Human embryonic stem cells: cells without end?

Recently, human embryonic stem cells (HESC) have been in the public discourse for a number of reasons. Prominent critiques have been about the ethical issues related to killing human embryos, adverse reactions, immune-rejections, malignancy, phenotypic/genetic anomalies in transplanted cells and futuristic notions of eternal life. Key stake holders in our social and health system need to provide sustainable solutions for an under-mentioned issue that concerns not only medicine and science; but also humanity as a whole.

HESC policy models vary between countries, from being restrictive to permissive and flexible. Countries like India, China and the United Kingdom have a flexible policy. In India, HESC treatment is allowed for incurable conditions. All countries except the USA have legally banned reproductive cloning. In the present scenario of varied legal frameworks, resource-limited nations like India still need an open platform for evidence-based HESC application and a responsible discussion on the HESC concept.

Should stem cell research be encouraged in India just because it is easier to produce embryonic cell lines owing to greater legal flexibility and lower costs? A significant chunk of the Indian population still exists below the poverty line and donors are willing to ‘sell’ eggs for meagre incentives without ever questioning their own rights or the medico-legal aspect. This certainly raises concerns about inducement or coercion of vulnerable groups. The issue is not just ‘whether to pay’ but also ‘when and how much to pay’. Who must set these boundaries, and how does society conduct an informed debate on this subject? The promise of stem cells is too alluring to be undermined just because these concerns are not posed and addressed adequately.

The common Indian is perplexed by extreme claims and confusing terminology. There is a clash between religion and science in this spiritual nation. But we don’t need a biology or philosophy degree to understand what the real issue is. The fundamental ethics is easy enough to understand when it involves large scale production and instrumental killing of viable embryos. Destruction of human life cannot be justified, even in the name of saving another life.

It must be remembered that benefits may still be a long way off as cures for complex diseases are never simple. We require many more years of intensified research to know what we are trading in. Till then, India and the rest of the world will remain in precarious speculation. No serious researcher is engaged in producing a ‘whole human being’ from stem cells; rather, the efforts revolve around standardising HESC usage and production methods. Still, it cannot be ruled out that human cloning is possible. As of now, there is a general consensus that human cloning is a boundary that should not be crossed (2).

India needs a stem cell debate that is coloured neither by religious and utilitarian fanatics nor by the ‘big science with big funding’ profit driven agenda of biotech corporate giants.

Uncontroversial progenitors like adult cells, marrow, placenta, cord blood and induced pleuripotent cell lines should be increasingly explored as a standard therapy medium that will be both useful and ethical. Using surplus embryos from IVF clinics with dignity and ‘multiple re-use’ of source embryo could further alleviate our moral burden. The medical benefits of HESC in the treatment of dilapidating diseases are quite promising and it certainly is a worthwhile direction to explore in India. However, ethical discussions must be advanced judiciously to avoid untimely political truncation of the true potential of stem-cell research in India.