“What You Need to Know about Stem Cells” Presenter’s Notes Accompanying the PowerPoint Presentation

“What You Need to Know about Stem Cells”
Presenter’s Notes Accompanying the PowerPoint Presentation
Prepared by the
Stem Cell Action Network (SCAN)
www.stemcellaction.org
The notes in this document amplify information in the SCAN PowerPoint presentation on
stem cell research. You can use these notes to help you give this presentation to an
audience. Additional materials that you may find helpful in preparing your presentation
are available online at: />The presentation and these notes are designed to serve the needs of a presenter who is
not a scientist and who does not know much about stem cell research. Please don’t be
intimidated by the complexity of this subject! Technical expertise is not needed to
give this presentation.
These notes are posted on the SCAN website at
www.stemcellaction.org/presentation.htm Encourage those in your audience who have
Internet access to read these notes if they wish to learn more about the points made in
your presentation.
Also helpful in “boning up” on the basics of SCR (stem cell research) are the following
online resources:
Regarding the science of stem cell research:
Princeton University Department of Molecular Biology
/>Stem Cell Network (a Canadian organization)
/>National Institutes of Health (NIH) Stem Cell Information
/>
Regarding he ethics of stem cell research:
/>Stem cell research is a many-faceted enterprise. In preparing your presentation, don’t
feel that you have to cover every single point made on the slides. And don’t be daunted
by the amount of material that we’ve included in these notes. We realize that this is
much more information here than would ever be fitted into a talk on this subject.
Tailor what you say to the needs and attention span of your audience. Choose whatever
you believe will be relevant and helpful to that audience. If questions are thrown at you
that you cannot answer, then relay them to us at SCAN (), and

we will try to reply in a timely way.
Here are addition guidelines.


1. There are several ways of giving this presentation to an audience. If you do not
have access to PowerPoint presentation technology, then you may take a “lowtech” approach, using only printed materials. Especially for an audience of ten or
twenty or so, that will work fine.
2. Whatever form your presentation takes, it’s a good idea to accompany

your talk with a printed document that you hand out to members of your
audience. You can make copies of the Word-document version of the
presentation at your local photocopy shop and distribute them to your
audience. (This document includes the two slides on California. You may
delete them if you're addressing a non-California audience.)
3. You can also ask the photocopy shop to make 11X17 inch color representations
of the three explanatory diagrams in the presentation:
1. "Embyronic Stem Cells”
2. “Stem Cells from In Vitro Fertilization (IVF)”
3. “Human Therapeutic Cloning (SCNT)”
For a diagram that combines diagrams 2 and 3 above, see: "IVF and SCNT Stem Cell
Sources"
By clicking on these images (try using a right-click, if your mouse has one), you can download
them to your computer. You can then email them to your local photocopy shop, to be printed out
in 11X17-inch color. Kinkos will do this for less than $2/slide. If your audience is a small one,
you can display the printed images to them while you discuss the scientific aspects of the
research.
In June, we will hold the "First International Stem Cell Action Conference" at the
University of California in Berkeley. Please invite your audience members to attend this
historic event. You can download, copy, and distribute the Conference Flier to your
audience.

4. You can go to your local photocopy shop and ask them to make 11X17 inch color
representations of the three explanatory diagrams in the presentation, entitled




“Embyronic Stem Cells”
“Stem Cells from In Vitro Fertilization”
“Human Therapeutic Cloning (SCNT)”

For a diagram that combines the last two diagrams above, see: "IVF and SCNT
Stem Cell Sources"
Files containing these images are posted at
/>

By right-clicking on these images you can download them to your computer. You
can then email them to your local photocopy shop, and they can print them out in
11X17 color. Kinkos will do this for less than $2/slide.
It is a good idea to accompany your talk with a printed hand-out that you
distribute to members of your audience. We have prepared such a hand-out and
it is available at: />5. You presentation is an overview, and in most cases shouldn’t last longer than 30
to 45 minutes. You don’t want to lose the interest and attention of your audience.
6. The most important parts of your presentation are likely to be the science, ethics,
and advocacy of the research. You may wish to focus on these three areas,
giving less attention to the details of the political regulation and support for the
research.
7. Be sure to hand out to your audience the flier about the conference, and invite
audience members to attend. Encourage members to learn more about the
conference by visiting the website. www.fisca.info, and/or telephoning Raymond
Barglow, whose phone number is at the bottom of the flier. (The conference flier

is included as Appendix 3 of this document, and is also available on line at
/>8. Ask audience members to provide you with their email addresses, if they are
willing to be added to the SCAN emailing list or if they have an interest in the
conference.
9. Encourage discussion during or following your presentation. Be open to
questions that audience members ask about any aspect of the research –
scientific, ethical, or political. If people have qualms about the prospects or
ethics of the research, they should feel free to express them. Please remain
tolerant and friendly toward people who question the research for one reason or
another.
Slide: What are stem cells?
Stem cells are the raw material from which all of the body’s mature, differentiated cells
are made. Stem cells give rise to brain cells, nerve cells, heart cells, pancreatic cells,
etc.
The cells that make up a human body are of different types and specialize in doing
specific kinds of work, just as in society, different people have different jobs. All cells,
however, either are stem cells or come from stem cells. Cells of the heart, the brain,
bones, the pancreas – whatever kind of cell you care to mention – all have their origins
in the versatile stem cell.
Once a stem cell has specialized, however, it cannot develop into yet another type of
cell. Stem cells don’t get to change careers -- cell differentiation is an irreversible
process.
Stem cells are found in embryos during their first few days of development, in fetal
tissue, and more rarely in organs such as the heart, bones, brain, etc.


Slide: What’s so special about stem cells?


They are self-renewing -- they can replicate themselves over and over for a very

long time.



They have the potential to replace cell tissue damaged by severe illnesses.



Understanding how stem cells develop into healthy and diseased cells will assist
the search for cures.

Stem cells are a raw material that has the capacity to renew itself. Stem cells can
divide over and over, for a very long time, generating an unlimited number of identical
undifferentiated cells exactly like themselves. A stem cell “line” is composed of a
culture of self-replicating stem cells.
Stem cells generate all of the cell types that a human body needs. Stem cells’ two
key properties – their self-renewing capacity and their capacity to become mature,
specialized cells -- make them well suited to restoring tissue that has deteriorated. Like
a very versatile building material, stem cells can be molded into just the right form to
repair a human body.
Let’s look at this restorative process in a little greater detail, to better understand how
stem cell research can lead to cures. Some children are born with organs that do not
work right. A child with juvenile diabetes, for example, has a pancreas that does not
generate enough insulin – a hormone needed by the body in order to digest sugars.
Adults too sometimes have cells or entire organs that have become damaged so that
they no longer function well. In the brain of a person who has Parkinson’s or
Alzheimer’s disease, for example, neurons no longer work in the normal way. In a
spinal cord injury, crushed or damaged cells cause paralysis. In a heart attack, heart
muscle is destroyed and replaced by useless scar tissue. In each of these cases, the
result is illness, disability, and suffering.

Doctors and scientists have long been looking for a way to replace damaged or worn-out
tissue in the human body with new healthy tissue, thereby giving patients a new lease of
life. The most promising path to cures is the regeneration of differentiated tissue
from stem cells, and especially from embryonic stem cells which are the most plastic
and versatile cells in the human body. Research using these cells may yield the cures
needed by the nearly 100 million Americans afflicted by conditions ranging from
Parkinson’s, Alzheimer’s diseases, heart disease, and spinal cord injury to juvenile
diabetes, multiple sclerosis, ALS, and many other medical conditions.
It is, however, NOT only in the domain of regenerative medicine that stem cells will prove
medically useful. Here are two additional valuable applications of the research:
1. Scientists will observe and learn how stem cells give rise either to normal
differentiated cells or to diseased ones. Discovering in this way how diseases
begin and develop will help us find more effective treatments and cures.


2. Stem cell research can also assist in the testing of drugs for safety and
effectiveness. Before trying a new drug out on human subjects, we can see how
it affects the development of stem cells into healthy or diseased tissue.
Slide: Two kinds of stem cells
 Embryonic (also called “pluripotent”) stem cells are capable of developing into all
the cell types of the body.
 Adult stem cells are less versatile and more difficult to identify, isolate, and
purify.
Scientists work with both embryonic and adult stem cells. These two kinds of stem
cell have quite different properties, and research using both is essential – the
research will advance most effectively if it “walks on two legs,” so to speak.
We don’t yet know which kind of stem cell – embryonic or adult -- will prove to be most
useful for medical purposes. Studies done on both stem cell types are likely to play an
essential role in finding new treatments and cures.
Most scientists believe, however, that embryonic stem cells are the more promising

because they are “pluripotent,” meaning that they have the potential to differentiate into
tissue of any organ (brain, liver, heart, pancreas, etc.) of the human body. Adult stem
cells, on the other hand, are, at best, "multipotent," meaning that they generate just a
few tissue types.
Adult stem cells exist in small amounts throughout the body. They are relatively rare,
however, and less plastic (capable of transforming into diverse cell types) than are
embryonic stem cells. Adult stem cells taken from the skin only become skin, cartilage
cells only become cartilage, etc. An additional problem with adult stem cells is that they
don’t replicate well in a lab – so it’s difficult to obtain enough of them to work with.
Embryonic cells hold more promise than adult ones for two additional purposes that
we’ve already mentioned: 1) understanding the origins and development of disease
processes, and 2) testing new drugs.
It should be noted, however, that to date, only adult stem cells have been used
successfully in medical therapies – most notably in treatments for non-Hodgkin’s
lymphoma and Leukemia. Embryonic stem cells have been used successfully for
treatment purposes in animal studies, but have not yet been shown to be effective for
human beings.
Moreover, using adult stem cells in medical treatment may have one significant
advantage over embryonic stem cells – the adult cells may be less likely than embryonic
ones to stimulate the growth of tumors. This is a potential problem that regenerative
medicine may need to address and solve.
Research using embryonic stem cells hasn’t been around as long as research using the
adult variety. But the pluripotency of these cells – their capacity to generate all of the
body’s cell types -- may make them especially useful in understanding and healing
illnesses of tissue deterioration or loss.


Slide: Embryonic Stem cells
Researchers extract them from a 5-7 days old blastocyst.
They can divide to form more of their own kind, thereby creating a stem cell line.

This research aims to induce these cells to regenerate tissue that the body needs.


Embryonic stem cells are found in a days-old embryo called a blastocyst. A
blastocyst is a ball of between 128 and 256 cells that exists from about day 5 to
day 7 following conception.



The ES cells in a blastocyst are part of the inner cell mass (ICM). These cells
are removed from the blastocyst and cultured – in a petri dish for example -where they can be kept alive and encouraged to reproduce, thereby creating a
stem cell line. This procedure destroys the blastocyst.



ES cells are pluripotent - they have the ability to become any type of cell in the
body (except for cells in the placenta or umbilical cord, which are generated out
of the cells surrounding the ICM.



The medical potential of stem cells has convinced many people to support stem
cell research, including research that works with embryonic stem cells. One of
the most famous advocates of ES cell research is Michael J. Fox. He has
Parkinson’s Disease, and is the founder of the Michael J. Fox Foundation, an
organization that supports Parkinson’s Disease research. Of the $17 million
donated so far, over $4 million has gone to ES cell research.



Another famous advocate of ES cell research is Christopher Reeve, the star of
the Superman movie series. When he was thrown from a horse, he severed his
spine, losing the use of his arms and legs. He regularly speaks on the
importance of ES cell research as a possible cure for his and other conditions.



Embryonic stem cell research is a very young science, and may have a long way
to go before it yields medical benefits. It is noteworthy, though, that the curative
potential of stem cells has already been demonstrated in animal studies. Here
are three examples:
1. Parkinson’s Disease. A team led by Lorenz Studer, M.D. at the Memorial
Sloan-Kettering Cancer Center, working with scientists from Cornell
University and the University of Connecticut, used cloned cells to generate
dopamine nerve cells in mice – these are the cells that Parkinson's patients
lack. The cloning technique insured that these cells would be immunologically
acceptable to these mice. The mice had a disease very similar to Parkinson's,
which the experimental therapy alleviated. Possibly this kind of therapy can
be made to work with human beings as well.
2. Juvenile Diabetes. "Diabetes," the journal of the American Diabetes
Association (July 25, 2003), reports that researchers at the Univ. of
Wisconsin observed mouse embryonic stem cells differentiate into a variety
of specialized cells, including insulin-producing cells. Therapeutic cloning to
generate such cells may solve problems facing promising therapies like the
Edmonton protocol.


The Edmonton protocol is a procedure developed in Canada for
transplanting healthy, insulin-producing islet cells into people with Type 1
diabetes. Most Edmonton protocol treatments are quite successful –

experimental data indicate that the transplanted cells continue to generate
insulin for years. Two factors, however, limit the usefulness of this protocol:
1) Pancreatic islet cells are rare, and 2) the treatment induces a rejection
response by the body’s immune system. The second of these problems all
but rules out the use of this treatment for children with juvenile diabetes.
Therapeutic cloning – as we will see in a moment -- could solve both of these
problems.
3. Spinal cord injury. A number of studies done on animals with spinal cord
injuries have shown that stem cell transplants are capable of treating these
injuries. For example, a research team at the University of California at Irvine
has demonstrated that when cells derived from human embryonic stem cells
were transplanted into rats that had received a spinal cord injury,
improvements in the animals’ ambulatory activity could be observed
approximately one month later.
Slide: Two Sources of Embryonic Stem Cells
1. Excess fertilized eggs from IVF (in vitro fertilization) clinics
2. Therapeutic cloning (somatic cell nuclear transfer)
There are currently two main sources of blastocysts – and of pluripotent stem cells
derived from them -- that researchers can use to advance the search for cures:
1. Scientists can use stem cells from left-over embryos that would otherwise
be discarded from fertility clinics. From these cells, healthy new tissue can
possibly be formed to replace the tissue that an illness or injury has damaged or
destroyed.
2. Scientists can use therapeutic cloning to generate stem cells for research
to find cures. The technical term for therapeutic cloning is “somatic cell nuclear
transfer” (SCNT).
Slide: Stem Cells from In Vitro Fertilization (IVF)


Excess embryos from IVF clinics. In vitro fertilization is a method of assisted

reproduction. “In vitro” means outside of the human body. For couples who
cannot have children in the usual way, in vitro fertilization unites an egg and a
sperm in a laboratory setting. This results in the formation of one or several
embryos (or “blastocysts,” more precisely), one of which can be implanted in a
woman’s uterus, where it develops into a baby. This procedure often leaves
behind one or several excess embryos that are not implanted. These embryos –
which number in the hundreds of thousands in American fertilization clinics -- are
frozen for future use or discarded. They can also be used to contribute to the
search for cures, since they are a potential source of embryonic stem cells.




Embryos created for research. It would be possible to use in vitro fertilization –
with donated eggs and sperm -- to deliberately create blastocysts for research.
Stem cells extracted from these blastocysts would be used in experiments to
advance scientific knowledge and the search for cures. The blastocysts would be
destroyed in the process of extracting their ES cells. In England, the use of
embryos discarded by IVF clinics for stem-cell research is allowed, as is the
deliberate cloning of human embryos for this purpose.



The diagram shows 5 types of differentiated cells that pluripotent stem cells could
generate: pancreatic, blood, heart, brain, and liver cells. Of course this is not an
exhaustive list. Every kind of tissue in the human body could possibly be
regenerated from stem cells.

Slide: Somatic Cell Nuclear Transfer (Therapeutic Cloning). Stem cells obtained
using this method originate not from a frozen embryo in an IVF clinic but from someone

who has already been born. The great advantage of stem cells generated in this way is
that they could be implanted into the individual from whom they have been derived
without generating an immune response.
The human body recognizes and attacks foreign cells, including stem cells. A “foreign”
cell is one that has different DNA (that is, different genetic material) than one’s own – as
is the case with the cells in an organ transplant, or a stem cell transplant when the stem
cells come from someone other than the patient.
The immune response is a serious obstacle to stem cell therapy – an obstacle that
therapeutic cloning eliminates. SCNT, which begins with DNA taken from a patient’s
cell, would produce stem cells that are genetically identical to that patient cell. Therefore
these stem cells, also containing the patient’s own DNA, could be used to treat the
patient without encountering resistance from his or her immune system. Just for this
reason, SCNT-generated tissue solves problems that make donor tissue transplants
difficult.
Therapeutic cloning begins by taking a somatic (body) cell from an individual. The
nucleus of that somatic cell is fused with a donated egg that has had its nucleus
removed. The resulting cell, with its new nucleus, is genetically identical to the individual
because it contains the DNA from one of that individual’s somatic cells. The new cell
behaves like a fertilized egg and develops into a blastocyst. ES cells are extracted from
the blastocyst and grown in culture.
This research cloning process, beginning with a person’s mature, differentiated cells and
yielding stem cells genetically compatible with that person, was carried through
successfully by Korean scientist earlier this year. The leader of the research team, Woo
Suk Hwang says, "Our approach opens the door for the use of these specially developed
cells in transplantation medicine.”
Notice that therapeutic cloning does not involve fertilization -- it does not involve the
union of an egg and a sperm. There is no “conception” and no creation of an “embryo” in
the usual sense given to these words. For this reason, even some people who believe

that a human person exists from the “moment of fertilization” approve of therapeutic
cloning research, since it does not require fertilization at all.
Most importantly, therapeutic cloning is not reproductive cloning. This point
deserves emphasis, since many people aren’t away of crucial differences between these
two kinds of cloning. The blastocyst with which therapeutic cloning research works
exists only in the laboratory. It will never be implanted in a woman’s uterus to produce a
baby. Therapeutic cloning (SCNT) produces no cloned individual (as does reproductive
cloning) but only cell tissue that can be used to heal an individual.
Therapeutic cloning research is strongly approved by scientists. This research is
endorsed by the American Medical Association, the National Academy of Sciences, the
Association of American Universities, and many other medical, scientific, and
educational associations. Almost all scientists who work in the domain of basic
biomedical research view therapeutic cloning (SCNT) research as crucial. The National
Academy of Sciences has concluded that therapeutic cloning "offers great promise for
treating diseases.... closing these avenues of research may have real costs for millions
of people who now have these diseases."
Using embryonic cells derived from a person who has a genetically-based, we can
examine the development and differentiation of those cells, and learn how the disease
gets underway. In their statement of support for therapeutic cloning research, forty
Nobel Laureates say that it is needed not only to develop cell-replacement therapies, but
also to increase our understanding of how inherited genetic predispositions lead to a
wide variety of diseases. A deeper understanding of how diseases arise will help us to
cure them.
Slide 12. The Ethical Debate.
In favor of ESCR:
Embryonic stem cell research (ESCR) fulfills the ethical obligation to alleviate human
suffering. Religious and secular ethical traditions recognize compassion as an essential
ethical value. We are called upon to help one another in times of need and suffering. In
the Christian tradition, this is expressed as “Love thy neighbor.” The good Samaritan in
Jesus’ parable is applauded because he offers healing to the suffering stranger. In

Judaism, Islam, Buddhism, Hinduism and other religions, doing what we can to remedy
human suffering is an ethical ideal.
Since excess IVF embryos will be discarded anyway, isn’t it better that they be used in
valuable research? Using an embryo in biomedical research to find cures is clearly
ethically preferable to throwing it away. It is worth noting as well that embryos didn’t first
become “excessive” because of in-vitro fertilization. In the course of nature itself, when
an egg is fertilized by a sperm inside a woman’s body, about half of the time this egg
does not implant in the uterus. That is, about one out of every two fertilized eggs is
normally destroyed, without any outside human intervention whatever. Is each of these
fertilized eggs a person with an absolute right to life? What we confront here is the
question: When does personhood really begin – a question that we will return to in a
moment, and that these notes explore in detail in “Appendix 1. Following Conception,
When Does Personhood Begin?”
SCNT (Therapeutic Cloning) produces cells in a petri dish, not a pregnancy.


This is a point that we’ve already discussed. Moreover, the distinction between
therapeutic and reproductive cloning can be made in legal terms. For example, the proresearch Hatch-Feinstein-Kennedy bill pending in the US Senate specifies that cloning
will serve only research purposes, and makes it illegal to implant a cloned egg into a
woman’s uterus.
Against ESCR:
In SCNT, stem cells are taken from a days-old, human blastocyst, which is then
destroyed. This amounts to “murder.” Given that we inhabit a world in which people do
treat one another inhumanely, and in which scientific research and technologies are
routinely used for destructive purposes – building bombs for example – we do to need to
take care that science serves only ethical purposes, and respects human life. But can a
blastocyst really be counted as a person with a right to life? Does a blastocyst have an
inherent moral status that we should respect?
There are many individuals who believe that using human embryos – even if they are of
microscopic size and only a few days old – for any purpose other than achieving a

pregnancy is unethical. This belief is grounded in the idea that the embryo is a fullfledged person, with human interests and rights, from the earliest time of conception.
There is a risk of commercial exploitation of the human participants in ESCR. There exists the
possibility that women could be mistreated and exploited in order to obtain eggs from them that
will be used in this research. This is an entirely legitimate concern. But advocates of the research
argue that our aim should be to regulate, not to criminalize, the procedures whereby scientists
obtain egg cells for research purposes. Moreover, there are clearly some cases where the
concern for improper incentives or risk of egg donation would not be relevant -- when a mother
wishes to donate an egg to help her child, for example, or to create stem cells that could be used
to save her own life. If a person can agree to participate, for example, in a dangerous malaria
vaccine study to help prevent or cure this disease, why should she be prevented from donating
eggs for similar (but much safer) lifesaving research?
Legislative bodies -- with the participation of scientists, medical practitioners, patients' groups, and
other interested parties – may need to improve already existing statutes regarding egg donation
for any purpose: in vitro fertilization, surrogate motherhood, or therapeutic cloning. This is the
democratic way to address the relevant social and ethical concerns.
It is also important to note that by researching therapeutic cloning, scientists hope to understand
the biological properties of a cloned egg cell that induce it to generate stem cells. Once
scientists learn how this cell “re-programming” occurs, they may no longer need to use
egg cells at all.
For further discussion of questions about the donation eggs for research, see below:
“Appendix 2. Protecting Donors of Eggs for Medical Research”
Slippery slope argument: ESCR will lead to reproductive cloning. A “slippery slope
argument” is an argument of the following form: A certain action should not be taken
because it is a stepping stone to another and another, until something terrible happens.
Theoretically, therapeutic cloning could pave the way to reproductive cloning, because it
develops the technology and the knowledge that might make reproductive cloning
possible.


Again, the concern here is justified. In the past scientific technologies that were

originally intended to serve benevolent purposes were in fact placed in the service of
inhumane purposes. In fact, just about any technology can be used in harmful ways.
But advocates of therapeutic cloning research submit that this possibility calls for
regulation, not for prohibition. Daniel Perry, president of the Coalition for the
Advancement of Medical Research, has pointed out that it is misuse of the research –
implantation of a cloned embryo into a women’s uterus -- that should be made illegal, not
the research itself: “There is a clear, bright line that divides reproductive cloning from
somatic cell nuclear transfer and that's implantation. Without it, no new human life can
be created.”

On the other hand, legislation may not in fact dissuade every single scientist in
the world from attempting a reproductive cloning. So there remains a problem
here. But should the entire domain of therapeutic cloning research be halted out
of fear of this possible abuse?
Slide 13. Key Ethical Issues
The blastocyst used in stem cell research is microscopically small and has no nervous
system. Does it count as a “person” who has a right to life? This is such a central and
controversial question that it merits detailed attention. Please see below: “Appendix 1.
Following Conception, When Does Personhood Begin?”
What do various religions say about when personhood begins? Does science have a
view on this? There is no consensus among religions about when personhood comes
into existence. According to the Islamic Koran, a person begins to exist 40 days
following conception. 40 days is widely accepted within the Orthodox Jewish tradition
too as the date before which an embryo is not yet a person. Christian faiths vary a great
deal in their view on this subject. And even within a single faith, opinion varies
considerably. For example, within the Roman Catholic tradition, Saints Augustine and
Thomas Aquinas, two of the most influential Catholic theologians, did not believe that a
person yet exists in the early stages of pregnancy. (Augustine compares the early fetus
to vegetation!) Prior to the 17th century, this view was predominant among Roman
Catholic thinkers.

Opinion polls indicate that most members in each of the major denominations in America
– Protestant, Catholic, and Jewish – support stem cell research, including therapeutic
cloning. In the case of Roman Catholicism, for example, officials of the Church speak
out and campaign against the research. Yet, according to an ABC News poll done in the
United States, Catholics support the research by a margin of 54 percent to 35 percent.
Bio-ethicist Laurie Zoloth of Northwestern University in Chicago submits that in the case
of therapeutic cloning, "No one religion, no one moral authority can claim to be the final
arbiter of this work."
Scientific findings alone cannot resolve difficult ethical issues. But science is relevant to
our ethical deliberations, because it provides relevant factual information. Science
indicates, for example, that the creation of a person is a gradual process – even
fertilization occurs not in an instant but over a period of about 24 hours. There is no


trace of a nervous system – which is required in order to have experience or awareness
of any kind -- in an embryo before it is about two weeks old. Factual information of this
kind is relevant to our judgment about when a person with a right to life first comes into
existence.

In a society where citizens hold diverse religious views, how can we
democratically make humane public policy? In our society, there is an official
“separation of church and state.” But in practice, this separation is often not
observed. Certain religious interests – represented vigorously especially by the
religious right in this country – pressure politicians into opposing stem cell
research. As well, they misinform the public about the science, ethics, and
politics of the research. This has resulted, for example, in widespread confusion
about the different aims of therapeutic cloning and reproductive cloning. It’s up to
those of us who support life-saving biomedical research to counter all the
misinformation that is out there. Our main tool for doing so: education of
politicians and the public about the safety and humanitarian value of stem cell

research.
Slide 14. Funding and Regulation of Stem Cell Research
Slide 15. Federal Legislation
Executive branch of the Federal government
On August 9, 2001, President Bush issued a long-awaited decision on stem cell
research. He authorized funding of stem cell research using existing stem cell lines that
had been derived from human embryos before August 9. Such research is eligible for
Federal funding if the following criteria are met: there must have been informed consent
of the donors; they must not have received any payment for their donation; the embryos
must have been created not for research but for reproductive purposes, and in excess of
clinical need.
During fiscal year (FY) 2002, the National Institutes of Health (NIH) funded the first
grants to conduct human embryonic stem cell research. The National Institutes of Health
spent more than $387 million on stem cell research in 2002, but the vast majority of that
was spent on adult stem cells. About $10.7 million was used to fund human embryonic
stem cell research, according to the federal agency.
Of the original 78 lines authorized by President Bush, fewer than 15 are actually
functional for research because of contamination and other problems. Some lines are
beginning to develop genetic abnormalities. Thus President Bush’s restriction has had
the effect of stifling publicly funded embryonic stem cell research.
US Congress
In March 2004, a bi-partisan effort in House of Representatives got underway to ask
President Bush to lift the restriction on federal funding for stem cell research. Many
Republican and Democratic Representatives have endorsed this effort.
House of Representatives Bill H.R. 534—Human Cloning Prohibition Act of 2003
On February 27, 2003, the House voted 241 to 155 in favor of this legislation, introduced
by Representative Dave Weldon (R-FL). H.R. 534 would prohibit both reproductive and
therapeutic cloning, and includes a criminal penalty of up to 10 years for violation of the

provisions of the bill. This bill cannot become the lawof the land, however, unless similar
legislation is also passed by the Senate.
Senate Bill S. 245—Human Cloning Prohibition Act of 2003
On January 29, 2003, Senator Sam Brownback (R-KS) introduced this bill. It would
prohibit both therapeutic and reproductive cloning, and is similar to H.R. 234. The bill
was referred to the Senate Committee on Health, Education, Labor and Pensions, and to
date has not come up for a vote on the Senate floor.
Senate Bill S. 303—Human Cloning Ban and Stem Cell Research Protection Act of
2003
On February 5, 2003, Senator Arlen Specter (R-PA) introduced this bill, and it is
sponsored as well by Senators Hatch, Feinstein, Kennedy, Harkin, and Miller. It would
prohibit reproductive cloning but would specifically permit therapeutic cloning, as long as
certain safeguards are met.
It appears that neither the pro-research nor the anti-research legislation proposed above
has enough support to be enacted into law. Hence, the issue is currently deadlocked in
Congress. Should either side believe that they could win the requisite votes for passage,
that side is likely to press for a vote on the bill it favors.
Responses to the unsupportive environment in Washington
Private industry. Given the barriers to stem cell research erected by federal and
state government, the private sector has been stepping in to fill the vacuum. In
some cases, private companies are collaborating with universities and other nonprofit institutions to conduct research studies. For example, early this year (2004)
the University of Minnesota announced its plans to use private funding to begin
research on donated human embryos and to create a new source of stem cells that
can serve therapeutic purposes.
PARAGRAPH REMOVED
March, 2004 - Douglas Melton of Harvard University has created 17 embryonic
stem cell lines that he plans to make available at no cost to interested researchers.
The new stem cell lines were created using funds from the **** Juvenile Diabetes
Foundation, Howard Hughes Medical Institute, and Harvard.
April, 2004 - An anonymous donor has given the University of Texas Health Science

Center at Houston its largest gift ever, $25 million, to boost its stem cell research
program.
Harvard University will soon launch a multimillion-dollar center to grow and study
human embryonic stem cells, in what could be the largest American effort yet to
circumvent the Bush administration's tight restrictions on the controversial
research. Though not housed in a central building, the initiative will be large, even
by Harvard standards, with a fund-raising goal of about $100 million, according to
the scientists involved.


Slide 16. State Legislation
These states have voted to outlaw reproductive cloning:
Arkansas, California, Iowa, New Jersey, Mississippi, Missouri, North Dakota, Rhode
Island, South Dakota, Virginia
These states prohibit therapeutic cloning:
Arkansas, Iowa, Mississippi, North Dakota, South Dakota.
These states permit therapeutic cloning:
California, New Jersey, Missouri, and Rhode Island
Pending state legislation. Ten states, including Illinois, are considering bills this
session that would explicitly permit scientific studies involving stem cells and therapeutic
cloning. The other nine states are Connecticut, Maryland, Massachusetts, Minnesota-where the public university wants to become a center for stem-cell science--New York,
Pennsylvania, Rhode Island, Tennessee and Washington.
Two states that are pro- SCR: California and New Jersey:
October, 2003. In California, Governor Gray Davis, in a direct challenge to the Bush
Administration, signed a bill into law to promote research on embryonic stem cells,
aiming to make the state a safe haven for this cutting-edge biomedical science.
The measure explicitly supports work on human stem cells, including those extracted
from cloned embryos. The bill requires clinics that do in-vitro fertilization procedures to
inform women they have the option to donate discarded embryos to research. It requires
written consent for donating embryos for research and bans the sale of embryos.

It is unclear where the new Governor, Arnold Schwarzenegger stands on stem cell
research.
January, 2004 A New Jersey bill passed that permits research involving “human
embryonic stem cells, human embryonic germ cells, and human adult stem cells from
any source, including somatic cell nuclear transplantation.” However, this same bill
makes cloning for the purposes of creating a baby a crime punishable by up to 20 years
in jail. The bill requires that infertility patients be informed that they can donate unused
embryos for research purposes.
Slide 17. International Legislation.
Embryonic stem cell research is highly controversial not only in the United States but
worldwide.
In the past two years, many nations have begun to tolerate, if not to support, the
research.
In the fall of 2004, the United Nations will consider enacting a global ban on both
therapeutic and reproductive cloning.


Embryonic stem cell research is supported in Sweden, England, Japan, Canada, Israel,
Singapore, and Denmark.
The United Kingdom is developing a stem cell bank that would make a variety of
characterized and newly derived stem cell cultures available to researchers. The Human
Fertilisation and Embryology Authority would oversee the selection of cell lines to be
established and included in the bank. The Medical Research Council would run the
bank.
In countries where the Catholic Church is influential, most notable in Latin America,
embryonic stem cell research is typically outlawed. It is noteworthy, though, that the
three largest countries in Latin America -- Mexico, Brazil, and Argentina – have not
supported the UN proposal to ban the research.
Switzerland
The Swiss Parliament is considering the possibility of allowing research on stem cells

derived from stored embryos remaining at the end of assisted reproduction procedures if
they were frozen at seven or fewer days of development. The research could only be for
non-commercial, therapeutic purposes. The proposal bans the creation of embryos
specifically for research purposes. In addition, work may eventually be allowed on a
limited number of stem cell cultures imported from other countries.
Germany
Legislation had banned the use of embryos in Germany for all purposes except
reproduction. But the import law passed last year takes exception to this legislation and
states that approval for import of embryonic stem cells may be given for research that
has "high-ranking" goals and for which there are no alternatives to using embryonic stem
cells.
The law also states that only embryonic stem cells that date before January 1, 2002, can
be imported into Germany. Other requirements include that stem cells come from
surplus embryos produced by in-vitro fertilization, and that couples providing the
embryos not be paid.
Canada
Canada has passed a bill that bans human cloning but permits research using stem cells
derived from embryos. The bill still requires "royal assent" from the governor general
before it becomes law, but that is considered a formality.
Regulations in other European Union Countries
Opinions on the legitimacy of embryonic stem cell research among EU countries are
divided, according to their different ethical, philosophical and religious traditions. The
members states have taken very different positions on the regulation of the research. As
of July 2003, some of their positions were:
Italy, Luxembourg, Portugal
No specific legislation regarding embryonic research.
Belgium, United Kingdom
Allow for the creation of human embryos for stem cell research.

Austria, Spain, France, Ireland
Prohibit the procurement of embryonic stem cells from human embryos.
Belgium, Denmark, Finland, Greece, Netherlands, Sweden, United Kingdom
Allow for the procurement of stem cells from excess embryos.
Austria, Denmark, Germany, Spain, Finland, France, Greece, Ireland, Netherlands,
Portugal
Prohibit the creation of human embryos for research.
Slide 18. United Nations
Discussion on a proposal before the United Nations to institute a worldwide ban on all
forms of human cloning has been suspended until October 2004. The United States,
together with several other countries, initiated the proposal, which would have included a
ban on research cloning as well as reproductive cloning. But a number of other
countries, including Great Britain, objected to the ban on research cloning and wanted to
suspend all debate on cloning until 2005. Following intense diplomatic and parliamentary
maneuvering, the parties finally agreed to take up the matter in 2004. More about the
activity at the United Nations concerning human cloning, and a record of the vote to
suspend discussion, may be found at />Appendix I. Following Conception, When Does Personhood Begin?
In the course of development from conception through birth, when does personhood
begin? What is it to be a person?
An individual cell – existing for example in heart tissue or muscle tissue —is not in and of
itself a person. That cell is human, in the sense that it belongs to someone who is of the
human species. And that cell is alive. So, one can say that an individual cell in the body
is “human life.” In fact, each time that a cell in the body divides, new human life is
created. But should we count that new life as a new person, having the same right to life
that we attribute to persons?
The right to life is very closely associated with being a person. We have ethical duties
not to each of the cells that make up a person, considered individually and separately,
but to the person as a whole. The individual cells in our bodies are not persons, morally
requiring from us care and protection.
It follows from this that the relevant question, when we are reflecting on our ethical

duties to the unborn, is not: “When does human life begin?” The question, rather, is:
“When does human personhood begin?
Being a person amounts to more than just being human life. Being a person requires,
many people believe, possessing a soul or self, or at least a capacity to have thoughts,
feelings, and other experiences. To be sure, a blastocyst may be regarded as a potential
person. But “potential” and “actual” are not the same thing. An acorn is not an oak tree,
although it has the potential to become an oak tree.
However, notoriously, there is no consensus among human beings regarding when, in
the course of human development, a human person first exists. Some people say that a


person is present when an egg has all of the DNA it needs to begin dividing. Some
people – those who favor abortion rights -- say that a full-blown person does not come
into existence until birth. Hence abortion is not taking the life of a person and is ethically
permitted. Still others hold an intermediary position: in the earliest stages of formation –
the one-celled zygote and the blastocyst – a person does not yet exist. Only later is
personhood constituted – with implantation in a uterus, formation of a primitive streak
(which is the first sign of a nervous system), and/or development into a fetus. Those
who hold an intermediate view will be inclined to regard abortion as ethically wrong, but
embryonic stem cell research as ethically permissible. This is the position held by
Senator Orrin Hatch of Utah.
There is a discrepancy between our moral intuitions and our scientific knowledge. In
morality, we often look for yes or now answers: some actions are permitted; others are
is forbidden. But science finds continuity and gradation throughout nature. Religion too,
at its best, acknowledges that development and change are typically gradual processes.
Many religious faiths (including Roman Catholicism in the tradition of Thomas Aquinas,
the most famous Catholic theologian) take a “developmental” view of personhood. The
developmental view believes that the early embryo only gradually develops into a full
human being, and thus is not entitled to the same moral protections that we give to
persons.

The right to do embryonic stem cell research is not the only issue that depends on when
personhood begins. Another such issue is abortion rights. People sometimes ask
whether there is any relationship between these two issues – stem cell research and
abortion rights – so it is worthwhile to clarify the differences.
In fact, the ethical issues that arise in stem cell research are distinct from those involved
in the abortion controversy. Support of embryonic stem cell research does not imply any
position at all regarding abortion rights. Senator Orrin Hatch, for example, is a strong
supporter of embryonic stem cell research, but he opposes abortion rights.
In his book, “Square Peg,” Senator Hatch writes in favor of what he calls a
“developmental view of life,” which holds that
“an early embryo, before the formation of the primitive streak that will eventually
become the spinal cord and brain, does not enjoy the same legal protections as a
person. This is based in part on the assessment by some scientists that for the first
fourteen days, a fertilized egg is little more than a jumble of cells…. The
blastocysts used for embryonic stem cell research, whether they are developed
through the somatic cell nuclear transfer process or are unused embryos from an
in vitro fertilization clinic, are not the same as a person or a fetus….
If an embryo were the legal equivalent of a person, the use of a variety of
contraceptive devices, such as those that impede fertilized eggs from attaching
onto the uterine wall, could potentially be considered a criminal act. For in vitro
clinics, the routine act of discarding "spare" frozen embryos could become an act
of murder and would, at a minimum, be inseparable from an abortion.”
Hatch’s thinking on this matter reflects, as he says, his discussions with patients and
much soul-searching on his part. Certainly, the dialogue about when personhood
begins is ongoing in the United States and elsewhere in the world.


Appendix 2. Protecting Donors of Eggs for Medical Research
Women of course, like men, will benefit from the cures that biomedical research
develops. The concern has been raised, however, that women might be exploited by

scientific inquiry that uses their eggs in research to help find cures. This is a legitimate
concern, but it should lead us to regulate, not to ban, the procedures whereby scientists
obtain egg cells for research purposes.
Alta Charo, Professor of Law and Bioethics at the University of Wisconsin Law and
Medical Schools, says:
“While I respect and applaud this concern for the dignity and well being of women, I
believe the concern is unwarranted and, perversely, would harm the millions of
women worldwide who act as the primary caregivers for husbands, parents and
children sickened by the very illnesses this research might someday cure.
Cloning does require obtaining eggs from women. This is not, however, harmful to
them. The drugs administered to make egg retrieval possible have been used for
infertility patients for decades without any evidence of either short-term or longterm harm, except for some discomfort during the month they are administered.
Furthermore, the development of transplantable tissue from stem cells derived
from cloned embryos is subject to extensive regulation in countries such as the
United States and the United Kingdom. In the U.S., for example, such research is
regulated by the Food and Drug Administration, which requires independent prereview and ongoing oversight of the work, including the effort to obtain human
eggs. Thus, an independent body reviews all the data concerning the safety of the
drugs to be administered, the form of advertising and incentive used to recruit
volunteers, and the information given to volunteers to ensure thoughtful informed
consent….
In addition, many countries around the world already ban the sale of human tissue,
whether eggs, sperm, or organs, thus completely eliminating concerns about monetary
incentives and exploitation. In sum, concerns about the physical and emotional
wellbeing of women can be and already are being addressed through research
regulation, and do not need to be addressed through prohibitions on the research itself.”
It is important to recognize as well that eggs from women may be needed only in the
early stages of this research. By conducting therapeutic cloning research, scientists
hope to better understand the biological properties of a cloned egg cell that induce it to
generate stem cells. Once they learn how this cell “re-programming” occurs, they may
no longer need to use human egg cells at all. There is also accumulating evidence that

stem cells themselves could become the source of eggs for research (The New
Scientist (May 1, 2003).
To be sure, it is appropriate that there be public oversight of biomedical research
standards. With respect to egg donation for any purpose -- whether it be in vitro
fertilization, surrogate motherhood, or therapeutic cloning research -- policy making
agencies in the United Nations, with the participation of scientists, medical practitioners,
patients' groups, and other interested parties, need to encourage the improvement of


already existing legislation. This is the cooperative way to address the relevant social
and ethical concerns.
Regulation should, however, be context sensitive. For instance, there are clearly some
cases where the concern for improper incentives or risk of egg donation would not be
relevant -- when a mother wishes to provide an egg to help cure her child, for example,
or to create stem cells that could be used to save her own life. Research too can be a
valid aim of egg donations. If it is legitimate for a person to agree to participate in a
dangerous malaria vaccine study to help prevent this disease, why should she be
prevented from donating eggs for similar (but much safer) lifesaving research?
Women's interests are in fact entirely consistent with the humanitarian aims of stem cell
research. In fact, women have an especially strong interest in the success of this
research. In many families, they are the one who provide the painstaking daily
care for sick children, husbands, and parents.
The largest women's organization in the United States, the National Organization for
Women (NOW), supports “research in the areas of therapeutic cloning, the use of
embryonic stem cells for such research, and the use of federal funds for therapeutic
cloning research."