Anhad Singh Brar

Adelphi University

How Principlism can be applied to

modern applications of bioethics

1 March, 2019

Abstract

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 Bioethics is the process to implement standards that aim to support those who participate

in the study of biology. It’s general principle is to avoid causing harm and taking away the rights

of others in the pursuit of the biological sciences. However, in modern times the debate

regarding the ethics of new biotechnologies continues. For example, stem cell research provides

a valuable source of cell lines but relies on using human embryos to do so. Thus, bioethics is

concerned on the intent and how this technology is being used in order to avoid causing harm to

others. Another important case in bioethics is gender conversion therapy in adolescents. The

concern here is regarding the physical and psychological effects this can have on a developing

mind. Bioethics involves seeing the good in both sides of any debate so that a healthy and safe

regulation to protect others can be made.

Introduction

Imagine a world rampant with man made diseases where the anyone’s consent can be

ignored and people are processed like animals for the contents of there cells and reaction to new

weapons. This world could have been if not for for the realization of the need for bioethics in the

medical and academic field. Ever since the Nuremberg trials, the newly awakened bioethics

movement strove to emphasize the individual and informed consent1. This protects the common

man from the tyranny of those who would seek to enforce horrifying uses of the biological

sciences on the vulnerable and innocent. Fortunately, today the principles of bioethics is in

nearly every facet in our society in order to ensure the safety and protection of everyone involved

in the biological field and in all of society as well.

One very common method to determine an ethical model of bioethics is through

Principlism. This philosophy relies on autonomy, beneficence, non-maleficence, and justice2. In

a general sense, these principles of principlism strive to make sure that the ethics implemented

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are not only fair to the law but fair to those who engage in the actions and that the intention

behind the sciences is beneficial to society and avoids potential malignancies that it may cause.

In order to effectively analyze if an aspect of biology falls in these ethical codes, one must

attempt to create a practical and theoretical analysis and use that data to determine whether or not

such ethical codes would be violated1. Two such contemporary situations where a need for such

analysis can be found in the controversy behind stem cells and the recent rise in sex reassignment

therapy in adolescents. These new issues in the field of bioethics must rely on every opposing

side to attempt to incorporate Principlism in order to reduce the risk of causing harm to those

who the biotechnology seeks to serve.

Stem Cell Research

Stem cell research has become the topic of heated debate within recent years. What

makes stem cells such a valuable asset for research and the medical field is that these cells are

undifferentiated. In addition, they are capable of self-renewal and eventual differentiation3. In

other words, stem cells are unspecialized cells with the unlimited potential to become a different

cell. In the human body, stem cells are the reservoir of cells used to replace damaged or deceased

cells3. It should be noted that adult stem cells encourage the proliferation of lineage specific cell

types4; however, embryonic stem cells have have unlimited in vivo differentiation making them

grossly more valuable to research efforts5. These cherished embryonic stem cells are synthesized

by removing the nucleus from a developing somatic cell and allowing it to grow to a blastocyst6.

Then, these embryonic stem cells must be extracted from the developing blastocyst of the

embreyo7. It should thus be noted that blastocysts are specifically ideal for the stem cells because

they contain homeodomain transcription factors OCT4/POU5F1 and NANOG that control the

process of stem cell identification as well as the activation and deactivation of gene expression4.

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Thus, despite the cost, these cells were one of the most versatile lines that researchers had access

to in their respective field.

However, as blastocysts are found in embryos ethical concern revolving around the

harvesting of stem cells from human embryos arose. If a cell line could be made out of the first

spawn of a human child, then did those stem cells grown in vitro count as humans? What aspect

of science was interfering with life and did those stem cells own any rights at all8? In technical

terms, the use of stem cells did infringe upon the right of an embryo to exist. However, would an

embryo that could be recreated have the right to refuse or to pursue justice for its use. These

early stem cells would rob a human from the life he or she could have lived. It took away justice,

autonomy, and imported maleficence onto the unborn. Yet, at the same time the research being

performed was one to existing people live through extensive studies on cancer with these cell

lines. Thus, by not using the stem cells one could be forsaking the future generations of humans

who would come under fire from various cancers. Thus, the question in ethics began to ask

whose life was more valuable: the unborn or the dying? These questions regarding the ethical

implications and effects would fester and grow as more and more began to debate the use of stem

cells.

Fortunately, the intent for beneficence on both sides of the debate would lead to research

into creating more sustainable stem cell lines. One such example was that researchers attempted

and succeeded in making embryonic cell lines from a single blastomere; these cells would be

known as human embryonic stem cells otherwise known as hESC9. However, their genesis was

not entirely met with open arms. Many believed that these new hESCs were not considered true

stem cells because they were derived from the preblastocyst stage of development. But most

importantly, the concern was over the fact that the embryo was not destroyed9. While, the entire

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embryo was not being used, it still was using the resources of an underdeveloped child in order

to create these cell lines. This process merely reduced the blunt of the ethical dilemma and would

soon be replaced by a more sustainable solution.

Fortunately, at around the same time of the creation of the hESCs, a new line to redeem

and solve the ethical crisis would arise from the dust. These cells that would vanguard the new

era of stem cells were the first human induced pluripotent cells otherwise known as hiPSC7. In

essence, these hiPSC cells are like skin cells that have been programmed to revert back to their

earlier immature or pluripotent state10. In essence, they were able to genetically reprogram such

cells into reverting back to their original state as stem cells. This revolutionary technique has

become widespread in the field of biology because it yields viable stem cells that are on par in

potential with embryonic stem cells. This boon allowed for scientists to no longer become

dependent on the unborn in order to explore the untapped secrets of our biology and forced to

risk their ethical compass in its pursuit.

However, despite this huge leap, there are still remnants of the topic at hand that must be

asked today. Despite the huge leap in improvement that hiPSCs provide, they are not the same as

hESCs. As these cell lines are different, there is experimentation onto the limits of which line is

better than the other. Thus there are experiments that do rely on experimentation with the hESCs

today. In addition, there is still debate on whether or not the cells taken from hiPSCs are able to

reproduce and potentially become a human embryo8. As such this may provide a risk to

autonomy and justice as the embryo could have the potential to have a viable life. Despite the

technological advances in this field, ethics still need to be maintained. Even during a scientific

breakthrough, one must make sure every variable is explored even in the name of bioethics; one

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must confirm the benefits and weaknesses of the new system in order be fully aware of the

ethical implications and limitations that each method possesses.

Gender

On the 25th of February, the BBC released an article discussing the stresses placed on

clinicians when confronted with pro-trans lobbies who wish to have adolescence and children

who wish to undergo gender reassignment treatment. One such doctor resigned from his post in

administration after an intense influx of individuals demanded what was termed “quick

solutions”11. It is assumed that both parties do not wish to cause harm to those who undertake

this treatment. After all, the goal is to help bring about a change to let one lead with the identity

of their choice. But at a youthful age, when undergoing such treatment, how much autonomy

does the patient have?

At such a young age, the question of one’s autonomy should be brought into question.

Afterall, transitioning genders is not an easy trek to undergo as the full extent of its effects are

still being looked into today. The United States and the United Kingdoms recognize that mature

and capable minors have the right to be involved in their own health. However, in many cases

this right does not equal decision-making powers in a medical setting. With that being said,

ultimately when determining ethical decisions in child care, the principle rule is that the

treatment should be in the best interest of the child12. If the treatment would compromise the

child’s health or overall quality of life, it can be deemed unethical to perform. Thus, when

determining if it is appropriate to allow a child gender therapy, the physician must ask whether

or not the treatment is viable to an adequate standard of life. He or she must ask if the physical or

mental side effects would cause harm before coming to this decision. As stated before, usually

the process of gender reassignment would be a slow process--especially to determine if it is

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psychologically viable--but with the sudden demand for a quick process, there is not enough data

to help condone it as a completely safe from risk practice.

The process of determining if a youth is experiencing gender dysphoria has been crafted

by a wide array of professionals over twenty years in order to attempt to maintain as ethical of a

standard as possible. In order to confirm the dysphoria, they must confirm if they experience

differences between their born and perceived gender for at least 6 months before meeting the

criteria for gender reassignment. In addition, the treatment claims that certain physical effects

(changing of vocal tone, deepening of breasts, or changes in body hair) can be reversed.

However, the treatment makes no claims regarding the psychological effects it may have13. It is

thus safer for the youth if the appropriate amount of time is waited in order to minimize any risks

that may occur from a false diagnosis. Thus, when pressures arose regarding the time duration,

that could have been detrimental as it would be an avenue to compromise the health of the

patient. In addition, physicians need to have a clear understanding as despite some of the

physical effects being reversible, not all of them may easily be undone. For example, as a youth

is developing, his or her estrogen or testosterone is affecting the growth of bones. Specifically,

estrogen helps bones develop faster than testosterone14. As such, if the gender change procedure

is done incorrectly or done with any doubt in the patient’s head, the permanent frame for which

he or she will use as the perceived gender may be compromised. If so, the patient would be

robbed of the justice of being able to reverse this effect, resulting in an unchangeable ethical

dilemma.

Conclusion

When applying Principlism to modern day bioethics, some of the tenants of it become

more clear than the others. Fortunately, it can be stated that in most modern biosciences, there

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have been no uses to cause maleficence or at the very least the thought of using the life sciences

with the intent of evil have been heavily ostracized in the past 50 years. Rather, the goal has been

to try to import a heavy sense of beneficence for all parties involved with the procedures. The

goal in both the creation of stem cells and gender therapy for adolescence is not to spread

maleficence and cruelty to those apart of it. However, it is the differences in the belief in the

process that leads to conflicts within bioethics for the intention to spread a positive influence

onto others. The goal of beneficence is to do the right thing at all cost even if one lands on a

different solution than another.

As for autonomy, in both cases the subjects were too young to be able to make conscious

unbiased decisions for themselves. As such, the field of biology must rely on the guardian to

make these decisions. However, the intent of the young and their desires should always be noted

as to keep and maintain a moral standard when conducting such procedures.

Finally, justice involves the right for one to correct wrongs that have been done.

Unfortunately, in many of these modern applications the procedures cannot be reversed. In

addition, even in the cases where they are--such as with gender reassignment therapy--there are

still numerous psychological effects that have not been properly studied. The best solution that

bioethics offers to this is before a procedure is undertaken, one must be completely and utterly

sure that they wish for the procedure. In other words, one should assume that there is no going

back when undertaking these life changing events.

It is the overall intention of people everywhere to do the right thing yet arise to different

conclusions and thus debate in the attempt to reach the same goal. Bioethics provides a mean to

evaluate the positives and negatives of the attempted solution in order to put it under scrutiny to

help provide questions to test the limits of the solution. In addition, bioethics helps to encourage

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adaptation and change in order to better reach an advancement in the field of biology that all of

humanity can be proud of.

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