In the realm of medical science, tissue engineering stands as a beacon of hope, offering revolutionary solutions to some of the most challenging health problems. It’s a field where biology meets engineering, aiming to regenerate, repair, or replace damaged tissues and organs using a combination of cells, scaffolds, and bioactive molecules. While the potential benefits of tissue engineering are vast, it also raises significant ethical questions that demand careful consideration.

At its core, tissue engineering holds the promise of transforming healthcare by providing alternatives to traditional organ transplants, which is often limited by donor shortages, immune rejection, and the need for lifelong immunosuppression. With tissue engineering, scientists can create tissues and organs tailored to individual patients (using their own tissue), which reduces the risk of rejection and eliminates the need for donor matching.

One of the most common applications of tissue engineering is in the field of regenerative medicine. Imagine a world where patients with severe burns can have their skin regenerated using bioengineered skin substitutes, or where individuals with a damaged cartilage can receive custom-made cartilage implants! These advancements have the potential to improve countless lives, offering hope to where previously there was none.

Ethical concerns loom over the field of tissue engineering, prompting researchers and policy makers to navigate a complex ethical area. One of the primary concerns is the source of cells used in tissue engineering. While some cells can be harvested from a patient’s own body, others may come from embryonic stem cells or induced pluripotent stem cells (iPSCs), raising ethical questions about the destruction of human embryos and the manipulation of genetic material. Moreover, the commercialisation of tissue engineering raises concerns about accessibility and fairness in healthcare. Will these cutting-edge treatments be available only to the wealthy and elite, widening the gap between those who can have access and those who don’t? Ensuring equal access to tissue-engineered therapies is not just a matter of scientific advancement but also a moral imperative.

Another ethical dilemma arises from the potential for unintended consequences. As we delve deeper into the complexities of tissue engineering, we must be mindful of the long-term effects of manipulating biological systems. Could bioengineered tissues lead to unforeseen health complications down the line? These are questions that require ongoing research.

Despite these ethical challenges, the field of tissue engineering holds tremendous promise for the future of medicine. By cultivating interdisciplinary collaboration and engaging in transparent dialogue with stakeholders, we can navigate the ethical complexities while harnessing the full potential of tissue engineering to alleviate human suffering and improve quality of life.

In conclusion, tissue engineering represents a remarkable collaboration of science, engineering, and medicine, offering unprecedented opportunities to address some of the most pressing health challenges of our time. However, as we journey into this brave new world of regenerative medicine, we must tread carefully, ensuring that our scientific advancements are guided by ethical principles and a commitment to the greater good. Only then can we fully realize the transformative potential of tissue engineering while upholding the rights of all individuals.

Since the development of the Egyptian ‘Cairo toe’, prosthetic limbs have developed greatly. The Cairo toe was made from pieces of wood sculpted into the appearance of a toe and held together by leather thread. This simple model contrasts drastically to the modern-day prosthetics often constructed using metals and synthetic materials such as plastic and silicone which can provide individuals with high levels of functionality and are available with a range of different aesthetics.

Scientists are constantly trying to improve prosthetics for their recipients. Recent developments have focused on the ability to control prosthetics in the same way we would control the natural limb – with our minds. Johns Hopkins University have developed the APL bionic arm which can be controlled by the human brain. In 2016, Melissa Loomis, who lost her arm after being bitten by a wild racoon, became the first recipient of this prosthetic and one of the only amputees at the time to be able to control her prosthetic with her mind. The arm receives inputs from her nerves in her nervous system which are interpreted by the arm and result in the desired output of movement. The prosthetic also has a range of sensors across it which send signals back to her nervous system allowing her to be able to detect temperature and provide some of the senses, such as touch, to the limb. This could be life changing to amputees like Melissa who said touch was ‘the thing she missed the most’ in an interview with Motherboard.

Whilst this was a huge leap forward in prosthetic science it is not without its disadvantages. The APL bionic arm is extremely expensive, and patients need to undergo a long invasive surgery known as targeted sensory innervation to allow the prosthetic to be connected to the patients nervous system. Whilst currently these factors make the prosthetic less accessible, it still provides an exciting glimpse into the future of prosthetics for amputees.

However, for those who are unable to consider this advanced APL bionic arm, prosthetics such as the MiniTouch, recently described in nature,  may be desirable. The MiniTouch technology allows the detection of temperature through prosthetic limbs without the need for surgery. The technology works similarly with temperature sensors on the prosthetic that deliver thermal information to the patients’ neurones through points on their skin. It can be attached to many different prosthetic limbs already on the market making it much more accessible to amputees.  

Developments like these were unimaginable during the time of the Cairo toe indicating that the possibilities with prosthetics could be endless. One limb amputation happens every 30 seconds and there are over 2.1 million people living with a limb amputation in the US alone. Therefore, these advancements provide a promising glimpse into the future of prosthetic limbs with increased functionality and accessibility.

You turn up at hospital and what is the first, most basic test that they carry out? Vital observations. From the most minor injuries to surgery and intensive care, throughout the hospital at every level, vital observations are integral to medical understanding and monitoring of the individual. They can be relatively rudimentary signal acquisition systems, relaying physical signals from the patient through a signal amplifier and analog to digital converter where electrical signals can be analysed and monitored on a computer. So how has this relatively straightforward technology become so outdated in anywhere other than the operating room, when recently in Los Angeles, California, I was presented with cutting edge, holistic, remote medical sensing technology at Massimo biotechnology?

Working throughout the RD&E Exeter and SGH Southampton Hospitals, and most recently work in Coronary Care and Emergency Majors department has raised my awareness of the failures of vital monitoring systems so highly relied upon. For instance, ECG monitoring on Cardiac units currently rely upon either static or cumbersome remote ECG monitors that can be very restricting to the patient (especially those generally mobile or that become agitated without activity), require manual operation, and generally provide minimal amount of information solely related to one requirement, in comparison to the holistic, versatile, and minimally invasive remote monitoring systems currently being innovated and sold on the market.

Currently, Massimo offer the Radius VSM which provides the ‘versatility of a bedside monitor in a wearable device’. This includes pulse oximetry monitoring, respiration monitoring and rates, noninvasive blood-pressure which have customisable intervals of observation, temperature, patient mobility and orientation monitoring providing ability to detect falls and prevent pressure sores, and ECG with 6 different waveforms. The ability to monitor these variables from the nursing desk, regardless of where the patient is, can be much more time efficient and less restricting than current methods. This must also be able to factor in for artefacts that can present themselves in readings, for instance mains interference or EMG (electricity radiated from muscle) as a result of movement.

While perhaps the NHS has equipment that will “do the job”, does it work to what could be its current full potential and reflect the incredible recent advances made in bioengineering (which could lead to improved patient outcomes)? No.

The NHS has a multifaceted problem with innovation and development. This comes down to difficulty in implementing changes to a highly decentralised and overly bureaucratic system which would require a lot of coordination and investment. Investment with a tight budget from the British taxpayer and high competition between arguably just as, if not more important medical devices and materials, proves another problem. In terms of innovation, inevitably there is a reluctance within healthcare professionals to step out of the comfort zone into a new era when the old is tried, tested, and already payed for.

Despite the NHS working at a sufficient level, how far does its ethical obligation to innovate, stretch into the modern age of technology. Patient wellbeing would improve with more accurate, less restrictive systems. Equality and access to healthcare across the country with better outcomes, improved efficiency and reduced waiting times for any individual regardless of background, would also be possible. Furthermore, innovation would be an obligation of beneficence and non-maleficence with patients best interests in mind. However, to what extent this is significant in terms of resource allocation must be up for contemplation.

Evidently now the NHS has realised their need to develop in this niche with necessary trials being launched. However, the delay in this being a priority is evidence of the NHS need to improve.

Hearing loss, whether congenital or developed later in life, affects many people. 1 in 5 adults in the UK experience hearing loss, are deaf or have tinnitus. More widely, 5% of the world’s population experience disabling hearing loss. Hearing, in conjunction with the other 4 senses, aids us in our understanding and interpretation of the world around us. So you would think that anything that helps to restore hearing is a net positive, right?

Not exactly.

There is a divide in the deaf community. Some see their deafness as a medical condition, whereas others see it as a cultural identity. The former group tend to see cochlear implants as a beneficial advancement and a great option as it can potentially improve their condition. Those who fall into the latter category tend to believe that cochlear implants are inherently negative, as the promotion of them implies that deafness is something that needs to be fixed. The deaf community have their own way of communicating that has been developed over many years, and the mass adoption of cochlear implants may cause them to lose the language and culture they have developed.

Cochlear implants are beneficial, with a 2020 study in adults showing that word recognition improved from 8.3% to 53.3% after implantation. However, it requires a lot of work for the person wearing the implant to reach this point. They will have to undergo speech and language therapy, and it can take many years to adjust to. The implant also does not restore hearing in the same way that non-deaf people can hear, as some may believe.

Below is a thread from an X/Twitter user, discussing how people without hearing loss may be insensitive to the emotions and agency of deaf people surrounding their choice of whether or not to use cochlear implants. The comments are taken from a video of a child who did not want to wear her implant after her parent asks her to put it on, and requests for her parent to sign with her instead.

In the thread, the user shares screenshots of people making comments such as, “If she didn’t want it she should pay her folks back for it”, and “Everyone cannot sign. She needs to be flexible and adaptable to make it in this world”, with many comments using ableist language.

With comments and language such as this, it’s understandable why there are deaf people who advocate for children to not be allowed to have cochlear implants until they can consent to the procedure.

The comments also display misconceptions about cochlear implants. There is a rampant attitude of “If you have an implant, why should I use sign language?” The consensus is that the child is choosing to not wear her implant out of insubordination. It is common for deaf people with hearing aids or implants to want “hearing breaks”. Some people with an implant still use lipreading and sign language as they may find it easier for many reasons.

This situation highlights the main issue that some deaf people have with cochlear implants; they can be seen as an excuse for the lack of accommodations that society has for deaf people.

Overall, cochlear implants are not a miracle cure. They have the potential to help deaf people, but it is an emotionally taxing process and it is not fair to expect all deaf people to want one (or two). If someone has a cochlear implant, but doesn’t want to use it all the time, we should be empathetic to that.