Abstract: The article highlights some of the major considerations in the important branch of applied ethics, Bio ethics. This branch of ethics is concerned with the study of ethical issues and decision-making associated with the use of living organisms. Bio ethics is the ‘applied ethics’, which focuses on the study of ethical issues that arise or might be anticipated to arise, in the context of real activities in the field of medicine, nursing, other healthcare professions, veterinary medicine, environmental sciences, life sciences and more. The article discusses the important branches of bin ethics, with special focus on medical ethics and much debated topics such as stem cell research and the human genome project.
Keywords: applied ethics, bio-ethics, reproductive technology, medical ethics, prenatal diagnosis, artificial insemination, Invitro, surrogate mother, genetic technology, cloning technology, gene therapy, somatic cell therapy, germline gene therapy, stem cell research, human genome project
After the second world war, the scars made by the destructive ‘nerve gas’ usage and mass destruction caused by atom bombs and upgraded weapons, made intellectuals and social philosophers think seriously about the various negative aspects of technological developments. Alfred Nobel and Albert Einstein were among those who regretted their scientific discoveries. In this context the importance of the application of ethics and moral values in the day to day technological development was highlighted. This practical application of morals later came to be molded into a separate field of study called Practical. Ethics.
Practical Ethics is the practical application of ethics in various activities of the human being, aided directly or indirectly by technology. As most of these activities deal with the ‘Bio sphere’, the term ‘Bio ethics’ is often used as a synonym for Practical Ethics. When we analyse the history of ethics, we can understand that the seeds of ethics were indirectly present in the human soul. That is, ethics is the correct determination of what is right or what is wrong, what to do or what not to do, what ought to be done or what ought not to be done, in various situations. The various ethical theories are cornerstones of ethics.
Ethical theory indicates a distinctive way of looking at ethical issues–a distinctive way of making sense of them and of attempting to resolve them. The three major types of ethics are:
- Normative ethics – the study of how to determine ethical values
- Meta ethics – the study of the concept of ethics
- Applied ethics – the study of the use of ethical values
Normative ethics deal with the study of ethical norms and ideals which will help to judge whether an action is right or wrong. Normative ethics is primarily concerned with establishing standards or norms for conduct and is commonly associated with general theories about how one ought to live. It is articulation of good character and the duties one should possess.1 It includes:
- Nicomachean ethics – the ethics of Aristotle, which highlights virtuous character and the golden means.2
- Utilitarian ethics – which considers the greatest happiness of the greatest number as the ultimate moral standard.3
- Kantian ethics – deals with the ethics of Kant.4
- Jaina ethics – which discusses the chief ethical concepts like universal brotherhood, five vows–ahimsa, satya, asteya, brahmacharya and aparigraha, tri-ratnas -right faith, right knowledge, right conduct.5
- Gandhian ethics – A new outlook on life based on the ethical doctrines of Ahimsa and Satya6 which can successfully resolve all the social, political and economical problems in the light of these principles.
Meta ethics centers on questions relating to the nature and origin of moral concepts and judgments. Philosophers in Meta ethics have taken markedly different positions on this matter. There has also been much disagreement over whether moral judgments are objective or subjective, absolute or relative. Of the various Meta ethical theories, the prima facie duty of W.D. Ross is most significant.
Prima facie duty of W.D. Ross – To him it is the moral consciousness which inspires moral activities. His intuitionalism speaks of the source of moral obligation in performing ‘Prima Fade Duty.‘7
Applied ethics or practical ethics deals with the practical problems and tries to resolve them in the wake of ethics. It includes: .
- Business ethics – The application of ethics in the field of business.
- Media ethics – The application of various ethical principles in the field of mass media communication.
- Computer ethics – The application of ethics in the field of Internet, cyber space etc.
- Legal ethics – The application of ethics in the field of law.
- Bio ethics
Bio ethics is the branch of applied ethics which deals with issues related to life. It may be defined as the study of ethical issues and decision-making associated with the use of living organisms. The term bio ethics is derived from the two Greek words ‘Bios’ which means life and ‘Ethike’ which means ethics.8 It is concerned with the study of ethical issues arising in the practice of biological disciplines which includes medicine, nursing, other healthcare professions, veterinary medicine, environmental sciences, life sciences etc. Bio ethics is the ‘applied ethics’, which focuses on the study of ethical issues that arise or might be anticipated to arise, in the context of real activities.
Three important branches of bio ethics are:-
- Environmental ethics – The study of various ethical problems affecting the environment as a whole. It includes issues such as global warming, ozone depletion, acid rains, and pollutions.
- Medical ethics – The study of various ethical issues involved in the medical profession. It includes the ethical issues involves in the patient-doctor relationship, assisted reproductive technology etc.9
- Ethics of Genetic Technology It is a very important field of bio ethics which deals with the various ethical issues involved in the technological advancement of genes.
Now let us look at these branches in detail.
Environmental ethics, which started as an ecological movement in the 1970s focuses its attention on the kind of relation between human, life and its natural environment.10 It emphasises the fact that the non-human environment is not just a passive surrounding but has a profound effect on human life. This movement springs out of the recognition of the manifold ways in which human activities can give rise to environmental degradation. It appeals to innumerable evidences from natural sciences such as food chain, ozone layer, green house effect etc. It also points out a wide variety of human attitudes including religious, social, and scientific which accounts for the deterioration.
Medical Ethics begins with the relationship of the doctor to the patient. It deals with important issues such as the autonomy of the patient which is the obligation of the doctor to help the patient to attain his own interests; informed consent which is the consent of the patient to decide what shall be done to him; confidentiality which is the informational privacy which should not be disclosed to a third party; justice or the right to health; the professional misconduct called malpractice; negligence; truth telling; and beneficence. It also deals with the issues of the usage of technologies. So ethics of medical technology refers to the systematic intervention of ethics with the diagnostic or therapeutic application of science and technology to improve the management of healthcare system. It always seeks practical solutions to problems normally raised by clinicians with defined medical needs. The various important technologies used in the medical profession are:-
Assisted Reproductive Technologies
These are the technologies used by the medical professionals for the management of the problems related to reproduction i.e., all the medical technologies used for the treatment of infertility. Medical technology is providing new choices for fulfilling the desires of infertile parents. More and more technologies are being developed which change the roles of different persons involved in reproducing, including genetic and social. parents. Important technologies used in assisted reproduction are prenatal diagnosis, Artificial insemination, Invitro – fertilisation, surrogate motherhood etc. ‘
Prenatal diagnosis is the general process of identifying the sex of the embryo with the help of technologies such as amniocentesis and scanning, even before its birth.11
This refers to the process of deposition of semen into the genital canal of a woman through a syringe in order to help fertilisation. Artificial insemination raises many questions like, what is the guarantee of pregnancy, percentage of the possibility of birth defects, is there any possibility of transmitting diseases, and guarantee about the fusion of real sperm and egg.
- There is no guarantee of pregnancy
- There are possibilities of birth defects
- There are possibilities of transmitting diseases
Invitro – Fertilisation
Invitro – fertilisation is the process of fertilisation inside a test tube and is most often proposed as a technique for overcoming infertility in married couples. It raises ethical questions like the norm adopted by the doctor to treat; whether the patient is a mere experimental substance; whether there is any value for the life of the baby and more. Invitro- fertilisation in general also involves questions related to aspects such as:
- Extraction of oocytes from a woman, impregnation within the laboratory by her lawful husband’s sperm
- Extraction of oocytes from a woman, fertilisation in the laboratory with sperm provided by a person other than the husband
- Oocytes extracted from another woman and fertilised by the husband’s sperm
- Third parties provide both the oocytes and the sperm
What is the role of the woman who acts the part of the mother by carrying the child as taxi mother in the place of the original mother? That is, a woman gets pregnant for another woman. Surrogate motherhood is a form of collaborative or assisted reproduction that typically involves three persons: a married infertile couple called the intended parents and a surrogate mother. Some considerations include:
- Do you think surrogate mothers should be paid?
- Would you consider being a surrogate mother as a part-time job?
- In some countries only married women who already have children are allowed to be surrogates. Why do you think that law was made?12
Euthanasia is the process of ending a person’s life in order to reduce pain from an incurable disease, intolerable suffering, or undignified death. Though the term is used to refer to causing death painlessly, it is also extended to mean the failure to prevent death from natural causes for merciful reasons.13 It is the intentional termination of the life of one human being by another.
Ethics of Genetic Technology
Ethical of genetic technology is the study of the moral or ethical implications of technologies resulting from the advancement of genetic researches or genetic technology. These technologies include:-
It is the technology by which an identical twin is produced from the body cell by manipulating the genes. It is the process of production of a cell or an organism from a somatic cell of an organism with the same nuclear genomic characters–without fertilisation. It refers to a method of reproduction apart from the parental, sexual mating process that is characteristic of most organisms.14 Some of the ethical issues involved are the problem of species diversity, problem of mutable diseases in clones, consequences of the human cloning and more.
- Technical and medical safety
- Undermining the concept of reproduction and family
- Ambiguous relations of a cloned child with the progenitor
- Confusing personal identity and harming the psychological development of a clone
- Contrary to human dignity
- Promoting treads towards designer babies and human enhancements15
Gene therapy is the usage of technologies for manipulation and treating of genes. In May 2007 Moorefield’s Eye Hospital and University College London’s Institute of Ophthalmology announced the world’s first gene therapy trial for inherited retinal disease. Researchers may use one of several approaches for correcting faulty genes:
- A normal gene may be inserted into a non-specific location within the genome to replace a non-functional gene. This approach is most common.
- An abnormal gene could be swapped for a normal gene through homologous recombination16
- The abnormal gene could be repaired through selective reverse mutation, which returns the gene to its normal function.
- The regulation (the degree to which a gene is turned on or off) of a particular gene could be altered.
Types of Gene Therapy
Gene therapy can be distinguished into two types, i.e., somatic cell therapy and germ line therapy.
Somatic Cell Therapy
The introduction of corrective genes into somatic cells (most cells of body) is called somatic cell therapy. All gene therapy to date on humans has been directed at somatic cells. Somatic gene therapy can be broadly split into two categories, i.e., ex vivo17 and in vivo.18
— Germline Gene Therapy
The replacement of the faulty studies, a ‘normal’ gene is inserted into the genome to replace an ‘abnormal’ disease-causing gene. A. carrier molecule called a vector must be used to deliver the therapeutic gene to the patient’s target cells. Currently, the most common vector is a virus that has been genetically altered to carry normal human DNA. Viruses have been delivering their genes into human cells in a pathogenic manner. Scientists have tried to take advantage of this capability and manipulate the virus genome to remove disease-causing genes and insert therapeutic genes.
Target cells such as the patient’s liver or lung cells are infected with the viral vector. The vector then unloads its genetic material containing the therapeutic human gene into the target cell. The generation of a functional protein product from the therapeutic gene restores the target cell to a normal state.
Stem Cell Research
Stem cell research is the technology by which the undifferentiated cells are used for various purposes such as treatment. Over the past decade or so we have seen a tremendous surge of information on stem cells in scientific literature. On the one hand there is an understandable excitement about the promise that these enigmatic cells hold of a major revolution in biomedical, sciences, On the other hand there are serious ethical concerns regarding the source from which they are obtained and also about their possible misuse. In Europe and the US, public opinion is playing a major role in shaping policies regarding research and use of stem cells. However, the issues surrounding the use of stem cells are complex and far from clear.19
Certain organisms have a fascinating capacity to regenerate tissues and body parts. The organism Planaria,20 for example, when chopped in to pieces, can grow back to a whole. The ability of salamanders to regenerate their tails is well studied. This phenomenon is more common among invertebrates; however, higher organisms are generally incapable of organ regeneration. Human beings have a very limited capacity of tissue repair, confined chiefly to wound healing. The first line of treatment for major tissue loss therefore, was by using synthetic substances. Starting with artificial limb prosthetics, a wide array of medicinal implants is used nowadays for advanced medical care. These include artificial teeth, joint replacements, cardiovascular stents, synthetic heart valves and more. The next stage was the use of biological materials from skin grafting to liver and bone marrow transplants. While the use of synthetic products is limited to particular cases, transplantation medicine is severely challenged by the host’s immune system. The need, therefore, was to find a biological material capable of tissue regeneration without invoking immune rejection. Stem cells are emerging as the most promising candidates for this new medicine.
The human body is assumed to be composed of three basic categories of cells: somatic cells, germ cells, and stem cells. The bulk of the organism, including all the organs that make up a human adult are made up of somatic cells. Somatic cells are already specialised; they can only give rise to similar cells. Skin cells can only make skin and not liver or heart cells, for example. They can only divide a finite number of times after which they become senescent and die. The theoretical limit for the number of times a specialised cell can divide is called the Hay flick Limit and is around 50 population doublings.
The germ cells are cells that give rise to the gametes, sperms and eggs. The fusion of the male and female gametes forms the Zygote. The zygote has the capacity to generate all cell types including the entire foetus, a unique characteristic called developmental “totipotency”. Though the zygote is placed at the top of the stem cell hierarchy, these cells cannot self- renew and are therefore not strictly considered as stem cells. Stem cells are defined as that which can (a) divide infinitely in culture, and, (b) have the potential to produce other mature specialised cells. So, when a stem cell divides, the daughters could be maintained as stem cells by self renewal or be differentiated to produce specialised cell types. Stem cells are theoretically considered to have a capacity for infinite divisions. Some human embryonic stem cells are known to have gone through 300 divisions, far exceeding the Hay flick Limit. Stem cells are totipotent, pluripotent and multi potent.21
In 1981, the first identification and isolation of embryonic stem cell or ES cells from mice was reported. ES cells have been consequently derived from primates and humans. These cells are derived from the inner cell mass (ICM) of mammalian embryos from the blastocyst stage.22 In labs they are sub cultured over feeder cell to establish what are called ES cell lines. They are pluripotent and hence a potential source for any given cell types. Studies have shown that ES cells can be used to regenerate damaged tissues of the nervous system, heart, bones, liver and blood, justifying the tremendous potential of this line of work. Additionally, the necessity of culturing these cells over mouse feeders is a problem to be dealt with as it can cause immune reaction in the recipient during transplant.
Foetal stem cells are stem cells in the foetus which later develop in to the various organs. There seems to be some advantage in the use of foetal stem cells over ES cells. For example, the umbilical cord is a source of foetal ha ematoietic cells and thus seems to provide a source free from ethical considerations. However, research on foetal stem cells is still under way.
Currently a lot of interest has focused on the adult stem cells (or somatic stem cells) which have been found in many tissues and organs. The best known example is the haematopoietic stem cell (HSC) which is the precursor of all blood cell types. HSCs have been known and used for the last 40 years in clinical settings for various diseases of the blood.
Although the adult cells are multipotent, they are not believed to be able to cross lineages. This implies that the haematopoietic progenitor can produce cells of the blood while the skin progenitor produces cells of the skin. But are there pluripotent adult stem cells too? Recently, researchers have observed in animal studies that haematopoietic stem cells appear to be able to form other kinds of cells, such as muscle, blood vessels and bone. This newly discovered plasticity of adult stern cells is now being called ‘transdifferentiation’ and seems to contradict the established notion of strict cell lineage commitment in development. If such cells do exist, it will be a major breakthrough in the field of stem cell research as it will circumvent the necessity of using ES cells, whose use still remains ethically controversial.
Human Genome Project
Human genome project is the project of tracing each and every gene. Initiation of the Project was the culmination of several years of work in 1984. The ultimate goal of this initiative is to understand the human genome. It is said that the knowledge of the human genome is as necessary to the continuing progress of medicine and other health sciences as knowledge of human anatomy has been for the present state of medicine.
Due to widespread international cooperation and advances in the field of genomics, in sequence analysis, as well as major advances in computing technology, a ‘rough draft’ of the genome was finished in 2000. Ongoing sequencing led to the announcement of the essentially complete genome in April 2003, 2 years earlier than planned. In May 2006, another milestone was passed on the way to completion of the project, when the sequence of the last chromosome was published in the journal Nature.
There are multiple definitions of the ‘complete sequence of the human genome.23 According to some of these definitions, the genome has already been completely sequenced, and according to other definitions, the genome has yet to be completely sequenced. There have been multiple popular press articles reporting that the genome was “complete.” The genome has been completely sequenced using the definition employed by the International Human Genome Project. A graphical history of the human genome project shows that most of the human genome was complete by the end of 2003. However, there are a number of regions of the human genome that can be considered unfinished. First, the central regions of each chromosome, known as centromeres, are highly repetitive DNA sequences that are difficult to sequence using current technology. The centromeres are millions of base pairs long, and for the most part these are entirely unsequenced. Second, the ends of the chromosomes, called telomeres, are also highly repetitive, and for most of the 46 chromosome ends these too are incomplete. We do not know precisely how much sequence remains before we reach the telomeres of each chromosome, but as with the centromeres, current technology does not make it easy to get there. Third, there are several loci in each individual’s genome that contain members of multigene families that are difficult to disentangle with shotgun sequencing methodologies – these multigene families often encode proteins important for immune functions. It is likely that the centromeres and telomeres will remain unsequenced until new technology is developed that facilitates their sequencing. Other than these regions, there remain a few dozen gaps scattered around the genome, some of them rather large, but there is hope that all these will be closed in the next couple of years. So our best estimates of total genome size indicate that we have completed about 92% of the genome. Most of the remaining DNA is highly repetitive and unlikely to contain genes, but we cannot truly know until we sequence all of it. Understanding the functions of all the genes and their regulation is far from complete. The roles of junk DNA, the evolution of the genome, the differences between individuals, and many other questions are still the subject of intense study by laboratories all over the world.
The goals of the original HGP were not only to determine more than 3 billion base pairs in the human genome with a minimal error rate, but also to identify all the genes in this vast amount of data. This part of the project is still ongoing, although a preliminary count indicates about 30,000 genes in the human genome, which is fewer than predicted by many scientists. Another goal of the HGP was to develop faster, more efficient methods for DNA sequencing and sequence analysis and the transfer of these technologies to industry.
The process of identifying the boundaries between genes and other features in raw DNA sequence is called genome annotation and is the domain of bioinformatics. While expert biologists make the best annotators, their work proceeds slowly, and computer programs are increasingly used to meet the high-throughput demands of genome sequencing projects. The best current technologies for annotation make use of statistical models that take advantage of parallels between DNA sequences and human language, using concepts from computer science such as formal grammars. All humans have unique gene sequences; therefore the data published by the HGP does not represent the exact sequence of each and every individual’s genome. It is the combined genome of a small number of anonymous donors.
HGP is the most well known of many international genome projects aimed at sequencing the DNA of a specific organism. While the human DNA sequence offers the most tangible benefits, important developments in biology and medicine are predicted as a result of the sequencing of model organisms, including mice, fruit flies, zebrafish, yeast, nematodes, plants, and many microbial organisms and parasites.
The work on interpretation of genome data is still in its initial stages. It is anticipated that detailed knowledge of the human genome will provide new avenues for advances in medicine and biotechnology. Clear practical results of the project emerged even before the work was finished. For example, a number of companies, such as Myriad Genetics started offering easy ways to administer genetic tests that can show predisposition to a variety of illnesses, including breast cancer, disorders of hemostasis, cystic fibrosis, liver diseases and many others. Also, the etiologies for cancers, Alzheimer’s disease and other areas of clinical interest are considered likely to benefit from genome information and possibly may lead in the long term to significant advances in their management.
There are also many tangible benefits for biological scientists. For example, a researcher investigating a certain form of cancer may have narrowed down his/her search to a particular gene. By visiting the human genome database on the worldwide web, this researcher can examine what other scientists have written about this gene, including (potentially) the three-dimensional structure of its product, its functions, its evolutionary relationships to other human genes, or to genes in mice or yeast or fruit flies, possible detrimental mutations, interactions with other genes, body tissues in which this gene is activated, diseases associated with this gene or other datatypes.
Further, deeper understanding of the disease processes at the level of molecular biology may determine new therapeutic procedures. Given the established importance of DNA in molecular biology and its central role in determining the fundamental operation of cellular processes, it is likely that expanded knowledge in this area will facilitate medical advances in numerous areas of clinical interest that may not have been possible without them.
The analysis of similarities between DNA sequences from different organisms is also opening new avenues in the study of the theory of evolution. In many cases, evolutionary questions can now be framed in terms of molecular biology; indeed, many major evolutionary milestones (the emergence of the ribosome and organelles, the development of embryos with body plans, the vertebrate immune system) can be related to the molecular level. Many questions about the similarities and differences between humans and our closest relatives (the primates, and indeed the other mammals) are expected to be illuminated by the data from this project.
The Human Genome Diversity Project, spinoff research aimed at mapping the DNA that varies between human ethnic groups, which was rumoured to have been halted, actually did continue and to date has yielded new conclusions. In the future, HGDP could possibly expose new data in disease surveillance, human development and anthropology. HGDP could unlock secrets behind and create new strategies for managing the vulnerability of ethnic groups to certain diseases. It could also show how human populations have adapted to these vulnerabilities.
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