Stem Cell Research: Ethical Implications for Nursing Practice

Introduction: Technology and the Modern Nurse

Nursing professionals and medical experts predict that modern nursing faces a complex future. This is mainly due to technological advancements in the field of medicine and the ongoing developments in science that have introduced new methods, techniques, and problems that the modern nurse must understand. Nursing as a profession is intimately linked to what happens in the broader medical and scientific environment, and the modern nurse must not only be aware of these issues but must incorporate them into everyday working life.

These challenges are part of the inescapable landscape of modern nursing. As Luptak (2004) states:

"The latter part of the 20th century introduced complexities because of longer life expectancy, technological developments, and new legal choices; the 21st century is likely to bring more bewildering changes. As new technologies and new decision points emerge, the profession needs to be ready to take a stand on policy and practice issues that are on the radar screen, such as physician-assisted suicide, euthanasia, cloning for body parts, and placing societal limits on individual autonomy." (Luptak, 2004)

This implies that issues at the forefront of medical science and healthcare — such as cloning and stem cell research — have a direct and important impact on both nursing theory and nursing practice. It also means that issues causing debate and concern in society will have to be dealt with by the modern nurse. The issue of cloning and stem cell research, for instance, has been debated across many different disciplines. People in many walks of life are worried about the moral and ethical implications of modern cloning and the use or misuse of stem cell research. Those in the nursing profession must not only be aware of these ethical problems but must also deal with them and often determine their own attitudes and positions on these issues. Another aspect worth considering is the way nursing has changed and has become more holistic and open to new methods and procedures.

Understanding Stem Cell Research

Stem cell research is part of an ongoing and often heated debate about cloning. It is also one of the most controversial areas of new medical technology, largely because of the conflict between the medical value and promise that stem cell research offers and the ethical and moral concerns it raises.

Briefly, stem cells are undifferentiated — or as yet undivided — cells found in the growing embryo or fetus. They can grow into any organ of the body. In other words, they are the "master" or originating cells responsible for the growth and development of the human body and its organs. A more complete definition is as follows:

"Stem cells have been called 'the essence of an embryo.' They are biological building blocks that serve as the common ancestry of all 210 different kinds of tissue in the human body. Stem cells grow and specialize to form the heart, skin, and other organs." (Stevens, 2003)

For example, a stem cell can be found in the blood, the bone marrow, or the various organs of the fetus.

The excitement surrounding stem cell research stems from the fact that these cells can be used to replace or repair organs damaged through illness or disease. They also carry the advantage of not being easily rejected by the person receiving them. For the doctor or medical expert, stem cells therefore represent a potential means of curing diseases that were previously incurable. Parkinson's disease, for example, results from a lack of dopamine in the brain, and the theory of stem cell research holds that stem cells could be used to generate dopamine and thereby treat the patient.

"Scientists are eager to pursue embryonic stem cell research because they believe that stem cells can be used to help improve the health of approximately 128 million Americans afflicted with various diseases. Scientists believe stem cells have the potential to treat Alzheimer's and Parkinson's diseases, spinal cord injuries, heart disease, and multiple sclerosis. Insulin-producing pancreatic beta cells could be transplanted into diabetic patients." (Stevens, 2003)

This would mean that millions of people worldwide could potentially be cured of their illnesses and diseases through stem cell research. Stem cell research therefore has many positive aspects of which medical doctors and nurses are aware. The general public has also recognized these possibilities; well-known actor Michael J. Fox, who suffers from Parkinson's disease, along with other celebrities, has approached Congress to request increased funding for stem cell research (Stevens, 2003). On the other hand, it must also be understood that stem cell research has not yet been conclusively proven effective; it remains only a potential cure for disease.

Many experts believe that clinical success for embryonic stem cell therapies is still a long shot. As one researcher observed, "With embryonic stem cells, it looks like we're a ways off from being ready for prime time in man" (Lomedico, cited in Hall, 2006). Another expert added, "Long-term, I think there will be some therapeutic benefit, but I mean really long-term" (Grompe, cited in Hall, 2006).

Ethical and Moral Controversies

The issue of stem cell research is not only a medical one; the moral and ethical problems raised by this new technology are considerable and confront the modern nurse directly. As one expert states:

"In the current debate on the new possibilities of modern biotechnology there is more at stake than just the pros and contras of a certain scientific method or procedure. It has, in fact, to do with a possible change in ethical culture, questioning the validity of fundamental ethical values which have so far been embedded in a broad societal consensus." (Bedford-Strohm, 2002)

The central problem that many people see with stem cell research is that the cells are taken from a dead fetus or embryo — meaning that extracting stem cells in fact kills that embryo. This debate is therefore closely related to the debate about abortion and raises questions such as when the fetus can be considered "alive" and when it is morally justifiable to destroy it.

Many modern organized religions, including the Catholic Church, view stem cell research as a violation of the sanctity of human life, and many religious groups oppose it on moral grounds, arguing that benefiting from the destruction of a human embryo constitutes a moral crime. There are many other ethical questions as well, including concerns about how stem cell research may affect social structures such as the family and parenthood. Opponents also claim that this technology could be exploited for commercial purposes, including the selling of body parts developed through stem cell research. Medical experts, by contrast, point to the benefits this research may produce and its potential to cure diseases that are incurable today. The important point is that stem cell research raises questions the modern nurse cannot avoid or ignore, working as nurses do in an environment where such issues play an increasingly important part.

Conclusion and Recommendations

The recommendations that have emerged from meetings like the one described above, and from other similar gatherings, are various general pointers and directives that can be applied to the nursing profession as a whole. It is emphasized that more research and organized meetings among nurses and nursing organizations are needed in order to make the modern nurse more familiar and up-to-date with the latest research and studies in stem cell science. This includes the recommendation that workgroups and seminars on this subject be offered to nurses on a regular basis (Chamberlain, 2005). There should also be a particular focus on the ethical, moral, and practical implications of stem cell research. This is important because, in the future of nursing, it is quite possible that nurses will need to explain the theories of stem cell research and cloning to patients, as well as be able to respond to ethical and other questions.

With advances in technology, it has become essential for those in the nursing profession to be able to deal with and understand these issues. Knowledge of the latest research is not only important in terms of staying current, but it forms an increasingly essential component of the development and requirements of advanced nursing practice. As noted at the beginning of this paper, modern nursing takes place in a complex medical and social environment. It is no longer possible to separate medical issues from social and ethical ones, and this applies fully to nursing. The modern nurse must be aware of the often complex social and cultural implications of the various technologies that he or she is called upon to endorse or apply.

References

Bedford-Strohm, H. (2002). Sacred body? Stem cell research and human cloning. The Ecumenical Review, 54(3), 240+.

Chamberlain, B. (2005). The power of the stem cell: Understanding scientific, ethical, and political implications for nurses. New Jersey Nurse, Nov/Dec 2005.

Greco, K. E. (2003). Nursing in the genomic era: Nurturing our genetic nature. MedSurg Nursing, October 1, 2003.

Hall, S. S. (2006). Stem cells: A status report. The Hastings Center Report, 36(1), 16+.

Luptak, M. (2004). Social work and end-of-life care for older people: A historical perspective. Health and Social Work, 29(1), 7+.

McCloskey, B. A. (2002). The controversy surrounding stem cell research. Nursing, 4.

Stevens, D. (2003). Embryonic stem cell research: Will President Bush's limitation on federal funding put the United States at a disadvantage? A comparison between U.S. and international law. Houston Journal of International Law, 25(3), 623+.