Against the ATS Statement on Human Embryonic Stem Cell Research/From the Authors

To the Editor.

Stem cells differentiate into many specialized cells and are therefore of interest in chronic conditions for which treatment is limited. Adult stem cells have been used successfully in treatment trials for cancer, genetic syndromes, and other conditions. There are no ethical or moral concerns with the appropriate use of adult stern cells. However, human embryonic stem cell (HESC) research is unethical since it results in the destruction of human life for research purposes. The unethical egg donor procurement practices and scientific fraud in South Korea highlight the compromised positions of researchers willing to take part in HESC research (1). As American Thoracic Society (ATS) members, we do not support HESC research, and we completely disagree with the recently published official ATS statement on HESC, which should be retracted or revised (2).

HESC research is morally wrong since it is the direct destruction of innocent human life and does not benefit the individual embryo undergoing the research (3). The authors' statement regarding use of embryos from in vitro fertilization (IVF) clinics is based on the argument that the embryos will die anyway, and therefore research benefit could be derived from them. The ends never justify the means. All of us will die someday, yet this does not give a researcher the right to terminate that life. In this case, the embryos will die because others have chosen their death for the purpose of research. The authors state that obtaining consent for embryos from IVF clinics justifies their use for research. Since consent can't be obtained from the embryo, it must be obtained from the donor acting as a legal surrogate. Consent for an incompetent research subject by a legal surrogate is allowed only if there is minimal risk and therapeutic benefit for the incompetent research subject. This principle is upheld by the Declaration of Helsinki, the Nuremberg Code, and the United Nations Declaration of Human Rights. As stated by the World Medical Association, "Concern for the interests of the subject must always prevail over the interest of science and society" (4). In the case of a human embryo that will be destroyed, there is no benefit and only harm. Physicians need to support life in all instances, especially the most vulnerable in society.

We believe it is irresponsible for the ATS to ignore the entire society it represents, which includes members who do not support HESC research. We encourage the Board and editorial staff to reconsider their position and to be inclusive of the Society they are empowered to represent.

Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

CHARLES F. THOMAS, JR.

ROBERT VASSALLO

Mayo Clinic College of Medicine

Rochester, Minnesota

MARIO CASTRO

Washington University School of Medicine

St. Louis, Missouri

References

1. Steinbrook R. Egg donation and human embryonic stem-cell research. N Engl J Med 2006;354:324-326.

2. American Thoracic Society. Human embryonic stem cell research. Am J Respir Crit Care Med 2006;173:1043-1045.

3. DeBlois J, Norris P, O'Rourke K. Research on human embryos: ethical perspective. In: DeBlois J, Norris P, O'Rourke K, editors. A primer for health care ethics: essays for a pluralistic society, 1st ed. Washington, DC: Georgetown University Press; 1994. pp. 188-190.

4. Declaration of Helsinki, World Medical Association. Ethical principles for medical research involving human subjects. Adopted 1964, amended 2000; Principle 5. Available at: www.wma.net/e/policy/b3.htm

From the Authors:

The American Thoracic Society (ATS) official statement on human embryonic stem cell research (1) acknowledges the ethical debate surrounding human embryonic stem cell research. Statements IV, VI, and VII in the document address moral criteria that should apply for carrying out such research, the importance of a healthy ongoing discourse, and the need for continued efforts to establish guidelines such as those developed recently by the National Research Council and the Institute of Medicine of the National Academies (2). The central ethical question is whether a 5-day-old blastocyst has the same moral and legal status as a fetus or newborn baby. This concern should be carefully considered but also balanced, in our opinions, against the needs of the millions of patients sick from diseases who may benefit from human embryonic stem cell-generated therapies. Another question is whether excess embryos that are stored in in vitro fertilization (IVF) clinics, and which are destined for discarding and destruction, should or should not be used for the generation of stem cells. Most IVF clinics create many more fertilized eggs than will ultimately be implanted, knowing from the start that the majority will need to be discarded. If one finds it immoral to sacrifice embryos for generating stem cells, then one must also find it immoral to sacrifice them for treating infertility (3). There is nothing in the President's statement of August 9, 2001, that challenges the legality of human embryonic stem research in this country. The statement simply prohibits the use of federal funds for research using cells that have been generated after that date.

The letter of Drs. Thomas, Vassallo, and Castro cites the recent scientific fraud and unethical egg procurement by one laboratory in South Korea. This example of scientific fraud emphasizes the importance of careful peer review and of independent validation of findings by many laboratories. It also illustrates the danger in our own country of having relatively few laboratories-that is, the ones able to procure nonfederal funding-that are carrying out human embryonic stem cell research. The lifting of the President's ban on federal funding would increase the numbers of laboratories, avoid the problem of a "monopoly" in this area by a few investigators, and increase the likelihood that any future fraudulent publication will be challenged promptly (4). Lifting the President's ban on federal funding also would lead to adoption of a uniform rigorous set of national guidelines so as to forbid, and monitor for, practices such as unethical egg procurement.

The ATS Board of Directors adopted this official statement believing that it reflected the sentiments of the majority of ATS members. This does not invalidate the opinions of Drs. Thomas, Vassalo, and Castro, or of other ATS members with similar views, which are duly respected.

Conflict of Interest Statement: J.K.B. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. G.E. is a full-time employee of the American Thoracic Society. He has no financial interest in the subject matter. B.LM.H. is on the scientific advisory board of Curis, Inc., which does not currently carry out research with human embryonic stem cells but may do so in the future. She has a patent on methods for deriving embryonic stem cell lines but has renounced any potential financial benefit for herself or her lab. J.N. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. S.H.R. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. B.S. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. D.J.W. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

JAMES K. BROWN

University of California San Francisco

San Francisco, California

GARY EWART

ATS Advocacy Office

Washington, DC

BRIGID L. M. HOGAN

Duke University School of Medicine

Durham, North Carolina

JUDITH NEUBAUER

UMDNJ-Robert Wood Johnson Medical School

Brunswick, New Jersey

SCOTT H. RANDELL

University of North Carolina School of Medicine

Chapel Hill, North Carolina

BARRY STRIPP

University of Pittsburgh School of Medicine

Pittsburgh, Pennsylvania

DANIEL J. WEISS

University of Vermont School of Medicine

Burlington, Vermont

References

1. American Thoracic Society. Human embryonic stem cell research. Am J Respir Crit Care Med 2006;173:1043-1045.

2. National Research Council and Institute of Medicine of the National Academies. Guidelines for human embryonic stem cell research. Washington, DC: The National Academies Press; 2005. Available from: http://www.nap.edu.

3. Sandel MJ. Embryo ethics: the moral logic of stem-cell research. N Engl J Med 2004;351:207-209.

4. Snyder EY, Loring JF. Beyond fraud: stem-cell research continues. N Engl J Med 2006;354:321-324.