Artificial Gametes: dynamics and ethics
Projectomschrijving
Dit project had als doel de ethische aspecten in kaart te brengen van onderzoek gericht op, en mogelijk (toekomstig) reproductief gebruik van, in het laboratorium gegenereerde geslachtscellen (in vitro derived gametes). Dit begrip wordt gebruikt als aanduiding voor technieken waarmee functionele geslachtscellen worden ontwikkeld uit voorlopercellen in reproductief weefsel, of uit pluripotente stamcellen (humane embryonale stamcellen of induced pluripotent stem cells).
In een prospectieve ethische analyse is verkend welke vragen en knelpunten zich in verband met de (verdere) ontwikkeling van deze technieken voordoen. Voordeel van deze nieuwe technieken zou zijn dat mensen die bij de huidige stand van wetenschap alleen een kind kunnen krijgen met behulp van een zaad- of eiceldonor, in staat gesteld zouden worden een voor beide partners genetisch eigen kind te krijgen. Het project omvatte een verkenning van opvatting van stakeholders (waaronder vertegenwoordigers van fertiliteitspatiëntengroepen) en een normatief ethische analyse.
Bereikte resultaten
- Nieuwe reproductieve technologie mag niet zonder adequaat pre-klinisch veiligheidsonderzoek worden toegepast in de kliniek. Waar het gaat om de mogelijke introductie van kunstmatige gameten moet daarbij behalve aan dieronderzoek ook aan onderzoek met speciaal te kweken menselijke embryo’s worden gedacht.
- Dat de ontwikkeling van kunstmatige gameten tot nieuwe mogelijkheden van gezinsvorming (beyond the nuclear family) kan leiden vraagt om nadere reflectie op de voorwaarden voor verantwoorde toepassing, maar is geen reden om de ontwikkeling van de relevante technieken bij voorbaat te problematiseren.
- De proportionaliteit van investeren in de ontwikkeling van deze technologieën hangt mede af van de vraag naar wat nu eigenlijk het belang is van een 'genetisch eigen' kind.
Verslagen
Eindverslag
Samenvatting van de aanvraag
In-vitro fertilisation (IVF) is an ‘open window’, that offers a view on innovative technology and new reproductive practices. An important development in this context, opening up new scientific horizons and challenging ethical frameworks, is the generation of human gametes in vitro, often also referred to as ‘artificial gametes’. This includes the following approaches: 1. Maturing human oocytes in vitro (in vitro maturation; IVM) 2. Growing (and maturing) human follicles in vitro (in vitro growth; IVG) 3. Culturing sperm from spermatogonial stemcells (SSCs) 4. Deriving sperm or oocytes from pluripotent stem cells (either human embryonic stem cells: ESC or induced pluripotent stem cells: iPSC) On the level of fundamental research, these techniques promise to provide new insights into male and female gametogenesis. But they are also expected to significantly contribute to the improvement and expansion of techniques for medically assisted reproduction and fertility preservation. The research efforts in the field of in vitro generated gametes raise a number of ethical, legal and societal (ELSI) issues, including: a. With regard to preclinical research applications: if oocyte donors are no longer needed, this removes an important practical limitation and moral objection to creating human embryos for research or therapy. It has been commented that the availability of ‘synthetic oocytes’ is a precondition for getting SCNT research off the ground (Testa and Harris 2005). But the research aimed at developing technologies for in vitro generating human gametes will itself require the creation of research embryos, for which donor oocytes are still needed. b. With regard to the step from preclinical (animal) to clinical research: under what conditions can this step responsibly be made? Is it acceptable to introduce the use of stem cell derived gametes in clinical practice without the intermediate step of preclinical safety studies in human embryos? A further question is what measure of uncertainty about safety risks can be accepted. This also depends on the moral weight of the interests served by the relevant application. E.g.: is the possibility of having one’s genetically own child important enough for taking certain risks? c. With regard to future clinical applications: there is a clear moral interest involved in providing better options for fertility treatment and fertility preservation. But these possible applications also lead to moral questions. Complex questions about the implications of ‘embryonic parenthood’ arise in case of reproduction with ES-cell derived gametes (Mertes and Pennings 2008, 2010). The possible use of interspecies transplantation of spermatogonia raises ethical issues related to the use of an animal as an incubator of human sperm. Apart from safety issues (sub b) this may raise intuitive feelings of repugnance. The question is whether these translate into tenable moral objections. Other ethical and societal questions arise as a result of further loosening the link between reproduction and fertility. Improved fertility preservation techniques and the possible future use of stem-cell derived oocytes will allow women to have a child at any age. Similarly, same sex couples may be given the possibility of having children of which both partners are genetic parents. The moral impetus for this application clearly rests on the assumed importance of a genetic link between parents and children. However, the possibility of helping same-sex couples to have their genetically own children clearly challenges common views of the relation between genetic parenthood and sexual identity with still uncharted ethical, legal and societal implications (Newson and Smajdor 2005, Testa and Harris 2004, 2005). Should societal funding for assisted reproduction also cover applications of in vitro generated gametes that do not answer to an infertility problem? Finally, an important conceptual issue is also what these developments entail for the (legal) definition of a gamete and an embryo (Dondorp and De Wert 2005). The main aims of this research project are: 1. Identify the state of the art and realistic applications of different types of in vitro generated gametes; 2. Identify normative (ethical, legal, societal) aspects of various possible future applications of in vitro generated gametes on the basis of both desk research and empirical research (the latter consisting of both group and individual interviews); 3. Investigate normative views of different stakeholder groups: scientists involved in the development of in vitro generated gametes, clinicians and patient/potential user representatives, social scientists and experts from the humanities, and policy makers; 4. Ethical analysis aimed at providing an informed chart of moral, legal and societal implications (opportunities, challenges) related to the possible future implementation of (different types of) in vitro generated gametes.