Ethical issues in tissue engineering

1. Ethical issues in tissue engineering Bert Gordijn Ethics Institute DCU

2. Three parts • Tissue Engineering • Method • Application

3. Tissue Engineering

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

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

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

8. 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

9. Method

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

11. 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?

12. Application

13. Step one: are the goals valuable?

15. 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

16. 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

17. Traditional goals • Some goals may be more important than others • Debate about priorities

18. Enhancement • Justice • One-sided focus on medical means • Medicalization

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

20. Achieving the goals Prediction in detail: not possible Assessment of probability: often possible • Scientific literature • Expert interviews

21. Hype • Scientists • Companies • Governments • Media

22. Lies and frauds

23. Step three: are the ethical problems avoidable or justifiable?

24. What are the ethical problems connected with further development?

25. The destruction of embryos

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

27. Moral status of the embryo • Conceptionalist view • Non-conceptionalist view

28. Proportionality

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

31. Informing subjects, patients and donors • Free and informed consent • Respect for autonomy

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

33. Protecting information Doctor/patient relationship Biobanks • Confidentiality • Privacy

34. Accompanying technologies

35. Importing ethical debates by using certain technologies • Cloning • Gene therapy • Nanotechnology

36. Changing body image

37. In the long run, successful TE might change • The concept of body • Attitudes towards the body

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

39. Conclusion • Three step method • Rational and systematic assessment • Interdisciplinary research groups • Responsible development