Biomedical Engineering Reference
In-Depth Information
The scientific and medical community is increasingly aware that fundamental
ethical principles should govern research and medicine. nearly every person
engages in ethical discourse, but the ethical analysis of complex biomedical
events, like regenerative medicine and the development of appropriate ethical
guidance, is usually considered to be the province of (bio)ethicists. While
ethicists are addressing these issues, it is unrealistic to expect that they will
provide simple answers to complex questions, or that they will present the
community with clear and prohibitive rules for shaping human conduct.
moreover, ethicists do not operate in a vacuum, but work within particular
paradigms and narratives that influence their analyses and conclusions.
Therefore ethicists will seldom be able to 'solve' ethical problems, such as the
use of human embryonic stem cells, in the same way that scientists, engineers
or physicians are able to solve the challenges they face. What ethicists do
is analyse the ethical relevance of a medical/scientific innovation, of the
circumstances under which it is applied and of its ends and ramifications.
They argue their position and advise those who must eventually make
their own decisions. sometimes this advice may gather a consensus and be
formalised later in guidelines, codes of conduct, conventions or legislation
at national or supranational level.
in this chapter we will focus exclusively on the ethical issues generated
by the development of bone tissue engineering as an example of regenerative
medicine because the inclusion of human cells in a tissue engineered product
entails a number of specific ethical issues that are not present in other
applications of bone repair (Trommelmans
et al
., 2007a). However, many
of the issues covered here are also relevant for other bone repair therapies,
such as the conduct of clinical trials and the difficulties of obtaining informed
consent.
Two questions come to mind: are there fundamental arguments for
rejecting regenerative medicine on ethical grounds? if not, what would be
the ethical requirements for the development and application of this new
technology?
Does the concept of regeneration itself raise fundamental ethical objections
that would compel us to reject this paradigm altogether? We argue that this
is not the case.
regenerative medicine contrasts with other medical approaches in that
it explicitly intends to regenerate the body into full physiological capacity.
The
ex vivo
construction of a bone tissue engineered product (BTeP), its
implantation and integration in the recipient's body is but one application of
regenerative medicine. regeneration occurs continuously in the human body,
although some tissues have an extremely limited spontaneous regenerative
capacity. regeneration of bone with the aid of a BTeP therefore does not
seem to alter any fundamental quality of the human body or person, unless one
finds every intervention in the body ethically unacceptable
per se
. enabling
