1
|
Moss MF. Constructing appropriate bioprinting regulations: the ethical importance of recognising a liminal technology. JOURNAL OF MEDICAL ETHICS 2024; 50:392-397. [PMID: 37451859 DOI: 10.1136/jme-2023-108925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
This article provides an analysis of bioprinting personalised medical device technology and its ethical challenges to regulation and research ethics. I argue the inclusion of bioprinting applications within existing regulatory frameworks does not adequately address the technologies disruption to the traditionally siloed activities of research and treatment. Using the conceptual framework of liminality, I offer a meaningful way to engage with this technology and address some identified concerns with how it will be categorised and the appropriate recognition of its evidentiary thresholds. I demonstrate these concerns through the exploration of limited conventional research methodologies tasked with the production of generalisable knowledge, specifically population-based evidence that is derived from Randomised Clinical Trials. I use Australian regulatory amendments introduced in 2021 as an example of current regulatory trajectories and highlight why I believe this approach to be insufficient. The significance of this argument will be to demonstrate the disruption of bioprinting applications to current approaches in medical policy, and how various jurisdictions are enacting regulation that is not fit for purpose.
Collapse
Affiliation(s)
- Megan Frances Moss
- School of Philosophical, Historical, and International Studies, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
2
|
van Daal M, de Kanter AFJ, Bredenoord AL, de Graeff N. Personalized 3D printed scaffolds: The ethical aspects. N Biotechnol 2023; 78:116-122. [PMID: 37848162 DOI: 10.1016/j.nbt.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/27/2023] [Accepted: 10/14/2023] [Indexed: 10/19/2023]
Abstract
Personalized 3D printed scaffolds are a new generation of implants for tissue engineering and regenerative medicine purposes. Scaffolds support cell growth, providing an artificial extracellular matrix for tissue repair and regeneration and can biodegrade once cells have assumed their physiological and structural roles. The ethical challenges and opportunities of these implants should be mapped in parallel with the life cycle of the scaffold to assist their development and implementation in a responsible, safe, and ethically sound manner. This article provides an overview of these relevant ethical aspects. We identified nine themes which were linked to three stages of the life cycle of the scaffold: the development process, clinical testing, and the implementation process. The described ethical issues are related to good research and clinical practices, such as privacy issues concerning digitalization, first-in-human trials, responsibility and commercialization. At the same time, this article also creates awareness for underexplored ethical issues, such as irreversibility, embodiment and the ontological status of these scaffolds. Moreover, it exemplifies how to include gender in the ethical assessment of new technologies. These issues are important for responsible development and implementation of personalized 3D printed scaffolds and in need of more attention within the additive manufacturing and tissue engineering field. Moreover, the insights of this review reveal unresolved qualitative empirical and normative questions that could further deepen the understanding and co-creation of the ethical implications of this new generation of implants.
Collapse
Affiliation(s)
- Manon van Daal
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Anne-Floor J de Kanter
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Annelien L Bredenoord
- Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Nienke de Graeff
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| |
Collapse
|
3
|
Tresker S. An account of medical treatment, with a preliminary account of medical conditions. THEORETICAL MEDICINE AND BIOETHICS 2023; 44:607-633. [PMID: 37620606 DOI: 10.1007/s11017-023-09641-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/26/2023]
Abstract
In this article, I present a philosophical account of medical treatment. In support of this account, I offer a suggestive account of medical conditions. The account of medical treatment uses three desiderata to demarcate treatment from non-treatment. Namely, a treatment should: (1) be describable by features that enable it to be standardized and characterized as a discrete intervention, (2) target a specific medical condition, and (3) have the possibility of being effective. The account of medical conditions underlies the second desideratum and attempts to tie medical conditions closely to biological dysfunction, while also including some conditions for which biological dysfunction is absent or its presence uncertain. I offer a simple typology of treatments and show how the accounts are relevant to treatment effectiveness, disease, placebos, contested treatments, and treatment standardization.
Collapse
Affiliation(s)
- Steven Tresker
- Department of Philosophy, University of Antwerp, Rodestraat 14, Antwerp, 2000, Belgium.
| |
Collapse
|
4
|
Pettersson ABV, Ballardini RM, Mimler M, Li P, Salmi M, Minssen T, Gibson I, Mäkitie A. Legal issues and underexplored data protection in medical 3D printing: A scoping review. Front Bioeng Biotechnol 2023; 11:1102780. [PMID: 36923458 PMCID: PMC10009255 DOI: 10.3389/fbioe.2023.1102780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/06/2023] [Indexed: 03/03/2023] Open
Abstract
Introduction: 3D printing has quickly found many applications in medicine. However, as with any new technology the regulatory landscape is struggling to stay abreast. Unclear legislation or lack of legislation has been suggested as being one hindrance for wide-scale adoption. Methods: A scoping review was performed in PubMed, Web of Science, SCOPUS and Westlaw International to identify articles dealing with legal issues in medical 3D printing. Results: Thirty-four articles fulfilling inclusion criteria were identified in medical/technical databases and fifteen in the legal database. The majority of articles dealt with the USA, while the EU was also prominently represented. Some common unresolved legal issues were identified, among them terminological confusion between custom-made and patient-matched devices, lack of specific legislation for patient-matched products, and the undefined legal role of CAD files both from a liability and from an intellectual property standpoint. Data protection was mentioned only in two papers and seems an underexplored topic. Conclusion: In this scoping review, several relevant articles and several common unresolved legal issues were identified including a need for terminological uniformity in medical 3D printing. The results of this work are planned to inform our own deeper legal analysis of these issues in the future.
Collapse
Affiliation(s)
- Ante B V Pettersson
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | | | - Marc Mimler
- The City Law School City, University of London, London, United Kingdom
| | - Phoebe Li
- Sussex Law School, University of Sussex, Brighton, United Kingdom
| | - Mika Salmi
- Department of Mechanical Engineering, Aalto University, Espoo, Finland
| | - Timo Minssen
- Center for Advanced Studies in Biomedical Innovation Law (CeBIL), Faculty of Law, University of Copenhagen, Copenhagen, Denmark
| | - Ian Gibson
- Department of Design, Production and Management, University of Twente, Enschede, Netherlands
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
5
|
Walker MJ, Bourke J, Hutchison K. Evidence for personalised medicine: mechanisms, correlation, and new kinds of black box. THEORETICAL MEDICINE AND BIOETHICS 2019; 40:103-121. [PMID: 30771062 DOI: 10.1007/s11017-019-09482-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Personalised medicine (PM) has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we examine PM strategies epistemologically in order to develop capacities to address these challenges, focusing on a recently proposed strategy for developing patient-specific models from induced pluripotent stem cells (iPSCs) so as to make individualised treatment predictions. We compare this strategy to two main PM strategies-stratified medicine and computational models. Drawing on epistemological work in the philosophy of medicine, we explain why these two methods, while powerful, are neither truly personalised nor, epistemologically speaking, novel strategies. Both are forms of correlational black box. We then argue that the iPSC models would count as a new kind of black box. They would not rely entirely on mechanistic knowledge, and they would utilise correlational evidence in a different way from other strategies-a way that would enable personalised predictions. In arguing that the iPSC models would present a novel method of gaining evidence for clinical practice, we provide an epistemic analysis that can help to inform the practical, regulatory, and ethical challenges of developing an iPSC system.
Collapse
Affiliation(s)
- Mary Jean Walker
- Monash University, Clayton, VIC, Australia.
- Australian Research Council Centre of Excellence for Electromaterials Science, Wollongong, NSW, Australia.
| | - Justin Bourke
- University of Melbourne, Parkville, VIC, Australia
- Australian Research Council Centre of Excellence for Electromaterials Science, Wollongong, NSW, Australia
| | - Katrina Hutchison
- Macquarie University, North Ryde, NSW, Australia
- Australian Research Council Centre of Excellence for Electromaterials Science, Wollongong, NSW, Australia
| |
Collapse
|