By Sarah N Boers
Recent advances in stem cell technology enable the cultivation of 3D human tissues in a dish called organoids or ‘mini-organs’ popularly. This constitutes only one example of the numerous ways in which human tissues can nowadays be utilized to create complex human tissue products. Growing commercialization can contribute to translating scientific promises of organoid technology from the bench to the bedside. However, commercialization of human tissues, that serve as the source for growing organoids, is ethically contentious.
How can we ethically evaluate this growing commercialization? Traditional bioethical literature gives two opposing answers to this question. The ‘gift paradigm’ holds that a profit motive is irreconcilable with the donation and use of human tissues. The ‘market paradigm’ alternatively frames human tissues as commodities.
How can we understand these opposing views? Our thinking about what we can(not) commercialize is underlined by a deeply rooted division between persons and things. Whereas we can own and sell things, we cannot own nor sell people, because this would be slavery. Human tissue and related products, however, fall between two stools. To handle this greyness the gift paradigm categorizes human tissues as ‘persons’ and the market paradigm as ‘things’.
These categories, however, simply do not fit. They black-box the moral value of organoids and overly simplify the intricacies of their commercialization.
In our paper we therefore take a step back and examine the following questions: ‘How do organoids relate to persons and their bodies?’, ‘How is this relation negotiated when organoids are commercialized?’, ‘What is the instrumental and technological value of organoids?’, ‘How to deal with the ethical challenges that arise from commercialization of organoids?’.
A central concept we use is ‘hybridity’. Hybrids are entities that challenge existing categories and that are neither human nor non-human. Organoids are such hybrids. To really wrap my head (and body) around the hybridity of organoids I entered a collaboration with ‘the arts’.
Together with fine artist Rosa Sijben I worked on a project that we titled ‘A Sculpture Like You and Me’. In a complementary performance and publication we investigate the ambiguous nature of objects and the interchangeable role of persons and things.
In the performance I act as an ethicist and give an accessible talk regarding the moral value and commercialization of organoids. In a square space Sijben and I perform together with several of Sijben’s sculptures and the people in the audience. During my monologue Sijben interrupts me regularly and directs me to repeat certain phrases while moving through the space or while holding or moving objects. Likewise, she directs the audience to move and to exchange objects.
In the publication the script of the performance is coupled to images of the performance sculptures and pictures of daily objects that served as an inspiration for the sculptures. It invites the reader to examine the hybridity of organoids and the objects.
Throughout this project my ethical reflection transformed from an individual, formal, and mental experiment to a free, creative, sensory, and external ethics lab in dialogue with different interrogators.
I could think freely, creatively, and leave existing frameworks, because both Sijben and I moved out of our respective disciplines to meet in a newly created hybrid space.
We had weekly creative ‘labs’ in which we experimented with the hybridity of organoids in dialogue with Sijben’s sculptures and images of daily objects from her archive. We visualized our associations on the wall of Sijben’s studio. We explored the factors, such as physical location and application, that influence their respective meaning. For instance, when organoids are used as a personalized drug testing tool for patient treatment in a hospital setting, they constitute a representation of that patient. Alternatively, when they are used for drug development in a distant commercial lab they are approached as commercial biotechnological artefacts. Likewise, one of Sijben’s works, ‘Baustelle’, consists of an installation of building materials that is ‘exhibited’ in a museum and at a construction site. In the museum it is regarded as a work of art, whereas at the construction site the materials are construction instruments.
In the performance my ethical reflection becomes ‘embodied ’ by Sijben, myself, the sculptures, and the audience. I have a lived experience of abstract philosophical concepts such as hybridity. For example, I am both an actor and a sculpture that forms a part of an art installation. Round clay-like objects are moved through the performance space. When I hold them packed in a box and talk about treating organoids as commodities I feel like a market woman selling goods. At a later moment I talk about how organoids could be seen as tiny parts of the human body that circulate the world. Simultaneously, the audience is asked to exchange the clay objects with their neighbors. Now they feel as intimate parts of their bodies. There meaning changes in a network of human and non-human actors. My spoken text constantly enters new relations with the objects and people.
Insights on the hybridity of organoids and the negotiation of the commercialization of organoids gained during ‘A Sculpture Like You and Me’ directly fed into the current academic paper. Not unimportantly, the project allowed me to engage with differences audiences.
This project has shown me that the arts can have an invaluable contribution to the ethical evaluation of novel biotechnologies that provoke existing norms and values as well as conceptions of ourselves and our bodies.
Paper title: Organoids as hybrids: ethical implications for the exchange of human tissues
Author(s): Sarah N. Boers1, Johannes J.M. van Delden2, and Annelien L. Bredenoord3
Affiliations:
1 PhD Candidate Medical Ethics, Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, the Netherlands
2 Professor of Medical Ethics, Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, the Netherlands
3 Professor of Ethics of Biomedical Innovation, Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, the Netherlands
Competing interests: None declared.
Social media accounts of author(s):
https://www.linkedin.com/in/sarahnboers/
https://www.linkedin.com/in/annelien-bredenoord-99565b/
https://twitter.com/albredenoord