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Stem cells

Stem cells are undiferentiated cells t hat have the ability to form dierent types of cells. For example adult stem cells from the bone marrow can form many types of blood cells. Embryonic stem cells can dierentiate into any type ty pe of ce cell ll an and d ar are e th ther eref efor ore e ca call lled ed plur They ey ha hav ve th the e pluripot ipotent ent cell cells s. Th capability to form nerve cells or heart muscle cells; these cells cannot normally regenerate. For example people who damage the nerve cells in their spinal cord are usually paralysed below the level of their injury because the nerve cells cannot repair and brain damage after a stroke is permanent. luripotent stem cells can dierentiate into any type of cells and so may be used to repair or replace nerves or even organs.  They have, until recently have had to be taken rom dead embryos and because o this many people have ethical objections.  !ohn "urdon showed that adult cells can be re programmed to behave like egg cells. That the nucleus of any cell has the information to make any other type of cell. #e transplanted the nucleus of an adult frog cell into an egg cell of th the e sa same me sp spec ecie ies s wh whic ich h gr grew ew in into to a he heal alth thy y ad adul ult. t. Th This is le led d to th the e possib pos sibili ility ty of clo clonin ning g and paved the way for $ol $olly ly the sheep. sheep.  Proessor  Yamanaka  Y amanaka rom Japan built on John urdon!s "ork and sho"ed in #$$% that mature cells could be &un"ound! and regressed to orm stem cells. %ot only does this evade the ethical problems of using embryos but it can mean that it may be possible to use a persons own skin cells to grow a replacement organ and because it is formed from his own cells there is no po &nfortunate tunately ly the te poss ssib ibil ilit ity y o or orga gan n re reje ject ctio ion. n. &nfor techn chni'u i'ue e o  &induced pluripotent stem cells! uses comple( genetic

techni'ues and is di'cult. ( !apanese team announced announced last week week that they had induced pluripote pluripotent nt cells by simply &shocking! adult cells by bathing them in mild citric forr le less ss th than an )* mi min n wh whic ich h ca caus used ed th them em to rev ever ertt in into to im imma matu turre acid fo embryonic stem cells. The cells were injected into a mouse embryo where they behaved like genuine embryonic stem cells. +hris ,ason -a professor of  regenerative medicine at &+ said that the simplicit simplicity y o the method &"as almost too good to be true. / /0f it works in man -this could be the game changer that ultimately makes a wide range of cell therapies available using the pati patient ent1s 1s own cel cells ls as sta starti rting ng mat mater erial ial.1 .1 &T &The he age o per person sonali alised sed medicine "ould have )nally arrived. & he said.

 

2rgans have been produced by removing dead organs such as a heart then stripping it of heart cells using a detergent like substance leaving a collagen fram fr ame. e. St Ste em cell lls s wer ere e th the en inj njec ecte ted d int nto o the fr fram ame e an and d th the ey sel elf  f  dier di erent entiat iated ed int into o hea heart rt ce cells lls and mul multip tiplie lied. d. The hea heart rts s pr produ oduced ced ev even en started pumpingbut were too weak to be used. So far stem ce cell lls s ha have ve be been en us used ed to fo forrm ne new w ret etin inas as an and d hav have e be been en successfully in retinal The ancet 4) 4*556 reported that a patientused in Sweden hadtransplants. received the worlds 7rst3%ov trachea p roduced produced from stem cells. The patient had a cancer in his wind pipe 3trachea6. (n arti7cial trachea was created by using a glass model to produce an arti7cial scaold.  Then stem cells were were inserted into the scaold then then the glass removed. removed. Stem cel Stem cells ls ar are e pr produ oducin cing g muc much h ex excit citeme ement nt in the 7el 7eld d of re regen gener erati ative ve medicine. 0f you have not already- have a look at the 5* min TE$ talk by rofessor (ubrey "rey 0 recommended a few months ago. #e believes that humans may possibly live for ever8 #e is a cra9y looking guy but his ideas have some merit and were discussed in the :,!. Since he did the talk the ,ethusela mouse pri9e he talks about has been won . Scientists actually managed to make a mouse younger not just stop aging83p;< of my book6 =ou may also want to read ;> ?>* /,edicine in the future1 from my book ,edical School Sch ool 0nt 0nterv erview iews s The @no @nowle wledge dge to hel help p ans answer wer the com common mon Aue Auesti stion on /Bhat do you consider to be the most exciting 7eld in medicine.1

 The Times1 headline on Friday ran /$iabetes a cure at last81 #owever the pres pr ess s of ofte ten n exa xagg gger erat ates es or mi misu sund nder erst stan ands ds.. Bh Bhat at rea eall lly y do does es th this is breakthrough breakthr ough really meanC ( team of #arvard scientists have used pluripotent stem cells to produce which ch sec secre rete te ins insuli ulin. n. Type * di beta bet a cel cells ls whi diabe abetes tes is an autoimmune disease 3where the body1s own white cells attack it1s own cells6 in which beta cells which produce produce insulin in the pancreas pancreas are destroyed destroyed leading to a lack of insulin which has to be given by injections. These stem cell derived werre sh show own n in la labo bora rato tory ry to be ab able le to pr prod oduc uce e in insu suli lin n in beta bet a cel cells ls we respo re sponse nse to hig high h glu glucos cose e lev levels els lik like e nor normal mal bet beta a ce cells lls.. The They y wer were e the then n transplanted into diabetic mice and were shown to be able to act like normal pancreatic transplanted cells. +hallenges remainD This study only used a small number o mice . Be do not know as yet if the same technology will work in humans. ancreatic

 

transplants from deceased donors have been used in diabetics with some success for decades. #owever after a few years these usually fail because thebody!s auto immune system destroys the beta cells as it did the patient!s original beta cells . 2ne idea is to put these stem cells into a &capsule!which would enable glucose and insulin to go freely in and out but prev pr even entt at atta tack ck fr from om im immu mune ne ce cell lls. s. :e :eta ta ce cell lls s de deri rive ved d fr from om st stem em ce cell lls s would not the much only ever be a iscure ordue type diabete more mainly to a*lack of cell ssensitivity to insulin. common type # which

Plurip Plur ipot oten entt st stem em ce cell lls s are cause of much hope and excitement.  These "ere derived rom discarded embryos  and hence research research using stem cells was banned in the &S( by the :ush administration but resident 2bama reversed reversed this ban. rofessor =amanaka showed in 4**< that mature cells could be &un"ound 1 and regressed to form stem cells. %ot only does this evade the ethical problems of using embryos but it can mean that it may be po poss ssib ible le to us use e a pe pers rson ons s ow own n sk skin in ce cell lls s to gr grow ow ot othe herr cel ells ls or a replacement organ and because it is formed from his own cells there is usua us uall lly y no po poss ssib ibil ilit ity y of rej ejec ecti tion on wh wher ere e th the e bo body dy1s 1s im immu mune ne sy syst stem em recognises it as /foreign1 and attacks it 3except in auto immune diseases such as type 5 diabetes6. luripot luri potent ent ste stem m cel cells ls se they ey ar are e gi give ven n seem em to ha have ve &a me memo mory ry!. !. 0f th the right environment and nutrients  they &recognise! the type o cell 2rgans ans have been produced produced by rem removing oving they are supposed to orm.   2rg dead organs such as a heart then stripping it of heart cells using a detergent like substance leaving a collagen frame. Stem cells were then injected into the frame and they self dierentiated into heart cells and multiplied. The heart hea rts s pr produ oduced ced even sta start rted ed pum pumpin pingg- but we were re too we weak ak to be use used. d. So far stem cells have been used to orm ne" retinas  and have been successfully used in retinal transplants. The ancet 3%ov 4) 4*556 reported that a patient in Sweden had received the "orlds )rst trachea produced rom stem cells. The patient had a cancer in his wind pipe 3trachea6. (n arti7cial trachea was created by using a glass model to produce an arti7cial scaol sca old. d. The Then n ste stem m cel cells ls wer were e ins inser erted ted int into o the sca scaol old d the then n the gla glass ss removed. 0n conclusion. Be are still far away from creating a cure for even type 5 diabetes. :ut 0 am excited not just about future cures for diabetes but the use of stem cell technology for a whole range of diseases. The idea o ne" healthy cells or old damaged ones  ?it is something we never thought possible and could lead to an explosion of medical ability possible cures for dement dem entiaia- arki arkinso nson1sn1s- re repai pairs rs for hea heart rtsp spinal inal cor cord d dam damage age-- in fac factt any organ- any system. 0n a way it feels too much to hope for- too greedy a

 

dream. =ou the doctors of tomorrow may be practising a totally dierent medicine than 0 am today8

%#S 0t is the party conerence season- when the main political parties meet with their members- talk about the issues of the day and "hat is likely to be in their maniestos or the election ne(t year. (s usual the +- has been a majo major r issue in the party conferences and is therefore likely to be in the forthcoming election with both parties promising that the %#S will be better of under their care. BhyC The +- re'uently comes top in lists of the things that the :ritish people are most proud of. %igel %ig el aw awson son a for forme merr hea health lth minister minister once sai said d tha thatt / the +- is the $avid id near ne ares estt th thin ing g th that at th the e r rit itis ish h ha have ve to a na nati tion onal al re reli ligi gion on/ $av +ame +a merron sa saiid be befo forre the la last st el ele ect ctio ion n th that at /Ton ony y :la laiir su sum mmed up his priorities  in three words G Education- education- education 0 can sum up mine in three letters ? +-.1 abourr ha abou has s pr prop opos osed ed a mans forr pr prop oper erti ties es ov over er 4 mi mill llio ionn- th the e mansion ion ta( fo proceeds of which will be used to fund more services for the %#S.This is estimated to raise a maximum of 4.> billion ?not so generous when you consider this represents less than an extra 4.>H of the present %#S budget of I55* billion. billion. $avis +amero +ameron n moved his wife to tears by speaki speaking ng about the death of his disabled son and the %#S during his conference speech and promised to ring ence the +- budget and have Ps "orking / days :oth th par parti ties es al also so pr prom omis ised ed /r /ref efor orms ms11 to th the e %# %#S. S. #a #avi ving ng ju just st a "e "eek ek.. :o weathered a period of major /reform1 with increasing privatisation and more administration and paperwork my heart sinks. oliticians rarely acknowledge thatt the Borl tha orld d #ea #ealth lth 2r 2rgan ganisa isatio tion n and the +om +ommo monwe nwealt alth h 0ns 0nstit titute ute 3a widely regarded (merican think tank6 have r ecently declared the +- to be th the e mo most st ef efec ecti tive ve,, e0 e0ci cien entt he heal alth th sy syst stem em in th the e de deve velo lope ped d "orld. Be have an ageing population, on one e wh wher ere e obes obesity ity relat related ed dise diseases ases such as type # diabetes are consuming an ever increasing the budget and ne" proportion  of drugs and medical advancements are going to cost more. (s a result al alll dev develo eloped ped countries have a problem "ith rising health care e(penditure . 0n my opinion opinio n reo reorgan rganisati isation on does not over overcome come these factors.-ta -taf f cos costs ts are said to be responsible or /12 o the +- budget.  +uts in sta and a

 

culture of target chasing were said to be some main reasons for the ,id Staordshire Staordshir e scandal.

( lot of papers talked about the %#S1s worsening 7nances and how it was failing to keep up with increasing demand for services. Some discussed a proposal for perhaps charging I5* for appointments and how if they did it might be the beginnings of a slippery slope. / 0t is worth remembering - before we panic- that 31$$ million, although it soun so unds ds a lo lott- is only $.1 2 o the +- budget "hich is over *$$ billion. ,any companies would be pleased to miss their target budget by such a narrow margin and that last year the %#S delivered a I))* million surplus. %o need to panic and start charging yet 0 would suggest.  The papers andthe politicians often about the %#S asBe if it is failing but theacts  =estalk there are challenges. have an ageing sho" opposite. popula pop ulatio tionn- pr probab obably ly the mos mostt unh unheal ealthy thy pop popula ulatio tion n in Eur Europe ope 3hi 3highe ghest st obesity- high alcohol intake and high smoking rates6. $espite this  in June #$*4 #$ *4 th the e + +- "a "as s de decl clar ared ed th the e be best st he heal alth thca care re sy syst stem em in th the e "orld by an international panel of experts who rated its care superior to countries which spend far more on health.  The report- produced by the 5ommon"ealt 5ommon"ealth h 6u 6und, nd, a Bashington?based foundat fou ndation ion re respe specte cted d ar around ound the wor worldld- ex exami amined ned an ar array ray of evi eviden dence ce about performance in the 55 most developed countries- including detailed data from patients- doctors and the 7orld ealth 8rganisation.  The same study declared healthcare provision in the &S as the worst of the 55 countries it looked at. (merica denies care to many patients in need because they do not have health insurance and is also the poorest at saving the lives of people who fall ill- it found. JThe &nited @ingdo @ingdom m ranks )rst overa overall, ll, scori scoring ng high highest est on 'ual 'uality ity,, access and e0ciency, K Their 7ndings amount to a huge endorsement of  the health service- especially as it spends the second9lo"est amount on healthcare among the **  G just I4-**L per head- less than half the I>-*5M in the &S. 2nly %ew % ew Nealand- with I5-LM<- spent less.

 

Some people argue that those who take risks with their health by over eating and poor life style choices should not expect the tax payer to pay for the conseAuences of their choices. 2thers argue that a person1s autonomy has to be respected. They have a right to decide how to live their life if they wish. 0t is important to be non  and act in the  which means  judgemental besthabits. interests o that treating the conseAuences of their 0f those who patient are obese are denied treat tr eatme ment nt for the their ir con condit dition ion a slip may y be cr crea eate ted d in wh whic ich h slippery pery slop slope e ma those suering from illnesses which may be in part also &sel in:icted1 such as smoking related diseases or injuries from extreme sports may in future also 7nd themselves excluded from state funded treatment. 0t is more cost eective for the %#S to pay for gastric by?pass operations than th an pa pay y fo forr th the e co cons nseA eAue uenc nces es of ob obes esit ity y 3e 3eg g di diabe abete tes s dr drug ugs s and jo join intt replacements for arthritis6 (t present ethical principles held by most- including the medical profession would value the principles of autonomy and bene)cence 3doing what most bene7ts the patient6 over the idea that in doing so we would not be fair to others in this &rights versus responsibili responsibility ty debate.1  

Figures published by the %#S1s #ealth and Social +are 0nformation +entre suggested that two thirds of men and half of all women are now overweight or obese in the &@. 2nly a third of adults manage )* minutes of exercise once on ce a we week ek.. 0t se seem ems s th that at th the e :r :rit itis ish h ar are e no now w th the e fa fatt ttes estt in Eu Euro rope pe88 Bhat can we do about itC The :,( demanded a ta( on sugary drinks  and aban on unhealthy ood adverts targeted at children . This of course raises Auestions about the inringement o personal liberties . :ut in this country and others such as the &S( and $enmark- which have introduced similar legislation- there is the growing realisation that unless we do some thing and try and tackle our un7t- overweight population our health systems might not be able to aord the conseAuences. (s a " 0 promote exercise for it seems most disorders G from diabetesmenopausal hot Oushes 3helps temperature regulation and maintains bone density6- to insomnia 3promotes natural relaxation and sleep6. 0 often write a very ver y sim simple ple ex exer erci cise se pla plan n on a pr presc escri ripti ption on to em empha phasis sise e its val value ue as a trea tr eatm tmen ent. t. 0 refe eferr th the e ove over"e r"eigh ightt to -li -limm mmim img g 7orl orld d and 7eig eight ht 7at atch cher ers s an and d gy gyms ms t the hey y ca can n at atte tend nd o or r r ree ee < co cour urte tesy sy o th the e doctor tors s get not notori orious ously ly bad re resul sults ts G hen hence ce the ri rise se in gas gastri tric c +-= but doc bypass operations. ,any have argued that "e should pay people to lose

 

"eight and e(ercise- give them a monetary incentive and this would be far cheaper in the long run for the %#S. Some health bodies have already tried this and it works 3see link below68 Bhat do you thinkC

Bhat a dierence a year makes. ast year we :oyle celebrated the %#Stoas one of  the great accomplishments of :ritain. $anny paid tribute the %#S during the 2lympics opening ceremony because  universal healthcare is one o the core values o ritish society. The health service was featured as on one e of :ri rita taiin1 n1s s pr prou oude dest st ach chiiev eve eme ment nts s du durrin ing g the I4 I4M M mi millli lio on spect spe ctacu acular lar.. :oy :oyle le sai said d the +- "as an >ama?ing thing to celebrate@ and dedicated a whole section of his show to the health service. Few dis disagr agreed eed with him him.. #ow #oweve everr 4* 4*5) 5)-- thi this s ye year ar has bee been n the year of  the Aid -tafordshire scandal and the Francis enAuiry into it. The %#S has been be en la lamb mbast asted ed an and d th the e ge gene nera rall pu publ blic ic1s 1s pe perrce cept ptio ion n ha has s pl plum umme mete ted d (ccordi (cc ording ng to this week1s :,! there there never has been such a bad year for the %#S in its entire <> yr history. (bout >** people are estimated to have died of negligence and appalling standards stand ards of care seem to have been unearthed unearthed in ,id Staordshir Staordshire. e. 0t is thought that there probably has never been a scandal on the scale of ,id Staordshire %#S Trust. The 6rancis report was published in February and talked of the &7ilul neglect! prompting the health secretary !eremy #unt to claim the need to put compassion back into the %#S.1 The Francis report also prescribed &a undamental culture change! or the entire +-  to put patients 7rst. The Franci rancis s Peport ment mentioned ioned that a culture o target chasing and management agendas o cost cutting took precedence over patient care in an eort to reach the  )nancial targets reAuired to gain %#S Trust status . ,any %ursing sta lost jobs and sta to patient ratios were badly hit.  T  Targets argets distort priorities. (s soon as you have a target the thin th ing g be bein ing g me meas asur ured ed be beco come mes s mo morre im impo port rtan antt- attributes  such as comp co mpas assio sion n an and d em empat pathy hy that are hard to count start not to even n har harder der count. 5aring andconsideration are har hard d to mea measu sure re and eve to legislate or.

Bpril *st 3(pril fools day6 marked the day of the  takeover o the +- by The e ne new w ch chan ange ges s ar are e designed the +ati +ational onal 5omm 5ommissi issioning oning oar oard d. Th to open up the +- in Cngland to competition by or pro)t companies. +T 3rimary +are Trusts6 have been abolished and their work allocat ate ed to P will now led commissioning groups who

 

have responsibility to ensure their patients1 health needs are met. They will decide how L*H of the %#S budget is spent. "s have been given this res espo ponsi nsibi bili lity ty as th they ey hav have e da dail ily y co cont ntac actt "i "ith th pa pati tien ents ts an and d lo loca call services and kno" their patient!s needs.  "s will have to put services out to tender 3consider &any "illing provider!= and any organisatio organisation n can bid to provide services not just %#S hospitals. +ritics warn that big- often multi national companies who have been active in lobbying the government will &cherry pick! the most pro)table services and destabilise the rest o the +-.  "s do not  relish becoming the masters of the new %#S universe. +lare "erada- their representativerepresentative- said that the new changes allow for Jth the e "h "hol oles esal ale e di dism sman antl tlin ing g o th the e + +- an and d pr priv ivat atis isat atio ion n o th the e supp su pply ly,, or orga gani nisa sati tion on,, pl plan anni ning ng,, )n )nan ance ce,, an and d di dist stri ribu buti tion on o  She e go goes es on to say th that at th the e reg egul ulat atio ions ns wi will ll leav healthcare. Sh leave e gener general al practitioners whil ile e mu much ch of th the e he heal alth th >bearing >bear ing the br brunt unt o the pu publi blic!s c!s "ra "rath, th, wh budget is handed over to the for?pro7t commercial sector , services are closed, and entitlements to universal healthcare are eroded.@

Ds this the beginning o the end o the +-  as the :,! cover that week suggested sugges ted 3see above picture picture66 and afte afterr the Franci rancis s rep report ort "ill any one carethat muchC #oward yons was given the job of making money by selling the %#S brand and expertise abroad by this "overnment. Today /#ealth &@1 will be o'cially launched at a health trade fair in $ubai. (ccording to ,r yons he already has ha s had do do9e 9ens ns of en enAu Auir irie ies s fr from om go gove vern rnme ment nts s ar arou ound nd th the e wo worl rld d an and d hundreds from embassies. $anny $ann y :o :oyl yle e sa said id in th the e su summ mmer er th that at he in incl clud uded ed da danc ncin ing g doc docto tors rs and nurses and the %#S because the %#S was /very dear to peoples1 hearts1. #e added /one /one of the core values of our society is that it does not matter who  you are, you will get treated the same in terms of healthcare…..And that felt  like li ke so some meth thin ing g th that at we th thou ough ghtt wa was s a gr grea eatt th thin ing g to ce cele lebr brat ate e 1. 2t 2the herr countries are apparently interested in the %#S because as #oward yons says sa ys /o /ove vers rsea eas s th the e %# %#S S is a ve very ry-- ve very ry st strrong br brand and.. 0t me mean ans s sa safe fety ty-security- health care for all and there are others who want to emulate that1. ,any hundreds if not thousands of doctors volunteer for spells in third world countries and many well known &@ hospitals already provide training and

 

send consultants to teach abroad having a central organisation promoting them as a part of the %#S would perhaps ensure it is done in a less ad hoc fashion. 2ur medical schools and Poyal +olleges and training are highly rated. Those of you who wil willl bec become ome doctors doctors in thi this s cou countr ntry y hav have e the satisfac satisfactio tion n of  knowing that among your medical degree,P0 is accepted and welcomed worldwide. The &@ invented other things scans- +T scansand 0QF and we have won ); %obel pri9es for medicine G more than any other country apart from the &S(. The %#S model of primary care is highly regarded. The skills and the /gate keeper1 role of "s are important in keeping costs down 3see p >< of my book ,edical School 0nterviews (ll =ou %eed To @now The @nowledge6.  The %ational 0nstitute of +linical Excelle Excellence nce 3%0+E6 is well regar regarded ded as a leader in evidence based medicine 3p <R?M46 (ll co (ll coun untr trie ies s fa face ce en enor ormo mous us ch chal alle leng nges es wi with th reg egar ard d to he heal alth th ca carre. (l (lll devel dev elope oped d cou countr ntrie ies s hav have e rap rapidl idly y ri risin sing g hea health lth car care e cos costs ts bec becaus ause e of an ageing population and increasing technology. Enoch owell- a former #ealth Secretary declared spending on health /a bottomless pit1 and indeed it can be.. :r be :rit itai ain n ho howe weve verr sp spen ends ds le less ss of it its s "$ "$  on he heal alth th th than an an any y ot othe herr developed country yet it does well in its performance with good survival and treat tr eatme ment nt rat rates es for chr chroni onic c con condit dition ions s and mid ran rankin king g rat rates es for can cancer cer surv su rviv ival al co comp mpar ared ed wi with th ot othe herr de deve velo lope ped d co coun untr trie ies. s. Th The e &S( wh whic ich h ha has s almost non existent primary care- spends twice as much of its "$ as :ritain on health care yet has the worst health care statistics of all the developed nations. 0n (ugust 4*55 The B#2 3Borld #ealth 2rganisation6 showed that the &@ saved more lives for each pound spent than any other developed country 3apart from 0reland6 over 4> years.  The %#S is an important subject for medical school applicants- as $anny :oyle said- it is dear to most people and you will be expected to know about it. Surveys consistently rank the %#S number one when :ritish people are asked to decide what things about :ritain they are most proud of. =ou as a potential medical student should know about how it was founded- its core principles and how it runs. The %#S will pay for some of your clinical years at medical school and your training as a junior doctor. 0ts principles and ethics shou sh ould ld be beco come me pa part rt of yo you. u. 0t do does es ha have ve pr prob oble lems ms an and d fa face ces s maj ajor or challenges and we should all strive to improve it. #owever like virtually all doctors- 0 am profoundly grateful and proud to work for the %#S and truly appr ap prec ecia iate te th the e fa fact ct th that at 0 ne neve verr hav have e to ad add d to a pat patie ient nt1s 1s di dist strres ess s by demanding payment8

 

? For further information about the NHS, how it works and comparisons with other health systems read my book edical School !nterviews All "ou Need #o $now #he $nowledge pages %&'()

ethics  A couple have a child with Fanconi*s Anaemia. #his is a severe genetic disorder which leads to early death. !t can be cured by a bone marrow tran tr ansp spla lant nt fr from om a su suit itab able le ma matc tch. h. Si Sibl blin ings gs co comm mmon only ly ca can n pr prov ovid ide e th that  at  match. #he couple want to have a child and are undergoing !+F in order to make sure that an embryo will not have Fanconi*s Anaemia. As well as screening embryos to ensure they do not have the disease they can also choose an embryo that will be a suitable match for the eisting embryo. Stem cells can be taken from the umbilical cord -which is usually discarded of the new baby and used to cure the eisting child. Should they be able to select an embryo for this reason/ 0hat issues arise/  Answer

0t is important to look at the issue from all points of view with the concepts of  the th e ; pi pill llar ars s in mi mind ndDD ha harrm 3m 3mal ale7 e7ce cenc nce6 e6 an and d be bene ne7t 7t 3b 3ben ene7 e7ce cenc nce6 e6-autonomy and !ustice 3is it fair6.

 The C(isting 5hild!s  The child has the possibility of  cure  cure from a serious condition. #owever how will he view his new sibling will he feel that there is a debt of gratitude owingC Bill he feel that he must be for ever grateulE

 The Parents! 0QF involves injections- egg stimulation and operations and is not without risk. #owever in this case the parents are going through DF6 any"ay because they wish to select an embryo unaected by the disease.  The parents want another child anyway and are not just having a child to cure another. another. (s parents they love the existing child and would want to avoid the pain and suering of seeing their existing child suer and die.

 

are arents nts sho should uld hav have e autonomy G th they ey sh shou ould ld th ther eref efor ore e pe perrha haps ps ha have ve theri cons nsid ider er th the e be bene ne7t 7ts s and ha harrms and mak righ ghtt to co make e a dec decisi ision on for themselves.

 The Gnborn 5hild!s 0t is important . The child up that the child is loved ortheir itsel  thinking that they were only created to cure sibling. 0f for may somegrow reason their sibling dies would they feel as if they had &ailed! and feel responsibleC

 -ociety!s Point o Fie" 0t is important to look at how such decisions may aect society. (re such procedures viewed as /fair1 3ethical pillar of !ustice6. $oes using science to ensure &perect! children raise the spectre of eugenics does it decrease tolerance o the disabledC Be have recently enjoyed the ara 2lympic "ames "am es but it wor worth th re remem member bering ing that man many y suc such h ath athlet letes es suc such h as Ell Ellie ie Simmonds and 2scar istorius may be nowadays aborted. 0s it right to have a society that says such lives are worth less than others G is that fairC Embryo Embry o sel select ection ion may con contin tinue ue dow down n a slip which ch may le lead ad slippery pery slop slope e whi to&designer babies! where parents choose embryos according to features such as hair colour- height and sex ,any- parti ,anyparticular cularly ly some religious religious gro groups ups would oppose embr embryo yo sele selectio ction n because it is unnatural and humans are in a way &playing od!.

Ay point o vie" -you will probably be pushed to say what you think but remember that you should give your point of view after you discuss all the arguments er erso sona nall lly y 0 fe feel el th that at th the e be bene ne7t 7ts s ou outt we weig ighs hs th the e ha harrms ms.. Th Ther ere e is an enormous bene7t to the existing child and parents who want another child and are under going embryo selection anyway. There is very little possible harm to the unborn child.  There is no evidence that decreasing decreasing disability leads to greater intolerance intolerance of  those th ose al alrrea eady dy di disa sabl bled ed.. 0 rej ejec ectt th the e ar argu gume ment nt th that at it is un unnat natur ural al an and d there the refor fore e soc societ iety y sho should uld not all allow ow it. The pra practi ctise se of me medic dicine ine inv involv olves es interfering with the natural course of illnesses and conditions to alleviate pain and suering and prevent death. Bhen ever a major advance is made in medicine 3such as blood transfusions or 0QF6 there are always some that say

 

that it is unnatural and wrong but these innovations tend to be eventually accepted by the majority of the population as being bene7cial. Emmanuelle @ant- the "erman philosopher stated that an action was moral if  the intention was good and it did not cause harm and a further test would be if all others in society carried out that action it would not cause harm. For example if aifcouple weredid to choose the sex their embryo does not0nharm society but everyone so it mayso itofshould not be itallowed. this case- the choosing of a saviour sibling there would be no obvious harm. The slippery slope scenario can be avoided by ensuring embryo selection was performed for severe- inherited diseases only. Stem +ells are crucial to develop organisms. They are nonspeciali9ed cells which have the potential to create other types of speci7c cells- such as blood?- brain?- tissue? or muscle?cells. Stem cells are in all of our body and lives- but are far more potent in a fetus also spelled foetus- ftus- faetus- or fUtusV than in an adult body. body. Some types of stem cells may be able to create all other cells in the body. 2thers have the potential to repair or replace damaged tissue or cells. Embryonic Stem +ells are developed from a female egg after it is fertili9ed by sperm. The process takes ;?> days.

7hat is -tem 5ell HesearchE Stem cel Stem celll rese esear arch ch is use used d for inv invest estiga igatio tion n of basi basic c cel cells ls whi which ch dev develo elop p organisms. The cells are grown in laboratories where tests are carried out to investigate fundamental properties of the cells.

Bborted etuses are not the only source o stem cells  There are stem cells in the both placenta and blood contained in the placenta. (lso the primary source of stem cells is from blastocysts. These are fertili9ed human eggs that were not implanted into a woman.  The controver controversy sy surroundi surrounding ng stem cell resear research ch led to an intense debate about ethics. &p until the recent years- the research method mainly focused on Emb Embryo ryonic nic Ste Stem m +e +ells lls-- whi which ch inv involv olves es tak taking ing tis tissue sue fr from om an abo abort rted ed embryo to get proper material to study. This is typically done just days after conception or between the >th and Rth week.

 

Since then- researchers have moved on to more ethical study methods- such as 0nduce 0nduced d lur luripote ipotent nt Stem +ell +ells s i iSV. SV. i iS S ar are e art arti7c i7cial ially ly der deriv ived ed fr from om a non?pluripotent cell- such as adult somatic s omatic cells.  This is probably an important advancement in stem cell resear researchch- since it allows researchers to obtain pluripotent stem cells- which are important in researchresear ch- without the controversi controversial al use of embryos.  There were two main issues concerning stem cell resear research ch with both pros and consD 5.

#ow the knowledge will be used

4.

+oncerns about the methods

 The 7rst issue is really not just about stem cell cell researchresearch- as it may be applied to most research about human health. Since 4**M- the second point- concerns about the methods involved- has been less debated- because of scienti7c developments such as iS.

*I -tem 5ell Hesearch 9 Brguments Hegarding the Gsage o the no"ledge (s you will most probably notice- the following arguments are not exclusively exclusively in use when talking about stem cell research.

Pros Stem cell research can potentially help treat a range of medical problems. 0t could lead humanity closer to better treatment and possibly cure a number of diseasesD •

arkinson1s arkin son1s $isease



(l9heimer1s $isease



#eart $iseases- Stroke and $iabetes Type 5V



:irth $efects



Spinal +ord 0njuries



Peplace or Pepair $amaged 2rgans





Peduced Pisk of Transplantation =ou could possibly get a copy of your own heart in a heart?transplantation in the future Stem cells may play a major role in cancer

 

:etter treatment of these diseases could also give signi7cant social bene7ts for individuals and economic gains for fo r society

5ons •

WBe WB e should not mess with human life.W



W#umans should not be trying to play "odW



Some ar Some argu gue e th that at st stem em ce cell ll res esea earrch in th the e fa farr fu futu turre ca can n le lead ad to knowledge on how to clone humans. 0t is hard to say whether this is truebut we have seen devastating conseAuences of other research?programseven with good intentions- such as nuclear research.

#I -t -tem em 5e 5ell ll He Hese sear arch ch 9 Pr Pros os an and d 5o 5ons ns Bb Bbou outt th the e Aet etho hods ds Dnvolved  The controver controversy sy regarding the method involved was much tenser when researchers used Embryonic Stem +ells as their main method for stem cell research. $0S+(0,EPD  These points are based on the old debate about the methods of stem cells research- from before 4**M. Since then- scientists have moved on to use more ethical methods for stem cell research- such as iS. This section serves as an il illu lust stra rati tion on of th the e di di'c 'cul ultt ev eval alua uati tion ons s res esea earrch cher ers s ma may y ha have ve to analy9e.

Pros eore #$$/ •







WThe bene7ts of stem cell research have such a great outcome that they outweigh the ethical issues.W +ost?bene7t?analysisV W0f someone is going to have an abortion- isn1t it better that we use it for something usefulCW (dult stem cells would not be that interesting because they do not have the same properties as stem cells from a fetus.  The research research would give great great insights about the basics of the body. body.

5ons eore #$$/ •



+ritics +ritic s aga agains instt ste stem m ce cell ll re resea searc rch h ar argue gued d that that the eth ethica icall iss issues ues of  scienti7c work on aborted fetuses did not justify the possible bene7ts. W( life is a life and that should never be compromised. ( fertili9ed egg should be valued as in a human lifeofeven if human it is inlife its isvery 7rst weeks. $estroying human life the hopes saving not ethical.W

 





Be sho should uld an and d wil willV lV dev develo elop p mor more e eth ethica icall met method hods s such such as usi using ng adult stem cellsV which will enable us to research ethically. Be should wait until those methods are available.  The scienti7c value has been overstated or has Oaws. E.g. we do not know for sure that we can use stem cells to clone transplantable organs.

5onclusion  The stem cell?research cell?research is an example of the- sometimes di'cult- cost?bene7t analysis in ethics which scientists need to do. Even though many issues regarding regar ding the ethics of stem cell research research have now been solved- it serves as a valuable example of ethical cost?bene7t analysis.  The previously heated debate seems to have lead to new solutions which makes both sides happier. Stem +ell pros and cons had cons  had to be valued carefully- for a number of reasons. Bhen you are planning a research projectproject- ethics must always a lways be considered. 0f you cannot defend a study ethically- you should not and will not be allowed to conduct it. =ou cannot defend a study ethically unless the presumed cost is lower than expected bene7ts. The analysis needs to include humananimal discomfortrisks- environmental environmental issues- material costsbene7ts- economy etc. Bhy was the debate regarding the stem cell research so intenseC First- it was a matter of life ? something impossible to measure. (nd in this case- researchers researchers had to do exactly thatD measure life against life. :oth an abo :oth aborti rtion on and som someon eone e dyi dyingng- su sueri ering ng fr from om a pos possib sible le cur curabl able e disease- is a tragedy tragedy.. Bhich have the highest valueC $oes a big breakthr breakthrough ough in the research justify the use of the method in the presentC Bould the bene7ts of studying abortions outweigh the costsC The choice was subjectiveD %obody knows all the risks or all the possible outcomes- so we had to value it with our perception of the outcome. erception is inOuenced by our individual feelings- morals and knowledge about the issue. Second- at the time we did not know whether the research was necessary and su'cient to give us the mentioned health bene7ts.  Third- other conseAuences of the research are uncertain. +ould the research be misused in the future or notC Be simply do not know. (ll knowledge

 

acAuired- within research or other arenas- may be used for evil causes in the future ? it is impossible to know.  The Stem cell resear research?debate ch?debate is an example on how people value various aspects dierently. dierently. 0t is also an example of how critics and debate can lead to signi7cant improvements improvements for both sides.

YES Tom Lynas To me it seems fair that those who take risks should accept their consequences. If an owner leaves the front door to their home open, they must remember no insurer will help if it is burgled. If a gambler stakes his last £10 on a horse, he should be prepared to go hungry that night. night. nd when a daredevil daredevil puts on his wingsuit wingsuit before leaping leaping over a precipice, he must reali!e that action might be his last.   similar argument can be made for the subsidising of "ational #ealth $ervice treatment with money from risk% taking individuals. &f course, every man and woman should be free to live as dangerous an e'istence as they choose,  but I feel that people who deliberately ignore ignore medical warnings are not the most most deserving of free medical care.

‘Recent cuts to health spending give this debate a renewed significance’  (ecent cuts to health spending give this debate a renewed significance. $ince its establishment in 1)*+, the "#$ has always struggled to reconcile the increasing costs of advances in medical knowledge and technology with the financial restrictio restr ictions ns of stat statee fundi funding. ng. The present situa situation tion is parti particularl cularly y grave  despi despite te its promises, promises, the -oalition -oalition overnment has made significant cuts to the healthcare budget /around £+00 million between 010 and 01 and a recent poll found that only *0 per cent of hospital bosses believe their organisation will balance the books in 01*%12.  3ith this in mind, the idea that the "#$ should begin to charge some patients for self inflicted visits seems worth e'ploring. "orthern Ireland #ealth 4inister 5dwin 6oots suggested earlier this year that the 789s overburdened accident and emergency departments should issue drunks with a bill for the cost of their care. 3hile 6oots9 proposal  was met with criticism, it has a certain appeal. I en:oy drinking as much the ne't person, but I know that illness and in:ury are likely results if I overdo it. I think the assumption that I can consume enough to need hospitalising without any penalty is a childish one.

‘Treating alcohol-related injuries costs the NHS £3 billion annuall’  Treating alcohol%related in:uries costs the "#$ £; billion annually and any charges would help cover this cost, while deterring e'cessive consumption and ultimately easing pressure on the service. The 78 had .+ hospital beds per 1,000 people in 01, compared to +.; in ermany and <.; in =rance  removing thousands of binge drinkers from the wards would be a good way to start tackling this deficit. $moking is another e'ample of a risky habit that people continue to practice against doctors9 advice. *<;,000 adults  were admitted to hospital last year as a result of smoking%related illnesses. 5stimates as to the cost of these patients  vary /somewhere between £%<bn but what cannot be disputed is that they divert precious resources away from those who have contracted illness through no fault of their own. It is terrible to hear of anyone being diagnosed with a respiratory disease or heart condition, but is it so wrong to ask those who have put themselves at an increased risk to take responsibility for their actions> 3hy not ask them to make a small contribution>

 

-ritics will doubtless look for flaws in this scheme. They may point out that one of founder neurin ?evan9s core principles was that the "#$ should be @free at the point of delivery9. They may fail to mention section  of the "ational #ealth ct, which states that an e'ception to this rule is where the in:ury or illness is self%inflicted.

‘!t is unfair that their "edical treat"ent should be of a di"inished #ualit because of the "inorit who willingl endanger the"selves’    &thers may claim that those who smoke and drink to e'cess fund their care through ta'es. nd yet so do many  millions of adults who have healthier lifestyles. It is unfair that their medical treatment should be of a diminished quality because of the minority who willingly endanger themselves. =inally, there is the question of :udging whether a visit is self%inflicted or not. I accept that there could be ambiguity as to how far an individual9s actions are the reason for their visit. ?ut every vetting process has to begin somewhere. It may, for e'ample, be difficult to :udge how much disability benefit a person is entitled to, or how much compensation someone requires after an accident. The sooner we introduce this fairer system, the sooner we can fine%tune the way   we assess incoming patients. patients.  3e all learn at some stage in life that our actions actions have consequences. If this principle applies to the the legal, political and financial worlds, why should healthcare be e'empt> The "#$ is a national treasure that sets a benchmark for the way  a state looks after its citi!ens. This said, the ever mounting costs of running such an operation have put its standards under threat.  3hile this small act of privatisation may be controversial, it will guarantee continued support to those who need it most. ‘$e "ust re"e"ber that the potential financial burden will cause "iser also%’ i"age credit& 'lic(r)*hiland*a" 'lic(r)*hiland*a"

 NO Nick Herbert  #ow do you determine determine a self%inflicted self%inflicted in:ury> in:ury> It seems as if people arguing that the "#$ should charge those with self%inflicted in:uries in A5 see it as a black and white issue. 3hereas to many, the issue seems confusingly grey. The potential problems with ascribing the title of @$elf%Inflicted9 to an in:ury seem too many to make this system plausible. The idea of paying for emergency treatment, regardless of whether you caused it yourself, :ars with the fundamental principles of the "#$. I can9t help but think of a two%tiered system in which those with less suffer more than they  need to. I do not mean that poorer people will not receive treatment, but we must remember that the potential financial burden will cause misery also.

‘! can’t help but thin( of a two-tiered sste" in which those with less suffer "ore than the need to’  The "#$ was created to help people regardless of economic background and by charging people we make that point redundant. redunda nt. oing to A5 will become some something thing that gets calcu calculated lated against against cost rather than something something we instinctively turn to. $omeone with a worrying stomach%ache might regret opting against the costly trip to the hospital  when their appendi' ruptures.

 

 nother problem is that of mitigating circumstances. 3hat makes an accident that person9s own fault> If a person uses tools which he knows are faulty, provided by an employer, and has an accident, is this the fault of the employer or the employee> $urely the employer should never have given the faulty tools out in the first place, but likewise, the employee shouldn9t have used the tools if they were known to be faulty. It can be argued that either party is liable. There will always be factors that mitigate the full e'tent of culpability and an investigation will mean more effort spent on an enquiry which would take up both money and time better spent elsewhere. This shows the idea of  payment within the "#$ would hinder not help. If we charge for self%inflicted in:uries, why not go further and charge for the treatment of self%afflicted diseases> If we are going to go against the fundamental principles of the "#$, let9s go all%out. 3hy should we pay for the treatment of  diabetes or heart conditions caused by what people will argue are @poor lifestyle choices9>  ccording to Biabetes 78, diabetes treatment reportedly costs the "#$ £10 billion, whereas the estimates of the cost of alcohol%related problems range from £;.2 bn  £< bn. ranted, not all of the £10 bn is being spent on self%afflicted cases, but a good portion of it is. nd you know what they say, a billion here and a billion there and soon you9re talking about real money. This argument is ludicrousC we pay for the "#$ with the knowledge that our ta'es may not be paying for our own treatment now but one day someone else9s money could be paying for your healthcare.

‘Not ev ‘Not ever ero one ne ca can n af affo ford rd to si si"p "pl l ac acce cept pt th thei eirr ch char arge ge++ Su Sure rel l th this is wo would  uld  necessitate an appeals process,’   nother question is who ad:udicates> The doctor> That would add another problem. It seems that, in these circumstances, the doctor in question could not win. It is perfectly plausible that a person could lie about their symptoms to avoid higher costs, this way the doctor cannot treat the patient. The doctor%patient relationship could be damaged, not :ust in the individual case, but also in a wider conte't. The idea of @4oney%rabbing Boctors9, whilst most likely false, is one that could get public support. "ot everyone can afford to simply accept their charge. $urely  this would necessitate an appeals process>  n appeals process would be necessary and beneficial to nobody. There would be the administrative costs of  launching and holding an appeals tribunal. 4edical staff involved in the treatment and subsequent appeal in question  would have to give up time and effort effort that could be better served elsewhere. $o we have financial costs for the tribunal itself and costs in terms of time.nd if the patient loses, are they now  lumbered with the cost of the appeal and the treatment, tre atment, which they might not have been able to afford anyway> nd if  the "#$ Trust in question loses, the ta'payer now funds the treatment they would have paid for anyway and also the cost of an appeal. The idea of this unnecessary added cost, which will be given to either party based on a sub:ective decision, helps nobody and can be avoided by disregarding the idea of people paying for self%inflicted in:uries.

‘$ant to "a ‘$ant "a(e (e "o "ore re "o "one ne  fo forr th thee NH NHS, S, Th Then en cl clos osee ta ta  lo loop opho hole les. s. in incr crea ease se education on health lifestles. and the dangers of s"o(ing and alcoholis"’  The "#$ is not a charityC it is paid for by ta'es. 3ant to make more money for the "#$> Then close ta' loopholes, increase education on healthy lifestyles, and the dangers d angers of smoking and alcoholism.

 

6eople who propose a charge to "#$ services need to consider that one day it may well be you being asked to pay for treatment you desperately need but desperately can9t afford. DDPeople

should take some responsibility for their own health: the treatment of self-inflicted diseases should not be the responsibility of doctors in the NHS.

“People taking some responsibility” implies that people should not only o nly be looking after their health by avoiding activities that have heavy consequences, but also paying for their treatment as it is there fault. For example, people shouldn’t smoke as they kno that they are likely to get lung cancer or emphysema and if they do smoke, they should immediately make efforts to quit smoking rather than continue ith treatment to solve all problems. p roblems. “!esponsibility of doctors in the "#$” suggests that tax money should not pay for people’s  problems hich they created and that doctors should instead take time to diagnose those ho are ill by external factors such as pathogens. %verall, this statement indicates that doctors in the "#$ should only treat those ho have no inflicted illness upon themselves& only innocent people should be helped in the crime of illness hile the guilty should pay for their disease.

  0mplications of /self /self?inOicted ?inOicted diseases1 includeD X

$isea $iseases ses that have come about by a perso person n doing an activ activity ity that has con conseA seAuen uences ces tha thatt ve very ry lik likely ely to occ occur ur in a per person son1s 1s lif lifeti etime. me. Smoking can cause lung cancer but people still smoke.

X

(n accident from doing an activity such as breaking your foot when  jumping down from a tree or a car crash. eopl eople e have many safe car  journeys but one stupid thing can cause a crash and serious injury. injury.

  2ne limitations of /self?inOicting1 could be whether perfect health means that you will never get ill again. 0f you get ill from a mild virus- for exampleperfect health would mean that the immune system would be strong and attack it without you getting too ill. So if another person got dangerously ill from the same virus- it1s a self?inOicted disease as they haven1t got perfect health hea lth.. 0t wou would ld be mor more e of an ind indivi ividua duall ana analys lysis is of wh what at sel selff?in ?inOic Oicted ted diseases were in treatment rather than a general perspective  $octor1s should treat all patients becauseD  The %#S is funded by us- tax payers. 0f the %#S decided decided to cap who got treated and who didn1t- there would be uproar. eople would claim it to be



unfair. $octor1s are being paid to treat in the best interests of the patient

 



and not to dictate whether a disease shouldn1t be treated because it is self self?? inOicted. Peasons Pe asons for self self?inOi ?inOicted cted disea diseases ses are not nece necessaril ssarily y the patie patient1s nt1s fa faul ult t exter xterna nall ca caus uses es su such ch as str stres ess s from from wo work rk or so soci cio? o?ec econ onom omic ic backgrounds can be a problem. For example- obesity is more common in poorer areas due to lack of education and money meaning junk food is a lot more cheaper to pay for.

*. Th The e em embr bryo yo ha has s u ull ll mo mora rall st stat atus us r rom om e ert rtil ili? i?at atio ion n on on"a "ard rds s Either the embryo is viewed as a person whilst it is still an embryo- or it is seen see n as a pot potent ential ial per person. son. The crite criteri ria a for /pe /perso rsonho nhood1 od1 ar are e not notori orious ously ly unclear dierent people de7ne what makes a person in dierent ways.

Brg rgum umen entts o or r this vie"

Brg rgum umen entts ag agai ains nstt th this is vie"

(n ea earl rly y em embr bryo yo that that ha has s not ye yett imp implan lanted ted into the fertili9ed egg into to baby is uter us do does es no nott ha have ve the the a co cont ntin inuo uous us pr proc oces ess s an and d uterus psychologi hologicalcal- emot emotional ional or any att attempt to pinpoi oin nt psyc when personhood begins is physical properties that we arbitrary arbit rary.. ( human embr embryo yo associate with being a is a human being in the person. 0t therefore does not ave e an any y int nter ere ests sts to be embryonic stage- just as an hav infant is a human being in protected and we can use it forr the the be bene ne7t 7t of pa pati tien ents ts the inf infant ant sta stage. ge. (ltho (lthough ugh fo an embryo does who (PE personsV. not currently have the characteristics of a person-  The embryo cannot develop into a ch chil ild d wi with thou outt be bein ing g it will become a become a person and into should be given the respect tr tran ansfe sferrred to a wo woma man1 n1s s uter ut erus us. . 0t ne need eds s e xter xt erna nal l and dignity of a person. help to develop. Even thenthe probability that embryos used for in vitr vitrofert ofertili9 ili9ation ation will wi ll de deve velo lop p in into to full full?t ?ter erm m suc su cce cess ssfu full bir birth ths s is low ow.. Something thatcould that could potentially  potentially become a person should not be treated as if it actually were a person $evelopment

from

a

 

#. There is a cut9of point at *4 days ater ertili?ation Some people argue that a human embryo deserves special protection from around day 5; after a fter fertili9ation becauseD •





(fter 5; days the embryo can no longer split to form twins. :efore this point- the embryo could still be split to become two or more babies- or it might fail to develop at all. :efo :e forre da day y 5; 5;-- the the em embr bryo yo ha has s no ce cent ntra rall ne nerv rvou ous s sy syst stem em an and d therefore no senses. 0f we can take organs from patients who have been declared brain dead and use them for transplants- then we can also use hundred?cell embryos that have no nervous system. Fertil ertili9a i9atio tion n is it itsel selff a proce processss- not a /mo /mome ment1 nt1.. (n emb embry ryo o in the earliest stages is not clearly de7ned as an individual.

K. The embryo has increasing status as it develops (n embryo deserves some protection from the moment the sperm fertili9es the egg- and its moral status increases as it becomes more human?like.

Brg rgum umen entts o or r this vie"

 There are several stages of  developm deve lopment ent that could be given increasing moral statusD 5. 0mplantation of the embryo into the uterus wall around six days after fertili9ation. 4. (ppearance of the primitive streak G the begi be ginn nnin ings gs of the the ne nerv rvou ous s system G at around 5; days. ). The phase when the baby could survive if born prematurely. ;. :irth.

Brg rgum umen entts ag agai ains nstt th this is vie" Be pr prot otec ectt a pe pers rson on1s 1s li life fe and an d in inte terres ests ts no nott be beca caus use e they are valuable from the point of view of the universeunive rse- but becau because se they  are important to the person concerned.. Bhatever moral concerned statu status s the the hu huma man n em embr bryo yo has ha s fo forr us us-- the the li life fe that that it  lives has a value to the embryo itself .

0f we judge the moral status of the embryo from its agethen we are making ar arbi bitr trar ary y de deci cisi sion ons s ab abou outt who is human. For exampleeven if we say formation of  nervou vous s sys system tem mar marks ks 0f a life is lost- we tend to the ner feel dierentl tly y about it the start of personhood- we depend dep ending ing on the stage of  still would not say a patient the lost life. ( fertili9ed egg

who has lost nerve cells in a

 

before befor e im impla planta ntatio tion n in the ut uter erus us co coul uld d be gr gran ante ted d a le less sser er de degr gree ee of res espe pect ct than a human fetus or a born baby.

stroke has human.

become

less

0f we are not sure whether a fer ferti tili li9 9ed egg sh shou oulld be considered a human being,ore than half of all then we should not destroy fertili9ed eggs are lost due it. ( hunter does not shoot if  to na natu turral cau ause ses. s. 0f th the e he is not sure whether his natu na tura rall proc proce ess invo involv lves es target is a deer or a man. such loss- then using some embryos in stem cell resea researc rch h sho should uld not wor worry ry us either e ither..

4. The embryo has no moral status at all (n embryo is organic material with a status no dierent from other body parts.

Brg rgum umen entts o or r this vie"

Brg rgum umen entts ag agai ains nstt th this is vie"

Fertil ertili9e i9ed d hum human an egg eggs s ar are e  just parts of other people1s bodies until they have developed enough to survive survi ve indep independen endently tly.. The only respect due to

:y tak taking ing em embry bryoni onic c ste stem m cells out of an early embryowe prevent the embryo from deve de vellop opin ing g in its no norrmal way. This means it is pr preve evente nted d from from bec becomi oming ng

blas blasto tocy cyst sts s is the the res espe pect ct what it was programmed to that should be shown to become G a human being. other oth er peo people ple1s 1s pr prope operty rty. 0f  we destroy a blastocyst before implantation into the uter uterus us we do no nott ha harrm it beca be caus use e it has no be beli lief efssdesiresdesir es- ex expectat pectationsions- aims or purposes to be harmed.

0QF

5hildren on holdL The case o ro?en supernumerary embryos

 

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2ne of th 2ne the e by by?p ?prrod oduc ucts ts of the the typi typica call 0Q 0QF F trea treatm tmen entt is the the cr crea eati tion on of supernumerary embryos. ,ore embryos are brought into existence than can be safely replaced in the 7rst cycle. The remaining embryos are fro9en to be used later if the 7rst trial prove proves s unsuc unsuccessf cessful ul or when the couple wants another child. #owever- not all embryos are replaced and not all parents in indi dica cate te wh what at sh shoul ould d be do done ne wi with th them them.. Th The e ac accu cumu mula lati tion on of fro9 fro9en en embry em bryos os has resul resulted ted in imp impre ressi ssive ve num number bers s of em embry bryos os sto stock cked ed in the free9ers of the large fertility clinics. The exponential growth of their number urges on the ethical reOection on the fate of these embryos. 0n 5RR<- a :ritis :ri tish h or organi gani9at 9ation ion kno known wn as the #um #uman an Fert ertili ili9at 9ation ion and Emb Embryo ryolog logy y (uthority #FE(V estimated that a total of >4-*** fro9en embryos existed in the &nited @ingdom. 0n 4*** there were a total of M5-5M< fro9en embryos in (us usttrali alia and %e %ew w Neal alan and d .(ny .(ny leg egiisl slat atiion on lim imiit of du durrati ation of  prese preserv rvati ation on pri prior or to the des destru tructi ction on of the these se sup super ernum numer erary ary emb embry ryos os underscores the potential pitfalls inherent in allowing political expediency to supersede basic /humannessY and commonsense.  There are several ethical and moral issues surrounding the embryo free9i free9ing ng process. These include the followingD Fate of the stored embryos on the death of couple YYorphanedY orphanedY embryos. 2wnership of the embryos if the couple divorce. Safety of embryo free9i free9ing. ng. +oncern that the length of time embryos have been kept in storage might have a detrimental eect on the outcome of fro9en embryo transfer and possible increase in fetal abnormalities. #owever- no long?term studies have been carried out since the age of the oldest child born as a result of  fro9en embryo transfer is only 5; years. 0n addition- there is no evidence that extended storage is detrimental to the outcome of treatment. *. Me)ning initiation o lie ethicallyE J(m (mid id all the tal talk k abo about ut the eve everr?in ?incr creasi easing ng ava avail ilabil ability ity of in vit vitro ro fertili9ation techniAues- one issue is almost never mentioned namelywhat happens to all a ll those extra embryosCK  







2ften surplus embryos are involved in process of 0QF to substantially enha en hanc nce e the the ch chan ance ce of pr preg egna nanc ncy y .B .Bhe heth ther er they they are are la labo bora rato tory ry artifacts or not and when life begins are obvious Auestions. This puts a Auestion mark on the Jsanctity?of?lifeK. So- theologists argue that we should give the embryo the Jbene7t of the doubtK and consider life at the the ve very ry be begi ginn nnin ing g 35*6. an and d hu huma mans ns sho shoul uld d be sp spat atio? io?te temp mpor oral ally ly continuous with the embryos and fetuses they once were. if human life initiates at fertili9ation then ivf is experim experimentation entation upon a human being and sh shou ould ld fo foll llow ow the the nor norms ms of that that type type of res esea earrch ch.. mo morreo eove verrdiscarded 9ygotes or embryos lost in unsuccessful implantations- at present a foreseen possibility of ivf- would be human. Peport suggests that out of 5>* attempts to implant human embryos onl only ywingly ; gly ac actu tual ally ly wi we wer re ysuc succe cessf ssful ul hum an and danon only ly ngs 5 wa was ca carr rrie ied d .to2n ter terthe m. @nowin @no and willi llingl ngly was wastin ting g human bei beings iss une unethi thical cal.

 





  •



other hand- if there is evidence that human life does not begin until after implantation- then 0QF would not be unethical from the point of  view of the 9ygote because only animal life would be present. The following Auery sums up this aspect of the issueD 0s the 9ygote human life with potential or potential human lifeC J#um J# uman an lif life e mus mustt be respe respecte cted d and prote protecte cted d abs absolu olutel tely y from from the moment mom ent of con concep ceptio tion. n. From rom the 7rs 7rstt mom moment ent of his ex exist istenc encee- a human being must be recogni9ed as having the rights of a person.K Bhen this fundamental moral line is violated or obscured- categories of  people become devalued and they become easily used for utilitarian purposes. #uman life is precious from the moment of conception butunfo un fort rtun unat atel ely y this this res espe pect ct fo forr hu huma man n li life fe is be bein ing g erod eroded ed in ou ourr contemporary society 5hromosomal and 8ther 5ongenital Meects regnancy is something of a lottery for all couples. #owever- compared with couples who conceive spontaneously- for those who reAuire 0QFthe lottery is weighted more heavily against a successful outcome at every stage of the process- not just conception. Stepping away from "odYs law always introduces chaos into our lives. %owhere is this truer than in the case of in vitro fertili9ation. This is the reality alongside the hope that must be conveyed at counseling to all couples contemplating treatment. Throughout the short history of assisted reproduction there has been concern to monitor the safety of this important technology 0t is well established that infants conceived following in vitro fertili9ation 0QFVare more likely to be born preterm- of low birth weight and to be a twin or highe higherr ord order er mult multiple iple than sponta spontaneousl neously y conce conceived ived infants 34*-45-446. the evidence relating to the risk of birth defects is less clear clear.. (n increase in chromosomal abnormality in 0QF babies due to technical inadeA ina deAuac uacy y has bee been n obs observ erved ed 35>6. nume numerical rical abnor abnormalit malities ies alone were found in M5.MH of morphologically normal embryos 3 ;6. and in thos those e mo morp rpho holo logi gica call lly y ab abno norrma mall- on only ly ) ou outt of 5; ha had d a no norrma mall

chrrom ch omos osom omal al co comp mple leme ment nt 3>6. co cong ngen enit ital al ma malf lfor orma mati tion ons s in incl clud ude e increased neural tube and cardiac defects 3<6. 0n such unfortunate cases- should the parents be able to sueC 0n fact it is no nott ea easy sy to pr prov ove e wh whet ethe herr the the faul faultt li lies es in ne negl glig igen ence ce du duri ring ng lapa laparros osco copi picc- 0Q 0QF F or im impl plant antat atio ion n pr proc oced edur ures es 35>6. the the co cong ngen enit ital al disability act- 5RM< helped little to solve the problem 3 5>6. the warnock comm co mmit itte tee e su sugg gges este ted d a li lice censi nsing ng sy syst stem em be us used ed to co cont ntro roll 34-)6. moreover- preimplantation diagnosis of genetic diseases may help to lower down the risk 3L6. Negal -tand 2ur jud judici icial al sys syste tem m has tra trail iled ed woe woeful fully ly beh behind ind the com comple plex x bio bioeth ethica icall dilemmas that accompany the rapid advances in biotechnology- biomedicineand ass assist isted ed repr reprodu oducti ctive ve tec techno hnolog logies ies.. (r (rti7 ti7cia ciall con concep ceptio tion n rai raises ses the •

 

• •

• •

• •

possib poss ibil ilit itie ies s of my myri riad ad pr prob oble lems ms ? le lega gall or othe otherw rwis isee- wh whic ich h ma may y ne need ed resolution by legislation or national guidelines. These relate toD  The Auestion of embryo research research and the tim time e limits to be placed on it :asic Auestions such as ? when does life beginC Bhat are the rights of  an embryoC J- remain unanswere unanswered. d. "uidelines on semen banking  The childYs right to access to information about hisher genetic background and mode of conception  The legality of surrogacy surrogacy  The registrati registration on and monitoring of 0QF clinics to ensure that infertile couples are not exploited.  This 7eld reAuir reAuires es legislative measures after considering these ethical concerns to prevent it from going down slippery slope of exploitation and abuse. Pegulations preventing commoditi9ation of embryos could save us from slouching toward a brave new world as we seek to redeem the great biomedical promise of our time.

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