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Home , Synthetic biology

Ethics and Synthetic : Four Streams, Three Reports Josep Egozcue Thomas H. Murray Lectures Contents

• Introduction Victoria Camps...... 3

• and Synthetic Biology: Four Streams, Three Reports Thomas Murray ...... 5

• About the author ...... 19 Reports of the Víctor Grífols i Lucas Foundation Ethics and Synthetic Biology: Four Streams, Three Reports (2012) Edited by: Fundació Víctor Grífols i Lucas. c/ Jesús i Maria, 6 - 08022 Barcelona • Publications ...... 20 [email protected] - www.fundaciogrifols.org ISBN: 978-84-695-4223-1 Josep Egozcue Lectures Introduction been interestedbeen issue inthe and contributed some regarding observation safe to say national that, since committee almost then, every has and contrasted applications those with fundamental values. It ethical is concept,the possible analysed the applications of various the techniques and one year later, in2011,it presented an excellent report that clarified CommissionThe political legal social. andconflicts –ethical, got to work to produce areport on synthetic and different the biology all foreseeable request that Presidential the Commission for Study the Issues of Bioethical of United the States, . Obama’s immediate reaction was to and it that seems one of firstthe thealarmed was be toPresident may bring. Information on Venter’s it the was alarmed unlucky; discovery informed of discoveries new the and possible the benefits risksthese and term of synthetic is how biology is spread news the and how people are innovations such that as those are grouped together under umbrella the and techniques. secondissueposed Theby ethical for that illnesses curing are currently incurable to biological new systems various techniques with different objectives, rangingfrom therapies new is “biological defined biology as engineering”,that a term encompasses well as establishing benefits which risksand mayfrom arise it. Synthetic biology, concept a new that requires still definition and understanding, as that inquestion discovery the was one of possibilities the of synthetic a number issues. of The ethical first and most general these issues of is scientists were who consulted, matter the was far fromand raised trivial Although content the of was immediately story the contested by first the quick to announce that created had been artificially, forthe first time. ”. Thewas a hotnews topic aroundthe world and headlines were DNAthe of an , creating “the what called they first synthetic A couple of years ago, and his team were able to synthesise Introduction 3 Josep Egozcue Lectures immediacy, simplicity and sensation. making public such complex issues through that media above seek, all, patents and Pérez disadvantages the Oliva discussed and challenges of Romeoperspectives, Casabona addressed, in particular, issuethe of The first synthetictwo from analysed scientific biology and technical juristSolé, Carlos Romeo Casabona and journalist Milagros Pérez Oliva. followed by around table attended by scientists Luis and Serrano Ricard information regarding scientific discoveries. Thomas Murray’slecture was intention of putting emphasis particular on issue the of disclosure and Communication of Pompeu the Fabra University (Barcelona), with the face of synthetic biology.Conferences The took place the at Faculty of his opinion personal attitude on ethical the that must adopted be inthe that document, he which explained introducing during while his speech, draftingthe the of report, betterMurray thanknew anyonethe content of of of institution view the he was directing. As afirst-handparticipant in United States Commission toissue the discuss and put forth points the Center in New York. Murray is one of peoplethe appeared who before the Murray was, who until recently, President the of prestigious the Hastings variousthe issues. Thethe chosen to conference speaker open was Thomas Egozcue Conferences to introduce subject this and spark discussion about The Víctor Grífols i Lucas Foundationthe context used the of annual Josep synthetic biology. of and samethe clarifying purpose enriching debate the on future the of Portuguese(the committee) bioethics recently produced a report with together with ConselhoNacional the deÉtica para as Ciências Vida da synthetic biology. For example, Spanishthe Committee, Bioethics the Josepthe Egozcue Conferences. controversial.ethically Thatthe intentionis this of new publicationfrom to promote interdisciplinary debate with dealing matters when that are touse anyone. Thatwhy is the Víctor Grífols i Lucas Foundation seeks speculation about concepts that is not intouch with reality and is of no withoutfacts, analysing what reflection synthetic is,is a ethical biology Center with Murray which Without beganhis speech. knowing the facts,” with good “Good begin ethics is amantra from The Hastings problems.serious social that it is not to easy manage advances inorder inscience to solve most the determine what “improving” and “better quality” mean, samein the way and providing better quality of life. However, it is not always to easy biomedicine works with ultimate the objective of improving people’s responsibleis partly for shaping future the of humanity. It is clear that citizens –must involved be two viewpoints, with these everybody because creating living new . –scientists, governments Everybody and and contemplate what limitsthe should on be controlling and it need who most.those As regards principles, to consider it is necessary demands, first and foremost,that it mustbenefit the underprivileged and biology, inmind requirements bearing the of principle the of justice which main the possible be beneficiaries the of will who applications of synthetic techniques donot outweigh benefits. the to consider necessary also It is to employ principle the of precaution and ensure that risks of the new consequences and principles. As regards former, the it is necessary Ethics questions scientific innovationsfrom two viewpoints: the Professor of Moral Philosophy at Autonomous the University of Barcelona and President of Víctor the Grífols iLucas Fundation Introduction Victòria Camps 4 Ethics and Synthetic Biology: Four Streams, Three Reports Thomas H. Murray Senior Research Scholar and President Emeritus of The Hastings Center Josep Egozcue Lectures of synthetic are biology currently arrayed. being illustrate principlethe dimensions analysesalong and which ethical policy additional organizations as signatories. Taken together, three the reports is credited groups to three society civil with more than one hundred other US,the the jointly Spain between and Portugal.third The report Two of reports the were produced by national one in bodies: bioethics consider three influential that reports illustrate the range of reactions. label «synthetic and biology» its putative benefits risks,and will we Following a description of majorthe variants gathered under umbrellathe come with it incheck? positive development of keeping synthetic while biology risks that the inorder used be to optimum the strike promoting balancebetween the assessment of risks,the and what governance measures can and should Third,what canbe done to providesophisticated, a scientifically grounded applications at while same the minimizing time or managing risks. the Wise to public support seeks rapid policy the development of beneficial and technological innovations routinely bring potential benefits risks.and risks provoking concern among knowledgeable commentators? Scientific it—promise, how likely are and realized to be they what are principal the Second, what synthetic benefits does its advocatesbiology—as describe one thing or many things brought together under an umbrella label? frontiersscientific the lifesciences? in Forthat matter, is synthetic biology to include , genetic engineering, and other scientific and developmentstechnological in broadlybiology understood as its proponents claim, or is it better understood as an incremental step in wefacts, must ask what synthetic is. Is biology it something distinctly new with The Center’sHastings principle beginswiththat good ethics good and governments requires answering three questions. First, inkeeping Understanding what synthetic requires biology from citizens, institutions, (or inspired) systems display which functions that donot exist innature. synthesis the of engineering«the of complex, biology: biologically based The EuropeanCommission’s it report as on synthetic described biology Four Streams of Synthetic Biology compounds. Theknown strategy as -combinedtherapy (ACT) treat combine malaria artemisinin-derived with other drugs anti-malaria dying are children insub-Saharan Africa. roughly 863,000diefrom More disease. the than 80percent of those 243 million people become symptomatic year while every with malaria biology: genetic engineering as synthetic Contemporary as synthetic biology». stream: this as such. «contemporaryadvertised Call genetic engineering not as labeled «synthetic though somebiology» lines of work have been of sophisticated the research now inmolecularbiology done being is a continuation of advances over in molecular biology Much decades. the ofmodel electronic or software engineering. Indeed, it is more directly under broadthe umbrella of synthetic least resembles biology the associateddesign with engineering. The first the of fourstreams included more amatter of hit or miss tinkering than of rational, the systematic complex enough to make hijacking metabolismtheir for human purposes than designing one from bottom the up. Even «simple» organisms may be label suggests. Scientists typically work with existing organisms rather organismsbetween is a far more bespoke activity than «engineering»the practicing «geneticbeen engineering» for But decades. swapping rational, systematic Astute . note will that observers scientists have emphasizing an engineering approach to biological systems along with have bodies Other adopted similar accounts of synthetic biology, ofdesign “biological systems” inarational and systematic way». of biological structures… In enable essence, synthetic will biology the perspective Thismay engineering be applied levelsall at the hierarchyof Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology: 2 The potentmost therapies to

Thomas H. Murray Approximately 1

6 Josep Egozcue Lectures biological much systems very of model inthe engineering. suchbiology as DNA-based construction, envisions which device than evolutionary development. But there are other strains of synthetic difficult thatmake to the case it representsrevolutionary change rather were entirety the of what is now synthetic biology, called it would very be Boyer’s pioneering work on recombinant DNA early inthe 1970s.If this with atradition of biological experimentation with roots inCohen’s and along with similar efforts by competing teams, exemplifythe continuity commercially viable biofuels. team is using similar techniques inan effort to engineer microbes to make work as synthetic that biology.) is described being same Thescientific themselves practicing to «synthetic be doand biology» artemisinin the whatbetween contemporary molecularbiologists donot who consider product. (It is important to acknowledge in difficulty distinguishing the first significant large-scale production of synthetic useful any biology therapeutic application attributed being to synthetic biology, indeed,the Biosynthetic artemisinin is candidate asolid for first the significant derivedbotanically artemisinin. at dose costthe per 25to 50cents, significantly lowerthan the price of commercial production commence will later year this or in2013,with metabolic developedwhich the pathway for synthetic artemisinin, claims three chemical stepsvia into artemisinin. tothem produce artemisinic acid, aprecursor that is readily converted refined tools traditionalof engineeringgenetic on cells to coax variations. Ateam of scientists by led Jay Keasling increasingly the used developing world. The supply is subject to climate conditions seasonal and Sweet Chinese harvesting the Wormwood plant, which is grown in the As of June 2012,artemisinin is only available commercially through strains of parasite. malaria the is intended to delay or prevent development the of artemisinin-resistant 7 These These research and development programs, 3, 4 6 4, 5 Amyris , synthetic proposed biology that biological systems imagined in could be engineer the desires.early Thepurpose developers and proponents of resistors, of from can myriad parts design they which devices. DNA-Based Construction: Device adaption environment to a particular at time. More a particular likely, what would «perfection» consist of except as ametaphor for successful environmental particular in their niches, but it’s difficult to imagine or goEnvironments extinct. they change. Speciesare more or less successful foreign to biology. of organisms adapt to environments-- their as a machine. that, Beyond that idea the nature seems «perfected» can be and revised can improved». be consider nature amachine, to be you that can see it isand not that perfect it , of aleader the movement, «ifyou hadto this say: hope to redesign biological systems according to an engineering model. and , may which great pose challenges who to those inelectronic systems,occur biological organisms are characterized by «simple»so-called intact organisms, are complex. While feedback loops visionthis achieved is can not be yet known. Biological entities, even predictably and inconformance with engineer’s the intentions. Whether and standardized and that assembled can be into systems that behave construction ingeneral is to bold: create biologicalthat parts are simplified Thevision animatingthe BioBricks movement and DNA-based device property characterized by software movements suchLinux as and Firefox. BioBricks movement embraces also open-source the of model intellectual contributors, be to also following principal the «give some, get some». The Standard Biological Parts» was created at MITin2003. characterize, catalogue and shareof biologicalThe «Registry «parts». BioBricks movement, for example, is acollaborative effort to identify, using terms such as sensors, actuators, motors, and switches. The an analogous fashion, conceiving of dynamics the of genetic expression Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology: and other components assembled can be to accomplish whatever 9 Many premise the reject of nature Electronics engineers have catalogues Transistors, capacitors, Transistors, capacitors, 8 It encourages users

Thomas H. Murray

7 Josep Egozcue Lectures with ones the synthesized specified inserted, by . Other prominent on grounds the that over of time, all ’s the structures were replaced Venter resulting the and colleagues describe entity as a«synthetic cell» keep organism the functioning. chromosome was able to provide genomic the to instructions necessary against invasion by foreign DNA haddisabled. to be Eventually, new the capricolum Mycoplasma synthesized this genome inserted they into aclosely related bacterium, marks with no effect the on organism’scapacities.functional Finally, as genomiccanbe described «tattoos»--decorativeThese identifying afew «texts»--theadded authors’ names, some quotes and an email address. complementfull of ever longer strands untilhad acompletethey finally chromosomewiththe scientiststhe yeast used cells to stitch lengths the of DNA together into pairs inlength), together which genome. replicated bacterial Then full the to produce 1078relatively short lengths of DNA (eachone was 1080base pairs),commissioned(1.08 million base they aDNA synthesis company DNA the ascertaining sequence of amicrobe with arelatively genome small to produce what claimed they was first the «synthetic cell». recent accomplishment was work the of Craig Venter and colleagues towards creating or recreating whole organisms. The mostwidely hailed Creating Cell: aMinimal aspirations. suggest also importantperfectibility differences inconceptual models and emphasisthe on such themes as standardization, interchangeability and biologists historically have understood and manipulated such entities; but way of about thinking biological entities that has clear affinities with how as cancers. Thevision of DNA-based construction device withbrings it a or as sensors acting that would provide early warnings such of diseases some specific perhapshuman purpose, producing biofuels or medicines, Endy is referring to redesign the of abiological systemoptimally to fulfill Mycoplasma mycoides’s . An inthe A third stream of synthetic works biology 11 DNA sequence, to they which M . capricolum that protects it 10 After 10

genome. cell. One could justbacterial as well say that «adopted» cell the its new to it into intact, hadinserted toclosely be related an otherwise functionalThe genomethat was, infact, of an existing organism. In order artimisinin, when it when artimisinin, produced can be insufficiently largequantity ata low is closest achievements. the to practical The introduction of biosynthetic fourOf the streams, contemporary genetic engineering as synthetic biology movementthis is far succeed from will certain. Ironically, it may possible be to create a «non-organic» biology. Whether such as mechanisms for , control, organization, and replication. components of acell, including essential the functions identifiedwith life proponents aspire to redesign, synthesize and assemble basic the normal, orthodox biological cells». endoplasmic reticulum or any of other the innumerable trappings vital of membranecell of ordinary the no nucleus, type, no mitochondria, no biological ingredients: no DNA, no conventional , no entity, albeit one noton and biology based not made out of customary the its as goal creatingsynthetic describes biology «agenuinely living new : as targetsused for genes new and combinations of genes. to organisms such as should noted be that «chassis» the metaphor could just applied as be easily building of organisms performing varietyof awide differentfunctions. It synthetic biology, such achassis as afoundation used could be for the builtbe up into apassenger car, station wagon, SUV or pickup For truck. vehicle to added build particular the desired.be same The chassis could an automotive chassis: a structurebasic onto which other components can One of potential the of uses cells minimal is as a chassis on of model the scientists suggested that alternative descriptions were more accurate. Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology: Ed Regis, a leader of a leader Regis, Ed movementthe to create a new, completely e .coli and yeast that molecularbiologists have long 13

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8 Josep Egozcue Lectures widely available. such as DNA sequencing and synthesis have become cheaper and more movement. Communities of DIY biologists have emerged as wish, includingthey engineers and budding the Do-It-Yourself (DIY) Bio investigators and designers eager to make biological systems do what traditional molecular biology. First, bring they communities new of appearbiology to share two features that to distinguish begin from them Whatever differences their from one another,the four streams of synthetic initsbiology quest for novel chemistries of life. tradition, and Protocell the movement bursts traditional the bounds of DNA-based construction represents device break even asharper with techniques, but its ambitions have more than ahint of novelty to them. synthesis and assembly may an be outgrowth of well-established those Work on cellsminimal and organismic chasses employing large-scale DNA artemisinic acidcomes directly from long-established those currents. genetic engineering that enabled creation the of yeast able to synthesize divergethey from main the currents of molecularbiology. The advanced The four streamsthat comprise in how synthetic vary biology much Dueling Narratives: Continuity Novelty versus Radical have major impacts on our lives or our planet. accomplishmentstheir to date cannot tell us ifany which ultimately will movement--tell intriguing stories about potential their significance. But construction, creationthe of cellsminimal as chassis, and protocellthe «synthetic» biology. The three other streams--DNA-based device of other developments that inmolecularbiology don’t labelthemselves notedbe that stream this is most the difficult to distinguish from a host as apotentially significant contributor to humanbeing. well But it must per-dose mark price, will of arrival the stream this of synthetic biology engineers working insynthetic risks oversimplification biology and categorical goals the distinctionand between mindsets of scientists and emphasizes standardization and control. Any effort to draw a sharp, engineering away mindset, of about thinking biological systems that secondThe shared featuresort of whatparticular is a mightcalled be with and mindset communities the participating there init. are So good sources The primary of novelty for synthetic have biology mainly to do . with dealing organisms when take capable of , adaptation, and with biological systems to shape what learn obligations particular those have obligations; ethical but have they not of had decades experience of scientists to same. dothe Engineers have acknowledged also that they responsibility responsibly to them use and to train coming generations powersnew to dogood--or harm. Andpowers with those came moral the with advent the of recombinant DNA, that was acquiring science their evolutionthe and governance of synthetic biology. Biologists recognized, There are differencesother among the communities that bemay relevant to «An alternative to understanding complexity is to get of rid it». BioBricks movement, succinctly characterized engineering this mindset: aim of to standardize efficiency. service inthe Tom Knight,leader a the of simplifying abstractions or building novel biological entities; engineers properties and complexity that evenwhen understanding entails creating molecular engineers to Scientists design. to look understand emergent to Scientists, on one the hand, have to goal as aprimary operates.biology and continua that help tothe define dimensions whichwithin synthetic endpoints. But it endpoints to maythose identify useful nevertheless be most investigators in synthetic somewhere the falling biology between exaggeration. Perhaps it is more helpful of to think acontinuum, with build, predict and control and predict build, Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology: . Molecular biologists to discover, seek understand

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9 Josep Egozcue Lectures the mostthe often toutedbenefits risks.and of Spain bodies Bioethics and Portugal, reports, along these discuss with onewill issued jointly by national the surprisingly, found they less reason to fear it or to regulate it harshly. biology’s continuity with and molecular biology genetic engineering. Not for Study the Issues, of Bioethical on other the hand, emphasized synthetic issued by anumber groups. of society civil The US PresidentialCommission with assertions abouttypically begin its novelty, as recent inthe report unknown.the Indeed, most the stringent criticisms of synthetic biology found inits safety record is not available. With novelty comes afear of genetic engineering, whatever reassurance have might otherwise been is enterprise, a new distinct from and decades-old methods the aims of have devised them largely abated. research until and better risks could the assessed be strategies to minimize of genetic engineering that prompted scientists to declare amoratorium on Of course, novelty have can also its disadvantages. Fears about dangers the scientists can declare that what are they doing and is new different. in genetic engineering are less of adrag on public perception when companies.new The long-unfulfilled promises ofrevolutionary advances help to attract funding form inthe of government grants or investments in popular and attract enthusiastic teams of young people. BioBricksnew and assemble to them performsome novel are function, iGEM competition, where college and school students high work to create novelty. New frontiers and inscience spark interest. The annual Proponents of synthetic have biology many reasons to emphasize its to portray synthetic as something biology new. radically reasons to favor continuity the narrative and to challenge wish who those 16, 17 To extent the that synthetic biology 19 following abrief description of 15 Novelty can also 18 I supplies of many including other drugs, some that are now expensive or benefits.Along with synthetic artemisinin may come plentiful, cheap Advocates for synthetic imagine biology an astonishing array of potential Risks andSynthetic Benefits Biology: that was far more transmitted easily among ferrets preferred (the as recent the concern over research that produced avian flu (H5N1) virus available, and scientists are profoundly reluctant to censor information, create pathogens. But materials the are needed likely increasingly to be terrorists equipment, the reagents, and information would to they need --have for look experts ways increased. to Security deny about malicious non-state actors ofmaking use synthetic biology-- recentthe of known rise DIY (also as biology «garage» worries biology), As it to becomes easier manipulate organisms, a reality underscored by agreements becomes evermore important. vigorous enforcement of effective, binding internationaltreaties and other makesbiology it for easier arogue nation to create biological weapons, the nations ways can devise to weaponize To them. extent the that synthetic to create necessary can assemble such pathogens, expertise the and to synthetic for use of biology biowarfare. purpose the could try Nations cause grave harm to people, agriculture or environment. the Nation-states makers was prospect the of intentional the creation of pathogens meant to But there are risks as well. Among first the to come the to attention policy of of and new, gentle ecologically stocks feed for industry. toxic spills: advocates envision far more environmentally sources friendly oceans or environmentally sensitive areas with ever-present the danger of No more of extraction oil from tar sands, to no need transport oil across manufacture alternatives fuels and to -based other products. envisionOthers of ponds organisms full that rely on to able to convert wastes agricultural or other plant-based inputs into biofuels. in short supply and others yet imagined. to Synthetic be organisms may be Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology:

Thomas H. Murray

10 Josep Egozcue Lectures recommendations mentions «suicide genes» any that kill would in theory intoescape environment, the what are risks? The the PCSBI in one of its or iforganisms meant contained to be inmanufacturing vats or ponds environmental remediation or to clean up oils spills or industrial accidents, If organisms created with help the of synthetic are biology for used systems failures or natural catastrophes such as earthquakes and floods. environment through accidental failures of containment due to carelessness, families and neighbors. Dangerous organisms cantheir find way into the infection the through with to them their sticks accidental and needle carry Laboratory workers with dealing dangerous organisms infected can be avian flu research just mentioned did not, in fact, rely on synthetic biology. risk; biological researchers can cause unintended harms inmany ways. The and release of something harmful. Bioerror is not of course an entirely new raises possibility the also biology of «bioerror»--the unintentional creation Biowarfare and bioterror are not only the causes for concern; synthetic apathogen tomodify increase its transmissibility, at least. the recent H5N1studies have altered assessment the of how difficult it is to and availability the of prophylactic or therapeutic interventions». host susceptibility, agent’s the infectivity, transmissibility and virulence, agents are dependent upon coordination the of multiple factors including sequence. Furthermore, consequences harmful the of biological genetic elements that properties underlie these rather than one specific understanding reveals that it is oftenthe combination or interaction of forBoard (NSABB) reported in2006that: «Current scientific regardedhas been as quite difficult. TheUS ScienceNational Advisory Making a novel pathogen that effectivelycould be in warfare used biological and likely to require resources the of anation. create apathogen, weaponizing it for is immensely delivery more difficult offer one reassuring piece of information: howevereasy it maybecome to analogueexperimental to humans) has shown. 21 20 Experts inbiowarfare Experts 22 The The (a well-known phenomenon we «microbial inbiology could call French- mutating, adapting, and exchanging genetic material with other microbes or ifsynthetic organisms biology would behave like other living things, confidentcan be that such built-insafeguards would work as intended, such organism. But agreat of deal research remains done to be before we they do--orthey donot--say about eight issues specific is Therevealing. issues organizing and presenting findings their and recommendations. Butwhat The emphasizereports different subjects differentand embody ways of Directions, Synthetic Biology, and Principles for Oversight followingthe refer discussion Iwill reports to respectively these as endorsementthe of over a hundred organizations. society civil International Center for Technology Assessment, and ETC Group, with of Synthetic Biology Ethics for Council and Life the Sciences; report by Spanish the Committee Bioethics and Portuguese the National Commission for Study the Issues; of Bioethical Synthetic Biology and supportive to staunchly opposed are: onviews synthetic biology.from Threethat markgenerally a spectrum National groups and society civil bodies bioethics have offered arange of Policy and Governance issuesmake these take up aliving. discussion Iwill inthe of that report. can get for Sweet Chinese Wormwood, potentially affectingtheir ability to biosynthetic artemisinin is likely to affectthe developingprice worldgrowers dislocation and injustice. groupssociety raise additional concerns about cultural and economic In addition worries to about these and health environment, the some civil kissing».) Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology: 18 , a report distributed by Friends U.S., of Earth the the 17 They point They out, for example,that the production of New Directions: The Ethics of The Principles for Oversightthe , from USPresidential the Synthetic Biology

Thomas H. Murray . 18, 19, 17 , ajoint New New In In

11 Josep Egozcue Lectures criteria». «principle of precaution» but expressly notes principle’s the «flexible The Spanish and Portuguese embraces also whatreport the calls it and commercial of use synthetic organisms». structures for oversight and regulation and for amoratorium «on release the Principle applied be to synthetic biology. Theexplicitly calls report for new something novel and therefore threatening. urge They that the Precautionary claim to have created a synthetic cell. The authorsportray synthetic as biology as reassembled the 1918influenza theandpolio viruses and Venter team’s rehearsed claims about synthetic and biology mentioning such particulars effort to defendingthe claim about significant hazardsbeyond reciting well- economicsocial, challenges». and ethical significantsafety health, and environmental hazards, as well as profound Risks: risk, justice and governance. engineering» on other the hand, synthetic an biology calls «extreme form of genetic precautionsnecessary must always taken». be sector.health Its development must therefore supported be though the development for humankind in variety a ofwide the sectors, especially first recommendationsays that the field «represents a potentially beneficial encourage innovation through licensing and sharing. issues; peer-review to use most the identify promising research; and biology, including research on risk assessment and and social ethical governmentthe to coordinate and evaluate public funding for synthetic frombenefits synthetic biology. Its first threerecommendations urge Benefits: where stand they on continuity/radical the discontinuity question. issues;justice; and, ethical underlying many judgments, of particular their are: benefits;risks; governance/regulation;patents; the role society; of civil

Principles for Oversight for Principles 19

New Directions This marks a sharp difference in tone from the 17 and makes no mention of possible benefits. is Its focus on is ingeneral quite optimistic about potential asserts that synthetic biology «poses that asserts synthetic «poses biology 17 The not does devotereport much 17 19

Principles for Oversight for Principles Synthetic Biology’s Principles for for Principles , there is an emergency products». circumstances or following afinding of substantialequivalence to approved intentional field releases--but the door opens to exceptions «inemergency In Recommendation 7, to limit or prevent should fromifthey them containment. escape surviving research on that barriers technical built could be into synthetic organisms directed at preventing inadvertent releases of synthetic organisms, and for of synthetic organisms. The calls for safeguardsreport and monitoring that may exist inhow government would respond to proposed field releases government agencies inassessing risks as well as for an analysis of any gaps known. areas It they otherwise for calls better coordination among as «low-probability,it describes potentially high-impact»--catastrophes, an emerging field for understandingrisksthe risks, particularly events of The the report challengeposed by recognizes novelty and uncertainty in agencies or oversighton synthetic specifically focused biology». bodies agencies:new Commission «The no sees need timethis at to create additional applications, report the suggests prior authorization would advisable be dealt with by risk management, monitoring, and follow-up. For certain risks such as are dual use acknowledged but regarded as appropriately more ominous account of risks likely the to arise. In Oversight their counterpartstheir US. inthe authorization suggests authors the might amore take cautious stance than of amoderate form of Precautionary the Principle and emphasis on prior any explicit recommendations regarding field releases but its endorsement were likely horrified thethis; at Spanish/Portuguese not does report offer may permissible. be The authors and signatories to equivalent to one that exists, afield then without release priorrisk assessment Recommendation 4in agencies are for, called and no moratorium is recommended. monitoringalong with periodic and No inspection. regulatory new Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology: report, not surprising latter the because document offers afar 18 This is a notablylarge loopholeframed as an either-or: or if or New Directions New Directions the synthetic the organism substantially is deemed includes an explicit judgment about calls for calls risk assessment prior to Principles for Oversight for Principles

Thomas H. Murray Synthetic Biology

18 if if ,

12 Josep Egozcue Lectures Principle; Require mandatory syntheticregulations; biology-specific Protect cover broad range avery of issues. include: They Employthe Precautionary organisms». must amoratorium be on release the and commercial of use synthetic law andfederal as local well as research and practices, there industry declares: «Until above the principles are incorporated into international, such things as bio-remediation or other applications...» of «intentional the release of synthetic organisms into environment the for Oversight for Principles -public or private, large organization or DIY. oversightcertain and reporting measures regardless of institutional status- Bureau of Investigation. It urges also government to consider requiring agencies such as Department the of Homeland and Federal the Security scrutiny of and engagement with DIYthe bio , including by New Directions growingthe community of do-it-yourself synthetic developers. biology industrial research and development may not apply withforce equal to that institutional the and cultural constraints built into and academic report, however, pays substantial attention to DIY biology, recognizing individual and corporate responsibility and self-regulation...». New Directions through mechanisms the of public participation». of use the synthetic biology, and for protection the of consumer’s interests achieving an effective and efficientprevention the risksassociated of with transparency, general the interest, insofar serve as they are adequate for and general the interest». a way that actions direct their towards they benefitingthe community responsibilities corresponding to varioustheir tasks and duties, in such entrepreneurs, and professionals media [that must they] assume the Spain and Portugal reminds «public and scientific authorities, companies, Governance: 17 With to respect governance and oversight, reportthe from The principles referred to constitute body thethe of report and sees no immediate sees danger, but it encourages continuing likewise places great likewise faith in«acontinued culture of demands restrictive actions, including aprohibition 19 The concludesreport that «self-regulation and 19 17 The also report 18 This justice, as other inthe two reports, as it is access to research basic and As matter, apractical amoratorium on any and «release and all commercial accountability and manufacturer liability. right-to-know and democratic participation; and, Require corporate public and health worker Protect safety; environment; the Guarantee the policies insyntheticpolicies biology». opinion on effectivenessthe currentof intellectual property andpractices discussion of patents’ impact on innovation but expressly «offers no specific The US PresidentialCommission, in such patents «could violate principle ethical the of justice». synthetic biology. Their concernthat is potentialthe economic impact of evaluate issues new that may inpatenting arise processes and products in Thefrom report Spain and Portugal asks «competent authorities» to of intellectual property. and development would place take absence inthe of patents or other forms protections». must precedence legal take over any patent or intellectual property agreements. Transparency, public safety and environmental protection avenues for bio-piracy and ways to circumvent access and benefit-sharing synthetic versions of natural organisms.patents These could open up new processes. Companies and researchers must not permitted to be patent privatization the further and control of naturally products occurring and synthetic organisms or products derived from synthetic could biology of patents «Patents insynthetic biology: on synthetic processes, biology Patents and Intellectual Property: many, many years, ifever. likely mean that no products of synthetic would biology available be for into international, law and federal as local well as into practicewould ofuse synthetic organisms» Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology: 17 The report offers no alternative account of how investment 17 18 until six principles these are incorporated The Commission’s The concern is notso much Principles for Oversight for Principles New Directions offerssophisticated a

Thomas H. Murray takes a dim view adimview takes 19

13 Josep Egozcue Lectures including setting research the agenda, context the and of scope the the development of synthetic and biology products the of synthetic biology, workers throughout entire the decision-making process related to the «Governments must provide involvement meaningful for public the and Public involvement is akey element for merely advisory. remit,legal commissions these could exercise executive authority or be synthetic and biology other emerging technologies. on Depending their community levels and to monitor local in activities and supervise Synthetic Biology by government, private foundations, and grassroots organizations. organizations,society communities, and other groups» supported to be expanded educational directed activities at «students at levels, civil all to vet claims about synthetic biology. Finally, report the recommends to suggestgo further a fact-checking mechanism, privately overseen, God”...» on grounds the that such language impedes understanding. They «sensationalist buzzwords and phrases such as “creating life” or “playing by urging to everyone «employ clear and accurate language» and to avoid Commission something does quite then unusual for such bodies bioethics intotake account relevant perspectives all to synthetic biology». and public. the Scientists makers and are policy reminded to «respectfully to maintain an ongoing exchange» on makers synthetic with policy biology makers,«scientists, and policy religious, secular, groups... and society civil New Directions society: Role of Civil and innovation. testimony given on relationship the intellectual between property regimes but declines to endorse any approach, particular citing conflicting the with interest open-source the philosophy of BioBricks the movement facilitatingthe or dampening impact on innovation. The notesreport promotes «democratic deliberation» by encouraging 19 recommends creating commissions at national, All three reports call for three reportsAll call engagement with public. the Principles for Oversight for Principles 18 18 The The : «Opportunities for participation indecisions on synthetic should biology Oversight for In addition for to call this independent scientific advice, for commissions at multiple levels appears directed primarily to be at injustices that might caused through be patenting. This report’s advocacy As noted earlier, an important tool to help technologies». people new reign inthese genetic engineering. The Principles Oversightforthe of Synthetic is Biology biofuels dictatorship joins dictatorship food the wrought by first the kind of or to makemilitary for cosmetics new rich.Using the synthetic biology, a of biofuels South Global the to make called so for planes and boats of the money from it. companies These now want take to overthe forests andland andpesticide oil companies to redesign life that can so make they more «Synthetic biology, next the wave of genetic engineering, allows seed, animating report: the Vandana Shiva, an environmental activist, displays clearly worldview the South. The endorsement it chose to place the on report’sback cover,from justice. The main axes of justice in view areits wealthy/poor and North/ and workers makes clear, Justice: land or use other relevant matters. concerned about cultural and economic social, implications related to safety groups concerned about work-related exposure; and communities where commercial facilities may sited; be labor unions and workplace categories of people: from communities, communities, poor especially processes». and economic considerations weight in decision-making should carry also including traditional knowledge as well as analysis of cultural, legal, social not narrowed be to only scientific input. Other forms knowledgeof to independent scientific and legal opinions the on proposed projects». risk assessment. This includes making surethat communities have access Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology: As its emphasis on public engagement communities with poor 17 The insistsreport that particular attentionpaidbe three to makes adistinctive claim for «traditional knowledge»: Synthetic Biology’s Principles for Oversight for Principles concerns about justice center on is deeply concerned with

Thomas H. Murray Principles Principles 17

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14 Josep Egozcue Lectures humankind’s control over nature and creation the or re-creation of life. justice. Scholars have explored questions about appropriate the limits to usualterrainthe of consequences such as risks and benefits as well as features of synthetic is its biology ability issues to raise beyond ethical considerations consequences: Ethical beyond medications,infectious diseases, and sources». fuel populations, including improved quality and access to vaccines against applications that mayto less beneficial advantaged particularly be associated disparities. with these Synthetic offers biology potential its potential to address some of longstanding, the significant problems much of optimism the surrounding synthetic stems biology directly from benefits as risks well as its tone could hardly contrast:be in sharper «(...) axes central so to CommissionThe the mindful also of is wealthy/poor and North/South from them». research reach individuals those and populations could who most benefit aim toalso ensure that important the advances that may result from this by individuals, certain subgroups, or populations. efforts These should including long-term impacts, are not unfairly or unnecessarily borne environment are and assessed managed that so most the seriousrisks, should ensure that risks and potential benefits to communities theand and others to synthetic seeking for use biology commercial activities ongoes to address justice and fairness inbenefits as «Manufacturerswell: of commercial production «should not unfairly be distributed». The report Directions’ is «promoting justice and fairness». Applying it to synthetic biology, Thelast the of fiveprincipals articulated the US by Presidential Commission protections against injustice. risk and community benefit, but could justboost easily procedural as final two final recommendations urgethat risksthe of research and 18 Principles for Oversight for Principles , but it because envisions potential One of interesting the 18 New New 23 A Principles for Oversight for Principles more immediately relevant--questions about consequences and justice. createdin fact, and move so quickly on to questions to believe be they But report’s the authors are not that persuaded life or aliving was, cell report notes that a claim such as invites this important very reflection...». contextthe of Venter the team’s claims to have created asynthetic cell. This consequentialist concerns, although and to justice. Neither report’s recommendations address explicitly non- attentiontheir issues to to ethical consequences such as risks and benefits pose anypose barrier. serious ethical That could change if whenand synthetic of life more complex than single-cellmicrobes, such considerations didnot (2) that as long as synthetic was confined biology to workingwith no form and concluded (1)that were they cogent and should seriously, taken be and research project at The CenterHastings stages of direction anew that Venter «the Institute’s research and synthetic are biology early inthe that «revolutionary advances» may on be horizon, the but it concluded also forms of biological and science technology. here emphasize, on whole, the synthetic biology’s continuity with earlier discontinuity: Continuity/Radical matters of justice. mention «intrinsic objections» as distinctfrom consequences or se per commentary leading up to Recommendation authors 10, the expressly capabilities inthe occur of and science this its applications». In the deliberative process» initiated, to be iffundamental «particularly changes to synthetic as field the biology develops.call They for an «iterative, New Directions making no mention of other categories concern. of ethical threeOf the reports, both took onbiology more complex forms of life,human especially life. Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology: , incontrast, recommends revisiting moral objections remains on steadfastly risks and focused justice, Principles for Oversight for Principles in along continuum of research in biology and Two of reports the under consideration Synthetic Biology 24 considered such questions several New Directions and and Synthetic Biology does raise in them does

Thomas H. Murray acknowledges limit

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15 Josep Egozcue Lectures their calls for calls their protecting workers’ rights and along health with justice for engagementslost inthose regained. can be It remains whether seen to be from geneticthat engineering and ground geneticallyfoods modified hoping to convince readers that synthetic is sufficiently biology different that case the authors the be also of report this are refighting battles,older and distinctmeans for controlling risk and assuring justice. But it may such as genetic engineering and therefore something that requires new treats different synthetic as something biology very from older technologies synbio exceptionalism--that is, and for of oversight, policy purposes the it oneOn the hand it may that seem or product». as independent environmental risk assessment for each proposed activity levelsstrictest of physical, biological and geographic containment as well and prosecutable synthetic biology-specific regulations» as well as «the thorough application of Precautionary the Principle and for «enforceable and recommendations stress novelty and discontinuity. The calls for report «extreme genetic engineering» gestures toward continuity, but analysis the Oversight for Principles technologies. way that similar»are to those «inevery inanumber arise likewise of other or intuited».described that there is to no need consider what others have already discovered, or spring from abrain that privileged is so or and original intelligent discoveries that come out of nowhere, that donot have any predecessors creating life. new The statesreport therescience «(...)in is no suchthing as Venter’s team created “biotechnological anew tool,” but fell far short of Thefrom report Spain and Portugaljudges likewise that the work by continuitythe account reigns. as engineers and DIY biologists; but in its analysis and recommendations, » . 18 [my emphasis]. The sensitive is report theentrants to new such 17 19 Again, continuity the account triumphs. is exception. the Its depiction of synthetic as biology 19 The that notesissuesreport thefurther ethical Principles for Oversight for Principles is embracing Malaria, Artemisinin synthetic biology. communities find South Global will inthe resonancethe context in of Principles for Oversight for Principles Contrast with discussion this the around synthetic artemisinin in frombenefit them». that reach individuals they those and communities would who most striving to pursue and these other applications and to ensure, ifsuccessful, production of biofuels, to promote well-being». global public,academic, non-profit, interestsand industry have come together artemisinin at as «one industrial scale example that demonstrates how the development The describes report thecapacity of to produce synthetic hundreds of millions of people by infected parasite malarial the eachyear. of motives, good partnerships, savvy and huge potential benefit the to New Directions developingin the world. Sweet Chinese the Wormwood plant, which is grown countries in several supplement or replace artemisinin the derived from its source, botanical An obvious candidate is production the of synthetic artemisinin to than ingeneralities, dealing study acase may more be illuminating. highlighted inone report receive little or no mention others. inthe Rather widely on amount the of attention give they to each;and some issues ranking. While many issues are up taken three, reports the in all differ three complex,these multifaceted documents to caricatures or any simple differences the Do these matter? in reports It be unfairwould to reduce (e.g., rubber, plant oils, artemisinin) with vat-based production systems may «replace production botanical of natural plant-based commodities Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology: tellsof story the synthetic and biology artemisinin as one 18 , which observes correctly that, which observes synthetic biology New Directions and S and 18 Referring to artemisinin and possible the ynthetic Biology states: «Theregreat is value in

Thomas H. Murray

16 Josep Egozcue Lectures communities to resolve expected difficult be issues. all recommendation to include and active «full participation» tofailed find asingle instancethe in report.) Norcan its well-considered biology, it lessens report’s the (Asearch usefulness. for word the «malaria» not evento consider possible the benefitsthat might flow fromsynthetic have long ignored. been For great it this, credit. deserves But in choosing powerless, for workers, for South, Global for the voices people whose Oversight for Principles enough to supply world’s the at needs afar lower price? What weight should voices their have decision inthe to whether produce affected, the object to production or distribution of synthetic artemisinin? self-interest? What communities, ifthese severely might which be indeed than it is for to them make money. But what follow ifthey path the of important to insure acheap and plentiful supply to people with malaria gracious be and will self-sacrificing. sayPerhaps thatwill they it’s more consulted about production the of synthetic artemisinin? Perhaps they that aresee they likely to suffer major financial losses, they when say are profitable, suffer.their livelihoodswill What these communities,will who markets for Sweet Wormwood or switch to other crops that are equally artemisinin is available inlarge quantities. Unless canalternative find they find less demandwill fortheir crops if whenand cheaper synthetic Unless laws the of economics are suspended, Sweet Wormwood growers impacted». be must include and active full participation the of communities the that will grabbing must considered be inany assessment of risk.assessments These impactsThese theand impacts of biomass extraction and associatedland communities on depend who natural compounds for livelihoods. their «could have devastating economic impacts on farming, fishing and forest plants». using synthetic microbes or to move production to genetically engineered 17 Principles for Oversight for Principles 17 attempts to stand up for and poor the the then goes on goes then to say that such developments 17 of affected affected of protest. It would far be better to invest inways to improve and health the South Global andin the elsewhere. Even ifsweet wormwood growers of course we should doit. It could benefit hundreds of millions peopleof and distribute artemisinin produced by synthetic is biology not a hard call: Assuming it is as safe and effectivewhether as botanical to twin, make its synthetic is informed biology by of all them. of three reports. We these can hope that conversation global the about problems injustice. There are nuggets wisdomof be to foundeach in complicated balancesof risks and benefitsalong with more complex It is likely that other products of present synthetic will biology far more against change at astaggering cost to inhealth others. livelihood of communities of wormwood growers than to insulate them Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology:

Thomas H. Murray

17 Josep Egozcue Lectures 12. 11. 10. 9. 8. 7. 6. 5. 4. 3. 2. 1. References 422-4. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20495545. Accessed April 16,2012. M,ChurchBedau G,Rasmussen Sycols. «Life afterthe synthetic cell». gov/pubmed/20488990. Accessed February 29,2012. synthesized genome». Gibson C y cols. D G, Glass «Creation J I, Lartigue cell controlled of a bacterial by a chemically Hotz «Scientists Create R. Synthetic Organism». 2007. Est RV, Vriend HD, Walhout B. Accessed April 9,2012. of StandardRegistry Biological Parts. Available at: http://partsregistry.org/Main_Page. diesel. Available at: http://www.guardian.co.uk/technology/2011/feb/27/jay-keasling-synthetic-biology- Sample I.Jay Keasling: «We can synthetic to use biology make fuel». jet amyris.com/en/markets/artemisinin. Amyris Press «Artemisinin –Anti-malarial Release. Therapeutic». Available at: http://www. American Journal of Tropical Medicine and Hygiene solution problem to global the of access to affordable antimalarial drugs». Hale V, Keasling JD, Renninger N,Diagana TT. «Microbially derived artemisinin: a Available at: http://www.news-medical.net/news/2009/03/08/46650.aspx?page=2. «Synthetic extends biology anti-malaria artemisinin’s drug effectiveness». World Health Organization. and-control-of-malaria-in-endemic-areas. Accessed April 9,2012. UpToDate Whitehorn C, Breman J. «, prevention, and control of in endemic malaria areas». America Comissió Europea. . 2005. . 2012.Available at: http://www.uptodate.com/contents/epidemiology-prevention- SynBiology: An Analysis of Synthetic Biology Research in Europe and North Science . World Malaria Report 2010,329(5987), 52-6. Available at: http://www.ncbi.nlm.nih. Constructing Life: The World of Synthetic Biology The Wall Street Journal . . 2010. . 2007,77(Suplement 6),198-202. Nature 2010. The Guardian The News Medical . 2010,465(7297), . La Haya; La . 2011. . 2009. 23. 22. 21. 20. 24. 19. 18. 17. 16. 15. 14. 13. of Human Ingenuity Gutmann MA,CarlsonBedau R, A,Kaebnick GE,Murray T. Kaebnick G.«OfMicrobes and Men». Concerns Related to the Synthesis of Select Agents The US NationalBoardScience for (NSABB). Advisory Biosecurity King N. «Biological Terrorism». Accessed April 16,2012. Nature Fouchier R A M, García-Sastre A, Kawaoka Y. «Pause on avian flutransmission studies», Sintetica_24112011.pdf http://www.comitedebioetica.es/documentacion/docs/es/CBE-CNECV_Informe_Biologia_ Nacional de Ética para as Ciências da Vida de Portugal Comité. Synthetic Biology and Emerging Technologies Presidential Commission for Study the Issues. of Bioethical 1-20. Hoffman E, Hanson J, Thomas J. at: http://scienceprogress.org/2010/07/the-promise-and-dangers-of-synthetic-biology/. Rugnetta M.«The Promise Dangersand of Synthetic Biology». pubmed/20010584. Nature Biotechnology Nature Smolke CD. «Building outside of box: the iGEMand BioBricks the Foundation». http://www.ncbi.nlm.nih.gov/pubmed/15470399. Accessed April 16,2012. P.Ball starting from «Synthetic scratch». biology: Farrar, Straus and Giroux; 2008. E. Regis Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology: . 2012, 481(7382), 443. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22266939. What Is Life?: Investigating the Nature of Life in the Age of Synthetic Biology Biología Sintética: Informe conjunto del Comité de Bioética de España ydel Conselho . 2011. . 2009,27(12),1099-102.Available at: http://www.ncbi.nlm.nih.gov/ Science, Technology, and An Society: Encyclopedia Principios para la supervisión de la biología sintética biología la de Principios para supervisión la Hastings Center Report . 2010. . 2006. Nature . Lisboa-Barcelona, 2011. Available at: . 2004,431(7009),624-6.Available at: . 2011,41,25-28. Science Progress Synthetic Biology and the Ethics New Directions: The Ethics of

Thomas H. Murray Addressing Biosecurity Biosecurity Addressing . 2010. Available . Nueva York: . 2005:28-30. . 2012,

18 Josep Egozcue Lectures committees, author the is also more than two hundred publications. Murray, has who appeared before alarge number of United States Congress Journal of Bioethical Inquiry and Journal of Law, Medicine &Ethics Cloning, Science, and Policy, Medscape General Medicine, Teaching Ethics, Hastings Center Report, Human , Politics and the LifeSciences, Review he is oneLikewise, of directors the and founders of the and president also for of and Americanthe Bioethics Society Humanities. standwhich out president the for of Health Society the and Human Values Murray has held many important positions inrelation to among bioethics, bioethics. in Cleveland, Ohio, where Susan E.Watson occupied chair the also of Biomedicalthe Ethics Center at Western Case the University Reserve Hastings Center of New York. Murray Doctor was previously of head of Uppsala, is Research Senior Scholar and President Emeritus of The Thomas H. Murray, an HonoraryDoctorate in medicine the by University About theauthor , and he is a member of editorialthe boards of publicationsthe Medical Humanities Humanities Medical . Doctor . Doctor The The Some ofSome hismostpublications significant are: • • • • Clinic», •

Technology: Proceed with Caution», M.A., Wilfond, B., A.and Ross, Berg, L.F.,«Newborn Screening J.R.,Botkin, Clayton, E.W., Fost, N.,Burke, W., Murray, T. H.,Baily, Screening: «Newborn Health Public of H., T. Murray, M., S. Complexities inUniversal Testing» Genetic Dolan, S., N. Green, 193-195, 2007. sport», constructed high-altitude environments to enhance performances in technologically of use the of ethics «The Murray,T.H., S., Loland, SteinbockBonnie (ed.), Oxford University Press, 2007. Murray, T. H.,«Enhancement», to Bench and Death Policymakers, and Campaigns 2009-2009 to Birth «From Enhancement Sports Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology: Scandinavian Journal of Medicine &Science in Sports The HastingsCenter Bioethics Briefing Book for Journalists, , vol. 96,n.11,November 2006. The Oxford Handbook of Bioethics Pediatrics , The CenterHastings 2008. , vol. 117,n.5,May 2006.

Thomas H. Murray American JournalAmerican , 17,

, 19 Josep Egozcue Lectures 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. monographs:Bioethics Publications

The ethics of medical communication medical of ethics The The management of medical errors The rational use of medication .Ethical aspects Ethics and sedation at the close of life Corresponsabilidad empresarial enel desarrollo sostenible (Corporate Los fines de la medicina (Spanish of The goals of medicine) The management of nursing care Health information and the active participation of users Addressing the problem of patient competency Informed consent and cultural diversity Autonomy and Dependency in Old Age Individual and Common Good in Bioethics Good Waiting lists: can we improve them? The person as the subject of medicine Ethical challenges of e-health Ethics in care for services people with severe mental disability Consent by representation Ethics and clinical research Maleficence in prevention programmes Ethics: an essential element of scientific and medical communication The three ages of medicine and the doctor-patient relationship Ethics and public health responsibility in sustainable development) sustainable in responsibility Ethics in health institutions: the logic of care and the logic of management 5. For more information visit: www.fundaciogrifols.org 1. 2. 3. questions:Ethical 1. 2. 3. 4. 5. Reports: 1. 2. 3. 4.

centres (Private in public services health organizations) Practical problems of informed consent What should we do with persistent sexual offenders? Sexuality and the emotions: can they be taught? Surrogate pregnancy: an analysis of the current situation TheSocial Perception of Biotechnology An ethical framework for cooperation between companies and research Therapeutic Cloning:scientific, legal and ethical perspectives prestacionesLas privadas enlas organizaciones sanitarias públicas Ethics and Synthetic Four Biology: Streams, Three Reports Freedom and Health Ethical and scientific standards in research medical progressand industry pharmaceutical The discrimination and medicine Predictive Ethics and Synthetic Biology: Four Streams,Ethics and Synthetic Three Reports. Biology:

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