Adult stem cells are widely distributed throughout the body and their functional role in tissue repair relates to their ability to divide to form specialized replacement cells relevant to the normal function of the organ in which they are located. They can also be extracted and grown to form cell types appropriate to introduce into other parts of the body to promote tissue repair. Embryonic stem cells also have this ability but have an even greater ability to develop into any of the cells in the human body. Worldwide, there has been a great deal of research in recent years into using additional supplemental concentrates of adult or embryonic stem cells for treating a wide range of diseases, with increasing technical success, to provide the cellular elements required for effecting in vivo repair and/or to stimulate the body’s intrinsic capacities for regeneration. What makes the future clinical use of stem cells particularly stand out from current therapeutic approaches is that in many diseases it is being developed to offer an immediate, definitive cure, and thus replacing years of future symptomatic management. Although expensive as a one-off approach, stem cell therapies may therefore become an extremely cost-effective way of treating many chronic diseases where long term costs of treating large numbers of patients, represents a considerable burden on a nation’s GDP (Gross Domestic Product), especially as patient numbers are set to rise sharply with known current improvements in life expectancy. This review discusses the ethical and socio/political issues involved in the introduction of stem cell treatments in The Kingdom of Saudi Arabia (KSA) [1-3].

To use human adult stem cells clinically requires collection of tissue from the patient. Sources of tissue might typically include skin, blood, bone marrow or adipose tissue. The stem cells collected are harvested and cultured, using a chemical cocktail, into the similarly specialized cells of the target organ before re-introduction to the patient. Using the patient’s own cells removes all concerns about subsequent immunological rejection of the re-introduced cells, and avoids the need for any post-transplantation drug treatment that might otherwise be needed to suppress the immune system.

To use human embryonic stem cells, however, requires the use of human embryos. This represents a far more controversial approach from an ethical perspective, and is a fundamental issue that has divided opinions across the general populations of countries around the world, sometimes along religious lines, as well challenging those with specialist interests in the development of stem cell treatments (such as scientists, clinicians, politicians and governments) for 25 years. Whilst the therapeutic use of adult stem cells avoids both the ethical and immunological difficulties mentioned above, and are technically much easier to use, in general the clinical use of embryonic stem cells currently offers two main advantages in treating many different diseases; i.e., they have greater cellular development potential than adult stem cells to produce exactly the type of cells required for treating the wide range of diseases in question (such as Parkinson’s disease, dementia, diabetes, multiple sclerosis, spinal injuries, rheumatoid arthritis, sickle cell anemia, several eye diseases, burn injuries etc), and that the therapeutic development of adult stem cells to treat a variety of diseases is perhaps a decade behind the current experience when using embryonic stem cells.

The development of embryonic stem cell treatments has thus created tensions surrounding the ethics involved, and has generated widespread debate among scientists, religious groups and politicians which follows on from an earlier debate when in vitro fertilization (IVF) techniques were first introduced. This ethical debate assesses deeply held religious, moral and scientific principles from within society and its individuals, and basically segregates into those people who are supporters of using embryonic stem cells to treat serious diseases, and those who feel that human life is sacrosanct from conception and must therefore not be used for therapeutic purposes. Additional arguments expressing concern that the therapeutic use of rapidly dividing embryonic stem cells might raise the risk of tumor formation (less of a risk when using adult stem cells), adds to the mix of the arguments used by the opponents of any treatment that involves embryonic stem cells.

Currently with a population of 35 million, KSA is a developing country that faces considerable future population growth, when compared to health care and agricultural developments. The life expectancy at birth is 61 years in males and 65 years in females. KSA needs improvements in the prevention and treatment of several major health threatening diseases, especially as the rate of increase of chronic, degenerative and acute diseases creates an ever-growing huge economic and psychological burden on the country and its population. Important stakeholders of healthcare in KSA (government, commercial enterprises, health providers, patients groups) will thus increasingly require cost-effective means of treating diseases. This brings together in sharp focus the commercial versus ethical questions surrounding the use of embryonic stem cells to treat chronic diseases throughout the Kingdom. Will embryonic stem cell treatments become acceptable to the Saudi people, and will their views differ from those of the other KSA stakeholders?

The main ethical issue raised by embryonic stem cell research surrounds the use, therefore destruction, of human embryos. One of the arguments used to justify the use of human embryos in research is that human embryos less than 14 days old cannot be considered to be individual humans because they are too rudimentary in developme. Devolder [4] argues that an early human embryo has no characteristics of being a cognitive, self-aware, individual person and that it is neither sentient, nor conscious. Huge numbers of frozen embryos already exist in freezers, maintained in storage, and originating from couples who have now completed their families, and with the majority of whom stating that they are happy for these embryos to be used clinically since it shows respect for human life if they are being used for curing chronic diseases.

In others, there is strong opposition to the destruction of human embryos [5]. They stress that the equality of all human beings means that some should never be treated differently to others, and therefore that human embryos require the same respect as other humans. O’Rahilly and Muller [5] argue that fertilization is the key moment because this is when a genetically unique human is formed. Embryonic stem cell research therefore delivers a moral problem across society that straddles opinions about how best to define and celebrate the value of human life, against the use of embryonic stem cells to alleviate debilitating medical conditions. These two principles cannot both be respected at the same time, it is simply a straight choice between banning the use of embryos to make stem cells, or allowing them to be use to treat other humans. Beauchamp and Childress [6] argue that when science is driven by commercial concerns, then ethics is often sidelined. If this happens ethics are no longer perceived as guidelines for good research, but more as an obstacle to be overcome to achieve profitability. Other ethical aspects to the future introduction of stem cell treatment that must be discussed within the Kingdom include issues surrounding informed consent, equal access to therapies amongst the population, risk minimization during clinical trials, and women’s rights (particularly in the context of egg donation).

The socio-political implications of stem cell therapies must be addressed to prevent societal exploitation. The facts about the future use of stem cell therapies are not widely known or understood by the general public. However, as it is an approach that carries the potential to alleviate human suffering and promote better health for patients, there is an argument to commence a public discussion/debate on the benefits, as well as on the ethics whenever therapeutically using embryonic stem cells rather than adult stem cells? Part of the public debate should aim to determine whether the distribution of costs and benefits is fair across the Kingdom, and according to the principles of justice. The essence is the protection of the weak and the voiceless in the society. Adult and embryonic stem cell treatments should thus be properly evaluated, and widely discussed amongst the population within the context of their future use within KSA, including a comparison of the cost implications as compared to the long-term therapeutic benefits to patients that these curative therapies aim to deliver. It should be determined if they will have a clear impact on the health of Saudis, that they will be safe, and acceptable from both sociological and ethical standpoints. Other questions surround the availability of the human and financial resources that will be required to undertake a national stem cell treatment program for the country. KSA should gain assistance from countries that have greater experience in stem cell therapy. For example, the Brazilian and Indian governments have invested millions of dollars on developing autologous stem cell therapies for the treatment of heart disease, whilst India is already generating substantial revenues from stem cell therapy programs [7]. Similarly, Singapore, China and Australia are dramatically expanding their stem cell therapy programs. Non-communicable diseases (such as hypertension, diabetes mellitus, coronary and rheumatic heart disease, sickle cell disease, cancers, mental health, blindness, and stroke) are already growing in importance in the overall burden of disease amongst the Saudi population. KSA must therefore evaluate the appropriateness of stem cell treatments within our own national context. Systematically KSA must identify and prioritize which treatments will be the most beneficial for it to adopt, both clinically and financially, in terms of all the chronic diseases which it aims to target, and with the notion that these are hopefully definitive stem cell procedures that will replace the current long term, therapy.