1. Stem Cells: Ethical Considerations David Orentlicher, MD, JD Indiana Schools of Law and Medicine March 25, 2009

2. What are stem cells? Original Cell (totipotent) Original Cell (totipotent) Embryonic Stem Cells (pluripotent) Embryonic Stem Cells (pluripotent) ? Induced pluripotential stem cells ? Induced pluripotential stem cells Adult Stem Cells (multipotent) Adult Stem Cells (multipotent) Adult Cells (highly specialized) Adult Cells (highly specialized)

3. Why are stem cells important? May be able to treat a wide range of diseases involving the loss of normal cellular function (e.g., people with heart attacks, Parkinsons disease, spinal cord injury, or cirrhosis of the liver). May be able to treat a wide range of diseases involving the loss of normal cellular function (e.g., people with heart attacks, Parkinsons disease, spinal cord injury, or cirrhosis of the liver). Potentially unlimited supply of replacement cells Potentially unlimited supply of replacement cells

4. Why are stem cells controversial? Taking stem cells from embryos destroys the embryos Taking stem cells from embryos destroys the embryos If the embryo is a person at conception, taking stem cells is akin to removing a heart from someone while still alive for transplantation If the embryo is a person at conception, taking stem cells is akin to removing a heart from someone while still alive for transplantation Destroying embryos erodes the sanctity of life Destroying embryos erodes the sanctity of life

5. The response to stem cell critics Rather than viewing embryos as persons, we should view them as having the potential for becoming persons Rather than viewing embryos as persons, we should view them as having the potential for becoming persons The embryos are sitting in a laboratory freezer, not in a womans bodyleft alone, the embryos do not become people The embryos are sitting in a laboratory freezer, not in a womans bodyleft alone, the embryos do not become people How should we punish someone who destroys frozen embryos? How should we punish someone who destroys frozen embryos?

6. The response to stem cell critics Destroying embryos for no purpose may erode societal respect for life Destroying embryos for no purpose may erode societal respect for life But stem cells are taken to heal disease and prolong life But stem cells are taken to heal disease and prolong life

7. Responding to uncertainty If we are uncertain about the embryos moral status and the medical promise of stem cells, how does that affect the analysis (i.e., who bears the burden of proof)? If we are uncertain about the embryos moral status and the medical promise of stem cells, how does that affect the analysis (i.e., who bears the burden of proof)? Err in favor of treating illness in living persons? (human vs. potential human) Err in favor of treating illness in living persons? (human vs. potential human) Err in favor of not destroying a potential for life? (adult stem cells may be sufficient) Err in favor of not destroying a potential for life? (adult stem cells may be sufficient)

8. Responding to uncertainty Even if it is wrong to destroy an embryo because of its potential for life, what of embryos that are destined for destruction? Even if it is wrong to destroy an embryo because of its potential for life, what of embryos that are destined for destruction? In the UK, unclaimed embryos are routinely discardedtaking stem cells from these embryos does not shorten the lifespan of the embryos In the UK, unclaimed embryos are routinely discardedtaking stem cells from these embryos does not shorten the lifespan of the embryos

9. Presidential policy Bush: federal funding for existing stem cell lines that were derived: (1) with the informed consent of the donors; (2) from excess embryos created solely for reproductive purposes; and (3) without any financial inducements to the donors Bush: federal funding for existing stem cell lines that were derived: (1) with the informed consent of the donors; (2) from excess embryos created solely for reproductive purposes; and (3) without any financial inducements to the donors Obama: federal funding for responsible, scientifically worthy human stem cell research, including human embryonic stem cell research, to the extent permitted by law. Obama: federal funding for responsible, scientifically worthy human stem cell research, including human embryonic stem cell research, to the extent permitted by law. Current law prohibits federal funding to create new cell lines Current law prohibits federal funding to create new cell lines