The embryos hold seemingly magical promise. What is to be done with them?

http://inq.philly.com/content/inquirer/2001/07/15/front_page/STEMBUSH15.htm

Sunday, July 15, 2001
By Marie McCullough
INQUIRER STAFF WRITER

Recently, Terasa and Salvatore Astarita of Lancaster confronted an ethical dilemma that President Bush is no doubt wrestling with:

What is the value of a surplus human embryo?

The President's dilemma involves his review of whether taxpayer dollars should fund research that destroys embryos in order to get their precious stem cells.

For him, these cells - the wellspring of all human tissue and a hope for treating many diseases - are tangled in the politics of abortion.

The promise of these embryonic stem cells comes from their seemingly magical ability to transform themselves into any of the more than 100 kinds of tissue that make up the human body.

The Astaritas' dilemma came in the context of a more personal review. Like thousands of other American couples seeking to have a child, they froze extra embryos created through in vitro fertilization. After nearly four years, their clinic sent a letter asking them to consider their options.

The Astaritas, who now have two adopted children, were willing to donate their two microscopic progeny to another infertile couple, but they didn't want to arrange it and their clinic was not set up to do so. They also did not want their few-day-old embryos - technically, pre-embryos, each with about eight cells - to stay in frozen limbo or simply be thrown away.

After some soul-searching, the couple decided to donate the embryos for research.

The letter "just brought up all the grieving you go through with infertility," said Terasa Astarita, a nurse practitioner. "You don't lightly make the decision of what to do with extra embryos. But I do not think it's a child; it's not even a fetus. And if they are going to be destroyed anyway, I'd rather they go to research and know they did some good."

That reasoning holds moral sway. Polls show most Americans, including a majority who say they oppose abortion and a majority of Catholics, support embryo stem-cell research.

As Boston University bioethicist George J. Annas put it last year in a New England Journal of Medicine article: "The donation of spare embryos for important medical research that cannot be conducted by other means is ethically superior to either destroying them or keeping them perpetually cryopreserved."

Pamela Madsen, head of the American Infertility Association, said last week: "In my mind, the fundamental question is why we as a nation aren't doing more to educate infertile couples" to encourage them to donate spare embryos for research.

Creating in vitro embryos solely for stem-cell research is another matter entirely. There was widespread cringing over last week's news that Virginia scientists with private funding were doing just that. Critics said it trivialized and commercialized the use of procreative cells that, while not human beings, deserve special respect.

But with anywhere from 100,000 to 250,000 embryos already sitting in freezers, most destined to die during thawing or to be discarded, President Bush must figure out: What is their worth?

To the Catholic Church, which opposes in vitro fertilization in the first place, they are worth no less than a human being.

"I find it distressing that many people continue to believe that obtaining stem cells from living embryos is an acceptable method of research, even though a living human being is destroyed in the process," wrote Karen Cahill, pro-life activities administrator for the Archdiocese of Philadelphia, in a letter published in The Inquirer.

That view is shared by antiabortion Republican leaders such as Reps. Dick Armey and Tom DeLay, both of Texas.

Significantly, it is not shared by some other staunch Republican abortion foes, notably Sen. Orrin G. Hatch of Utah and former Florida Sen. Connie Mack. Both support embryo stem-cell research.

President Bill Clinton's administration sought a middle ground, ruling that federal money could be used for stem-cell research, but not for extracting the cells from embryos. Bush suspended this compromise policy in February pending his review.

Leading bioethicists say the research should be disentangled from the abortion debate, but that is not likely to happen.

In fact, whether or not Bush approves federal support, scientists in Pennsylvania are prohibited from doing research on in vitro embryos because of the state's abortion-control law, which was written when embryonic stem cells were still science fiction.

Various research restrictions exist in 23 other states, according to Lori B. Andrews, a law professor at Chicago-Kent College of Law. (Louisiana bans disposal of a frozen embryo on the grounds that it is a "person.")

Although some of the laws are so broad and vague that they could be challenged in court, most researchers don't even realize the laws apply to them, Andrews said.

"Given the volatility of the abortion issue, if there is any possibility of going after a researcher, some pro-life prosecutor in some state will do so," Andrews said.

In many ways, the debate over stem cells echoes the battle over fetal-tissue transplantation that stung Bush's father a decade ago.

President George Bush blocked federal funding for the transplant research, bowing to antiabortion influences but going against patients with Parkinson's and other diseases, Congress, and even a White House-approved advisory panel. Clinton lifted the ban after taking office.

While the elder Bush was barring money for transplants of aborted fetal tissue, federal dollars were funding other types of research that used aborted fetal tissue, such as vaccine development.

Similarly, while stem-cell research has thrown the spotlight on embryos, taxpayers are now paying for other types of research using human embryonic tissue. The embryos come from miscarriages or abortions, not IVF clinics, according to a recent report to the National Institutes of Health by Elisa Eiseman of the Rand Science and Technology Policy Institute.

She found, for example, that embryonic tissue is being used for research on an insulinlike growth factor, an egg follicle-stimulating hormone, and gene therapy.

To improve the muddle of what is allowed in public and private labs, the government should fund all embryo research and develop uniform rules, University of Pennsylvania bioethicist Arthur Caplan and others say.

Abortion foes maintain that stem-cell researchers do not need embryos in the first place. After all, they say, stem cells can be obtained from umbilical-cord blood and adult tissue.

"The Catholic Church sees great promise in adult stem-cell research, which does no harm [and] takes no human life," Cahill wrote.

She also contended that adult stem cells are often "more effective in treating illness."

But since it is anybody's guess which type of stem cells may ultimately help in cases of incurable diseases such as Parkinson's and Alzheimer's, scientists and patients want to pursue all promising avenues.

Abortion opponents also argue that surplus IVF embryos should be donated to other infertile couples.

"No human embryo is 'spare' or 'leftover,' " Republican Rep. Christopher H. Smith of New Jersey wrote last month in a plea to President Bush. "Every human embryo, even if he or she can no longer be cared for by their genetic parents, is needed for implantation and the chance for a good life with an adoptive couple."

Nightlight Christian Adoption Agency in California and a few other centers have begun arranging such "adoptions."

But there are practical and emotional obstacles, not to mention legal uncertainties about such high-tech parentage.

A study at the University of Iowa College of Medicine's IVF clinic - one of the few that arranges anonymous embryo donation - found that about 90 percent of couples won't even consider it. Some are put off by required counseling and health tests. Many find creepy the idea that they might have unknown genetic offspring - children their own biological children might someday meet and even marry.

"Embryo donation is certainly one solution, but it's not going to be the whole answer" to the surplus embryo problem, said Dr. Bradley Van Voorhis, who set up the University of Iowa's program.

No matter what Bush decides, there may be unintended consequences, as science races on.

Cautioned lawyer Andrews: "Writing policy is like writing science fiction: You try to foresee what will happen."