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Allen JW, Gyngell C, Koplin JJ, Vears DF. The Parliamentary Inquiry into Mitochondrial Donation Law Reform (Maeve's Law) Bill 2021 in Australia: A Qualitative Analysis. JOURNAL OF BIOETHICAL INQUIRY 2024; 21:67-80. [PMID: 37530962 PMCID: PMC11052762 DOI: 10.1007/s11673-023-10257-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 04/03/2023] [Indexed: 08/03/2023]
Abstract
Recently, Australia became the second jurisdiction worldwide to legalize the use of mitochondrial donation technology. The Mitochondrial Donation Law Reform (Maeve's Law) Bill 2021 allows individuals with a family history of mitochondrial disease to access assisted reproductive techniques that prevent the inheritance of mitochondrial disease. Using inductive content analysis, we assessed submissions sent to the Senate Committee as part of a programme of scientific inquiry and public consultation that informed drafting of the Bill. These submissions discussed a range of bioethical and legal considerations of central importance to the political debate. Significantly, submissions from those with a first-hand experience of mitochondrial disease, including clinicians and those with a family history of mitochondrial disease, were in strong support of this legislation. Those in support of the Bill commended the two-staged approach and rigorous licencing requirements as part of the Bill's implementation strategy. Submissions which outlined arguments against the legislation either opposed the use of these techniques in general or opposed aspects of the implementation strategy in Australia. These findings offer a window into the ethical arguments and perspectives that matter most to those Australians who took part in the Senate inquiry into mitochondrial donation. The insights garnered from these submissions may be used to help refine policy and guidelines as the field progresses.
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Affiliation(s)
| | - Christopher Gyngell
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Julian J Koplin
- Monash University, Wellington Rd, Clayton, Australia
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia
- Melbourne Law School, University of Melbourne, Parkville, Australia
| | - Danya F Vears
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia.
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.
- Melbourne Law School, University of Melbourne, Parkville, Australia.
- Department of Public Health and Primary Care, Center for Biomedical Ethics and Law, Leuven, Belgium.
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Dziadek MA, Sue CM. Mitochondrial donation: is Australia ready? Med J Aust 2021; 216:118-121. [PMID: 34719038 PMCID: PMC9297849 DOI: 10.5694/mja2.51309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
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Aryamvally A, Myers MF, Huang T, Slone J, Pilipenko V, Hartmann JE. Mitochondrial replacement therapy: Genetic counselors' experiences, knowledge, and opinions. J Genet Couns 2021; 30:828-837. [PMID: 33469959 DOI: 10.1002/jgc4.1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/13/2020] [Accepted: 12/21/2020] [Indexed: 11/08/2022]
Abstract
Mitochondrial disorders affect at least 1 in 5,000 individuals worldwide and are often incurable and fatal. Mitochondrial replacement therapy (MRT) is an in vitro fertilization technique used to prevent the transmission of mitochondrial disorders. Currently, MRT is the only approach that provides mothers who carry a pathogenic variant in their mitochondrial DNA (mtDNA), the opportunity to have a biological child without a mitochondrial disease. MRT involves the combination of nuclear DNA from the egg of the carrier mother and the cytoplasm from an oocyte donor, which contains healthy mitochondria. While MRT was approved for use in the UK in 2015, the ban on congressional funding for research on 'heritable genetic modification' has made MRT unavailable within the US borders. This survey-based study aimed to describe genetic counselors' experience, knowledge, and opinions about MRT. Additionally, we also assessed whether genetic counselors' comfort discussing MRT with patients, and feelings about clinical use of MRT in the United States changed after providing information about MRT compared with baseline. Responses were received from 139 genetic counselors in North America. Findings indicate low awareness and knowledge about MRT among participants. However, more participants expressed comfort with discussing MRT with patients and more participants were able to form opinions about statements about MRT after they were provided with information about MRT. This study is the first to assess genetic counselors' opinions toward MRT and suggests the need for more education about novel technologies such as MRT among genetic counselors.
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Affiliation(s)
| | - Melanie F Myers
- Divison of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Taosheng Huang
- Divison of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jesse Slone
- Divison of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Valentina Pilipenko
- Divison of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Julianne E Hartmann
- Divison of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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4
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Lavazza A. Potential ethical problems with human cerebral organoids: Consciousness and moral status of future brains in a dish. Brain Res 2020; 1750:147146. [PMID: 33068633 DOI: 10.1016/j.brainres.2020.147146] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/04/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023]
Abstract
Human cerebral organoids (HCOs) are an in vitro model of early neural development, aimed at modelling and understanding brain development and neurological disorders. In just a few years there has been rapid and considerable progress in the attempt to create a brain model capable of showcasing the characteristics of the human brain. There are still strong limitations to address, including the absence of vascularization which makes it difficult to feed the central layers of the organoid. Nevertheless, some important features of the nervous system have recently been observed in cerebral organoids: they manifest electrical activity (i.e. communication between neurons), are sensitive to light stimulation and are able to connect to a spinal cord by sending impulses that make a muscle contract. Recent data show that cortical organoid network development at ten months resembles some preterm babies EEG patterns. Although cerebral organoids are not close to human brains so far due to their extremely simplified structure, this state of things gives rise to ethical concerns about the creation and destructive experimental use of human cerebral organoids. Particularly, one can wonder whether a human cerebral organoid could develop some degree of consciousness and whether, under certain conditions, it could acquire its own moral status with the related rights. In this article, I discuss the conditions under which HCOs could be granted their own moral status. For this purpose, I consider the hypothesis that HCOs might develop a primitive form of consciousness and investigate the ways in which it could be detected. In light of all this, I finally point out some cautionary measures that could be introduced into research on and with human cerebral organoids.
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Affiliation(s)
- Andrea Lavazza
- Centro Universitario Internazionale, via Garbasso, 42, 5200 Arezzo, Italy; University of Pavia, Piazza Botta, 11, 27100 Pavia, Italy.
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Degeling C, Carter SM, van Oijen AM, McAnulty J, Sintchenko V, Braunack-Mayer A, Yarwood T, Johnson J, Gilbert GL. Community perspectives on the benefits and risks of technologically enhanced communicable disease surveillance systems: a report on four community juries. BMC Med Ethics 2020; 21:31. [PMID: 32334597 PMCID: PMC7183724 DOI: 10.1186/s12910-020-00474-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background Outbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing (WGS) and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy. Method Four community juries were convened in two demographically different Sydney municipalities and two regional cities in New South Wales, Australia (western Sydney, Wollongong, Tamworth, eastern Sydney) to elicit the views of well-informed community members on the acceptability and legitimacy of:
making pathogen WGS and linked administrative data available for public health research using this information in concert with data linkage and machine learning to enhance communicable disease surveillance systems
Fifty participants of diverse backgrounds, mixed genders and ages were recruited by random-digit-dialling and topic-blinded social-media advertising. Each jury was presented with balanced factual evidence supporting different expert perspectives on the potential benefits and costs of technologically enhanced public health research and communicable disease surveillance and given the opportunity to question experts. Results Almost all jurors supported data linkage and WGS on routinely collected patient isolates for the purposes of public health research, provided standard de-identification practices were applied. However, allowing this information to be operationalised as a syndromic surveillance system was highly contentious with three juries voting in favour, and one against by narrow margins. For those in favour, support depended on several conditions related to system oversight and security being met. Those against were concerned about loss of privacy and did not trust Australian governments to run secure and effective systems. Conclusions Participants across all four events strongly supported the introduction of data linkage and pathogenomics to public health research under current research governance structures. Combining pathogen WGS with event-based data surveillance systems, however, is likely to be controversial because of a lack of public trust, even when the potential public health benefits are clear. Any suggestion of private sector involvement or commercialisation of WGS or surveillance data was unanimously rejected.
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Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, Australia. .,School of Health and Society, University of Wollongong, Wollongong, Australia.
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, Australia.,School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Antoine M van Oijen
- Molecular Horizons and the Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | | | - Vitali Sintchenko
- The Centre for Infectious Diseases and Microbiology - Public Health, Westmead, Sydney, Australia.,Marie Bashir Institute for Infectious Disease and Biosecurity, The University of Sydney, Sydney, Australia
| | - Annette Braunack-Mayer
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, Australia.,School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Trent Yarwood
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia.,Cairns Clinical School, James Cook University, Cairns, Australia.,Rural Clinical School, University of Queensland, Brisbane, Australia
| | - Jane Johnson
- The Centre for Infectious Diseases and Microbiology - Public Health, Westmead, Sydney, Australia.,Sydney Health Ethics, School of Public Health, The University of Sydney, Sydney, Australia
| | - Gwendolyn L Gilbert
- The Centre for Infectious Diseases and Microbiology - Public Health, Westmead, Sydney, Australia.,Marie Bashir Institute for Infectious Disease and Biosecurity, The University of Sydney, Sydney, Australia.,Sydney Health Ethics, School of Public Health, The University of Sydney, Sydney, Australia
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Cohen IG, Adashi EY, Gerke S, Palacios-González C, Ravitsky V. The Regulation of Mitochondrial Replacement Techniques Around the World. Annu Rev Genomics Hum Genet 2020; 21:565-586. [PMID: 31961722 DOI: 10.1146/annurev-genom-111119-101815] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mitochondrial replacement techniques (MRTs, also referred to as mitochondrial replacement therapies) have given hope to many women who wish to have genetically related children but have mitochondrial DNA mutations in their eggs. MRTs have also spurred deep ethical disagreements and led to different regulatory approaches worldwide. In this review, we discuss the current regulation of MRTs across several countries. After discussing the basics of the science, we describe the current law and policy directions in seven countries: the United Kingdom, the United States, Canada, Australia, Germany, Israel, and Singapore. We also discuss the emerging phenomenon of medical tourism (also called medical travel) for MRTs to places like Greece, Spain, Mexico, and Ukraine. We then pull out some key findings regarding similarities and differences in regulatory approaches around the world.
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Affiliation(s)
- I Glenn Cohen
- Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, Massachusetts 02138, USA; ,
| | - Eli Y Adashi
- Warren Alpert Medical School, Brown University, Providence, Rhode Island 02912, USA;
| | - Sara Gerke
- Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, Massachusetts 02138, USA; ,
| | - César Palacios-González
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford OX1 1PT, United Kingdom;
| | - Vardit Ravitsky
- Bioethics Programs, Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Quebec H3C 3J7, Canada;
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