Human tissue and global ethics

Published on August 31, 2015   37 min
0:00
My name is Donna Dickenson. And I'm Emeritus professor of Medical Ethics at the University of London. I'm going to be speaking to you today on the topic of human tissue and global ethics.
0:12
We now have a situation where there is a global trade in human tissue. And in a book I wrote about five years ago, I called this trade body shopping. And this is an international trade, which began really as a trade in human eggs and sperm sold by private banks and IVF clinics. And I think that aspect is quite widely known, sometimes called rather flippantly, reproductive tourism. And two examples of that are this US college newspaper advertisement, which was headed, Girls sell your eggs and enjoy the night life of Chennai! The idea being that American, female college students would go to India, go to Chennai and would undergo the rather laborious process of egg extraction, at the same time would be able to enjoy the nightlife. And here's another example of this slightly flip attitude towards reproductive tourism towards the global trade. And this is from the founder of a commercial egg and sperm bank called beautiful people. And he said, everyone, including ugly people, would like to bring good looking children into the world and we can't be selfish with our attractive gene pool.
1:24
Now, that is the rather flip approach to what is actually a very serious question. And what is actually a very complex market in human tissue. To stay with the topic of eggs for the time being, the market in human eggs is differentiated by what buyers think are desirable phenotypes. And I hasten to say that I don't think there's anything particularly desirable about any of these. There's a slightly eugenic take to this. But the market in human eggs does reward certain phenotypes. And those tend to be musicality, high intelligence, height, tall height, athletic ability, and blonde hair color seems to be rewarded. Now, this is actually in contravention of professional guidelines, even in America, where this market is perhaps most complex. And the American College of Obstetricians and Gynecologists has actually stipulated that there should be no higher payment than $5,000 for human eggs. But the so-called right traits, that is the ones that I've just enumerated, can command up to 10 times that. And this is not just limited to America. The reason why the advert was targeting American female students for a Chennai clinic is that in India, in southern India in this case, European or American egg sellers of European extraction can also command high prices because of fair skin as a desirable phenotype. Of course, that's not really a guarantee at all that the genotype will come out that way.
3:03
And I think this is an interesting example, this tissue trade, of the way in which we face a phenomenon of what I call, outside inside, inside outside. Modern biotechnology increasingly blurs the line between things that are external to the body and things that are internal to it. So for example, mechanical ventilators or pacemakers can be incorporated from outside into our bodies. While tissues, taken from our bodies, such as DNA swabs or blood, or gametes, can be processed and turned into a commercial product.
3:39
This global trade, this body shopping trade, is not confined to the private sector. Although, I have mainly been talking about the private sector. And an example of this is umbilical cord blood. This is blood which is donated by the mother after the delivery of the baby, taken between the delivery of the baby and the delivery of the placenta. And there is some evidence that it can be valuable in treating blood and other disorders. Although, many of uses that are promised for it are really quite speculative. There are both private and public banks. The public banks bank the blood which is given altruistically for the use of others. And private banks bank it for the baby's own use, in later years that is. Now both types of banks are growing in number but it's very hard to say that one is commercial and the other isn't. Because public cord blood banks, which don't pay their donors, now trade their units internationally at between $25,000 to $45,000 per unit in what is called the immunitary bioeconomy. And that is because they need to make up minority ethnic blood types that they may not have in their own stock.
4:53
Now, you can see the size and scope of this trade, this body shopping trade. And I think it can be said that body shopping has caught mainstream bioethics unawares. Usually, bioethics and medical ethics are seen as dealing with issues mainly about individual autonomy and consent. Now, in the doctor patient relationship, that is, of course, important. But in most of these cases, we're not really looking at the doctor patient relationship directly. We're looking at something much more commodified and globalized. So this is really too limited to focus only on autonomy and consent. And it leaves these markets in tissue really out of control and insufficiently examined. So I think that we need to shift our gaze outward, beyond autonomy and the individual level, to global justice and to compare to other countries responses to this trade. And I'll be doing that later. And I think it's important that policymakers and research ethics committees in the more local context, hospital or LREC research ethics committees, should be aware that the relevant ethical questions are no longer confined to the individual or the local context.
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Human tissue and global ethics

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