Between the Cross and the chromosomes: locating the line in biomedical ethics

Bernadette Rose considers the relationship between biomedical ethical codes and Christian morality.

Biomedical research forms the bedrock of medical advancement, shaped by a myriad of guidelines and rules that are strictly adhered to. Ethical guidelines are one of the most important checklists that researchers orient their lives around, ensuring the delivery of quality, reproducible results which cure patients of their ailments. 

The consequences for breaking such ethical codes are severe: project funding can be lost, professors can lose their tenured positions at universities, and some scientists can even be jailed, as happened in 2019.

Biomedical ethics do not always accommodate for Christian morality; some practices which Christians would objectively denounce as unethical are fully permitted in research.

Navigating these intricacies, to distinguish areas where bioethics preserve human dignity from those which blatantly disregard the Christian belief in life from conception, is essential for a Christian biomedical researcher. 

As researchers engage with ongoing and emerging challenges, they must remember historical precedents and consider the theological understanding of the principle of double effect (where negative outcomes may be an unforeseen and unintended consequence of positive outcomes). Put simply, an ethical scientist would not do anything they view as bad, but they cannot control all consequences of their research; bad things may still arise from the work in spite of their efforts.

Research for the prevention or cure of human diseases must, by regulation, undergo rounds of testing in various model organisms, from cells to insects to mice to monkeys, thus protecting humans from preventable harm. This happens in fields of genetic engineering research. But is genetic engineering morally licit? 

It all depends on what it involves and what is being researched. Genetic engineering refers to the artificial alteration of our genes with the view to prevent disease or reduce debilitating symptoms. This field clearly distinguishes between ‘enhancement’ (altering natural traits) and ‘engineering’ (to cure disease). 

Genetic engineering techniques can be packaged as treatments provided to patients, but very few of such therapies have been approved for human administration. These remain limited to non-heritable cells; in other words, the genetic engineering brought about by such therapies do not impact systems or cells involved with reproduction (no targeting gametes, developing foetuses, or anything that would be passed down or inherited by future children). The World Health Organization (WHO) provides an in-depth introduction to this very topic, outlining that among approved genetic engineering therapies for humans are those that target HIV virus and sickle cell disease.

As intense ethical debates continue to wage over the engineering of heritable genetics, research in model organisms continues. This occurs largely as there is a lack of understanding as to the potential side effects of genetic alteration in heritable cells, so guidelines serve to protect humans from these unknowns. 

The afore-mentioned 2019 arrest was due to a scientist tampering with foetal genetics, against the law. The fears that genetic enhancement could revive eugenic ideas are another key factor in shaping this ethical code. It is important to highlight that many pioneering genetic discoveries in the twentieth century were made by eugenicists, a movement to which modern science wishes to clearly separate itself. This is almost the opposite of the double effect principle: at times bad actions can have at least some positive consequences.

This aversion to eugenic ideologies is in line with Christian theology, where all human life is valued with equal dignity, deserving of equal respect, although historically eugenic Christians have certainly existed, and undoubtedly also eugenic Christian researchers.

Genetic engineering produces a wealth of information and has brought researchers to treatments which can drastically reshape children’s lives. There are many examples of this. These include helping patients with severe combined immunodeficiency disorders, also referred to as ‘bubble kids’ as they are born with a genetic condition that prevents the normal function of their immune systems, forcing children to live in an isolating ‘bubble’ which prevents contact with sources of bacteria and viruses. 

Treatments that eliminate this immunodeficiency by genetic engineering have shown tremendous promise, and similar life-changing alterations could be managed for patients with cystic fibrosis or haemophilia, to outline but a few. And research into genetic approaches to treatment of neurodegenerative diseases like Parkinson’s and Alzheimer’s disease have led to insights into their onset and earlier diagnosis. 

The understanding of a person’s genetic makeup can even prevent fatal consequences in hospitals with the administration of certain medications. The CYP2D6 gene dictates the rate of drug metabolisation, so delayed-action pain killers like codeine can be appropriately administered to prevent accidental patient overdoses and ensure pain relief, while the CYP2C19 gene impacts the dosage of routine anti-platelet drugs prescribed subsequently to heart attacks, which could otherwise have fatal consequences. 

The advanced understanding of genetics can therefore impact medical intervention at multiple levels, all with the view of minimising suffering and protecting human life.

Christian theology teaches to care for the sick, to heal, and have compassion, using all morally licit means and the intelligence God has given us. This would support the continuation of genetic engineering research, where technological advancement and the researcher’s abilities are viewed as so many gifts of God. 

The idea of editing our biological make-up at the genetic level may cause some to hesitate out of fears of ‘playing God’, but this is a common misconception. It arises from the idea that a disease may be providential in origin and it may be God’s will for the patient to suffer and die (and a few, albeit non-mainstream, Christian groups do have this mentality). But how can this be if God has equally given us the tools to alleviate the patient’s suffering, and to look for a cure? And the Bible demonstrates that a major part of Christ’s ministry was to cure the sick, to which he also entrusted his disciples. 

An interesting question that does require further thought is whether the potential elimination of all genetic disorders in a far-off but hopeful future would impact our understanding of suffering.

Christian upholding of the sanctity of life thus promotes life-saving care in accordance with bioethics, yet not every question can be tidily answered. Certainly Christianity insists on respecting life from its conception but others disagree on the exact ‘start-time’ of life. 

The need to respect each individual’s right to their human body in biomedical research has been strongly highlighted in past actions where this has not occurred, and remains central to medical ethics. This refers to the past exploitation of marginalised populations and vulnerable peoples in medical trials, with lack of informed consent, or consent at all. 

Bioethical experts and Christians both agree that human dignity and autonomy must be upheld via informed consent throughout clinical trials and research studies. Historical atrocities include a myriad of evil practices in the 1900s alone, ranging from experimentation in Nazi concentration camps, to the Tuskegee Syphilis study, to Hepatitis studies at Willowbrook state school, and to human radiation experiments in the USA, to name just a few. Unfortunately, allegations still persist in modern day despite the clear ethical regulations and international laws.

Another example of a marginalised community being mistreated by medical researchers occurred subsequently to Henrietta Lacks’ death in 1951. In the mid-twentieth century, harvesting tissue for cell line formation without receiving patient consent was fairly routine. HeLa cells were named after Henrietta, whose cervical cancer was used to establish the line after a biopsy was taken in one of the Maryland hospitals open to treating the African American community. 

HeLa cells led the field to unparalleled medical discoveries and advancement, but Henrietta’s family received no compensation, nor even knew that her cells were living and reproducing in multiple laboratories, until over 20 years of biotechnical profit had elapsed. Researchers continued to publish her name, medical records, and the cell’s genome without the family’s consent. Ethical regulations now require informed consent prior to cell line formation, but still have no qualms against the continued use of HeLa or similar cell lines, as a wealth of information is accessible through their use (corroborating with the principle of double effect).

Cell lines, when immortalized for research purposes, undergo a series of changes resulting in an end-state that bears very little resemblance to the original patient. They present as a steady dividing population that reproduces every 2-3 days, indefinitely, allowing experiments to be conducted quickly on large sample sizes. There is no chance of the cells evolving into a new organism or exhibiting any independent activity beyond that of their tissue-of-origin. 

So, for instance, a solid tumour cell line will grow into three dimensional microscopic clumps and adhere to their culture flask, while blood cell lines will float in their suspension media. Mouse cell lines in fact exist, too, as do insect cell lines, guinea pig cell lines, and so forth. The cells continue to divide for years and often undergo rounds of freezing and re-freezing in liquid nitrogen, going down to -190 degrees. Organs and tissues of the native human could not survive this and maintain functionality. Cell lines (evidenced particularly in Henrietta Lacks’ case, but present in all) even outlive their donor. The difference in the end-product (the cell line) from the original patient is another factor considered by ethicists when allowing the continued use of ‘tainted’ cell lines.

Tainted cell lines are so termed due to their ethically murky origins, also including those derived from aborted foetuses (notably not considered ‘tainted’ by researchers who do not accept there is life from conception, as informed consent was provided by the parent). The question remains whether using such cell lines and publishing studies which highlight their use cause researchers to cooperate with the original immoral act. 

Christian ethicists contest whether cell lines derived from such practices can be morally used in research. HEK293 cells, abbreviated from Human Embryonic Kidney cells, are an excellent example for this discussion, deriving from a 1973 abortion of a female child, used widely in research. 

The Anscombe Bioethics Centre in Oxford released an article by Dr Helen Watt providing guidance on the use of such cell lines in the wake of COVID-19 vaccine research. This article highlighted that many practices in current society derive from immoral acts of injustice, including even ‘walk[ing] on paving laid by slaves’. A similar line of thinking can thus be drawn in parallel to the use of tainted cell lines, and accordingly Dr Watt argues that “the more pairs of hands that separate us from the original wrongdoers, and the less we are part of an organized system, the less scandalous the messages we send out and the more likely it is that our actions are defensible.” 

This touches on a key point, however, especially for a Christian biomedical researcher: what message is being sent out?

Especially considering, as Dr Watt points out, that such acts as abortion still continue widely in society. She suggests that such practice can unintentionally support the creation of more foetal cell lines.

This area is therefore highly impacted by Christian beliefs and morality. It is important for Christian researchers to seek alternative cell lines from ethical origins where possible. However, HEK293 cells are considered the most practical for the laboratory technique of lentivirus production, its ‘industry standard’, and an efficient substitute remains unknown. 

The principle of double effect would therefore allow continued research using HEK293 cells, as a significant benefit is provided and an alternative would not be suitable due to a lack of knowledge. This is a difficult line to draw, but there is insufficient funding for research projects to simultaneously investigate their disease area while seeking an ethical alternative, unless the very research question was to locate the desired alternative. 

Change needs to therefore start from the top and funding trickle down to research projects. The 2008 document Dignitas Personae by the Catholic Church’s Congregation of the Doctrine of Faith (CDF) was an excellent contribution to providing moral guidelines for researchers on this journey. 

The key difference between Christian morality and bioethical guidelines therefore stem from the different premises as to when human life begins. Both schools of thought wish to preserve human dignity. But frictions arise regarding when that human dignity begins. 

Stem cell research is a rapidly advancing field of tremendous medical potential which relies on several sources for stem cells, mainly adult tissue, cord blood, and embryos. Embryonic stem cells derive from spare embryos donated by consenting parents undergoing in vitro fertilisation (IVF) procedures. 

Christian ethics strongly oppose embryonic stem cell research as it results in the destruction of the embryo, and thus the death of the child.

This can raise complex dilemmas for researchers who wish to pursue treatments which alleviate suffering while respecting the sanctity and dignity of human life, especially as academic research environments are so collaborative. 

Can a researcher accept input on their experiment which derives from a fellow scientist who works with embryonic stem cells? What if that scientist were to offer to run a similar experiment in their laboratories, on embryonic stem cells?

The 2006 discovery by Dr Shinya Yamanaka and successful reprogramming of ‘ordinary’ adult cells into functioning stem cells termed induced pluripotent stem cells, leading to the joint award of the 2012 Nobel prize, provides a respite from this intense ethical debate. iPSCs, as they are known in the field, provide relief for many stem cell researchers, as embryonic projects are characterized by intense ethical scrutiny and high costs to ensure that the strict guidelines are adhered to. iPSCs therefore make a much more attractive (and ethical) alternative. 

Thankfully, this remains in line with Christian morality and, furthermore, could result in even better eventual care as it opens the possibilities to personalized medicine, where the patient’s own cells are reprogrammed for subsequent therapeutic use (although this broaches another ethical dilemma of ensuring equitable access to treatments). 

However, as iPSC research forges forward into new realms, novel ethical questions emerge which require continual review. These include the ability of neurones grown in laboratories as organoids investigating brain development to fire signals that seem to feel pain.

The tremendous increase in accessibility to artificial intelligence in professional and research settings in the last decade has also resulted in AI implication for bioengineering, genetic research, and drug discovery. But important questions over its ethical management have been raised and remain ongoing, including preservation of data privacy and informed consent. 

Medical professionals have even found that AI software can streamline diagnostic procedures, such as the potential rapid detection of cancer cells using a 2018 Japanese software originally developed for croissant selection at checkouts. While concerns over the deterioration of patient-doctor relationships have been flagged, the potential to eliminate human error is tremendous, especially in treatment-plan construction by access to large data sets. For instance, the differing responses to medications based on patient genetics, like CYP2D6 and CYP2C19.

Biomedical research fields have not been immune to historical ethical challenges, and while stringent research guidelines exist today, they unfortunately do not wholly align with Christian morality. Friction with Christian theology, whereby life and human dignity must be preserved and upheld from the moment of conception, raises many issues for a biomedical researcher trying to advance science in line with his or her faith. 

It is, however, important to assume good intention on the part of biomedical scientists and remember that all schools of thought attempt to preserve human dignity and avoid past exploitations to medically alleviate human suffering. 

As ethical guidelines continue to be evaluated in the wake of societal advancements and changes in the research climate, Christian biomedical researchers can be careful to locate the line which separates what is morally good from what is morally not and thereby carry their spiritual Cross together with their biological chromosomes forward into a hopeful future.

Like what you’ve read? Consider supporting the work of Adamah by making a donation and help us keep exploring life’s big (and not so big) issues!