Human stem-cell-derived embryo models: When bioethical normativity meets biological ontology.

The use of human stem-cell-derived embryo models in biomedical research has recently sparked intense bioethical debates. In this article, we delve into the ethical complexities surrounding these models and advocate for a deeper exploration of their biological ontology to discuss their bioethical normativity. We examine the ethical considerations arising from the implementation of these models, emphasizing varying viewpoints on their ethical standing and the ethical obligations associated with their development and utilization. We contend that a nuanced comprehension of their biological ontology is crucial for navigating these ethical quandaries. Furthermore, we underscore the indispensability of interdisciplinary cooperation among bioethicists, biologists, and philosophers to unravel the complex interplay between biological ontology and the normative framework of bioethics. Moreover, this article introduces a novel combinatorial approach to resolve the ethical dilemma surrounding these models. We propose a distinction between models that closely emulate natural embryos, based on the status of synthetic embryos, and those capable of reproducing specific dimensions of embryonic development. Such differentiation allows for nuanced ethical considerations while harnessing the value of these models in scientific research, paving the way for a more comprehensive ethical framework in the context of evolving biotechnologies.

Understanding genetic justice in the post-enhanced world: a reply to Sinead Prince.

In her recent article, Prince has identified a critical challenge for those who advocate genetic enhancement to reduce social injustices. The gene-environment interaction prevents genetic enhancement from having equitable effects at the phenotypic level, even if enhancement were available to the entire population. The poor would benefit less than the rich from their improved genes because their genotypes would interact with more unfavourable socioeconomic environments. Therefore, Prince believes that genetic enhancement should not be used to combat social inequalities, since it can likely aggravate them. In this article, I raise various objections to this conclusion. I argue first that genetic enhancement need not necessarily magnify social injustices. I then show that genetic enhancement can play a modest but not insignificant role in the quest for social justice in the future. Finally, I conclude by arguing for the need to consider the complex interplay between the social lottery and the natural lottery in our aspirations for justice linked to genetic technologies.

Anticipatory gaps challenge the public governance of heritable human genome editing.

Considering public moral attitudes is a hallmark of the anticipatory governance of emerging biotechnologies, such as heritable human genome editing. However, such anticipatory governance often overlooks that future morality is open to change and that future generations may perform different moral assessments on the very biotechnologies we are trying to govern in the present. In this article, we identify an 'anticipatory gap' that has not been sufficiently addressed in the discussion on the public governance of heritable genome editing, namely, uncertainty about the moral visions of future generations about the emerging applications that we are currently attempting to govern now. This paper motivates the relevance of this anticipatory gap, identifying the challenges it generates and offering various recommendations so that moral uncertainty does not lead to governance paralysis with regard to human germline genome editing.

Value change, reprogenetic technologies, and the axiological underpinnings of reproductive choice.

Value change is a phenomenon that is gaining increasing attention in ethical analyses of technologies. However, a comprehensive study of how reprogenetic technologies and values coevolve is lacking. To remedy this gap, in this overview article, I address the relationship between reprogenetics and value change. This contribution thus argues for the importance of investigating the phenomenon of value change in relation to the technological controversies discussed in bioethics. To meet this goal, I begin by clarifying, first, how technologies shape reproductive choice. I then clarify what "values" and "moral values" are, how reprogenetic technologies are value laden, and what values are often discussed in reprogenetics debates. Next, I show five types of value changes that have occurred in advance in reproductive and genetic technologies. Finally, I argue for the bioethical relevance of discussing future techno-value change, pointing out the descriptive and normative challenges of this philosophical endeavor.

Synthetic embryos: a new venue in ethical research.

In brief: Two independent groups have reported the development of 'artificial embryos'. Those are in vitro models made of mouse embryonic stem cells, without the need for egg or sperm, and grown ex utero without requiring implantation. This system might open new venues in bioethical research if human cells show the ability to replicate this system. Abstract: The recent publications reported in 2022 reveal the possibility of obtaining mouse embryos without the need for egg or sperm. These 'artificial embryos' can recapitulate some stages of development ex utero - from neurulation to organogenesis - without implantation. Synthetic mouse embryos might serve as a valuable model to gain further insights into early developmental stages. Indeed, it is expected for these models to be replicated by employing human cells. This promising research raises ethical issues and expands the horizon of ethics in regard to the development of the human embryo. From this point of view, we state some of the new open venues for bioethical research.

Genetic enhancement, human extinction, and the best interests of posthumanity.

The cumulative impact of enhancement technologies may alter the human species in the very long-term future. In this article, I will start showing how radical genetic enhancements may accelerate the conversion into a novel species. I will also clarify the concepts of 'biological species', 'transhuman' and 'posthuman'. Then, I will summarize some ethical arguments for creating a transhuman or posthuman species with a substantially higher level of well-being than the human one. In particular, I will present what I shall call the Principle of the Best Interests of Posthumanity, which states that the enhancement of the human and transhuman species must be directed towards the creation of a posthuman existence that is substantially more valuable than its predecessors. I suggest that human extinction may be considered, within that principle, as one of the best interests of posthumanity. Finally, I will develop three objections that make that principle unattractive and that show that pursuing a full-blown programme of posthuman evolution is ethically flawed.

Socrates in the fMRI Scanner: The Neurofoundations of Morality and the Challenge to Ethics.

The neuroscience of ethics is allegedly having a double impact. First, it is transforming the view of human morality through the discovery of the neurobiological underpinnings that influence moral behavior. Second, some neuroscientific findings are radically challenging traditional views on normative ethics. Both claims have some truth but are also overstated. In this article, the author shows that they can be understood together, although with different caveats, under the label of "neurofoundationalism." Whereas the neuroscientific picture of human morality is undoubtedly valuable if we avoid neuroessentialistic portraits, the empirical disruption of normative ethics seems less plausible. The neuroscience of morality, however, is providing relevant evidence that any empirically informed ethical theory needs to critically consider. Although neuroethics is not going to bridge the is-ought divide, it may establish certain facts that require us to rethink the way we achieve our ethical aspirations.

Doctor, please make me freer: Capabilities enhancement as a goal of medicine.

Biomedical innovations are making possible the enhancement of human capabilities. There are two philosophical stances on the role that medicine should play in this respect. On the one hand, naturalism rejects every medical intervention that goes beyond preventing and treating disease. On the other hand, welfarism advocates enhancements that foster subjective well-being. We will show that both positions have considerable shortcomings. Consequently, we will introduce a third characterization in which therapies and enhancements can be reconciled with the legitimate objectives of medicine inasmuch as they improve the capabilities that enable the freedom to pursue personal well-being.

Ageism in the COVID-19 pandemic: age-based discrimination in triage decisions and beyond.

Ageism has unfortunately become a salient phenomenon during the COVID-19 pandemic. In particular, triage decisions based on age have been hotly discussed. In this article, I first defend that, although there are ethical reasons (founded on the principles of benefit and fairness) to consider the age of patients in triage dilemmas, using age as a categorical exclusion is an unjustifiable ageist practice. Then, I argue that ageism during the pandemic has been fueled by media narratives and unfair assumptions which have led to an ethically problematic group homogenization of the older population. Finally, I conclude that an intersectional perspective can shed light on further controversies on ageism and triage in the post-pandemic future.

Immunity passports, fundamental rights and public health hazards: a reply to Brown et al.

In their recent article, Brown et al analyse several ethical aspects around immunity passports and put forward some recommendations for implementing them. Although they offer a comprehensive perspective, they overlook two essential aspects. First, while the authors consider the possibility that immunological passports may appear to discriminate against those who do not possess them, the opposite viewpoint of immune people is underdeveloped. We argue that if a person has been tested positive for and recovered from COVID-19, becoming immune to it, she cannot be considered a hazard to public health and, therefore, the curtailment of her fundamental rights (eg, the right to freedom of movement) is not legitimate. Second, they omit that vaccine distribution will create similar problems related to immunity-based licenses. Vaccine certificates will de facto generate a sort of immunity passport. In the next phases of the pandemic, different immunity statuses will be at stake, because the need to identify who can spread COVID-19 is unavoidable. If a person does not pose a threat to public health because she cannot spread the infection, then her right to freedom of movement should be respected, regardless of how she acquired that immunity.

Human mesenchymal stromal cells modulate T-cell responses through TNF-α-mediated activation of NF-κB.

Although mesenchymal stromal cells (MSCs) possess the capacity to modulate immune responses, little is known about the mechanisms that underpin these processes. In this study, we show that immunosupression is mediated by activation of nuclear factor kappa B (NF-κB) in human MSCs. This pathway is activated by TNF-α that is generated following TCR stimulation of T cells. Inhibition of NF-κB through silencing of IκB kinase ß or the TNF-α receptor abolishes the immunosuppressive capacity of MSCs. Our data also indicate that MSC-associated NF-κB activation primarily leads to inhibition of T-cell proliferation with little effect on expression of the activation markers CD69 and CD25. Thus, our data support the hypothesis that the TNF-α/NF-κB signalling pathway is required for the initial priming of immunosuppressive function in human MSCs. Interestingly, drugs that interfere with NF-κB activation significantly antagonise the immunoregulatory effect of MSCs, which could have important implications for immunosuppression regimens in the clinic.

May Artificial Intelligence take health and sustainability on a honeymoon? Towards green technologies for multidimensional health and environmental justice.

The application of Artificial Intelligence (AI) in healthcare and epidemiology undoubtedly has many benefits for the population. However, due to its environmental impact, the use of AI can produce social inequalities and long-term environmental damages that may not be thoroughly contemplated. In this paper, we propose to consider the impacts of AI applications in medical care from the One Health paradigm and long-term global health. From health and environmental justice, rather than settling for a short and fleeting green honeymoon between health and sustainability caused by AI, it should aim for a lasting marriage. To this end, we conclude by proposing that, in the upcoming years, it could be valuable and necessary to promote more interconnected health, call for environmental cost transparency, and increase green responsibility. Highlights Using AI in medicine and epidemiology has some benefits in the short term.AI usage may cause social inequalities and environmental damage in the long term.Health justice should be rethought from the One Health perspective.Going beyond anthropocentric and myopic cost-benefit analysis would expand health justice to include an environmental dimension.Greening AI would help to reconcile public and global health measures.

The morally disruptive future of reprogenetic enhancement technologies.

Emerging reprogenetic technologies may enable the enhancement of our offspring's genes. Beyond raising ethical questions, these biotechnologies may change some aspects of future morality. In the reproductive field, biotechnological innovations may transform moral views about reproductive choices regarding what we consider to be just or even of equal standing.

Rethinking techno-moral disruption in bioethics, society, and justice.

In response to De Proost and Segers, we provide further reflections on how technologies induce moral change. We discuss moral changes at the societal level as distinguished from changes in bioethical principles or ethical concepts, impacts on theories of justice, and whether the transformations are negative or positive.

Digital Covid Certificates as Immunity Passports: An Analysis of Their Main Ethical, Legal, and Social Issues.

Digital COVID certificates are a novel public health policy to tackle the COVID-19 pandemic. These immunity certificates aim to incentivize vaccination and to deny international travel or access to essential spaces to those who are unable to prove that they are not infectious. In this article, we start by describing immunity certificates and highlighting their differences from vaccination certificates. Then, we focus on the ethical, legal, and social issues involved in their use, namely autonomy and consent, data protection, equity, and international mobility from a global fairness perspective. The main conclusion of our analysis is that digital COVID certificates are only acceptable if they meet certain conditions: that they should not process personal data beyond what is strictly necessary for the aimed goals, that equal access to them should be guaranteed, and that they should not restrict people's autonomy to access places where contagion is unlikely. We conclude that, if such conditions are guaranteed, digital COVID certificates could contribute to mitigating some of the most severe socioeconomic consequences of the pandemic.