As medicine becomes increasingly tailored to individual needs, the one-size-fits-all approach is fading into the past. Thanks to advancements in stem-cell technology and tissue engineering, doctors are developing personalised treatments, designed for each patient. Among these breakthroughs, induced pluripotent stem cells (iPSCs) are pushing the boundaries of personalised medicine, offering therapies tailored to our unique genetic makeup. However, as this vision becomes a reality, critical questions emerge: how far can we take personalised medicine, and what hurdles stand in the way?

Stem cells in personalised medicine

Stem cells have a unique ability to self-renew and differentiate into various cells, making them invaluable in disease modelling and regenerative medicine. iPSCs, created by reprogramming adult cells to behave like embryonic stem cells (ESCs), offer a powerful tool in personalised medicine. As they are crafted from a patient’s own cells, iPSCs enable highly individualised therapies:

• Disease modelling: iPSCs allow researches to create patient-specific cell models to study diseases and test targeted treatments
• Personalised drug testing: scientists can predict how a patient will respond to specific drugs, minimising trial-and-error in prescribing medications
• Regenerative medicine: iPSCs can generate patient-specific tissues for transplants, reducing immune rejection and improving long-term success
• Gene editing: iPSCs can be genetically modified (e.g. CRISPR) to correct mutations, offering potential cures for genetic diseases

Advantages of iPSCs over past technologies:

iPSCs over embryonic stem cells

Unlike ESCs, iPSCs bypass the ethical concerns of destroying human embryos, making them a more widely accepted alternative, particularly in areas with stricter bioethical regulations. Since they are derived from the patient’s own cells, iPSCs are genetically identical enabling patient-specific disease modelling and reducing the risk of immune rejection – a major concern with ESCs.

iPSCs over animal models

iPSCs offer a more accurate representation of human disease, improving relevance and predictability of experimental outcomes, as physiological and genetic differences between species can give rise to misleading results in research. iPSCs also bypass ethical concerns in animal testing, allowing a more humane alternative approach to research and drug testing. Additionally, iPSCs rapidly proliferate in culture, allowing high-throughput screening that is difficult to achieve with animal models.

Balancing innovation and ethics

Whilst iPSCs evade the ethical dilemmas of past technologies, concerns remain:

• Privacy: iPSCs contain sensitive genetic data that could be misused
• Genetic manipulation: gene editing technologies may be exploited for enhancing traits rather than treating diseases
• Inequality: the high cost of iPSC therapies could make them accessible only to the wealthy, deepening health disparities

The first success story

In 2014, Japan conducted the first clinical study using iPSCs. Masayo Takahashi led a groundbreaking trial transplanting iPSC-derived retinal pigment epithelial (RPE) cells to treat age-related macular degeneration. Whilst promising, high costs and lengthy cultivation times posed challenges. Scientists overcame this by developing allogenic iPSCs from rare donors, making iPSC therapy more accessible. In 2017, five successful allogenic RPE transplants were performed by Kobe City Medical Centre and Osaka University [1].

Looking ahead

iPSCs offer unparalleled opportunities to redefine medicine, from regenerative therapies to truly personalised treatments. This marks a promising shift away from the traditional one-size-fits-all approach, paving the way for customised healthcare tailored to each individual. While challenges remain, continued research and innovation ensure that the future of personalised medicine is bright – and this is only the beginning!

[1] https://www.amed.go.jp/en/seika/fy2018-05.html

Organoids: what are they and how are they made?

Organoids are a three dimensional miniaturised version of an organ or tissue that are derived from stem cells.

Heart organoids look like the the picture on the left, and act and function like a heart does.

These heart organoids that have been engineered from stem cells can be used for a variety of research as well as have medical applications.

Heart organoids can be used for disease modelling, especially coronary heart disease, and can be used to see scenarios which include ventricular septal defects that can happen during maternity. They may also be used for regenerative medicine and tissue engineering, as they can be engineered to produce specific cardiac tissues, that can be used to treat medical issues; such as myocardial infarction and heart failure. The risk of heart failure in the USA has increased to 24% in 2024. This is expected to carry on increasing. At the moment heart failure is treated with either a pacemaker, heart surgery or medication. These measures only help prevent heart failure from worsening. Cardiac organoids can be used to restore the damage on the cardiac tissue as well as restore the damaged blood vessels. This is still in the preclinical stages of testing, however is very promising, but leads to the question of how and where will we get these stem cells that are required to form the organoids?

Stem cells are able to regenerate/differentiate into specialised cell types. There are multiple different types of stem cells, Multipotent stem cells, Pluripotent stem cells, embryonic stem cells and induced pluripotent stem cells.

These all have different functions through the human life and are needed at different times throughout growth.

What is the difference between embryonal and induced pluripotent stem cells?

Embryonic stem cells are acquired from early stage embryos (blastocyst) and are able to differentiate in to any cell type within the body, they have no limitations. However, the use of embryonal stem cells leads to ethical concerns and debates. The testing and growing of embryos leads to multiple questions, when is an embryo considered alive? How long do can this embryo grow for before it becomes a cause for concern? What testing is allowed on the embryo?

I think these questions will always be open for debate, due to there being no definitive answer to any of these questions, so where do scientist draw the line? At the moment there is a 14 day rule, and after 14 days the embryos must be killed.

Should this be extended, reduced or kept the same?

The other type of stem cell that can be used to produce organoids are induced pluripotent stem cells. These are created by altering adult (somatic) stem cells by using genetic factors. The use of induced pluripotent stem cells eliminates the ethical debate that using embryonic stem cells creates.

This video explains how induced pluripotent stem cells are made using transcription factors.

Is stem cells the future of medicine? Will scientists eventually be able to grow organs and use them as transplants? Only time will tell.

References

Aleksandra Kostina, Volmert B, Aguirre A. Human heart organoids: current applications and future perspectives. European Heart Journal [Internet]. 2023 Dec 16;45(10). Available from: https://academic.oup.com/eurheartj/article/45/10/751/7476619?login=true

Delivering cardiac organoids to help the heart to recover after a heart attack [Internet]. Musc.edu. 2025 [cited 2025 Mar 11]. Available from: https://web.musc.edu/about/news-center/2023/06/05/cardiac-organoid-delivery

Bozkurt B, Ahmad T, Alexander K, Baker WL, Bosak K, Breathett K, et al. HF STATS 2024: Heart Failure Epidemiology and Outcomes Statistics An Updated 2024 Report from the Heart Failure Society of America. Journal of Cardiac Failure [Internet]. 2024 Sep 1;31(1). Available from: https://www.sciencedirect.com/science/article/pii/S107191642400232X?via%3Dihub

As I walked through the corridors of the Education wing of the hospital and entered into the anatomy lab, I was intrigued by the specimens laid out in front of me. The solemn aura in the room overcame me as we explored the cadavers before us. A sense of immense respect for the specimens occupied the room. I began to reflect on the journey and evolution of ethical medical research that led to the situation I was, at that exact moment, standing in.

The Nuremberg Trials

During World War II, many deadly experiments on thousands of prisoners were undertaken without their permission. These experiments were undertaken without consent, in inhumane conditions, and with concerning research standards.

Such experiments were conducted with intention to facilitate survival of military personnel, test drugs, and advance Nazi racial goals. These included, and were not limited to:

• High-altitude experiments  (to determine the maximum altitude from which damaged aircraft crews could parachute to safety)
• Freezing experiments (in order to find treatment to hypothermia)
• Testing antibodies for treatment of contagious diseases (malaria, typhus, tuberculosis, typhoid fever, yellow fever, infectious hepatitis)
• Sterilisation experiments on children
• Experimentation on child twins
• Disfiguration and torture

From these experiments it is clear that no moral or ethical guideline was followed, especially in consent to being utilised in such examinations as highlighted by the tests on children. It has been since stated that those that died were dissected and studied, and their surviving twins were killed and subjected to the same scrutiny. The expendable nature of the subjects in these experiments, combined with the inhumane conditions, led to what would be known as, the Nuremberg Trials.

 “Survivors of medical atrocities are able to confront history and point to the inadequacies of care and compensation”

-Paul Weindling

From 1945 to 1946, 23 physicians and scientists were prosecuted for mass murder in the form of euthanasia, and human experimentation in Nazi concentration camps. They were under trial for their willing participation in war crime and crimes against humanity, with it sparking ethical questions in the medical approach to the inhumane experiments on prisoners in the Auschwitz concentration camp. As a result, seven of the doctors were found guilty and sentenced to prison, and twelve sentenced to death. From this significant trial was formed the Nuremberg Code, a statement of ten points delimiting medical experiments on human subjects , shaping the future of medical ethics.

The Nuremberg Code

From these trials was formed the Nuremberg Code. Consisting of a ten point statement , this code’s purpose was to delimit permissible medical experiments on human subjects.

In summary..

In the half century after the trial, the code informed numerous international ethics statements.It did not however have established legal force. Due to this, some argue that it would be incorrect to credit it as the framework on which ethical codes have since been based.

My Thoughts…

In my opinion, the Nuremberg code serves as a landmark document on medical ethics from one of the most significant humanitarian crises in history. For this alone, I believe that these ten statements have significance in the evolution of medical ethics of human specimens, acting as the baseline for further ethic codes developed afterwards, such as Beauchamp and Childress’ Principles of Biomedical Ethics (1979), and Medicines for Human Use (Clinical Trials) Regulations (2004).

Significance of Tissue Engineering

Whilst protheses are a good mechanism to improve patient quality of life and aid daily function, there remain limitations in which they may not fulfil the needs of the patient.

• They can only provide limited forms of support, meaning they are not appropriate for use with many medical issues

• Requires replacement on a timely basis

• Body often rejects them due to foreign material

Living biological materials may be better suited to meet medical needs – introducing the need for tissue engineering.

Following discussion on the limits of prosthesis, I thought about what biological materials would be structured for longevity in the body.

The Regenerative Nature of the Liver

The liver is the only organ which can regenerate damaged tissue – the organ has the ability to regrow around two thirds of the healthy cells. In line with this, reading led to me an ongoing trial which acts to use the regenerative nature of liver cells in order to help those suffering from end-stage liver disease.

Growing Mini Livers

The emerging medical experimental treatment is titled “Allogenic Hepatocyte Transplantation Into Periduodenal Lymph Nodes”

This entails the use of Hepatocytes, the cells which make up the majority of the liver, which are also allogenic cells, which are sourced from human tissue donors. Using these to try to successfully create an engraftment into the lymph nodes essentially aims to create functioning mini livers in the body!

The purpose of the trial is to help patients diagnosed with end-stage liver disease.

The main objectives of the trial are listed as:

Should we grow Mini Livers?

It is likely that participants will have to take immunosuppressants, as they would for other transplants, to help reduce chance of rejection.

I think that despite the participants potentially having to alter their lifestyle, if the trial is successful than benefits of the treatment would outweigh potential side effects. As end-stage liver disease can cause decreased life expectancy, treatment which counters this should be approached positively. I also believe the treatment would be significant because:

• There is a shortage of liver transplants so treatment may not be feasible
• Increasing liver mass through the transplantation of hepatocyte may be notably beneficial to those with end-stage liver disease

Liver disease is the only major disease in which mortality rates are rapidly increasing

Figure 1: The increase in mortality rates of major diseases

Available at: [https://www.alcoholpolicy.net/2014/10/liver-disease-profiles-highlight-alcohols-role-in-premature-deaths.html] (Accessed: 10/03/25)

I think this trial is significant due to the provision it seeks to give for a widening gap between life expectancy in comparison to other diseases. Whilst many other major diseases have shown decreases in mortality, liver disease has worsened rather than improved alongside other medical advances. I believe the implementation of new treatments is essential to address the imbalance between fatalities of liver disease in comparison to others.

Also, the idea of being able to have lots of mini livers is fascinating!

What are embryonic stem cells and what can they be used for?

An embryonic stem cell is a specialised stem cell derived from the early stages of an embryo, which is capable of differentiating into any type of body cell.  These stem cells have pluripotent properties, allowing them to develop into almost any cell type in the body, giving embryonic stem cells potential medical applications in regenerative medicine. In theory, these cells could be used to create whole new organs, potentially allowing embryonic stem cells to cure blindness, replace damaged tissue in spinal injuries and more!

The use of embryonic stem cells raises human life considerations, as their creation requires embryo destruction. This raises questions about when human life begins and its moral status, leading to the formation of the 14-day rule in response to these ethical concerns.

What is the 14 day rule ?

The rise of interest in the potential of embryonic stem cells began when Louise Brown, the first human born from in vitro fertilization (IVF), was born on July 25, 1978.

‘These spare embryos can be very useful … they can teach us things about early human life’

Robert Edwards, 1982

The UK Government established the Warnock Committee in 1982 under Dame Mary Warnock’s chairmanship to set boundaries for embryo research and medical practice. The committee took a pragmatic approach, focusing on political consensus rather than moral absolutes.

This framework led to the 14-day rule, which marks the period before primitive streak formation and the stage when twinning becomes impossible. However, this was done to bring ease to the public, rather than establish moral boundaries.

“The requirement for precision of setting a limit on embryo testing was not primarily based on scientific or philosophical reasons, but to “allay public anxiety”.

Warnock Report [11.19]

However, at the time, maintaining embryos alive in vitro beyond 14 days seemed technically impossible, making it a convenient limit for research, meaning that the rule was initially based on technical limitations rather than ethical considerations.

What are some of the modern lab techniques that have challenged the 14-day rule?

Modern laboratory techniques have challenged the traditional 14-day rule through groundbreaking developments. Among these, Stem Cell-Derived Gametes (SCDGs) represent a significant advancement in reproductive biology, enabling scientists to create egg and sperm cells from stem cells in laboratory settings. This technology opens new possibilities for fertility treatment, potentially allowing prospective parents with infertility and same-sex couples to have genetically related children.

The development of SCDGs has become particularly significant for embryonic research, providing an alternative to traditional embryo sources and helping establish the safety and efficacy of new reproductive technologies while bypassing ethical issues.

So Should We Protect Human Life Before 14 Days?

The question of whether human life should be protected before 14 days raises fundamental moral and ethical considerations as Human embryos possess inherent dignity and moral value from conception, and their destruction at any stage constitutes a serious ethical violation.

However, the 14-day rule arbitrarily distinguishes between equally valuable human lives, highlighting the need for consistent ethical standards. Modern imaging techniques and Stem Cell-Derived Gametes (SCDGs) now allow for detailed study without destructive research. The ethical implications of reducing the limit would further devalue early human life, while current restrictions protect vulnerable human beings and maintain fundamental human rights principles.

Bibliography

1.

What are stem cells? – Craig A. Kohn [Internet]. YouTube. 2013. Available from: https://youtu.be/evH0I7Coc54

2.

Appleby JB, Bredenoord AL. Should the 14‐day rule for embryo research become the 28‐day rule? EMBO Molecular Medicine. 2018 Aug 7;10(9):e9437.

3.

Jones DA. The injustice of destroying embryonic human beings [Internet]. Mercator. 2016 [cited 2025 Mar 11]. Available from: https://www.mercatornet.com/the-injustice-of-destroying-embryonic-human-beings

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Staff C. Bioethicists deplore relaxation of 14-day limit on human embryo research [Internet]. Catholic News Agency. 2021 [cited 2025 Mar 11]. Available from: https://www.catholicnewsagency.com/news/247880/bioethicists-deplore-relaxation-of-14-day-limit-on-human-embryo-research

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Buckley G. Embryonic Stem Cell – Definition and Uses | Biology Dictionary [Internet]. Biology Dictionary. 2019. Available from: https://biologydictionary.net/embryonic-stem-cell/

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Wikipedia Contributors. Louise Brown [Internet]. Wikipedia. Wikimedia Foundation; 2019. Available from: https://en.wikipedia.org/wiki/Louise_Brown

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Dawson J. Stem cell research – ethics & law. 2025.

What is ECM?

All tissues and organs contain the extracellular matrix (ECM), a non-cellular substance that serves as a physical scaffold for the cellular components and initiates vital biochemical and biomechanical signals necessary for tissue morphogenesis, differentiation, and homeostasis (1).

The structures and functions of extracellular matrices (ECMs), which are multifaceted, well-organised, three-dimensional architectural networks, are crucial for tissue organisation and remodelling as well as for controlling cellular functions. Collagens, proteoglycans (PGs) and glycosaminoglycans (GAGs), elastin and elastic fibres, laminins, fibronectin, and other proteins and glycoproteins, including matricellular proteins, are the constituents of these ultrastructures (2).

The most prevalent protein in human tissue and the most important part of the extracellular matrix is collagen(3).

ECM in healing

Healing is needed for several incidences for example surgical incisions or a clean laceration, soft tissue loss such as ulcerations, severe burns, and major surgeries.  These tissues heal with the help of several ECM components; granulation tissue formation, which is followed by the production of extracellular matrix (ECM), largely because of fibroblasts. Collagen provides tensile strength but leaves a scar this is because elastin is not produced which is present in the native skin(4).  

Current techniques involve the capacity of scaffolds to imitate native extracellular matrix (ECM) at scale makes their microarchitecture relevant to tissue engineering. This is believed to promote cellular ingrowth, ECM deposition, and the development of neotissue (4).

Tissue polarity and asymmetric stem cell division are maintained by the ECM acting as a point of anchoring for the cells. Growth factors can bind to many ECM components, regulating their release and presentation to target cells.  Because it creates morphogen gradients, this is particularly significant in morphogenesis.  Numerous intracellular signalling pathways and cytoskeletal machinery are activated when the extracellular matrix (ECM) sends mechanical signals to the cells(3). 

ECM-Based Therapies

Several scaffolding techniques are used to heal peri-implant soft tissues for example Decellularized human dermis, Human amniotic membrane, Bilayer collagen matrix, Volume-stable collagen matrix and many more(5).

The use of three-dimensional (3D) cell culture, Scaffolds, Hydrogels, Decellularized tissues, Microfluidics, Extracellular matrix (ECM) for cancer research as these techniques are more cost effective as well as ethical(6).

Through the transplantation of bone tissue engineering scaffolds to the bone defect site and the subsequent bodily replacement of the scaffold materials with new bone tissues, the combination of scaffolds, seed cells, and cytokines aims to repair the bone defect. Scaffold, a transient and synthetic extracellular matrix, directly affects cell proliferation and differentiation and can stimulate the growth of new bone(7).

Conclusion

The extracellular matrix (ECM) is a dynamic and vital component of tissue regeneration, directing cellular activity and the healing process. It is much more than just a structural framework. Scientists are creating innovative treatments, such decellularized scaffolds and synthetic mimics, that have great potential for mending injured tissues and organs by comprehending and utilising the natural features of the extracellular matrix. We are getting closer to a time when regenerative medicine may fully utilise the body’s own healing mechanisms as long as research into the ECM continues to reveal its full potential. In addition to providing patients with injuries or degenerative diseases with hope, this opens the door for novel, transformative therapies. The ECM serves as a reminder that sometimes the finer aspects of our own biology hold the secret to healing.

References

1.           Frantz C, Stewart KM, Weaver VM. The extracellular matrix at a glance. J Cell Sci [Internet]. 2010 Dec 15 [cited 2025 Mar 11];123(24):4195. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2995612/

2.           Karamanos NK, Theocharis AD, Piperigkou Z, Manou D, Passi A, Skandalis SS, et al. A guide to the composition and functions of the extracellular matrix. FEBS J [Internet]. 2021 Dec 1 [cited 2025 Mar 11];288(24):6850–912. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/febs.15776

3.           Walker C, Mojares E, Del Río Hernández A. Role of Extracellular Matrix in Development and Cancer Progression. Int J Mol Sci [Internet]. 2018 [cited 2025 Mar 11];19(10). Available from: https://pubmed.ncbi.nlm.nih.gov/30287763/

4.           Diller RB, Tabor AJ. The Role of the Extracellular Matrix (ECM) in Wound Healing: A Review. Biomimetics [Internet]. 2022 Sep 1 [cited 2025 Mar 11];7(3):87. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9326521/

5.           Tavelli L, McGuire MK, Zucchelli G, Rasperini G, Feinberg SE, Wang HL, et al. Extracellular matrix-based scaffolding technologies for periodontal and peri-implant soft tissue regeneration. J Periodontol [Internet]. 2020 Jan 1 [cited 2025 Mar 11];91(1):17–25. Available from: https://pubmed.ncbi.nlm.nih.gov/31475361/

6.           Abuwatfa WH, Pitt WG, Husseini GA. Scaffold-based 3D cell culture models in cancer research. J Biomed Sci [Internet]. 2024 Dec 1 [cited 2025 Mar 11];31(1):7. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10789053/

7.           Su X, Wang T, Guo S. Applications of 3D printed bone tissue engineering scaffolds in the stem cell field. Regen Ther [Internet]. 2021 Mar 1 [cited 2025 Mar 11];16:63. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7868584/

What is Brain-machine interface and how does it work?

In recent years, the field of neuroprosthetics has advanced greatly. Neuroprosthetic devices use Brain-Machine Interface (BMI), devices which translate signals from the brain to prosthetic limbs. These devices allow an amputee or a patient who has suffered a spinal cord injury to have prosthetic limbs which closely mimic the action of a natural limb. ⁽¹⁾

When a patient has a missing limb, the brain still thinks that the limb is there, and still transmits signals to the missing limb. A BMI picks up these signals using sensors, either electrodes on the scalp or brain implants. Some BMIs are more advanced and can send back signals to the brain, allowing prosthetic users to feel touch, pressure, texture and even pain. The Utah array is one example of this, an implant which allows the feeling of different textures and pressures. ⁽²⁾ The Modular Limb Prosthesis (MLP) is another example. In 2018, Johnny Matheny was able to play the piano with his MLP, and users have said it almost feels like a real hand. ^(3).

There are a lot of requirements for an implanted BMI to work, such as dealing with the hostile environment of the body. It’s unsurprising that an electrical device implanted into the most complex system known to man could cause an uproar from the brain’s immune system. Implants can cause inflammation which weakens signals and decrease the accuracy of the signal. Those in the field are still exploring materials which the brain would welcome i.e. increase the biocompatibility of BMIs ⁽⁴⁾.

Do we risk losing what makes us human? The ethical side 

Aside from the bioethics involved in many areas of medicine, such as the balance of risk and benefit, user safety, and unknown effects, the area of brain-machine interface raises a whole new set of ethical considerations. ⁽⁵⁾

A big one is the issue of humanity and personhood. The interaction between brain and machine raises the question of whether the machine is part of the person, or simply a tool. Could the person be considered a cyborg? Does it change their sense of identity? There are also considerations of whether the device actually changes the way users think and how it affects neural pathways. Going down this route, we eventually reach the question of what is it that really makes us human, and does a little device change that? ⁽⁶⁾

You could say that something like a missing limb changes the patient’s identity anyway, and that because of the improvement it brings to a patient’s life, using BMIs is worth it. You could also say that many medical interventions already link us with technology, such as pacemakers, so BMI doesn’t make us any more a ‘cyborg’ than any other medical device. However, BMI advancements do mean that nervous signals can be processed by artificial intelligence before reaching the prosthetic limbs, which raises questions of privacy. Does it open the possibility of thoughts being transferred to computers? It might sound far-fetched, but without appropriate regulation, the use of BMIs could lead to an almost dystopian man-machine hybrid. The field of neuroprosthetics has great potential for improving the lives of many people, and it is an exciting task which combines neuroscience and cutting-edge engineering. However, should BMI be treated with caution? Does it have the potential to alter our humanity? ⁽⁷⁾.

Sources:

(1) https://pmc.ncbi.nlm.nih.gov/articles/PMC3497935/#sec2

(2) https://www.wired.com/story/this-man-set-the-record-for-wearing-a-brain-computer-interface/

(3) https://www.jhuapl.edu/news/news-releases/210318-home-study-Modular-Prosthetic-Limb-Matheny-piano-Amazing-Grace

(4)https://www.sciencedirect.com/science/article/pii/S2452199X24003724#:~:text=Some%20materials%20trigger%20tissue%20reactions,response%20is%20minimal%20%5B42%5D.

(5)https://pmc.ncbi.nlm.nih.gov/articles/PMC7654969/#:~:text=Implanting%20the%20BCI%20sensor%20into,are%20referred%20to%20as%20the

(6) https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-017-0220-y

(7) https://pmc.ncbi.nlm.nih.gov/articles/PMC11091939/

Joint replacement has always been about restoration. It allows individuals to move again, to relieve pain, and live normal lives. But what if they could improve on that? What if implants did not only replace failing parts but enhance them? A knee that never degenerates. A hip that allows you to run faster. A shoulder that never tires.

For generations medicine has tried to heal the damaged, but we are moving toward a time when biomedical engineering could redefine human abilities to extend beyond biological limits. The question is no longer just how do we replace joints, but rather how much should we go in improving them? This raises profound ethical, legal, and social concerns–concerns we are possibly not yet equipped to answer.

The Science: When Repair Becomes Enhancement

Standard joint implants are mechanical prostheses–titanium, ceramic, or polyethylene devices that stimulate natural function. But new technologies are blurring the line between mechanical need and performance gain.

• Smart implants that monitor motion through sensors and real-time stress adjustments.
• Regenerative implants that include stem cells and bioactive material to merge into bone and muscle.
• Electroactive polymers that release minute electrical stimuli to stimulate healing in tissue and aid function.

If we can create a joint that is stronger, more effective, and less susceptible to damage than the natural one, is it still just a replacement? Or is it an upgrade?

The Ethics: Who Gets to Be Better

The idea of enhancement challenges traditional medical ethics. Joint replacements are typically reserved for those who need them, but if there are enhanced implants available, will healthy people start demanding them? Athletes, military personnel, and even everyday individuals in need of a competitive advantage may choose to have implants that exceed human potential. This raises serious questions about access and fairness:

• Will only the wealthy have access to bodies that have been upgraded?
• Would enhanced individuals be able to outperform others at sports, in the workplace, or even in everyday life?
• Would society begin to discriminate between the naturally gifted and the enhanced?

Medical advancements have always improved lives, but when do they begin to enhance social inequality instead? If these technologies become widespread, should legislation regulate human enhancement, or would this restrict personal freedom?

The Legal Gray Areas: Is an Enhanced Human Still Human?

Law struggles to keep up with emerging science, and enhanced implants raise difficult legal issues:

• If a person with a smart, AI-driven knee commits a crime, could their implant data be used as evidence against them?
• If an athlete has performed-enhancing implants, should they be allowed to compete in sports?
• If a person’s identity is tied to their body, does replacing biological parts with artificial ones change their legal status?

We have seen similar debates in gene editing and cyborg technology, but joint implants are a subtler, more immediate reality–one we may soon have to legislate.

The Future: A choice Between Healing and Advancing

We are standing at a crossroad. Do we use bioengineering to simply restore what we lost, or do we allow it to take us beyond natural human limits? Some will argue that enhancement is inevitable, and that as soon as the technology exists, people will demand it. Others worry that a world of enhanced bodies will divide humanity into the “natural” and the “modified”.

One thing is clear: joint implants are no longer just about healing. Whether we embrace enhancement or restrict it, we need to have these conversations now, before science makes the choice for us.

References

prezi.com. (2023). The Ethics of Enhancement. [online] Available at: https://prezi.com/p/u-qx9kjiuf4n/the-ethics-of-enhancement/ [Accessed 11 Mar. 2025].

‌chen (2012). The Ethics of Human Enhancement – SlideServe. [online] SlideServe. Available at: https://www.slideserve.com/chen/cognitive-enhancement [Accessed 11 Mar. 2025].

Shutterstock. (2025). 1,073 Advanced Prosthetics Images, Stock Photos, 3D objects, & Vectors | Shutterstock. [online] Available at: https://www.shutterstock.com/search/advanced-prosthetics [Accessed 11 Mar. 2025].

With the advancements in scientific technology continuing to push new discoveries, the concept of designer babies has posed excitement along with controversy. The modifying of embryos to select desirable traits such as intelligence, appearance and resistance to genetic diseases have been made possible through techniques such as CRISPR. Amongst the potential this technology has to eliminate hereditary illnesses and improving the health of a population, there is a concern regarding the ethical considerations. The statements in questioning: ‘could genetic editing widen social inequality’ and ‘ should it be allowed for the parents to dictate their child’s genetic makeup’ are still being pondered. This matter is urgent now more then ever as technological advancements show designer babies being a reality in the near future.

What Are Designer Babies?

Designer Babies are Babies whose genetic make up has been selectively chosen or altered for the advantageous reasons of enhancing beauty, intelligence or for the freedom of diseases such as cardiovascular disease via removing and excluding particular genes.

How is the genetic code modified and altered?

In order for an embryo to be modified it must first be screened. Pre-implantation genetic diagnosis (PGD or PGDI) is used to profile the embryo, which is useful for when one parent is a carrier for a heritable disease such as colour blindness. The selectivity of the genome is carried out by the removal of an inferior gene by nucleases where it’s then replaced by a superior gene with better adaptability. CRISPR is a common technology used where RNA guides the nucleases. It’s being investigated that this technique has the chances to help treat HIV and potentially even mitochondrial disease.

“We use a pair of molecular scissors and a molecular sat-nav that tells the scissors where to cut” Dr Perry, University of Bath based, told the BBC. This cutting allows mutations to be cut, along with insertion of new pieces of genetic code at the site of the cut. However, further studies are needed to assess the effectiveness and safety in the long term, as it could cause other unwanted genetic modifications that are undesirable for future generations.

An ethical concern?

The designer baby process is labour intensive, requires great intelligence, advanced technology and can only be accessed by developed countries and individuals who can afford it. The ethical remarks thrown into question include the ideas of social justice and the question of individuality being taken away. From a bioethicist, if a parent is allowed to choose the biological characteristics on behalf of their offspring, does this violate the child’s right to live as an independent individual? Additionally, there are thoughts that germline modification would contribute to the widening of the social inequality gap. If these techniques are only available to the those who can afford them, how’s it fair to those suffering the burdens of genetic diseases and can’t afford the treatment creating disparity.

The benefits

PGD can be used to scan for 600 genetic diseases according to the human fertilisation and embryology authority, HFEA. This can help to reduce the risk of threating genetic alignment in unborn babies and avoid parents transferring genetic conditions to their babies. It’s said that new gene editing could correct up to 89% of genetic defects including diseases such as sickle cell anaemia.

An open conclusion

Genetic engineering holds potential benefits like eliminating hereditary diseases and improving quality of life but genetic enhancement for non medical traits such as appearance and intelligence complicates discussions further, as it deepens the social divide and ultimately challenges the fundamental values of diversity and acceptance. A balance is essential to ensure genetic engineering serves humanity in a fair and just manner, as designer babies put scientific advancements and moral responsibility against each other. This can be monitored by careful regulation and ethical oversight into societal impact.