Taking Life, Making Life, and Faking Life:  An Overview of Bioethics  for a Brave New World    Northwest Association for

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Taking Life, Making Life, and Faking Life: An Overview of Bioethics for a Brave New World Northwest Association for

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1. Taking Life, Making Life, and Faking Life*: An Overview of Bioethics for a Brave New World Northwest Association for Biomedical Research Summer, 2007 Dr. Andrew D. Shaw Westminster Christian Academy, St. Louis

2. What is Bioethics?

3. Why is Bioethics important? What is at stake… The elimination of much suffering The essence of being human The ethical use of technology

4. Some History…

5. The Hippocratic Oath ~400 BC I will use treatment to help the sick according to my ability and judgment, but I will never use it to injure or wrong them. I will not give poison to anyone though asked to do so, nor will I suggest such a plan. Similarly I will not give a pessary to a woman to cause abortion. But in purity and in holiness I will guard my life and my art. I will not use the knife either on sufferers from stone, but will give place to such as are craftsmen therein. Into whatsoever house I enter, I will do so to help the sick, keeping myself free from all intentional wrong-doing and harm, especially from fornication with woman or man, bond or free. Whatsoever in the course of practice I see or hear (or even outside my practice in social intercourse) that ought never to be published abroad, I will not divulge, but consider such things to be holy secrets.

6. Source: Dehumanizing the Vulnerable: When Word Games Take Lives, Wm. Brennan, Chicago: Loyola University Press, 1995.Source: Dehumanizing the Vulnerable: When Word Games Take Lives, Wm. Brennan, Chicago: Loyola University Press, 1995.

7. New England Holocaust Memorial Boston, Massachusetts They came first for the Communists, and I didn't speak up because I wasn't a Communist. Then they came for the Jews, and I didn't speak up because I wasn't a Jew. Then they came for the trade unionists, and I didn't speak up because I wasn't a trade unionist. Then they came for the Catholics, and I didn't speak up because I was a Protestant Then they came for me, and by that time no one was left to speak up. original version attributed to Pastor Martin Niemöller (1892–1984)

8. Some genocides going on today… www.genocidewatch.org Sudan (Darfur) – Zaghawa, Fur, Massaleit Burundi, Rwanda – Tutsi, Hutus Indonesia – Irian Jaya, Moluccas, Sulewesi Sri Lanka – Tamil, Sinhalese India – Hindus, Muslims, Sikhs China – Christians, Muslims, Falun Gong, minorities Pakistan – Christians, Shiites Iraq – Kurds, Shiites, Sunni Viet Nam – boat people Laos – Hmong Somalia – Isaaq Congo – Hema, Lendu Morocco – Sahrawis Botswana – Bushmen, Namibians Nigeria – Ibos, Tiv, Hausa, Yoruba, Ogoni Israel – Jews Russia – Chechens

9. But it’s science… Tuskegee (Ala.) Syphilis Study (1932-1972) 300 sharecroppers - placebo Willowbrook (Mass.) Hepatitis Study (1950’s) retarded children fed contaminated fecal solution Jewish Chronic Disease Studies (1960’s) chronically ill injected with live cancer cells San Antonio Contraceptive Study (1970’s) homeless given “contraceptives”

10. American Eugenics Immigration Act of 1924 Sought to limit influx from southern & eastern Europe, who were “biologically inferior and jeopardized the blood of the nation.” Secretary of Labor, James Davis: “America has always prided itself upon having for its basic stock the so-called Nordic race…we should ban from our shores all races…who are physically, mentally, morally and spiritually undesirable and who constitute a menace to our civilization.” Not fully reversed until the Immigration Act of 1965

11. American Eugenics

12. German Eugenics (WW II) 1. Freezing 2. High altitude 3. Malaria 4. Mustard gas 5. Intentional infections 6. Transplantations 7. Making sea water potable 8. Sterilizations 9. Poisonings http://en.wikpedia.org/wiki/Nazi_human_experimentation 10. Burnings

13. Nuremberg Code 1947 Directives for Human Experimentation The voluntary consent of the human subject is absolutely essential.  This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion… 4. The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury. 5. No experiment should be conducted where there is an a priori reason to believe that death or disabling injury will occur; except, perhaps, in those experiments where the experimental physicians also serve as subjects. 7. Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death.

14. I. Taking Life A. Abortion B. Infanticide C. Euthanasia and Assisted Suicide

15. Some important terms… Egg Sperm Fertilization Zygote Embryo Implantation Fetus Abortion Infanticide Euthanasia Suicide

23. I. Taking Life (cont.) Ethical Questions…

24. When Does Human Life Begin? At birth? (40 weeks) At “quickening?” (22 weeks) When the baby can be sustained technologically? When brain waves are detected? (9 weeks) Jewish and Muslim tradition (40 days) When the heart starts beating? (3 weeks) At implantation? (1 week) At conception.

25. “…Union of these gametes during fertilization produces a zygote or fertilized ovum which is the primordium or beginning of a new human being. (emphasis in original text) Human development begins at fertilization… This highly specialized, totipotent cell marked the beginning of each of us as a unique individual.” When Human Life Begins…

27. When Does Personhood Begin? When the Human is big enough? When the Human is old enough? When the Human becomes conscious? When the Human is able to reason? When the Human can communicate? When the Human is self aware? At birth? At individuation? At ensoulment? At conception?

28. When Does Personhood Begin? At the age of about one? “Human babies are not born self-aware, or capable of grasping that they exist over time. They are not persons… the life of a newborn is of less value than the life of a pig, a dog, or a chimpanzee …. a period of 28 days after birth might be allowed before an infant is accepted as having the same right to live as others.” Peter Singer - Practical Ethics

29. Types of Euthanasia and Assisted Suicide  1. Termination of Life Support (TLS); aka “passive euthanasia” a) If a competent adult patient requests it. b) If the treatment is clearly of no benefit to the patient. c) If the burden to the patient outweighs the benefit. 2. Physician-Assisted Suicide (PAS) 3. Active Euthanasia; aka “mercy killing”

30. The Case For Assisted Suicide and Active Euthanasia The Argument from Mercy The Argument from Utility The Argument from Autonomy It Is Not a Violation of the Hippocratic Oath There Is No Morally Relevant Difference Between Killing and Allowing to Die It Does Not Always Involve Killing a Person

31. The Case Against Assisted Suicide and Active Euthanasia It Is Playing God Suffering May Be Redemptive Misdiagnoses Are Possible Euthanasia Will Likely Move from Voluntary to Involuntary Euthanasia Prohibition of Active Euthanasia Will Keep the Law Out of the Medical Setting Prohibition of Active Euthanasia Will Humanize the Ending Edge of Life Prohibition of Active Euthanasia Will Create a Safer Context for End-of-Life Decisions

32. Important Distinctions6 Voluntary vs. Involuntary Ordinary vs. Extraordinary Means of Treatment or… Obligatory vs. Optional Means of Treatment Prolonging Life vs. Prolonging Death

33. II. Making Life - part 1 A. Assisted Reproduction 1. artificial insemination (AI) 2. in vitro fertilization (IVF) 3. intracytoplasmic sperm injection (ICSI) 4. surrogacy

34. Some important terms… Artificial insemination In Vitro fertilization Embryonic stem cells (ESC’s) Adult stem cells (ASC’s) Cloning (somatic cell nuclear transfer – SCNT) Surrogacy

35. II. Making Life - part 2 B. Augmented Reproduction: (Genetic Therapy) 1. stem cell research – adult and embryonic 2. pre-implantation genetic diagnosis (PGD) 3. genetic engineering a) somatic vs. germline b) xenotransplantation and chimeras

36. II. Making Life - part 3 C. Alternative Reproduction: 1. cloning (somatic cell nuclear transfer - SCNT) a) reproductive b) therapeutic (experimental) 2. parthenogenesis (egg) and androgenesis (sperm)

37. “Making” Life

38. II. Making life…

40. In Vitro Fertilization

41. What’s so exciting about stem cells? The human body is made of trillions of cells. When cells are injured, missing or not working properly we experience disease/disability. One way to treat some disease/disability is to replace injured/missing cells with healthy ones. Stem cells can change into other cells and sometimes serve as these replacements.

42. What is a stem cell?

43. What is a “stem” cell?

44. Two types of stem cells… Adult stem cells – come from: Placentas and Umbilical cord blood Various body tissues in babies through adults (fat, blood, bone marrow, brain, skeletal muscle, esophagus, stomach, pancreas, nasal tissues, eye, liver, hair follicles, skin, pulp from lost baby teeth,…) Embryonic stem cells – come from: 5 day-old human embryos

45. ESC’s vs. ASC’s Easier to find Easier to culture More “active” (regenerates faster) pluripotent Immortal (can be maintained in vitro indefinitely) Not subject to autoimmune rejection Easier to control Totipotent More “focused” Does not form tumors Does not destroy the embryo

46. Sexual Reproduction

47.

49. II. Making Life (cont.) Ethical Questions…

50. When do we become human and when do we become a person?

51. Where will we get all the eggs? A woman is injected with powerful hormones that cause her ovaries to produce multiple eggs. (superovulation) The eggs are surgically removed. Up to 14% of women experience complications, some life-threatening.

52. Potential Complications… Possible negative effects on future fertility Ovarian cysts Severe pelvic pain Rupture of the ovaries Stroke Death Exploitation of women Eggs become a commodity

53. One Common Adult Stem Cell Use Bone marrow-derived stem cells are used in cancer and auto-immune disease treatment protocols. Stem cells are given to replace the patient’s bone marrow after high dose chemotherapy or radiation. This is done over 15,000 times a year in the U.S. alone and has resulted in formerly unattainable cures & regressions. “The first hint that adults still harbor some multipotent cells came in the 1960’s, when scientists discovered that bone marrow contained something that made white blood cells, red blood cells and platelets. That something turned out to be hematopoetic (“blood-forming”) stem cells.” Verfaillie, Catherine “Seeds of Hope.” The Stem Cell Revolution Winter 2001: 4. “The first hint that adults still harbor some multipotent cells came in the 1960’s, when scientists discovered that bone marrow contained something that made white blood cells, red blood cells and platelets. That something turned out to be hematopoetic (“blood-forming”) stem cells.” Verfaillie, Catherine “Seeds of Hope.” The Stem Cell Revolution Winter 2001: 4.

54. Other Current ASC Therapies Brain Tumors Retinoblastoma Ovarian Cancer Solid tumors - sarcomas, etc. Testicular Cancer Multiple Myeloma Leukemia Breast Cancer Neuroblastoma Non-Hodgkins Lymphoma Renal Cell Cancer Autoimmune - SLE, JRA, RA, MS Crohn's Disease 1. Brain Tumor - Dunkel, IJ. “High-dose chemotherapy with autologus stem cell rescue for malignant brain tumors.” Cancer Invest 18 (2000):492-493. 2. Retinoblastoma - Dunkel, IJ. “Successful treatment of metastatic retinoblastoma.” Cancer. 89 (15 Nov 2000):2117-2121. 3. Ovarian - Stiff, PJ et al. “High-dose chemotherapy and autologous stem-cell transplantation for ovarian cancer: An autologus blood and marrow transplant registry report.” Ann. Intern. Med. 133 (3 Oct. 2000): 504-515. 4. Solid Tumors - Blay, JY et al. “High-dose chemotherapy with autologus hematopoetic stem-cell transplantation for advanced soft tissue sarcoma in adults.” J. Clin. Oncol. 18 (1 Nov 2000): 3643-50. 5. Testicular Cancer - Bhatia, S. et al. “High-dose chemotherapy as initial salvage chemotherapy in pts. With relapsed testicular cancer.” J. Clin. Oncol. (19 Oct 2000): 3346-51. 6. Multiple Myeloma - Bensinger, W. I. Et al. “Transplantation of bone marrow as compared with peripheral-blood cells from HLA-identical relatives in patients with hematologic cancers.” New England Journal of Medicine 344 (18 Jan. 2001): 175-181. 7. Leukemia - Marco, F. et al. “High survival rate in Infant acute leukemia treated with early high-dose chemotherapy and stem-cell support.” J. Clin. Oncol. 18 (15 Sept. 2000): 3256-61. 8. Breast Cancer - Damon, L.E. et al. “High-dose chemotherapy and hematopoietic stem cell rescue for breast cancer: experience in California.” Biol. Blood Marrow Transplant 6 (2000): 496-505. 9. Neuroblastoma Kawa, K. et al. “Long-term survivors of advanced neuroblastoma with MYCN amplification: A report of 19 patients surviving disease-free for more than 66 months.” J. Clin. Oncol. 17 (Oct. 1999): 3216-20. 10. Non-Hodgkins Lymphoma - Josting, A. “Treatment of primary progressive Hodgkin’s and aggressive Non-Hodgkin’s lymphoma: Is there a chance for Cure?” J. Clin. Oncol. 18 (2000): 332-339. 11. Renal Cell Carcinoma - Childs, R. et al. “Regression of metastic renal-cell carcinoma after nonmyeloblative allogenic peripheral-blood stem-cell transplantation.” NEJM 343 (14 Sept 2000): 750-758. 12. Autoimmune Diseases - Rosen, O. et al. “Autologus stem-cell transplantation in refractory autoimmune diseases after in vivo immunoblation and ex vivo depletion of mononuclear cells.” Arthritis 2 (2000): 327-336. 1. Brain Tumor - Dunkel, IJ. “High-dose chemotherapy with autologus stem cell rescue for malignant brain tumors.” Cancer Invest 18 (2000):492-493. 2. Retinoblastoma - Dunkel, IJ. “Successful treatment of metastatic retinoblastoma.” Cancer. 89 (15 Nov 2000):2117-2121. 3. Ovarian - Stiff, PJ et al. “High-dose chemotherapy and autologous stem-cell transplantation for ovarian cancer: An autologus blood and marrow transplant registry report.” Ann. Intern. Med. 133 (3 Oct. 2000): 504-515. 4. Solid Tumors - Blay, JY et al. “High-dose chemotherapy with autologus hematopoetic stem-cell transplantation for advanced soft tissue sarcoma in adults.” J. Clin. Oncol. 18 (1 Nov 2000): 3643-50. 5. Testicular Cancer - Bhatia, S. et al. “High-dose chemotherapy as initial salvage chemotherapy in pts. With relapsed testicular cancer.” J. Clin. Oncol. (19 Oct 2000): 3346-51. 6. Multiple Myeloma - Bensinger, W. I. Et al. “Transplantation of bone marrow as compared with peripheral-blood cells from HLA-identical relatives in patients with hematologic cancers.” New England Journal of Medicine 344 (18 Jan. 2001): 175-181. 7. Leukemia - Marco, F. et al. “High survival rate in Infant acute leukemia treated with early high-dose chemotherapy and stem-cell support.” J. Clin. Oncol. 18 (15 Sept. 2000): 3256-61. 8. Breast Cancer - Damon, L.E. et al. “High-dose chemotherapy and hematopoietic stem cell rescue for breast cancer: experience in California.” Biol. Blood Marrow Transplant 6 (2000): 496-505. 9. Neuroblastoma Kawa, K. et al. “Long-term survivors of advanced neuroblastoma with MYCN amplification: A report of 19 patients surviving disease-free for more than 66 months.” J. Clin. Oncol. 17 (Oct. 1999): 3216-20. 10. Non-Hodgkins Lymphoma - Josting, A. “Treatment of primary progressive Hodgkin’s and aggressive Non-Hodgkin’s lymphoma: Is there a chance for Cure?” J. Clin. Oncol. 18 (2000): 332-339. 11. Renal Cell Carcinoma - Childs, R. et al. “Regression of metastic renal-cell carcinoma after nonmyeloblative allogenic peripheral-blood stem-cell transplantation.” NEJM 343 (14 Sept 2000): 750-758. 12. Autoimmune Diseases - Rosen, O. et al. “Autologus stem-cell transplantation in refractory autoimmune diseases after in vivo immunoblation and ex vivo depletion of mononuclear cells.” Arthritis 2 (2000): 327-336.

55. Other ASC Applications Kidney Failure: grow new kidney for transplant. Alzheimer’s: modify cells to produce nerve growth factor. Muscular Dystrophy: neural stem cells transformed into muscle. 1. Kidney Transplant - “Stem cell biology holds enormous potential for artificial organ development and transplantation.” The researchers propose taking homologous stem cells and growing kidneys on microfabricated polymers having microarchitecture similar to the patient’s native organ. Niklason, Laura and Robert Langer. “Prospects for Organ and Tissue Replacement.” JAMA. 285-5 (7 Feb 2001): 573-576 2. Alzheimer’s - A neuronal cell derived from bone marrow stem cells could be used in new treatments for Alzheimers. “Bone marrow cells could treat the brain.” 3. Muscular Dystrophy - Transformation took place not only in culture but after injection into mice. “With adult stem cells there would also be the possibility of auto-transplantation, eliminating all the problems of immunological compatibility and rejection.” Transplant rejection would be a significant problem if using embryonic stem cells. Galli, R. et al. “Skeletal myogenic potential of human and mouse neural stem cells.” Nature Neuroscience 3 (Oct 2000): 986-991. 1. Kidney Transplant - “Stem cell biology holds enormous potential for artificial organ development and transplantation.” The researchers propose taking homologous stem cells and growing kidneys on microfabricated polymers having microarchitecture similar to the patient’s native organ. Niklason, Laura and Robert Langer. “Prospects for Organ and Tissue Replacement.” JAMA. 285-5 (7 Feb 2001): 573-576 2. Alzheimer’s - A neuronal cell derived from bone marrow stem cells could be used in new treatments for Alzheimers. “Bone marrow cells could treat the brain.” 3. Muscular Dystrophy - Transformation took place not only in culture but after injection into mice. “With adult stem cells there would also be the possibility of auto-transplantation, eliminating all the problems of immunological compatibility and rejection.” Transplant rejection would be a significant problem if using embryonic stem cells. Galli, R. et al. “Skeletal myogenic potential of human and mouse neural stem cells.” Nature Neuroscience 3 (Oct 2000): 986-991.

56. 1. Functional Genomics - Enable scientists to identify the factors involved in the cellular decision-making process that results in cell specialization. What turns the expression of genes off and on so a cell develops into muscle instead of nervous tissue? Some of our most serious medical conditions, such as cancer, are due to abnormal cell specialization and cell division. 2. Drug Testing - Stem cells could allow scientists to test new drugs using human cell lines which could hasten new drug development. Only drugs that were safe and had beneficial effects in cell line testing would graduate to whole animal or human testing. It would allow quicker and safer development of new drugs. 3. Genetic Disorders - Ability to integrate and generate new cells within an organ makes stem cells prime candidates to deliver gene therapy to replace genetically defective cells. 4. Cell Therapy - A number of diseases are characterized by the death of specific cell populations that do not regenerate themselves - neurodegenerative disorders, paralysis caused by trauma and Type 1 diabetes - for example. Stem cell transplants could repair tissue damaged by disease and injuries. This is the primary benefit stem cells could provide. 5. Transplantation - Skin could be grown in the lab for grafting onto serious burn victims; new livers, kidneys or hearts could be grown on “frameworks” in the lab and then transplanted. This complicated technology will take decades to develop. ‘Stem cells: A Primer.” National Institute of Health. May 2000. <http://www.nih.gov/news/stem cell/primer.htm>1. Functional Genomics - Enable scientists to identify the factors involved in the cellular decision-making process that results in cell specialization. What turns the expression of genes off and on so a cell develops into muscle instead of nervous tissue? Some of our most serious medical conditions, such as cancer, are due to abnormal cell specialization and cell division. 2. Drug Testing - Stem cells could allow scientists to test new drugs using human cell lines which could hasten new drug development. Only drugs that were safe and had beneficial effects in cell line testing would graduate to whole animal or human testing. It would allow quicker and safer development of new drugs. 3. Genetic Disorders - Ability to integrate and generate new cells within an organ makes stem cells prime candidates to deliver gene therapy to replace genetically defective cells. 4. Cell Therapy - A number of diseases are characterized by the death of specific cell populations that do not regenerate themselves - neurodegenerative disorders, paralysis caused by trauma and Type 1 diabetes - for example. Stem cell transplants could repair tissue damaged by disease and injuries. This is the primary benefit stem cells could provide. 5. Transplantation - Skin could be grown in the lab for grafting onto serious burn victims; new livers, kidneys or hearts could be grown on “frameworks” in the lab and then transplanted. This complicated technology will take decades to develop. ‘Stem cells: A Primer.” National Institute of Health. May 2000. <http://www.nih.gov/news/stem cell/primer.htm>

57. Proposed ASC Therapies: Miracle Cures for “Incurable” Diseases Diabetes: transplant insulin-producing islet cells. Multiple Sclerosis: replace damaged nerve cell sheath. Paralysis: re-grow destroyed nervous tissue. Stroke: repair brain damage. Heart Attacks: skin cell ? stem cell ? to replace damaged heart muscle. AIDS: replace damaged immune system. 1. Diabetes - There are 16 million diagnosed diabetic patients in U.S. There are 798,000 more diagnosed annually--this is a $5 billion cost a year. 5-10% of diabetics have Type I diabetes and need new islet cells to produce insulin. Pancreatic duct stem cells have been isolated and induced to become islet cells in mice and have cured their diabetes. “Pancreatic Stem Cell Program.” Stem Cells. 26 Feb. 2001 <http://www.cyto.com/tec/tec002b.htm> 2. Multiple Sclerosis - Proposes nerve stem cell harvesting that are then multiplied in the lab and reinplanted. This process was successful in restoring myelin (the nerve insulating substance) in mice using Schwann cells grown in culture. “Frozen Human Cells Restore Function in Animal Mode.” Pain & Central Nervous System Week. 24 Feb. 2001: 2-3. 3. Paralysis - Stem cells were transplanted into the spinal cords of rats after 9 days of paralysis. They were able to stand and walk, though not perfectly, within two weeks. Seppa, N. Findarticles.com “Stem cells repair rat spinal cord damage.” 1 Jan 2000. Science News. 12 April, 2001. <http://www.findarticles.com/cf/_0/m1200/1/157/59021043>. 4. Stroke - Umbilical cord blood stem cells were cultured into immature neuronal stem cells, and injected intravenously into rats that had been given artificial strokes. The cells migrated to the damaged areas and remarkably improved the recovery of animals. The stemcells replaced dead cells and boosted the rodents’ own brain repair mechanism. Amos, Johnathan. “Umbilical cords to repair brain damage.” BBC News. 19 Feb 2001. <http://news.bbc.co.uk/hi/english/in_depth/sci_tech?2001/san_francisco/newsid _11…1177766.st 4. Heart Attacks - The creators of Dolly took a cow udder cell, turned it into a stem cell and then differentiated that cell into beating heart muscle. Guerrera, Francisco. “PPL follows Dolly with cell breakthrough.” Financial Times. 23 Feb 2001. <http://globalar…les.html> 5. AIDS - Autologous stem cells transplanted after they were made resistant to the HIV virus through gene therapy. The stem cells survived and produced CD4+ cells for a minimum of six months. “Biotech firm says stem cell gene therapy may work for AIDS.” NewsRx.com. 20 Feb 2001 TB & Outbreaks Week. 26 Feb 2001 <http://ww.stemcellresearchnews.com>1. Diabetes - There are 16 million diagnosed diabetic patients in U.S. There are 798,000 more diagnosed annually--this is a $5 billion cost a year. 5-10% of diabetics have Type I diabetes and need new islet cells to produce insulin. Pancreatic duct stem cells have been isolated and induced to become islet cells in mice and have cured their diabetes. “Pancreatic Stem Cell Program.” Stem Cells. 26 Feb. 2001 <http://www.cyto.com/tec/tec002b.htm> 2. Multiple Sclerosis - Proposes nerve stem cell harvesting that are then multiplied in the lab and reinplanted. This process was successful in restoring myelin (the nerve insulating substance) in mice using Schwann cells grown in culture. “Frozen Human Cells Restore Function in Animal Mode.” Pain & Central Nervous System Week. 24 Feb. 2001: 2-3. 3. Paralysis - Stem cells were transplanted into the spinal cords of rats after 9 days of paralysis. They were able to stand and walk, though not perfectly, within two weeks. Seppa, N. Findarticles.com “Stem cells repair rat spinal cord damage.” 1 Jan 2000. Science News. 12 April, 2001. <http://www.findarticles.com/cf/_0/m1200/1/157/59021043>. 4. Stroke - Umbilical cord blood stem cells were cultured into immature neuronal stem cells, and injected intravenously into rats that had been given artificial strokes. The cells migrated to the damaged areas and remarkably improved the recovery of animals. The stemcells replaced dead cells and boosted the rodents’ own brain repair mechanism. Amos, Johnathan. “Umbilical cords to repair brain damage.” BBC News. 19 Feb 2001. <http://news.bbc.co.uk/hi/english/in_depth/sci_tech?2001/san_francisco/newsid _11…1177766.st 4. Heart Attacks - The creators of Dolly took a cow udder cell, turned it into a stem cell and then differentiated that cell into beating heart muscle. Guerrera, Francisco. “PPL follows Dolly with cell breakthrough.” Financial Times. 23 Feb 2001. <http://globalar…les.html> 5. AIDS - Autologous stem cells transplanted after they were made resistant to the HIV virus through gene therapy. The stem cells survived and produced CD4+ cells for a minimum of six months. “Biotech firm says stem cell gene therapy may work for AIDS.” NewsRx.com. 20 Feb 2001 TB & Outbreaks Week. 26 Feb 2001 <http://ww.stemcellresearchnews.com>

58. Stem Cells and Parkinson’s 2006 - ASC from umbilical cord blood to treat rats; significant recovery - ESC to treat rats; many severe tumors 2005 - used protein to stimulate patient’s brain stem cells; significant improvement - turned monkey ESC into neural ASC; mild relief 2004 - successfully treated mice with nerve cells developed from their own bone marrow - turned human ESC into neural ASC and treated mice; partial improvement, but too early to detect tumors 2003 - injected protein into patient’s brain, stimulating neural ASC; 61% improvement in motor function - neurons from mice ESC transplanted into mice; some decrease in symptoms but 20% died due to teratomas Parkinson’s Treatments, Family Research Council, www.frc.org

59. Embryonic Stem Cell therapies None

60. What should we do with the leftover frozen embryos? Discard, i.e., destroy and kill Use in research, i.e., experiment upon (sacrifice one life for another) Adopt: “Snowflake” Babies

61. Evaluating Reproductive Technologies 1. Coercion – an inferior relationship. Sadly, history – present and past – is replete with examples of man’s inhumanity to man, both at the individual level as well the national and international levels. Abominable examples include slavery, racism, eugenics, and genocide. When these criteria are used, the following words and phrases often result: manipulation, exploitation, discrimination, oppression, caste system, and lack of informed consent. Consequently, when such terminology is apropos, then the reproductive technology in question is unethical.

62. Evaluating Reproductive Technologies 2. Commodification – an inhuman relationship. The difference between coercion and commodification is that at least with the former, the human beings are generally acknowledged to be beings, though they certainly are not usually treated humanly. With the latter, the human beings are really not even considered as beings, just raw materials, spare parts, or disposable property – a commodity that is consumable. Therefore, any reproductive technology that considers a human being as nothing more than a plant or animal – something to be farmed or harvested – is deemed unethical.

63. Evaluating Reproductive Technologies 3. Continuity – an inherited relationship. Continuity implies a continuum of humanity, particularly our relationship to our past as well as our future. In other words, when this criterion is applied, the impact of our heritage and the implications for future generations must be considered. What are our responsibilities to our ancestors, and what claims (burdens, obligations, loss of freedom, genetic changes) are we imposing on our progeny? Any reproductive technology that deprives future human beings of their humanness, including their uniqueness, individuality, personhood, and genetic freedom is unethical.

64. 4. Collaboration – an interactive (shared) relationship. Particularly in light of the fact that humans are created imago Dei – in the image of God – humans are genuinely relational beings, biologically, genetically, (and spiritually!) hardwired for connections with each other. Therefore, any procedure or technology that interferes with the opportunity to form deep and meaningful relationships must be considered unethical. In addition, other relationships that might be affected include the relationship with God, the relationship with the environment, and the relationship with one’s self (self-image and the sense of one’s self-worth).

65. III. Faking Life A. Nanotechnology B. Cybernetics and Artificial Intelligence C. Transgenics

66. Some important terms… Nanotechnology Cybernetics Artificial Intelligence Neural Implants Transgenics Transhumanism Posthumanism

67. Faking Life: Nanotechnology The engineering or manipulating of matter (and life) at the nanometer scale via a top-down approach (manipulating matter atom by atom and molecule by molecule) or a bottom-up approach (using or controlling or reprogramming existing biological materials in new and different ways). (*p. 80) * Hook, C. Christopher. “Techno Sapiens: Nanotechnology, Cybernetics, Transhumanism and the Remaking of Humankind.” In Human Dignity in the Biotech Century, ed. Charles W. Colson and Nigel M. de S. Cameron, 75-97. Downers Grove, IL: InterVarsity Press, 2004.

68. NANOSCALE 1 billionth of a meter 10 hydrogen atoms DNA = 2.3 nm wide

70. Nanotechnology: Applications 1. Miniaturization of electronic components 2. Improved durability – less pollution and more efficient 3. Military – stealth garments, interface with electronics; cyborg soldier 4. Cosmetic enhancement 5. Medical uses (next slide)

71. Nanotechnology: Medical Uses Rational drug design Devices specifically targeting and destroying tumor cells or infectious agents In vivo devices for at-the-site-of-need drug manufacture and release Tissue engineering or re-engineering Early detection or monitoring devices In vitro lab-on-a-chip diagnostic tools Devices to clear existing atherosclerotic lesions in coronary or cerebral arteries Biomimetic nanostructures to repair or replace DNA or other organelles Artificial replacements for red blood cells and platelets Tools to augment or repair interaction between neurons in the brain Devices to improve biocompatibility and the interface between brain tissue and cybernetic devices More durable prosthetic devices or implants

72. Faking Life: Cybernetics The science of the control and communication in the animal and the machine. (*p. 76)

73. Cybernetics: Applications 1. Neural-silicon junctions – seamless integration of electronics with our nervous system 2. Virtual reality 3. Repair nerve damage 4. External (wearable) computing devices 5. Augmented reality – supplementing senses (e.g., retrograde vision, projected hearing, infrared vision, GPS)

74. Faking Life: Transhumanism The study of the means and obstacles to humanity using technological and other rational means to becoming posthumans, and of the ethical issues that are involved in this. “Posthumans” is the term for the very much more advanced beings that humans may one day design themselves into if we manage to upgrade our current human nature and radically extend our capacities. from http://www.nickbostrom.com/old/transhumanisn.html, p. 85)

75. Transhumanism - Issues A. “The human species does not represent the end of our evolution but the beginning.” B. Technological immortality C. Reductionism, libertarianism, postmodernism Four transhuman assumptions (p. 87, from N. Katherine Hayles How We Became Posthuman, 1999) 1. information is more important to being human than is the body. 2. consciousness is an epiphenomenon. 3. the body is simply a prosthesis. 4. seamlessly articulated with intelligent machines.

76. Transhumanism - Issues E. Accidents, Abuses, Regulation 1. just distribution of technology 2. impact on jobs and economy 3. effects created by increased longevity F. The “Borgification” of Humanity 1. physical and emotional safety 2. personality fragmentation 3. personal relationships ? cyber-relationships 4. encouragement of inauthentic behavior 5. increased dissatisfaction with reality 6. cyber-addictions

77. III. Faking Life (cont.) Ethical Questions…

78. When does healing become enhancement? 1. Human propensity to enslave, destroy, and demean 2. Clouds the perception of the darkness of the unredeemed human heart

79. What is the purpose of technology? To improve and enrich the lives of ALL living things. To countermand the physical effects of natural calamity and human evil. To more effectively do that which is uniquely human.

80. Technology: Master or Servant? 1. Idol worship  2. Marginalization  3. Isolation  4. Held captive

81. Tranhumanism: Master or Servant? Thesis: Technological efforts to make us more than human, i.e., to be like God, inevitably make us less than human, i.e., enslaved by technology.

82. Are we “playing God?” Assault on reality: Striving for Omnipotence Virtual reality Augmented reality Denying reality  2. Aspiration for Immortality: Striving for Eternality  3. Assumption of Knowledge: Striving for Omniscience  4. Presumption of Grace: Striving for Redemption

83. Suggested Reading: 1. Cameron, Nigel M. de S. The New Medicine: Life and Death after Hippocrates. Chicago: Bioethics Press, 2001. 2. Colson, Charles W. and Cameron, Nigel M. de S. Human Dignity in the Biotech Century. Downers Grove, IL: InterVarsity Press, 2004. 6. Rae, Scott B. Moral Choices. Grand Rapids, MI.: Zondervan, 2000. 7. 8. Smith, Wesley J. Consumer’s Guide to a Brave New World. San Francisco: Encounter Books, 2004.

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