Monitoring Stem Cell Research

The President's Council on Bioethics
Washington, D.C., January 2004

http://www.thenewatlantis.com/docLib/20091130_monitoring_stem_cell_research.pdf

[목차]

LETTER OF TRANSMITTAL TO THE PRESIDENT ...ix
MEMBERS OF THE PRESIDENT’S COUNCIL ON BIOETHICS ...xiii
COUNCIL STAFF AND CONSULTANTS ...xv
PREFACE ...xvii
1 INTRODUCTION ...1
I. WHAT ARE STEM CELLS, AND WHY IS THERE CONTENTION
ABOUT THEM? ...2
II. BROADER ETHICAL ISSUES ...5
III. TYPES OF STEM CELLS: AN INTRODUCTION ...8
A. EMBRYONIC STEM (ES) CELLS ...8
B. EMBRYONIC GERM (EG) CELLS ...9
C. ADULT (OR NON-EMBRYONIC) STEM CELLS ...10
D. CORD BLOOD STEM CELLS ...11
IV. TERMINOLOGY ...12
V. ABOUT THE REPORT ...15
ENDNOTES ...20
2 CURRENT FEDERAL LAW AND POLICY ...21
I. A BRIEF HISTORY OF THE EMBRYO RESEARCH FUNDING
DEBATE ...22
II. THE PRESENT POLICY ...28
III. MORAL FOUNDATION OF THE POLICY ...30
IV. THE SIGNIFICANCE OF FEDERAL FUNDING ...37
V. IMPLEMENTATION OF THE PRESENT POLICY ...41
VI. CONCLUSION ...47
ENDNOTES ...49
v
vi CONTENTS
3 RECENT DEVELOPMENTS IN THE ETHICAL AND POLICY DEBATES ...53
I. THE NATURE OF THE MORAL ARGUMENT ...54
II. THE MORAL AIMS OF POLICY ...58
A. THE IMPORTANCE OF RELIEVING SUFFERING ...58
B. FREEDOM TO CONDUCT RESEARCH ...61
C. THE MORAL STANDING OF HUMAN EMBRYOS ...62
III. THE CHARACTER OF THE POLICY ...63
A. ARBITRARY ...63
B. UNSUSTAINABLE ...65
C. INCONSISTENT ...67
IV. THE MORAL STANDING OF HUMAN EMBRYOS ...74
A. CONTINUITY AND DISCONTINUITY ...76
1. THE CASE FOR CONTINUITY. ...76
2. THE CASE FOR MEANINGFUL DISCONTINUITY AND DEVELOPING MORAL STATUS. ...78
B. SPECIAL CASES AND EXCEPTIONS ...84
1. IVF “SPARES.” ...84
2. NATURAL EMBRYO LOSS. ...88
3. PREDICTION OF NON-VIABILITY OF EMBRYOS. ...89
4. CREATION OF NON-VIABLE EMBRYO-LIKE ARTIFACTS. ...90
V. SOCIETAL SIGNIFICANCE AND PUBLIC RESPONSIBILITY ...93
VI. CONCLUSION ...97
ENDNOTES ...98
4 RECENT DEVELOPMENTS IN STEM CELL RESEARCH AND THERAPY ...109
I. STEM CELLS AND THEIR DERIVATIVES ...111
II. REPRODUCIBLE RESULTS USING STEM CELL PREPARATIONS AND THEIR DERIVATIVES ...116
A. INITIAL STEM CELL PREPARATIONS CAN CONTAIN MULTIPLE CELL TYPES ...116
B. GENETICALLY HOMOGENEOUS STEM CELLS THROUGH SINGLE CELL CLONING ...117
C. EXPANSION IN VITRO, PRESERVATION, AND STORAGE ...118
D. CHROMOSOME CHANGES ...119
CONTENTS ...vii
E. DEVELOPMENTAL HETEROGENEITY OF STEM CELL PREPARATIONS ...119
F. MICROBIAL CONTAMINATION ...120
III. MAJOR EXAMPLES OF HUMAN STEM CELLS ...121
A. HUMAN ADULT STEM CELLS ...122
1. HUMAN MESENCHYMAL STEM CELLS. ...122
2. MULTIPOTENT ADULT PROGENITOR CELLS (MAPCS). ...123
3. HUMAN NEURAL STEM CELLS. ...124
4. ADULT STEM CELLS FROM OTHER SOURCES. ...125
B. HUMAN EMBRYONIC STEM CELLS ...125
1. HUMAN EMBRYONIC STEM CELLS (ESCS). ...126
2. EMBRYONIC GERM CELLS. ...127
3. EMBRYONIC STEM CELLS FROM CLONED EMBRYOS (CLONED ESCS). ...128
IV. BASIC RESEARCH USING HUMAN STEM CELLS ...129
V. HUMAN STEM CELLS AND THE TREATMENT OF DISEASE ...131
A. WILL STEM CELL-BASED THERAPIES BE LIMITED BY IMMUNE REJECTION? ...131
B. CASE STUDY: STEM CELLS IN THE FUTURE TREATMENT OF TYPE-1 DIABETES? ...133
1. THE DISEASE AND ITS CAUSES. ...133
2. CURRENT THERAPY CHOICES AND OUTCOMES. ...134
3. STEM CELL THERAPY FOR TYPE-1 DIABETES? ...135
C. THERAPEUTIC APPLICATIONS OF MESENCHYMAL STEM CELLS (MSCS) ...137
D. EVALUATING THE DIFFERENT TYPES OF STEM CELLS ...138
VI. PRIVATE SECTOR ACTIVITY ...138
VII. PRELIMINARY CONCLUSIONS ...139
ENDNOTES ...141
GLOSSARY OF TERMS ...147
APPENDIX A. NOTES ON EARLY HUMAN DEVELOPMENT ...157
STAFF OF THE PRESIDENT’S COUNCIL ON BIOETHICS
APPENDIX B. REMARKS BY THE PRESIDENT ON STEM CELL RESEARCH,
AUGUST 9, 2001 ...183
PRESIDENT GEORGE W. BUSH
APPENDIX C. BUSH ADMINISTRATION NIH GUIDELINES FOR EMBRYONIC
STEM CELL FUNDING ...189
APPENDIX D. CLINTON ADMINISTRATION GUIDELINES FOR EMBRYONIC
STEM CELL FUNDING ...191
COMMISSIONED PAPERS ...198
APPENDIX E. LEGISLATORS AS LOBBYISTS: PROPOSED STATE REGULATION
OF EMBRYONIC STEM CELL RESEARCH, THERAPEUTIC
CLONING AND REPRODUCTIVE CLONING ...199
LORI B. ANDREWS, J.D.
APPENDIX F. THE MEANING OF FEDERAL FUNDING ...225
PETER BERKOWITZ, J.D., PH.D.
APPENDIX G. REPORT ON THE ETHICS OF STEM CELL RESEARCH ...237
PAUL LAURITZEN, PH.D.
APPENDIX H. HUMAN EMBRYONIC GERM CELLS: JUNE 2001-JULY 2003,
THE PUBLISHED RECORD ...273
JOHN GEARHART, PH.D.
APPENDIX I. CURRENT PROGRESS IN HUMAN EMBRYONIC STEM CELL
RESEARCH ...279
TENNEILLE E. LUDWIG, PH.D., AND
JAMES A. THOMSON, PH.D.
APPENDIX J. MULTIPOTENT ADULT PROGENITOR CELLS: AN UPDATE ...295
CATHERINE M. VERFAILLIE, M.D.
APPENDIX K. ADULT STEM CELLS ...309
DAVID A. PRENTICE, PH.D.
APPENDIX L. STEM CELLS AND TISSUE REGENERATION: LESSONS FROM
RECIPIENTS OF SOLID ORGAN TRANSPLANTATION ...347
SILVIU ITESCU, M.D.
APPENDIX M. POTENTIAL USE OF CELLULAR THERAPY FOR PATIENTS
WITH HEART DISEASE ...365
SILVIU ITESCU, M.D.
APPENDIX N. THE BIOLOGY OF NUCLEAR CLONING AND THE POTENTIAL
OF EMBRYONIC STEM CELLS FOR TRANSPLANTATION
THERAPY ...385
RUDOLF JAENISCH, M.D.