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Bioethic information and analysis newsletter

Following Letter

N°50 - February 2004

Korea : Human embryos obtained by cloning ?

South Korean research workers are reported to have produced a human embryo by cloning. They were then able, starting with this cloned embryo, to cultivate a lineage of embryonic cells ⁽¹⁾.

Embryonic stem cells are those which give rise to all the types of tissue in the body. Their withdrawal is a sensitive question from the ethical point of view, since the operation leads to the destruction of the embryo. Over fifty nations, including the United States, prohibit this type of research.

The research workers in Seoul had to submit 16 woman volunteers to at least two hyper-ovulation cycles to obtain 242 ova ; the nucleus they transferred to the de-nucleated ovum was not a "conventional" somatic cell (such as a skin cell), but one from a cumulus cell (ova supporting cell). This has led to questioning in scientific circles; the Korean scientists have declared that they « cannot rule out the possibility of a parthenogenetic source of the cells ». Moreover, in order to achieve the most favourable conditions for cloning, the embryos were obtained by transferring the nucleus into a de-nucleated ovum from the same donor.

Scepticism among scientists
Dr Rudolf Jeanisch, from the Whitehead Institute of Biomedical Research in Cambridge (Massachusetts) explains that this cloning « is of no concrete use at this stage. Years of further research are required before transplants of stem cells can be envisaged for humans ». He adds: « for the time being, this gigantic deployment of means, time and money makes it improbable that such a technique will ever lead to a revolutionary medical procedure widely available to patients... »

Nicole Le Douarin, Permanent secretary at the Academy of Science explains : « It would be better to continue research on stem cells using ordinary embryos, from in vitro fertilisation ». « These scientists bear the responsibility for providing the recipe for reproductive human cloning to all the sorcerer's apprentices on the planet », worries Professor Axel Kahn. « My bet is that the birth of a cloned baby will be announced before any healing by therapeutic cloning is ever achieved » he declares. In the opinion of Jean-Yves Nau, a journalist with Le Monde « We are today witnessing a worrying phenomenon […] We are looking on powerless at the beginnings of a new experimentation on the human species, which nothing, not even research on animals, can justify. »

⁽¹⁾ Sciences 12th February 2004

Embryonic stem cells : Reversal of opinion by scientists

Instability in culture
A publication of « Nature Biotechnology » in January 2004 reveals that embryonic stem cells have encountered a new major problem : a lineage of these cells used in research was found to be unstable under long term culture. After six months' growth, the cells exhibit an excess of chromosomes 12 and 17. However, this lineage, considered as stable and free from chromosomic anomalies had been approved by the American NIH prior to distribution to 150 laboratories around the world. This discovery for some research scientists jeopardises the development of therapeutic strategies based on embryonic stem cells ⁽¹⁾.

About turn by scientists
In October 2002, the Catholic University of Louvain-la-Neuve in Belgium « decided to authorise the taking of human stem cells from supernumerary embryos », in spite of the warning issued by the Pontifical Academy for Life.
A year later, none of the seven research groups has yet worked on embryonic stem cells. These scientists have radically changed their opinion. A year ago, they considered that only embryonic stem cells could be used to replace diseased cells ; today, they recognise that adult stem cells taken from the sick patient's body provide the considerable advantage of being immune to rejection. Jean-François Denef, Vice-Rector of the Catholic University has declared: « The research conducted on stem cells taken from adults lead to the hope that many cases could be solved in that way»⁽²⁾ .

⁽¹⁾ Nature Biotechnology, jan. 2004, p. 53
⁽²⁾ La Croix, 20th January 2004

Euthanasia at the Council of Europe

The debate on the Marty report, concerning euthanasia, initially planned for 29th January 2004, at the European Council Parliamentary Assembly, has been postponed till April 2004 ⁽¹⁾.

The « Marty » report
It is aiming at legalising euthanasia in the Council of Europe member states.
The draft resolution invites the Council of Europe member states « to consider whether it is envisageable to introduce, where it does not already exist, a legislation to exempt doctors from legal proceedings when they accept to help the incurably sick, subject to constant and intolerable suffering, and without hope of improvement, to end their days if they so ask repeatedly, freely and after careful thought, in accordance with rigorous and transparent conditions and procedures established by the law ».
Although the resolution is not coercive in the European states individually, if it is approved, it will constitute an element for pressurising national parliaments, the medical profession and public opinion.

Reaction of doctors
The FIAMC (International Federation of Catholic Doctors) is against the report ; they point out that the report does not clearly define euthanasia : it does not distinguish between
- the limitation and ending of treatments which have become useless or refused by the patient (which result from good medical practice)
- or certain practices to relieve recalcitrant pain or unbearable worry, which could possibly cause unwanted death.
The notion of loss of dignity of the patient is also debatable.
The FIAMC reaffirms its support for
- rejection of prolonging life by technological means,
- accompaniment of the sick at the end of life, palliative care and consideration of the profound distress which may be expressed as a wish for death, with respect to which euthanasia seems to them to be simplistic and inhuman remedy.

They fear that the report will apply pressure on doctors to act against their convictions and against the Geneva Convention of Human Rights.

⁽¹⁾ Doc 9898, 10th September 2003, Dick Marty report on euthanasia

How does one define death?

An article by Bernard Marie Dupont, a geneticist and professor of philosophy⁽¹⁾ asks fundamental questions about the present day definition of death.

Brain death
The notion of brain death, which appeared in 1959, overthrew the rules for « dying human » by removing the triple rule of the unity of place, time and action.

The place : The end of life is moving from the home to the hospital ; currently, 75% of the population die in specialised institutions, at least in wealthy western nations.
Additionally, death has moved from the heart to the brain ; brain death has taken over, including legally, from cardio-vascular death.

The time : The remarkable advances in resuscitation have in some cases led to death in stages. It has become possible to keep human beings alive, whose brains are irretrievably destroyed. « A multitude of intermediate states is also developing, various depths of coma, more or less total paralysis. There is therefore no longer a before death and an after life, but a limitless succession of spaces of less being, a no man's land, a true lay purgatory or medical hold-all in which the patient is gradually stripped of its humanity ».

The action : Resuscitation alienates the freedom of the person being saved. « Freed for a while from death, but paralysed for the time remaining, the body, bound hand and foot no longer exists without the other ».

This leads to the question of death by delegation (assistance to die, assisted suicide, whether medically or otherwise) and the view which society is able to form of itself. It is therefore quite understandable that « the question of euthanasia is a profoundly political question in the Greek sense of the word : polis organises the life of the City, it makes us all citizens, in other words players and co-citizens, which commits our responsibility towards others ».

Euthanasia
Bernard Debré, the author of a recent book on euthanasia also wonders whether : euthanasia might be the answer for those who are in good health and who wish to avoid facing the spectacle of death in others ? « But where does true dignity lie ? In the act of killing an old person deformed by sickness or in the act of accompanying them to the end, with all the care they deserve ? » ⁽²⁾

⁽¹⁾ Libération, 13th January 2004
⁽²⁾ Bernard Debré, We loved him so much, euthanasia, the impossible law, ed. du Cherche Midi, 2004