1
|
van Daal M, de Kanter AFJ, Custers RJH, Martínez-Sanz E, Bredenoord AL, de Graeff N. Patient, parent and professional expert perspectives on personalized regenerative implants: a qualitative focus group study. Regen Med 2024; 19:393-406. [PMID: 39222046 PMCID: PMC11370919 DOI: 10.1080/17460751.2024.2386214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
Background: Perspectives of patients, parents and professional experts on personalized regenerative implants for regenerative medicine purposes are largely unknown.Method: To better understand these perspectives, we conducted four focus groups with professional experts of mixed European nationality (n = 8), Dutch patients with regular implants (n = 8), Dutch and Belgian (n = 5) and Spanish (n = 8) parents of children with cleft palate.Results: Two overarching themes were identified: 'patient-centered research and care' and 'ambivalent attitudes toward personalized regenerative implants'.Discussion: The results reveal that stakeholders should adopt a participatory rather than an impairment discourse and address the ambivalence among professional experts, patients and parents.Conclusion: Considering stakeholder perspectives facilitates ethical and responsible development and use of personalized regenerative implants.
Collapse
Affiliation(s)
- Manon van Daal
- Department of Bioethics & Health Humanities, Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne-Floor J de Kanter
- Department of Bioethics & Health Humanities, Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roel JH Custers
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elena Martínez-Sanz
- Department of Anatomy & Embryology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Annelien L Bredenoord
- Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Nienke de Graeff
- Department of Medical Ethics & Health Law, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| |
Collapse
|
2
|
Hendriks S, Grady C, Wasserman D, Wendler D, Bianchi DW, Berkman B. A New Ethical Framework for Assessing the Unique Challenges of Fetal Therapy Trials. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:45-61. [PMID: 33455521 PMCID: PMC8530458 DOI: 10.1080/15265161.2020.1867932] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
New fetal therapies offer important prospects for improving health. However, having to consider both the fetus and the pregnant woman makes the risk-benefit analysis of fetal therapy trials challenging. Regulatory guidance is limited, and proposed ethical frameworks are overly restrictive or permissive. We propose a new ethical framework for fetal therapy research. First, we argue that considering only biomedical benefits fails to capture all relevant interests. Thus, we endorse expanding the considered benefits to include evidence-based psychosocial effects of fetal therapies. Second, we reject the commonly proposed categorical risk and/or benefit thresholds for assessing fetal therapy research (e.g., only for life-threatening conditions). Instead, we propose that the individual risks for the pregnant woman and the fetus should be justified by the benefits for them and the study's social value. Studies that meet this overall proportionality criterion but have mildly unfavorable risk-benefit ratios for pregnant women and/or fetuses may be acceptable.
Collapse
Affiliation(s)
- Saskia Hendriks
- Department of Bioethics, Clinical Center, National
Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, MD 20892, USA
| | - Christine Grady
- Department of Bioethics, Clinical Center, National
Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, MD 20892, USA
| | - David Wasserman
- Department of Bioethics, Clinical Center, National
Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, MD 20892, USA
| | - David Wendler
- Department of Bioethics, Clinical Center, National
Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, MD 20892, USA
| | - Diana W. Bianchi
- National Human Genome Research Institute, National
Institutes of Health, 31 Center Dr, Room 2A03, Bethesda, MD 20894, USA
| | - Benjamin Berkman
- Department of Bioethics, Clinical Center, National
Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, MD 20892, USA
| |
Collapse
|
3
|
Oerlemans AJM, van Hoek MEC, van Leeuwen E, Dekkers WJM. Hype and expectations in tissue engineering. Regen Med 2014; 9:113-22. [PMID: 24351011 DOI: 10.2217/rme.13.89] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Scientific progress and the development of new technologies often incite enthusiasm, both in scientists and the public at large, and this is especially apparent in discussions of emerging medical technologies, such as tissue engineering (TE). Future-oriented narratives typically discuss potential applications with much hype and expectations. In this article, we analyze the discourse on TE, its history and the promises present in the discourse surrounding it. Subsequently, we regard discussions about implantable bioartificial kidneys, and consider the concepts of hype and expectations in TE in general. Finally, we discuss what ethically responsible choices should be made in discussing TE to adequately deal with the scientific reality and public expectations surrounding this technology.
Collapse
Affiliation(s)
- Anke J M Oerlemans
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, PO Box 9101 (IQ 114), 6500 HB Nijmegen, The Netherlands
| | | | | | | |
Collapse
|
4
|
Oerlemans AJM, van Hoek MEC, van Leeuwen E, van der Burg S, Dekkers WJM. Towards a richer debate on tissue engineering: a consideration on the basis of NEST-ethics. SCIENCE AND ENGINEERING ETHICS 2013; 19:963-81. [PMID: 23229374 DOI: 10.1007/s11948-012-9419-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 11/06/2012] [Indexed: 05/04/2023]
Abstract
In their 2007 paper, Swierstra and Rip identify characteristic tropes and patterns of moral argumentation in the debate about the ethics of new and emerging science and technologies (or "NEST-ethics"). Taking their NEST-ethics structure as a starting point, we considered the debate about tissue engineering (TE), and argue what aspects we think ought to be a part of a rich and high-quality debate of TE. The debate surrounding TE seems to be predominantly a debate among experts. When considering the NEST-ethics arguments that deal directly with technology, we can generally conclude that consequentialist arguments are by far the most prominently featured in discussions of TE. In addition, many papers discuss principles, rights and duties relevant to aspects of TE, both in a positive and in a critical sense. Justice arguments are only sporadically made, some "good life" arguments are used, others less so (such as the explicit articulation of perceived limits, or the technology as a technological fix for a social problem). Missing topics in the discussion, at least from the perspective of NEST-ethics, are second "level" arguments-those referring to techno-moral change connected to tissue engineering. Currently, the discussion about tissue engineering mostly focuses on its so-called "hard impacts"-quantifiable risks and benefits of the technology. Its "soft impacts"-effects that cannot easily be quantified, such as changes to experience, habits and perceptions, should receive more attention.
Collapse
Affiliation(s)
- A J M Oerlemans
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | |
Collapse
|
5
|
Oerlemans AJ, Feitz WF, van Leeuwen E, Dekkers WJ. Regenerative Urology Clinical Trials: An Ethical Assessment of Road Blocks and Solutions. TISSUE ENGINEERING PART B-REVIEWS 2013; 19:41-7. [DOI: 10.1089/ten.teb.2012.0136] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Anke J.M. Oerlemans
- Scientific Institute for Quality of Healthcare, Section Ethics, Philosophy and History of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Wouter F.J. Feitz
- Department of Urology, Radboud University Nijmegen Medical Centre, Radboud Children's Hospital, Nijmegen, The Netherlands
| | - Evert van Leeuwen
- Scientific Institute for Quality of Healthcare, Section Ethics, Philosophy and History of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Wim J.M. Dekkers
- Scientific Institute for Quality of Healthcare, Section Ethics, Philosophy and History of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
6
|
Saxena A, Ackbar R, Höllwarth M. Tissue Engineering for the Neonatal and Pediatric Patients. JOURNAL OF HEALTHCARE ENGINEERING 2012. [DOI: 10.1260/2040-2295.3.1.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
7
|
Oerlemans AJ, van den Berg PP, van Leeuwen E, Dekkers WJ. Ethical Issues Regarding the Donation and Source of Cells for Tissue Engineering: A European Focus Group Study. TISSUE ENGINEERING PART B-REVIEWS 2011; 17:229-34. [DOI: 10.1089/ten.teb.2010.0683] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Anke J.M. Oerlemans
- Section Ethics, Philosophy, and History of Medicine, Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Paul P. van den Berg
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Evert van Leeuwen
- Section Ethics, Philosophy, and History of Medicine, Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Wim J.M. Dekkers
- Section Ethics, Philosophy, and History of Medicine, Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|