The ethics of 3D bioprinting

3D bioprinting is a developing technology relying, as its name indicates, on the principles of 3D printing (also known as additive manufacturing). It involves the ability to build bones and various kinds of human tissue, and might ultimately give us the ability to build whole organs, layer by layer, in a digitally controlled manner, using cells as raw material.

The technology is becoming the object of increasing attention, first and foremost because of the great promise it holds: for instance, if fully functional organs could be printed at a reasonable cost, it could help us address the current problem of the shortage of organs available for transplant. 3D bioprinting also offers a new avenue for testing not only cosmetics, but also drugs and antidotes to chemical weapons. Noted biotechnologist Craig Venter even suggested that bioprinters could be used to better disseminate vaccines – which could be printed on the basis of an emailed set of instructions – in urgent situations. On the other hand, the rise of 3D bioprinting also elicits some concerns. Last year, IT research and advisory company Gartner thus released a study arguing that the rapid development of 3D bioprinting would “spark a major ethical debate” by 2016, leading some to call for a ban on the technology.

What aspects of the 3D bioprinting should we be concerned about? First, we may note that beyond the medical applications just described, the technology could also be used to enhance “normal” human capacities, e.g. by printing stronger bones or muscles less susceptible to fatigue, which could have applications both in the military and in competitive sport. To the extent that 3D bioprinting gets put to such uses, the ethical concerns typically raised about the general issue of human enhancement will extend to it. The three most important such concerns are safety, fairness, and coercion.

The issue of safety is not specific to enhancement uses of bioprinting: it is equally important to ensure quality control in the context of treatment. Current use of 3D bioprinting will always involve trained doctors to implant the results. However, concerns about safety could be more pronounced in relation to enhancement if monitoring by health professionals were more limited in that context. It would be crucial to at least ensure that those who chose to use such interventions for purposes of enhancement are properly informed about any risks involved.

In the military context, it is debatable whether the advent of 3D bioprinting will prove a boon or a bane overall. Will enhanced bioprinted organs help reduce the number of injuries and casualties caused by war, through the extra protection they might provide soldiers? Or will they rather render wars even more lethal and destructive (for both soldiers and civilians)? The “do-it-yourself” use of 3D bioprinting might be another source of threats: for instance, one might fear the prospect of items like printable vaccines being modified and turned into bio-weapons by rogue individuals or states.

The fairness issue concerns the possibility that only the wealthy might reap the benefits from 3D bioprinting, which would further increase the gap between the haves and the have-nots in our society. One relevant question in this regard is how much we can expect the costs of those interventions to drop as the technology gets perfected. A related question is whether interventions like organ bioprinting will prove sufficiently cost-effective. If yes, there will be a strong reason to publicly subsidize them (for treatment and perhaps also for enhancement purposes), but otherwise not.

Finally, people might experience both direct and indirect coercion to use the relevant interventions: direct, if some organizations –  like the army – choose to demand of those under their authority that they use such interventions (e.g. soldiers might be required to undergo certain bodily enhancements as part of their job). And indirect, if a sufficient number of people start using those interventions and thereby improve their level of performance, as might happen in competitive sports. A question to be asked here is whether such coercion is ethically problematic as such, or only when it is combined with other factors, such as health risks.

These remarks do not aim to do more than scratch the surface of the subject. The ethics group from the DiDIY project at Anatolia/ACT (composed of Vincent C. Müller and Alexandre Erler) is planning to explore those issues further in the coming months.