Embryo futures and stem cell research: The management of informed uncertainty

This article is available open access and is distributed under a Creative Commons license (http://creativecommons.org/licenses/by/3.0/). Copyright @ 2011 The Authors.In the social worlds of assisted conception and stem cell science, uncertainties proliferate and particular framings of the future may be highly strategic. In this article we explore meanings and articulations of the future using data from our study of ethical and social issues implicated by the donation of embryos to human embryonic stem cell research in three linked assisted conception units and stem cell laboratories in the UK. Framings of the future in this field inform the professional management of uncertainty and we explore some of the tensions this involves in practice. The bifurcation of choices for donating embryos into accepting informed uncertainty or not donating at all was identified through the research process of interviews and ethics discussion groups. Professional staff accounts in this study contained moral orientations that valued ideas such as engendering patient trust by offering full information, the sense of collective ownership of the National Heath Service and publicly funded science and ideas for how donors might be able to give restricted consent as a third option.The Wellcome Trus

Donation of 'spare' fresh or frozen embryos to research: Who decides that an embryo is 'spare' and how can we enhance the quality and protect the validity of consent?

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited - Copyright @ The Author 2012.This paper analyses elements of the legal process of consent to the donation of ‘spare’ embryos to research, including stem-cell research, and makes a recommendation intended to enhance the quality of that process, including on occasion by guarding against the invalidity of such consent. This is important in its own right and also so as to maximise the reproductive treatment options of couples engaged in in vitro fertilisation (IVF) treatment and to avoid possible harms to them. In Part 1, with reference to qualitative data from three UK IVF clinics, we explore the often delicate and contingent nature of what comes to be, for legal purposes, a ‘spare’ embryo. The way in which an embryo becomes ‘spare’, with its implications for the process of consent to donation to research, is not addressed in the relevant reports relating to or codes of practice governing the donation of embryos to research, which assume an unproblematic notion of the ‘spare’ embryo. Significantly, our analysis demonstrates that there is an important and previously unrecognised first stage in the donation of a ‘spare’ embryo to research, namely: consent to an embryo being ‘spare’ and so, at the same time, to its disuse in treatment. This is not explicitly covered by the Human Fertilisation and Embryology (HFE) Act 1990, as amended by the HFE Act 2008. Having identified this important initial stage in the process of consent to the donation of a ‘spare’ embryo to research in conclusion to Part 1, in Part 2 we analyse the idea of consent to an embryo's disuse in treatment on the basis that it is ‘spare’ with reference to the legal elements of consent, namely information as to nature and purpose, capacity, and voluntariness. We argue that there are in fact three related consent processes in play, of which the principal one concerns consent to an embryo's disuse in treatment. If the quality of this first consent is compromised, in turn this will impact on the quality of the consent to the donation of that ‘spare’ embryo to research, followed by the quality of consent to future cycles of assisted reproduction treatment in the event that these are needed as a result of a donation decision. The analysis overall is of central relevance to the debate as to whether, and if so when, it should be permissible to request the donation of fresh embryos for research, as opposed to those that have been frozen and, for instance, have reached the end of their statutory storage term. This has a particular bearing on the donation of embryos to stem-cell research since there is a debate as to whether fresh embryos are most useful for this.This work is funded by the Wellcome Trust Biomedical Ethics Programme, Project Grant No 081414

Choosing embryos: Ethical complexity and relational autonomy in staff accounts of PGD

Copyright @ 2008 the authors. This article is available in accordance with the Creative Commons Deed, Attribution 2.5, see http://creativecommons.org/licenses/by-nc-nd/2.5/deed.en_CA.The technique of preimplantation genetic diagnosis (PGD) is commonly explained as a way of checking the genes of embryos produced by IVF for serious genetic diseases. However, complex accounts of this technique emerged during ethics discussion groups held for PGD staff. These form part of a study exploring the social processes, meanings and institutions that frame and produce ‘ethical problems’ for practitioners, scientists and others working in the specialty of PGD in the UK. Two ‘grey areas’ raised by staff are discussed in terms of how far staff are, or in the future may be, able to support autonomous choices of women/couples: accepting ‘carrier’ embryos within the goal of creating a ‘healthy’ child; and sex selection of embryos for social reasons. These grey areas challenged the staff’s resolve to offer individual informed choice, in the face of their awareness of possible collective social effects that might ensue from individual choices. We therefore argue that these new forms of choice pose a challenge to conventional models of individual autonomy used in UK genetic and reproductive counselling, and that ‘relational autonomy’ may be a more suitable ethical model to describe the ethical principles being drawn on by staff working in this area.The Wellcome Trust Biomedical Ethics Programme, who funded the project ‘Facilitating choice, framing choice: the experience of staff workingin pre-implantation genetic diagnosis’ (no: 074935)

Social welfare, genetic welfare? Boundary-work in the IVF/PGD clinic

Copyright @ 2006 Elsevier Ltd. All rights reserved.Through the lens of the ‘welfare of the child’ assessment, this paper explores how staff working in the area of in vitro fertilisation and preimplantation genetic diagnosis (IVF/PGD) balance reflexive relations of legitimacy and accountability between the public and private spheres, and between medicine, the citizen and the state. The wider research of which this analysis is a part uses multiple methods to study two National Health Service Assisted Conception Units in England. Research methods used included observation clinics and interviews with staff from a range of disciplines. We illustrate how the staff reveal tensions between their views that the welfare of the child assessment can be seen as intrusive and discriminatory, and on the other hand that medical intervention in reproduction should be socially and professionally accountable. These tensions can be understood sociologically in terms of a gradual movement from socially based solutions to fertility problems and disabilities, towards a biomedical, and arguably genetically oriented world view of such problems. Rather than being viewed as discrete, these two orientations should be seen as indicating an emergent direction of travel along a continuum, with elements of both being present in the accounts. We argue that consideration of the welfare of the child involves staff in ethical boundary-work across the two orientations and between the accountabilities and responsibilities of healthcare professionals, individuals and the state.The Wellcome Trust Biomedical Ethics Programme, who funded the project ‘Facilitating choice, framing choice: the experience of staff working in preimplantation genetic diagnosis’ (no. 074935)

A new method for accurate assessment of DNA quality after bisulfite treatment

The covalent addition of methylgroups to cytosine has become the most intensively researched epigenetic DNA marker. The vast majority of technologies used for DNA methylation analysis rely on a chemical reaction, the so-called ‘bisulfite treatment’, which introduces methylation-dependent sequence changes through selective chemical conversion of non-methylated cytosine to uracil. After treatment, all non-methylated cytosine bases are converted to uracil but all methylated cytosine bases remain cytosine. These methylation dependent C-to-T changes can subsequently be studied using conventional DNA analysis technologies. The bisulfite conversion protocol is susceptible to processing errors, and small deviation from the protocol can result in failure of the treatment. Several attempts have been made to simplify the procedure and increase its robustness. Although significant achievements in this area have been made, bisulfite treatment remains the main source of process variability in the analysis of DNA methylation. This variability in particular impairs assays, which strive for the quantitative assessment of DNA methylation. Here we present basic mathematical considerations, which should be taken into account when analyzing DNA methylation. We also introduce a PCR-based assay, which allows ab initio assessment of the DNA quality after bisulfite treatment and can help to prevent inaccurate quantitative measurement resulting from poor bisulfite treatment

STRUCTURAL PROCESSING OF VISUAL INFORMATION

One lesson that has been learned from previous approaches to scene analysis is that local methods are insufficient for extracting reliable information about the contents of a scene. Two different procedures that have been tried in order to remedy this deficiency are the use of knowledge via a priori information and internal models and multilevel analysis based on hierarchies of representations such as cone systems. It does not seem appropriate to drive the very first levels of analysis by a priori knowledge. It is doubtful that it will be possible to use knowledge in a way general and versatile enough to direct low level processing, and there is a need for some powerful data driven mechanisms that might at a later stage invoke internal models. It would seem more appropriate to obtain some crude global information through glancing or planning at low resolution levels that can drive a more scrutinous analysis at high resolution levels. While hierarchal systems are therefore good, the way they are currently being constructed is not necessarily good. In this context the issue of low level representation becomes more and more important, and not enough attention has been paid to this issue. Even Marr's provocative ideas about his primal sketch do not go to a sufficient level of analysis, and it is felt that more of the workload should be thrown onto the first processing levels. In this paper is posited a comprehensive hierarchal data structure that requires no decisions and therefore no parameters for its construction. The technique does not require preselected windows, but rather uses context-dependent criteria. The data structure is versatile, easily computed, and invertible in the sense that the original image is completely recoverable

CONTEXTUAL BOUNDARY FORMATION BY ONE-DIMENSIONAL EDGE DETECTION AND SCAN LINE MATCHING

No abstract available

CONTEXTUAL BOUNDARY FORMATION BY SCAN LINE MATCHING

In this paper an algorithm is given for generating linked edge boundaries between adjacent regions of different gray levels. In contrast with peak following algorithms, edges are treated as variable width regions, and the edge linking procedure is really a region grower. Edge linking is a parallel process on all the edges in pairs of adjacent scan lines, and contextual information in the direction of the scan lines is used to resolve ambiguous linking situations. The procedure relies heavily upon a one- dimensional edge detector that defers the formation of local edge interpretations until more informed decisions can be made by the edge linking procedure