Monday, May 6, 2013

A bioethical question

I recently had an interesting exchange with Ray P., a Secular Pro-Life member and scientist whose current project involves the study of gestational diabetes and insulin production. Of course, I'm thrilled to see an SPL member working to improve maternal health. But Ray has an ethical conundrum: many scientists in his field use cell lines derived from abortion victims.

With his permission, I am sharing our conversation, and I encourage you all to share your thoughts on the matter.

Ray began:
I'm curious if SPL has ever covered the topic of using cell lines and/or tissue derived from aborted fetuses for the use of scientific study, and I'm not referring to human embryonic stem cells, but rather cell lines such as HEK293. They are shockingly common in much of the scientific community, and I try to go out of my way to avoid them (I do not know what exactly yours or SPL's stance is on this particular issue, but please know I am not trying to be judgmental regardless of the case). That said, the scientific community is extremely interconnected, and indirectly contributing to or benefiting from the study of cells and tissues from aborted fetuses seems inevitable at times. Believe me when I say the issue weighs on me heavily at times, and I would love to hear other people's thoughts on the matter.
I replied: 
That's a fascinating question, and SPL has never addressed it before. I'm not familiar with HEK293, but it occurs to me that there may be an analogy to HeLa. There's no doubt that HeLa was obtained without the family's consent, and that this violates modern principles of medical ethics. But HeLa is ubiquitous, and when a researcher uses HeLa, it is not taken as an endorsement of its origins. Of course, as pro-lifers, we affirm that killing an unborn child is a much greater wrong than failing to get consent before using a deceased person's tumor for research.  
"Thinking out loud" here: can we pinpoint exactly what is objectionable about HEK293? Fetal cells aren't objectionable in and of themselves; if a woman suffered a miscarriage and decided to donate her baby's body to science, that would be laudable. So clearly the problem is with the way the child died. Of course, it's not as though the child was aborted for the purpose of creating HEK293. How do we feel about research on other victims of violence? If an adult murder victim's family chose to donate the body to science, again, I think that would be laudable. But what if it were a domestic violence situation, and the person giving consent and the person responsible for the death were one and the same? Ah, now we've hit on the problem.  If you chose to kill the person, and then you donate the person's body to science, it hardly seems like a noble sacrifice.  It seems just plain creepy.  And so it is with the mother who graciously allows researchers to use cells from the baby she aborted.
So I think you're right to avoid HEK293 to the extent that you can.
Ray responded with some more details on HEK293 and its alternatives:
Thank you for your thoughts on cell lines from aborted fetuses, it's great to hear more thoughts on the matter, and I'll also provide more background information in the following few sentences if you're curious to learn more. HEK293 cells were derived from an abortion performed in the Netherlands in the early 1970s. To put it simply, they were created by breaking up the kidney tissue of the fetus into individual cells, then introducing genes from a virus into some of those cells which will make those cells replicate indefinitely.  Much of the information regarding the initial abortion has been lost to time, but those involved with the creation of the cell line believe that it was a purely elective abortion. [To clarify, all HEK293 cells are derived from this single abortion.] They are an extremely popular cell line in many scientific labs for many reasons, most notable of which they are very good at making a lot of protein. This is very useful if you want to purify large quantities of a certain protein for other studies, or if you wanted to study what your protein of interest did within the context of a living cell. Not only that, but because they are derived from human tissue, scientists generally see the study of these cells as having a closer link to human physiology than studying a cell line from another animal.
There are a few caveats with these cells, however. The biggest of which is no one knows what kind of kidney cell they actually are. After being extensively modified and manipulated (and even after probably undergoing some natural evolution of their own), they are very different from any kidney cell you would actually ever find in a living person (fetus or otherwise). Furthermore, it is generally accepted in the field that studying a decades old cell line is inferior to studying a cell line "freshly" derived (say, from a recent autopsy) or even from a living animal model. For this reason, HEK293 cells really aren't used to study kidney cells terribly often. Like I mentioned earlier, they are more commonly used to create vast quantities of a particular protein or simply to create a cellular environment to study a protein in.  
Furthermore, many other cell lines have been used for the exact same purposes as HEK293. A very common example is the CHO cell line, which are made from cells from a chinese hamster ovary (hence CHO). Like HEK293 cells, CHO cells replicate indefinitely and are very good at making proteins. Sometimes people will argue that HEK293 cells and CHO cells each have their own strengths, but to be completely blunt everything that I've ever read on the two cell lines indicate they are essentially interchangeable under most circumstances (which, aside from moral reasons, is why I will be using CHO cells in a portion of my research instead of HEK293). From my experience, the biggest factor that determines if a lab will use HEK293 cells or CHO cells is which cell line is more easily accessible at that particular moment and if anyone in the lab already knows how to use one or the other (both are very easy to obtain and use). Even if you're studying a human protein, HEK293 cells aren't necessarily the best choice.
From my personal experience, I have encountered numerous scientists who didn't even know the origin of HEK293 cells. I, for one, did not know for several years after I learned of their existence, and even a tenured faculty member I know was shocked when I told her of their origin (who has since vowed not to use them anymore).  That said, I certainly don't think the majority of scientists would stop using them even if they did. 
In addition to cell lines such as HEK293, tissues from aborted fetuses are often used to study the development of human organs, as it allows snapshots of an organ at different stages of fetal life. Likewise, sometimes a fetus is aborted due to a certain birth defect, and in those cases the tissue may be harvested to study rare genetic diseases and conditions.
You brought up the example of HeLa cells in your email, which, as you mentioned, obtained and used without the permission of either the patient they were taken from or that of her family. While this is a blatant disregard of patients rights and a clear moral violation, I also feel this is less serious than using cells from aborted fetuses. After all, HeLa cells were obtained while the patient was being treated for her cancer, and she was not harmed through or by their creation, and I thus feel it is morally acceptable to use HeLa cells.
The morality of benefiting from cell lines created from abortions, as you implied, is much more complicated. Many other cell lines are also created from aborted fetuses, including several that are used to make vaccines, including the MMR (measles, mumps, rubella) vaccine. This issue, I feel, is more complicated than using HEK293 cells in the lab. In my situation, I can choose to study a different cell line to further the same research goals. Thus, in my opinion, it is not morally acceptable to use HEK293 cells for research. 
However, in terms of medicine, often times the only vaccine available is created from cell lines from aborted fetuses. My personal opinion in this case is that it is morally acceptable to receive (at least some) of these vaccines as the alternative consequence is often an immediate and severe health risk for both the individual and the community. That said, I still believe it is our moral duty to demand a morally acceptable alternative be created.
But you also raised an excellent point of other cell lines derived from human tissue. Although considerably more rare, I do believe that cell lines derived from spontaneous miscarriages are certainly morally acceptable, as this was the result of a natural death.  
But then you raised the point of using cells or tissues derived from victims of an act of violence (such as murder, or maybe even a drunk driver) - this is an extremely relevant remark as it is what led me to ask you my original question. My knee jerk reaction is that "yes", it would be acceptable, if not even noble, to use cells or tissues derived from the victim of murder or drunk driving, even if the actions that brought those results are downright evil. How this is different from using cells and tissues from an abortion, I cannot say - it just seems "different" to me in ways that are difficult for me to currently articulate. A similar question would be to ask if it is morally acceptable to use cells and tissues derived from a death row inmate. As I regard capital punishment as almost universally evil, my immediate response to that would be "no" - but even then, the situation seems different in some ways than abortion or a victim of domestic violence/drunk driving.  
I feel a good example (that is sadly true) is in the original study of Clara cells done in the late 1930s. Clara cells are found in the lung, and are named after the scientist who discovered them, Max Clara. Tragically, Max Clara was actually a Nazi doctor who discovered Clara cells by studying the bodies of Holocaust victims. I have little doubt that if we were to ask Max Clara how he could live with what he had done, he would simply state that those Holocaust victims would have died anyways, and he was simply utilizing the tissue. Today, of course, scientists regard his original studies as sick and twisted, and no knowledge gained justified being complicit with that tragedy. Again, I ask myself, what exactly separates using tissues of Holocaust victims and using tissues of victims of domestic violence and drunk driving? And again, I do not know - although the situations feel very different none the less. Forgive me for introducing Godwin's Law into the discussion, but I feel I need to remember the past tragedies of scientists so I do not repeat them, there are sadly more examples than just those we mentioned in our emails.
Readers, any further thoughts for Ray and other pro-life scientists wrestling with these questions?

1 comment:

JA said...

It seems to me that a stem cell line that is almost 40 years old is so removed from it's origins that using it now does not constitute an ethical violation for a pro-lifer. I mean, of course it's disgusting that it originated with an elective abortion, but there are no fetal cells present in it now and haven't been for a long, long time. In daily life we continually encounter items whose genesis was under less than ethical terms; we can't avoid using every product with a dark history.