New Vatican Document Offers Strong Support for Adult Stem Cells

The Vatican, December 12, 2008

In what can hardly be considered a surprising document, the Roman Catholic Church has released a new publication addressing matters of bioethics. Referred to simply as "Dignitas Personae" ("The Dignity of the Person"), a shortened version of the full title which is "Dignitas Personae - Instruction on Certain Bioethical Questions", the 23-page-long document takes a serious look at recent advancements in biomedical science and the resulting ethical dilemmas. The purpose of the document is to offer guidance not merely to Roman Catholics, but "to all who seek the truth", as is stated on page 2 of the Introduction.

Although this document itself is new, its intrinsic message is not. The stance reiterated throughout all 23 pages is the same thesis that is always promoted by the Catholic Church, namely, that "the Magisterium of the Church has constantly proclaimed the sacred and inviolable character of every human life from its conception until its natural end." (p. 10) It should therefore come as no surprise to anyone, whether or not one agrees with such a stance, that this is the basic premise of the document. According to the website of the United States Conference of Catholic Bishops, the new Vatican document offers instruction "on ethical issues arising from biomedical research" and "provides guidance on how to respect human life and human procreation in our heavily scientific age." In fact, the paper is in may ways an updated, modernized version of another Vatican "instruction" document, "Donum Vitae" ("The Gift of Life"), which was issued in 1987 under the pontificate of John Paul II, and to which "Dignitas Personae" makes repeated reference. "Instruction" documents, which are not authored directly by a Pope but are approved by a Pope, are not to be confused with papal encyclicals, which are authored directly by a Pope, such as "Veritatis Splendor" (1993) and "Evangelium Vitae" (1995), both of which were personally written by Pope John Paul II, and the more controversial "Humanae Vitae" which was written in 1968 by Pope Paul VI, all of which reinforce the same themes as "Donum Vitae" and "Dignitas Personae".

Critics of the Vatican and of Roman Catholic Church policy often point out, and justifiably so, previously erroneous stances taken by the Church in the past, most notably in the field of science. One of the most egregious examples involved the trial of Galileo in 1633 by Pope Urban VIII, during which Galileo was found guilty of promoting the "heretical" view of a heliocentric solar system (in which the sun, not the earth, is located at the center), for which Galileo was imprisoned and then sentenced to house arrest for the remainder of his life. Only in 1992 did the Church finally and officially exonerate Galileo, when Pope John Paul II expressed public regret for the incident that had occurred over 3-and-a-half centuries earlier. As Church critics will also point out, the legal body which interrogated and imprisoned Galileo, for the "heresy" of defending what is now known to be a scientific fact, was none other than the ecclesiastical tribunal infamously known as the "Inquisition" and which today is known by the name of "The Congregation for the Doctrine of the Faith" - the very same Church institution which issued "Dignitas Personae". Such facts, coupled with the highly publicized priest scandals in recent years, have not given the Roman Catholic Church a very admirable public-relations image. Nevertheless, there do exist modern bioethical dilemmas, which are the result of recent breakthroughs in medical science, and there are people throughout the world who do seek guidance and moral direction on such topics. Since very few other organizations are issuing formal "doctrinal instruction" in such matters, documents such as "Dignitas Personae" are received with widespread and genuine interest. Whether or not the instruction offered by such a document will ever actually be followed, however, is yet to be seen.

It has commonly been observed that the Vatican does not update its official doctrine casually nor hastily. Nevertheless, although it took nearly 4 centuries for the Church to apologize for the Galileo incident, it has taken only 21 years for "Donum Vitae" to be updated with "Dignitas Personae". Indeed, the relatively swift and timely release of "Dignitas Personae" at this particular moment in history is seen by many as an indication of the urgency and the importance with which the Church views the bioethical problems that are the focus of the document.

Contrary to popular opinion, the Roman Catholic Church is not against stem cell research in general, but, more specifically, is only against embryonic stem cell research. Such objections are not random nor without basis, since the derivation of embryonic stem cells requires the destruction of an embryo, which is an act that most theologians, Christian and otherwise, believe to be morally and ethically wrong. By sharp contrast, however, as is clearly stated in "Dignitas Personae", the Roman Catholic Church is strongly in favor of research and therapies that involve adult stem cells. As stated on page 19 of the document, "Research initiatives involving the use of adult stem cells, since they do not present ethical problems, should be encouraged and supported." Even with research and therapies that fall exclusively within the adult stem cell realm, however, the authors of the document are clear in their emphasis that, "Such use should be characterized by scientific rigor and prudence, by reducing to the bare minimum any risks to the patient and by facilitating the interchange of information among clinicians and full disclosure to the public at large." The central argument of the document, in effect, is one that calls for serious ethical consideration of all aspects of biomedical science, not only in those fields that involve the use of stem cells.

Of the 23 pages that constitute "Dignitas Personae", the topic of stem cells is only specifically addressed on pages 18 and 19. The rest of the document examines other issues, such as in vitro fertilization, the cryopreservation of embryos and oocytes, "embryo reduction", intracytoplasmic sperm injection (ICSI), forms of interception and contragestation, the manipulation of embryos and of "the human genetic patrimony", reproductive and therapeutic cloning, gene therapy and germ line cell therapy, transgenic experimentation and hybrid cloning with human somatic cellular nuclei that are reprogrammed within nonhuman mammalian oocytes, among other topics - all within the context of "anthropological, theological and ethical aspects of human life and procreation." Following the Introduction, the paper is divided into 3 sections which progress systematically through successive logical developments that build upon what the authors describe on the first page as "principles of Christian anthropology". In authoring this document, the Congregation for the Doctrine of the Faith assures its readers that it has "consulted numerous experts with regard to the scientific aspects of these questions".

The paper is not meant to be an exhaustive scientific treatise on all aspects of modern medicine, and some topics are conspicuous by their absence, such as, most notably, iPS (induced pluripotent stem) cells. Teratomas are also never explicitly mentioned, per se, although there are many scientists throughout the world who seriously question whether embryonic stem cells can ever be usable as a safe and viable medical therapy due to the innate tendency of embryonic stem cells to form the specific type of tumor known as a teratoma. Since adult stem cells do not carry any risk of forming teratomas, and since adult stem cells are already being used as clinical therapies throughout the world, there are many scientists who do not advocate embryonic stem cell research but who do advocate adult stem cell therapies, for reasons that have nothing to do with religion, theology or ethics, but which have everything to do with principles of sound science and with the practical realities of medicine. Nevertheless, "Dignitas Personae" boldly addresses all of the uncomfortable, most emotionally charged and sensitive ethical issues that are unavoidably entangled in stem cell research, and which most scientists and researchers diplomatically go out of their way to try to avoid.

Theologians are not the only people who believe that many aspects of modern science "call for attentive moral discernment", as the authors of "Dignitas Personae" assert. To borrow another phrase from the Vatican document, for many people there still remains the nagging, seemingly unresolved question of whether embryonic stem cells might possibly be something more than just "biological material". Indeed, classes and entire departments in "bioethics" are springing up in law schools throughout the U.S. with increasing popularity, a prime example of which was the founding in 2005 by Harvard Law School of an entire center, "The Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics", precisely to provide a forum in which legal experts can debate and address, and formulate legislative policy on, such issues. With an increase in the number and types of new therapeutic modalities that are developed within the various medical specializations, the number and types of litigation are also expected to increase, and a new generation of lawyers who specialize in bioethics is currently being groomed to meet the future legal needs of a world that will be dramatically unlike the world for which current laws were designed. Even though doctors and scientists may not be formally addressing matters of medical bioethics, the lawyers are. If not for an interest in ethical reasons per se, then perhaps for an interest in legal ramifications, the scientific and medical communities might wish to join the conversation.

Outside of medicine, in many other branches of science, such as with the growing concern over ecological consequences of combustible fuel, a strong sense of ethics is encouraged and applauded. Even outside the realm of science, such as with the recent global economic crisis, there is a loud outcry for serious legal reform requiring transparency, responsibility, accountability and oversight, both at the corporate and at the individual levels. Similarly, "Dignitas Personae" calls for nothing more nor less than the same type of objective ethical standards to be applied to medical science. Without "an ethical point of reference", that is, without some sense of prudence, without concern for the safety and dignity of others, and without a high degree of personal responsibility and accountability built into the system, the authors of the document warn that it is all too easy for people to "surrender to the logic of purely subjective desires and to economic pressures which are so strong in this area" (p. 9), especially in the potentially lucrative field of regenerative medicine.

As stated on page 2 of the Introduction of "Dignitas Personae", the authors seek "to offer a word of support and encouragement for the perspective on culture which considers science an invaluable service to the integral good of the life and dignity of every human being." As such, the authors make a compelling argument for "the ethical use of science". In clear and direct language, "Dignitas Personae" specifically "calls everyone to ethical and social responsibility for their actions." (p. 6) Although many people will not agree with the particular details of the stance that is promulgated by this particular document, most people will still agree that at least an open and healthy debate on such topics might be more productive than a systematic attempt to ignore the topics categorically. The authors also recall the words of Pope John Paul II, who made an "appeal to the conscience of the world's scientific authorities and in particular to doctors", but in "Dignitas Personae" it is everyone - patients and doctors alike - who are summoned to an honest and critical examination of conscience.

Regardless of one's religious affiliation, and whether or not one has any religious affiliation at all, most if not all people, especially scientists, would probably agree to an ethical and responsible use of the modern powers of science and technology. The precise definitions of "ethical" and "responsible", however, are currently the subject of widespread disagreement. One topic over which there is no disagreement nor debate at all, however, is the fact that embryonic stem cells cause teratomas, since this is, by definition, the gold standard by which pluripotency is identified in laboratories throughout the world. For anyone who may seek "guidance" in the field of stem cells but who prefers to avoid theological inquiry altogether, such people need look no further than the topic of teratoma formation for one of the many exclusively scientific reasons to be extremely cautious when considering embryonic stem cells as a medical therapy. Since adult stem cells are already in use in clinics around the world, as real therapies in the treatment of real human beings with a wide range of real diseases and injuries, and since adult stem cells do not pose any of the numerous medical risks that embryonic stem cells pose - such as biological contamination and genetic mutation in addition to teratoma formation, among other problems - the use of adult stem cells has already been proven as both legitimate and responsible science. Religion and politics aside, in the use of adult stem cells, there is no discrepancy between science and ethics.