February 28, 2007 (the date of publication in Russian)
A FACTORY OF SACRIFICE
Can one human life be prolonged at the expense of another?
PROLONGATION AND EXECUTION
The national referendum on the issue of criminal persecution for abortions, held in Portugal on February 28, 2007, indicated that 60% of the citizens of the historically Catholic country are indifferent to the subject: this share of the Portuguese ignored the vote.
On February 23-24, the same problem of artificial interruption of pregnancy became the central point of the agenda of the International Congress on Medical Ethics, convened in Vatican.
The Catholic Church's interest to the sphere of medical ethics is caused with the concerns of the religious community over the erosion of traditional views on moral restrictions of scientific research, and particularly, over the new phenomenon of replacement of religious postulate on immortality of the soul with quasi-scientific postulate on immortality of the body. A human of today is increasingly tolerant to the idea of prolongation of his own life at the expense of another human life – which is the essence of a number of technologies, selected for eventual implementation of "a physical immortality project".
In 2003, a group of Ukrainian specialists from the Kiev-based Embryonic Tissues Center (EmCell) applied for a patent for the self-named Kukharchuk-Radchenko-Sirman effect, essentially suggesting a complete renovation of human immune system by injecting a mega dosage of human embryonic stem cells. Until today, efficiency (as well as safety) of this therapy hasn't been verified at a molecular level. Still, that is not an obstacle for practical use of this kind of transplantation. A possible side effect is a postponed genome conflict – which, according to EmCell's scientists, "has not yet been detected".
On the background of the ongoing debate, massive banks for storing embryonic stem cells (ESC) are created across the globe. In most countries, relevant therapy is today prohibited. Still, the very existence of such banks and their regular replenishment reflects an intention to establish a qualitatively new system of therapy. That means that not only the human immune system, but also human conscience is going to be "reloaded".
In order to address this problem without bias, one has to consider both ethic and scientific arguments – the second one advocating the "benefit of a smaller death" for the sake of life. The embryo's life, sacrificed for saving an already born human, is described as "a smaller death". All the ethical problems, raised around abortions and related research, are meeting exactly in the focus of a human life's salvation.
A "non-scientific" artificial abortion is today considered as a "private sin", the major responsibility being laid on the committed individual. On the opposite, a conscious decision for an abortion, implying a scientific research, or delivering biological material for certain therapeutic needs, lays responsibility for interruption of life both upon the pregnant woman and the scientists.
From this viewpoint, it is important that the embryo destined for subsequent scientific operations, is aborted in a special way. In this case, before being alienated from his habitat, the fetus undergoes a D&X (distraction and extraction) procedure. Otherwise, most of the fetal tissues rapidly decompose, and can't be used both for experimental and medical purposes.
Extraction of material, supposed to serve for scientific needs and/or for therapy, involves use of a special set of medical instruments. First of all, the embryo's location in the uterus is detected by means of an ultrasonic impulse. In case the fetus's extremities are conveniently approximate to the cervix, the physician inserts a special instrument in the uterus, for the purpose of hooking an extremity. Partially extracting the fetus, the surgeon leaves it still viable, in order to be able to extract the needed neural and visceral tissues before life is interrupted. In case the supersonic device indicates that the embryo's location is not favorable for partial extraction, or this procedure is regarded is inconvenient because of the particular woman's constitutional peculiarities, scientists use a different set of devices. First, an aperture is drilled in the fetus's skull, in order to pump out the brain tissue; next, the viscera are extracted. In both cases, the whole fetus is later extracted and placed into a refrigerator for further processing .
The described manipulation is hazardous for the woman's health, as in uterine insertion of instruments, the cervix may be injured as well as the myometrium (which frequently results in sterility. The supervising physician is obliged to warn the client of essence of the procedure, its technical aspects and possible implications in advance.
Definitely, the method of abortion described above is disputable not because the "sacrificing" woman is usually unaware of all the details of the procedure. Questions are raised over the ethical possibility of not just interruption of life, but a sophisticated torture the fetus is supposed to undergo.
THE ASSEMBLY LINE OF "SMALLER DEATHS"
Religion and science provide different response. Religion assumes that an embryo, and even a blastocyst, has got a soul. Science tries to prove that the gestational age of the aborted creature "does not suppose reactions of pain", which is regarded as a prior argument for the procedure's moral aptness. Another argument of science says that the life of an unborn may save several lives of adult humans. Still, all the three arguments, from the standpoint of cognition, are not more than hypothetical.
"The lack of evidence of ESC implantation's efficiency and safety is a serious problem", indicates Prof. Yuri Belousov, Correspondent Member of Russian Academy of Medical Sciences (RAMN). "Until today, despite a lot of research in this sphere, it is not proven that the cells, originating from the embryonic stem, can be safely implanted into an adult organism, in order to restore the function of the injured tissue or organ. Great difference between experiments in vitro and in vivo, as well as between the peculiarities of experimental animals and a human, should be also taken into account" . Moreover, as we illustrate below, the biological material, borrowed from one fetus, is even insufficient for salvation of a single life.
Is simple elimination of biological material, which has no opportunity for a normal route from impregnation via birth to a natural death, just an unreasonable waste? In case we can't prevent abortion, why don't we make at least some use of it? Opponents of abortions insist that this practice only serve to justification of an increasing frequency of artificial interruption of life. Meanwhile, scientists argue that the frequency of artificial abortions is definitely constant, while their "inevitability", in a way of a paradox, appears essential for prolongation of other lives.
Today, the latter argument seems correct. However, a simple mathematical calculation suggests that the more successful ESC transplantation is going to become, the larger quantity of this biological material will be demanded. In this way, ESC supply is likely to develop into a surgical assembly line. Meanwhile, there are no guarantees that this method of treatment does not transform into a large-scale trading business. Today, ESC research is very costly, while any kind of relevant therapy is affordable for a narrow minority: in particular, one ESC injection in EmCell is estimated in $25,000.
In 2000, the US Congress officially permitted to use ESC for purposes of medical treatment (exceptionally with private, non-public financing), but George W. Bush vetoed the paragraph permitting deliberate "planting" of embryos for the purpose of research. In its amended version, the law appeared to be rather flexible. It only prohibits "obtainment and use of human fetal tissues in case it is known that pregnancy was destined for this purpose". Meanwhile, today's science is even unable to precisely diagnose pregnancy in its initial period, and thus to provide relevant proof of intention.
In case a "conveyer" emerges, any potential mother and any surgeon, involved in the described practice, may be considered as partners in a grand commercial project. Conditions, under which a woman (whose intention may be revealed only by voluntary confession) can be transformed into a producer of precious ESC, can be easily imagined.
Still, is it more appropriate just to "uselessly eliminate" the aborted "biological mass"?
In many fast-food chains, strict regulations prohibit the personnel to consume the unsold meals: the whole remainder of the food is thrown out into a waste-bin. Such practice is substantiated with the desire to avoid unhealthy competition among the personnel, along with temptation of theft.
Sounding incorrect, this parallel is actually relevant, as utilization of aborted biological materials for any purpose definitely justifies the future practice of abortions, making the very phenomenon of artificial abortion usual and natural in common human life. In some Western countries, this result is already achieved: 17 of 100 women, inquired in a poll conducted by the University of Toronto in 1995, would agree to interrupt their pregnancy if the aborted material "would serve to science".
"THERAPY" WITH A DOUBTFUL EFFECT
Academician Vladimir Kulakov, the now deceased director of RAMN's Center of Obstetrics, Gynecology and Perinatology, recognized embryonic cells as a "promising object of research". His long-term forecast sounded as follows: "They (ESC) are to be thoroughly studied, before being used. Though a lot of research in embryonic cells has been accomplished, their practical use will be available maybe in 30 or 40 years, when we learn how to manage them. This problem is as globally important as the problem of growth of cancer cells" . The recognition of complicity and "global" importance of the problem ostensibly ignores the question of expediency of abortions themselves. However, it justifies abortions, suggesting that the larger their frequency is, the better. In this case, we refrain from evaluation of particular activities, just using logics for our judgments.
Can embryonic tissues be received without abortion and the described manipulations with the fetus? Use of embryos, grown in vitro (particularly, for artificial fertilization), as well as younger (blastocystic) abortive material in vivo, when the gestational age does not exceed several days, seems to be more humane. However, these alternatives display a very low efficiency. Stem cells with no "experience" of existence in a living organism, produce a low, almost zero therapeutic effect. In their turn, blastocystic stem cells are potentially carcinogenic, while the mechanism of their differentiation remains undiscovered. A research, dated 2003, displayed development of malignant tumors in experimental animals after BSC injections . Thus, the optimum age of human embryonic cells is restricted to the fetal age of 17 to 24 weeks.
BSC cloning remains an open question, as it suggests interruption of life of an artificially planted but still human being, whose fate can't already be determined by a particular mother. Nevertheless, in 2000 the government of Great Britain permitted to conduct cloning of embryonic stem cells for tissue engineering and subsequent therapeutic use, earmarking around $30mln from the state budget. In the EU generally, use of human ESC for research purposes is permitted since July 2006.
Thus, an assembly line extraction of ESC from cloned embryos is just a question of time required for the juridical determination of the clone's right for life. Still, "classical" abortive material will be still regarded as more acceptable, in terms of both costs and qualitative properties. Already in 2004, British scientists conducted an analysis of gene expression, which revealed dysregulation of many genes in cloned mice, experimentally visible only in an adult age, when the earlier indiscernible genetic lesions develop into severe organic malfunctions and pathology of metabolism .
Embryonic stem cells are also more favorable for transplantation than adult stem cells, as their histological match is much higher, the risk of rejection being minimal.
Hypothetically, amniotic stem sells (ASC), derived from the amniotic fluid, can appear to be even more promising, as such cells never generate tumor proliferation and don't require destruction of the embryo . Though the research in these cells would require years, the result is expected to be very positive.
However, in this case one problem is replaced with another, as amniocentesis (evacuation of amniotic water) is a potentially hazardous procedure, frequently resulting in a spontaneous abortion. This procedure is acceptable only in a restricted category of pregnancies. Meanwhile, in case ASC research turns a success, massive proscription of amniocentesis implies a hazard of an especially menacing dimension – as women, undergoing amniocentesis, are supposed to bear a child. On the other hand, this procedure is more usually administered in cases of a suspected anomaly of the fetus. Amniotic cells, extracted from a fetal genome with a potential pathology, may be unusable for therapeutic means.
Thus, amniotic liquid is supposed to be extracted only from healthy women with a good hereditary background, who would hardly agree to undergo their future child a high risk.
The society as a whole is supposed to view the discussed problem also from the standpoint of demography. In case a nation is overwhelmed a demographic crisis, will it mitigate or aggravate in case some severe diseases appear to be curable by means of fetal tissues? In case of a choice, which life is more promising – the future being, or the existing person and citizen? The fact that treatment of one adult patient requires biological material from several embryos may be an answer to this question (only one ESC injection requires interruption of life of four fetuses). In addition, most of the diseases in which fetal tissue may be used, are typical for old age.
Still the major problem is that efficiency and safety of such therapy is very questionable. A research, published in 1999 in Nature Neuroscience (№12), has revealed that injection of embryonic stem cells to patients with Parkinson disease, produced a positive result only in one of seventeen cases, and even in this single case, a placebo effect can't be ruled out.
VACCINES AND RELIGIOUS ETHICS
The ethic problem of vaccination, which is important primarily for religious people (others being more focused on the possibility of carcinogenic effects of vaccines), is also relevant – in case abortive material was used in production of the vaccine. One of the most popular arguments in favor of such vaccines says that allegedly, just a few abortions were used to plant specific cell lines. This argument ignores the fact that before a necessarily effective cell line is produced, a lot of attempts result in a failure. In the particular case of rubella, production of vaccine required material from 62 abortions . Still, even in cases of a much larger sacrifice, as well as in cases where the positive result is only hypothetic, the very purpose of the research is supposed to justify the costs.
Meanwhile, the most important property of a vaccine is its efficiency rather than the method of production. According to specialists in vaccinology, non-human vaccines, or analogues of vaccines, are usually not less efficient than the material extracted from human abortive tissues.
For religious persons, the ethical aspect of use of any medication produced from aborted human fetus, is derived from denunciation of artificial interruption of life, expressed in sacred texts and commandments of particular religions. For the Christians, a relevant commandment may be found in the cannons, adopted by the Sixth Oecumenical Council (691): "Women, who deliver medicines causing miscarriage or death of child in the womb, are to undergo penance, as homicides".
In the XX century, his issue had to be raised repeatedly, in order to clarify details and formulate them in modern language. The Church repeatedly confirmed its categorically negative attitude towards artificial interruption of fetal life, and therefore, towards use of embryonic stem cells, as well as organs and tissues. This attitude was reflected, in particular, in Paragraph XII.6 of the Russian Orthodox Church's Social Concept. It is logically expanded also to the methods of ESC treatment, and remedies (including vaccines), involving abortive materials.
IS HUMAN LIFE GOING TO BECOME A COMMODITY?
It is quite obvious that the human civilization is "not prepared" to an unconditioned justification of medical use of abortive materials. A number of authors, including late Academician Vladimir Kulakov, estimate the time, necessary for implementation of a relevant global project, in 30 to 40 years. It is supposed that during this period, a generation change may provide also a change in human perception of prolongation of life at the expense of another life, justified as "death for the sake of good".
Institutions of traditional religions, remaining strictly opposed to artificial abortions, cloning and relevant experiments, comprise a significant obstacle for this planning. However, the abovementioned referendum on Portugal indicates a decline of religious electorate, even in post patriarchal states of Europe, as well as reduction of the parish, supposed to keep the moral foundations inviolable.
The offensive of the globalized civilization into the "third world", as well as secularization of states, historically dominated with traditional religions, also clears the way for essentially new ideological definitions, which not only elaborate moral justification for abortions but portray women who sacrifice embryonic tissues almost as "new saints". Psychological correction of a woman, thinking of an abortion, would thus become unthinkable. Instead, a woman’s commitment for sacrifice of her potential child is rather likely to be protected as zealously as once the child itself.
 The Hand of God - A Journey from Death to Life by the Abortion Doctor Who Changed His Mind. The Autobiography of Dr. Bernard N. Nathanson, M.D. Published by Regnery Publishing, Inc.. Published by Regnery Publishing, Inc.
 Yuri Belousov. Ethical Examination of Biomedical Research. First Edition. Russia, Moscow, 2005
 Nine Months, 2004, № 9
 Hochedlinger, K. & Jaenisch, R. Nuclear transplantation, embryonic stem cells, and the potential for cell therapy. N. Engl. J. Med. 349, 275–286(2003).349, 275–286(2003).
 Human cloning – the science and ethics of nuclear transplantation. Jaenisch R N Engl J Med 351: 2787–2791 (2004).
 Isolation of amniotic stem cell lines with potential for therapy, Nature Biotechnology– 25, 100–106 (2007)
 Behavior of rubella virus in human diploid cell strains. II, Studies of Infected Cells.1967; 21 (3): 296–308.
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