Bioethics 2013 PDF
Bioethics 2013 PDF
Dept Medicine-Hematology/Oncology
2012 Nobel Laureates in Medicine for Cell Reprogrammming
• Caveat:
– Issues with epigenetic and phenotypic stability of
their differentiated cells.
– Rejection issue is circumvented but other issues
remain the same.
1. Chung Y, Klimanskya I et al, Nature (Online, Oct 16, 2005); 2. Klimanskaya I, Chung Y et al, Nature (Online, 23 Aug, 2006)
Constance Holden, Science 2006;313:1869; Stem Cells Online 9/06
Research Cloning vs. Therapeutic
Cloning
• Therapeutic Cloning:
• Implies we are close to cures.
• Research Cloning:
• Implies we are do cloning, only for research
purposes.
• We do not know how far away we are from a cure
for any disease.
International Perspectives
◻ First IVF baby, 1978
◻ Studies began on early human development in
UK
◻ UK government took the initiative with laws.
◻ The Warnock Commission, 1984, the Human
Fertilization and Embryo Act:
⬜ Regulated research with human embryos derived
by IVF
⬜ Legal in UK to do research with human embryos
up to 14 days of fertilization.
◻ US: no laws on IVF
Peter W. Andrews Stem Cells Dev 2009;18:1113
• PROBLEM IN USA:
– REGULATE ESC DERIVED FROM AN
UNREGULATED SYSTEM
Timeline
◻ 1998: Dr. James Thompson reported on isolation of human ESC.
◻ No federal funding for Dr. Thompson, as the law then in the US (Rep
Jay Dickey, 1995):
⬜ Funded by Geron Co and WARF
◻ 1999: NIH draft guidelines with hESCs (derived in private sector); left
over from fertility clinic with consent; no profit by the clinic.
◻ 2000, Final guidelines, solicited application for research.
⬜ During election, statement by then candidate G.W. Bush against
ESC research, no application.
⬜ Intense lobbying when President Bush was sworn into office on
hESC research.
◻ 2001:
⬜ Protectionist view of the embryo
● 1999:
● Human ESC derived:
● Clinton administration argued that research can be
done providing that actual destruction of embryos is
performed with non-federal dollars.
● Research on the resulting lines would be qualified for
federal dollars;
o Reason: ESCs were not direct destruction of the
embryos.
o Contradiction of the above because federal dollars
Executive Order 13505
⦿ Major quandary:
◼ Is an embryo a human life?
• If so, is it something needed for protection?
⦿ Ques:
◼ How does one match the beginning of life with
the ends of science?
⦿ Outside of the above Ques:
◼ Open the path for manipulations and design a
human.
RELIGIOUS ISSUES
RELIGION
HOW DOES THE EMBRYO GO FROM
BEING ESSENTIALLY AN `OBJECT’ TO A
PERSON.
● Hinduism
● Believes in reincarnation of the soul rather than death:
● The time of incarnation of the soul into the fetus can be
about 4-7 months.
● Sikh: Life begins at conception
● Islam:
● The Sunni and Shi’s Muslim scholars believe that the ensoulment
takes place about the end of the fourth month (120 days PC).
● Stem cell research and cloning for therapeutic purposes is
permissible with full consideration and all possible precautions in
pre-ensoulment stages of fetal development
● In other views, ensoulment could occur after 40 days.
B. Larijani and F. Zahedi, Transplantation Proceedings, 36, 3188–3189 (2004); Evans J, Nature Med 2009;15:4
Sharî'ah Perspective
• 6 stages of development:
• The preimplantation embryo
• Embryo (from implantation to identifiable organogenesis, 40 days PC
• The fetus (from organogenesis, 40 days PC to 20 or more wks).
• The viable fetus (20 or more wks until onset of labor)
• Dislodged fetus (from the beginning of the second stage of labor until birth
• Neonate
Given the above argument, preimplantation embryo cannot develop into a human.
Thus, the preimplantation embryo does not have the same sacred title to life as
the implanted embryo.
and Differentiation
Science, 2010;327:25
PAYMENT
● Hematopoietic Stem Cells
◦ Registry:
⚫ US
⚫ World Marrow Donor Association (WMDA)
⚫ No payment/Altruism
⚫ 70% of match from another country
● No payment policy in US:
◦ Challenged
◦ Why employee of transplantation services paid?
◦ Why not the donor?
⚫ No loss to donor, still have the salary + reimbursement for lost wages
● Reimbursement:
◦ Payment for cost by donor, e.g, loss of wages, travel
● Renumeration:
◦ Payment above reimbursement.