-Yanguang Wang, Ph.D., M.D. Centre for Bioethics, Institute of Philosophy, Chinese Academy of Social Sciences, P.O. Box 8527, Beijing 100015, CHINA Email: firstname.lastname@example.org
There are four sources of human Embryonic Stem Cells: cadaveric fetal tissue, embryos remaining after infertility treatments, embryos made solely for research purposes using IVF, and embryos made using somatic cell nuclear transfer into oocytes. Each source of material raises ethical questions as well as scientific, medical, and legal ones. The resolution of these ethical and scientific issues depends to some degree on the source of the stem cell. The ethical view has been expressed among the conclusions and recommendations.
The ethical issues related to embryo stem (ES) cell research are becoming a hot global topic in recent years. After ES cell research cases in China that were reported widely in the Western mass media, restrictions are being contemplated. The question whether China adheres to any ethical standards at all, is a concern of Western people. Some Western people even predicted that China would do everything anyway, once it gets hold of the technological means to do so. Sometimes Western people ask, how "Western" countries could responsibly train and support and co-operate with Chinese scientists, when taking for granted that all sorts of research are possible in China that would be forbidden in their home countries.
In the face of this situation, we Chinese bioethicists need a great effort to illuminate the morals and ethics in Chinese ES cell research sciences. In this light, I would like to clarify that China has a host of regulations already and a very vivid debate is taking place all over the country. I hope that people from Western countries will see and learn much more about Chinese medical ethics in this field.
On September 7, 2001 a report was published in Beijing Youth Daily: Professor Chen Xigu in the Experimental Animal Center of Sun Yat-sen University, transferred a skin cell nucleus from a 7 year old boy into a rabbit's denucleated egg, and created an embryo. The aim is to use cloning to develop cures for such illnesses as diabetes and Parkinson's disease. Chen said that he had been able to grow the hybrid embryos only to the stage at which they remain a cluster of undifferentiated cells. He acknowledges that he was far from his goal of extracting stem cells from the embryos and turning them into treatments.
We soon found, in fact, there are many institutions and individuals most closely engaged in HES research in China. For example, Professor Li Lingsong, the director of a research center at Peking University, announced earlier in 2002 at a biotechnology seminar in Shanghai that his group already has cloned an elementary glandular structure that can secrete chemicals helpful in treating diabetes and Parkinson's disease. He said he hopes to be able to produce more advanced human organs within five years, and is experimenting with techniques to introduce human cells into animal embryos to produce human organs for use in transplants. Apart from Professor Li, there are more than 20 leading individuals who are engaged in stem cell research in their institutes in more than 10 big cities.
However, obviously it is quite difficult to understand the full situation in all legal and practical details. We don't know what is the most important purpose for those scientists who do HES cell research. Most research is aimed at creating new treatments for injuries or diseases. One research group has acquired embryonic brain tissue from 6 to 8 months gestation, but we don't know where do these researchers and others get the biomaterial (HES cells) from? Who is in charge of obtaining the material (researchers themselves, IVF clinicians, other parties)? Some research has cultured the fertilized ovum gotten from volunteers, which was supplied by a reproduction center, but we don't know whether the donors were asked to give informed consent. Would they receive any compensation? For most of the research, we don't know whether the embryonic tissues are taken from IVF clinics, from early abortions, or donated by women.
There was a rapid response to the Western reports on HES cell research, in the August 2001, with the Center of control of genetic technology of the Ministry of Science and Technology organizing a meeting attended by leading scientists and bioethicists and Government officials. This meeting discussed the ethical issues and the ways to make an administrative structure. The Ministry of Science and Technology decided to issue a recommendation and submit to government by scientists and bioethicists. Two recommendations have been worked out from the bioethicists in Beijing and Shanghai, and have been submitted to government officials before the October 2001.
After the disclosure that US researchers at the company Advanced Cell Technology have created a cloned human embryo, on 25 November 2001, the Chinese government announcement was made partly in response to the news. Chinese government quickly reiterated its opposition to human cloning for reproduction. At the same time the government declared its opposition to "reproductive cloning", Chinese government' announced that Chinese government officially support for what is widely referred to as "therapeutic cloning". However, Chinese government official has not announced its officially support of research using cloned human embryo. Chinese government has stressed that any such research in China must be "rational" and closely monitored. It has also urged the rapid approval of legislation on human cloning so that cloning technology can be developed healthily and used safely. (Xiaoyan Ying, 2001)
In 181th Xiangshan high level policy meeting held by the Ministry of Science and Technology in April this year, the topics were mostly focused on the ethical issues on stem cell research, and In May this year, it is heard that a office in the Ministry of Health, China will be in change to issue guidelines on the stem cell research in not so long time, based on the recommendation made by scientists and bioethicists.
After Professor Chen's case, stem cell research occupied a prominent position in the Chinese mass media. Two days after the case, four scientists from The Chinese National Human Genome South Center published their views in the newspaper, they pointed out that Professor Chen's case violated human dignity, and this was a big challenge to the human life. A director of Chinese Academy of Medical Sciences said to the mass media that such a mixed embryo would harm human beings safety and violate social ethics. A director of the Chinese Academy of Science Bureau of Life Science and Biotechnology said to the People's Daily on 30 November that we need to develop cloning technology, but we have to be very careful and make sure that scientific exploration is carried out under strict experimental conditions and laws. (Huiling Liao, 2001)
At the beginning there are the conceptual ambiguity about the stem cell research between reproductive cloning and therapeutic cloning. The mass media invited some scientist and bioethicists to write articles on this topic and introduce the knowledge of stem cell research, the benefit of this research as well as the ethical issues especially the distinguish between reproductive cloning and therapeutic cloning. The general public turned to pay more attention to the benefit and thought that the embryonic cells for biomedical research purposes and patients are so importation, they would like it is not banned. Because some researchers had already done research on embryonic stem cells, the public called for a government voice and law on this. The basic of the major point of the general public view might be the permission of research on embryos does not violate the fundaments of Chinese's moral culture by offering the life and dignity of humans at the beginning of coming into life for the sake of possible medical benefit. (Jie Wu, 2001)
A case discussion attended by 60 younger university students and organized by Dr. Yanguang Wang found two different views on ES cell research. One part of students thought that ES cell research should be without ethical limits and ethical principles should be changed following the development of science. Another part of students thought that HES cell research should be forbidden, because if human beings play God and go against natural law, human beings will be punished by nature.
One of the arguments held by some scientists in the field of life science has been that freedom of scientific research must not be violated. Freedom of the sciences, in a certain sense, could be proved by the history of science. A scholar made his argument stronger by using the theory of Marxism that the moral declare should be based on the developing level of science and technology. They point out that the moral doctrines are results of historical processes and subject to scrutiny or revision. (Shusheng Xie, 2002, Pp 4-6) Some scientists who involved in 181st high policy meeting to be the most outspoken supporters of freedom of research on human embryos were advocating a strategy to adopt the less restrictive norms as English, Australian or Israel's for embryo research. They mainly emphasize the pragmatic urge to obey the dictate of the global markets as well as to aggressively probe the economic and medical promises of stem cell therapy, and Chinese cultural integrity and national identity.
Next to general life scientists, mainly researchers support this view, arguing for freedom of research. For the most of leading researchers in the field of stem cell research, both for the research reason and for its value, the general opinions seems to be quite optimistic in supporting any kind of research on embryos. Some Chinese scientists claimed that in the beginning of this scientific research and when the benefit and risks are not very clear, the scientific research should be without the extremely forbidden. But most of the leading Chinese scientists who have studied in foreign countries in the field of stem cell research agree that the stem cell scientific research should be conducted in conform with ethical requirements and help the bioethicist to understand ethical issues they have met in the practice.
The big puzzle to the mainly Chinese researchers is how to properly balance scientific freedom with ethical constraints, and how those scientists are concerned about the ethics of the origins of the biomaterials they are working on? A hot debate about this balance happened between those leading Chinese scientists and bioethicists, it appears that we just cannot be sure what to take for granted for the balance, but both side are would like to build a new National Central Ethics Commission comprising top experts from all the involved disciplines to examine the ethical dimensions, and a national authority under the auspices of the Ministry of Health and Ministry of Science and technology should be empowered to issue the licenses and to monitor the importation conditions (Yingyin Chen, 2002, Pp.47-57).
The positive attitude to using stem cells among the leading stem cell researchers also comes from worrying about the double standards used in Germany and USA. The double standard is such as USA federal institutes observe one standard, but private institutes are permitted not to do so, or Germany law prohibits embryo research and embryo cloning within the state, but permits import of stem cells, which are derived from human embryos outside the country. In face of this situation, Chinese leading stem cell researchers wondered that in the situation of high controlling by Chinese government, if the embryo stem cell research is limited, the developing of Chinese stem cell research will be deterred greatly. Whether permission embryo stem cell research or not, it will be a very sensitive decision, and puts China in a similar or difference situation as the United Kingdom, some European countries and US.
The senior bioethicist Professor Renzong Qiu made arguments for therapeutic cloning. He defined therapeutic cloning to refer to using the technology of nuclear transfer to create an embryo from which totipotent stem cells can be derived for therapeutic cloning. Therapeutic cloning may create a possibility to cure some fatal, currently incurable diseases and relieve human sufferings. Therapeutic cloning could help research into exciting new stem cell treatments for a range of degenerative diseases and serious injuries.
Professor Qiu thinks that arguments for therapeutic cloning depend upon the position on the embryo's moral status. According to the accepted Confucian view, a person begins with birth. A person is an entity that has a body or shape and psyche, and has rational, emotional and social-relational capacity. So a human embryo is not a person, a personal life. Destroying an embryo as well as an abortion should not be taken as killing a person. However, a human embryo is a human biological life, not merely stuff like placenta. So it deserves due respect. If there is no sufficient reason, it won't be permissive to manipulate or destroy it. Saving a great number of human personal lives can be a sufficient reason. About Professor Chen' chimera issue, Qiu said that on the basis of human dignity arguments, creating a chimera by the use of the fusion of human and animal embryo, or the hybrid between human and gamete should be rejected. However, the chimera between human nucleus and animal mitochondria is permissive only if it is for research within 14 days and only if there is sufficient reason to do so. But Professor Chen did not have sufficient reason for the proposed research, so now he stopped his research (Renzong Qiu, 2002, Pp. F1-F6).
The view of director of Medical Ethics Committee, Ministry of Health, Professor Reicong Peng was if ethically there is no way to prove either claim right or wrong, based on many arguments, time will tell more about the consistency of moral claims and real actions. But now we should made a guideline in detail about what research should be under much strict terms of constraint, such as opposition to "reproductive cloning", forbidding putting a cloned embryo into a women's uterus, forbidding to change the human embryo's gene in stem cell research. Four bioethicists in Shanghai Second Medical University and Academy of Social Sciences took the principles of do- no harm and harm- reduction to balance the dilemma between patient's rights and the embryo's right.
Ethical views and restrictions on Chinese embryo stem cell research were contemplated by myself. According to my point of view there are four sources of human stem cells: cadaveric fetal tissue, embryos remaining after infertility treatments, embryos made solely for research purposes using IVF, and embryos made using somatic cell nuclear transfer into oocytes. Each source of material raises special ethical questions as well as scientific, medical, and legal ones in China. The resolution of these ethical and scientific issues depends to some degree on the sources of the stem cell and how these should be constrained by the ethical committee and government.
I thought that the core ethical issue for many is that the research of HES cells will destroy the embryo, even at the earliest stages of development. For the reason of respect for the dignity of embryo, if there are alternative sources to derive totipotent stem cells other than from human embryo, such as the use of aborted fetal germ cells, we have no reason to use human embryos. Furthermore, if we can make adult stem cells totipotent, we have no reason to use an aborted fetus either. In the same vein, if there is no sufficient reason, we should not create a human embryo for deriving totipotent stem cells. Instead, we can use the spare human embryo after the success of in vitro fertilization. However, the use of spared embryo after IVF or the use of nucleus transfer to create embryos to derive ES cells from, should not be absolutely prohibited, instead, it is permissible if there is a sufficient reason to do so. For the hybrid embryo, Wang thought that some questions were raised: Is this a human embryo? Are these human stem cells? Can these be used to treat human disease? A further question is a chimera between humans and animals permissible? (Yanguang Wang, 2002, p.7-10).
An associate professor of ethics at the Chinese Academy of Social Sciences claimed his position to favour HES cells for the patient interests. He tried to avoid the arguments about when and how a human being is achieving the status worthy of protection, and how to define the term "dignity" to express the rationale to be worthy of protection. Does dignity come in gradually, or is it endowed at a certain moment in the process of gestation? He appeals to the different human feelings to an embryo and a patient. He said that there is a stronger feeling when a general person faces an infant, an adult or a patient than a cluster of cells who have no nerve, no brain and no self-consciousness. From this perspective, killing a cluster of cells for an individual's interest could be justified. A bioethicist who also works at the Chinese Academy of Social Sciences criticized the above view and took an opinion. She said that there are no such feelings in the general people; on the contrary, many people who regard the embryo as a human being hold the same feelings to both the cluster of cells and a patient (Ziying He, 2001).
A philosopher who did not used to engage in the issues on bioethics gave his views on HES cell research. He said that HES cell research could be justified by the reasons of good for the patients and social interests. He thought that most Chinese might not deny it, thinking of the case of Chinese family planning. Two experts who engaged in medical ethics had a similar view on embryo study. They used the laws that permit abortion in many countries and altruism to argue in support of HES cell research.
A senior bioethicist criticized such views and regarded them as a product of collectivism based on "Confucianism". He argued "Confucianism" put collective-family, community, society, country or nation in priority. The idea of "Ren or "good birth" combined with collectivism is the basis of values, so that Chinese generally has a concern to reduce the number of deleterious genetic disease population for the poor nation's good and than that of the embryo and individual rights.
The director of Medical Ethics Committee of Chinese Society of Genetics, a senior scientist, Professor Fujiliang showed the view on the Professor Chen' Case. He said that when we are not able to respond to biomedical selection, we are not able to respond the social and moral difficulties connected with bioengineering in any responsible way. If we do something we do not really understand, this is dangerous to human being in the far long future.
A lawyer who involved in the ethical issues' discussion argued that the embryos have a right to inherit property in law, so he has dignity and should enjoys the full protection of basic human rights. Before a law has been issued, some caution to the aggressive pursuit of science breakthroughs should be made in our nation with a weak regulatory environment till now.
The director of the Chinese Society of Medical Ethics, Professor Benfu Li outlined the ethical principles of Embryo stem cell research. He thought the embryo stem cell research should obey the principles of respect, informed consent, safety utility and non-commercialization.
Yanguang Wang drafted an "Administrative Recommendation" with the help of Professor Renzong Qiu in September 2001, and the "Administrative Recommendation" was discussed in a workshop attended by the bioethicists coming from the Center for Applied Ethics, Chinese Academy of Social Sciences; Center of Bioethics, Chinese Academy of Medical Sciences/ Peking Union Medical University; Society of Science and Philosophy, Chinese Society of Dialectics of Nature; The ELSI Committee of Human Genome, China; Medical Ethics Committee, Ministry of Health, China.
The draft of Administrative Recommendation on Chinese Embryonic Stem Cell Research issued was:
The Medical Ethics Committee, Chinese South Center Human Genome Project has passed an "Ethical Guideline on Chinese Human Stem Cell Research" in October 2001. The main consensus between the guidelines compared with the above draft are that even if the scientific basis for an appropriate benefit/risk balancing is not given enough attention, and even if the results from animal experimentation do not suffice, the use of cell nuclear replacement to produce embryonic stem cells is a potentially important area of research, particularly with regard to circumventing the problem of rejection of cell or tissue, so we should try to support it under strict and reasonable conditions. Both support the research using embryos up to 14 days old, because there are less harms if destroyed embryos are less than 14 days old than the harm from a patient dying without curing. A 14-day-old embryo is simply a cluster of cells without bones, organs or other traits. The main difference of the guidelines compared with the above draft is that it objects to the stem cell research using hybrid embryos in any condition (Xiangxing Qiu, 2001, Pp. 54-58).
We bioethicists have not arrived at a conclusion on Chinese Ethical Views for grants on HES cell research, and the absence of a general ethical standpoint is apparent. The current draft or guideline on embryo stem cell research is being revised. We have to face the challenges of Western Culture, double standards, and other debates in the international area. We have to make further observations regarding the ethical and legal regulation of biomedical research, based on the particular situation in China. It will be important for Chinese bioethicists to renew their efforts to distinguish legal and instrumental arguments from ethics, and to explore the related cultural issues more seriously. It is the most important responsibility that Chinese bioethicists educate researchers, decision-makers and the general public to achieve progress on the embryo stem cell research in terms of ethics.
Xiaoyan Ying, "Chinese Government objects Human Cloning Clearly." Beijing Evening News (3), Beijing, 13 November 2001.
Linghui Liao, "Benefit to Human or Harm to Human" Beijing Evening News (20), Beijing, 21 September 2001.
Jie Wu, "Thinking of Stem Cell", Science and Technology Daily (8), Beijing, 6 August, 2001.
Shusheng Xie, "What is the Way of Stem Cell Research, Medicine and Philosophy, Dalian, Volume 23, Number 2, February 2002 Pp.4-6.
Yingyin Chen, "Criticize German Law on Stem Cell Research", Newsletter for Research of Applied Ethics (22), Institute of Philosophy, National Central University, Taiwan, April 2002, Pp. 47-57.
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