5. Evolution of Ethical Priorities Allen R. Dyer: Ethics of Human Genetic Intervention Experimental Neurology 144,168-172 (1997) Social control Autonomy Beneficence Social justice Autonomy Beneficence Autonomy Beneficence Social justice Beneficence Autonomy Justice 2000+ 1990s 1970s-1980s 1950s-1960s
6. Human Genetic Intervention Allen R. Dyer: Ethics of Human Genetic Intervention Experimental Neurology 144,168-172 (1997) Genetic Engineering Genetic Engineering Enhancement of capabilities Genetic Engineering Gene therapy Cure or prevention of disease Germ-line Somatic cells
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8. Ethical issues in assisted reproduction “ Ethics, Advertising and Assisted Reproduction: The Goals and Methods of Advertising” Concern for “commodification” of life and life products Concern for availability, allocation, and pricing of the technology Allen R. Dyer: Women’s Health Issues 7:3, pp. 143-148. May/June 1997
11. STEM CELL (DEFINITION) A cell that has the ability to continuously divide and differentiate (develop) into various other kind(s) of cells/tissues Fetal tissue, cord blood, and adult stem cells Cells differentiated, but can form a number of other tissues Multipotent Some cells of blastocyst (5 to 14 days) Cells can form any (over 200) cell types Pluripotent Cells from early (1-3 days) embryos Each cell can develop into a new individual Totipotent Examples Description Stem cell type
14. Genetics Cancer is a genetic illness: It is not necessarily a hereditary illness.
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16. Glass, D. A. et. al. N Engl J Med December 25, 2003 Formation of Osteolytic Lesions in Multiple Myeloma
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23. Diseases potentially treatable with stem cells Cancer Diabetes Parkinson's Alzheimer’s Spinal Cord injury Heart Disease Infertility Basic knowledge of cell development
24. Who are stakeholders? People with illnesses Parents of children with illnesses Physicians and scientists Research Institutes: NIH, Universities, Corporations and shareholders (those who might profit) Government (s) USA, California, UK, Australia, Czech Republic, South Korea Taxpayers Churches and clergy The cells themselves
25. Misconceptions hamper understanding Sources of stem cells: Adult stem cells: bone marrow, blood, muscle, fat, nerves , etc. Umbilical cord stem cells: Umbilical cord blood and placenta Embryonic stem cells: From TABs or (supernumerary) IVFs Embryos made solely for research purposes Embryos made using somatic cell nuclear transfer (SCNT) DNA
35. Legislation on Reproductive/Therapeutic Cloning, Embryo Research, and Stem Cell Research 2003 Source: Encyclopedia of Bioethics 12 Stem Cell Research on Spare Embryos allowed 13 (General) Research on Embryos allowed +Australia, Brazil, Canada, Finland, France, Iceland, Spain, Sweden 5 Therapeutic Cloning (SCNT) allowed (US, UK, Netherlands, Japan, Israel) None Reproductive Cloning allowed
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39. The Case for Federal Funding “ The only possible source for adequate support of our medical schools and medical research is the taxing power of the Federal Government. Such a program must assure complete freedom for the institutions and the individual scientists in developing and conducting their research work.” b) 1945 US Surgeon General Thomas Parran arguing for the establishment of the National Institutes of Health (NIH)
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51. Buddhist Ethics "Cloning is a different way of thinking about the recycling of life,” "It's a Buddhist way of thinking.” Professor Yong Moon from Korea's Seoul National University at the American Association for the Advancement of Science 2004 Just a few days earlier at the same conference, Moon was part of the team that announced it had successfully cloned human embryos and extracted sought-after and versatile embryonic stem cells. *Hwang, W.S., et al. 2004. Evidence of a Pluripotent Human Embryonic Stem Cell Line Derived from a Cloned Blastocyst. Science 303: 1669-1674.
56. PGD Cancer (Colon and Breast) Cystic fibrosis Cycle cell anemia Ankylosing spondylosis Huntington’s disease
57. Partial Birth Abortion Currently under consideration by US Supreme Court Challenges constitutionality of Partial-Birth Abortion Act of November 2003. (Nebraska law struck down in 2000) Fails to provide an exception for procedures preformed to protect the health of the pregnant woman. Vaguely written Places undue burden on women seeking abortion. Supporters of the law argued that procedure was never medically necessary.
58. Partial-birth abortion With the ban, Congress targeted an abortion procedure, known medically as "intact dilation and extraction," that involves the partial delivery of a fetus. The skull is then punctured and its contents evacuated to make it easier for the head to pass through the birth canal. Doctors say it is used only in exceedingly rare circumstances (1 in 500). American College of Obstetricians and Gynecologists has said that the procedures banned under the measure -- called "intact dilation and extraction and evacuation" and "dilation and extraction” (D & X) -- are increasingly regarded as the safest abortion procedures during the second trimester of pregnancy.
59. Partial-birth abortion Constitutional issues: Right to privacy Right to life (and definition of life) “ Child” or “Fetus” Interest of the state Freedom of religion Legal versus moral considerations Responsibility to make moral choices
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61. Conclusion The religions today, even in their disagreements, serve to focus both our awe at the mysteries of our humanity and our anxieties about our futures. Religious traditions will probably continue to adapt to our changing knowledge of ourselves and our growing powers to modify our nature. In so doing they will perhaps shed some light on our biological origins and on our technological destiny. Ronald Cole-Turner Encyclopedia of Bioethics
62. Your role in 21st century medicine There are still many unanswered questions: As physicians, you will be concerned with the particular details of your patients’ lives. You will face situations in which there will inevitably be uncomfortable choices. You will hope to be able to make those decisions with your patients and for your patients best interests. You will hope to be able to practice with in a legal environment that respects science, knowledge, your training, and your own moral convictions.
![Ethical and Scientific Issues in the use of Human Stem Cells Allen R. Dyer, M.D., Ph.D. [email_address] http://faculty.etsu.edu/dyer](https://image.slidesharecdn.com/1180661/85/Stem-cell-ethics-06-1-320.jpg)
