RESUMEN
In this issue of Cell, Tan et al. report the first injection of human stem cells into in vitro non-human primate blastocysts with significant survival of the human cells, raising new scientific possibilities but also important ethical issues.
Asunto(s)
Quimera , Embrión de Mamíferos , Animales , Blastocisto , Haplorrinos , Humanos , Células MadreAsunto(s)
Encéfalo/fisiología , Estado de Conciencia/fisiología , Experimentación Humana/ética , Modelos Biológicos , Neurociencias/ética , Organoides/fisiología , Animales , Encéfalo/citología , Quimera , Muerte , Embrión de Mamíferos/citología , Xenoinjertos , Humanos , Técnicas In Vitro , Consentimiento Informado/ética , Ratones , Organoides/citología , Organoides/crecimiento & desarrollo , Propiedad/ética , Ratas , PorcinosRESUMEN
OBJECTIVE: Some have argued that physicians should not presume to make thrombolysis decisions for incapacitated patients with acute ischemic stroke because the risks and benefits of thrombolysis involve deeply personal values. We evaluated the influence of the inability to consent and of personal health-related values on older adults' emergency treatment preferences for both ischemic stroke and cardiac arrest. METHODS: A total of 2,154 US adults age ≥50 years read vignettes in which they had either suffered an acute ischemic stroke and could be treated with thrombolysis, or had suffered a sudden cardiac arrest and could be treated with cardiopulmonary resuscitation. Participants were then asked (1) whether they would want the intervention, or (2) whether they would want to be given the intervention even if their informed consent could not be obtained. We elicited health-related values as predictors of these judgments. RESULTS: Older adults were as likely to want stroke thrombolysis when unable to consent (78.1%) as when asked directly (76.2%), whereas older adults were more likely to want cardiopulmonary resuscitation when unable to consent (83.6% compared to 75.9%). Greater confidence in the medical system and reliance on statistical information in decision making were both associated with desiring thrombolysis. INTERPRETATION: Older adults regard thrombolysis no less favorably when considering a situation in which they are unable to consent. These findings provide empirical support for recent professional society recommendations to treat ischemic stroke with thrombolysis in appropriate emergency circumstances under a presumption of consent.
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Isquemia Encefálica/tratamiento farmacológico , Consentimiento Informado/ética , Prioridad del Paciente/psicología , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica/ética , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Defensa del Consumidor/legislación & jurisprudencia , Asesoramiento Genético/legislación & jurisprudencia , Pruebas Genéticas/legislación & jurisprudencia , Genética Médica/legislación & jurisprudencia , Genómica/legislación & jurisprudencia , United States Food and Drug Administration/legislación & jurisprudencia , Femenino , Genes BRCA1 , Asesoramiento Genético/ética , Asesoramiento Genético/psicología , Asesoramiento Genético/normas , Pruebas Genéticas/ética , Pruebas Genéticas/normas , Pruebas Genéticas/estadística & datos numéricos , Genética Médica/ética , Genética Médica/normas , Genómica/ética , Genómica/normas , Síndrome de Cáncer de Mama y Ovario Hereditario/genética , Humanos , Estrés Psicológico/etiología , Estados UnidosRESUMEN
Despite extensive research, amyotrophic lateral sclerosis (ALS) remains a progressive and invariably fatal neurodegenerative disease. Limited knowledge of the underlying causes of ALS has made it difficult to target upstream biological mechanisms of disease, and therapeutic interventions are usually administered relatively late in the course of disease. Genetic forms of ALS offer a unique opportunity for therapeutic development, as genetic associations may reveal potential insights into disease etiology. Genetic ALS may also be amenable to investigating earlier intervention given the possibility of identifying clinically presymptomatic, at-risk individuals with causative genetic variants. There is increasing evidence for a presymptomatic phase of ALS, with biomarker data from the Pre-Symptomatic Familial ALS (Pre-fALS) study showing that an elevation in blood neurofilament light chain (NfL) precedes phenoconversion to clinically manifest disease. Tofersen is an investigational antisense oligonucleotide designed to reduce synthesis of superoxide dismutase 1 (SOD1) protein through degradation of SOD1 mRNA. Informed by Pre-fALS and the tofersen clinical development program, the ATLAS study (NCT04856982) is designed to evaluate the impact of initiating tofersen in presymptomatic carriers of SOD1 variants associated with high or complete penetrance and rapid disease progression who also have biomarker evidence of disease activity (elevated plasma NfL). The ATLAS study will investigate whether tofersen can delay the emergence of clinically manifest ALS. To our knowledge, ATLAS is the first interventional trial in presymptomatic ALS and has the potential to yield important insights into the design and conduct of presymptomatic trials, identification, and monitoring of at-risk individuals, and future treatment paradigms in ALS.
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Esclerosis Amiotrófica Lateral , Enfermedades Neurodegenerativas , Humanos , Superóxido Dismutasa-1/genética , Esclerosis Amiotrófica Lateral/tratamiento farmacológico , Esclerosis Amiotrófica Lateral/genética , Superóxido Dismutasa/genética , Oligonucleótidos Antisentido/uso terapéutico , Biomarcadores , ARN Mensajero , MutaciónAsunto(s)
Isquemia Encefálica/terapia , Consentimiento Informado , Apoderado , Accidente Cerebrovascular/terapia , Terapia Trombolítica , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/complicaciones , Reanimación Cardiopulmonar , Tratamiento de Urgencia , Femenino , Paro Cardíaco/terapia , Humanos , Masculino , Persona de Mediana Edad , Prioridad del Paciente , Accidente Cerebrovascular/etiologíaRESUMEN
The NIH Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative is focused on developing new tools and neurotechnologies to transform our understanding of the brain, and neuroethics is an essential component of this research effort. Coordination with other brain projects around the world will help maximize success.
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National Institutes of Health (U.S.)/ética , Neurociencias/ética , Bioética , Humanos , National Institutes of Health (U.S.)/normas , Neurociencias/métodos , Neurociencias/organización & administración , Guías de Práctica Clínica como Asunto , Estados UnidosAsunto(s)
Predisposición Genética a la Enfermedad , Homicidio , Jurisprudencia , Violencia , Conducta , Testimonio de Experto , HumanosRESUMEN
The goal of this study was to examine the growing use of neurological and behavioral genetic evidence by criminal defendants in US criminal law. Judicial opinions issued between 2005-12 that discussed the use of neuroscience or behavioral genetics by criminal defendants were identified, coded and analysed. Criminal defendants are increasingly introducing such evidence to challenge defendants' competency, the effectiveness of defense counsel at trial, and to mitigate punishment.