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Stem Cells & Cloning 3/23/05

Mr. JOHN MICHAEL O. LORENA,


RN MAN
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Objectives:
1. Define the domains of ethics
2. Explain basic ethical principles
3. Formulate ideas and stand on various
bioethical issues


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Course Description
Deals with the ethics and moral decision
making in relation to advances in the life
and health sciences.
It includes issues and principles on death,
animal welfare, beneficence, maleficence,
respect for persons, resource allocation
and biotechnology
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Basics of
BIOETHICS
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Course Outline
Dates Chapters Topics
April 12-16 1-2 Ethics
Hippocratic Oath
April 19-23 3-4 Death, Abortion and Animal
Welfare
Benefitting and Avoiding
Harm
April 26-April 30 5-6 Respect for Persons
Avoiding Killing
May3-7 7-8 Death & Dying
Social Ethics
May 10-14 9-10 Human Control of Life
Resolving Conflicts among
Principles
May 17-21 11 Virtues in Bioethics
Final Exam
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1. Basics of
Bioethics by
Veatch, 2
nd
Edition
2. Other books
(Ethics)
Required Book:
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Classroom Management
1. No opening of book during lecture sessions
1. Must have notebook (Major requirement)
2. Punctuality
1. Locking of doors
2. Readmission slips/ Medical certificate
3. Examination
1. Quizzes
1. No Make-up quizzes
2. Graded Recitation
3. Examination booklet
1. Blue ink
2. Crossing out scheme
4. No using of cellular phone during lecture hours
1. Penalty
5. Grading System


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Basics of
BIOETHICS
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What is.
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Phencyclidine
Case 1
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Personal reflection.
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ETHICS
Greek word ethicos or ethos (custom or
character)
Philosophical science that deals with the
morality of human conduct
Philosophical discipline that provides the
principles on the morality of human acts
Provides theories and principles of right or
wrong and good or bad actions
The should of human behavior
The study of morals
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Types of ethics
1. Bioethics or Clinical ethics
1. Ethics applied to human life or health
1. Abortion or euthanasia
2. Nursing ethics
1. Refers to ethical issues that occur in the
nursing practice
1. Patient confidentiality; being patient advocate
3. Management or business ethics
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Morality
Latin word mos or moris
Means custom
Actualizes the theories and principles
(provided by Ethics)
Relates to peoples behavior
Other term is Applied ethics
Function:
Apply these theories and principles
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1. I do not talk with my seatmates during fire
drill because that is one of the rules.
2. I do not say bad words because if I do,
mommy will get mad at me.
3. I pay taxes because it is the right thing to
do.
4. For a cookie, I will pick up my toys.
5. I do not eat in class because my teacher
does not like it.
6. I pay taxes because it is the law.


What specific stages of Moral Development are the
following examples?

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Moral Development Stages
PRECONVENTIONAL / PREMORAL LEVEL
(Egocentric focus)
Stage 1 (Punishment Avoidance - Obedience)
right and wrong is determined by what is
punished
Stage 2 (Instrumental-Relativist) right and wrong
is determined by what is rewarded; own needs a
priority
CONVENTIONAL LEVEL (Societal focus)
Stage 3 (Good Boy/Girl) right and wrong is
determined by close others approval or
disapproval; pleases others
Stage 4 (Law and Order Orientation) right and
wrong is determined by societys rules and laws,
which should be obeyed rigidly; rules as
inflexible, unchangeable
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POSTCONVENTIONAL LEVEL (universal focus)
Stage 5 ( Social Contract Legalistic Orientation )
right and wrong is determined not only by
social rules but also higher moral principles like
equality, justice or due process
Stage 6 (Universal-Ethical Principle Orientation)
right and wrong is determined by abstract
ethical principles that emphasize justice and
equity; decisions are based on conscience rather
than social laws

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BIOETHICS
Daniel Callahan together with Willard
Gaylin, 1969 (Hastings Center)
Van Rensselaer Potter, 1970 (popularized)
Oncologist
Bio (life)
Ethos (ethics/custom)
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"Biology combined with diverse
humanistic knowledge forging a
science that sets a system of
medical and environmental
priorities for acceptable survival.
Global Bioethics (1988)
Bioethics
-------- 1911 - 2001 --------
Van Rensselaer Potter
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BIOETHICS
Discipline that deals with morality of human
conduct
Multidisciplinary (law, philosophy, religion,
medicine)
Branch of ethics
that deals with the life sciences and their impact in
society
Analyzes moral values in the context of biomedical
sciences
Deals with the life sciences, namely, medicine,
health care, genetics, biology and research

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Bioethical Issues and
Concerns
1. Ends and purposes of life sciences,
quality of life, death and pain sufferings
2. Reproduction: genetic engineering,
cloning, in-vitro fertilization, sperm
banking
3. Organ harvesting and transplantation
4. Advanced biomedical technology
1. Stem cell
2. Gene therapy
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Individual Homework.
Submit a picture/clipping of a recent
bioethical issue that has a relevance on
your life as a student nurse and make a
reaction (30 sentences).
Submission is tomorrow
Short bond paper



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Given that case 1, the people involved are
faced with some difficult and controversial
ethical choices.
Thus, we need to study the map of
ETHICAL TERRAIN (overview of the
ethical issues at stake)
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Levels of Moral Discourse
METAETHICS

Normative Ethics
Rules and Rights (Codes of Ethics)
Cases (Casuistry)
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Casuistry
Rely on paradigms cases (similar)
Similar cases should be treated similarly
New case is similar in all relevant respects
May consult a colleague or refer to a hospital
ethics committee
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Rules & Rights
Tell us what is legal and ethical
If considered ethical
Seen as grounded in our moral system
Groups of rules or rights-claims are called
CODE of ETHICS
Therefore, can consult the Codes of Ethics a
particular discipline
Rule-like maxim (Nurse)
Right-claims (Patient)
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Rules & Rights
When organization gather together collection of
rules or right-claims
they produce a CODE of ETHICS
Can also be in a form of OATHS or Directives
When made up of rights-claims
Bill of Rights
Physicians may consult the Code of Ethics of the their
Medical Association
Controversies
1. Legalism (no exceptions)
2. Antinomianism (every case is unique)
3. Situationalism (must be evaluated)
4. Rules of practice
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Rules & Rights continuum
Antinomianism Situationalism Rules of Practice
Legalism

No Rules apply Rules
apply rigidly
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Normative ethics
1. Norms of behavior/character are discussed
2. Norms of good moral character are
articulated
1. It involves (3) questions
1. What principles make actions morally right?
(ACTION)
2. What kinds of consequences are good or valuable?
(VALUE)
3. What kinds of character traits are morally
praiseworthy? (VIRTUE)
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Normative ethics
A. Action Theory (Questions of ethical
principle)
A. Principles of Beneficence and Nonmaleficence
B. Value Theory (Intrinsic goods)
A. Value
A. Money (Instrumental)
B. Happiness, beauty, knowledge and health
(Valuable)
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Normative Ethics
C. Virtue Theory (Good character)
A. Morally praiseworthy character traits
(VIRTUE)
A. Compassion (Professional VIRTUE)
A. Hippocratic Oath
B. Benevolence (Willingness to do good) = (Secular
VIRTUE)
A. Japanese, Greek
C. Faithfulness (Religious VIRTUE)
A. Christian, Muslim, etc.

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Metaethics
Deals with the most basic questions of
ethics
What is the meaning?
How it can be justified?
Which one is correct?
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Metaethics
Source?
Religious
Approved by God
Secular
Natural law or Contract (hypothetical)
Relativists
Culture or personal preference
Is it ethical?
Divine Law or church tradition
Secular
Empirical experience by Kant
Experience of sympathy by Hume

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Hippocratic
Oath
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Hippocrates
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Hippocrates
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I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the
gods and goddesses as my witnesses, that, according to my ability and judgment, I will
keep this Oath and this contract:
To hold him who taught me this art equally dear to me as my parents, to be a partner in
life with him, and to fulfill his needs when required; to look upon his offspring as equals
to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or
contract; and that by the set rules, lectures, and every other mode of instruction, I will
impart a knowledge of the art to my own sons, and those of my teachers, and to students
bound by this contract and having sworn this Oath to the law of medicine, but to no
others.
I will use those dietary regimens which will benefit my patients according to my greatest
ability and judgment, and I will do no harm or injustice to them.
I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and
similarly I will not give a woman a pessary to cause an abortion.
In purity and according to divine law will I carry out my life and my art.
I will not use the knife, even upon those suffering from stones, but I will leave this to
those who are trained in this craft.
Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any
voluntary act of impropriety or corruption, including the seduction of women or men,
whether they are free men or slaves.
Whatever I see or hear in the lives of my patients, whether in connection with my
professional practice or not, which ought not to be spoken of outside, I will keep secret,
as considering all such things to be private.
So long as I maintain this Oath faithfully and without corruption, may it be granted to me
to partake of life fully and the practice of my art, gaining the respect of all men for all
time. However, should I transgress this Oath and violate it, may the opposite be my fate.
Hippocratic Oath
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I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that
according to my ability and judgment I will keep this Oath and Stipulation.
TO RECKON all who have taught me this art equally dear to me as my parents and in the same
spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with
diligence to keep abreast of advances in medicine. I will treat without exception all who seek my
ministrations, so long as the treatment of others is not compromised thereby, and I will seek the
counsel of particularly skilled physicians where indicated for the benefit of my patient.
I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider
for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither
prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any
such thing nor perform the utmost respect for every human life from fertilization to natural death
and reject abortion that deliberately takes a unique human life.
WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for
the prudent correction of an imminent danger, I will neither treat any patient nor carry out any
research on any human being without the valid informed consent of the subject or the
appropriate legal protector thereof, understanding that research must have as its purpose the
furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the
benefit of the sick and will abstain from every voluntary act of mischief or corruption and further
from the seduction of any patient.
WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see
or hear in the lives of my patients which ought not be spoken abroad, I will not divulge,
reckoning that all such should be kept secret.
WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the
practice of the art and science of medicine with the blessing of the Almighty and respected by
my peers and society, but should I trespass and violate this Oath, may the reverse by my lot.
Hippocratic Oath (Modern)
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Why Bioethics?
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Current Bioethical Issues
1. Check the local news paper
2. Stem cells (state, national, international)
3. Genetically Engineered Organisms
4. Knowing your genes
5. In vetro fertilization choosing your child's
genes and characteristics
6. Global warming
7. Chemicals exposures human health
8. Environmental health
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"A thing is right when it tends to
preserve the integrity, stability, and
beauty of the biotic community. It is
wrong when it tends otherwise." -
Aldo Leopold, 1949, A Sand County
Almanac
The First Bioethicist
---------- 1887 - 1948 ----------
Aldo Leopold
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An ethic, ecologically, is
a limitation on freedom of
action in the struggle for
existence
Aldo Leopold
Limits on Freedom
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The Commons
The Tragedy of the Commons
By Garrett Hardin, Science, 1968
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Technical Solutions
It is our considered
professional judgment that
this dilemma has no
technical solution.

The Tragedy of the Commons
By Garrett Hardin, Science, 1968

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Problems Solutions?
Lead and kids
Fetal alcohol syndrome
Nuclear disarmament
Bioterrorism
Ocean Fisheries
Persistent chemicals
The Commons
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"Biology combined with diverse
humanistic knowledge forging a
science that sets a system of
medical and environmental
priorities for acceptable survival.
Global Bioethics (1988)
Bioethics
-------- 1911 - 2001 --------
Van Rensselaer Potter
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1860s - Scientific method in medicine, Gregor Mendel
1928 - Penicillin discovered widely used WWII
1920s - Lead in gasoline, lead in paint
1931 - 30 states had sterilization laws on books
1932 - Tuskegee syphilis study initiated
1947 - Nuremberg - The Doctors Trial
1952 - First open heart surgery & Chlorpromazine
1953 - Structure of DNA Watson & Crick
Ethics and Science
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60s - Thalidomide, mercury, chronic hemodialysis,
amniocentesis, informed consent, IRBs
70s - Hastings Center founded, bioethics defined,
Tuskegee noticed, Belmont Report (3
principles), Genentech Inc. founded, awareness
of FAS, sensitivity of developing CNS
80s - Recombinant microorganism could be patented,
lead is harmful to developing brain
90s - molecular biology, sequencing of human
genome (other species), Jurassic Park
00s - US stem cell research restricted
03 - Human cloned?
Ethics and Science
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Question??
Who were the most influential people
of the past century?
James Watson (L)
and Francis Crick
(R), and the model
they built of the
structure of DNA
(and Rosalind
Franklin).
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ELSI
Ethical
Legal / Regulatory
Social
Implications or Issues
What is unsaid or missing?
Science
Values
Politics
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Topics
Why this is topic important
DNA to RNA to Proteins
Stem Cells
Cloning Therapeutic and Human
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Stem Cell History
1998 - Researchers first extract stem cells from human
embryos
1999 - First Successful human transplant of insulin-making
cells from cadavers
2001 - President Bush restricts federal funding for
embryonic stem-cell research
2002 - Juvenile Diabetes Research Foundation
International creates $20 million fund-raising effort
to support stem-cell research
2003?? - California ok stem cell research
2004 - Harvard researchers grow stem cells from embryos
using private funding
2004 - Ballot measure for $3 Billion bond for stem cells
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Importance
Disease
Diabetes, Spinal
cord injury,
Parkinsons
disease, heart
disease
Genetic based
Disease
Cystic fibrosis,
Huntingtons
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DNA T-A C-G
Thymine (T) Adenine (A)
Cytosine (C) Guanine (G)
Over 3 billion base pairs, 30,000 genes
Humans are over 99.9% identical
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Central Dogma of Molecular Biology
DNA
RNA
Protein
Transcription
Translation
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RNA Transcription Protein Translation
DNA RNA Protein
Gene Expression
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Human Variability in DNA
SNPs (single nucleotide polymorphisms)
Many examples directly cause disease
Huntingtons, Cystic Fibrosis, Muscular
Dystrophy, etc.
The environment also plays a big role
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...AUC AUC UUU GGU...
...Ile Ile Phe Gly...
...AUC AU- --U GGU...
...Ile Il e Gly...
Normal
CF
Common Cystic Fibrosis Mutation
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Parents to Children
Mother & Father both Carriers
Children?
1 Not a carrier (25%)
2 Carrier (50%)
1 With CF (25%)
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Gene Environment Interactions
PKU and consumption of phenylalanine
Malaria and Sickle Cell gene
HIV infection and CCR5 receptor variant
Alcohol intolerance and aldehyde
dehydrogenase
Beryllium disease (exposure to beryllium)
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Sexual Reproduction
The Association of Reproductive Health Professionals
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Stem Cell Differentiation
Princeton University
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Stem Cell Cultivation
University of Wisconsin-Madison
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Embryonic Stem Cells (ESCs)
August 9, 2001 - President Bush
restricted federal funding of human
embryonic stem cell research to 70
lines thought to be in existence

Only 11 now available and useable

Many researchers calling for change
Science and Politics of ESCs research
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Blastocyst Diagram
Princeton University
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Human Clones?
Are there human clones?
Yes Identical Twins
(Time 2.19.01)
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Cloning Defined
What is cloning?
Asexual reproduction

Examples?
Bacteria, fungus
Plants cutting potato
Farm animals
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Asexual Reproduction
The Association of Reproductive Health Professionals
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Cloning Dolly
1997 - 2003
(Roslin Institute http://www.roslin.ac.uk/library/)
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Cloning A Sheep
(Roslin Institute http://www.roslin.ac.uk/library/)
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Human Stem Cell Production
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Removing Nucleus
Removing the maternal nucleus before
nuclear transfer
(Roslin Institute http://www.roslin.ac.uk/library/)
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Nuclear transfer
Nuclear transfer embryo about to be
activated
(Roslin Institute http://www.roslin.ac.uk/library/)
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Coning for use in Stem Cells
Cloning techniques for
creating stem cells

Therapeutic cloning

Reproductive cloning
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IVF In Vitro Fertilization
Available since 1986
About 100,000 IVF kids in U.S.
Often creates extra embryos
U.S. - About 400,000 frozen
embryos (unregulated)
England 52,000 (regulated by
government)
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End of Lecture/Discussion
Questions or Comments?