Another Promising Result Using Induced Pluripotent Stem Cells

Last Friday it was announced in Medical News Today that researchers at Johns Hopkins have discovered a means to fix the genetic defect that causes sickle cell disease with the patient’s own stem cells.  According to the announcement, “The corrected stem cells were coaxed into immature red blood cells in a test tube that then turned on a normal version of the gene.”[1]  This does not mean that a clinical application is imminent or that the procedure is safe.  As stated in the original abstract from Blood, the Journal of the American Society of Hematology, “the safety and feasibility of stem cell mobilization in individuals with sickle cell trait (SCT) has not been documented.”  However, the report added that “no untoward adverse events occurred in either group, including sickle cell crises.” [2]

The new treatment could prove to be revolutionary; at present the only existing therapy for sickle cell disease is through bone marrow transplantation.  However, the journal Blood reports that, “many patients are ineligible [for bone marrow transplantation] because of either the lack of a suitable donor or their underlying condition.”  The advantage of “peripheral blood stem cells” (PBSC) from the patient are obvious: patients don’t have to wait for a suitable donor – they are their own source of the stem cells.  The study concludes that, “Products from SCT donors require only minor changes in ex vivo cell processing, allowing for the use of mobilized peripheral blood as a potential source of stem cells for transplantation in sickle cell disease.”  Furthermore, as one researcher stated, “The beauty of iPS cells is that we can grow a lot of them and then coax them into becoming cells of any kind, including red blood cells.”[3]  In short, scientists believe they are now one step closer to successful stem cell therapy for sickle cell disease.

Of course, the word is still out on the success of PBSCs.  But ethicists should applaud any research that is as promising as embryonic stem cell research, but does not require the destruction of human embryos.


[1] http://www.medicalnewstoday.com/releases/235221.php

[2] There were two separate control groups with eight individuals in each group – one SCT group and one non-SCT group.  In the words of the research team, the study does “not permit the conclusion that G-CSF is completely without such risk. Our study, however, suggests that the risk is limited…” http://bloodjournal.hematologylibrary.org/content/99/3/850.full?sid=62767506-48e6-45f1-be88-b033f616fcc7

[3] http://www.medicalnewstoday.com/releases/235221.php

South Korea Takes an Ethical Step Backwards

This week (Sept. 19) it was reported that the government of South Korea will invest $89 million to recommence its pursuit of human embryonic stem cells (http://www.bbc.co.uk/news/world-asia-pacific-14968613).  You may remember the scandal that erupted in 2006 when a South Korean scientist (Hwang Woo-suk) declared that he had generated human embryonic stem cells by means of cloning.  Later it was discovered that the research had been faked.  Woo-suk, who was considered a national hero before the scandal, “caused inevitable damage to the entire stem cell research community in Korea,” according to South Korea’s president, Lee Myung-bak.  The money will be invested, proclaimed Lee, to “…restore our national fame as a stem cell powerhouse.”  The BBC report ends with the oft-cited list of all the diseases that may be treated by stem cells including, “Parkinson’s disease, heart disease, stroke, arthritis, diabetes, burns and spinal cord damage.”[i]

The announcement by President Lee troubles me on several levels:

1) there is no evidence that human embryonic stem cells (hESC) can actually treat human diseases.  Yet, the technology is touted as the panacea to all the major diseases that inflict humans today.

2) thus far, the research has produced more hype than tangible hope.  Indeed, the promises of hESC therapy entice those with money to burn in the search for a magic cure.  For example, recently it was reported that Peyton Manning traveled to Europe to seek stem cell treatment for a neck injury.  ABC News referred to Manning’s efforts as a “Stem Cell Hail Mary.”  Apparently the treatment was unsuccessful.  The ABC News article included the following statements by Dr. Ruth Macklin (bioethics professor, Albert Einstein College): “We live in an era where physicians are encouraged to practice ‘evidence-based’ medicine.  However, a sports superstar has the money… to travel anywhere in the world to receive an experimental procedure that is not based on any evidence that works for his condition.”  Another stem cell researcher, Dr. Lawrence Goldstein, noted that “he was unaware of any stem cell approach that is proven to help any sort of spinal issue.”[ii]

3) hESC research, of course, destroys human embryos.  Yet we know that zygotes formed at fertilization are genetically unique with an intrinsic capacity of self-development.  The zygote does not become a human being at some later stage (e.g., implantation); it is a human being!

4) other types of stem cell research, such as somatic stem cells and induced pluripotent stem cells, show far more promise for present and future therapy than hESCs.  Furthermore, somatic stem cells and induced pluripotent stem cell research are not ethically problematic because they do not entail the destruction of embryos.

It is unfortunate that South Korea has renewed its pursuit of the unethical practice of hESC research.  It could instead follow the example of several Japanese scientists (e.g., Shinya Yamanaka and Kazutoshi Takahashi of Kyoto University) who have researched ways to reprogram skin tissue in mice to mimic embryonic stem cells.  In the end, South Korea’s effort to become a “stem cell powerhouse” will be overshadowed by its moral compromise.


[i] http://www.bbc.co.uk/news/world-asia-pacific-14968613

[ii] http://abcnews.go.com/blogs/health/2011/09/19/peyton-mannings-stem-cell-hail-mary/

See also The Center for Bioethics and Human Dignity website for the story on Peyton Manning.  http://cbhd.org/ is an excellent source for bioethical news.

Do-it-yourself DNA Analysis for $19.95!

Well, not quite, although a very cheap version may be just around the corner.  In this month’s edition of Wired (September 2011), one article reports that it is now possible to build your own DNA research lab for just “a few hundred bucks.”  The technology promises consumers the ability to turn “small samples of DNA into quantities large enough to analyze.”  The advantages to such technology are obvious; imagine having the capability of examining and identifying DNA in your own garage or basement.  Indeed, DIYbio (http://diybio.org/) is “dedicated to creating pop-up labs and doing biology outside the traditional environments of universities and industry.”  Currently there are DIYbioer groups all over the world, especially in the U.S.

In the past, the chief obstacle was affordability; the technology was simply far too expensive for the average amateur on a shoe-string budget.  The situation is changing, however.  Wired reports that “Behind the scenes, engineers and science enthusiasts are teaming up to mod tools and technologies and sell their inventions – or simply share tips on how to build them – to anyone interested.”  For example, PCR (polymerase chain reactions) kits, described as a “copy machine for DNA,” are attracting lots of attention.  According to DIYbio, for under $600, you can purchase a PCR to diagnose diseases or explore your own genome.

As with any technology, DIY DNA analysis is a mixed bag.  Professional PCR machines range from $6,000 to $17,000.  With a small investment, individuals interested in the technology can bypass the big corporations and achieve some of the same results.  Three years ago, high school students used DNA testing in the classroom and discovered that “sushi restaurants and supermarkets were mislabeling their fish” (an event known as “Sushigate,” Wired).

Then again, there is always the dark side to technology.  Suppose it becomes viable to detect one’s own genetic defects with the technology?  Or, what if it’s possible to discover someone else’s genetic defects?  Needless to say, the technology raises a couple of ethical questions:

*what should a person do with knowledge of a future genetic disease, especially if there is a gap between diagnosis and treatment, or if there is no treatment in the foreseeable future?

*then there is the question of whether a person has a moral obligation to inform others of genetic defects, such as one’s potential spouse.

Perhaps the most worrisome aspect to pop-up labs is the lack of regulation or ethical guidelines.  Also, what else can be done with the technology, and who is going to oversee the research and monitor the results?

As humans, we have this unfortunate tendency to be self-centered, to ignore our finiteness, to press forward without caution, to abuse technology to gain greater power, and to proceed without moral guidelines.  We do well to heed the frequently quoted warning of Hans Jonas, “Modern technology has introduced actions of such novel scale, objects, and consequences that the framework of former ethics can no longer contain them.”  Where then is the ethical framework to restrict the misuse of this technology?

From IVF to human trafficking, and how liberal bioethics led the way (actually, it followed)

 

Ross Douthat of The New York Times wrote recently of The Failure of Liberal Bioethics to provide any ethical guidance in the area of reproductive technologies. He recounts how liberal bioethicists, for all their eloquence about monitoring and controlling new reproductive technologies, really just act as a rubber stamp for whatever anybody wants to do, finding reasons “to embrace each new technological leap while promising to resist the next one . . . You can always count on them to worry, often perceptively, about hypothetical evils, potential slips down the bioethical slope.  But they’re either ineffectual or accommodating once an evil actually arrives. Tomorrow, they always say — tomorrow, we’ll draw the line. But tomorrow never comes.”

This marked failure in line-drawing in years past is bearing grim fruit today. In the August 4th New England Journal of Medicine, George Annas wrote of Canadian legal efforts to regulate the international trade in reproductive medicine. In order to bypass local regulations and expenses, people buy sperm from one country, ova harvested from women in another country, and rent a woman to act as a gestational surrogate from a third country, to try to have a child. These are just the sort of practices against which “conservative” bioethicists, those concerned with human dignity, the meaning of procreation, and the commodification of children, have warned; and about which “liberal” bioethicists have opined, “Well, there’s a theoretical risk here, we’ll have to watch that —” and then watched as theory became practice and practice became madness. Annas writes of the fear of many that reproductive medicine is “becoming a branch of international trafficking in women and children.”

This fear is reality. Last winter the Wall Street Journal ran an article featuring PlanetHospital.com LLC, a California company that scours the globe to find the “components” for its “business line” of internationally trafficked reproductive materiel and technology. ”PlanetHospital’s most affordable package, the ‘India bundle,’ buys an egg donor, four embryo transfers into four separate surrogate mothers, room and board for the surrogate, and a car and driver for the parents-to-be when they travel to India to pick up the baby.” The international nature of this enterprise places it under the radar of any governmental regulation that might interfere with the “business line,” and there does not appear to be much internal ethical regulation on the part of the company itself; anything goes, even when an apparent pedophile wants to have a child. As chief executive of PlanetHospital Mr. Rupak says, “Our ethics are agnostic. How do you prevent a pedophile from having a baby? If they’re a pedophile then I will leave that to the U.S. government to decide, not me.”

If liberal bioethicists continue to have their way, the unthinkable practices of today will become the commonplaces of next week. Annas bears disquieting witness to this when he writes of ”acts that were once thought to be so universally condemned that prohibitions against them could be incorporated in an international treaty.  These prohibitions include the knowing creation of a human clone, the creation of an embryo from the cell of a human fetus or from another embryo, the maintenance of an embryo ex utero for more than 14 days after fertilization, the use of sex-selection techniques for a reason other than the diagnosis of a sex-linked disorder, the performance of germline genetic engineering, the use of nonhuman life forms with human gametes, the creation of chimeras for any purpose, and the creation of hybrids for reproduction.”

How many of these “acts that were once thought to be so universally condemned” are already standard procedure today? If liberal bioethics continues to have its way, which of today’s unthinkables will be the next California company’s “business line?”

 

(If you have time, read all three articles.  They are very disturbing. If you think that the work of CBHD is unimportant, you may just change your mind.)

Of Machines and Men (Part I)

 

As part of my job, I have the privilege of participating in the delivery of many babies.  I was at one such blessed event earlier this week.  There were several medical personnel and the father standing around the bed of the expectant mother. Due to the wonders of epidural anesthesia, she was quite comfortable, despite the fact that she was in the final stages of labor.

Suddenly I became aware of what all of us were doing — myself, my residents, the nurse, even the father: we were watching a machine. The mother was hooked up to a machine that monitored both the baby’s heart rate and her own contractions. The rest of us stood and stared at the machine. When the machine showed she was having a contraction, we would all turn towards her and encourage her to push, cheerleaders for her and the little life that she was bringing into the world.  But we kept one eye on the machine, and as soon as it indicated the contraction was over, we turned away from the mother and towards the machine again, waiting expectantly for it to tell us when the next contraction was coming.

With a sense of deja vu I realized that I had observed a similar phenomenon in the ICU: doctors, therapists, nurses, even family and visitors who had no idea what the little multi-colored squiggly lines on the monitor meant, nonetheless staring expectantly at the monitor on the wall instead of at the patient in the bed.  And in my training of resident physicians, I have watched videotaped patient encounters showing them sitting in the office with the patient, staring deeply into the computer screen instead of at the patient who has come to see them.  Similarly, in their inpatient work, the residents spend a few minutes on the hospital floor seeing their patients, and the remaining hours of the day (and night) staring into a computer screen, tending to the computerized chart — the “iPatient,” as Abraham Verghese called it here.

The practice of medicine has historically been founded on the physician-patient relationship;  on that foundation has been erected an edifice of techniques and technologies, tools for medical practitioners to use in serving their patients. However, it seems that in our time the tools are beginning to attack the foundation of medicine rather than just being used by it. For a variety of reasons, the tools and technologies increasingly become the center of the physician’s attention. Instead of medical practitioners defining how the tools are used, the tools begin to define what medicine is. We are becoming what Neil Postman called a Technoloply: our tools change and determine our practice’s purpose and meaning, our very way of knowing and thinking and relating to our patients.

 

Edmund Pellegrino once wrote, “Men have always sensed that the more they forged and the more machines they built, the more they were forced to know, to love, and to serve these devices.” (From Humanism and the Physician.)

 

Next week:  Some thoughts on what we can do about the ascendancy of the machine in medicine.

 

The limits of medicine and technology

 

In Too Much to Know, author Ann Blair notes that in our culture, which virtually deifies technology, we believe that we can find technological solutions to all problems, even those that are actually addressable only by attending to ourselves.*

Perhaps this confusion about the proper solution to a problem is part of the crisis in medicine and bioethics. The knee-jerk expectation of the public and the medical enterprise alike is that for every problem people bring before a doctor there can be found a solution, and that a technical solution will be the best. But what if that assumption is incorrect?

What if there are some patients for whom a technical solution is the worse option? Maybe there are some depressed patients for whom the best solution to their problem is not another pill, but the balm of human compassion and the encouragement to use the resources they have at hand to find comfort. Maybe there are some people with terminal diseases for whom the best solution is not every last possible intervention trying to sustain bodily function indefinitely, but rather help in strengthening faith and preparing for death.

Maybe instead of attempting to eliminate disabilities by trying to detect and eliminate fetuses that have them, we should be striving to be a people who can love and cherish those among us with worse disabilities than our own. Maybe instead of seeking absolute certainty (an illusion at best) by demanding that every technological test and scan be made available, we should be learning to live in the freedom of the inevitable uncertainty that comes with life on this planet.

Maybe there are types of human suffering that medicine was never meant to address. Maybe there are problems that we can only address by fixing not the problem, but our selves. And maybe part of the task of bioethics should be seeking the wisdom to discern between the two.

 

*This summary of Blair’s thought is from Alan Jacobs’s review in the May/June 2011 Books & Culture.

Cybrid-gate in the UK

In last week’s blog (July 26), I highlighted an article from Wired magazine (August 2011) titled “Extreme Science”  in which Wired explores seven “shocking experiments” that scientists could learn from if they were willing to set aside their ethical concerns.  One experiment involves cross-breeding humans with chimpanzees in order to better understand human development.

What I find fascinating about all of this is that the Wired article was written as if unethical experiments don’t occur; as if, in reality, scientists are guided by a moral compass.  But are they?  Just 2 days before I wrote my blog, The Daily Mail (a British publication) reported that over a 3-year span scientists “have created more than 150 human-animal hybrid embryos in British laboratories.”  So, what Wired posed as a hypothetical thought experiment was already happening (albeit secretly) in the UK.

According to The Daily Mail, “155 ‘admixed’ embryos, containing both human and animal genetic material, have been created since the introduction of the 2008 Human Fertilization Embryology Act.  This legalized the creation of a variety of hybrids, including an animal egg fertilized by a human sperm; ‘cybrids’, in which a human nucleus is implanted into an animal cell; and ‘chimeras’, in which human cells are mixed with animal embryos.”  http://www.dailymail.co.uk/sciencetech/article-2017818/Embryos-involving-genes-animals-mixed-humans-produced-secretively-past-years.html

The Human Fertilization and Embryology Act of 2008, Section 4A, contains some of the following prohibitions:

“(1) No person shall place in a woman –

(a) a human admixed embryo,

(b) any other embryo that is not a human embryo, or

(c) any gametes other than human gametes.

(2) No person shall –

(a) mix human gametes with animal gametes,

(b) bring about the creation of a human admixed embryo, or

(c) keep or use a human admixed embryo…”

So far, so good.  Or so I thought.  The Act continues:  It is illegal to do #2 above (i.e., mix human gametes) “except in pursuance of a license.

In other words, it is still possible, with government authorization, to mix human gametes with animal gametes to create an admixed embryo.  The only restriction, according to the Act, is that the admixed embryo cannot be kept or used after the first 14 days of its existence.  Indeed, it is also possible, according to the wording of the Act, to create an admixed embryo, store it (i.e., freeze it) over a period of time, and then at some future point do research on it, as long as it is not allowed to live beyond 14 days.

(To view The Human Fertilization and Embryology Act of 2008, go to:  http://www.legislation.gov.uk/ukpga/2008/22/contents)

But the story’s intrigue deepens.  The creation of the cybrids” in the UK was apparently done in secret.  As noted in a recent Christian Medical Fellowship blog (July 26): “there seems to be a murky mix of confusion and secrecy from which the true facts and figures are difficult to extract.”  But why the secrecy if research was being done within the guidelines of The Human Fertilization and Embryology Act?

Furthermore, the research was not carefully documented.  It is less than clear the exact numbers of cybrids that were created.  The Christian Medical Fellowship reports that, “According to The Independent “many more cybrid embryos were created – 278.  That large number is naturally of concern, but also of concern is that the numbers don’t match the figure of 155 released last week.  The Government has avoided answering that question.  Moreover, if all funding (apparently) stopped in 2010 and the licence was revoked from the only researcher, when were these 155 (or 278) embryos created?  Were they all created before 2010?  Or are they still being created?  If so, by whom?” http://www.cmfblog.org.uk/2011/07/26/155-animal-human-embryos-created-in-the-uk-%E2%80%93-we-think/?doing_wp_cron

In other words, in spite of government oversight, an assortment of so-called “ethical guidelines,” and the best intentions of scientists, it’s less than obvious that research is done within any firm restrictions.  The CMF concludes that “the glaring discrepancies in the figures issued by The Human Fertilization and Embryology Authority shows it is not fit for purpose when it comes to regulating the scientists.  It is incapable of keeping accurate records and is unable to keep on top of what is going on in research, either with embryos or eggs.”

I ended last week’s blog with the following observation:  “Humans have also demonstrated a natural tendency to push the moral envelope, to give priority to what can be done over what should be done.  Time will tell whether experiments that are now considered unethical will one day be the norm.”  Apparently we no longer need to wait for “time” to make this announcement.

Is a CT Scan an Ethical Issue?

All third-year students at Texas A&M are required to attend Saturday-morning radiology lectures, and I was surprised to hear my professor speak for the final 30 minutes yesterday on when not to order imaging.   Radiology is his life’s calling, but he recognizes that imaging studies like the CT scan can be harmful.  Of the $2.3 trillion spent on healthcare in the U.S., the largest share is spent on imaging, totaling $800 million.  CT scans have become a part of the American vernacular, but it is estimated that 1/3 of them are unnecessary.  What ethical issues concern the use of imaging in healthcare?

  • Patient Safety: Concerning chest scans, an X-Ray exposes the patient to 0.1-0.2 mSv of radiation, but the CT dose is 8.0 mSv.  At 50 mSv a person is at increased risk of cancer, so minimizing the number of exposures to a CT scan should be an important goal in healthcare.
  • Cost: Some of the ballooning in healthcare costs over the last decade is due to tests ordered by physicians.  Many doctors order tests not because they are indicated by the patient’s symptoms but because they serve as an extra layer of protection in the case of a lawsuit.  The irony of such defensive medicine is that one day a doctor may find himself in court for exposing the patient to too much radiation.  Patients never see the thousands of dollars of imaging charges, so they often authorize such studies and let the insurance companies handle the rest.
  • Physicians Lining Their Pockets: Research has shown that physicians increase the number of scans ordered when they are able to bill for the use of their own equipment.  One gastroenterologist related to me how his clinic moves a number of unnecessary endoscopies through his office for various reasons.  An endoscopy does entail some risk and is certainly not comfortable, but every CT scan is sure to expose the patient to radiation.  Physicians should refrain from allowing revenue strategies to trump good medical practice.

For more information on radiology, visit www.radiologyinfo.org.

Stem Cells and Fast Pitches

In April 2010, Yankee pitcher, Bartolo Colon, received experimental stem cell therapy to mend torn ligaments in his elbow and shoulder and a torn rotator cuff. The procedure involved taking some of his stem cells from bone marrow and fat tissues and injecting them in the elbow and the shoulder. Since then, he has been back in the game again pitching as he did pre-injuries. The therapy was experimental and was done in the Dominican Republic. And while the Dominican Republic has dragged its heels on releasing Colon’s medical records, things seem to be on the up-and-up regarding this procedure. The MLB commission is investigating whether Colon received any banned substances along with the stem cell procedure as well as whether this procedure is within regulation. (See this New York Times article and this New York Daily News article for background.)

Here are the ethical issues that seem to be presented here:

  • Cheating

Human growth hormone (HGH) is a banned substance that is touted as a wonder drug for the veteran athlete. See this Mayo Clinic article for a brief description on myths and facts about HGH. In short, we all make HGH until we are about forty years old. If a teen or twenty-something were to take HGH, there would be no effect because they are already making the hormone. If a middle-aged person takes HGH, they will notice some slight changes, like firmer skin, scars that disappear, and bones and injuries that heal faster. Their bones and bodies are healing faster, like when they were young – think about the little boy who wears a cast for four weeks versus the middle-aged man who wears a cast for six-to-nine weeks to heal the same type of fracture. The doctor who did the stem cell therapy on Colon is known to use HGH which is illegal for professional athletes. Is Colon covering up the use of HGH by saying that he received experimental stem cell therapy? Maybe he actually did receive stem cell therapy, but did he also use HGH? This is still under investigation.

  • Stem Cells

It is worth noting that since adult stem cells are being used in this procedure, the stem cell source is not morally objectionable. As far as the procedure itself, obtaining bone marrow can be painful, but this procedure is technically minimally invasive. However, it is an experimental procedure, so not all risks are known.

  • Therapeutic vs. Enhancement

This seems to be a therapeutic procedure. I do not follow the Yankees or their stats nearly as much as my Texas teams, but from what I understand, Colon is throwing well, but not necessarily better than ever. He isn’t breaking his own personal record or other pitcher’s records at age 38, including oldest pitcher. He is, apparently, back to his pre-injury skill level. To me this seems to be a therapeutic procedure more than an enhancement procedure, but this is not a clear-cut, black-and-white issue. I wrote an article on the use of anabolic steroids several years ago when the Mitchell Report was out. The steroids make a player’s body do what it was never designed to do. Not everyone was designed to build that much muscle, and the consequences of stressing your joints and ligaments with loads they were never meant to take can cause permanent damage.

The reason why this is not a clear issue is because the therapy is to correct injuries are the result of age and use, but not every pitcher has the same problems as they age. The question is: Is this part of the natural consequences of aging or is it fixing an injury? Is Colon getting an unfair advantage over other players? Certainly, I am less likely to injure ligaments in my elbow and shoulders because it’s not part of my job to use them to their full potential every day. By way of example, however, I am a runner. Not a professional runner, by any means, but does this mean that if I am dealing with a nagging knee injury 20 years from now I should chalk it up to old age? Good-bye track; l hello pool? I do preventative things now for my knees, liking icing and stretching in hopes that I will not have to make that decision later, but some people have bad ligaments and some don’t. As one orthopedist I know said, “Some people have forty year knees, some have eighty year knees.” If there is a therapy out there to fix a knee injury, is it fair for runners with this therapy available to them to use it and compete in races in their age range?

  • The Athletes’ Attitude

The last issue is what I believe gets people a little uneasy about this procedure. It’s the athletes’ attitude. Whether we’re talking about Brett Farve or Michael Jordon or Lance Armstrong or some of the less famous, athletes are who they are because they are not quitters. They will push themselves to the limit and do what it takes to win. But the one foe that they will never beat, no matter how hard they try, is old age. Eventually they are going to get too old to play the sport professionally, and no amount of physical therapy, green tea, and weight lifting is going to stop it. But, they will most certainly try.  I am not a professional athlete (so this might be me stretching), but here’s what might be going through my mind: Is it fair that Colon at thirty-eight years old gets some experimental procedure and now gets to live even one more year in the spot light while I had to go through the difficult transition of retiring at a ripe old age of thirty-five? Is it fair that he gets to wipe away the wear and tear while I never had that opportunity? After all, at 38, your mind is sharper than ever, even if your body is “slowing down” a bit. How much better can an athlete be with experience and maturity under his belt?

Autonomous Robots Autonomous Children

I read an article recently in IEET, a transhumanist journal, about regulating autonomous robots. The author lays out reasons why it is hypocritical to regulate or prohibit the construction of autonomous robots. His initial premise is that we make children all of the time, and for all intents and purposes they are the same thing as autonomous robots:

My suggestion is this: If creating children is morally unproblematic, then so is creating autonomous robots, unless we can identify morally relevant differences between the two acts. But what exactly is the moral issue with creating robots that is avoided when we create human beings? Or, in other words, when we’re talking about autonomous beings, why is the responsibility of the parent seemingly less than the responsibility of an inventor?

He lays out several of the arguments people typically give for why children are different from robots and then proceeds to refute them. He concludes that “[u]ltimately, it could be that there is a defensible moral difference between creating children and autonomous robots. But it is not obvious what that difference is, despite our taking it for granted.”

Robots don’t mature from infant to adult. They don’t bleed. They don’t reproduce. They don’t suffer. Robots are assembled by people, and the only way they can “do” any of these functions is if they are programmed to mimic human beings. They cannot do these things on their own. Children are assembled by a series of hormonal and biological mechanisms, some of which remain a mystery to us today. Parents merely provide the parts; they don’t program children to bleed or suffer or rebel. And while the author makes a distinction that children born through IVF are constructed just as robots are constructed, I would contend that IVF doctors are putting the parts together, but that the child does not grow in the directional process to adulthood until it is put back in the uteral environment where that same set of signals and biological mechanisms can do its work.

Most importantly, human beings are more than the sum of their parts. They have personalities, creativity, and are capable of things that no mechanical object can be capable of without being programmed to mimic human behavior.  Humans suffer, and they hope. Even robots that solve novel problems are programmed to do so. The information and tools to assess a scenario is front-loaded by the programmer, while humans are capable of true creative innovation. To assume the premise that creating children is not morally different from creating a robot presumes a reductionistic and deterministic view of children that does not match with experience and observation. Robots are programmed by their inventor, but anyone who has children knows that while they may take on certain personality traits of their parents, they are most assuredly not “programmed” by their parents (See your nearest toddler).

Even my husband’s Mac which seems slightly autonomous because everything is automatic and it seems to correct its own problems, is not truly autonomous. The only way a Mac would “attack” a human being is if it is programmed to do so, and in that case it still comes down to the evil that men do to one another, the weapons are just smaller, faster, and more complex.