Fresh or frozen? Classifying ‘spare’ embryos for donation to human embryonic stem cell research

United Kingdom (UK) funding to build human embryonic stem cell (hESC) derivation labs within assisted conception units (ACU) was intended to facilitate the 'In-vitro fertilisation (IVF)-stem cell interface', including the flow of fresh 'spare' embryos to stem cell labs. However, in the three sites reported on here, which received this funding, most of the embryos used for hESC research came from long term cryopreservation storage and/or outside clinics. In this paper we explore some of the clinical, technical, social and ethical factors that might help to explain this situation. We report from our qualitative study of the ethical frameworks for approaching women/couples for donation of embryos to stem cell research. Members of staff took part in 44 interviews and six ethics discussion groups held at our study sites between February 2008 and October 2009. We focus here on their articulations of social and ethical, as well as scientific, dimensions in the contingent classification of 'spare' embryos, entailing uncertainty, fluidity and naturalisation in classifying work. Social and ethical factors include acknowledging and responding to uncertainty in classifying embryos; retaining 'fluidity' in the grading system to give embryos 'every chance'; tensions between standardisation and variation in enacting a 'fair' grading system; enhancement of patient choice and control, and prevention of regret; and incorporation of patients' values in construction of ethically acceptable embryo 'spareness' ('frozen' embryos, and embryos determined through preimplantation genetic diagnosis (PGD) to be genetically 'affected'). We argue that the success of the 'built moral environment' of ACU with adjoining stem cell laboratories building projects intended to facilitate the 'IVF-stem cell interface' may depend not only on architecture, but also on the part such social and ethical factors play in configuration of embryos as particular kinds of moral work objects.     

Fresh or frozen? Classifying ‘spare’ embryos for donation to human embryonic stem cell research

United Kingdom (UK) funding to build human embryonic stem cell (hESC) derivation labs within assisted conception units (ACU) was intended to facilitate the ‘In-vitro fertilisation (IVF)-stem cell interface’, including the flow of fresh ‘spare’ embryos to stem cell labs. However, in the three sites reported on here, which received this funding, most of the embryos used for hESC research came from long term cryopreservation storage and/or outside clinics. In this paper we explore some of the clinical, technical, social and ethical factors that might help to explain this situation. We report from our qualitative study of the ethical frameworks for approaching women/couples for donation of embryos to stem cell research. Members of staff took part in 44 interviews and six ethics discussion groups held at our study sites between February 2008 and October 2009. We focus here on their articulations of social and ethical, as well as scientific, dimensions in the contingent classification of ‘spare’ embryos, entailing uncertainty, fluidity and naturalisation in classifying work. Social and ethical factors include acknowledging and responding to uncertainty in classifying embryos; retaining ‘fluidity’ in the grading system to give embryos ‘every chance’; tensions between standardisation and variation in enacting a ‘fair’ grading system; enhancement of patient choice and control, and prevention of regret; and incorporation of patients’ values in construction of ethically acceptable embryo ‘spareness’ (‘frozen’ embryos, and embryos determined through preimplantation genetic diagnosis (PGD) to be genetically ‘affected’). We argue that the success of the ‘built moral environment’ of ACU with adjoining stem cell laboratories building projects intended to facilitate the ‘IVF-stem cell interface’ may depend not only on architecture, but also on the part such social and ethical factors play in configuration of embryos as particular kinds of moral work objects.     

Ethical boundary-work in the embryonic stem cell laboratory

Most accounts of the ethics of stem cell research are de- contextualised reviews of the ethical and legal literature. In this chapter we present a socially embedded account of some of the ethical implications of stem cell research, from the perspectives of scientists directly involved in this area. Based on an ethnography of two leading embryonic stem cell laboratories in the UK, our data form part of the findings from a larger project mapping the scientific, medical, social and ethical dimensions of innovative stem cell treatment, focusing on the areas of liver cell and pancreatic islet cell transplantation. We explore three key issues: what individual scientists themselves view as ethical sources of human embryos and stem cells; their perceptions of human embryos and stem cells; and how scientists perceive regulatory frameworks in stem cell research. We argue that these dimensions of laboratory practice are all examples of 'ethical boundary-work', which is becoming an integral part of the routine practice and performance of biomedical science. Our work adds to the relatively few sociological studies that explore ethics in clinical settings and to an even smaller body of work that explores scientists' views on the ethical issues relating to their research.     

From bench to bedside? Biomedical scientists' expectations of stem cell science as a future therapy for diabetes

The movement of scientific research from the bench to the bedside is becoming an increasingly important aspect of modern 'biomedical societies'. There is, however, currently a dearth of social science research on the interaction between the laboratory and the clinic. The recent upsurge in global funding for stem cell research is largely premised on the promise of translating scientific understanding of stem cells into regenerative medicine. In this paper, we report on the views of biomedical scientists based in the United Kingdom who are involved in human embryonic stem cell research in the field of diabetes. We explore their views on the prospects and problems of translational research in the field of stem cell science. We discuss two main themes: institutional influences on interactions between scientists and clinicians, and stem cell science itself as the major barrier to therapies. We frame our discussion within the emerging literature of the sociology of expectations.     

Egg donation for stem cell research: ideas of surplus and deficit in Australian IVF patients' and reproductive donors' accounts

We report on a study undertaken with an Australian in vitro fertilisation (IVF) clinic to understand IVF patients' and reproductive donors' perceptions of oocyte (egg) donation for stem cell research. Such perspectives are particularly valuable because IVF patients form a major recruitment group for oocyte donation for research, and because patients and donors have direct experience of the medical procedures involved. Similar studies of oocyte donation have been carried out elsewhere in the world, but to date very little social science research has been published that reports on donation for research, as distinct from donation for reproduction. Our respondents expressed a distinct unwillingness to donate viable oocytes for stem cell research. In our analysis we consider a number of factors that explain this unwillingness. These include the labour of oocyte production, the inscrutability of oocytes (the lack of a test to identify degrees of fertility) and the extent to which the oocytes' fertility sets the parameters for all downstream reproductive possibilities. We draw on the science studies literature on affordances to make sense of the social intractability of oocytes, and compare them with the respondents' much greater willingness to donate frozen embryos for human embryonic stem cells research.     

Doctors as moral pioneers: Negotiated boundaries of assisted conception in Colombia

New biotechnologies such as assisted conception are socially embedded artefacts that raise context‐specific ethical, moral and social anxieties. In contexts where the regulations of these profitable developments are limited or ambiguous, and competition between private facilities is high, individual doctors become morally and socially responsible for determining the parameters of administering such therapies. Ethnographic research at two private fertility centres in Colombia reveals that doctors do not determine boundaries based on monetary gain but rather personal morals, social norms and professional obligations. Medical professionals hold diverse perceptions of assisted conception, and often struggle to make decisions regarding who should access such therapies, who are ideal gamete donors and the fate of extra embryos. The complexity of these perceptions applied in a context of limited regulation and the competition of private medicine impacts the praxis of assisted conception. As doctors determine the boundaries of their practice they not only create variation between clinical practices, but also make moral decisions regarding who should be parents, how families should be formed and the significance of embryos. Thus, in navigating their everyday practices, doctors also shape the social world.     

Paid to share: IVF patients, eggs and stem cell research

Following a recent decision by the human fertilisation and embryology authority (HFEA), British women undergoing in vitro fertilisation (IVF) treatment can be 'paid to share' their eggs with stem cell researchers. The HFEA and the clinic proposing the scheme present this as a 'win-win' arrangement benefiting both infertile women and couples and British science. It is also represented as concurrently both 'business as usual' and an exceptional case. Constituting a significant departure from the previous policy and practice of altruistic donation, the scheme has raised significant concerns among clinicians and activists. Here, we ask what questions feminists can bring to these debates without resorting to a position of either refusal or affirmation. Drawing on diverse materials from public debates, as well as social scientific literature on gamete and embryo donation, we undertake a close analysis of the discursive framing and justification of the proposal. We argue that these discourses are characterised by three linked areas of elision and distinction: treatment and research; eggs and embryos; and donation and selling. Our analysis highlights the need for innovative social, ethical and political consideration of egg sharing for stem cell research.     

Our cells/ourselves: creating human embryos for stem cell research.

In September 1999, the National Bioethics Advisory Commission (NBAC) submitted its report, "Ethical issues in human stem cell research." The report recommends federal funding for stem cell research involving human embryos remaining after infertility treatment. It also suggests that at some later time, it may be appropriate for there to be federal funding for this same research using embryos expressly created for research purposes. This essay compares this recommendation to a similar recommendation reached 5 years earlier by the Human Embryo Research Panel of the National Institutes of Health. The NBAC recommendation is found to be much better packaged relative to the (contentious) goal of securing federal funding for this type of research. The merits of this goal are not discussed here. Instead, disappointment is expressed with the absence of any serious discussion of the ethical issues raised by the future possibility of stem cell research using research embryos. The report's silence on this question is significant given its promise to promote public debate on the profound ethical issues regarding human stem cell research.     

(Re)constructing embryos in stem cell research: exploring the meaning of embryos for people involved in fertility treatments

The use of human embryos is a key controversy in public debates on stem cell research (SCR), yet little attention has been given to the context or sources from which embryos are obtained: people involved in fertility programmes. How they feel about the use of embryos in SCR, and what may lead them to agree or refuse to donate embryos, remains unexplored. In this paper, I investigate the views of people involved in fertility programmes who may be approached to donate their embryos for SCR, drawing on focus group discussions with two support groups in Scotland. I illustrate how people come to make particular decisions and what factors shape this, and show that participants' views are context-bound, borne out of lived experiences both within the clinic and wider society. In particular, the evidence highlights the importance of understanding their views of what constitutes a 'spare' embryo and what areas of medical research are considered potentially legitimate for using embryos. Peoples' understandings of embryos as potential lives, and the context in which embryos are created, have direct implications for their views about donating embryos for SCR. Attention is paid to how SCR further disrupts the teleology of embryos and undermines the narrative of life that suffuses the hopes of people undergoing fertility treatment. The paper also brings to the fore the sense of moral obligation experienced by participants who feel they have little means or power for influencing the topic and content of SCR. In this context, I suggest there is a need to explore further the views of people involved in fertility treatments in order to identify mechanisms for limiting the potential for coercion when SCR is embedded in and dependent on fertility practices. Debates about using embryos for SCR must, therefore, include the voices of those who thus remain marginalised.     

The Ethics of Moral Compromise for Stem Cell Research Policy

In the US, stem cell research is at a moral impasse—many see this research as ethically mandated due to its potential for ameliorating major diseases, while others see this research as ethically impermissible because it typically involves the destruction of embryos and use of ova from women. Because their creation does not require embryos or ova, induced pluripotent stem cells offer the most promising path for addressing the main ethical objections to stem cell research; however, this technology is still in development. In order for scientists to advance induced pluripotent stem cell research to a point of translational readiness, they must continue to use ova and embryos in the interim. How then are we to ethically move forward with stem cell research? We argue that there is personal integrity and value in adopting a ‘moral compromise’ as a means for moving past the moral impasse in stem cell research. In a moral compromise, each party concedes part of their desired outcome in order to engage in a process that respects the values and desires of all parties equitably. Whereas some contend that moral compromise in stem cell research necessarily involves self-contradiction or loss of personal integrity, we argue that in the US context, stem cell research satisfies many of the key pre-conditions of an effective moral compromise. To illustrate our point, we offer a model solution wherein eggs and embryos are temporarily used until non-egg and non-embryonic sources of pluripotent stem cells are developed to a state of translational readiness.     

Shifting paradigms? Reflections on regenerative medicine,embryonic stem cells and pharmaceuticals

Will human embryonic stem (hES) cells lead to a revolutionary new regenerative medicine? We begin to answer this question by drawing on interviews with scientists and clinicians from leading labs and clinics in the UK and the USA, exploring their views on the bench‐bedside interface in the fields of hES cells, neuroscience and diabetes. We employ Bourdieu's concepts of field, habitus and capital in order to understand stem cell science and cell transplantation. We also build on research on the sociology of expectations, and explore expectations of pharmaceutical approaches in hES research through our concept of ‘expectational capital’. In the process we discuss emerging expectations within stem cell research, most especially the ‘disease in a dish’ approach, where hES cells will be used as tools for unravelling the mechanisms of disease to enable the development of new drugs. We argue that experts’ persuasive promises advance their interests in the uncertain stem cell field, and explore how this performative strategy might stabilise the emerging ‘disease in a dish’ model of translational research.     

Forecasting science futures: legitimising hope and calming fears in the embryo stem cell debate

Controversies about biotechnologies often centre not so much on present scientific facts as on speculations about risks and benefits in the future. It is this key futuristic element in these arguments that is the focus of this article. We examine how competing visions of utopia or dystopia are defended through the use of diverse vocabularies, metaphors, associations and appeals to authority. Our case study explores how these rhetorical processes play out in the debate about embryo stem cell research in UK national press and TV news media. The findings show how predictions from those in favour of embryo stem cell research are supported by both hype and by anti-hype, by inconsistent appeals to the technologies' innovative status and by the selective deconstruction of concepts such as 'potential' and 'hope'. The debate also mobilises binary oppositions around reason versus emotion, science versus religion and fact versus fiction. This article highlights how traditional assertions of expertise are now combined with ideas about compassion and respect for democracy and diversity. It also highlights the fact that although news reporters are often responding to topical events the real focus is often on years, even decades ahead. Close attention to how images of the future are constructed, and the evolution of new strategies for legitimation are, we suggest, important areas of on-going research, particularly in discussions of scientific and medical developments and policy.     

老龄健康的跨学科研究：从自然科学到社会科学

人口老龄化进程的加快,已形成一个日趋严重的世界性问题。在此背景下,老龄健康问题的跨学科研究已备受关注。鉴于人体的健康状况是生理因素和社会因素共同作用的结果,因此对老龄健康的研究涉及自然科学与社会科学的多个学科。只有跨学科研究老龄健康问题,才能为这一现实问题的解决,提供更为全面的指导和政策建议。本文通过对国内外文献的整理和总结,探寻老龄化研究的自然科学与社会科学的学科路径,说明老龄健康在两个学科间的内容差异,以及相互补充的趋势。本文认为,老龄健康的交叉相融研究,有利于解决老龄化问题,并会逐渐成为一种主流的研究趋势。     

Therapeutic journeys: the hopeful travails of stem cell tourists

The recent growth of so‐called stem cell tourism reflects the high optimism that currently surrounds stem cell science. Stem cell treatments for various conditions are increasingly advertised over the Internet as being available at hospitals and clinics around the world. However, most are clinically unproven. Despite numerous warnings from scientists about the dangers posed by such treatments, many individuals are evidently prepared to take the risk, sometimes on more than one occasion. This article explores the dynamics of hope that underpin stem cell tourism. Drawing on ideas from the sociology of hope, as applied to biomedicine, the article explores how hope is constructed and shapes actions in relation to stem cell treatments. Making reference to the findings from an Australian study of patients and carers who travelled overseas to receive stem cell treatments, it is argued that hope has an ambiguous significance in the context of deregulated health care. As we explain, this has implications for patients' and carers' treatment decisions and experiences. The findings are discussed in light of current responses to stem cell tourism.     

Stammzellforschung aus rechtsvergleichender Sicht

The article is based on the results of a comparative legal study of the status and protection of extracorporeal embryos in a number of European and non-European countries. In this context, the study also deals with the extent to which in vitro embryos can be created and/or used for research purposes (especially for stem cell research). The results show a considerable divergence with regard to existing solutions. This divergence is not due solely to different concepts of protection but is also an indication of the controversial debate on whether such entities are worthy of protection and, if so, to what degree it should be granted. The discussion indeed begins at the level of terminology where the attribute(s) characterizing an "embryo" in the legal sense are - already and seemingly without deeper meaning - anything but uniform. The reasons for this disparity, such as the time factor (which stages of development must have taken place after fertilization of an egg cell by a sperm cell?) or the method of genesis itself (aside from conception, which other methods are used to generate embryos?), could be particularly relevant. The differences mentioned lead, in turn, to the question of which legal consequences researchers must keep in mind - especially regarding the risk of criminal liability - when engaging in international cooperation efforts with peers from more permissive countries.     

Human embryonic stem cell science and policy: The case of Iran

The paper is based on a large qualitative study of ethics, policy and regulation of human embryonic stem cell (hESC) science in Iran. This case study in five academic research centres used semi-structured interviews to examine in depth the views of stem cell scientists, embryologists and ethics committee members on hESC research policy in this Shia Muslim country. Although Iran's policy approach has been considered 'intermediate', what is described here seems to be a 'more flexible' policy on hESC science. This article describes three arguments to explain why Iran has shaped such a policy. These are: (1) a flexibility of the Shia tradition has allowed for hESC science; (2) permissive policy related to other fields of biomedicine, such as new assisted reproductive technologies, facilitated approval of hESC research; and (3) a lack of public debate of bioscience in Iran influences how its hESC research policy is perceived. Based on the empirical data, this paper then expands and refines the conceptual bioethical basis for the co-production of science, policy, and society in Iran. The notion of co-production implies that scientists, policy-makers, and sometimes other societal actors cooperate in the exchange, production, and application of knowledge to make science policy.     

Body work in assisted conception: exploring public and private settings

Body work has been foregrounded in recent sociological writings on health and social care, particularly the emotional labour of patient care. In this article I explore the social and emotional dimensions of body work in assisted conception in private and public National Health Service (NHS) clinics. Drawing on an ethnographic study, I explore how tensions around bodily attributes, treatment costs, clinic performance and the extent of consumer sovereignty were managed in decisions about who to treat and in what manner. In NHS settings, body work involved efforts to standardise and constrain bodies in line with an ethics of justice that included the co‐construction of protocols and performance measurement and a strong emphasis upon teamwork and influencing the behaviour of the sector as a whole. In contrast, body work in private settings was more overtly organised around an ethos of individual consumption that emphasised bespoke treatment together with an active critique of the regulator, based on a strong entrepreneurial ethos. Emotional labour in private settings was also more overt. I conclude by exploring the implications of my analysis for the study of assisted conception, the sociology of body work and the further marketisation and deregulation of medicine.     

A European discussion about stem cells for therapeutic use

Stem cells as a source material for growing cellular transplants to repair dysfunctional organs appear to be a new challenge for medical science. Though stem cells are also present in foetal and adult organs, embryonic stem cells from the pre-implantation embryo in particular have the potency to proliferate easily in vitro and the capacity to differentiate into all the body's organ-specific cells. Therefore, these are the ideal cells for developing new cell transplantation therapies for diseases such as Parkinson's disease, diabetes mellitus and heart failure. The use of spare in vitro fertilization (IVF) embryos or pre-implantation embryos specially created to harvest human embryonic stem cells is, however, controversial and an ethical problem. In a European discussion platform organised by the European Commission Research Directorate-General, the status quo of the progress was presented and subsequently commented upon and discussed in terms of medical-ethical, social, industrial and patient interests. The expectations of this new medical technology were high, but clinical trials seem only acceptable once the in vitro differentiation of stem cells can be adequately controlled and once it is known how in vitro prepared stem cells behave after implantation. The ethical justification of the use of in vitro pre-implantation embryos remains controversial. The prevailing view is that the interests of severely ill patients for whom no adequate therapy exists, surmounts the interest of protection of a human in vitro pre-implantation embryo, regardless of whether it was the result of IVF or of transplantation of a somatic cell nucleus of the patient in an enucleated donor egg cell (therapeutic cloning).     

Envisaging the embryo in stem cell research: rhetorical strategies and media reporting of the ethical debates

Abstract How is the embryo defined, envisaged, imagined? Who speaks on its behalf, and how? Based on a study of UK press and TV news reporting, this paper identifies the rhetorical strategies used to assert competing ethical positions around embryonic stem cell research. We show how both sides in the dispute mobilise metaphors and use personification to recruit support; and how they promote different ideas about the embryo's significance, size, and social embeddedness and present competing narratives about its origins, destiny and ‘death’. The role of visual representation is key here. It does not follow the usual pattern whereby, in the abortion debate, those ‘on the side’ of the fetus display its image while those who are ‘pro‐choice’ shy away from this. In the stem cell debate the pattern is inverted, highlighting the role of technologies of visualisation in defining what counts as human. Our analysis also shows how the media coverage marginalises women's perspectives, disregards more fundamental challenges to science, side‐lines concerns about effectiveness or safety and curtails discussion of broader issues. We reflect on the media processes restricting debate in this way and conclude by identifying opportunities for a more inclusive discussion of science ethics.     

Where the rubber hits the road: Neuroscience and social work

ABSTRACT

Multidisciplinary scholarly dialogue can bring academics and researchers together and open up new areas of inquiry. This paper is a case study about how two scholars, one in social work and the other in science, have found common ground. It discusses their respective research projects and how ‘the rubber hits the road’ by exploring why the knowledge of science/neuroscience is important to non-science majors like social workers in their practice, using childhood trauma, to illustrate that. Finally, it makes recommendations regarding the inclusion of science education in social work curricula and offers some ideas for future research.