Science, Technology, and Society

Bioethics
BIOETHICS
- is a field of study that examines the moral, social, and philosophical aspects of
biomedical and life sciences research, healthcare, and medical technology. It
involves the analysis of ethical principles, such as autonomy, beneficence,
non-maleficence, and justice, to address complex dilemmas emerging from
medical advancements. (Beauchamp & Childress, 2019).
ETHICS
- refers to the moral principles, values, and rules that guide human behavior and
decision-making. It is concerned with distinguishing right from wrong and
determining what is morally acceptable.
- Key Elements:
- Values: Personal beliefs and principles that influence ethical decisions
- Moral Principles: Fundamental rules, like honesty, fairness, and respect
- Social Norms: Shared expectations within a community or culture

Historical Development

Ancient Roots
- Bioethics has ancient origins in various cultures and medical traditions, with
ethical considerations dating back to ancient civilizations such as Egypt, India,
and Greece.
Hippocrates (460-370 BCE)
- "Father of Medicine“
- Hippocratic Oath: Introduced the Hippocratic Oath, emphasizing the importance
of patient well-being, confidentiality, and ethical conduct. This oath serves as a
cornerstone of medical ethics.
Modern Foundations (mid-20th century saw the formalization of bioethics as a
field of study)
- Nuremberg Code (1947) - developed ethical guidelines in response to the
unethical medical experiments during World War II
- Declaration of Helsinki (1964) - outlined ethical principles for medical research
involving human subjects
- Formation of Bioethics Centers - the Hastings Center (1969) and the
President's Commission (1983) marked key institutions in the growth of bioethics
Key Principles in Bioethics

Autonomy
- respect for an individual's right to make informed decisions about their own
healthcare
Beneficence
- the duty to do good and act in the best interests of the patient
Non-Maleficence
- the obligation to do no harm
Justice
- the fair and equitable distribution of healthcare resources
Veracity
- refers to the principle of truthfulness and honesty in healthcare
Confidentiality
- healthcare providers must keep patients' personal and medical information
confidential and not disclose it without the patient's consent

Notable Bioethics Violations

Professional Ethics
Stem Cell Case (2005-2006)
- Dr. Hwang Woo-Suk, a researcher and professor at Seoul National
University, published two papers in the journal Science that claiming his
team had succeeded in creating human embryonic stem cells through
cloning.
- Allegations followed from a co-worker that these paper was based on
fabricated data.
- As a result:
- The papers were editorially retracted
- Dr. Hwang lost his position at Seoul National University
- The South Korean government ended its financial and legal support
of his research

Patient Ethics
James Wilson (1999)
- Gene therapy researcher at the University of Pennsylvania in Philadelphia.
- Working in gene therapy for OTC deficiency (A genetic disorder of
resulting in a mutated and ineffective form of the enzyme Ornithine
transcarbamylase)
 - Directed a clinical trial involving gene therapy that led to the death of
18-year-old Jesse Gelsinger
- He failed to report the extent of the adverse reactions.
Consequences of Violating Bioethics

Loss of credibility
- trust between patients, colleagues, and the public can erode, making it difficult to
rebuild trust
Professional sanctions
- regulatory bodies and professional organizations may impose sanctions,
including license revocation or suspension
Lawsuits and criminal charges

Loss of funding and accreditation

Public outcry and reputation damage

Retraction of findings

Research blacklisting

Ethical violations can lead to harm, suffering, or even death of patients, which is
a profound consequence.

Reevaluation of ethics guidelines

Principle of non-contradiction

- The Principle of Non-Contradiction is crucial in navigating ethical dilemmas in

bioethics, ensuring consistency and coherence in moral reasoning.
- Bioethical principles, such as autonomy, beneficence, non-maleficence, and
justice, should not contradict each other within a given ethical framework.
- Example: "Respecting patient autonomy" and "Ensuring patient well-being" are
compatible, but these principles would contradict if a medical intervention is
performed without proper informed consent.
- In research, the principle ensures that the pursuit of scientific knowledge does
not compromise the well-being and rights of research subjects.
 Artificial Organs
DILEMMA - There's growing shortage of hearts, livers, and
lungs suitable for transplant

Organ Donation Statistics

As of November 2023 (US Data)

- More than 104,000 people are on transplant list
- Only 19,216 deceased and living donors give up organs for transplants

In the Philippines
- 139 transplant candidates (2022)
- About 40 organ donations for deceased donors transplanted (2022)

Challenges in Tissue Engineering

Cells form organs inside the human body

They need:
- support to grow
- supply of nutrients
- removal of waste
- protection against immune rejection

Blood Type Compatibility

BLOOD TYPE CAN RECEIVE FROM CAN DONATE TO

Type A A, O A, AB

Type B B, O B, AB

Type AB A, B, AB, O AB

Type O O A, B, AB, O

- A, B, AB, and O are the main blood types.

 - Rh factor (+ or -) is another important consideration.
- Rh Factor Compatibility:
- Rh+ individuals can receive Rh+ or Rh- blood.
- Rh- individuals should ideally receive Rh- blood.
- In emergencies, O - blood is often used because it can be given to individuals
with any blood type.

Solution
Xenotransplantation
- Transportation of organs from one species to another
- For example: a pig organ to a human
- Why pigs?
- Pigs can provide the organs that we need.
- They are of the right size, and we have an infrastructure to grow
them in large numbers.
- A pig's organ can buy time for a patient waiting for a human organ.
- But…
- The human immune system does not take kindly to the presence of
a pig organ.
- human leukocyte antigen (HLA)
- Pigs also have another antigen called galactose-alpha
1,3-galactose (alpha-Gal)
- Humans have longer lives
- “bridge organ”
- What about spread of diseases?
- Pig genomes also contain the remnants of viruses that stowed
away millions of years ago.
- Genetically modified pigs are housed in pristine conditions and
regularly checked for
infections.
- Alternatives:
- Decellurating Organs
- Decellularization involves
thoroughly breaking
down and eliminating all
cells, extracting the
cellular elements from
biological tissue, and
retaining solely the
 extracellular matrix (ECM).

Stem Cells
Stem Cell History

1998
- Researchers successfully extract stem cells from human embryos, marking
apivotal moment in stem cell research.
1999
- The first successful human transplant of insulin-making cells from cadavers
demonstrates the potential therapeutic applications of stem cells.
2001
- President George W. Bush imposes restrictions on federal funding for embryonic
stem cell research, sparking debates on ethical and scientific fronts.
2002
- The Juvenile Diabetes Research Foundation International launches a $20 million
fundraising effort to support stem cell research, highlighting the growing interest
in private funding for such endeavors.
- California becomes a trailblazer by endorsing state-funded stem cell research.
2004
- Harvard researchers achieve a significant breakthrough by growing stem cells
from embryos using private funding, showcasing the importance of diverse
funding sources.
- A ballot measure for a $3 billion bond to support stem cell research reflects
public support for advancing this field.

STEM CELLS
- Stem cells are undifferentiated cells characterized by their unique ability to
develop into various specialized cell types.
- Self-renewal: Stem cells can divide and produce identical daughter cells,
maintaining a pool of undifferentiated stem cells.
- Differentiation: Stem cells can undergo a process called differentiation,
where they mature into specific cell types with distinct functions. This
ability to differentiate into various cell types is what makes stem cells
remarkable and crucial for development, tissue repair, and regeneration.
Possibilities of Stem Cells
- Regenerating damaged or diseased tissues and organs
- Disease modeling
- Personalized medicine
- Addressing individual variations for enhanced treatment outcomes
- Treatment of: leukemia, neurological disorders, diabetes management, cancer
- Improved quality of life
- Tissue regeneration
- Longevity research
- Immune system enhancement
- Artificial organs and tissues

Stem Cell Characteristics

- 'Blank cells' (unspecialized)
- Capable of dividing and renewing themselves for long periods of time
(proliferation and renewal)
- Have the potential to give rise to specialized cell types (differentiation)

Kinds of Stem Cells

Stem Cell Type Description Examples

Totipotent Each cell can Cells from early

develop into a new (1-3 days) embryos
individual

Pluripotent - Cells can form Some cells of

any (over 200) blastocyst
cell types ( 5 to 14 days)
- Possess greater
potential to
differentiate into
any type of cell
 Multipotent - Cells Fetal Tissue, cord
differentiated, blood, and adulth
but can form a stem cells
number of other
tissues
- Limited in their
capacity to
differentiate into
specific
celltypes

Types of Stem Cells

1. Embryonic Stem Cells (ESCs)

- Source: Derived from the inner cell mass of a five to six-day-old embryo
- Characteristics: Exhibit a 'tabula rasa' state
2. Embryonic Germ Cells
- Source: Derived from the part of a human embryo or fetus that will ultimately
produce eggs or sperm (gametes)
- Function: Pluripotent stem cells with the potential to differentiate into various cell
types
3. Adult Stem Cells
- Location: Found among specialized or differentiated cells in a tissue or organ
after birth
- Characteristics: Limited differentiation, capable of self-renewal
In Vitro Fertilization (IVF)

In Vitro Fertilization (IVF)

- is an assisted reproductive technology (ART) that involves fertilizing an egg with
sperm outside the body, in vitro, and then implanting the fertilized embryo into the
uterus.
- Process Overview:
a) Stimulation of Ovaries
b) Egg Retrieval
c) Fertilization
d) Embryo Culture
e) Embryo Transfer

Intra-Cytoplasmic Sperm Injection

1 2 3 4

5 6 7 8
At what point is this a fetus?

● Days 7-14: Uterine implantation

● Day 14: Three distinct layers form
● Formation of three germ layers marks the end of pluripotent stem cell stage.
● Embryo development begins with the ectoderm, mesoderm, and endoderm.
● Days 14-21: Beginning of future nervous system
● Days 21-24: Facial features start taking shape, marking the beginning of facial
development
● Weeks 3-8: Key organs and body systems begin to form during this critical period
● Weeks 5-8+: Transition to fetus

NOTE: There's no consensus on a specific timepoint for the transition

Adult Stem Cells

- Undifferentiated cells found among specialized or differentiated cells in a tissue
or organ after birth
- May be found in: skin, fat cells, bone marrow, brain, many other organs & tissues

How do cells know what to become?

- The central dogma of biology: DNA to RNA to proteins.
 - All cells in an individual have the same set of genes.
- Genes are segments of DNA that carry instructions for building proteins.
- The type of proteins produced influences a cell's function and fate.
- Cells receive signals from their environment that guide their development.

Induced Pluripotent Stem Cells

- These stem cells are created or induced in
the laboratory
- Unlike embryonic stem cells, which are
naturally found in embryos, iPSCs are
generated by reprogramming adult cells.
- Induces the adult cells to regain
pluripotency, meaning they regain the ability
to differentiate into various cell types,
similar to embryonic stem cells

Pros and Cons to iPS cell technology

Pros: Cons:

- Eliminates the need for embryos in the - iPSCs derived from a patient with a
generation of pluripotent stem cells genetic defect will retain the same
- iPSCs can be created from a patient's genetic abnormalities.
own cells, reducing the risk of - Potential for genetic mutations or
rejection in therapeutic applications. abnormal cell behavior
- Valuable tool for studying diseases in - iPSCs have the potential to form
 a controlled environment. tumors, raising concerns about their
- Can be directed to become specific safety for clinical applications.
cell types needed for specific - Can be complex and costly
therapies.

Bone Marrow
- Soft and spongy tissue inside bones that
plays a crucial role in the body's blood and
immune system
- Houses hematopoietic stem cells (HSCs), a
type of multipotent stem cell
- HSCs give rise to various blood cells,
including red blood cells, white blood cells,
and platelets.
- Treat patients diagnosed with leukemia,
aplastic anemia, and lymphomas
- Need for greater histocompatibility

Umbilical Cord Stem Cells

- Adult stem cells of infant origin, obtained

from the umbilical cord tissue
- Collection is less invasive compared to
procedures like bone marrow extraction
- Shows enhanced compatibility,
minimizing the risk of rejection in
transplants
 - Used in the treatment of diseases such as leukemia, blood disorders, and
immune system disorders.

Technical Challenges

- Cell differentiation control

- Genetic stability
- Immunocompatibility issues
- Tissue integration
- Ethical considerations
- Scalability and production efficiency
- Long-term safety and efficacy
- Transitioning from preclinical success to successful clinical applications

Why the controversy over stem cells?

- Controversy often centers around the use of embryonic stem cells, derived from
early-stage embryos.
- Fundamental disagreements about when life begins contribute to ethical
dilemmas.
- Balancing scientific progress with the moral responsibility to respect and protect
human life.

National Institutes of Health Guidelines for Research Using Human Stem Cells

Scope of Guidelines:
- Apply to NIH funds for research using human embryonic stem cells (hESCs) and
certain induced pluripotent stem cells.
- Implement Executive Order 13505 and align with HHS regulations for the
Protection of Human Subjects.

Eligibility Criteria - U.S. Embryos (Effective Date Onwards 07/07/2009):

- Derived from embryos created for reproductive purposes, no longer needed for
this purpose.
- Donated voluntarily with written consent for research.
- Assurance of compliance with specific conditions, ensuring transparency and
ethical standards.

Principles Guiding Guidelines:

 - Responsible research potential for improving human health understanding.
- Voluntary and informed consent for individuals donating embryos for research.
- Consistent review and periodic updates as directed by Executive Order 13505.

Informed Consent Highlights:

- Clarity on the purpose of hESC derivation for research.
- Disclosure of potential commercial implications and lack of direct medical benefit
to donors.
- Assurance of donors' right to withdraw consent until actual hESC derivation.