Al's Morning Meeting

The House passed the bill a year ago, and it seemed then that the Senate would have an easy time passing it. While there is practically no chance that Congress could override a presidential veto (scroll to the bottom of the page to find the video about the stem cell veto), the stem cell story is big and getting bigger.

For that reason, I am dedicating all of Al's Morning Meeting today to this one issue. I am including:

• background on stem cell research
• background on President Bush's position
• details about the legislation states have passed while Congress has stalled
• background on why some oppose embryonic stem cell research
• an explanation of the difference between embryonic and adult stem-cell research
• an exploration of the issue of what to do with embryos if they are not used for stem cell research

CNN has an easy-to-follow interactive page that explains how stem cell research works, how stem cells are harvested and the politics and ethics of the stem cell debate.

Now, let's turn to the National Institutes of Health for a definition of what is at issue:

Embryonic stem cells, as their name suggests, are derived from embryos. Specifically, embryonic stem cells are derived from embryos that develop from eggs that have been fertilized in vitro -- in an in vitro fertilization clinic -- and then donated for research purposes with informed consent of the donors. They are not derived from eggs fertilized in a woman's body. The embryos from which human embryonic stem cells are derived are typically four or five days old and are a hollow microscopic ball of cells called the blastocyst. The blastocyst includes three structures: the trophoblast, which is the layer of cells that surrounds the blastocyst; the blastocoel, which is the hollow cavity inside the blastocyst; and the inner cell mass, which is a group of approximately 30 cells at one end of the blastocoel.

1. Introduction
2. What are the unique properties of all stem cells?
3. What are embryonic stem cells?
4. What are adult stem cells?
5. What are the similarities and differences between embryonic and adult stem cells?
6. What are the potential uses of human stem cells and the obstacles that must be overcome before these potential uses will be realized? ... Perhaps the most important potential application of human stem cells is the generation of cells and tissues that could be used for cell-based therapies. Today, donated organs and tissues are often used to replace ailing or destroyed tissue, but the need for transplantable tissues and organs far outweighs the available supply. Stem cells, directed to differentiate into specific cell types, offer the possibility of a renewable source of replacement cells and tissues to treat diseases including Parkinson's and Alzheimer's diseases, spinal cord injury, stroke, burns, heart disease, diabetes, osteoarthritis, and rheumatoid arthritis.
7. Where can I get more information?

The legislation to come before the Senate is actually in the form of three bills:

-- The Stem Cell Research Enhancement Act, H.R. 810, which was passed last year by the House of Representatives and would provide federal funds for stem cell research that involves embryos created in fertility clinics.

-- The Fetus Farming Prohibition Act, S. 3504, which would ban the acceptance of tissue from an embryo implanted or developed in a woman or animal for research purposes.

-- The Alternative Pluripotent Stem Cell Therapies Enhancement Act, S. 2754, which would promote the development of embryo-like stem cells without creating or knowingly harming embryos.

Who Opposes Embryonic Stem Cell Research?

It is not unlike the abortion issue. Practically everyone, it seems, is fine with stem cell research that does not involve embryos. In fact, there is a Web site dedicated to stem cell (and other) research that does not involve embryos. It is the use of the embryos that raises concerns over whether life is being destroyed in order to save or treat another life.

The Baptist Press explains one line of opposition. Here is another explanation from the Catholic Church in America. The Christian Science Monitor ran a story last year about the role of stem cell research in the Muslim world. Both Beliefnet.com and Religion & Ethics Newsweekly have produced stories related to religion and stem cell research.

Whatever happens next week, embryonic stem cell research will not become illegal, except in those states where it already is (see the link to a list of state laws below). Not even the president proposes ending the research that is already going on.

If (or, when, as the case may be) the president vetoes the main bill, the Senate may not have enough votes (a two-thirds majority is necessary) to override the veto, and the House certainly does not have enough support to do so.

Senate Majority Leader Bill Frist, a physician, supports stem cell research and has tried to bring the legislation to the floor for a year. On Thursday, Frist wrote an op-ed piece explaining why he supports stem cell research and how he can be "anti-abortion," and at the same time support embryonic stem cell research. 

As you will read in the president's 2001 speech below, there are existing lines of stem cells, from embryos that were already destroyed, that can produce cells to be used for research. But since that 2001 speech, Frist says, the original 80 stem cell lines (Bush cited 60) that scientists had to work with have proven to be less useful researchers they had hoped. Only a fourth or so of the lines are viable for research, Frist says. The question at hand is whether or not federal dollars will support research involving embryonic cells.

You might find the Stem Cell Research Foundation's Web site useful, for more information from supporters of the process. 

Where Does the President Stand?

Below is an excerpt from a speech that President Bush made August 9, 2001. Five years ago, the president said:

Research on embryonic stem cells raises profound ethical questions, because extracting the stem cell destroys the embryo, and thus destroys its potential for life. Like a snowflake, each of these embryos is unique, with the unique genetic potential of an individual human being.

As I thought through this issue, I kept returning to two fundamental questions: First, are these frozen embryos human life, and therefore, something precious to be protected?  And second, if they're going to be destroyed anyway, shouldn't they be used for a greater good, for research that has the potential to save and improve other lives?

I've asked those questions and others of scientists, scholars, bioethicists, religious leaders, doctors, researchers, members of Congress, my Cabinet and my friends. I have read heartfelt letters from many Americans. I have given this issue a great deal of thought, prayer and considerable reflection. And I have found widespread disagreement.

On the first issue, are these embryos human life -- well, one researcher told me he believes this five-day-old cluster of cells is not an embryo, not yet an individual, but a pre-embryo. He argued that it has the potential for life, but it is not a life because it cannot develop on its own.

An ethicist dismissed that as a callous attempt at rationalization. Make no mistake, he told me, that cluster of cells is the same way you and I, and all the rest of us, started our lives. One goes with a heavy heart if we use these, he said, because we are dealing with the seeds of the next generation.

And to the other crucial question, if these are going to be destroyed anyway, why not use them for good purpose -- I also found different answers. Many argue these embryos are byproducts of a process that helps create life, and we should allow couples to donate them to science so they can be used for good purpose instead of wasting their potential. Others will argue there's no such thing as excess life, and the fact that a living being is going to die does not justify experimenting on it or exploiting it as a natural resource.

At its core, this issue forces us to confront fundamental questions about the beginnings of life and the ends of science. It lies at a difficult moral intersection, juxtaposing the need to protect life in all its phases with the prospect of saving and improving life in all its stages.

As the discoveries of modern science create tremendous hope, they also lay vast ethical mine fields.  

The president continued:

Research offers hope that millions of our loved ones may be cured of a disease and rid of their suffering. I have friends whose children suffer from juvenile diabetes. Nancy Reagan has written me about President Reagan's struggle with Alzheimer's. My own family has confronted the tragedy of childhood leukemia. And, like all Americans, I have great hope for cures.

I also believe human life is a sacred gift from our Creator. I worry about a culture that devalues life, and believe as your president I have an important obligation to foster and encourage respect for life in America and throughout the world. And while we're all hopeful about the potential of this research, no one can be certain that the science will live up to the hope it has generated.

Eight years ago, scientists believed fetal tissue research offered great hope for cures and treatments -- yet, the progress to date has not lived up to its initial expectations. Embryonic stem cell research offers both great promise and great peril. So I have decided we must proceed with great care.

As a result of private research, more than 60 genetically diverse stem cell lines already exist. They were created from embryos that have already been destroyed, and they have the ability to regenerate themselves indefinitely, creating ongoing opportunities for research. I have concluded that we should allow federal funds to be used for research on these existing stem cell lines, where the life and death decision has already been made.

Leading scientists tell me research on these 60 lines has great promise that could lead to breakthrough therapies and cures. This allows us to explore the promise and potential of stem cell research without crossing a fundamental moral line, by providing taxpayer funding that would sanction or encourage further destruction of human embryos that have at least the potential for life.

I also believe that great scientific progress can be made through aggressive federal funding of research on umbilical cord, placenta, adult and animal stem cells which do not involve the same moral dilemma. This year, your government will spend $250 million on this important research.

States Take a Stand

The stem cell issue has a state legislative side too. Click on the link below to see state-by-state regulations and laws about the use of stem cells, especially embryonic cells.

The National Conference of State Legislatures explains the legal landscape:

State laws on the issue vary widely. Approaches to stem cell research policy range from statutes in California, Connecticut, Maryland, Massachusetts and New Jersey and an executive order in Illinois, which encourage embryonic stem cell research, to South Dakota's law, which strictly forbids research on embryos regardless of the source. States that specifically permit embryonic stem cell research have established guidelines for scientists such as consent requirements and approval and review processes for projects.

Many states restrict research on aborted fetuses or embryos, but research is often permitted with consent of the patient. Almost half of the states also restrict the sale of fetuses or embryos.

• Louisiana is the only state that specifically prohibits research on in vitro fertilized (IVF) embryos.
• Illinois and Michigan also prohibit research on live embryos.
• Finally, Arkansas, Indiana, Iowa, Michigan, North Dakota and South Dakota prohibit research on cloned embryos.
• Virginia's law also may ban research on cloned embryos, but the statute may leave room for interpretation because human being is not defined. Therefore, there may be disagreement about whether human being includes blastocysts, embryos or fetuses.
• California, Connecticut, Massachusetts, New Jersey and Rhode Island also have human cloning laws. These laws prohibit cloning only for the purpose of initiating a pregnancy, or reproductive cloning, but allow cloning for research. 
• Several states limit the use of state funds for cloning or stem cell research. Missouri law forbids the use of state funds for reproductive cloning but not for cloning for research, and Maryland's statutes prohibit state-funded stem cell researchers from engaging in reproductive cloning. 
• Arizona law prohibits the use of public monies for reproductive or therapeutic cloning.
• Nebraska statutes limit the use of state funds for embryonic stem cell research. Restrictions only apply to state healthcare cash funds provided by tobacco settlement dollars.
• State funding available under Illinois Executive Order 6 (2005) may not be used for reproductive cloning or for research on fetuses from induced abortions.
• Several states have authorized funding for stem cell research in 2004 and 2005. In early 2004 New Jersey became the first state to appropriate funds specifically for adult and embryonic stem cell research.
• State funding for adult stem cell research was already occurring in at least one state, Ohio.
• Over the last two years $8.5 million and $14.5 million in general revenues have been allocated to [The Stem Cell Institute of New Jersey], according to New Jersey's Commission on Science and Technology. 
  

More Questions: What to Do with the Embryos?

For those who oppose the use of embryonic stem cells because they represent human life, there is another lingering and difficult issue. What should happen to the 400,000 or so embryos still sitting, frozen, in fertility clinic tanks? If, as some argue, using them for embryonic research is wrong, then wouldn't the same opponents be against the notion of destroying them and not using them for research, too?

In 2005, President Bush appeared with backers of "embryo adoption" -- the process of donating frozen embryos that people no longer need for their fertility treatment. Click here to go to the National Embryo Donation Center's Web site. 

I first heard of the issue years ago from bioethicist Arthur Caplan, who occasionally teaches with us here at Poynter.  He explained the ethical issues involved in embryo donation three years ago, in a commentary piece for MSNBC:

Most frozen embryos are not healthy enough to ever become babies. The chance they will grow to full term is about one in 10 for those frozen less than five years, and even less for those that have been frozen longer. This is why so few couples have taken Snowflakes up on its idea of "adopting" frozen embryos.

Moreover, using terms like "adoption" encourages people to believe that frozen embryos are the equivalent of children. But they are not the same. In fact, infertile couples who want children can frequently make embryos but they cannot make embryos that become fetuses or babies.

So what happens to embryos that do not get donated? Some just sit there and stay frozen. Others are discarded. Read this 2001 passage from the San Francisco Chronicle:

Despite the national soul-searching stirred up by stem cell research, human embryos are discarded all the time in fertility clinics -- and hardly anyone seems to mind.

At one Bay Area clinic, they are flushed down the drain in a metal sink. At another, a technician drops them into a medical waste bin, to be picked up and incinerated by hospital staff.

At still another, a "quiet area" is set aside in the lab, where frozen embryos are thawed and allowed to live out their last days -- usually no more than three or four at most.

"We have to follow the wishes of the patient," said Dr. Carl Herbert, president of the San Francisco Fertility Centers, which operates two clinics in the city. "It's up to them to decide what happens to their own embryos."

The Associated Press reported in 2004:

The nation's fertility clinics vary widely when it comes to how they perform one of the most delicate aspects of their jobs: disposing of unused frozen human embryos that were created to help infertile women become pregnant.

In a survey believed to be the first of its kind, 217 in vitro fertilization clinics across the country described the variety of methods they use to dispose of the frozen clusters of cells, which are the size of a dot and incapable of living outside a womb.

The reverence that some clinics gave to the task surprised researchers at the University of Pennsylvania and Rutgers University.

Seven clinics said they performed a quasi-religious ceremony, including a prayer, for each embryo they destroyed.

If your news organization does any special coverage on this story over the weekend or on Monday, please feel free to add the URL of your work to the feedback section of this column so we can all see your coverage.

If you want to offer additional resources for journalists to consider as this story develops, add those to the feedback section as well. If you are the author of any of those resources, consider including your contact information so journalists can get in touch with you.