The year 2008 was an eventful year in the fields of science, medicine, and government in the United States and abroad. Many of these events and discoveries present significant bioethical challenges, while others are advances in promoting the value and dignity of human life. Several of these challenges surround the results of the November 2008 election, while others include recent medical and scientific discoveries. We offer the following as a compilation of some of the top bioethics stories of 2008.
by Associated Press New York Times, December 6, 2008,
Accessed January 24, 2009 A Montana judge has ruled that doctor-assisted suicide is legal in the state, but the decision is likely to be appealed. The judge, Dorothy McCarter, issued the ruling late Friday in the case of a Billings man with terminal cancer who had sued the state. (http://www.nytimes.com/2008/12/07/health/07montana.html?bl&ex=1228798800& en=8a47220b90bc54e4&ei=5087%0A)
This ruling if upheld legalizes physician-assisted suicide through an individual judge, instead of through the legislature. The ruling is pending appeal to the Montana Supreme Court. If the ruling stands, Montana will become the third state in the U.S. to legalize physician-assisted suicide and the first to do so through a non-legislative act.
AFP, December 12, 2008, Accessed January 24, 2009
The Vatican on Friday condemned techniques that manipulate embryos including cloning and stem cell research, saying they undermine human dignity. (http://www. google.com/hostednews/afp/article/ALeqM5hkivig14vZUYrnaSGRQsfBdazehg)
Dignitas Personae is the first instruction in 20 years given by the Vatican on the use of reproductive technology and the status of the embryo.
by Michelle Roberts, BBC, November 19, 2008, Accessed January 24, 2009
Surgeons in Spain have carried out the world’s first tissue-engineered whole organ transplant - using a windpipe made with the patient’s own stem cells. The groundbreaking technology also means for the first time tissue transplants can be carried out without the need for anti-rejection drugs. (http://news.bbc.co.uk/2/hi/ health/7735696.stm)
This transplant is the first of its kind and highlights the effectiveness of adult stem cells in this type of transplant, demonstrating promise for other transplants.
by P. Jayaram, Straits Times, Accessed January 24, 2009
India’s Supreme Court has not only confirmed what everyone already knew, that sur- rogacy is a commercial industry in the country, but it also ruled that renting a womb is legal. (http://www.straitstimes.com/Breaking%2BNews/Asia/Story/STIStory_286442. html)
This ruling legalizes gestational surrogacy in India giving legitimacy to a thriving indus- try that promotes international “fertility tourism.” This industry is viewed by many as exploitive of poor women in addition to the complications introduced by the practice of surrogacy in general.
by Curt Woodward, Seattle Times, November 4, 2008, Accessed January 24, 2009
Voters approved Initiative 1000 on Tuesday, making Washington the second state to give terminally ill people the option of medically assisted suicide. The ballot measure, patterned after Oregon’s “Death with Dignity” law, allows a terminally ill person to be prescribed lethal medication, which would be self-administered. (http://seattletimes. nwsource.com/html/localnews/2008352565_apwaassistedsuicide2ndldwritethru. html)
Upon passage of this initiative, Washington became the second state after Oregon to legalize physician-assisted suicide in the United States. The passage of this initia- tive also causes concern that physician-assisted suicide is becoming an increasingly accepted practice within the U.S.
Associated Press, November 5, 2008, Accessed January 24, 2009
Supporters of a ballot measure that loosens restrictions on embryonic stem cell research say its passage means millions of dollars in research grants will come into the state -- and medical breakthroughs for a host of ailments will come out of it. Michigan voters on Tuesday approved Proposal 2, which changes state law to allow people to donate embryos left over from fertility treatments for scientific research. (http://www. mlive.com/politics/index.ssf/2008/11/michigan_voters_approve_stem_c.html)
The passage of this measure is significant, since exit polls demonstrated an increased acceptance of embryonic stem cell research and opposition to the tactics taken by the pro-life advocates trying to defeat this measure.
by Gardiner Harris, New York Times, October 23, 2008, Accessed January 24, 2009
Half of all American doctors responding to a nationwide survey say they regularly prescribe placebos to patients. The results trouble medical ethicists, who say more research is needed to determine whether doctors must deceive patients in order for placebos to work. (http://www.nytimes.com/2008/10/24/health/24placebo.html?_ r=1&hp&oref=slogin)
This study is troubling to many who fear that the doctor-patient relationship is placed in jeopardy due to the deception involved in prescribing placebos.
Science Daily, September 24, 2008, Accessed January 24, 2009
In a promising finding for the field of regenerative medicine, stem cell researchers at Children’s Hospital of Pittsburgh of UPMC have identified a source of adult stem cells found on the walls of blood vessels with the unlimited potential to differentiate into human tissues such as bone, cartilage and muscle. (http://www.sciencedaily.com/ releases/2008/09/080922122429.htm)
This was another significant discovery in the field of adult stem cell research. This discovery is the first to identify multipotent stem cells known as pericytes. In this study, these cells demonstrated the ability to repair injured muscle tissue suggesting that they have significant potential for use in regenerative medicine.
by Maggie Fox, Reuters, August 7, 2008, Accessed January 24, 2009
U.S. stem cell experts have produced a library of the powerful cells using ordinary skin and bone marrow cells from patients, and said on Thursday they would share them freely with other researchers. They used a new method to re-program ordinary cells so they look and act like embryonic stem cells — the master cells of the body with the ability to produce any type of tissue or blood cell. (http://www.reuters.com/article/ scienceNews/idUSN0731595620080807)
These induced pluripotent (IPS) cell lines came from patients with incurable genetic diseases such as ALS, Parkinson’s and type 1 diabetes in order to better understand the pathophysiology of these diseases. The creation of this library highlights the incredible benefit of IPS cells in the understanding and hopefully treatment of inherited genetic diseases.
by Elisabeth Rosenthal, New York Times, August 20, 2008, Accessed January 24, 2009
Two vaccines against cervical cancer are being widely used without sufficient evidence about whether they are worth their high cost or even whether they will effectively stop women from getting the disease, two articles in this week’s New England Journal of Medicine conclude. (http://www.nytimes.com/2008/08/21/health/21vaccine.html?_r= 1&partner=MYWAY&ei=5065&oref=slogin)
This study highlights the lack of evidence regarding the long-term effectiveness of the HPV vaccines against cervical cancer. More study will be needed in order to determine if these vaccines will be successful in reducing the rate of cervical cancer.
by Rob Stein, Washington Post, August 28, 2008, Accessed January 24, 2009
Scientists have transformed one type of fully developed adult cell directly into another inside a living animal, a startling advance that could lead to cures for a variety of illnesses and sidestep the political and ethical quagmires associated with embryonic stem cell research. (http://www.washingtonpost.com/wp-dyn/content/article/2008/08/27/ AR2008082701829.html)
While this study involved mice, this discovery shows significant promise for use in regenerative medicine in humans. Pro-life advocates welcome this discovery since it appears to eliminate the need for embryonic stem cell research.
by Roger Fortuna and Joann Brady, ABC News, June 20, 2008, Accessed January 24, 2009
A London doctor used genetic screening to help a woman conceive Britain’s first baby guaranteed to be free of hereditary breast cancer. The 27-year-old woman decided to have her embryos screened for an inherited gene that would have left the baby with a 50 percent chance of developing breast cancer. The woman has a long history of breast cancer in her family, and her husband tested positive for the gene. (http://abcnews. go.com/GMA/OnCall/story?id=5275445&page=1)
This was a highly publicized case of the use of in vitro fertilization with pre-implantation genetic diagnosis to screen for hereditary disease. This case is significant since PGD, normally used to test for congenital disorders, was used in this instance to screen for the BRCA-1 gene, which increases an individual’s risk of developing breast cancer.
by Kevin Sack, New York Times, June 5, 2008, Accessed January 24, 2009
Race and place of residence can have a staggering impact on the course and quality of the medical treatment a patient receives, according to new research showing that blacks with diabetes or vascular disease are nearly five times more likely than whites to have a leg amputated and that women in Mississippi are far less likely to have mammograms than those in Maine. (http://www.nytimes.com/2008/06/05/health/ research/05disparities.html?_r=2&partner=MYWAY&ei=5065&oref=slogin)
This is a significant study indicating serious inequality of healthcare and medical treatment between regions in the United States. The study also identified such factors as race, education, poverty, variation in medical practice and spending as contributing to health care disparities.
by Sarah Kate Templeton, Times Online, May 11, 2008, Accessed January 24, 2009
Scientists have created what is believed to be the first genetically modified (GM) human embryo. A team from Cornell University in New York produced the GM embryo to study how early cells and diseases develop. It was destroyed after five days. (http:// www.timesonline.co.uk/tol/news/uk/science/article3908516.ece)
This is the first genetically modified human embryo to be created. While this embryo was created for research purposes, many fear that the creation of GM embryos will be created for reproductive purposes in the future.
by Ann Fernholm, San Francisco Chronicle, May 21, 2008, Accessed January 24, 2009
One of the most promising materials for the future of technology, carbon nanotubes, might be as harmful as asbestos if inhaled, according to a new study published Tuesday in the scientific journal Nature Nanotechnology. (http://www.sfgate.com/cgi-bin/ article.cgi?f=/c/a/2008/05/20/BUDG10P518.DTL&type=science)
This study causes great concern over the safety of creation and use of carbon nanotubes. More research is needed to understand the effects of carbon nanotubes on the environment.
BBC, January 17, 2008, Accessed January 24, 2009
Regulators have given scientists the green light to create human-animal embryos for research. The Human Fertilisation and Embryology Authority granted permission after a consultation showed the public was “at ease” with the idea. (http://news.bbc. co.uk/2/hi/health/7193820.stm)
Many view the creation of human-animal hybrid embryos as scientifically unnecessary and are opposed to this type of research since it involves the alteration and destruction of human embryos.
by Fergus Walsh, BBC, April 1, 2008, Accessed January 24, 2009
Scientists at Newcastle University have created part-human, part-animal hybrid embryos for the first time in the UK, the BBC can reveal. The embryos survived for up to three days and are part of medical research into a range of illnesses. (http://news.bbc. co.uk/2/hi/health/7323298.stm)
This is the first time a human-animal hybrid embryo has been created in the U.K. The embryos were created with special approval of the Human Fertilisation and Embryology Authority prior to the passage of specific legislation allowing for the creation of these hybrid embryos. This is significant since many feel the HFEA acted outside its jurisdiction by allowing this controversial research.
by Ricardo Alonso-Zaldivar, LA Times, April 25, 2008, Accessed January 24, 2009
The Senate unanimously passed landmark legislation today that would outlaw discrimination by health insurance companies and employers because a person’s genes raise their risk of breast cancer, Alzheimer’s disease or any ailment that has a hereditary component. (http://articles.latimes.com/2008/apr/25/nation/na-genes25)
This legislation is the first of its kind. This bill is a step forward to ensure against genetic discrimination by health insurance companies and employers.
by Andy Coghlan, New Scientist, January 10, 2008, Accessed January 24, 2009
For the first time, human embryonic stem cells have been obtained without having to destroy the embryos they came from. The breakthrough sidesteps the primary ethical objection to human embryonic stem cell (hESC) research – that embryos must perish to yield up hESCs. (http://www.newscientist.com/article/dn13170-stem-cellbreakthrough-leaves-embryos-unharmed.html)
This is a significant discovery believed to sidestep the ethical issues of destructive embryonic research. Many individuals, however, are reticent to accept this new method since it may cause possible harm to the embryo and since twinning may still be possible during this stage of embryonic development.
by Lawrence K. Altman, New York Times, December 16, 2008, Accessed January 24, 2009
Cleveland Clinic surgeons have performed the nation’s first near total face transplant, officials said on Tuesday. The patient is a woman who was not identified. (http://www. nytimes.com/2008/12/17/health/17face.html?scp=4&sq=face%20transplant&st=cse)
While this was not the first face transplant performed internationally, it was the most extensive face transplant performed so far. Critics of face transplants cite concern over the protection of the dead donor’s identity and the possible psychological effects on the patient if the face transplant is rejected.
by Andrew Pollack, New York Times, October 6, 2008, Accessed January 24, 2009
For three decades, scientists have been trying to develop a noninvasive prenatal test for Down syndrome that would replace amniocentesis, which can cause miscarriages. Now, scientists using powerful genetic techniques are closing in on that goal with tests that require only a blood sample from the pregnant woman. A biotechnology company in San Diego called Sequenom says it will begin selling such a test next June. (http:// www.nytimes.com/2008/10/07/health/research/07down.html?scp=1&sq=blood%20 test%20for%20down%20syndrome&st=cse)
While this test would avoid the risk of miscarriage involved in amniocentesis, the development of this test should cause concern, since there is no preventative treatment for Down syndrome and the majority of individuals choose to abort their fetus based upon a positive diagnosis of Down syndrome.
by Gene Emery, ABC News, December 11, 2008, Accessed January 24, 2009
Doctors in St. Louis said they have successfully transplanted a full ovary from a volunteer, allowing her infertile twin sister to give birth to a healthy baby girl on November 11. It is the first time an entire ovary has been transplanted and resulted in a live birth, the researchers said. Writing in the New England Journal of Medicine, they said the method may offer a way to preserve fertility for cancer patients or for women who want to wait until they are older to start families.(http://abcnews.go.com/Health/ wireStory?id=6438193)
This type of transplant shows great promise in allowing women facing the potential of losing ovarian function to preserve fertility, although it also introduces a variety of ethical issues such as the issue of extending the time period when a woman is fertile.
