Ethics and law of stem cell treatment of diabetes

December 21, 2016

Pär SegerdahlMany people support in various ways medical research, which they perceive as urgent in view of the needs of various patient groups. But patients typically won’t benefit from research unless the results are translated into development of medical products.

Type 1 diabetes is an incurable disease that requires daily life-sustaining treatment and strict dietary rules. Disease onset usually occurs at an early age.

In Sweden, about 50 000 people have this form of diabetes and of these around 8 000 are children. In type 1 diabetes, the immune system attacks the insulin-producing cells. Without insulin the body cells cannot use glucose for energy, and the sugar level in the blood rises. Energy is recovered instead from fat and protein, which causes waste products that can cause diabetic coma and attacks on vital organs.

Today, diabetes is treated with daily insulin injections, or by using an insulin pump. This requires continuous measurement of blood sugar levels, as incorrect doses of insulin entails risks and can be life-threatening. It is not easy to live with diabetes.

An alternative treatment, which is still at the research stage, is to generate new insulin-producing cells using human embryonic stem cells. The insulin-producing cells detect blood sugar levels and regulate the secretion of insulin. In order not to be attacked by the immune system, the transplanted cells are encapsulated in a protective material. It may become easier to live with diabetes.

But research alone doesn’t treat diabetes. Encapsulated insulin-producing cells need to be produced and made available also to patients; not only to research participants. But this is a big step and a host of ethical and legal issues, including embryo donation, patentability and consent, need to be examined and discussed.

The Swedish Research Council recently granted funding for a project to examine these issues. The project is led by Mats G. Hansson at CRB and is a collaboration with Olle Korsgren, professor of transplantation immunology, as well as with lawyers Anna-Sara Lind and Bengt Domeij, and philosophers and ethicists Jessica Nihlén Fahlquist and Pär Segerdahl.

The step from stem cell research to available treatments requires reflection. I look forward to start thinking about the ethical and philosophical questions.

Pär Segerdahl

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Approaching future issues - the Ethics Blog

How are ethical policies justified?

January 20, 2016

Pär SegerdahlEthical policies for practices such as abortion and embryonic stem cell research should, of course, be well justified. But how does one justify that activities involving the destruction or killing of human embryos and fetuses should be allowed? How does one justify that they should be banned?

Just because the issues are so sensitive and important, they awaken a desire to find the absolutely conclusive justification.

The questions arouse our metaphysical aspirations. Ethicists who discuss them can sometimes sound like the metaphysicians of the seventeenth century who claimed they had conclusive arguments that the soul affects the body, or that it absolutely cannot affect it; who thought they could prove that God is the soul of the world, or that such a view detracts from God’s perfection.

Since both parties claim they have absolutely conclusive proofs, it becomes impossible to exhibit even the smallest trace of uncertainty. Each objection is taken as a challenge to prove the superiority of one’s own proofs, which is why metaphysical debates often resemble meetings between two hyper-sensitive querulants.

This is how I perceive many of the arguments about the embryo’s “moral status,” which are believed to provide conclusive evidence for or against moral positions on abortion and embryonic research – based on the nature of things (i.e., of the embryo).

Others, who want to reason more rigorously before drawing conclusions, instead scrutinize the arguments to demonstrate that we haven’t yet found the metaphysical basis for a policy (you can find an example here). From metaphysical dogmatism to metaphysical pedantry.

The metaphysical vision of an absolute path through life does not seem to give us any walkable path at all. It does not even allow meaningful conversations about what we find sensitive and important. But isn’t that where we need to begin when we look for a justification?

Pär Segerdahl

This post in Swedish

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Gene editing: a threat to the moral ecosystem?

January 13, 2016

Pär SegerdahlA few years ago it was discovered that bacteria can protect themselves against viruses by cutting the viruses’ DNA at specific positions. The discovery is the basis for new, easier and more precise ways to make changes in the genome. Researchers have begun to talk about “cutting and pasting” in the genome; about “editing” the genome.

The new gene-editing technique has been applied to plant breeding. But it can, of course, be applied elsewhere too. And as often is the case, the issues appear extra controversial when applications to humans are considered.

I read an intellectual debate between a proponent of therapeutic use of the technique on humans (Julian Savulescu), and an opponent (Margaret Somerville). (You find it here.) The opponent used an analogy to summarize her position, which I cannot resist commenting upon here on the Ethics Blog. Here is the analogy (as I render it):

  • Today we are acutely aware that we must take responsibility for our environment, for the physical ecosystem. But the same can be said of our metaphysical or moral ecosystem. We must care about our values, beliefs, attitudes, principles and narratives. Genetically editing a human embryo, perhaps to remove a disease gene, may have good consequences from an individual perspective. But it threatens the moral ecosystem at its roots: it contradicts the respect for human life.

Say what you want, but it is a dramatic analogy! Maybe a little too dramatic. For essentially the same threat has been depicted many times before, when new forms of biotechnology appeared on the horizon. If this kind of threat was real, morality should lie in ruins since long ago. But we quickly forget and it is always only the latest techniques that Threaten Morality at its Foundation.

I believe that the idea of ​​a major technological threat to morality is based on intellectualizing both technology and morality. One attaches enormous significance to the fact that aspects of the technology can be described with certain words, such as “editing” or “designing.” The description, ​​”designing a child,” sounds like it logically clashed with another intellectualization – of morality as a system of propositions about what a “person” is, about what “respect” is, and about what is “right and wrong.”

The idea of an apocalyptic threat is thus based on reading the new technique and morality literally, so that it sounds as if the technique contradicted the basic tenets of morality.

Is there nothing to worry about, then? Should we not care about important values? Of course we should. My point is that in practice this looks differently than it verbally sounds like.

When new biotechnologies are implemented in society and put to use, this occurs in specific practical contexts where there are recognized problems that one wants to solve or treat. These applications are regulated, ethically and legally.

In vitro fertilization (IVF), another technique, is embedded in its specific contexts. Within these contexts, the technique solves problems for people. But it hardly threatens morality by, on some general and verbal level, contradicting the basic tenets of a moral system – such as “the respect for human life.” Rather, the technology has become a new way to concretely respect people and take their problems seriously.

The practical aspects disappear in the intellectualization of the issues, with its focus on words and theses. But it is the living contexts we have to take responsibility for. That is where we find the respect and the disrespect. That is where the problem lies.

Some moral problems are just false readings, overinterpretations of words.

Pär Segerdahl

This post in Swedish

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Stress turns ordinary cells into pluripotent stem cells

February 19, 2014

PÄR SEGERDAHL Associate Professor of Philosophy and editor of The Ethics BlogTissues of the body originally form when “naïve” undifferentiated embryonic stem cells differentiate to form the “mature” cells of specific tissues: liver cells, brain cells, skin cells, and so on.

The mature cells are then locked in their differentiated forms, as if they met their fate.

I recently mentioned that Yamanaka and Gurdon were awarded the Nobel Prize in Medicine in 2012 for their surprising findings about dedifferentiation. Through direct genetic modification of nuclear function, mature cells can be reprogrammed to return to naïve stem-cell states. These dedifferentiated cells are pluripotent and can differentiate again and form a variety of mature cell types.

The rejuvenated cells regain the naïve properties of embryonic stem cells!

In January this year, an article published in Nature reported that the genetic reprogramming can be achieved more easily, without direct nuclear manipulation.

All you need to do to dedifferentiate mature cells, according to this article, is to subject them to stress: like an acid environment. Not all but some of the mature cells will be freed from their fate as liver or skin cells and return to naïve pluripotent states.

An easy to read summary can be found in BioEdge, and here is a link to the article:

Using mature cells to create stem cells with properties of embryonic stem cells might thus be easier than expected. In fact, the new findings weren’t even made in a stem-cell laboratory.

The ethical responses to the findings are not as thrilling as the findings. Some welcome the possibility of creating “ethical stem cells” that avoid the controversy about embryonic stem cells. Others see “new ethical issues” on the horizon.

These responses are characteristic of a routine view of ethical assessment as a static one-way process: ethicists assess others. But these findings indicate that processes in the opposite direction are possible as well, since they seem to challenge ethical assumptions about the unique function of the embryo.

I’m tempted to extend Thomas Kuhn’s notion of scientific revolutions to ethics. The new findings could function as anomalies for ethically paradigmatic ways of thinking about the embryo.

As stress turns mature cells into naïve pluripotent stem cells, these findings could stress some ethicists to return to more open-minded states that in the future can differentiate in new and unexpected directions.

Pär Segerdahl

We like challenging findings - The ethics blog

Scholastic reasoning versus modern cell biology

January 30, 2014

PÄR SEGERDAHL Associate Professor of Philosophy and editor of The Ethics BlogEmbryonic stem cell research can find effective treatments for a wide range of currently untreatable diseases. No wonder embryonic stem cell research can be perceived as an important practice.

A human embryo can develop into someone’s child, who breathes, talks and lives. No wonder embryonic stem cell research can be perceived as a controversial practice.

What interests me here is how these two in my view humanly comprehensible perceptions of stem cell research are translated into an intellectual arena called “ethical debate.”

On this arena, forms of reasoning with different historical roots meet to combat each other. The idea is that here finally the issue shall be settled: is embryonic research, as a matter of fact, morally controversial, or is it not?

Or are we rather debating Aristotle versus modern cell biology?

Attempts to prove that the research is controversial bear witness of a legacy from the metaphysics of Aristotle. The human embryo is supposed to have a unique potentiality to become a person: a potentiality so actively present in the embryo that the embryo is to be understood as a “prenatal person” or as a “potential person.”

Attempts to disprove such scholastic claims instead rely on the latest scientific evidence in cell biology. In 2012, Shinya Yamanaka and John B. Gurdon were awarded the Nobel Prize in Medicine for their work on what is called “dedifferentiation.” Stem cells derived not from embryos but from, for example, skin cells can be genetically induced to regress into less differentiated states that in turn can differentiate into various directions.

These findings are invoked in an article in The American Journal of Bioethics to finally take leave of the argument from potentiality:

  • “Technically speaking, fertilized egg cells (earliest embryos), iPSCs (induced pluripotent stem cells), and skin cells are all potential ‘baby-precursors,’ in part due to modern cell biology.”

So much for the unique potentiality of the human embryo: a skin cell will suffice.

To what extent do such debates concern the two perceptions of stem cell research in their human comprehensibility?

Pär Segerdahl

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What are absolute borders made of?

December 17, 2013

I return to the question in my previous post. I was wondering why biotechnological developments repeatedly invite moral responses in terms of borders that shouldn’t be transgressed by humans. (Think of stem cell research using human embryos.)

What is fundamental in these responses? Is it the absolute border? Do people already have stable notions of borders that shouldn’t be transgressed by humans, as part of semi-metaphysical views of life? Do they respond, “Controversial!”, because they deem some new practice to be transgressing a border that already is in place within their view of life?

Or is the notion of the border itself part of the reaction? Is “the absolute border” reactive rather than the source of the reaction?

I’m inclined to say that the “absolute border” arises with and through the reaction. Let’s call it the intellectual part of the reaction. It is how the reaction presents itself as legitimate; it is how the reaction transforms itself into a reason against the new developments.

The notion of an “absolute border” is how the reaction translates itself into the “space of reasons.”

If so, the recurrent reaction is almost bound to misunderstand itself in accordance with my first suggestion: the border will be perceived as basic, and the reaction will present itself as rational verdict: “The absolute border is being transgressed here; therefore, a moral response is in order!”

We must not forget that entire views of life can be reactive. Even when they are beautiful and admirable human achievements, their function can be that of digesting reactions and providing them with meaning.

My conclusion is that if we want to understand these recurrent reactions, we must not be fooled by how they spontaneously translate themselves into “the space of reasons.” We need a practice of back-translation.

We seem bound to repeatedly misunderstand ourselves. Our much praised faculty of understanding easily becomes a faculty of misunderstanding.

Pär Segerdahl

We challenge habits of thought : the Ethics Blog

Absolute limits of a modern world?

June 21, 2012

A certain form of ethical thinking would like to draw absolute limits to human activity. The limits are often said to be natural: nature is replacing God as ultimate moral authority.

Nature is what we believe we still can believe in, when we no longer believe in God.

God thus moves into the human embryo. As its nature, as its potential to develop into a complete human being, he continues to lay down new holy commandments.

The irony is that this attempt to formulate nature’s commandments relies on the same forms of human activity that one wants to delimit. Without human embryo research, no one would know of the existence of the embryo: no one could speculate about its “moral status” and derive moral commandments from it.

This dependence on modern research activities threatens the attempt to discover absolute moral authority in nature. Modern research has disassociated itself from the old speculative ambition to stabilize scientific knowledge as a system. Our present notion of “the embryo” will be outdated tomorrow.

Anyone attempting to speculate about the nature of the embryo – inevitably relying on the existence of embryo research – will have to acknowledge the possibility that these speculations already are obsolete.

The changeability of the modern world thus haunts and destabilizes the tendency to find absolute moral authority in nature.

Pär Segerdahl

We challenge habits of thought : the Ethics Blog

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