The University of Southampton

Category: Ethics and the law

Can we sell medical waste?

Posted on by

Immortal cells

I recently read The Immortal Life of Henrietta Lacks by Rebecca Skloot1; the remarkable story of an American woman whose cervical cancer was used to make the first immortal cell line, HeLa. In vitro cell research is normally constrained by the Hayflick limit2; cell lines die out after a few days. Lacks’ cancer was so aggressive that its cells could divide indefinitely, providing an invaluable biological material still used today. Incredibly, few know her name. The cells were used without her knowledge or consent, and her family knew nothing for twenty years.

This story raises important questions about human tissue ownership, notably: who owns medical waste, and can it be sold? Skloot heavily implies that the Lacks family should be compensated for Henrietta’s cells, but I’m not sure it’s so simple.

A video by Hank Green on SciShow, with further information about immortal cell lines and HeLa cells.3

Tissue ownership in the UK

My friend works for the Southampton Imaging4 group and routinely uses femoral heads, leftover from hip replacement surgery, in his research. Recently introduced to tissue ethics, I had several questions for him. My Gran had a hip replacement – are scientists experimenting on her bone? Could they extract stem cells from the marrow and make a cell line like HeLa?

Thankfully, the Human Tissue Act 20045 (HTA) restricts research on tissue to licensed labs and requires informed consent from all donors. My friend assures me that strict protocols are followed, from surgery to the lab to disposal, and that his lab must comply with the Declaration of Helsinki6.

What does this mean for Lacks’ family?

Henrietta Lacks was treated unethically. Her cells should not have been used without her consent, violating her dignity when she was extremely vulnerable. Furthermore, it’s now possible to sequence HeLa’s genome, raising concerns about Lacks’ and (her family’s) privacy. Unfortunately she died in 1951, before widespread adoption of informed consent as best practice.

Henrietta Lacks. Photo from the National Geographic7

In her book, Skloot implies that Lacks’ family should be paid for the cells. It’s important to note that HeLa cells are not full organs, nor were they healthy – if not for their scientific usefulness they would have been deemed medical waste. In the US it is illegal8 to sell one’s organs, but consent and payment law for other tissue is more permissive than in the UK, where selling human tissue is banned.

I strongly support the UK position that selling human tissue for money, regardless of purpose or usefulness, is unacceptable. Tissue derived from a person’s body deserves to be treated with more dignity than a mere commodity.

Even if the act of selling one’s own tissue were ethical, a culture that allows it is not. It would encourage objectification of the human body and provide incentive for organ theft. Nobody should have to resort to selling their tissue. Meixuan Li’ 9 wrote a post exploring this concept taken to a dystopian extreme; prisoners exchanging their organs for reduced sentences. The very idea is abhorrent.

This is why, while Henrietta Lacks was wronged, her family should not be financially compensated. Payment for human tissue, even retrospectively, is morally unacceptable.

Read my full book review on Goodreads

Sources

  1. Skloot R. The Immortal Life of Henrietta Lacks. Crown Publishing Group (2010) ↩︎
  2. Hayflick’s handy guide to immortality and cell senescence. The Genetics of Basic Things and Stuff. 30th November 2022 (cited 24th March 2025). Video: 5:13 min. Available from: https://www.youtube.com/watch?v=w5SBZOa_qAg ↩︎
  3. Immortal Cells Turn 96. SciShow. 1st August 2016 (cited 20th March 2025). Video: 4:41 min. Available from: https://www.youtube.com/watch?v=sXY6-wLesYY ↩︎
  4. Southampton Imaging. University of Southampton (cited 21st March 2025). Available from: https://www.southampton.ac.uk/research/institutes-centres/southampton-imaging ↩︎
  5. Legislation. Human Tissue Authority (cited 21st March 2025). Available from: https://www.hta.gov.uk/guidance-professionals/codes-practice-standards-and-legislation/legislation ↩︎
  6. WMA Declaration of Helsinki – Ethical Principles for Medical Research involving Human Participants. World Medical Association. 2024. (cited 21st March 2025). Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki/ ↩︎
  7. Marc Silver. A New Chapter in the Immortal Life of Henrietta Lacks. National Geographic. 2013 (cited 21st March 2025). Available from: https://www.nationalgeographic.com/science/article/130816-henrietta-lacks-immortal-life-hela-cells-genome-rebecca-skloot-nih ↩︎
  8. Can you sell organs in the United States? Donor Alliance; Tissue and Organ Donation. 2025. (cited 21st March 2025). Available from: https://www.donoralliance.org/newsroom/donation-essentials/can-you-sell-organs/ ↩︎
  9. Li M. Prisoners ‘Donating’ Organs for Sentence Reduction: Should the Punishment Fit the Crime? 12th March 2025 (cited 21st March 2025). In: Engineering Replacement Body Parts 2024-2025. Available from: https://generic.wordpress.soton.ac.uk/uosm2031-2025/2025/03/12/prisoners-donating-organs-for-sentence-reduction-should-the-punishment-fit-the-crime-2/ ↩︎

A Joint Effort: NHS or Private – What’s the Right Option?

Posted on by

Audio transcript:

The lecture series by Prof Dickinson on prosthetic joints prompted my thoughts on this topic with my tennis interest in Andy Murray and how it has affected close family friends.

The comeback of Murray following his hip resurfacing was astounding. Watching him win the European Open tournament in Belgium post-surgery demonstrated his determination and ability to compete at the highest level.

Andy Murray
An image of Andy Murray playing at the 2012 US Open. Available at https://commons.wikimedia.org/wiki/File:Andy_Murray_(US_Open_2012).jpeg (Accessed: 14/03/2025). By Francisco Diez, licensed under the Creative Commons Attribution 2.0 Generic license from Wikimedia Commons.

Murray’s hip resurfacing was done privately and quickly. I will share two stories from close family friends who have had very different experiences on knee replacements.

What is a knee replacement?

This topic is explained here. The summary is that knee replacements are used to treat pain and stiffness in the joint, usually caused by osteoarthritis. The process involves making an incision in the knee with metal and plastic replacement parts fitted as seen in the image below.

Total knee replacement image
An image of the components for a total knee replacement. Available at https://commons.wikimedia.org/wiki/File:Knee_Replacement.png (Accessed: 14/02/2025). By BruceBlaus, licensed under the Creative Commons Attribution-Share Alike 4.0 International license from Wikimedia Commons.

How successful are knee replacements?

A 2020 NHS report found that from over 80,000 patients, 75% responded that they felt much better following the operation with 64% being very satisfied with the results. The success of this treatment is why I feel access to them is so important, but the question of how to make it fair is challenging.

Wait times

The NHS has a very open website called My Planned Care. Taking the University Hospital Southampton statistics accessed on 21/03/2025, in the orthopaedic department the average wait time for treatment was 21 weeks. This led me to read a journal article “Who should have priority for a knee joint replacement?”. The degree of suffering, payment of National Insurance and caring for dependants are reported as the most important factors.

My friends

Ms D went down the private route for her knee replacement and had the operation within three weeks. Before this time, she had put on weight and was withdrawn socially. After the operation, Ms D’s mobility improved, and she resumed frequent international travels.

Ms C suffers from severe knee pain such that she rarely travels far on foot, something that has dampened her usually bubbly spirits. Ms C is opposed to private treatment. She also has a close friend who had a private knee replacement that was infected. Ms C is on an NHS waiting list for knee replacements and is hoping to have the operation in the next few months.

My dilemma

Both people have very different outlooks. My main concern is regarding quality of life. Ms D has now sadly passed away, but she lived ten years with her knee replacement. Ms C is in her late seventies and suffers. I tried to put it to Ms C’s husband in a recent phone call about “Why don’t you consider the private option?”, but it was quickly shot down. If it could be afforded, then the quality of life improvement would be massive, surely it would be worth the money?

Concluding thoughts

Having been a medical student for a couple of years before switching university courses, I have seen first-hand how the NHS system is struggling. I often have a pessimistic view on its survivability in its current form and I see private healthcare as a necessary evil.

Knowing that both suffered greatly, with Ms D having a huge quality of life improvement, makes me uncomfortable with the fact that this could’ve been avoided in Ms C’s case. I find myself feeling regret that Ms C hasn’t put her morals aside for the benefit of her physical and mental wellbeing.

The video below summarises my debate

Unwilling Immortality: The Stolen Cells of Henrietta Lacks

Posted on by

Previous to our lectures on bioethics, I believed that I had a very uncompromising way of assessing scientific ethical concerns: with some exceptions, the advancement of science was worth the cost of a few. From someone who grew up surrounded by scientific minds, this utilitarianism made sense. Why shouldn’t we strive for “the greatest happiness of the greatest number” as stated by Jeremy Bentham? However, since learning about watershed moments in history like the Nuremberg trials, I have learnt that not everything can be so easily segregated into right and wrong. This lead me to reflect on a scientific controversy that I had learned of in my previous year of study: HeLa cells.

What are HeLa cells?

HeLa cells were the first immortal human cell line to be created. Derived from cervical cancer cells, they were cloned in 1953 and freely given to researchers for use in labs. Since then, they have been at the forefront of many medical breakthroughs: from gene mapping to cancer research. Arguably, their most notable use was in the development of the Polio vaccine in 1952.

The Woman Behind The Cells

Henrietta Lacks was an African-American woman born in August 1920. She died of an aggressive cervical cancer at the John Hopkins hospital at the age of 31. Unbeknownst to her, one of the gynaecologist who performed her biopsies, Dr Grey, had removed a sample of the tumour for research purposes. He was able to isolate the cancer cells and thus create the first immortal human cell line: HeLa. Knowledge about the use of her cells was not revealed to the family until an article published in Rolling Stone until 1976. Since then, there has been much conversation about the unethical obtainment and distribution of Henrietta’s cells.

Henrietta Lacks

Learning from the Past

The main issue regarding HeLa cells was lack of consent. Although this was acceptable at the time, since then, Henrietta’s name has been shared alongside her medical record and even her cell’s genome. Following this, the Henrietta Lacks Foundation, established in 2010, provides grants to descendants, and families whose bodies have been used for research without consent. Henrietta’s descendants have worked tirelessly to create rules over the use of HeLa cells but there is still work to be done. Suggestions of revisions to the NIH Common Rule to protect human participants in US government funded research regarding consent have been put forward. In addition, there is a general consensus that institutions that have used HeLa cells must examine how they will right histories previous wrongs.

What are my Thoughts?

From a scientist’s perspective, the actions of Dr Grey seem understandable. To some, even justifiable. To me however, it is a clear example of where our thirst for knowledge clouds our judgment on what is morally right. Informed consent is a relatively easy standard to meet when obtaining samples for research, especially in cases such as these where the patient is of sound mind. I do not condone the actions of Dr Grey. Despite this, the argument could be made that to remove or limit both past and future contributions of the HeLa cells to modern medicine would be both a disservice to Henrietta. Without her, many scientific advancements would not have been possible. Instead, I think it possible to find a middle ground. One which allows the continued use of the HeLa cells in research whilst also acknowledging their origins.

So reader, over to you. What are your thoughts on the continued use of these cells?

Learn More

If you’re interested in Henrietta Lack’s story, you can find out more with these links below:

The Future and Ethics of Stem Cell Research

Posted on by

It is clear that the future of medicine lies in stem cell research, offering treatment possibilities to an enormously wide range of diseases using the body’s own healing mechanisms. Despite this, stem cell research faces many ethical implications (particularly embryonic stem cells), posing a dilemma between morality and furthering scientific innovation.

What are Stem Cells

Stem cells are undifferentiated cells that have the potential to become many types of specialised cells. The ethical problems lie in collecting the stem cells a there are two separate types: adult (somatic) and embryonic. Adult stem cells are multipotent, meaning they can differentiate into a wide range of specialised cells, but they are limited and they eventually sensece. In comparison, embryonic stem cells are pluripotent, meaning they can divide into any cell type.

Why are Stem Cells Useful?

The potential of stem cells is massive, it is believed that they could be involved in the cure for Parkinsons’s, Alzheimer’s and type 1 diabetes. Conditions relating to tissue damage could become things of the past as scarred tissue from liver cirrhosis or scarred heart tissue from heart disease can be replaced without the need for an organ transplant. They are also useful in laboratory purposes as they are useful in making ‘knockout mice’. Knockout mice are made from mating two chimeric mice in which you can remove certain genes, giving a great insight into what each gene does.

Ethical Concerns

Adult stem cells pose little ethical dilemma as all the methods used to extract them pose very little risk, the most common being a bone marrow extraction under local anaesthetic. Ethical dilemmas are raised when embryonic stem cells are used because it can be seen as destroying an early human life, raising the ethical question: when does a human life start?

While those who argue against the use of embryonic stem cells argue that the embryo has a potential for life and therefore the elimination of it is equivalent to the taking of a human life. The argument against this is that there are countless spare embryos after fertilisation procedures that would be discarded anyway, so scientific testing that could save and improve lives is not just permitted, but the right thing to do.

To combat these ethical concerns, a surprising discovery was made that by knocking out 4 genes, adult skin cells could be reverted into pluripotent cells. This helps deal with the ethical dilemma of harvesting the stem cells, but it raises more questions relating to the idea of human enhancement.

Conclusion

This ethical dilemma is a cornerstone moment for human scientific research because it creates a line between morality and scientific research. How far are we willing to go to understand how our body works? Is it okay to cross moral lines against embryos in order to save more lives in the future? At what point do biological enhancements make a person inhuman? The answers to all of these questions will be used as the precedent for the future of medicine.

Embryonic Stem Cells: Medical Breakthroughs vs. Moral Boundaries

Posted on by

What Are Embryonic Stem cells?

Stem cells have the unique ability to change into other types of cells, offering exciting possibilities for future medical treatments. The most versatile type are embryonic stem cells (ESCs), which can self-renew and are pluripotent meaning they can change into any cell type. These cells are collected from 3–5-day-old embryo called a blastocyst.

Image: A basic diagram of embryonic stem cells https://www.eurogct.org/embryonic-stem-cells-where-do-they-come-and-what-can-they-do-0

What can these cells potentially be used for?

In many diseases damaged cells cannot replace themselves. For example, after a heart attack, the body cannot replace lost heart tissue. Therefore, there’s a wide range of potential uses including treatment of Alzheimer’s, blindness, deafness, lung disease and autoimmune diseases. A key example from Shufaro and Reubinoffs paper in 2004 is in the treatment of neurological diseases like Parkinson’s disease and multiple sclerosis, which may one day be cured by stem cells.

Stem cell treatments are not only a futuristic idea. In his book, Embryonic stem cells and the law: crafting a humane system of regulation, Joshua Weiser shares his experience with a reoccurring tumour in his leg. The removal left him with scar tissue causing him a lot of pain. Stem cells were injected to allow new tissue to grow, which was lifechanging for Joshua, relieving him of his pain.

The ethical debate

Protest outside a lab in San Diego, California, in 2002 https://www.spiegel.de/fotostrecke/photo-gallery-the-future-of-stem-cell-research-fotostrecke-95152.html

The prominent ethical issue of ESCs centres on when life begins, at conception, or later in development. The Catholic Church for example opposes research involving human embryonic stem cells. In a conference for the Centre for Stem cells and Regenerative Medicine, the Catholic Bishops stated that “we must protect life at all times”.  

A news article example of an ESC protest https://www.nature.com/articles/21946.pdf

This statement from an interview with the president of the Harvard stem cell institute demonstrates the opposing view: “It is important to be clear about the embryo from which stem cells are extracted. It is not implanted and growing in a woman’s uterus. It is not a foetus. It has no recognizable human features or form. It is, rather, a blastocyst, a cluster of 180 to 200 cells, growing in a petri dish, barely visible to the naked eye.”. I believe the reason this debate is so divided is because once someone’s opinion has formed it cannot be changed and often no amount of evidence will alter this.

What are the laws?

Christopher Reeve https://www.yorkshirepost.co.uk/whats-on/arts-and-entertainment/christopher-reeves-story-uk-cinema-release-date-age-rating-runtime-cast-list-4844415

As opinions of ESCs are so varied, the laws can be very different worldwide. The UK has one of the most permissive set of laws with the Human Fertilisation and Embryology Act (legislation.gov.uk, 2008), which allows research on fertility, contraception, gene and chromosomal abnormalities, and potential disease cures. On the other hand, some countries do not allow ESC research, for example Italy, which prohibited ESCs in 2009.  A famous advocate for stem cell research was the Superman actor Christopher Reeve, who became quadriplegic after a horse-riding accident in 1995. The US was considering banning ESCs at the time and his inspiring work helped prevent this.

What Are The Alternatives?

To avoid ethical concerns, adult stem cells can be used, but these cells are limited as they cannot produce all cell types. In 2007 induced pluripotent stem cells (iPSC) were first discovered by Dr Shinya Yamanaka. This video shows how these cells are made and some of the ways they are used:

 I believe whenever possible, alternatives should be prioritised. However, in cases where there are no other options, I personally believe ESCs should be used and are justified, as the potential scientific breakthroughs could save lives. That said, it is important to consider the differing beliefs and therefore ensure informed consent is gained from anyone donating embryos.

References

legislation.gov.uk (2008). Human Fertilisation and Embryology Act 2008. [online] Legislation.gov.uk. Available at: https://www.legislation.gov.uk/ukpga/2008/22/contents.

Shufaro, Y. and Reubinoff, B.E. (2004). Therapeutic applications of embryonic stem cells. Best Practice & Research Clinical Obstetrics & Gynaecology, 18(6), pp.909–927. doi:https://doi.org/10.1016/j.bpobgyn.2004.07.002.