Showing papers by "Arthur L. Caplan published in 1999"

Ethical Considerations in Synthesizing a Minimal Genome

Abstract: Researchers are attempting to model and eventually to create "minimal organisms," organisms with the smallest set of genes that allow for survival and reproduction. Although the ability to create such an organism is beyond current technology, the work of Hutchison et al. , reported in this issue, represents an important step in the path toward the creation of such an organism. Here we identify ethical, social, and religious issues raised by this research. Issues discussed include the potential abuse of the technology (biological weapons, environmental problems), as well as the challenge it poses to our conception of the meaning of life.

Stem cell politics, ethics and medical progress.

Abstract: Tremendous controversy has surrounded efforts to undertake research on totipotent human stem cells. To date public policy in the United States has attempted to skirt the ethical and social questions raised by this research. Annas et al. argue that research using human embryos as a source of totipotent stem cells can secure broad public support if there is an open and public discussion about the ethical justification for undertaking such research and the assurance of adequate federal regulation and oversight.

What is immoral about eugenics

Abstract: It is a “given” in discussions of genetic engineering that no sensible person can be in favour of eugenics. The main reason for this presumption is that so much horror, misery, and mayhem have been carried out in the name of eugenics in the 20th century that no person with any moral sense could think otherwise.1–3 In fact, the abysmal history of murder and sterilisation undertaken in the name of race hygiene and the “improvement” of the human species again and again in this century is so overpowering that the risk of reoccurrence, sliding down what has proved time and time again to be an extremely slick, slippery slope, does seem enough to bring all ethical argument in favour of eugenics to an end. However, before dismissing any favourable stance towards eugenics it is important to distinguish what has happened in the past under the banner of eugenics and what might happen in the future. It is important to distinguish between genetic changes undertaken with respect to improving a group or population and genetic change that takes a single individual as its focus. #### Summary points The horrible abuses committed in the name of eugenics through coercive policies imposed by governments have obscured the fact that eugenic goals can be the subject of choice as well as coercion In the rush to map the human genome and reap the benefits of new genetic knowledge it has become commonplace to argue that eugenic goals will play no part in how new genetic knowledge is used The moral case against voluntary choices to advance eugenic goals by individuals or couples has not been persuasively made Given the power and authority granted to parents to seek to improve or better their children by environmental interventions, at least some forms of genetic selection or …

The ethics and politics of small sacrifices in stem cell research.

Abstract: Pluripotent human stem cell research may offer new treatments for hundreds of diseases, but opponents of this research argue that such therapy comes attached to a Faustian bargain: cures at the cost of the destruction of many frozen embryos. The National Bioethics Advisory Commission (NBAC), government officials, and many scholars of bioethics, including, in these pages, John Robertson, have not offered an adequate response to ethical objections to stem cell research. Instead of examining the ethical issues involved in sacrificing human embryos for the goal of curing fatal and disabling diseases, they seek to either dismiss the moral concerns of those with objections or to find an "accomodation" with those opposed to stem cell research. An ethical argument can be made that it is justifiable to modify or destroy certain human embryos in the pursuit of cures for dread and lethal diseases. Until this argument is made, the case for stem cell research will rest on political foundations rather than on the ethical foundations that the funding of stem cell research requires.

The future of human reproduction: ethics, choice, and regulation

Abstract: Eds John Harris, SOren Holm Oxford University Press, £35, pp 264 ISBN 0 19 823761 8 Rating: ![Graphic][1] ![Graphic][2] ![Graphic][3] It is very hard to produce a timely book about a subject that changes as quickly as technologically assisted reproduction, but John Harris and SOren Holm have managed to do exactly that. The 14 essays in this small volume provide an extremely useful and highly readable overview of the key moral, legal, and social themes raised by new ways of making babies. The topics covered range across a broad intellectual terrain: the moral status of embryos, whether gametes can be treated as property, the usefulness of a framework of “rights” for thinking … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif

The case for using pigs.

Abstract: The question of whether or not to use pigs, genetically altered to minimize the likelihood of organ rejection, as sources for transplantable organs seems to hinge only on whether xenografting poses an intolerable danger to public health. As Dr Daar accurately notes in his comprehensive review of the state of xenografting, recent debates about the morality of xenografting in the United States and Europe, especially the United Kingdom, have arrived at different answers to the question based on their assessment of the public health risk posed. The decision in Europe has been that the threat to public health of disease transmission is too great, given the limited knowledge available, to justify clinical trials of any xenografts at the present time. Expert panels in the US are not so convinced of the dangers, and see the science as more promising. In one way the differences between the American and European assessment of the morality of xenografting reflect deep cultural differences in attitudes toward biomedicine and science. Americans tend to be more positive toward the promise of science then do Europeans, who tend toward caution in their assessment of risk when it derives from scientific activities. Strangely, it is also the case that for all the difficulty that surrounds the computation of the risks posed by transmission of viruses and microorganisms to people from animals, questions of safety provide a framework within which scientists and policy-makers are comfortable. Attitudes and answers may differ from country to country, but there are no sticky, complex or ineffable ethical issues to tackle if the debate about xenografting can be reduced to a question of safety. Public safety surely must be a primary consideration in deciding whether or not genetically modified animals ought be used as sources of organs for people in need of transplants. The threat of a public health catastrophe caused by a lethal virus transmitted from a pig or primate to a human transplant recipient and thence to a large segment of the human population is small but real. It is a risk that cannot be justified simply by the possibility of saving a comparatively small number of lives by means of transplants. But, as Daar correctly and insightfully perceives, the ethics of xenografting involves more than an analysis of the safety question. Equally important questions in assessing the morality of xenografting are whether it is ethical to breed and kill pigs or other animals for this purpose; whether it is ethical to ask a human subject to face the risks, emotional as well as physical, that will attend any attempt to xenograft; or whether the psychosocial issues raised for recipients are too great to bear. Each of these issues must be answered in a way that the public finds convincing. I suspect this will require clinical research in xenografting to follow very specific protocols if it is to be an option for solving the problem of scarce supply in the field of organ transplantation. There should be no doubt that serious risks are posed when organs from any animal are placed inside a human body. It is a well-established fact that many viral and prion agents are capable of moving from animal vectors to humans. The natural defences of the human body against viruses and other microorganisms that can be carried along in an animal organ may well be compromised when that organ comes into direct contact with the body's own internal organs and fluids. It might be supposed that the danger posed is greatest with the earliest experiments, but this is not true. It may well be easier to manage the danger of transmission and infection by animal-borne viruses and microorganisms in the earliest stages of xenografting than later in the development of the technology. The first experiments can be done under very carefully controlled conditions. Those involved in the first xenografts can be closely monitored. Recipients can be rigorously isolated and those who come into close contact with them can be required to wear appropriate protective clothing and equipment. …

Multimedia: The Future of Human Reproduction: Ethics, Choice, and Regulation

Abstract: Eds John Harris, Soren Holm Oxford University Press, £35, pp 264 ISBN 0 19 823761 8 ——————— Rating: ★★★ It is very hard to produce a timely book about a subject that changes as quickly as technologically assisted reproduction, but John Harris and Soren Holm have managed to do exactly that. The 14 essays in this small volume provide an extremely useful and highly readable overview of the key moral, legal, and social themes raised by new ways of making babies. The topics covered range across a broad intellectual terrain: the moral status of embryos, whether gametes can be treated as property, the usefulness of a framework of “rights” for thinking about assisted reproduction, who should control the use of genetic information and reproductive materials, and whether there is any reason to set limits by age for women who wish to reproduce after menopause. The book is unique in that it offers perspectives on all these topics from a variety of disciplines and professions as well as from a broad range of national and cultural perspectives. Of all the topics considered, I found the contributions on postmenopausal reproduction the most interesting. Inez de Beaufort, of Erasmus University, Rotterdam, offers a moving and fascinating hypothetical letter written by a woman who conceived at the age of 54 to her now 18 year old daughter. The technique works nicely in highlighting the complex motivations and thinking that might lead someone to decide to use technology to reproduce late in life. Guido de Wert, of the Institute for Bioethics, Maastricht, offers a succinct overview of the major moral concerns about honouring the wishes of older women to reproduce and finds them inadequate. He is especially persuasive in noting that there is no compelling reason to think that helping a 55 year old woman to have a baby is “unnatural,” a misplaced use of medical skills, or an unjust use of scarce medical resources. He is less persuasive in arguing that older parenting might not be in the best interest of a child created in this way. Fleur Fisher and Ann Somerville of the BMA also make this point in a trenchant review of the data about the health of older women who procreate and the risks they face. Proponents of permitting older women to use technology tend to focus on the argument that many older men sire children and no one challenges their right to do so. But, until recently, older men always had younger partners so that any offspring ought to have at least one parent around during their childhood. De Beaufort does a better job of explaining why having a parent who is suffering the ills of old age might not really be in the best interest of a child. To put the argument succinctly, whoever requests the use of technology to have a child in old age needs to be reminded by society that making orphans is not good public policy. The debate about setting limits by age in using reproductive technology is just one of a number of issues usefully presented in this book. Those who are looking for a resource that can help them explore what is often an ethically complex and emotional topic could not do better then to spend some time reading these essays.

Human Primordial Stem Cells: What's in the Dish?

Abstract: It is hard to dispute some of the conclusions of Geron's Ethics Advisory Board: stem cell research holds medical promise, is morally problematic, and suggests a need for careful political oversight to ensure responsible progress, the support of the public, and the fair distribution of benefits and costs. And as participants ourselves in several corporate efforts to develop ethical standards for research and oversight mechanisms within biotechnology, we applaud Geron for sponsoring a position statement on moral issues. The effort of the Geron EAB participants to walk a fine line between sponsored research and apologetics is also commendable. However, there is a long way to go, both in developing bioethical review of corporate-based science and in encouraging moral analysis of stem cell research. One area where Geron's brief report needs work is in elaborating the subtle issues associated with the moral status of human stem cells. As reported by the EAB and in Science, Geron investigators' research into human embryonic stem cells (hES) has resulted already in the successful isolation and establishment of cell lines. Such research holds great promise for tissue transplantation, gene therapy, pharmaceutical development, and human embryology. Human and transgenic stem-cell-based research also promises a secondary wave of progress in related areas of science and technology--the "double effect" of stem cell research. For example, while Geron's and other teams working on stem cells may not be directly invested in reproductive genetics, one likely effect of Geron's work would be the acceleration of research on reproductive cloning. In their report, the EAB distinguishes between stem cell research that involves cells derived from blastocysts and research that involves cells from fetal tissue obtained from an abortus. We do not quibble with EAB's view of the issues involving tissue from aborted fetuses. However, its defense of hES research on blastocyst-derived cells is insufficient. The report argues that the moral status of a human, and thus our responsibility to a developing embryo and fetus, grows in strict relation to its development. It accepts what EAB member Ted Peters (following dozens of others in genetics and ethics) terms a "developmental" approach according to which, roughly, an embryo gets more status as it becomes more like a person, with the transition to blastocyst marking an important jump. The developmental approach to embryo status appears helpful on its face. After all, it links moral status to scientifically ascertainable developments. It recognizes that capacities and potential are both important in deciding whether an entity has rights or other moral standing, and it distinguishes between material that is "headed" for human personhood and material that is merely a repository of some component of personhood. It also distinguishes, or could, between tissues in vivo and tissue stored on ice. Most importantly, it is (or at least Peters claims it is) a threshold concept, roughly separating material that can be thought of as an end in itself from material that is merely a means to some other end. Moral Status and Context However, in the work of the EAB, the idea of development as a moral barometer does nothing to clear up the moral issues faced by those who work on stem cells. Worse, it rests on a conceptual confusion that must be resolved before progress can be made in this area of research more generally. Embryonic and germ cell status is not a scientific matter. There is neither consensus nor fact from which to deduce the social meaning of different embryonic or fetal tissues. In fact, hES research, and other basic research on reproduction, radically enlarges the problem of defining basic facts about embryos. We call this problem one of determining "what is in the petrie dish." It is a problem with two parts. First, it is becoming possible to isolate and separate human germ cells and embryonic/fetal tissues from their ordinary environments. …