Ethics: Managing the impact of innovation

If you had epilepsy, and a doctor told you she could implant a device in your brain to predict an oncoming seizure, you probably wouldn’t stop long to think about the unintended consequences.

You want a better life, right?

You want to be able to take action and prevent the catastrophic consequences of having a seizure at the wrong time; a car accident, a burn or drowning.

You might also expect that someone had thought about the ethical issues and flagged them with you as part of decision making process.

That’s why ACES is developing new 3D printing technologies and biomedical applications—like the brain implant to treat epilepsy—in partnership with researchers like Dr Frederic Gilbert from the University of Tasmania.

Frederic’s research tackles the ethical questions around emerging medical technologies that are being used to treat neurological or psychiatric conditions.

“It’s now possible to implant a device in the brain of someone with a neurological disease,” Frederic said. “Most patients love the results, however a significant number have seen their lives fall apart. Invasive brain technologies present some profound ethical questions.”

“As a society, we must remember that all great and current medical technologies that can be used to treat us have been at a certain point experimental,” he said.

“In other words, before becoming a standard intervention, a new medical treatment has to be tested first and it’s often during this phase that we discover unexpected consequences.”

Looking out for patients ahead of time

Protecting trial participants, and future patients matters enormously to Frederic and he is interested in establishing and discussing ethical considerations ahead of time.

Last year, Frederic and his colleagues found that there has been a recent increase in discussion of ‘3D bioprinting’ in scientific publications, issued patents, and media reports.

“We also found there has been significant medical innovations in this technology, especially the use of 3D-bioprinted biomaterials in patients with life-threatening conditions,” he said.

“There has been little discussion about the ethical issues that are related to bioprinting and I felt it was important to initiate the first international discussion.”

First international workshop to explore the ethics of bioprinting

Frederic was competitively awarded a grant from the prestigious Brocher Foundation which allowed him to organise the first international, interdisciplinary workshop on the ethics of bioprinting.

The Brocher Foundation is an internationally renowned institution which hosts scientists and experts in the ethical, legal and social implications of the development of medical research and biotechnologies. Due to its close collaboration with major organisations like the World Health Organisation, the Brocher Foundation has become a critical meeting and reflection venue to debate emerging technologies.

The two day workshop, held last month at the Foundation’s grounds in Geneva, Switzerland generated wide international interest and active exchange across a range of disciplines.

Prominent scientists, bioethicists, clinical trial specialists, neurosurgeons, philosophers and scholars from 10 countries attended, including a participant from the World Health Organisation, to discuss the legal, medical, social, and ethical issues raised by the potential use of 3D bioprinting in medical treatment and research. The workshop also allowed collaborative contacts to be made with policy analysts of the European Parliament.

Key outcomes from the workshop

Frederic said participants agreed that more needs to be done to:

• Understand and anticipate societal impacts of bioprinting technologies, for example should we simply restore organ function or replace the entire organ?
  Consider what medical conditions the technology should be used to assist.
• Address issues of access, given the need to harvest stem cells, and how to allocate resources, considering the potentially expensive cost of 3D bioprinting.
  Clarify what should be classified as a 3D-bioprinted material.

“It was raised that aside from the technology itself, we should also reflect on how portrayals and discussions of 3D bioprinting could have profound societal impact,” Frederic said.

“For instance, the narrative we are using now to examine bioprinting, will likely forge future public understanding and acceptance of the technology in the future.”

Photo: (L-R) ACES Ethics, Policy and Public Engagement team members Dr Frederic Gilbert, Prof Rob Sparrow, Prof Susan Dodds, John Noel Viaña and Dr Katrina Hutchison attended the Brocher Workshop in Switzerland to discuss the ethical implications of 3D bioprinting.