GESTIÓN EN SALUD PÚBLICA: BioEdge: ‘Artificial embryos’ created at the University of Michigan

domingo, 15 de septiembre de 2019

BioEdge: ‘Artificial embryos’ created at the University of Michigan

BioEdge: ‘Artificial embryos’ created at the University of Michigan

Bioedge

‘Artificial embryos’ created at the University of Michigan

by Michael Cook | 15 Sep 2019 |

^{Embryoids growing in the device / University of Michigan}

American scientists are creating embryo-like structures which can be used for studying embryonic development, for fertility drug testing and for genetic research. Earlier this week researchers from the University of Michigan reported in the journal Nature that they have turned induced pluripotent stem cells into models of human embryos in a micro-fluidic environment.

They are able to make hundreds of these “artificial embryos” successfully. “It’s uncanny how much it is like a human embryo,” says Alfonso Martinez Arias, a geneticist at the University of Cambridge, told MIT Technology Review. “This one is particularly spectacular.”

“Our stem cell structures that mimic embryos can help fill critical gaps in knowledge about early human development, and that could lead to a lot of good,” says the lead researcher Jianping Fu.

“This research could give us a window into the pivotal but barely observable period between two and four weeks after conception. This is a time when many miscarriages happen, and serious birth defects can form. Scientists have even begun to find connections between late-onset diseases and early development. We need to understand these processes better if we’re ever going to develop preventative measures.”

While the University of Michigan researchers are highlighting the benefits for studying fertility and birth defects, the larger question, of course, is whether their techniques can be used to create viable embryos. The “artificial embryos” are being destroyed after four days and do not have all the cell types needed to develop normally. MIT Technology Review comments:

“But scientists believe that it might not be long before they can synthesize embryos in the lab that are almost indistinguishable from naturally created ones. Already, research on artificial mouse embryos has progressed to the point where scientists are transferring them to female surrogates and trying to make live animals, though they haven’t succeeded yet.
“The concern is that if scientists could make human embryos in the lab, someone might use the systems to generate genetically modified people, a dystopian scenario similar to the central hatcheries described in the novel Brave New World.”

Last December, Fu and other published an article in Nature which called for regulation of this type of research, especially banning “the use of stem-cell-based entities for reproductive purposes”. However, the line between viable human embryos and “artificial embryos” is far from clear. Their criterion is the intention of the researcher, not “surrogate measures of the equivalence between the human embryo and a model”.

The distinction is important, especially in the United States, where Federal funding for embryo research is banned under the Dickey-Wicker Amendment.

Michael Cook is editor of BioEdge

Conscientious objection to procedures like abortion and euthanasia often features in BioEdge. There is a growing consensus that CO has no place in modern medicine. It’s often argued nowadays that a doctor’s duty is to carry out the wishes of patients, regardless of whether they agree with them or not.

I stumbled across an interesting hypothetical on the American Medical Association Journal of Ethics which makes me question this consensus. In it, three bioethicists analyse a situation involving a difficult patient with deep Christian convictions. He is refusing post-operative pain medication because he believes that he needs to suffer in order to atone for his life as an alcoholic. What should the physician do?

The bioethicists conclude that he should neither acquiesce nor refer the patient to another doctor who will acquiesce. Instead, the physician should “refuse to offer this course of action, regardless of the religious rationale for such a request”.

They go on to assert that “Indeed, as part of their professional commitment to the patient’s health, physicians have some obligation to respectfully challenge patients' refusals of medical care that the physician believes is needed. A sincere discussion—even a respectful debate—in no way denigrates [his] religious beliefs.”

Indeed, this makes good sense. But, viewed from another angle, the bioethicists are advising the physician to conscientiously object to a course of action determined by a lucid patient after serious consideration. They even counsel him to argue (respectfully) with the patient to convince him that he is wrong.

If this is so obviously the case, why is it wrong for a doctor to refuse to perform an abortion? I’m having trouble reconciling the ethical reasoning of the two situations. Can anyone help?