Ethical issues in tissue engineering Bert Gordijn Ethics

Ethical issues in tissue engineering Bert Gordijn Ethics Institute DCU

Three parts Ø Tissue Engineering Ø Method Ø Application

Tissue Engineering

Tissue Engineering The regeneration of biological tissue using cells, supporting structures and/or biomolecules

Tissue engineering Scaffolds Time Environment Cells TISSUE REGENERATION Signaling molecules (growth factors)

Ageing is associated with an increase in damaged and/or lost tissues and organs

Challenge for the emerging field of tissue engineering and start-up companies Ø Ø Ø Develop a clear idea of the ethical issues connected with the research Know what issues might be debated in the future Defend their position in ethical discussion Limit the activities to what is ethically desirable Prospective ethical analysis

Method

Conditions for ethical desirability of research 1. The goals must be valuable. 2. Further development must contribute to the achievement of these goals. 3. Ethical problems must be avoidable or justifiable.

Three step method 1: Are the goals valuable? Ø 2: Does further development contribute to the achievement of these goals? Ø 3: Are the ethical problems avoidable or justifiable? Ø

Application

Step one: are the goals valuable?

Different subfields of research, different goals & ethical problems Example: Ø Ø Ø Fat stem cells for breast enhancement Stem cell treatment for Lou Gehrig's disease Viable corneal tissues to replace diseased or damaged areas

What are the goals? ØMore traditional goals such as new knowledge, improved prevention of pain and disease, better diagnosis and superior therapy ØMore unusual and unconventional goals, for example life extension & cosmetic interventions: enhancement

Traditional goals Ø Some goals may be more important than others Ø Debate about priorities

Enhancement Ø Justice Ø One-sided focus on medical means Ø Medicalization

Step two: will further development contribute to a realization of the goals?

Achieving the goals Prediction in detail: not possible Assessment of probability: often possible ØScientific literature ØExpert interviews

Hype Ø Scientists Ø Companies Ø Governments Ø Media

Lies and frauds

Step three: are the ethical problems avoidable or justifiable?

What are the ethical problems connected with further development?

The destruction of embryos

What to do? Ethical problems in connection with the various possible ways of harvesting pluripotent stem cells New knowledge Improved health or alleviated suffering for patients The moral status of the human embryo

Moral status of the embryo Ø Conceptionalist view Ø Non-conceptionalist view

Proportionality

Animal experiments Ø Harms vs. benefits Clinical trials Ø Harms and risks vs. various forms of benefit Clinical treatment Ø Harms and risks vs. therapeutic benefit

Informing subjects, patients and donors Ø Free and informed consent Ø Respect for autonomy

Informing others (colleagues, policy makers, media & public) about the science Ø Honesty Ø Accurateness Ø Openness

Protecting information Doctor/patient relationship Biobanks Confidentiality Ø Privacy Ø

Accompanying technologies

Importing ethical debates by using certain technologies Ø Cloning Ø Gene therapy Ø Nanotechnology

Changing body image

In the long run, successful TE might change Ø The concept of body Ø Attitudes towards the body

Are these ethical problems avoidable or justifiable? Example: Embryonic stem cells Ø Use adult stem cells Ø Moral grounds that justify embryonic stem cells

Conclusion Three step method Ø Rational and systematic assessment Ø Interdisciplinary research groups Ø Responsible development Ø