Jews and Genes: The Genetic Future in Contemporary Jewish Thought
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Jews and Genes: The Genetic Future in Contemporary Jewish Thought
456eBook
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Overview
Jews and Genes brings together leaders in their fields, from all walks of Judaism, to explore these most timely and intriguing topics—the intricacies of the genetic code and the wonders of life, along with cutting-edge science and the ethical issues it raises.
Product Details
| ISBN-13: | 9780827611924 |
|---|---|
| Publisher: | The Jewish Publication Society |
| Publication date: | 03/01/2015 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 456 |
| File size: | 854 KB |
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Jews and Genes
The Genetic Future in Contemporary Jewish Thought
By Elliot N. Dorff, Laurie Zoloth
UNIVERSITY OF NEBRASKA PRESS
Copyright © 2015 Elliot N. Dorff and Laurie ZolothAll rights reserved.
ISBN: 978-0-8276-1224-2
CHAPTER 1
Summary of the Science of Stem Cell Research
Elliot N. Dorff and Laurie Zoloth
Both the goals and methods of scientific research are rooted in the historical and social terrain in which science seeks answers to its questions. This is true as well for the specific fields of science relevant to stem cell research, including molecular biology, genetics, and clinical medicine. Because scientific research is by definition an inquiry at the frontiers of the known world, its questions are often destabilizing ones. The researchers, then, are often brought into conflict with those aspects of human culture that express the traditional and familiar, including political structures, law, and religions. In such cases science represents the intrusion and insistence of the modern against the veracities of tradition. Sometimes traditions can adjust easily through new interpretations and applications of the tradition that can accommodate new scientific discoveries. Other times, though, the new science raises immense problems of self-understanding and of ethics, requiring everyone, scientists included, to assess the implications of the new science for how we understand our world, our place in it, and our duties to maintain and repair it. In every generation this is a persistent task for Jewish intellectual life.
Questions of ethics are especially challenging when the new science undermines our fundamental understandings of identity (who we are and who we choose to be) or changes our sense of the limits of our power (when it gives us tools to do things that our ancestors never were able to do). This leads us to ask whether we should assume the new identity and new agency that are available. This is the dilemma identified by Immanuel Kant in the late eighteenth century. As he pointed out, "Ought implies can." That is, if I cannot do something, then I never have to ask whether I should, because it is simply beyond my ability to do it anyway; but if I can do something, then I do need to ask whether I should do it, because there are all kinds of things that I can do that I should not do. This is obviously the case when new technologies are produced, and it is the case when new research presents us with dramatically new choices.
In the last two decades, one of the fiercest debates about our limits and our choices has been around the issue of human stem cell research — ever since James Thompson of the University of Wisconsin and John Gearhart of Johns Hopkins University first demonstrated that human embryonic stem cells, with their nearly infinite possibilities for differentiation and regeneration, could be grown in the laboratory from human embryos or gametes. Before we knew about stem cells and could manipulate them, we never had to ask whether or when we should do that, but now we must. In doing so we find ourselves not only addressing specific questions about the advisability and limits of using a particular technique but also reassessing the very nature of who we are, the connections we have to family, community, the environment, and God, and the limits, if any, we should impose on our capacity to do research and to heal.
Although science has historically often been the cause of much of the unease about the new, the events surrounding the struggle over the research on human embryonic stem cells, beginning in the summer of 2001, have proven to be especially controversial. In fact, this debate was one of the critical issues that generated the meetings that led to this book. This introduction to this section of the book about stem cell research begins with a definition of stem cells and a brief review of the emerging science and technology dealing with embryonic stem cells and the very newest research that has produced "induced pluripotent stem cells" from somatic or adult cells, something that was not possible at the time when many of our essays were written. The introduction then asks how this research challenges our understanding of the nature of knowledge and forces us to confront anew the moral limits, freedoms, and responsibilities of research. Following this introduction to the science of stem cell research are several chapters in which Jewish scholars consider how Jewish texts, laws, concepts, and values can be interpreted and applied to this new emerging science in order to gain wisdom about how we think about ourselves and our world and how we should act in it in light of this new science and technology.
The State of the Science
Stem cells are called "stem" because they are cells that can change into several different kinds of more specialized cells. They are undifferentiated; that is, they are not yet specifically one kind of cell. Stem cells can produce either any kind of cell in the human body (they are "totipotent") or at least several different kinds of cells (they are "pluripotent"). Of course, all living creatures begin as one cell, a zygote. In people, as in all mammals, this is the fertilized human egg, just after the sperm cell has entered it. The most flexible stem cells are those in the early embryo that is formed five to eight days after a sperm and an egg combine; these are "embryonic stem cells." The one hundred to two hundred cells produced in these first few days after fertilization ultimately mature into each and every kind of cell in the complex human organism. That is, they "differentiate" — specialize — into specific kinds of cells so that some become the heart, others the brain, others the lungs, and so on, each group with its particular nature to enable the human body to live and function. At about five days of gestation, the form we call an early embryo looks like a small circle (the perimeter of which later in pregnancy becomes the placenta) with a clump of cells inside that circle called the "inner cell mass." The inner cell mass and the large circle that surrounds it are together called a "blastocyst." That is the name of the embryo at this stage. It is these inner cells that are extracted for purposes of embryonic stem cell research, and in the process, the blastocyst is destroyed. The cells are then placed in chemical solutions to enable them to develop; these are human embryonic stem cells in culture. As of this writing, sixteen years after the first stem cells were isolated, they are still replicating, which is why they are called "immortal" cell lines.
There are also stem cells in fully formed human beings; these are called "somatic stem cells" or sometimes "adult stem cells," whether they come from an infant or an adult. Somatic stem cells are not as flexible as embryonic stem cells, for they can change into only a few kinds of cells on their own, and they are not immortal. Still, the body uses them to renew blood, skin, and hair, for example, throughout an individual's life.
Biologists have long sought to understand how a single cell created when a sperm and egg combine ultimately creates a complex and highly differentiated system of intricate tissues and organs organized perfectly into a human being. How does the DNA program in the nucleus signal the cell to duplicate and differentiate? How does the small, microscopic mass of identical cells that have been formed in a woman's uterus or in a petri dish approximately five days after a sperm and an egg unite, the embryonic stem cells, ultimately form a human fetus? Perhaps most intriguingly, if each of these cells of the early embryo has the capacity to develop into any and all cells of the human body, can that cell's mutability be used to create new cells in a person in order to heal him or her from a disease or to repair tissue that has been damaged?
The process of embryology has long been studied through the use of animal models. Embryonic stem cells were first isolated in mice in 1981, and ever since then research has been conducted with embryonic mice, rats, and nonhuman primates. Much of the current success in understanding and using human stem cells, in fact, can be traced to the intensity of research in animal models, including the rapidly unfolding sciences of genomic mapping and molecular biology.
Telomerase is an enzyme that enables genes to be flexible and to reproduce. In 1995 the genes for telomerase were cloned, enabling scientists to produce large numbers of them so that they could study them more easily. Biologists have used their expanding access to and knowledge about telomerase to search for ways to understand how the cells in the early human embryo maintain their plasticity and immortality.
Parallel work has studied stem cells that are found in some tissues of adults. It had long been understood that some cells of the body, such as the lining of our intestines, blood cells, hair cells, and skin cells, are constantly renewed. Researchers found that some of these tissues contain rare precursor or stem cells that are undifferentiated and that develop into mature and functional cells in the body. These adult stem cells have been found, cultured, and used to treat some conditions. In bone marrow transplants, for example, harvested blood stem cells have been used to regenerate a new blood supply, and harvested stem cells in skin have been used to begin the process of creating new skin for skin grafts to repair the skin of burn victims, for example. But these cells are limited in several ways. They are rare and hard to find; they are not available for all tissue types; and, when cultured in the laboratory, they always cease dividing and lose their self-renewal properties because, with each division, the telomerase at the end of the nuclear chromosomes shortens.
Because of these difficulties with adult, or somatic, stem cells, researchers have long been intrigued by the embryonic stem cells that are the precursors to these adult stem cells. In part, the interest is purely investigational. It has been the quest of some researchers to study precisely how the embryonic stem cell is programmed to do this, to understand what goes awry in genetic diseases, and to observe how the environment affects developing cells. In part, the research has been driven by a therapeutic goal, not only to understand and observe the process but also to find ways to coax embryonic stem cells into specific uses. Researchers began to speak about creating banks of tissues to repair tissues damaged by illness or injury.
The benefits of such an endeavor, if it succeeds, would clearly be enormous, for many of the diseases that beset us in modernity are precisely degenerative diseases. These include stroke (6 million people have one each year), congestive heart failure (6 million), neurological diseases (3 million with Parkinson's alone), diabetes (100 million), and liver failure (5 million from hepatitis alone). It is important to note that, unlike much of the focus of high-technology-driven medical research, diseases of cell death and cell control are not limited to the elderly or to certain classes or groups, for degenerative diseases also plague children. Spinal cord injury repair is a target of this research as well. Furthermore, unlike the search for medical treatment of the symptoms of disease, molecular-cellular medicine is in pursuit of permanent cures to disease by alteration or replacement of the genetic and cellular causes of the disease itself.
Risks and Benefits in Transplantation Therapies
To make regenerative medicine work either financially or ethically, it must be scalable, biologically stable, safe, and universally usable. For human use, the problem of histocompatibility must be solved. That is, a way must be found to introduce stem cells into a person's body without its immune system reacting to them as foreign objects and attacking them, ultimately leading to the patient's death and thus frustrating the effort to cure the patient (the "graft-versus-host problem").
The science is thus interesting not only in its own terms but also because of the premise of widespread access to significant therapy, an essential health-care justice issue. The hope is that tissue transplantation, unlike organ transplants, would not be a boutique therapy for the lucky or wealthy few but could be widely available to large numbers of people worldwide and could be used without the terrible risk of graft-versus-host disease. The idea is to use human embryos to derive stem cells that can be used for tissue transplants — either by creating tissue-banking systems, or by finding a way to match donor and recipient, or by creating a universal donor cell — or to understand enough about the way that cells reprogram themselves to regulate this process within the human body itself. So far, reports of scientific progress are remarkable and swiftly appearing in peer-reviewed journals. It was only in 1999 that the first human embryonic cells were grown in the laboratories at the University of Wisconsin and Johns Hopkins University, and in 2001 they were still dividing, well beyond their six hundredth population doubling. Researchers have already discovered that neural cells placed in animals with neurodegenerative disease migrate to the affected site, synthesize neurotransmitters, and extend neuronal processes. In laboratory studies at Johns Hopkins, John Gearhart has demonstrated that neuronal cells not only migrate to viral lesions in a living rat but also enable rats who have lost motor function to walk again. Liver cells make liver proteins; heart cells make contractile proteins, beat spontaneously, and respond normally to cardiac drugs; pancreatic cells make insulin. Blood cells have been made for all four blood groups. Still, with all this progress, the researchers were the first to admit that much of what they were seeking was a mystery — a terrain largely unknown. How do cells program and reprogram themselves? Can one create a universal donor cell?
The Ethical Problem of the Embryo's Moral Status
To procure embryonic stem cells, however, one extracts them from a five- or six-day-old embryo in a petri dish, thus killing it. Hence, the use and destruction of embryos for stem cell procedures immediately pose the significant moral question of the nature, meaning, and moral status of the human embryo. If it is already a human being, the killing of an embryo would amount to killing a person, so even though the goal of curing diseases is laudable, one may not kill one person in an effort to save another. On the other hand, if the early embryo is merely a clump of cells that would otherwise be discarded, then one may and arguably should instead use such cells to advance human knowledge and therapies.
Human embryonic stem cell research has been made possible by the technology first used in 1978 of in vitro fertilization (IVF), that is, bringing sperm and egg together in a petri dish. The resulting fertilized egg cell (the zygote) is cultured for a few days and then implanted in a woman's uterus. However, when a couple has produced several embryos in an effort to overcome infertility problems and either has had as many children as they want or has given up trying to have biological children of their own, the remaining frozen embryos that they produced in this effort are discarded. When the research first began, embryonic stem cells used by scientists came from embryos that such couples donated (and, in a Jewish side note, the initial embryos came largely from one IVF clinic in Haifa, Israel). Typically, twelve embryos are created in the IVF process. If they are not transferred to a uterus, they will die. They can be frozen and stored (in the United Kingdom for five years, and in the United States indefinitely, as 100,000 of them are); they can be discarded (the most common course of action); or they can be donated for research. It is this creation and use of an embryo outside of a human body and in the hands of a largely unregulated marketplace driven by the deepest of yearnings for children that has reconfigured the moral landscape of reproduction in the developed world. For once one has created an embryo artificially, one is engaged in what has been a large but unstructured clinical trial without controls or even, in many cases, the careful consent of the people involved as required in other cases of medical practice and research.
How does one regard the central question of the moral status of the human embryo? As the National Bioethics Advisory Committee report on embryonic stem cell research clearly indicates, this is one of the key ethical disputes in society generally and among religions in particular. It is also at the heart of American legal treatments of both abortion and embryonic stem cell research. Furthermore, does the status of the embryo in a woman's womb differ from that of an embryo in a petri dish?
In American law, the United States Supreme Court ruled in Roe v. Wade in 1973 that in a woman's womb a fetus is part of the body of the woman. Because American law grants adults the right to determine what may be done with their bodies, this means that a pregnant woman may choose to abort a fetus at will until such time that it can live outside her body — and even then, according to the Supreme Court's 1992 Casey decision, state statutes may impose some restrictions on the woman's right to abort but not to the extent that such statutes make it impossible for a woman to exercise this right. Recent state statutes that are being tested in the courts place significant restrictions on abortion, ultimately testing also the Supreme Court's determination that the fetus is a part of its mother's body and therefore subject to her will.
(Continues...)
Excerpted from Jews and Genes by Elliot N. Dorff, Laurie Zoloth. Copyright © 2015 Elliot N. Dorff and Laurie Zoloth. Excerpted by permission of UNIVERSITY OF NEBRASKA PRESS.
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Table of Contents
Contents
Foreword by Mark S. Frankel,Introduction by Elliot N. Dorff and Laurie Zoloth,
Abbreviations,
Part 1. Stem Cell Research,
1. Summary of the Science of Stem Cell Research Elliot N. Dorff and Laurie Zoloth,
2. Applying Jewish Law to Stem Cell Research Elliot N. Dorff,
3. Divine Representations and the Value of Embryos: God's Image, God's Name, and the Status of Human Nonpersons Noam J. Zohar,
4. "Like Water": Using Genesis to Formulate an Alternative Jewish Position on the Beginning of Life Yosef Leibowitz,
5. Reasonable Magic: Stem Cell Research and Forbidden Knowledge Laurie Zoloth,
Part 2. Genetic Mapping and Identity,
6. Summary of the Science of Genetic Mapping and Identity Elliot N. Dorff and Laurie Zoloth,
7. Folk Taxonomy, Prejudice, and the Human Genome Judith S. Neulander,
8. What Is a Jew? The Meaning of Genetic Disease for Jewish Identity Rebecca Alpert,
9. Yearning for the Long-Lost Home: The Lemba and the Jewish Narrative of Genetic Return Laurie Zoloth,
Part 3. Genetic Testing,
10. Summary of the Science of Genetic Testing Elliot N. Dorff and Laurie Zoloth,
11. Genetic Testing in the Jewish Community Paul Root Wolpe,
12. Jewish Genetic Decision Making and an Ethic of Care Toby L. Schonfeld,
Part 4. Genetic Intervention,
13. Summary of the Science of Genetic Intervention Elliot N. Dorff and Laurie Zoloth,
14. Some Jewish Thoughts on Genetic Enhancement Shimon Glick,
15. Curing Disease and Enhancing Traits: A Philosophical (and Jewish) Perspective Ronald M. Green,
16. Genetic Enhancement and the Image of God Aaron L. Mackler,
17. "Blessed Is the One Who Is Good and Who Brings Forth Goodness": A Jewish Theological Response to the Ethical Challenges of New Genetic Technologies Louis E. Newman,
18. Jewish Reflections on Genetic Enhancement Jeffrey H. Burack,
19. Mending the Code Robert Gibbs,
Part 5. The New Genetics and Public Policy,
20. Religious Traditions in a Postreligious World: Does Halakhah Have Insights for Nonbelievers? John Lantos,
21. How the Unconscious Shapes Modern Genomic Science Robert Pollack,
22. To Fix the World: Jewish Convictions Affecting Social Issues Elliot N. Dorff,
Contributors,
List of Classical Sources,
General Index,