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Stem Cell Research as a Healthcare Ethical Dilemma

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Stem cell research has allowed researchers and healthcare providers to understand the human body and develop new treatments for diseases, the use of stem cells especially those from embryos remains a controversial issue. While medicine contains many known principles and theories, there remain opportunities for experimentation, which is subject to ethical examination. Science and research have allowed Americans to lead a healthier lifestyle, with many Americans living significantly longer than the preceding generation. The purpose of this paper is to examine the ethical dilemma surrounding stem cell research. Included in this discussion will be the introduction and background, analysis, proposed strategies for the healthcare system, and healthcare policy related to stem cell research and therapy.

Introduction and Background of the Stem Cell

Research on stem cells is not new and started in the United States in the 1950s. Stem cells are the building blocks of normal growth and development. They are critical for rebuilding and repairing damaged tissue. Numerous degenerative diseases such as Retinal Degenerative Disease or Osteoarthritis arise from the malfunctioning of a specific cell type, which has the potential of being treated through stem cell therapy. Stem cells have the ability to grow and adapt for a specialized function that is determined by where in the tissue it is located (differentiation). For example, hepatic cells placed in the liver will become part of the liver. Reisman and Adams explained that embryonic cells have not yet acquired a specific role, and thus are able to differentiate and divide to reproduce multiple copies of these cells with extreme efficiency.

Analysis of Stem Cell Dilemma

While stem cell research holds much promise, the use of embryonic stem cells is an ethical dilemma among researchers and the public. The ethical dilemma is centered on the question of when life begins. Proponents hold hope for stem cell research as the answer to repairing organs and tissue damage caused by illnesses such as Parkinson’s disease, Multiple Sclerosis, and Type I Diabetes. Opponents view the use of embryonic stem cells as unethical in that a human embryo is a human individual in an early stage of development. While opponents do not deny the potential benefits of embryonic stem cell use, the question is asked if the end justifies the means.

The embryonic stem cells are pluripotent cells that can transform into all cell types that make up a human body.  Pluripotent stem cells can be obtained from the fetal tissue after abortion and as a result, raise ethical and controversial dilemmas for individuals that are opposed to abortion. Similarly, the destruction of human embryos continues to be a major factor in slowing the progress of the development and use of hESCs as a result of conflict with the religion and beliefs of many individuals. However, Provision One of the Code of Ethics for Nurses calls for the protection, promotion, and health restoration of patients. The right of the diseased patient must be considered and provided easy access to the advantages of stem cell therapy for a cure from a terminal disease. The argument here is that more lives will be saved by using donated embryonic stem cells.

Proposed Strategies

Issues surrounding stem cell research involve the development of processes that help ensure there are donor education programs, explicit informed consent, and protect the privacy and confidentiality of donors and recipients. Consent forms are gathered from the donor and the recipient. These consent forms should contain all identified risks, benefits, and alternatives to the procedure.

The Advance Practice Registered Nurses (APRN) and the Doctor of Nursing Practice (DNP) have a responsibility to safeguard the integrity of individuals and adopt a process that respects the values, and desires of equitability of all involved in the stem cell process. Provisions Seven and Eight of the Code of Conduct calls for nurses’ involvement in research and professional development in ensuring quality healthcare and reducing health disparities. Two ethical principles to remember here are beneficent and non-maleficence. This would include providing compassionate care with autonomy to make an informed decision and avoid harm to others based on our individual beliefs and values.

Essential Three of the DNP guides APRNs to participate in evidence-based practices (EBP) that would ensure health promotion and disease prevention of all individuals in the community. We also know that EBP is about the integration of the best research evidence and clinical expertise with consideration of patient needs to deliver quality, safe, and cost-effective health care, excellent customer service, and optimal outcomes. However, the translation of research into the practice settings and integration of the EBP into nursing practice has been a challenge. One main contributing factor, studies have shown that the nurses’ cultural beliefs have been impeding this implementation in numerous healthcare settings. In general, nurses have a positive attitude towards evidence-based practice; however, this behavior should be eliminated to allow for EBP to become a daily practice to benefit all patients.

Federal funding and restrictions should be monitored and controlled to safeguard social justice and equity. A group or committee can develop guidelines and monitor stem cell research and therapy so that it is conducted in a socially just manner and promote and ensure social justice essentials. Individuals with a utilitarian approach seek to maintain social justice based on the effect that an intervention would have on the members of the community. They will select the intervention that would benefit the majority. A libertarian individual acknowledges the right to life, liberty, and property and respects the right of others. They ensure that all services are available regardless of social and economic status and denials of services are not based on race, ethnicity, or politics when treatment is needed to save alive.

Provision three of the Code of Conduct calls for the nurse to promote and advocate for the health and safety of all patients. Thus, the goal should be to have stem cell research and therapy available to everyone. The cost of integrating stem cell research and therapies into clinical practice is high however, it is a resource that should be allocated and distributed so that all benefit. This will require the DNP to participate in continuous monitoring and attention to policies and practices to ensure equitable and ethical use.

Healthcare Policy Regulating and Addressing Dilemma

Congressional hearings, and public meetings by government agencies, along with media coverage, have pushed stem cell research issues into the spotlight with tremendous expectations. Stem cell research and technology have exploded over the past several years since embryonic cells were first isolated in l998. Each agency’s role is slightly different but all contribute to it by providing either the infrastructure for or influencing stem cell research.

In the United States, abuses in the research guided the enhancement of the National in 1974, which created the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. In 1978, the Commission published Ethical Principles and Guidelines for the Protection of Human Subjects of Research, which is also known as the Belmont Report. This identified three fundamental ethical principles for all human research to ensure respect for individuals, beneficence, nonmaleficence, and justice. The term beneficence is defined as trying to help others and nonmaleficence to enforce individuals not to harm others.

The infrastructure of the stem cell projects lay with the National Institute of Health (NIH). All acceptable research in relation to stem cells needs to be submitted, listed, and approved through the NIH. The Sub-components of the NIH are Organizations of Center or Research Resources (NCRRO), Institute on Aging (NIA), Institute of Child Health and Human Development (NICHD), and Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Within these different sub-components is the actual process of developing cures for major illnesses and diseases that affect Americans every day.

With the growing use of Human Embryonic stem cells (hESC) in understanding and treating degenerative diseases, there were individuals who opposed the idea of destroying human embryos. In response, in 2001, President Bush signed a bill that allowed federal National Institutes of Health (NIH) funding for stem cell research only for those embryonic stem cell lines that were produced before 2001. This was a major incentive to get more researchers involved to increase the chance of therapeutic breakthroughs to cure diseases that would routinely kill individuals.

In cases involving blastocysts, gametes, and somatic cells for research purposes, the procurement process requires approval from an Institutional Review Board (IRB). The membership and functions of IRB are described in the Department of Health and Human Service (DHHS) regulations at 45 CFR 46.107-115. The DHHS’s mission is to protect human subjects of research and extends its protection to vulnerable populations such as pregnant women, viable fetuses, prisoners, and children.

The Food and Drug Administration Center (FDA) regulates human cells, tissues, and cellular and tissue-based products for the purpose of biologics evaluation and research. This covers all purposes of implantation, transplantation, infusion, or transfer into a human recipient including stem cells.

Conclusion

While stem cell research continues, for patients that are dealing with deadly diseases such as Parkinson’s disease, multiple sclerosis, and Type I Diabetes, its progress is slow and controversial. The basic argument of, when life begins, remains at the center of the stem cell research dilemma. While science moves ahead, the moral dilemma remains for government and society to reconcile. In hope of a cure, patients are looking for treatment with untested cell-based therapies internationally for an affordable cost. Therefore, it is critical for DNPs to understand these ethical issues. A sense of these issues should help to put emerging scientific advances into appropriate context and to ensure the responsible clinical translation of promising therapeutics.

References

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  3. Institute of Medicine and National Research Council. (2005). Guidelines for Human human Embryonic Stem Cell Research. Washington, DC: The National Academies Press. doi: 10.17226/11278.
  4. Knoepfler, P. S., & Turner, L. G. (2018). The FDA and the US direct-to-consumer marketplace for stem cell interventions: A temporal analysis. Regenerative medicine, 13(1), 19-27. doi: 10.2217/rme-2017-0115.
  5. Koch, T. (2011). Care, compassion, or cost: Redefining the basis of treatment in ethics and law. Journal of Law, Medicine, and Ethics, 130-139.doi.org/10.1111/j.1748-720X.2011
  6. Lipworth, W., Stewart, C., & Kerridge, I. (2018).The need for beneficence and prudence in clinical innovation with autologous stem cells.Perspectives in biology and medicine, 61(1), 90-105. doi: 10.1353/pbm.2018.0029.
  7. [bookmark: ReferencesBookmark]Lo, B., & Parham, L. (2009). Ethical issues in stem cell research.Endocrine reviews, 30(3), 204-213. doi: 10.1210/er.2008-0031
  8. Lowenthal, J., &Sugarman, J. (2015). Ethics and policy issues for stem cell research and pulmonary medicine.Chest, 147(3), 824-834.doi: 10.1378/chest.14-1696 Comment by Alatrash, Manal: Italicize the volume
  9. Mader, S., Windelspecht, M., & Preston, L. (2016).Essentials of biology.McGraw-Hill higher education.
  10. Master, Z., & Crozier, G. (2012). The ethics of moral compromise for stem cell research policy. Health Care Analysis, 20(1), 50-65.doi 10.1007/s10728-011-0171-2
  11. Reisman, M., & Adams, K. T. (2014). Stem cell therapy: A look at current research, regulations, and remaining hurdles. Pharmacy and Therapeutics, 39(12), 846. https://www.ncbi.nlm.nih.gov/pubmed/25516694
  12. Volarevic, V., Markovic, B. S., Gazdic, M., Volarevic, A., Jovicic, N., Arsenijevic, N., … Stojkovic, M. (2018).Ethical and safety issues of stem cell-based therapy.International journal of medical sciences, 15(1), 36. doi.org/10.7150%2Fijms.21666

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