In 2009 it came to the attention of LLDF that the California Institute for Regenerative Medicine (CIRM) was seeking to engage in education, not only of doctoral and post-doctoral students, but also of public school children and undergraduate students. Part of this education has occurred at the behest of the California legislature through the passage of the California Stem Cell and Biotechnology Education and Workforce Development Act of 2009. One provision of the Act specifically sought to establish collaborative education efforts between the California Department of Education and CIRM.
Education is of particular interest to those following CIRM because Proposition 71, the California Initiative that created CIRM, makes no provision for funding of education and thus all education efforts are arguably outside the scope of CIRM’s mission and are a misuse of taxpayer money. This report seeks to provide an update on the education efforts CIRM is undertaking.
Money Spent on Education
According to its 2009 Annual Report, CIRM has put more than $106 million into training and education, $69 million in 2009 alone. This figure included funding of the Bridges grants, the Training II grants, and the support CIRM provided to pass the California Stem Cell and Biotechnology Education and Workforce Development Act of 2009, which requires CIRM to collaborate with the Department of Education to incorporate stem cell education into existing science and career development programs at the high school and college level.
According to its own description, CIRM has established extensive programs to explain its mission and science product to various constituents, from legislators, to the general public, to high school classes. The education modules CIRM developed in collaboration with U.C. Berkeley was presented to teachers at the California Science Teachers Association in October 2010.
Stem Cell Awareness Day
In 2009 more than 5000 students were presented with CIRM’s message on stem cell research by virtue of Stem Cell Awareness Day activities. The website dedicated to Stem Cell Awareness Day states: “In particular, we encourage efforts to get stem cell researchers into high school classrooms that day.”
IS THE EDUCATION THAT IS OCCURRING UNBIASED IN ITS PRESENTATION OF STEM CELL RESEARCH?
In considering the following discussion, it should first be remembered that the education is being presented by organizations and individuals with vested financial and professional interests in the continuation of human embryonic stem cell research (hESC research). With that in mind, it is reasonable to assume that the materials presented would tend to favor hESC research. Secondly, it appears that the creators of the materials think they have provided an unbiased representation of the issues, and that they have made an attempt at presenting in a neutral manner, at least with regard to the ethical considerations involved.
University of California Berkeley’s Education Program
In addition to CIRM’s education, and in collaboration with CIRM, U.C. Berkeley has been engaged in educational outreaches for some time. The Stem Cell Education outreach Program (SCEOP), a collaboration of the U.C. Berkeley’s Student Society for Stem Cell Research (SSSCR) and the Science, Technology, Ethics, and Law Working Group (STELA) have collaborated to produce a stem cell science presentation. These presentations last about two hours, and include the basics of stem cell science using videos and slide presentations. They also reserve an hour of this time to present current ethical issues regarding stem cell research. The topics they touch on include the use of discarded embryos from IVF clinics, how the research should be funded, representation of racial/ethnic diversity in stem cell lines, and which stakeholders should get to decide the fate of stem cell research. The ethics discussions they seek to foster revolve around deciding which stakeholders should have a say regarding stem cell research and how ethical decisions should be made in the first place. The science and ethics program is supposed to be tailored to the grade level at which the presentation is given.
The website indicates that funding for the project comes from the Edmund D. Rothschild Foundation, but there has previously been indication that CIRM has at least partially funded this effort as well. There was no indication as to the number of schools or specific teachers participating in the classroom presentation effort. Quite possibly the effort is still gaining momentum. Further, it appears to be quite localized since it a specific effort of UC Berkeley.
Powerpoint presentations for U.C. Berkeley’s education module are available for download on the internet. As to the bias of the presentation, the slides include a discussion of ethics that is revealing. The manner in which the material is presented would leave an impressionable school-aged student with the conclusion that hESC research is ethical. But more chilling is the teaching on bioethics, how to make an ethical decision. The example used is of a “classic bioethical decision.” “One heart available who should get it? A 17-year-old girl, a 40-year-old school principal, a 70-year-old woman?”
This scenario is followed by a presentation of “Basic Bioethics Principles” which are set out as follows:
“Respect for people’s rights—autonomy—dignity
“Beneficence: Benefits must be proportionate to risks—potential harm = potential good
“Justice: The even distribution of benefits and risks throughout society
“Nonmaleficence: Do no harm—experiment must stop if it causes harm”
Although not cited in the power point presentation, these “principles” are an almost direct repetition of Tom L. Beauchamp and James F. Childress’ “primary guidelines” set out in their book “Principles of Biomedical Ethics.” They state them as follows:
—Autonomy: “respecting the decision making capacities of autonomous persons”
—Beneficence: “providing benefits and balancing benefits against risks and costs”
—Nonmaleficence: “avoiding the causation of harm”
—Justice: “distributing benefits, risks, and costs fairly”
These “guidelines” have led to modern medicine forsaking the sanctity of human life ethic. Their relativism makes these guidelines useful to prove whatever position the person asserting them may seek. Thus, while giving an appearance of a principled approach to decision making, the guidelines do nothing but provide a formula for doctors, scientists, and people in general to do whatever they wish to do.
Going back to the test-case scenario used in the presentation (made presumably to high-school-aged students), the ages and occupations of the persons waiting for the heart are the only facts given; there is no discussion of whose condition is most urgent, or who would be most likely to be able to use the heart without immune rejection. Using the guidelines given, the decision could be made (and justified) to save any of the three persons described, depending on which “guideline” was given the most weight. An inherent danger in presentations such as this is that the young and impressionable will come away (whether on their own or at the suggestion of the teacher) devaluing the elderly and those who are mentally or physically challenged as soon as they are no longer able to “contribute” to society.
CIRM’s Education Modules
The California Stem Cell and Biotechnology Education and Workforce Development Act of 2009 requires the California Department of Education (CDE) to collaborate with CIRM and the biotech industry to include stem cell science and biotechnology in existing career development programs. It also requires the CDE to post on its website and provide the model curriculum to teachers and school districts. A review of the CDE website did not reveal a posting of the curriculum at this point, but CIRM has an education portal on its own website.
The portal contains four units, as follows: Unit 1: Embryonic stem cells, in-vitro fertilization, and pre-implantation genetic diagnosis; Unit 2: Adult stem cells, homeostasis, and regenerative medicine; Unit 3: The microenvironment, its role in cell fate decisions, and cancer; Unit 4: The immune system and the hematopoietic stem cell lineage tree. The first two units are designed for basic biology classes and the last two are more appropriate for advanced placement classes. At least one more module is in development. The portal also facilitates the opportunity to match teachers’ classes with stem cell scientists from neighboring universities or companies to give this introductory lesson or just come and talk to their classes.
Reviewing the Units for their objectivity:
Unit One: The teacher’s background reading states as objective number 7 “The student will be able to recognize areas of debate regarding the ethics of preimplantation genetic diagnosis and stem cell research.” The teacher materials include a Powerpoint presentation. At slide 3, the presentation describes the central ethical question surrounding embryonic stem cell research as follows: “Under what circumstances, if any, can 5-14-day-old human embryos be: 1. Created and destroyed (prevented from developing further, then immortalized) for research purposes? 2. Donated as research material as a result of the In Vitro Fertilization procedure? 3. Checked and screened for certain genes then selected for or against?”
Notice the way the question is framed, “under what circumstances, if any,” leading to the conclusion that there may be circumstances in which the listed actions would be ethical.
The notes to slide number 15 discuss the 5-day-old embryo, “There is a clump of cells sitting inside the blastocyst that is destined to become the fetus. However, this is definitely not a fetus yet.” There is no indication that it is only a matter of time before this tiny being grows to the stage when it is scientifically referred to as a fetus. Within the presentation, a bright student could definitely put it together that the embryo is an early-stage human, but by emphasizing that the embryo is not a fetus, the presentation seeks to take the focus off the reality of what is occurring. (It is reminiscent of abortion promoters claiming that a fetus is not a baby.) Slide #31’s notes on the Ethics of Pre-implantation Genetic Diagnosis state the following:
As always, with new technology comes the ethical choices and ramifications that accompany it. Just because a child might be genetically abnormal does not always mean that they themselves will be abnormal when born. Also, there is a chance that the testing might yield a “false positive,” where the tests show statistically there is a genetic disease but in reality the embryo is normal. What we consider as abnormal can also be seen as genetic variation and some disabled individuals have incredible capabilities. There is also the danger that this procedure used to prevent the possible children from suffering or living disadvantaged lives may be used to select for other features beyond disease. It is a slippery slope that may, in the future, lead to designer babies like in the movie GATTACA where each child was genetically made and modified at the requests of the parents.
One of the more disturbing elements of the ethics approach taken in the curriculum is demonstrated by a student activity and handout. The handout “Preimplantation Genetic Diagnosis (PGD) Policy Options In vitro Fertilization and Embryonic Development Application” requires students to do the following:
I. Rank these policy options in order of which seems most reasonable to you . . . with number 1 being most reasonable.
____ a. Federal or state bans. This option appeals to those who feel any creation or destruction of human embryos is immoral, said Susannah Baruch, JD, a policy researcher at the Hopkins Center. However, such restrictions on reproductive decision making will raise Constitutional concerns and could drive determined couples underground or to less restrictive countries.
____ b. Legal limits. Congress could pass laws prohibiting preimplantation genetic diagnosis for certain uses—sex selection, for instance—while authorizing it for others, or establish a new regulatory agency. Such an agency could list acceptable uses of the technology while inspecting and licensing clinics. Such limits on a currently accepted medical practice would likely face stiff opposition from physicians.
____ c. Professional guidelines. Physicians almost always favor self-regulation over more intrusive approaches, and professional guidelines can evolve alongside advances in science. But such guidelines are generally unenforceable. “There will always be providers to step in if there’s a market for it,” said Baruch.
____ d. Status quo. Today, prospective parents decide if they want to pursue preimplantation genetic diagnosis; providers decide which tests to offer. Such an approach allows for a range beliefs, said Baruch, and avoids the follies of foisting a particular worldview onto all. But some argue that such a laissez-faire approach fails to address the profound social changes that the technology portends.
The presentation of these ideas in this manner is far from giving students a complete view of the subjects and arguments involved. By focusing on “who should decide” the emphasis is taken off “what should be decided.” All moral imperative is lost, and students are left thinking the best option is to leave things as they are—let doctors do whatever they want.
As to the other 3 CIRM Education Units, there was little regarding ethics discussed. The material was more technical and focused more on the sciences involved. However, when referring to stem cells, and especially stem cell therapies, the materials often do not differentiate between adult and embryonic stem cells; thus this material may have many students assuming that the stem cells referenced are all embryonic. Several of the outside materials referenced in the student resources portion of the module were far from neutral in their analysis of stem cells. Often the fault lay in talking about “stem cell cures” and not differentiating whether this referred to adult or embryonic stem cells.
Lastly, in the teacher resources section, under “questions,” one of the questions and answers was so incomplete as to be unfair. The question was “I’m opposed to abortion. Can embryonic stem cell lines come from aborted fetuses?” The answer:
No. Cells with the potential to form embryonic stem cells in a lab dish only exist in these very young, four to five day old blastocysts. They are a fleeting cell type that disappears after that point in time. A common misconception is that the cells can come from older embryos or from aborted fetuses, which is in fact not possible. (Emphasis added.)
While this is a technically correct answer, it implies the cells in an embryo actually do not grow up to form a fetus. What happens when these “fleeting cells” disappear? The fetus is formed! The embryo is but one stage of human development. This seems to be the fact lost in the answer to this question. Nor does the answer address why a person who is uncomfortable with abortion might also be uncomfortable with embryonic stem cell research: the destruction of human life. And the way the question is asked assumes that a person who opposed abortion would be automatically alright with embryonic stem cell research as long as the cells did not come from aborted fetuses. Although this concern is certainly one aspect of objection to hESC research, it is far from the only objection, or even the most important objection.
On the other hand, the teacher resources also include a link to the Catholic teaching on IVF and embryonic stem cell research, and to the Jewish perspective. These links are presumably provided so that the claim of presenting both sides in the debate could be more credibly made, although there is no attempt to actually present the Catholic teaching