Personalized 3D printed scaffolds:The ethical aspects

Personalized 3D printed scaffolds are a new generation of implants for tissue engineering and regenerative medicine purposes. Scaffolds support cell growth, providing an artificial extracellular matrix for tissue repair and regeneration and can biodegrade once cells have assumed their physiological and structural roles. The ethical challenges and opportunities of these implants should be mapped in parallel with the life cycle of the scaffold to assist their development and implementation in a responsible, safe, and ethically sound manner. This article provides an overview of these relevant ethical aspects. We identified nine themes which were linked to three stages of the life cycle of the scaffold: the development process, clinical testing, and the implementation process. The described ethical issues are related to good research and clinical practices, such as privacy issues concerning digitalization, first-in-human trials, responsibility and commercialization. At the same time, this article also creates awareness for underexplored ethical issues, such as irreversibility, embodiment and the ontological status of these scaffolds. Moreover, it exemplifies how to include gender in the ethical assessment of new technologies. These issues are important for responsible development and implementation of personalized 3D printed scaffolds and in need of more attention within the additive manufacturing and tissue engineering field. Moreover, the insights of this review reveal unresolved qualitative empirical and normative questions that could further deepen the understanding and co-creation of the ethical implications of this new generation of implants.</p

A value hierarchy for inclusive design of heart valve implants in regenerative medicine

Aim: This paper investigates the conditions for inclusive design of regenerative medicine interventions from a bioethical perspective, taking regenerative valve implants as a showcase. Methods: A value hierarchy is construed to translate the value of justice into norms and design requirements for inclusive design of regenerative valve implants. Results: Three norms are proposed and translated into design requirements: regenerative valve implants should be designed to promote equal opportunity to good health for all potential users; equal respect for all potential users should be shown; and the implants should be designed to be accessible to everyone in need. Conclusion: The norms and design requirements help to design regenerative valve implants that are appropriate, respectful and available for everyone in need.</p

Fair governance of biotechnology : patents, private governance, and procedural justice

Published online: 14 Dec 201

Opinions about euthanasia and advanced dementia: A qualitative study among Dutch physicians and members of the general public

Background: The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive (AED) when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia. Methods: In this qualitative study, 16 medical specialists, 19 general practitioners, 16 elderly physicians and 16 members of the general public were interviewed and asked for their opinions about a vignette on euthanasia based on an AED in a patient with advanced dementia. Results: Members of the general public perceived advanced dementia as a debilitating and degrading disease. Physicians emphasized the need for direct communication with the patient when making decisions about euthanasia. Respondent from both groups acknowledged difficulties in the assessment of patients' autonomous wishes and the unbearableness of their suffering. Conclusion: Legally, an AED may replace direct communication with patients about their request for euthanasia. In practice, physicians are reluctant to forego adequate verbal communication with the patient because they wish to verify the voluntariness of patients' request and the unbearableness of suffering. For this reason, the applicability of AEDs in advanced dementia seems limited

SHARE -- workpackage 5: evidence-based recommendations for diagnosis and treatment of kawasaki disease and henoch schönlein purpura

Peer reviewe

Gene drive technologies: navigating the ethical landscape

Gene drives are technologies that modify a particular genetic element in animals or insects so that this genetic element does not follow the typical rules of heredity, and is passed onto future generations with an increased likelihood. Gene drive technologies could be used to tackle intractable problems such as vector-borne diseases like malaria or the biodiversity impact of invasive species. At the same time, the development and governance of gene drives raise a range of ethical questions and concerns that warrant proactive ethical evaluation. In the PhD thesis ‘Gene drive technologies: navigating the ethical landscape’, Nienke de Graeff analyzes these questions and concerns. In Part I, she outlines the ‘ethical landscape’ of gene drive technologies by identifying the associated ethical challenges through literature review and empirical ethical research. Important challenges concern how the uncertainty and risks of these technologies should be navigated, whether it is morally permissible to intervene in nature in this way, and how the development, governance, and potential deployment of gene drive technologies should be guided. In Part II, De Graeff normatively analyzes various of these challenges and provides guidance to navigate them. In Part III, she stipulates recommendations for researchers and policymakers in the gene drive field as well as lessons learned for ethics parallel research as an approach for early ethical guidance of new and emerging technologies more generally

Gene drive technologies: navigating the ethical landscape

Gene drives are technologies that modify a particular genetic element in animals or insects so that this genetic element does not follow the typical rules of heredity, and is passed onto future generations with an increased likelihood. Gene drive technologies could be used to tackle intractable problems such as vector-borne diseases like malaria or the biodiversity impact of invasive species. At the same time, the development and governance of gene drives raise a range of ethical questions and concerns that warrant proactive ethical evaluation. In the PhD thesis ‘Gene drive technologies: navigating the ethical landscape’, Nienke de Graeff analyzes these questions and concerns. In Part I, she outlines the ‘ethical landscape’ of gene drive technologies by identifying the associated ethical challenges through literature review and empirical ethical research. Important challenges concern how the uncertainty and risks of these technologies should be navigated, whether it is morally permissible to intervene in nature in this way, and how the development, governance, and potential deployment of gene drive technologies should be guided. In Part II, De Graeff normatively analyzes various of these challenges and provides guidance to navigate them. In Part III, she stipulates recommendations for researchers and policymakers in the gene drive field as well as lessons learned for ethics parallel research as an approach for early ethical guidance of new and emerging technologies more generally

Alleviating the burden of malaria with gene drive technologies? A biocentric analysis of the moral permissibility of modifying malaria mosquitoes

Gene drive technologies (GDTs) have been proposed as a potential new way to alleviate the burden of malaria, yet have also raised ethical questions. A central ethical question regarding GDTs relates to whether it is morally permissible to intentionally modify or eradicate mosquitoes in this way and how the inherent worth of humans and non-human organisms should be factored into determining this. Existing analyses of this matter have thus far generally relied on anthropocentric and zoocentric perspectives and rejected an individualist biocentric outlook in which all living organisms are taken to matter morally for their own sake. In this paper, we reconsider the implications of taking a biocentric approach and highlight nuances that may not be evident at first glance. First, we shortly discuss biocentric perspectives in general, and then outline Paul Taylor's biocentric theory of respect for nature. Second, we explore how conflicting claims towards different organisms should be prioritised from this perspective and subsequently apply this to the context of malaria control using GDTs. Our ethical analysis shows that this context invokes the principle of self-defence, which could override the pro tanto concerns that a biocentrist would have against modifying malaria mosquitoes in this way if certain conditions are met. At the same time, the case study of GDTs underlines the relevance of previously posed questions and criticism regarding the internal consistency of Taylor's egalitarian biocentrism