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STEM CELL ETHICS: AN IMPORTANT CONSIDERATION IN TISSUE

ENGINEERING ADVANCEMENTS
Andrew Sassani ([email protected])

INTRODUCTION: THE ETHICAL DILEMA function. As a solution to this problem, engineers have
OF TISSUE ENGINEERING: developed extremely small biological scaffolds that allow
physiological connection between cells [4]. Blood vessels are
Tissue engineering is a relatively new concentration in the also grown with extreme accuracy to encompass every cell in
medical field that focuses on all aspects of tissue growth and the organ [3]. Without this precision, tissue cells could not
regeneration [1].The field is not limited to tissues though; function, ultimately making the organ useless. After
many engineers focus on the development of organs via stem development, these organs can have a multitude of uses.
cells and biological scaffolds [2]. The results of tissue
engineering can be helpful in many applications in the USES FOR ENGINEERED TISSUES
biomedical field. Such applications include surgical
replacement and testing of new drugs [3]. The practical uses Surgical Replacement
of tissue engineering are numerous and more are bound to be
discovered with continual research. Tissues are the building blocks of all organs in the human
Working as a tissue engineer, I have been given a new body. Therefore, when a large tissue or entire organ becomes
project. Doctors at University Pittsburgh Medical Center damaged enough, the organ can lose all function and
(UPMC) need an engineered bladder for a patient with eventually die. On June 9, 2011, doctors had implanted a lab-
bladder cancer. The patient doesn’t have an immediate threat grown trachea into a patient that had been battling cancer for
of dying, but is experiencing discomfort from treatment. Also, almost a year. An artificial trachea mold, resembling the
the patient has been battling cancer for almost a year and has patient’s trachea, was created and then covered in stem cells
exhausted all other forms of treatment with no positive from the patient. The stem cells were manipulated in the lab
results; this is his last hope for survival. so they could grow into the appropriate cells for the trachea.
As project leader, I will be responsible for various steps in Once the trachea was covered in cells, it was implanted into
the process of developing tissues including ordering supplies the patient; the surgery was successful. The total time for an
and equipment. I will have to face an ethical dilemma over the organ to be developed using this process takes about 10-12
stem cells needed to be ordered: Should I order stem cells days [5]. The patient I am working for will undergo a similar
from a certain company that harvests stem cells through the surgery. Knowing that he has been fighting cancer for so long,
destruction of embryos? Recently, researchers have I do not want to delay the project by ordering ethically derived
developed a method to create stem cells from patient skin cells stem cells, but I cannot simply ignore the rights of the embryo.
(the process will be described later). Or should I find stem This is another factor that must go into my final decision.
cells that have been formed skin cells despite their low
availability, possibly delay the project and inadvertently ETHICS OF TISSUE ENGINEERING
discomfort the patient? As the lead engineer, I must consider
both sides of the debate and make my own decision on how Clearly, the work of tissue engineers has led to
to act. By reflecting on personal values and engineering codes exponential advances over the past decade, but what sacrifices
of conduct, I must make a decision that will greatly impact should be made in the name of progress? How far should we
this project. continue with medical development before we consider our
knowledge too great? These are key questions that engineers
THE BASICS: HOW TISSUES ARE and scientists must face in the development of tissues. The
DEVELOPED main issue that affects the development of tissues is the use of
stem cells and how they are obtained.
The process of engineering a tissue/organ is a relatively The popular method for harvesting the stem cells is
standardized process. For most laboratories, engineers start extraction from a fertilized embryo. A fertilized egg cell can
with stem cells that can be obtained from multiple sources. contain up to 250 stem cells five days after conception. These
Stem cells have the ability to form mainly any type of cell in cells can divide and form more even after they are extracted.
the human body (heart, liver, nervous, etc.). Engineers The stem cells are vital in a developing embryo because they
manipulate these cells to form the desired cell of the have the ability to form any cell in the body. Therefore, upon
tissue/organ they are developing. However, developing extraction, the embryo will die and the possibility of creating
organs is not as easy as letting cells divide in the lab. Cells a child with that cell is impossible. Although one life is taken,
rely on interaction with neighboring cells for complete should it be deemed paramount despite the enormous benefits
of developing tissues? That is, are the needs of many more

University of Pittsburgh Swanson School of Engineering

2013-10-29
Andrew Sassani

important than those of an individual? It surely seems embryo will die which would be a direct violation of this
tempting to agree with this tenet, but many, including myself cannon.
find this unethical. The main driving force behind this Another tenet from the Professional Engineering Code of
argument is the possibility of life the embryo possessed. The Ethics states, “Engineers shall at all times strive to serve the
central reason the embryo was fertilized was to bring a new public interest” [9]. If the engineers should act in the public
life into this world, so it rightly seems researchers are not interest, do most people approve of stem cell research? The
entitled to take that gift away [6]. answer is yes. According to one survey, 68% of the
Another ethical argument that arises is about the “moral population approves of embryonic stem cell research [10].
status” of the embryo. The moral status mainly refers to the Therefore, in the public’s interest, it seems that the utilization
status of “personhood” so to speak. Proponents of stem cell of embryos for their stem cells is acceptable and should be
research claim that the embryo has no moral status because it done. However, 68% is not exactly an “overwhelming”
has no properties of a human (emotions, physical properties, majority of the population. The Professional Engineering
etc.). Based on that theory, they are correct and the embryo Code of Ethics seems too general and vague to draw a
should be utilized to help someone how actually is a living complete conclusion on how to act in this situation.
human being. Those with opposing views claim that trying to The Biomedical Engineering Society has their own code
pinpoint an exact point of “personhood” is only an inaccurate of ethics developed to center around their unique medical
guess. Development of an embryo into the final stage of an work. Although no specific canons address the controversy
infant is a continual process, so the question of when life over stem cells, a few can be interpreted to help make a
begins is something we cannot fully answer. Also, it should decision for the scenario. Canon 4 states, “[Biomedical
not matter because life is supposed to develop fully and Engineers shall] Consider the larger consequences of their
should not be abruptly ended [7]. work in regard to cost, availability, and delivery of health
Looking at the moral status from a scientific standpoint care”. To comply with this ethical statement, before I decide
can bring up a new viewpoint. The genetic makeup of the where to order the stem cells and ultimately consider the
embryo clearly identifies it as a human being. Although the consequences. Should I be content with knowing an embryo
fertilized egg does not have the ability to think or feel (the was destroyed and receive stem cells on time and continue
qualities of “personhood”), it is still technically a human with the project? Or should I risk a delay in progress just to
being. Therefore, this human being, along with other human get ethically formed stem cells?
beings, is granted basic human rights for living, one of the Another canon directly related to research states,
rights being the right to live [8]. The decision I make as an “[Biomedical Engineers in research shall] Comply fully with
engineer must be based on the debate issues that arise over legal, ethical, institutional, governmental, and other
stem cells. However, much of the ethical considerations applicable research guidelines, respecting the rights of and
should be based on public opinions of the issue. As an exercising the responsibilities to colleagues, human and
engineer in charge of making the decision, I must also look at animal subjects, and the scientific and general public”. I must
professional engineering ethics, biomedical engineering respect human test subjects which includes the embryo itself.
ethics, public opinions and personal values including my So even if it delays the project, it might be more beneficial to
religion. ethically acquire the necessary stem cells for the project to act
in accordance with this cannon [11].
PUBLIC RECEPTION OF STEM CELLS
AND ETHICS Religious Views

Professional Views Despite many outside deciding factors, much of influence

on a decision will come from internal values and morals.
Engineers are held to high standards which are listed in Being a practicing Catholic, a considerable portion of
the Professional Engineering Code of Ethics. This code tends decision I make will based on religious teaching. Catholics
to be more general guidelines because most engineering oppose stem cell research because they feel it is immoral to
disciplines have their own codes unique to their profession; destroy an innocent embryo that would have formed into an
however, some canons from the professional code can be actual person. Some Catholic bishops claim that embryo
applicable to this situation. Cannon II.1 states that, “Engineers research will lead to a “domino-effect” where we will begin
shall hold paramount the safety, health, and welfare of the to test on living humans because we have crossed a “moral
public” [9]. This tenet can justify both sides of the argument. line”. They claim that stopping testing on embryos will deter
If engineers are to hold the health and welfare of the public at future testing on other subjects [12]. Although I do not
upmost importance, then it seems that stem cells should necessarily agree with the domino-effect philosophy, I
harvested to develop tissues to help the public in need. understand the moral objection to destruction of embryos.
However, when harvesting embryonic stem cells, the human Many Catholic officials do not completely disregard the
importance of stem cells though. In fact, there is much
attention given by Catholics to ethically harvested stem cells.

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Andrew Sassani

In fact, in 2005, Catholics in South Korea raised $10 million FIGURE 1 [14]
into advancing adult stem cell research [13]. However, adult Process of Developing Stem Cells from Skin Cells
stem cells are not as versatile as embryonic stem cells because
they can only form certain cells based on where they were
found. For example, bone marrow is responsible for large
amounts of blood and blood cell production. Many stem cells
can be harvested from marrow, but they would only be able
to form blood related cells. Since I am trying to engineer a
new bladder, I would need to find stem cells from the patient’s
bladder [10]. It isn’t the most efficient way of harvesting stem
cells, but at least the Catholic Church does not completely
ignore the necessity of stem cells in many medical
procedures.

ETHICAL HARVESTING OF STEM CELLS

Researchers at Oregon Health and Science University
have developed a method that uses human skin cells and
unfertilized egg cells to develop stem cells. The process
begins by obtaining skin cells from the patient and an
unfertilized egg from a donor. The DNA is removed from the
egg and the skin is inserted into the egg cell membrane. The
researchers then initiate a series of chemical reactions that
allow the cells to fuse. When the cells fuse, the combined cell
is basically identical to an embryo. The formed embryo can
exhibit all the properties of a fertilized egg too, therefore, it
can form useable stem cells. A diagram that illustrates the
process can be seen to the right. The main attraction to
forming stem cells this way is the fact that unfertilized eggs
are used. Without a fertilized egg, no embryo (an embryo is a
fertilized egg) is destroyed, and therefore there is no debate if
a human being was murdered or not [9].

The diagram above outlines the process of how researchers

at Oregon Health & Science University grew stem cells from
skin cells and unfertilized embryos [14].

CONCLUSION: THE DECISION NEEDS TO

BE MADE
Approaching the final decision, there are many
considerations I must keep in mind. The patient and the
embryo are the two entities that will be affected by my
decision. I cannot simply place the importance of one over the
other. To help make the decision, I kept in mind the pros and
cons of each debatable topic on stem cells, the professional
ethics I work by and the personal values that define me. I feel
that stem cells created from skin cells are the best way to solve
the ethical dilemma. They might not be as readily available as
embryonic stem cells, but they can be found and used for this
project to produce desired results. Once they are received by
my lab, coworkers and I will put the project at top priority and
work past normal hours to complete the project on time and

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Andrew Sassani

ultimately minimize the discomfort by the patient. I believe [12] N. O’Brien. (2013). “Embryonic stem-cell research
that issues engineers face should be solved through the most immoral, unnecessary, bishops say.” Stem-cell Research and
ethical and efficient manner possible. President Barack the Catholic Church. (Online Article).
Obama once stated, “As our nation invests in science and http://www.americancatholic.org/News/StemCell/
innovation and pursues advances in biomedical research and [13] (2013). “Catholic Support for Ethically Acceptable Stem
health care, it's imperative that we do so in a responsible Cell Research.” Stem Cell Research. (Website).
manner” [15]. In accordance with presidential advice, I feel http://www.usccb.org/issues-and-action/human-life-and-
this solution has provided effective medical care that is done dignity/stem-cell-research/catholic-support-for-ethically-
in “a responsible matter” yielding an optimal solution for an acceptable-stem-cell-research.cfm
ethical engineering dilemma. [14] J. Koebler. (2013). “Scientists Convert Human Skin
Cells Into Embryonic Stem Cells.” News. (Online Article).
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convert-human-skin-cells-into-embryonic-stem-cells
[1] A. Mikos, P. Johnson. (2012). “Overview.” Tissue [15] “Presidential commission for the Study of Bioethical
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http://www.liebertpub.com/overview/tissue-engineering- Issues. (Website). http://www.bioethics.gov/
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[2] R. Yang, W. Gao. (2013). “Introduction.” Generation of ACKNOWLEDGEMENTS
functional organs from stem cells. (Online Article).
http://www.cellregenerationjournal.com/content/2/1/1 I wish to commend the library for providing the useful
[3] A. Trafton. (2012) “Tissue Engineering: Growing new search engine to find compelling articles about stem cell
organs, and more.” MIT news. (Online Article). ethics. In addition, I would like to recognize Cody Fannin,
http://web.mit.edu/newsoffice/2012/engineering-health- Andrew Sivaprakasam and Henry Phalen for proofreading my
tissue-engineering-growing-organs-1214.html essay. I would also like to thank Daxton Scholl for providing
[4] J. Lannutti, D. Reneker, T. Ma, D. Tomasko, D. Farson. help with formatting.
(2007). “Abstract.” Electrospinning for tissue engineering
scaffolds. (Online Article).
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[5] M. Park. (2011). “Lab-made organ implanted for first
time.” CNN Health. (Online Article).
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[6] A. Siegel. (2013). “Ethics of Stem Cell Research.”
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http://plato.stanford.edu/entries/stem-cells/
[7] K. Hug. (2011). “The ethical dilemma.” Embryonic stem
cell research: an ethical dilemma. (Online Article).
http://www.eurostemcell.org/factsheet/embryonic-stem-cell-
research-ethical-dilemma
[8] R. Doerflinger. (2010). “Old and ethics in the stem cell
debate.” American Society of Law, Medicine & Ethics.
(Online Article).
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[9] (2013). “NSPE Code of Ethics for Engineers.” Ethics.
(Website).
http://www.nspe.org/Ethics/CodeofEthics/index.html
[10] “Stem Cell Facts.” Americans for Cures: Stem Cell
Facts. (Website).
http://www.americansforcures.org/article.php?uid=1000
[11] (2004). “Biomedical Engineering Society Code of
Ethics.” 2004 Approved Code of Ethics. (Online Document).
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f%20Ethics(2).pdf

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