Ethical issues in tissue engineering

Bert Gordijn Bert Gordijn Ethics Institute Ethics Institute

DCUDCU

Three parts

Tissue EngineeringMethodApplication

Tissue Engineering

Tissue Engineering

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

Tissue engineering

Scaffolds

Cells Signaling molecules(growth factors)

Time

Environment

TISSUE REGENERATION

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

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? 2: Does further development contribute to the

achievement of these goals? 3: Are the ethical problems avoidable or

justifiable?

Application

Step one: are the goals valuable?

Different subfields of research, different goals & ethical problems

Example:

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?

More traditional goals such as new knowledge, improved prevention of pain and disease, better diagnosis and superior therapy

More unusual and unconventional goals, for example life extension & cosmetic interventions: enhancement

Traditional goals

Some goals may be more important than others

Debate about priorities

Enhancement

Justice One-sided focus on medical

means 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 possibleScientific literatureExpert interviews

Hype Scientists Companies Governments 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

Conceptionalist viewNon-conceptionalist view

Proportionality

Animal experiments Harms vs. benefits

Clinical trials Harms and risks vs. various forms of

benefit

Clinical treatment Harms and risks vs. therapeutic benefit

Free and informed consentRespect for autonomy

Informing subjects, patients and donors

Informing others (colleagues, policy makers, media & public) about the science

Honesty Accurateness Openness

Protecting information

Doctor/patient relationship

Biobanks

Confidentiality Privacy

Accompanying technologies

Importing ethical debates by using certain technologies

CloningGene therapyNanotechnology

Changing body image

In the long run, successful TE might change

The concept of bodyAttitudes towards the body

Are these ethical problems avoidable or justifiable?

Example: Embryonic stem cells

Use adult stem cells

Moral grounds that justify embryonic stem cells

Conclusion

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