Bioethical Issues Research Articles

Assessing the Awareness of the Staff of a University of Medical Sciences about Organ Donation Following Brain Death

Background: Organ donation is fast becoming an important bioethical issue from a social perspective, because it is a humanitarian act with the goal of saving human lives and deliverance from suffering. Donation may be for research or, more often, healthy transplantable organs and tissues may be donated to be transplanted into another person. Organ donors are usually dead at the time of donation, though sometimes may be alive. The purpose of this study is to assess the awareness of the employees of a university of medical sciences, Tehran- Iran, about organ donation following brain death. Methods: A questionnaire containing ten questions regarding participant's knowledge about “organ donation” was filled. To evaluate the reliability of the questionnaire Cronbach's alpha method test was used. SPSS software was used for statistical analysis of the data. Findings: Out of 70 participants (those who answered the questionnaire), 61 were male (87.1%) and 9 were female (12.9%). Based on the education, most of the participants (36 people) were general practitioner with MBBS degree, masters and medical student (51.4%). Analyses of the collected data indicate that 60% of the 70participants are "familiar" with organ donation (P> 0.05). 72.9% of the participants expressed interest in having more information about organ donation. Conclusion: Motivating people to donate organ is a multi-approach task. It involves applying effective methods of teaching and learning, social network interventions and exposing educational content about organ donation for social media users.

Bioethical issues in imaging cancer in pregnancy

Bioethical issues in imaging cancer in pregnancy

Editing the Human Genome with CRISPR/Cas: A Review of its Molecular Basis, Current Clinical Applications, and Bioethical Implications.

CRISPR/Cas genes evolved in prokaryotic organisms as a mechanism of defense designed to identify and destroy genetic material from threatening viruses. A breakthrough discovery is that CRISPR/Cas system can be used in eukaryotic cells to edit almost any desired gene. This comprehensive review addresses the most relevant work in the CRISPR/Cas field, including its history, molecular biology, gene editing capability, ongoing clinical trials, and bioethics. Although the science involved is complex, we intended to describe it in a concise manner that could be of interest to diverse readers, including anyone dedicated to the treatment of patients who could potentially benefit from gene editing, molecular biologists, and bioethicists. CRISPR/Cas has the potential to correct inherited diseases caused by single point mutations, to knock-in the promoter of a gene whose expression is highly desirable or knockout the gene coding for a deleterious protein. CRISPR/Cas technique can also be used to edit ex vivo immune cells and reinsert them in patients, improving their efficiency in attacking malignant cells, limiting the infectious potential of viruses or modulating xenotransplant rejection. Very important bioethical considerations on this topic include the need to internationally regulate its use by ad hoc expert committees and to limit its use until safety and bioethical issues are satisfactorily resolved.

Non-surgical In Vivo Germ Cell-mediated Gene Editing by CRISPR Mutagenic Chain Reaction with the Aid of Magnetic Nanoparticles.

Gene therapy via germline cells leads to a permanent genetic modification. The promise of this method is due to its potential for providing a stable therapeutic effect for all who inherit the gene of interest. If germinal therapy is successfully performed, it can eliminate certain diseases from the family and the population. The feasibility of genetic modification in the human germline raises several controversial and bioethical issues. However, gene transfer via male and female germinal cells has been recently explored in animal models. Previous studies have shown that delivering DNA to the testes followed by electroporation is relatively successful in producing germline-mediated alterations. Since this method includes surgical procedures, non-surgical, safer, and less timeconsuming methods would be ideal. Herein, we discuss a potential approach for nonsurgical in vivo germ cell-mediated gene editing by CRISPR mutagenic chain reaction with the aid of magnetic nanoparticles.

Evolution of Spanish Deontology (1978-2022). What has changed in the last 40 years?

The article reviews the evolution of the deontology of the Spanish Medical Organization through how it has been reflected in the diverse codes of deontology approved by this institution. After an approximation to the spirit and contents of the first Code of ethics approved in 1978, born after the Spanish Constitution, passed that same year, which established the recognition and the need to regulate professional associations and the exercise of qualified professionals. The 1978 Code is compared with the one recently approved in December 2022, using the second 1990 Code as a bridge. In the comparison we find many bioethical issues on which, through the last decades, reflections have been made and answers have been introduced that respond to the many social and technological changes that have occurred. Special reference is made to the concept of respect, embodied in the relationship between the doctor and the patient. It is a relationship that is often not symmetrical because the sufferer may feel or endure extreme vulnerability. The article also reflects on the evolution of relevant issues or those that may raise more controversies, such as respect for initial and final life. The synthesis of the current 2022 Code of Medical Ethics can be done in three words: Respect and Human Rights.

Carrying the same pregnancy: A bioethical overview on Reciprocal effortless IVF and similar techniques

Nowadays, novel techniques such as Reciprocal effortless in vitro fertilization (ReIVF) enable two individuals to “carry the same pregnancy,” that is to “carry” the same embryo in both their bodies. However, even though these techniques are likely to be increasingly requested, little is known about their safety and efficacy, and much less about their bioethical legitimacy and issues. Considering their uniqueness, this study assesses the compatibility of ReIVF as well as of another similar technique with the classical principles of medical ethics: autonomy, beneficence, nonmaleficence, and justice. The aim is twofold: (i) to start investigating whether these techniques and their underlying reasons are, or could ever be, bioethically justifiable and (ii) to make clinicians and any other potentially interested persons such as researchers, lawmakers and prospective parents themselves are more aware of the health and social implications of using these techniques. Hence, after a brief overview of the technical aspects of the procedures that allow two persons to carry the same pregnancy, this study offers a general moral framework that can be useful for starting to address some relevant aspects of these procedures, such as their benefits and harms on the health of the individuals involved, the reasons behind their use, and the possibility that they might be covered by states in the future. Finally, this study provides a bioethical overview on ReIVF as well as on similar techniques considering different perspectives, while also suggesting some questions and recommendations for further research.

Pain in Pets: Beyond Physiology.

Animals do not speak a language humans understand, making it easy to believe that they do not experience pain the way humans do. Despite data affirming that companion animals can and do experience pain much as do humans, there remains a gap between companion animal acute pain management knowledge and its execution. Companion animal pain is not simply a physiological issue. Veterinary clinicians can and should embrace the foundational principles of clinical bioethics-respect for autonomy, nonmaleficence, beneficence, and justice-translated from human medicine for the benefit of their patients. By reframing companion animal pain as a bioethical issue, as described in this paper, veterinarians affirm their commitment to closing the gap between what is known and what is done for painful companion animals. This takes pet pain beyond physiology.

A Framework for Examining Bioethical Issues from a Sunni Perspective: Maslaha.

All religions should develop convincing responses to emerging bioethical problems stemming from medical and technological advancements. Additionally, believers need to know their faiths' interpretations of bioethical issues to be able to make medical decisions in line with their religious values. Therefore, Islamic bioethics should provide Muslims with conclusive and credible answers regarding newly rising problems in health care by revisiting the religious norms and decrees. However, the diversity in the Islamic denominations, the traditionalist aspect of the Sunni jurisprudence demanding strict compliance with the scriptural texts, the lack of unanimously accepted authority, and the limited number of academic works in Islamic bioethics (at least in English) complicate exploring new standards or rules for new ethical matters. In this view, the present paper aims to delineate two primary Islamic theological schools and propose al-Ghazali's maslaha as a general framework to analyze bioethical issues in the Sunni tradition. Maslaha allows exercising discretion in light of the protection of five fundamental values: religion, life, reason, lineage, and property. Maslaha has the potential to enable Sunni Muslims to appraise contemporary ethical questions, concerns, and dilemmas through an Islamic view and make more autonomous decisions by having religious guidelines.

Life between god and biomedical interventions: Narratives of church believers of the Serbian Orthodox Church on certain bioethical issues

The text offers an insight into the narratives of church believers in Serbia that were interviewed as ? part of the project ?Church-religious practices of Orthodox believers in Serbia: an anthropological research? from 2021 to 2023. The focus is on topics from the domain of bioethics and modern biomedical procedures concerning the beginning, maintenance and ending of the life of an individual, the well-being of the body, but also of the spirit. Through examples of statements and attitudes on biomedically assisted reproduction, organ donation, euthanasia and abortion, an especially complex relation between church norms, interpretations, rules and real experiences of believers is presented. Believers build these from secular sources, the Orthodox literature they read, popular clergy active on social media that they follow, but also from the official positions of the church hierarchy.

Биоэтические аспекты применения репродуктивных технологий

The demographic situation in the modern world is problematic: the birth rate is declining, the rates of primary and secondary infertility are progressively increasing. Assisted reproductive technologies are methods to solve the problem of infertility. From the point of view of bioethics, there are a number of controversial issues: determining the personal status of the embryo, the ratio of risks and benefits for participants in the procedures, the possibility of cryopreservation, the destruction of “extra embryos”, etc. The purpose of our research was to study the attitude of the population to assessing the importance of bioethical aspects of the use of assisted reproductive technologies. During the study, an anonymous survey was conducted on the Google platform. The study involved 104 respondents of both sexes (83 women, 21 men) of various ages, mostly (59.6 %) in the category of 15–20 years. The survey questions were aimed at determining the degree of awareness of the participants about the problem of infertility and assisted reproductive technologies, the bioethical issues that they affect, as well as the subjective attitude to the use of these methods. Most of the respondents had an idea about the goals of assisted reproductive technologies and the bioethical problems that they generate. The survey participants noted the importance of communication between a doctor and a patient as one of the factors that makes it possible to increase the effectiveness of assisted reproductive technologies protocols: sympathy and moral support should be considered the basic norms of communication between a doctor and a patient with an infertility issue.

A Review on Alternative Methods to Experimental Animals in Biological Testing: Recent Advancement and Current Strategies.

With an increase in the progression of research and development in the medical field, the experimental use of animals for the efficacy and safety testing of pharmaceuticals is on rise. Every year, millions of animals are used for experimental testing during which these suffer from pain and are then eventually sacrificed. Besides bioethical issues, animal experimentation is associated with many disadvantages like high cost, the requirement of skilled manpower, approval, and is time-consuming. Therefore, attempts have been made by researchers to design and develop a number of alternative methods that could bypass animal experiments. These methods not only give accurate results but can also save lives of millions of animals annually. Research techniques, including computer and robotics together with molecular biology techniques, are applied to discover new methods to replace animal testing. Several alternative methods are discussed in this review. Some of these methods can predict the behavior of drugs accurately and are as reliable as in-vivo animal models. Furthermore, these alternative methods offer a variety of advantages over experimental animals. However, there is still a great need to discover and develop new, accurate, and reliable methods to replace experimental animals.

ТЕОРЕТИКО-ПРАВОВОЕ ОБОСНОВАНИЕ БИОЭТИКИ И БИОПРАВА В ИХ ВЗАИМОСВЯЗИ И ВЗАИМОДЕЙСТВИИ

Introduction: modern legal science pays increasing attention to the regulation of relations associated with the development of new technologies. Biotechnologies, and consequently bioethics and biolaw, are one of the areas related to the arrangement and protection of legal relations. Biolaw and biorights (so-matic human rights) is a relatively new but extremely progressively developing field of scientific know-ledge. There arise numerous unresolved regulatory issues in law enforcement and law implementation practice, which results, among other things, from theoretical problems related to defining the nature of the rules of morality and the rules of law, their belonging to a specific branch, the parties involved, their differentiation and mutual influence. The paper provides a theoretical and legal analysis of the above-mentioned field, the authors formulate their opinion on the most relevant, problematic, and ambiguous issues, including the differentiation and interaction between bioethics and jurisprudence, some individual issues of bioethics and biolaw. Purpose: to study the theoretical and legal provisions in the field of bio-ethics and biolaw in their interrelation and interaction; basing on these provisions, to develop the under-standing of biolaw, its theoretical and legal aspects, nature, somatic rights, to gain insight into biolaw as a legal formation and its principles. Methods: dialectical method of cognition, directly related to the principle of development, used as the methodological basis; general scientific methods and methods of cognition of individual sciences, including analysis, synthesis, abstraction, system-structural, and others; special methods of legal science: formal legal analysis in the context of various modifications of legal positivism; textual approach makes it possible to identify relevant legal ideas through hermeneutics, to formulate existing doctrinal, normative and law-realization problems; a comparative legal method. Re-sults: the theoretical and legal provisions in the field of bioethics and biolaw were researched in their in-terrelation and interaction, they were used as the basis for the development of the authors’ understand-ing of biolaw; categories such as bioethics, biolaw, somatic rights, medical law were investigated and described, the authors’ vision of these categories was proposed; the analysis of biolaw as a legal forma-tion was carried out, its interbranch nature is defined. Conclusions: bioethics and biolaw are in direct in-terrelationship and interaction. Modern science has not formulated a unified approach to the under-standing and content of bioethics and biolaw, which makes it necessary to perform qualitative analysis of these, including theoretical-and-legal analysis. Bioethics is the substantive basis of biolaw. Somatic rights, underlying biolaw, are currently at the stage of systemic formation, they require proper legal for-malization, security, and protection. Legal formalization should take place both at the level of interna-tional law and in the national legislation of individual states, including the Russian Federation; the key role in this process should be given to biolaw as an interbranch formation. It is currently premature to classify biolaw as a branch of law, including due to the absence of a single consolidated subject of legal regulation and method. One of the problems is the absence of a well-formed system of the biolaw prin-ciples which could become the proper fundamentals for legal regulation of this sphere. The paper pro-poses a vision of the corresponding system of principles and their characteristics.

Cross-Species Hybrids and Bioethics in Early Soviet Fiction

My article addresses issues of bioethics in cross-species hybridism raised in Robert and Beylis’ well-known “Crossing species boundaries” (2003) and the ensuing discussion by examination of two important stories written in the Soviet 1920s, “A Dog’s Heart” and “The Amphibian Man”. I argue that these two fictional narratives show that literature not only responds to changing trends in biological sciences but also heuristically considers and intuits wider social implications of radical experimentation. My approach is both synchronic and diachronic as I demonstrate that while being grounded in the same reformative atmosphere of the 1920s, the two texts present divergent responses to the issue of cross-species hybridism relevant for our contemporary debates. In particular, I deal with the notions of man playing God, species identity in analogy to ‘race’, procreation of human-animal hybrids, and also consider the relevance of culture-specific concepts of charismatic and distant species for cross-species discourse.

Formation of bioethical views of students - future veterinarians: review of a source database

The source database for the formation of bioethical views of students - future veterinarians was analyzed at the article. The search for sources is carried out in the scientific resources of the electronic system of the National Library of Ukraine named after V.I. Vernadskyi (2023). The results of the research show that this problem is not sufficiently covered in domestic scientific sources. Thus scientific works on the formation of bioethical views of students - future veterinarians have not been identified. At the same time, some aspects of bioethical issues are revealed in domestic scientific thought. In the course of the search and analysis of scientific works, the sources on the problem of formation of bioethical views were classified according to the type of scientific publication, in particular, monographs, dissertations and abstracts to them, materials of scientific conferences and symposia, articles in specialized professional journals. In monographs and dissertations, since 2007, domestic scientists have revealed philosophical (H. Horpenko, N. Nikolayenko, K. Rassudina), medical (Y.Kundiiev, O.Ternova), pedagogical (V. Bak I. Nazarko, A.V. Stepaniuk, O.Trotska), theological (P.Melnychuk), legal (O.Kashintseva, V.Tretiakova, Ya. Tryniova). O.) aspects of the investigated problem. It has been established that over the last 5 years (2019-2023), the following aspects of the research problem have been covered in scientific articles: medical (euthanasia, the COVID-19 pandemic, reproductive medicine, cellular transplantation), educational (formation of the bioethical culture of the future medical specialist, educational experiments using living organisms), legal (legal regulation of ethics committees, bioethical principles of international law), philological (bioethical terminology), philosophical (bioethical concept of quality of life), ecological and environmental (bioetic aspects of methodology of hydrobiological research).

Judaism.

Judaism offers a rich body of traditional beliefs and practices surrounding end-of-life, death, mourning, and the afterlife. A more detailed understanding of these topics might prove helpful to clinicians seeking guidance for how best to care for Jewish patients, to anyone supporting dying individuals, or to anyone interested in learning more about the subject. The objectives of this chapter are to examine Jewish approaches to key bioethical issues surrounding palliative care, to analyze meaning-making rituals following a loss, at a funeral, and throughout mourning, and to explore Jewish beliefs in an afterlife. Research was collected from sacred texts, legal codes, modern rabbinic responsa literature, and secondary sources. Core, guiding principles include human beings' creation "in the image of God," an obligation to save life, an obligation to mitigate pain, a prohibition against self-harm and hastening death, respect for the dead, and ritualized mourning periods ("shiva," "shloshim," and "shanah"), which feature special liturgy ("kaddish") and practices. Judaism is a religion that values thorough questioning, debate, and argumentation. It also encompasses diverse cultural and ethnic backgrounds, and various denominations. Many Jews are also unaffiliated with a movement or rarely engage with traditional law altogether. For all of these reasons, no summary can comprehensively encapsulate the wide range of opinions that exist around any given topic. That said, what follows is a detailed overview of traditional Jewish approaches to artificial nutrition/hydration, extubation, dialysis, euthanasia and more. It also outlines rituals surrounding and following death. Finally, views and beliefs of the afterlife are presented, as they often serve to imbue meaning and comfort in times of grief, uncertainty, and transition.

Bioethical Problems of China’s Demographic Policy: Background and Present

The article is devoted to the study of bioethical problems of China’s demographic policy. One of the main instruments of birth control in the country for 30 years was artificial termination of pregnancy – abortion. Because of this, contradiction between the political course of the state and the traditional, rooted in society, moral principles and values arises. Population policy has become a harsh method of restricting the reproductive rights and freedom of private life of the Chinese population. The current situation determines relevance and necessity of studying China’s demographic policy from the point of view of bioethics. Thus, the article discusses background for approval of the policy “One family – one child”; the implications of this policy, such as the bioethical issues of medical termination of pregnancy and selective abortion in China; transformation of the traditional institution of the family; moral and ethical status of the second child; the problem of the prohibition of surrogate motherhood; gender imbalance; increase in illegal services in the field of medical and reproductive technologies. Bioethical aspects of modern Chinese demography; socio-cultural changes in Chinese society due to a long period of birth control policies are analyzed. The reasons for the low efficiency of modern state measures to stimulate childbearing are considered.

A Scoping Review on the Ethical Issues in the Use of CRISPR-Cas9 in the Creation of Human Disease Models

Introduction: The remarkable advances in molecular science and technology have dramatically changed the landscape of Deoxyribonucleic Acid (DNA). With the rapid pace of new gene editing technologies like Clustered Regularly Interspaced Short Palindromic Repeats and CRISPR-associated protein 9 (CRISPR-Cas9), human disease models can be created to reduce the burden of morbidity and mortality caused by genetic defects and congenital malformations. However, despite its potential to advance human health and well-being, the use of CRISPR-Cas9 technology raises numerous ethical concerns, including the lack of a well-defined regulatory framework. Aim: To outline the ethical concerns that arise in the creation of human disease models using CRISPR-Cas9 technology and to design a conceptual framework to identify the ethical challenges and address these concerns. Materials and Methods: The data on ethical issues in the use of CRISPR-Cas9 in the creation of human disease models were obtained by reviewing 530 articles retrieved from scientific databases such as Google Scholar, PubMed, Scopus, and Excerpte Medica dataBASE (EMBASE) from the year 2015. Based on the eligibility criteria, 24 publications from 56 full-text articles that were screened were included in this study. The selection process was conducted in three phases-screening of the title, abstract, and full text. The articles selected after full-text screening were analysed, and the data was scrutinised independently. Tables, charts, figures, and graphs were used to organise and illustrate the obtained data. The entire paper was drafted using the Preferred Repoting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for scoping review reporting criteria. Results: The present study included 24 articles for review after the screening process. The articles emphasised the bioethical issues related to CRISPR-Cas9 technology and gene editing while also shedding light on the current level of research in the field. The studies included different countries, with the maximum number of papers from the United States of America (USA), followed by the United Kingdom (UK), China, Turkey, Spain, Canada, Pakistan, Australia, Italy, France, Korea, and Sri Lanka. These articles were published between 2015 and 2021. The disease for which models were created was not mentioned in the majority of articles, while a few investigated the application of CRISPR-Cas9 in genetic disorders, cardiovascular diseases, neurodegenerative diseases, and eye disorders. The major ethical concerns identified included safety, efficacy, unintended consequences, harm to the environment, off-target effects, obtaining informed consent, and the risk of misuse. Conclusion: The use of CRISPR-Cas9 technology in creating human disease models has raised many ethical concerns. One of the primary ethical issues is the potential for unintended consequences, which could have serious long-term effects on individuals and their offspring. To address these ethical issues, it is important to develop ethical guidelines and best practices, as well as to support ongoing research to investigate the longterm effects of gene modifications.

Core issues, case studies, and the need for expanded Legacy African American genomics.

Introduction: Genomic studies of Legacy African Americans have a tangled and convoluted history in western science. In this review paper, core issues affecting African American genomic studies are addressed and two case studies, the New York African Burial Ground and the Gullah Geechee peoples, are presented to highlight the current status of genomic research among Africa Americans. Methods: To investigate our target population's core issues, a metadatabase derived from 22 publicly accessible databases were reviewed, evaluated, and synthesized to identify the core bioethical issues prevalent during the centuries of the African American presence in North America. The sequence of metadatabase development included 5 steps: identification of information, record screening and retention of topic relevant information, identification of eligibility via synthesis for concept identifications, and inclusion of studies used for conceptual summaries and studies used for genetic and genomic summaries. To these data we added our emic perspectives and specific insights from our case studies. Results: Overall, there is a paucity of existing research on underrepresent African American genomic diversity. In every category of genomic testing (i.e., diagnostic, clinical predictive, pharmacogenomic, direct-to-consumer, and tumor testing), African Americans are disproportionately underrepresented compared to European Americans. The first of our case studies is from the New York African Burial Ground Project where genomic studies of grave soil derived aDNA yields insights into the causes of death of 17th and 18th Century African Americans. In the second of our case studies, research among the Gullah Geechee people of the Carolina Lowcountry reveals a connection between genomic studies and health disparities. Discussion: African Americans have historically borne the brunt of the earliest biomedical studies used to generate and refine primitive concepts in genetics. As exploited victims these investigations, African American men, women, and children were subjected to an ethics-free western science. Now that bioethical safeguards have been added, underrepresented and marginalized people who were once the convenient targets of western science, are now excluded from its health-related benefits. Recommendations to enhance the inclusion of African Americans in global genomic databases and clinical trials should include the following: emphasis on the connection of inclusion to advances in precision medicine, emphasis on the relevance of inclusion to fundamental questions in human evolutionary biology, emphasis on the historical relevance of inclusion for Legacy African Americans, emphasis on the ability of inclusion to foster expanded scientific expertise in the target population, ethical engagement with their descendants, and increase the number of science researchers from these communities.

International Legal Regulation of Bioethics Issues

International Legal Regulation of Bioethics Issues

A Landscape of CRISPR/Cas Technique for Emerging Viral Disease Diagnostics and Therapeutics: Progress and Prospects.

Viral diseases have emerged as a serious threat to humanity and as a leading cause of morbidity worldwide. Many viral diagnostic methods and antiviral therapies have been developed over time, but we are still a long way from treating certain infections caused by viruses. Acquired immunodeficiency syndrome (AIDS) is one of the challenges where current medical science advancements fall short. As a result, new diagnostic and treatment options are desperately needed. The CRISPR/Cas9 system has recently been proposed as a potential therapeutic approach for viral disease treatment. CRISPR/Cas9 is a specialised, effective, and adaptive gene-editing technique that can be used to modify, delete, or correct specific DNA sequences. It has evolved into an advanced, configurable nuclease-based single or multiple gene-editing tool with a wide range of applications. It is widely preferred simply because its operational procedures are simple, inexpensive, and extremely efficient. Exploration of infectious virus genomes is required for a comprehensive study of infectious viruses. Herein, we have discussed the historical timeline-based advancement of CRISPR, CRISPR/Cas9 as a gene-editing technology, the structure of CRISPR, and CRISPR as a diagnostic tool for studying emerging viral infections. Additionally, utilizing CRISPR/Cas9 technology to fight viral infections in plants, CRISPR-based diagnostics of viruses, pros, and cons, and bioethical issues of CRISPR/Cas9-based genomic modification are discussed.