, voted down the amendment and Yeckel voted against moving Bartles bill out of committee. And there the bill remained with votes tied at four for the bill and four against. Yeckels vote put her at odds with other pro-lifers in the Senate.
Without [Harold] Caskeys amendment, the bill didnt make sense to me, she said. You would outlaw something that could potentially help a diabetic child. With something that would be the product of a child and its mother, and something that the mother and child own? This is not the same as procreation.
Before a second hearing Feb. 24 to move the bill out of committee and to the Senate floor, Bartle approached Yeckel weekly to assess her vote.
I could tell he was counting votes, she said. But the more I read about the procedure, the more I studied the subject, I found I was moving farther away from him.
Yeckel, who was educated at Jesuit St. Louis University, said, I was using what the Jesuits taught me. I was using that ability to reason, to look at things from a couple of perspectives. When I tried to talk to Matt about it, he would just say the embryo was human life and clam up. I tried to talk to the Catholics, and they would do the same.
As the evening approached for the hearing, lobbyists from the Catholic conference and Missouri Right to Life visited her office, often dropping off literature and offering prayers and solace.
They knew I was a good Catholic, she said. And they were courteous. But they never once wanted to really discuss the issue. At some point, they always say that its killing a baby and that ends it. Still, they will accept other killings -- the death penalty, the war.
On Feb. 24, Bartle approached Yeckel at the hearing just before the vote on his anti-cloning bill. He said if I wanted to take a walk, it would be easier on me, she said. It would be easier on everyone. But I told him I had made a stand and was willing to suffer for it. I voted against moving it out of committee, again.
There the bill died when the legislative session ended in May. Bartle says he couldnt get his bill out of committee because Cape Girardeau Republican Sen. Peter Kinder, a pro-life voter, wouldnt come to the hearings on his bill.
And Rep. Yeckel, a member of church, wont vote for it. I tell you, its in these things you begin finding out what peoples true colors are.
Bartle expects to come out of the box with all his energies in the legislative session that begins in the fall. We have a pro-life majority here. Were going to get it.
Neaves of the Stowers Institute said the dream of regenerative medicine, for example, is to reawaken those genes in a fibroblast in a piece of heart scar tissue so that it might regenerate heart muscle, or after a stroke, to regenerate lost neurons in the brain.
Or if we can only reawaken gene expression in cells that are still resonant in the brain of a person who has developed Parkinsons or Alzheimers disease to cause cells that are somewhat idle in the brain to replace those that have been lost, he said.
Scientists today know of only one way to reawaken that developmental potential -- placing the nucleus of an ordinary cell in the body, say from the liver, skin, fibroblast, inside the cytoplasm of an egg from which its own nucleus has been removed or pushed out. The special environment inside the cytoplasm of the egg has many transcription factors, switches that turn genes on again.
The special constellation of transcription factors resonant inside the cytoplasm of the egg, Neaves said, is able to reawaken the developmental potential of an ordinary body cell. So it can retrace its own developmental steps and be in a position to redifferentiate again into any specialized cell or tissue in the body.
Somatic cell nuclear transfer is important to scientists not merely for the stem cells it produces that can be given back to the donor, but for the knowledge it may bring of wakening gene expression in ordinary cells in the body. Once these transcription factors are understood, the process of somatic cell nuclear transfer may, itself, become obsolete.
Burke, however, said the churchs position is clear. Whether produced sexually by union of egg and sperm or asexually in somatic cell nuclear transfer, the cluster of cells that arises is human.
I think it is a manner of speaking, he said. Theres creation of a human life. However they want to describe it, what we have is a human life. In fact, as I understand it, there is the creation of a number [of somatic cells] at the same time in order to find the right one or the best one for the procedure. So I just dont agree with that.
The question of the beginning of human life as a priority and all the moral questions pertaining to human life, if youre talking about the gift of life itself, at its beginning it calls for protection and care as that life grows and develops.
Bartle concedes that pursuit of somatic cell nuclear transfer research may lead to groundbreaking therapies, but taking one life to save another is inappropriate, he said. When we begin making those kinds of judgments, weve gone well beyond our authority.
Its not morally right or just to experiment on jail populations or death row inmates. Why then let scientists kill human embryos to advance science? My problem, and that of pro-lifers and the pro-life community, is that we believe life begins at conception. If you bypass that concept and create a human embryo, indistinguishable from the conceived one, youre still there.
St. Louis Republican Rep. Jim Lembke had introduced a bill identical to Bartles in the Missouri House, HB 1151, which also died in committee this year. He doubts claims that human suffering will be relieved through somatic cell nuclear transfer research, though the research is only now beginning.
I think its a way to sell the item, he said. Even if it were the fact, the ends dont justify the means. Just the idea that through research into the process we would be harvesting stem cells from human embryos for this purpose ends the life of this human for better quality for another -- it goes against all underpinnings of moral society.
Thomas Shannon, professor of religion and social ethics at Worchester Polytechnic Institute, said the church and many pro-life advocates assume that fertilization is a specific, identifiable moment. But scientists, such as Neaves and his colleagues, may have more room to move.
The problem [with the church view] is that embryology is a process, said Shannon. Fertilization itself is a process. It takes about 24 hours for the sperm to penetrate the ovum, and then for the chromosomes to line up, then for the union and formation of the DNA to occur, and then to have a beginning of cell division.
One thing important to me is that in the blastocyst at the beginning, the cells have capacity to become other organisms. The cells have a unity, but it is not a unity of individuality. They are going in a direction, but they are fluid. It is at this point that twinning can occur, and a number of other things that are not individual. It takes a week to two weeks before the cells are committed to body parts they will become.
This is a critical time. For the first two weeks, the organism is not an individual, and there cant be a person without an individual.
On the other side, Shannon said, the blastocyst, essentially a small ball filled with stem cells, is a living organism with the human genome worthy of respect. It is not due the same respect as that accorded to a person, but respect. If you end its life, then its killing, not murder. And if its not murder, then there are offsetting reasons to justify killing. In this case, embryonic stem cell research for the benefits it may bring to living persons.
Burke said, however, that the beginning of human life means the ensoulment of the individual. My approach in that regard is that when you have a human life you have the ensoulment, he said. In other words, I think to separate the beginning of human life from the ensoulment is false.
Neaves, who considers himself to be a strong Christian, said, There is a firm scriptural basis for doing everything in our power to relieve human suffering.
What Ive been talking about so far has been taking that cluster of stem cells and growing them in a petri dish and introducing them back into the body to regenerate damaged heart tissue, to regenerate damaged lost insulin-secreting cells, to regenerate lost neurons in the brain. If, however, that small cluster of stem cells is taken and implanted into a uterus, we know from the example of Dolly the sheep that, in at least some mammals -- certainly in sheep and cattle, I believe its been done successfully in cats and mice.
Theres debate whether it would be successful in humans. None of us here at the institute have any desire to go along that pathway at all. Actually, we would be quite happy if the implantation of that small cluster of stem cells into a uterus were outlawed. But the possibility that you could take that cluster of stem cells and place it in a uterus and it would grow up to be a clone of the individual who donated the cell is a basis of objecting to somatic cell nuclear transfer.
Because the technology can be misused, he said, should not preclude good faith research with the technology strictly for the purpose of regenerative therapy, so that the stem cells become the basis of regenerating damaged tissues in a patients body.
Burkes effect on the legislature
Stem cell research and somatic cell nuclear transfer is a ready-made issue for Burke, who was a politically known figure before he came to St. Louis.
He had made a name for himself as an outspoken religious leader when, as the bishop of the La Crosse, Wis., diocese, he took public stances against abortion. On Nov. 23, 2003, Burke issued a pastoral notification on the La Crosse diocese Web site stating that in accordance with canon law, Catholic legislators, who are members of the faithful of the diocese of La Crosse and who continue to support procured abortion or euthanasia may not present themselves to receive Holy Communion. They are not to be admitted to Holy Communion, should they present themselves, until such time as they publicly renounce their support of these most unjust practices.
He arrived in St. Louis in early January from La Crosse amid a storm of controversy. Shortly before the Missouri Democratic primary in January, after he assumed his new job, he said publicly he would deny Sen. John Kerry the Eucharist.
Critics said he was violating the separation of church and state. Pastoral letters, notifications and public statements have deep influence on the political life of the community. Some recalled fears of American political leaders answering to the Vatican, which preceded John F. Kennedys election to the White House.
Burkes supporters, however, welcome his strong voice. Robert P. George and Gerard V. Bradley on the Web site for the National Review called the charge of violating church and state separation silly.
No one is compelled by law to accept his authority, they wrote in a Jan. 29 editorial headlined Leading his flock. But Bishop Burke has every right to exercise his spiritual authority over anyone who chooses to accept it. There is a name for such people: They are called Catholics.
In an interview in April with NCR, Burke said he has studied the constitutional matter closely. His understanding is that separation of church and state is that the Constitution and Bill of Rights prohibits the establishment of a religion. In other words, the making of a religion of the state -- that this would be a Catholic state or a Lutheran state, or whatever. But it certainly does not prohibit its leaders from making their contribution to civic discourse in the interest of promoting the common good. In fact, to the contrary, our country would be harmed very much if religious and moral leaders did not speak up and make their contribution to the discussion of whatever issues are before the nation.
I consider this a very serious duty, said Burke, speaking in his office at the chancery of the St. Louis archdiocese, located next to the Cathedral Basilica of St. Louis near Forest Park. I do not consider this interference. I do not tell anyone you have to vote this way or that way. Im simply saying to a Catholic legislator, if you vote for legislation that provides for a procured abortion, you are violating your conscience in a very serious matter.
State Sen. Jon Dolan, a Catholic and a Republican, said he welcomes Burke and the influence he will bring to bear on pro-life issues in the Missouri General Assembly. Im happy we have him on the pro-life side, he said. Hes outspoken and hes made me proud to be a Catholic again.
Dolan is emblematic of the separation between the churchs stand on abortion and cloning issues and other social issues on which it has taken strong stances.
Dolan was in the Army National Guard and was called to duty in Guantanamo Bay, Cuba, in 2003 to serve as a public affairs officer. He was granted leave in September, during which time he came back to the Missouri Senate to cast the deciding vote on controversial legislation that would allow Missourians to carry concealed forearms with special permits. Missouri voters had turned down the same legislation in a referendum a few years before. The church in Missouri lobbied against both the passage of the referendum and the bill Dolan came back from Cuba to vote on.
Dolan was chastised by the military, and after a brief investigation, forbidden from undertaking any political activity while on active duty. His vote was allowed to stand.
When it comes to the gun control, the death penalty and other social issues, many Missouri Republicans and the Catholic church part ways.
I like the way Archbishop Burke plays ball, said Bartle. I hear about his work, and obviously hes supportive of my work. From what I understand hes doing, the Catholic church is willing to put its actions where its mouth is, and not just be pro-life but actually engage, let people know. We part ways on the death penalty and social issues. I think government does great harm by creating dependence. When it comes to the death penalty, I believe that if you take someones life intentionally, the state has right to execute you. Period.
Lifes beginning, Burke said, is a fundamental and prior moral consideration to all others regarding the protection of life. With regard to war, he said, the judgment with regard to the justice of a particular action or not lies with the civic officials. In that sense, the church respects that decision, even though she may criticize it, may call into question.
So the approach is different because they are two different situations. Both involving human life and the protection of human life, but the situations being different and, therefore, the way to address them has to be different.
With regard to the death penalty, Burke said, the Catholic catechism and the teachings of the pope make clear that the church stands against the death penalty except in instances of self-defense. We have forms of incarceration and so forth to deal more humanely with the punishment of someone who has committed a horrible crime, he said.
Burke said he will not be shy, however, about pursuing the churchs antiabortion/anti-cloning stance. He will call legislators, much as he did Yeckel, when appropriate.
I have the obligation as the bishop to call Catholic legislators to respect the moral law as taught in the church. It is my responsibility for their sake and for the sake of others to remind them of the churchs teaching. So I will be in communication with them. Wherever I think it is a question of protecting the common good, fostering the common good, I will speak out.
Burke doesnt like to be called an activist. On the other hand, he sees himself as a teacher of the faith and his job is to care for souls, including the souls of politicians, Catholic politicians, and of the others who are impacted by the actions of Catholic politicians, he said.
The other thing is, I mean, we live in a world which is very secularized, he said. There isnt any more a kind of pervasive culture very much influenced by Judeo-Christian teaching. And, therefore, it is even more incumbent upon a bishop to teach clearly.
When asked if he plans to issue public notifications related to political issues, whether on the death penalty or social issues, he said that because he is so new to his position in St. Louis, to say would be premature. He insists though that anyone at the head of the St. Louis archdiocese assumes a moral leadership position.
If a Catholic legislator persists in a public position contrary to the churchs position respecting human life, that person should of his own not come to holy Communion, he said. But because these acts are public, I, as archbishop, or others, would be obligated if that person did come up to say, you know, You may not receive the holy Eucharist.
Larry Weber feels he has a great ally in Burke. I feel that if there was an issue that was important to the church that was coming to or in the legislature, I could call on him. The time may come when he will make those calls for me.
As for being available to Weber and the Missouri Catholic Conference, Burke said he will not be a puppet, but that when it comes to important issues, he would study the issues Weber brings to his attention and make the appropriate calls, if I thought it was the right thing to do.
Conscience vs. rightly formed conscience
In matters of faith, Anita Yeckel considers herself strong. I am a good Catholic, she said. I have never disobeyed my church. But I do believe the church should not have taken this stand as comprehensively as quickly as it has in the context of this research. I think some people sat at a table and made a decision.
In years to come, I may find out that a bunch of gray heads spent years and years debating these things, but right now, I believe Im doing the right thing.
Neaves thinks that if more people could understand clearly that this is not fertilization, its not conception, its not the creation of a new life, that a lot of the hesitancy about embracing the technology would disappear.
Even when it comes to stem cells derived from fertilized embryos, such as those of the 30 or so stem cell lines approved by the Bush administration for research in 2001 obtained from destroyed or aborted embryos, Americans seem to favor stem cell research.
The Juvenile Diabetes Research foundation found in a survey of 600 self-identified conservative voters conducted in late 2003 that while 36 percent of those surveyed said they strongly opposed such research, 56 percent said they somewhat or strongly supported it. Of the same group of people, only 23 percent wanted to ban stem cell research altogether, 22 percent agreed with Bush administration limitations, and 44 percent believed the policy should be broadened.
Problems that researchers now have with the existing cells lines are several. The first and foremost is that while these stem cells are just as amorphous as those produced in somatic cell nuclear transfer, problems arise with immune reaction and rejection similar to that experienced in organ transplant surgery.
That is another reason we are so excited about this, said Neaves. You dont have to worry about that individual patient mounting an immune reaction and rejecting the reintroduced cells. Its his or her own cells being placed back into their bodies. Not recognized as being foreign at all.
Another is that the cells themselves tend to form cancers or tumors after a period of multiplication in the petri dish environments in which they are reproduced for research.
Adult stem cell research holds promise, but adult stem cells arent nearly as malleable as those produced either in human embryos or by somatic cell nuclear transfer. For instance, stem cells harvested from bone marrow are good for reproducing red and white blood cells, and platelets, but arent good for replacing neurons, muscle or organ tissue.
The other substitute for somatic cell nuclear transfer is placental or umbilical cord stem cells from newborns. But these, again, tend to have the same kinds of rejection and immune reaction problems as the existing stem cell lines.
Neaves said that somatic cell nuclear transfer research holds so much promise, holds so much potential for the relief of human suffering that we believe its extremely important to preserve an environment in Missouri where this kind of work can be done.
In this instance, I think its justified for a person to use his or her own cells, said Anita Yeckel. I would bring up that intent is a big part of sin, and intent is important. To me, there is no intention ever to grow a human, or to grow a person to harvest kidneys or that sort of thing. Rather, this is a way, as far as I can see, of finding beneficial cells to inject back into the donor.
Patrick Dobson is a freelance journalist based in Kansas City, Mo.
National Catholic Reporter, June 18, 2004 [corrected 07-02-2004]
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