Transcript Die medizinische Utopie. Eine Kritik aus ethischer Sicht

Ethical issues in tissue
engineering
Bert Gordijn
Ethics Institute
DCU
Three parts
 Tissue
Engineering
 Method
 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


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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:
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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 possible
Scientific
literature
Expert 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
view
 Non-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
Informing subjects,
patients and donors
 Free
and informed consent
 Respect for autonomy
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
 Cloning
 Gene
therapy
 Nanotechnology
Changing body image
In the long run,
successful TE might change
 The
concept of body
 Attitudes 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
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