USCJ Review - Spring 2002

Embryonic Stem Cell Research: The Jewish Perspective

by Elliot N. Dorff

(The following is adapted from a responsum by Dr. Elliot N. Dorff, presented to the Committee on Jewish Law and Standards in December 2001.)

Today, scientists are especially interested in doing research on embryonic stem cells, which can and do transform themselves into all of the tissues of the body (i.e., they are “pluripotent”). From the study of these cells, scientists hope to accomplish at least the following three things:

Learn about the process of cell specialization. How do stem cells decide which tissues to become and how many to make of each type of tissue? We know that turning genes on and off is central to the process of human development, but we do not know much about how these decisions are made in the process of human development or how stem cells are turned on or off. Some of our most serious medical conditions, such as cancer and birth defects, are due to abnormal cell specialization and cell division. A better understanding of normal cell development is necessary for scientists to learn what goes wrong with cells when cancer or birth defects occur so that, hopefully, some day such abnormal developments can be arrested and reversed.
Test drugs more safely and efficiently. Research on pluripotent cells could also dramatically change the way we develop drugs and test them for safety. Only the drugs proven to be safe and effective in cell line testing would graduate to further testing in laboratory animals and ultimately in human subjects.
Develop cell therapies. Each year, thousands of people die for want of a suitable organ for transplant. Pluripotent stem cell research has the potential to resolve this problem. Once we know how to direct such cells to create specific kinds of cells and how to turn them on and off, we have the potential of using them to create whatever organs are needed.

Furthermore, stem cell therapies may cure conditions that organ transplantation has not yet been able to cure. Specifically, scientists hope to use cell therapies to cure Parkinson’s and Alzheimer’s diseases, spinal cord injuries, strokes, burns, heart diseases, diabetes, osteoarthritis, and rheumatoid arthritis. Preliminary work in mice and other animals has already demonstrated that healthy heart muscle cells transplanted into a diseased heart successfully repopulate the heart tissue and work together with the host cells to repair diseased heart muscle; it is therefore not simply a “pipe dream” to imagine that the same kind of therapy might work in humans.

Embryonic stem cells may be derived from any of the following sources:

Aborted fetuses. This method, of course, immediately raises the issue of the conditions under which abortion is permitted, if ever. In the context of America’s “abortion wars,” researchers do not plan on using this source of stem cells.
Frozen embryos destined to be discarded. Couples having difficulty conceiving a child may use in vitro fertilization (IVF)– that is, fertilization in a glass dish – in that effort. When the couple has had as many children as they plan to have, they commonly ask that their remaining frozen embryos be destroyed so that they no longer have to pay for the storage. But with the informed consent of such couples, the embryos may be used instead for medical research. It is this method that most scientists interested in carrying out embryonic stem cell research plan on using.
Stem-cell “farms.” Very few couples, though, agree to have their frozen embryos used for medical research, probably because producing them in the first place was so expensive and emotionally draining for the infertile couple. For that reason and others, the Jones Institute for Reproductive Medicine of Eastern Virginia Medical School revealed that it had procured sperm and eggs from donors who had expressly agreed that their gametes would be used not to overcome infertility but for medical research. This raised a storm of protest.

In addition, scientists are experimenting with several other methods to produce stem cells: Somatic Cell Nuclear Transfer (SCNT), the same technique that has been used for cloning plants and animals; extracting a cell from an embryo; and even prompting the egg cell alone to produce stem cells.

Fundamental Jewish Perspectives Relevant to Stem Cell Research

Jewish tradition holds that our bodies belong to God; we have them on loan during our lease on life. God, as owner of our bodies, can and does impose conditions on the use of our bodies. Among those is the requirement that we seek to preserve human life and health (pikuah nefesh). As a corollary to this, we have a duty to seek to develop new cures for human diseases.

Jewish tradition accepts both natural and artificial means to overcome illness. Physicians are the agents and partners of God in the ongoing act of healing. Thus, the mere fact that human beings created a specific therapy rather than finding it in nature does not impugn its legitimacy. On the contrary, we have a duty to God to develop and use any therapies that can aid us in taking care of our bodies, which ultimately belong to God. At the same time, all human beings, regardless of their levels of ability and disability, are created in the image of God and are to be valued as such.

Moreover, we are not God. We are not omniscient, as God is, and so we must take whatever precautions we can to ensure that our actions do not harm ourselves or our world in the very effort to improve them. A certain epistemological humility, in other words, must pervade whatever we do, especially when we are pushing the scientific envelope, as we are in stem cell research. We are, says Genesis 2:15, supposed to work the world and preserve it; it is that balance that is our Divine duty.

Jewish Views of Genetic Materials

During the first 40 days of gestation, the fetus, according to the Talmud, is “as if it were simply water,” and from the 41st day until birth it is “like the thigh of its mother.” Neither men nor women may amputate their thigh at will because that would be injuring their bodies, which belong to God. Thus, according to Jewish law, abortion is generally prohibited, not as an act of murder (the Catholic position) but as an act of self-injury. On the other hand, if the thigh turns gangrenous, then both men and women have the positive duty to have their thigh amputated in order to save their lives. Similarly, if the woman’s life or health is at stake, an abortion must be performed to save the life or the physical or mental health of the woman, for she is without question a full-fledged human being with all the protections of Jewish law, while the fetus is still only part of the woman’s body.

When there is an elevated risk to the woman beyond that of normal pregnancy but not so much as to constitute a clear threat to her life or health, abortion is permitted but not required; that is an assessment that the woman should make in consultation withthe father, other members of her family, her physician, her rabbi, and anyone else who can help her grapple with the many issues involved in her particular case. Some recent authorities, including the Conservative Movement’s Committee on Jewish Law and Standards, would also permit abortions in cases where testing indicates that the fetus is “severely defective,” suffering from serious malformations or terminal diseases like Tay-Sachs.

The upshot of the Jewish stance on abortion, then, is that if a fetus had been aborted for legitimate reasons under Jewish law, then the aborted fetus may be used to advance our efforts to preserve the life and health of others. If we may, and even should, use the bodies of human beings to enable others to live through organ transplantation, how much more so may we use a part of a body – in this case, the fetus – for that purpose. Using aborted fetuses to do research is not as directly and clearly permitted as using them for the cures themselves once they have been developed; but since aborted fetusus would otherwise just be discarded or buried, we may and should extend the permission to use them for research that holds out the hope for curing diseases and saving lives.

Stem cells for research purposes, though, can also be procured from donated sperm and eggs mixed together in a petri dish and cultured there. Since genetic materials outside the uterus have no chance of developing into a human being, they have even less legal status in Jewish law than zygotes and embryos in the first stages of gestation, when the Talmud classifies them “as if it were simply water.” Abortion is still prohibited during that time except for therapeutic purposes, for in the uterus such gametes have the potential of growing into a human being, but outside the womb, at least as of now, they have no such potential.

In our own day, when we understand that the fertilized egg cell has all the DNA that will ultimately produce a human being, we must clearly have respect for human embryos and even for human gametes alone (sperm and eggs), for they are the building blocks of human procreation. That is, given modern scientific knowledge, we cannot simply say that since the sources of Jewish law never talk about embryos outside the womb, no law exists on the subject, and we may rule however we wish. We Conservative Jews, who take an historical approach to Jewish law, must take modern science into account in our decisions. For that matter, even the Rabbis who proclaimed the embryo in the first 40 days to be “as if it were simply water” clearly were announcing an analogy and not an equivalence, for they say that the embryo is “as if” it were water, and they clearly knew that from that water a child might develop, unlike any glass of drinking water!

Still, while we should have respect for gametes and embryos, they may be discarded if they are not going to be used for some good purpose. Since they cannot become a human being outside a woman’s uterus, their status is even less than that of an embryo in the first 40 days of gestation, and thus we should not prohibit simply discarding them. Moreover, when a couple agrees to donate such embryos for purposes of medical research, our respect for such pre-embryos and embryos outside the womb should certainly be superseded by our duty to seek to cure diseases.

As a result, frozen embryos originally created for purposes of overcoming infertility may be discarded (presumably after the couple has had as many children as they plan to produce or has given up in that effort), but they may also be used for good purposes. One such purpose is to produce stem cells for medical research. Indeed, couples should be encouraged to donate their extra embryos for such efforts.

What about creating embryos specifically for the purpose of doing medical research? That lacks the justification of using materials that would just be discarded anyway, but creating embryos specifically for research is nevertheless permissible under one condition.

Unlike the Catholic view, the problem in doing this for the Jewish tradition is not that it would amount to murder to destroy an embryo outside the uterus, for in that state an embryo has even lesser status than an embryo in its first 40 days in utero, much less that of a person. Neither would procuring the sperm for “farmed” embryos through masturbation constitute “wasting seed,” for here the purpose of masturbating would be specifically to use the man’s semen for the consecrated purpose of finding ways to heal illnesses.

Procuring eggs from a woman for this purpose, however, does pose a problem. It is not so much that this requires subjecting her to an invasive medical procedure, for now eggs can be procured without surgery and with minimal risk or pain through laparoscopy. To produce the eggs, though, the woman must be exposed to the drugs that produce hyper-ovulation, and there is some evidence that repeated use of such drugs increases a woman’s risk of ovarian cancer.

While such risks may be undertaken to overcome a woman’s own infertility – or even, I have held [see Matters of Life and Death: A Jewish Approach to Modern Medical Ethics (Philadelphia: Jewish Publication Society, 1998)], to donate eggs once or twice to infertile couples – taking such risks for medical research is less warranted, especially since embryos can also be obtained from frozen stores that couples plan on discarding and possibly from some of the other new methods that researchers are now developing. Thus, while obtaining embryonic stem cells from frozen embryos that would otherwise be discarded is best, embryos may also be specifically created for purposes of medical research on the condition that the woman providing the eggs for such efforts does so only once or twice.

Other Factors in this Decision

Given that the materials for stem cell research can be procured in permissible ways, the technology itself is morally neutral. It gains its moral valence on the basis of what we do with it. The question, then, reduces to a risk-benefit analysis of stem cell research. In this context, two things should be noted:

Jewish tradition sees the provision of health care as a communal responsibility. Especially since much of the basic science in this area was funded by the government, the government has the right to require private companies to provide their applications of that science to those who cannot afford them at reduced rates or, if necessary, even for free. At the same time, Jewish tradition does not demand socialism, and, for many good reasons, we in the United States have adopted a modified, capitalistic system of economics. The trick, then, will be to balance access to applications of the new technology with the legitimate right of a private company to make a profit on its efforts to develop and market applications of stem cell research.
As difficult as it may be, we must draw a clear line between uses of this or any other technology for cure, which are to be applauded, as against uses of technology for enhancement, which must be approached with extreme caution. Jews have felt the brunt of campaigns of eugenics and so we are especially sensitive to creating a model human being that is to be replicated through some of the technologies that have evolved in our time and in times to come. Moreover, when Jews see a disabled human being, we are not to recoil from the disability or count our blessings for not being disabledin that way;rather, we are commanded to recite ablessing thanking God for making people different.

The potential of embryonic stem cell research for creating organs for transplant and c ures for diseases is, at least in theory, both awesome and hopeful. In light of our Divine mandate to seek to maintain life and health, I would argue that, from a Jewish perspective, we have a duty to proceed with this research.

Rabbi Dorff is Provost and Professor of Philosophy at the University of Judaism in Los Angeles.