King's College London, UK.
Soc Sci Med. 2010 Dec;71(12):2204-11. doi: 10.1016/j.socscimed.2010.09.045. Epub 2010 Oct 21.
United Kingdom (UK) funding to build human embryonic stem cell (hESC) derivation labs within assisted conception units (ACU) was intended to facilitate the 'In-vitro fertilisation (IVF)-stem cell interface', including the flow of fresh 'spare' embryos to stem cell labs. However, in the three sites reported on here, which received this funding, most of the embryos used for hESC research came from long term cryopreservation storage and/or outside clinics. In this paper we explore some of the clinical, technical, social and ethical factors that might help to explain this situation. We report from our qualitative study of the ethical frameworks for approaching women/couples for donation of embryos to stem cell research. Members of staff took part in 44 interviews and six ethics discussion groups held at our study sites between February 2008 and October 2009. We focus here on their articulations of social and ethical, as well as scientific, dimensions in the contingent classification of 'spare' embryos, entailing uncertainty, fluidity and naturalisation in classifying work. Social and ethical factors include acknowledging and responding to uncertainty in classifying embryos; retaining 'fluidity' in the grading system to give embryos 'every chance'; tensions between standardisation and variation in enacting a 'fair' grading system; enhancement of patient choice and control, and prevention of regret; and incorporation of patients' values in construction of ethically acceptable embryo 'spareness' ('frozen' embryos, and embryos determined through preimplantation genetic diagnosis (PGD) to be genetically 'affected'). We argue that the success of the 'built moral environment' of ACU with adjoining stem cell laboratories building projects intended to facilitate the 'IVF-stem cell interface' may depend not only on architecture, but also on the part such social and ethical factors play in configuration of embryos as particular kinds of moral work objects.
英国(UK)为在辅助受孕单位(ACU)内建立人类胚胎干细胞(hESC)衍生实验室提供资金,旨在促进“体外受精(IVF)-干细胞界面”,包括将新鲜的“备用”胚胎流向干细胞实验室。然而,在本文报道的三个获得该资金的地点,用于 hESC 研究的大多数胚胎来自长期冷冻保存储存和/或外部诊所。在本文中,我们探讨了一些可能有助于解释这种情况的临床、技术、社会和伦理因素。我们报告了我们对接近妇女/夫妇捐献胚胎用于干细胞研究的伦理框架的定性研究。工作人员参加了 2008 年 2 月至 2009 年 10 月在我们的研究地点举行的 44 次访谈和 6 次伦理讨论小组。我们在这里重点关注他们在将“备用”胚胎进行偶然分类时对社会和伦理以及科学维度的阐述,这涉及到在分类工作中的不确定性、流动性和自然化。社会和伦理因素包括承认和应对分类胚胎时的不确定性;在分级系统中保持“流动性”,让胚胎“有机会”;在实施“公平”分级系统时标准化和变异之间的紧张关系;增强患者选择和控制,预防遗憾;以及在构建在伦理上可接受的胚胎“稀疏”(“冷冻”胚胎和通过植入前遗传学诊断(PGD)确定的胚胎遗传上“受影响”)时纳入患者价值观。我们认为,ACU 与毗邻的干细胞实验室建设项目旨在促进“IVF-干细胞界面”的“内置道德环境”的成功,不仅取决于建筑,还取决于这些社会和伦理因素在将胚胎配置为特定种类的道德工作对象方面所起的作用。