Bioethical pluralism and complementarity

This essay presents complementarity as a novel feature of bioethical pluralism. First introduced by Neils Bohr in conjunction with quantum physics, complementarity in bioethics occurs when different perspectives account for equally important features of a situation but are mutually exclusive. Unlike conventional approaches to bioethical pluralism, which attempt in one fashion or another to isolate and choose between different perspectives, complementarity accepts all perspectives. As a result, complementarity results in a state of holistic, dynamic tension, rather than one that yields singular or final moral judgments.     

From inverse problems in mathematical physiology to quantitative differential diagnoses

The improved capacity to acquire quantitative data in a clinical setting has generally failed to improve outcomes in acutely ill patients, suggesting a need for advances in computer-supported data interpretation and decision making. In particular, the application of mathematical models of experimentally elucidated physiological mechanisms could augment the interpretation of quantitative, patient-specific information and help to better target therapy. Yet, such models are typically complex and nonlinear, a reality that often precludes the identification of unique parameters and states of the model that best represent available data. Hypothesizing that this non-uniqueness can convey useful information, we implemented a simplified simulation of a common differential diagnostic process (hypotension in an acute care setting), using a combination of a mathematical model of the cardiovascular system, a stochastic measurement model, and Bayesian inference techniques to quantify parameter and state uncertainty. The output of this procedure is a probability density function on the space of model parameters and initial conditions for a particular patient, based on prior population information together with patient-specific clinical observations. We show that multimodal posterior probability density functions arise naturally, even when unimodal and uninformative priors are used. The peaks of these densities correspond to clinically relevant differential diagnoses and can, in the simplified simulation setting, be constrained to a single diagnosis by assimilating additional observations from dynamical interventions (e.g., fluid challenge). We conclude that the ill-posedness of the inverse problem in quantitative physiology is not merely a technical obstacle, but rather reflects clinical reality and, when addressed adequately in the solution process, provides a novel link between mathematically described physiological knowledge and the clinical concept of differential diagnoses. We outline possible steps toward translating this computational approach to the bedside, to supplement today's evidence-based medicine with a quantitatively founded model-based medicine that integrates mechanistic knowledge with patient-specific information.     

克隆技术引发的伦理之争

自从克隆羊多莉诞生以来,有关克隆人的伦理学争论就一直喋喋不休。世界上的各种政治组织和各国政府都明确反对生殖性克隆,而科学家们则对克隆技术的不完善心存疑虑。为了克服克隆过程中的伦理学障碍和技术缺陷,科学家们在核移植技术的基础上,又发展了异种核移植技术、诱导多能干细胞技术等。诱导的多能干细胞可以分化成各种组织,甚至能发育成个体,这些方法使克隆技术不再破坏胚胎,避免了伦理学纠纷。尽管科学技术在进步,但是人们对克隆人仍有很多不解和困惑。从自主、不伤害、行善和公正等四大生命伦理学原则着手,在技术层面上提出了尽管克隆人不会搞乱人际关系,不会减少人类基因多样性,也不会克隆出类似希特勒的战争狂人,但是,人类的生殖性克隆却剥夺了克隆人的自主性,对克隆人的生理和心理都有所伤害,违反了公正和行善的原则。因此,是否可以克隆人在伦理上仍然是需要长期讨论的问题。     

Bioethical aspects of regenerative and reproductive medicine

The birth announced in 1997 of Dolly, the lamb cloned from the somatic mammary cells of an adult ewe, and the discovery of human embryonic stem cells in 1998 have been the most exciting developments in the biological sciences in the past decade. Reproductive somatic cell nuclear transfer (SCNT) in additional species has been inefficient in that relatively few births, harmful side effects and high fetal and neonatal death rates have resulted from many attempts. Ongoing debates about the ethics of reproductive SCNT have revealed that some researchers regard human reproductive SCNT as morally unacceptable in all circumstances, others see merit in reproductive SCNT in certain circumstances and others await more information before making judgment about the ethical status of the procedure. Regenerative medicine and emerging biotechnologies started to revolutionize the practice of medicine. Advances in stem cell biology, including embryonic and postnatal somatic stem cells, have made the prospect of tissue regeneration a potential reality. Mammal cloning experiments have provided new impetus to the prospect of regenerative medicine through stem cell research. The procedure of SCNT could be used to create the raw material to replace defective or senescent tissue as a natural extension of the biology of stem cells. Researchers working in reproductive medicine should consider the potential hope given to many patients against the requisite and ethically contentious creation of human blastocysts for therapeutic intent.     

The methodological problems of the correlation of biochemistry and physiology in current research

An attempt to treat critically the key methodological positions of modern biochemistry, primarily, the medical biochemistry with reference to the physiologic, pathophysiologic and clinical tasks is made. The author puts forward questions: 1) if it is possible to apply traditional approaches (principles) of biochemical investigation developed on purified systems to the whole organism systems in situ and etc.; 2) if it coincides the methodical approaches of biochemistry on the one hand and physiology (pathophysiology)--on the other one, considering the mechanisms of disease development and correspondingly the assessment and choice of therapeutic methods; 3) if there exists a necessity to create a unite methodology of biochemical and physiologic knowledge as a basis of modern medical science as a whole. Some examples showing the possible ways of new methodic consideration of traditional conceptions of in vitro biochemistry are given.     

Bioethical decisions: the political context and challenges

The biomedical and societal forces which are thrusting bioethical decision making into the political arena are described. Reasons why American political institutions and processes are poorly equipped for resolving sensitive bioethical issues are analyzed. Some potential adaptations in public policy mechanisms are suggested to increase their responsiveness and effectiveness.