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Bioethics of Tissue Engineering

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Video 1: Bioethics
Hello everybody.Today we are going to talk about the Bioethics of Tissue Engineering.So, we have discussed tissue engineering, we have now seen the different aspects oftissue engineering, what promises it holds.However, with any advance developments especially, in the areas related to human life the ethicsbecomes a major question.So, it is important for us to look at the ethical questions which need to be addressedwell while we are performing research when it comes to tissue engineering.So, today we will be talking about the different ethical questions which are posed for theresearchers and also the society, when it comes to the area of tissue engineering.So, when you first talk about the bioethics, the first aspect which I would like for youto know about is the difference between ethics and regulations.So, please think for a minute what is ethics and what are the regulations?So, do you understand that they are different or do you think they are same?So, think about this, ethics are basically moral guidelines which are based on individualvalues.So, what are regulations then?Regulations are basically rules, which are imposed by an external agency.So, the fundamental differences is ethics is based on our own morals.So, it could either be what an individual person believes or the society believes orhis religion believes versus regulations being what governmental agencies actually enforce.So, regulations are usually from external forces; however, in an ideal society the ethicsshould be of higher standards than regulations.So, it is important that we understand this difference.Today, we will be focused on the ethics of these issues.Regulations of tissue engineering is a whole another debate which involves a lot more legalissues which is, which will not be discussed as part of this course.So, when we are talking about regulations, we said that it is enforced by external agencies.So, can you name a few such agencies?Think about it, what would be the external agencies which act as regulatory bodies whenit comes to biotechnology.Most of you would have thought of FDA which is the Food and Drug Administration in theUS.So, this organization is the one which approves what is used for food products and what areused as drugs.And, this is also the agency which approves medical instruments and also any of the tissueengineered products which might actually reach the market.However, this is an agency which is set up by the United States government and it isactually implemented only for the US.So, you could get an FDA approval, but that is only required if it needs to be marketedin the US.However, if you are looking for something to be marketed in India, where do you go?Where do you get the approvals?So, in India you have two regulatory bodies: one is the FSSAI which approves the food relatedproducts.And, then you have the CDSCO which is the Central Drugs Standard Control Organization.So, these two regulatory bodies actually approve food and drug related products when it comesto India.Now, as I mentioned we will not be talking about regulations, which means we will notbe talking about the agencies which are involved in the policy making, the regulations whichare governing the ethical debates.One of the reasons we would not be talking about these is, this can actually vary fromcountry to country or even state to state depending on the values of the particularenvironment.So, we will focus primarily on the larger debate, which are the ethical dilemmas.So, we will focus on major questions which are post in front of us, when we talk abouttissue engineering.So, this area is called as bioethics.So, bioethics is basically the study of ethical issues related to advances in biology andmedicine.So, as tissue engineering ultimately wants to be developing a product which can helpin improving the quality of life of people and develop into a biomedical product.So, bioethics governs how tissue engineering research should be carried out.So, when we are talking about bioethics, what are the factors?What actually influences bioethics or even ethics in general?You can have legal factors, the rules that can guide what is right and wrong.So, these are basically rules, which are enforced and this if somebody does not have their ownguidelines, the legal guidelines which are set forth by the external agencies will actas the ethical guidelines as well.So, that is not the highest standard that needs to be met.So, you could also have organizational factors.So, organizational factors depend on the ethics of the leader or the values imbibed throughpolicies and publications and speeches by the organization.For example, you could be working in a company where there would be certain rules about whatto wear or the timings in which you need to work and these are policies which are implementedby the company.So, you have these organizational factors which decide how you actually behave.So, the ethical guidelines here are not just dependent on the legal bodies, but on theorganizational bodies.So, technically these are not binding because you can actually leave the company and goto a different place.There is no law forcing you to work in that company.So, by choosing to work there you have agreed to abide by the organizational values of theplace where you are working.So, this could also apply to colleges or in general any society.In a family get together you would have a certain organizational value which may beunsaid, but you still have to follow them because that is how your family would function.So, that is the organizational factor.Then comes the more important factor which is the individual factor.As an individual, all of us have our own moral standing.So, when we have these moral standings this is what will drive us towards doing somethingor not doing something?We need to realize what can be done and what should not be done and that comes from ourown belief system.It could be either the moral development or the personal values and personality.It could also be religious influences or family and peer influences, it could be life experienceor situational factors.So, these are the governing factors when you are talking about how an individual behaves.So, moral development is based on so many things, right.So, you need to have a certain set of values on different issues and this comes from whoyou are, this defines who you are and personal values in personality.So, there may be certain things I would feel uncomfortable doing; however, someone elsemight be more comfortable doing and that comes simply because of the personality.There can also be religious influences; all of us follow our own religion.Individual religions have different guidelines which people follow.There are religions which would restrict certain activities whereas, other religions mightnot be so strict.So, it depending on the religious beliefs somebody might actually follow or do certainthings, while the others might not and this plays a huge role in how a person behaves.Family and peer influences, looking at your peers and your family you learn values.Looking at your parents you know what they do and what they do not do.If a parent does not stop at the red light when the in the signal; then the kid assumesthat it is ok to do that although the legal guidelines say otherwise.So, the values are imbibed by looking at the peers and your family.Life experiences would also change your values.So, as you grow either more experiences you have you see more things.So, based on that your value system will evolve, some of the values you would hold dear whenyou are younger would not be seen as such strict things and thinks might change overa period of time.The last and the crucial factor is a situational factor.There are certain things which we would find repugnant today when we have all the facilitiesand amenities; however, when we are pushed to a corner then the situation might demandus to cross a line which we would not cross today.So, how do we take all these factors when we are looking at ethics?So, when we are talking about bioethics all these factors can play a role.So, we will talk about some of the major questions which actually haunt the field of biologyand even tissue engineering, specifically which actually need to be addressed and discussed.

Video 2: Ethical Dilemmas in Embryonic Stem Cells
So, we will first talk about one of the major ethical debates when it comes to tissue engineering,it is the embryonic stem cells.So, what are embryonic stem cells?First, we need to know what are stem cells.So, in this lecture in this course we have already discuss what stem cells are; so, Iam assuming you would already know what stem cells are.So, if you do not, basically stem cells are cells which actually can differentiate todifferent types of cells.These do not have the functionalities already determined.They can differentiate to form different cells; they are also self-renewing cells.So, this is what a stem cell is.So, what is embryonic stem cell and why is it so special?An embryonic stem cell is a cell which is obtained from the embryo.So, these stem cells have much higher potency, these are pluripotent and that actually makesit very useful tool used to makes them a useful tool for research.So, what are the others types of stem cells?There are many other types of stem cells; you can actually find stem cells in all partsof your body.So, you have the mesenchymal stem cells, you have the hematopoietic stem cells, you canhave adipose derived stem cells and many other there, dental pulp has stem cells.Stem cells can be found in many parts of your body.So, why is the fuss about embryonic stem cells?As I mentioned, these are pluripotent stem cells, which mean they have a lot more potencywhen it comes to differentiating and growing.So, recent research has also shown that the somatic cells can actually be converted toinduced pluripotent stem cells.So, these are called as the iPSCs or Induced Pluripotent Stem Cells.So, by incorporating certain transcription factors, the somatic cells can be convertedto pluripotent stem cells which are called as the iPSCs.So, these are the different types of stem cells.So, as I already mentioned, embryonic stem cells show pluripotency and that is why thathas been a lot of the interest in working on embryonic stem cells.So, before we look at the ethical question about embryonic stem cells, we need to understandhow embryonic stem cells are obtained.So, what you do is, first step is fertilization of an egg and you create an embryo and thisembryo is allowed to grow till it reaches a stage called the blastocyst.So, in the blastocyst you have an inner cell mass, which is basically the mixture of cellswhich contains the embryonic stem cells.So, from this mixture or from this inner cell mass you obtain the embryonic stem cells.So, the fertilized egg which grows to a blastocyst is actually disrupted to get your embryonicstem cells.And, these embryonic stem cells can then be differentiated to form different types ofcells.It could be form endoderm, mesoderm and ectoderm cells and for this reason there is been alot of interest in looking at embryonic stem cells.Now, what is ethical dilemma?So, the major question which plagues the discussion on bioethics of embryonic stem cells is youneed to choose between two moral principles.The first principle is the duty to prevent and alleviate suffering.As human beings we have to prevent or minimize suffering.When you see somebody who is suffering, you should try to do what you can to help themand alleviate the suffering.So, this is one of the moral guidelines which humans are driven by.The other guideline is duty to respect the value of human life.Human life is one of the most precious things; we need to value it and we cannot sabotageit.So, these are two principles which end up being conflicting when you talk about embryonicstem cell research.There is actually no way to respect both when you are working on embryonic stem cells.So, what happens here is to obtain embryonic stem cells an early embryo has to be destroyed,which means you are destroying potential human life.But embryonic stem cell research can lead to treatments that can alleviate suffering.So now, these are two guidelines which we said are moral guidelines which we are drivenby moral principles that we are driven by.But these end up being conflicting when you talk about embryonic stem cell research.So, that is what makes it a hard question to answer.How do we decide which is more important?So, do we say that alleviating suffering and preventing suffering is way more importantor do we say that respecting the value of human life is way more important.So, this is dependent on how we view the embryo, embryo can be seen in different ways and whatdo we see it as, is the question.So, the ethical question we are faced with is, when does life start?So, life starting at the time of conception is one of the beliefs, legally life startsonly at birth or in a, but you have to decide when exactly life starts for addressing thisquestion.Can we come to a consensus on that?That is the million-dollar question.So, the status of the embryo is a complex question, there are many, many view pointswhen it comes to how an embryo should be viewed.Whether the embryo should have rights, whether it should be treated as equally as a humanor whether it should not be, whether it should be treated only as a mass of tissue or massof cells.So, how do you actually view an embryo?So, we will talk about some of the common view points.We will talk about some of the common viewpoints here.Embryo has full moral status from fertilization onwards.So, this belief is what say where you believe that life starts at conception.So, what you are saying here is an embryo as soon as it is formed, the time after fertilization,it needs to be treated equally like human.So, this is a one of the arguments; however, if you were to believe in this, then embryonicstem cell research cannot be done.So, this would also mean abortions which are done to save lives of the mother or even forother reasons, if there is a non-viable embryo and you still think that it need should bejust it needs to be protected.So, then that would be the guideline driven by the moral status of thinking embryo hasfull moral status at that the time of fertilization itself.There is also a group of people who believe that embryo has should have a for full moralstatus after 14 days of fertilization.Why 14 days?What is the specialty there?So, after 14 days the embryo is implanted and it does not have a chance to actuallydivide to become twins.So, once in the first 14 days is when it can actually form twins.So, this means that the belief is after 14 days the embryo has reached a stage whereit is now has the potential to form human life.So, within 14 days the embryo could also be lost without implantation.So, we people believe the 14-day cutoff would be a good point to start.So, if this is going to be the guideline then how does this control embryonic stem cellresearch, how do we then proceed?So, that is another question.The third option which people believe in is embryo has an increasing status as it develops.So, an embryo at the time of fertilization has no moral status; however, as it developsinto more of a human form, you would have more of a right as a human.So, this is one of the generally accepted views and the last one is an embryo has nomoral status at all.So, until the time of birth, life does not start.So, these are the four different views and people see it differently and based on howone sees it, the ethical guidelines which are driving the embryonic stem cell researchwould also evolve.However, there is no scientific consensus on when life starts.So, these needs to be stated because there is no scientific consensus, there is no realway of saying this is the point at which life starts.You can only decide on that based on your belief system; it is not based on any scientificproof.So, one of the compromises which people have looked at is to use spare embryos from fertilitytreatment.So, people have been doing IVFs or the In-Vitro Fertilization to have kids and in that case,what happens is eggs are fertilized to form multiple embryos.And, not all of them are used for being placed in a womb for further growth your human being.However, embryos which are which are not used are actually discarded.So, people have said that these embryos are anyways going to be discarded; so, why notuse them for embryonic stem cell research.Now, the question is are there arguments for and against this as well, as one would expectthere are.So, we will talk about some of the arguments which support using spare embryos and thearguments which oppose using spare embryos.Embryos have been created for IVF treatment and will be destroyed when it is not implantedand this has been done for many years and this has not changed how we value life.So, it is not a problem; however, if you have the argument against this point is human embryoscould be exploited as therapeutic agents which can decrease the respect for human life.So, when you are only doing at for IVF, you are actually not intentionally creating itas therapeutic agents, you are creating it with the hope of creating a human life.Whereas, when you start doing it as a creating it for therapeutic agents, for therapy thenwhat you are doing is you are intending to create them for a different use which mightlead to an abuse.So, these are the two arguments which have put forth.And the next thing is many embryos are created in a, in a IVF which are not implanted andare actually left to perish.So, the moral dilemma of ending human life is not applicable here.So, you are actually anyways going to destroy them.So, it is not like you are destroying human life because it is being done already, butthe argument against it is this is a slippery slope.So, what can happen is potentially people can start creating embryos with the sole goalof destroying them for therapeutic purposes which is not an acceptable thing for manypeople.So, this is where the issue comes in when it come to this argument.There is also the argument which is put forth saying that it is better to use these spareembryos for research rather than to let it go to waste.However, the argument against this is this could encourage a society which toleratesthe loss of life to save a life.So, these are the different viewpoints which are put forth.So, it is up to you to think of what is acceptable.So, when it comes to framing guidelines or regulations the ethical guidelines will bethe driving principle.And, the rules which would be put forth or the regulations will be put forth should bedriven by our ethical guidelines as a society.So, overall societal ethics would dictate what would be seen as acceptable for the societywe live in.Here, I am only presenting the arguments for and against some of these points.So, I want to be very clear that I am not supporting or opposing any of the argumentsand I am not interested in selling one of the ideas to you.What I am interested in is for you to look at this and see that there is an argument,then there is a debate which is going on and both sides have valid arguments.And, it is important to see both sides of the argument, it is important to reach acrossthe table and find a compromise which will actually work for both parties.So, moving onto the next topic animal testing; animal testing has long been an ethical questionin bio-research.When comes to tissue engineering, it will again be a problem.Anytime you were working on creating tissues, you would have to test it before you can useit for humans.So, do we test it in animals?So, when we test it in animals, it creates a unethical dilemma.So, in the next lecture we will talk about animal ethics; so, animal testing as the oneof the ethical questions.Thank you.