Three-dimensional
(3-D) printing technologies have good potentials to improve medical treatments
and procedures. Orthopaedic surgeons have already been using 3-D printing
technology to print artificial bones of exactly the same dimensions to replace
the broken or damaged bones of patients. With technological advancements, 3-D
printing of human organs such as heart, lungs and livers will soon become a
reality. While “3-D bio-printing technology” can possibly improve health
outcomes, the technology also raises a number of important bioethical issues
which should not be under-estimated. This paper examines such issues as 3-D
printing of stem cells for research and treatment; safety considerations;
community accessibility to the technology; human enhancement from the
development/ production of more “advanced” or “durable” organs; and
government’s regulatory roles in the context of the Church’s position on these
issues. When these issues have been properly and adequately addressed in an
ethical way, it is believed that 3-D bio-printing technology will be “at the
service of the human person, of his inalienable rights and his true and
integral good according to the design and will of God” (O’Rourke and Boyle,
Kindle location 4118-4120).
First,
let’s examine adoption of the technology in stem cells research. Some
scientists have recently made use of 3-D bio-printing technology to create
“building blocks” of embryonic stem cells, which can be used for “growing
micro-organs, performing tissue regeneration experiments, testing medication
and other biological research purposes.” It is claimed that the this novel
technique can better resemble the early stages of embryo formation than growing
cells on a flat petri dish, which “serves as a much better starting point for
further tissue growth” (Science alert, “3D-print embryonic stem cell
building-blocks”). Such experimental research on embryonic stem cells is
severely morally illicit as it involves the destruction of living embryos. The
Congregation for the Doctrine of the Faith (CDF) unambiguously pointed out:
If
the embryos are living, whether viable or not, they must be respected just like
any other human person; experimentation on embryos which is not directly
therapeutic is illicit. No objective, even though noble in itself, such as a
foreseeable advantage to science, to other human beings or to society, can in
any way justify experimentation on living human embryos or foetuses, whether
viable or not, either inside or outside the mother's womb (CDF “Instruction on
respect for human life in its origin”).
As for dead embryos, the CDF also instructed that
“they must be respected just as the remains of other human beings. In
particular, they cannot be subjected to mutilation or to autopsies if their
death has not yet been verified and without the consent of the parents or of
the mother.” In other words, the human embryo, a member of the human species,
must be respected from the time of conception like any other human being and
should never be subjected to any experimental manipulation or exploitation,
including using 3-D bio-printing technology to create building blocks of
embryonic stem cells. Advancement of science and improved health care outcomes
cannot provide a proportionate justification for destroying human embryos which
is an intrinsic evil act. The end does not justify the means.
On the
other hand, if the medical research is on “adult” stem cells, which are derived
from the umbilical cord blood, the bone marrow and other tissues, the Church
encourages such research because it is compatible with the dignity of human
beings. In fact, the “unexpected plasticity of adult stem cells has made it
possible to use this type of undifferentiated, self-renewing cell successfully
for the healing of various human tissues and organs, particularly in hearts
damaged after myocardial infarction” (Document of the Holy See on human
cloning, 2). With 3-D bio-printing technology, a team of doctors, researchers,
technicians and students at the Cardiovascular Innovation Institute on Muhammad
Ali Boulevard in Louisville, Kentucky has successfully taken steps toward
printing a working human heart which aims to “help repair or replace damaged
human organs and tissues, improve surgeries, and ultimately give patients far
better outcomes in dealing with a wide range of illnesses and injuries” (TechRepublic,
“3D bioprinter to reproduce human organs, change the face of healthcare”).
Obviously,
3-D bio-printing of adult stem cells is still at the infant stage of development
and a lot more research efforts would have to be spent and animal
experimentation conducted before 3-D printed human organs may be used to
replace damaged organs. Unlike 3-D printing to replace bones using materials
such as titanium in orthopaedic surgery in which the material has been safely
tested for a long period with many patients, the expanded use of 3-D
bio-printing of human organs is a different story. For example, if the whole
heart is replaced with a cloned 3-D printed heart, it is unknown as to whether
the replaced heart would function properly and even if it does, for how long it
would continue to function in the normal manner. The risk is very high as the
patient will unlikely survive if the replaced heart does not function properly.
And unlike the case of developing a new drug, it is virtually impossible for
the technology to be tested in a sizable population of patients before it is
available as a standard treatment. For this reason, it may be more prudent for
the technology to be used initially in repairing or replacing less critical
organs before it is put on clinical trial with the informed consent of the
patient or his surrogate for replacing critical organs, in order that the
potential harm and undesirable effects on the patient can be minimized for
justifying the proportionate benefits.
Furthermore,
this kind of technology, when successfully researched, is not completely free
of ethical issues when it is put into ongoing practice for patient treatment.
If the stem cells are harvested from the patient or from a donor as a gift with
his informed consent, it should be morally licit provided that it does not pose
serious health risks on the donor. If, on the other hand, the stem cells are
harvested from different donors for commercial purposes, the replacement of the
human organ will be reduced to the level of a commercial transaction, thus
greatly undermining the underlying meaning of gift, making the donation act
morally illicit. The ethical consideration for the donation of adult stem cells
for bio-printing organs is similar to that of organ donation in the sense that
“the freedom of the prospective donor must be respected and economic advantages
should not accrue to the donor” (O’Rourke and Boyle, Kindle location 430).
Another
potential issue with 3-D printing biotechnology is community accessibility to
the technology, i.e., whether the technology can be made widely available to
patients in need, especially those who are poor and vulnerable. Catholic social
teaching stated that “the Church must stand on the side of the poor, that it
must be a church of the poor, and that it must stand in solidarity with the
poor.” As such, not only that Catholic health care organizations should be
marked by service to and advocacy for the poor, it is also important that the
Church should help to protect common good by promoting community health care
services particularly those which are life-saving and contributing to human
development so that they are easily accessible to and affordable by the poor,
the uninsured and the underinsured (O’Rourke and Boyle, Kindle location
477-481). One major concern with the development of personalized medicines is
the cost of treatments. Until recently, it has been considered that the
personalized medicines, while having the ability to substantially improve
health outcomes, would only be affordable by the rich, thus undesirably
increasing the disparity in health care between the rich and the poor. However,
the advancement of 3-D printing biotechnology may be able to solve this
dilemma. Because of the versatility and highly personalized nature of the
technology, therapeutic treatments offered to patients by 3-D bio-printing can
bring much more benefits than standardized treatments. For example, the 3-D
bio-printing of a new leg for a child who has lost his leg to cancer may
obviate the need for the frequent replacements of artificial legs affected by
his growing bones, if the bio-printed leg can be adapted to the rapidly growing
body of the child, thereby making “a very big difference in the child’s comfort
and capacity to participate in ordinary childhood activities and play” (Dodds,
“3D printing raises ethical issues in medicine”). This will also result in
substantial financial saving because repeated orthopaedic surgeries to restore
lost bone structures would no longer deem necessary, thus making personalized
health care affordable by and reachable to many more patients in need. Looking
into the future, when the technology becomes more mature, 3-D bio-printing of
critical organs using the patient’s own stem cells can also give hope to dying
patients and their family who are eagerly awaiting the transplantation of
organs which will not be rejected by the body of the patient.
A more
controversial moral issue of 3-D bio-printing technology is whether it should
be used in human enhancement for the development/production of more “advanced”
or “durable” organs or bones. In other words, should the technology be used to
develop human capabilities beyond what is normal for human beings? Some people
may favor this possibility and see it as conducive to human growth and
development. For example, installing a “tele-eye” or “tele-ear” would enable
one to have superior capabilities over others for achieving a special mission.
In reality, the debate about human enhancement is not a brand new topic
considering the unethical use of medical technology by some athletes to improve
their capabilities such as speed, strength or endurance beyond other “normal”
athletes so that they stand a better chance to win the game. As for 3-D
bio-printing of organs and bones, it may become possible in future for the
replacement of some parts of the body to make an athlete stronger than others
in competitions. Clearly, this act involves cheating other athletes in a fair
competition, is contrary to the level-playing field, and should be rejected as
morally illicit (Dodds, “3D printing raises ethical issues in medicine”). The
basic ethical consideration of such “human enhancement” act is the intention of
the act. If its intention is to create an elite tribe of human beings, the act
can be very dangerous as it would promote a eugenic mentality leading to the
indirect social stigma with regard to people who lack certain qualities while
privileging qualities that happen to be appreciated by a certain group, culture
or society. “This would be in contrast with the fundamental truth of the
equality of all human beings that is expressed in the principle of justice, the
violation of which, in the long run, would harm peaceful coexistence among
individuals.” Also importantly, it must also be noted that “in the attempt to
create a new type of human being one can recognize an ideological element in
which man tries to take the place of his Creator” (CDF Instruction Dignitas
Personae on certain bioethical questions, 27).
Worse
still, the misuse of 3-D bio-printing in enhancing human capabilities may tempt
nations to “improve” their military personnel in making them less vulnerable to
physical harm and fatigue, thus opening the possibilities of a new kind of arms
race. Increasing the offensive and defensive capabilities of soldiers in a
battle will result in the increasing power of weapons to overcome such
capabilities. The consequences could be devastating as it would undoubtedly
lead to increasing exposure and harm to the civilians (Dodds, “3D printing
raises ethical issues in medicine”).
All the
above suggest the need for a government’s regulatory role. It is apparent that 3-D
bio-printing technology would contribute to authentic human development if it
can serve the health care needs of individuals who are unable to get such
treatment with the existing medicines and technologies. Governments have the
responsibility to ensure that the new technology can be safely applied to
treatments and before it can become widely available, new models and standards
of testing should be devised for approval by the regulator. Otherwise, prudent
and safe deployment of the technology to individuals cannot be guaranteed.
Moreover, governments have to consider the “universal accessibility” of the new
technology so that its use will not be limited to the rich and privileged
people in the society. The earlier discussion on the potential use of the
technology in orthopaedic surgery serves as an example that the technology can
indeed reduce the cost of customizing and producing prosthetic legs, thus
enabling personalized treatments to be reachable to many more patients.
Finally, governments have the primary responsibility to introduce legislations
to prevent the misuse of 3-D bio-printing technology in morally illicit
activities such as the development of “super humans,” continued proliferation
of embryonic stem cell research, and creation of organs for solely commercial
purposes, in which either the intention or the means or both of these
activities are unethical.
It is
clear that 3-D bio-printing technology has huge potentials to improve health
outcomes through personalized treatments. Nevertheless, as with any other new
technologies, only when it is designed and implemented in an ethical manner
will it respect human life and dignity and be conducive to true and integral
human growth and development.
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