Integrated Human Practices

Bioethics Interviews

To understand more about the global perspectives on a field fraught with ethical considerations as synthetic biology, we spoke with Sherine Hamdy, scholar of Islamic Bioethics.

Can you tell us about the origins of islamic bioethics?

Islamic bioethics is not a formal field of study, but rather it exists as a branch of the bigger field of islamic jurisprudence. Modern technologies and advances in biology and healthcare have spurred conversation among doctors, patients scholars of islamic law. These conversations though are not legally binding and more closely resemble advice and guidelines. With that said, traditions vary from region to region with Islamic bioethicists bearing a more formal role in institutions of Saudi Arabia.

How might bioethics differ based on geographic region (within sect)? Is there a difference in interpretation in Saudi Arabia Vs. Egypt?

There is a wide range of interpretations in Islamic law especially in Sunni world, lending to the plurality of opinion. Monarchical government structures, such as that in Saudi Arabia, generally do not consider the population’s opinion, resulting in more streamlined policy decisions but less representation of the people. However, historically in Egypt policy served the convenient purpose of appeasing the people as a counterweight to authoritarianism.

Does a stricter doctrine necessarily mean a more restrictive biological praxis?

Absolutely not and it is useful to separate interpretation of scripture from permissions and prohibitions. In Iran the state appoints islamic scholars as part of legislation producing governments, so Iran is a true theocracy. The scholars there permit infertile heterosexual couples to use donor egg and sperm to alleviate infertility, but this opinion is not as widely accepted in Sunni states with equally rigorous, though different, interpretation of Islamic law.

Does Islam see a tension in humanity’s manipulation of another organism’s DNA, the code that defines the chemical essence of that organism, and its espoused mandate to save lives when possible?

The framing of the question here matters: Islam is not one person or one entity so Islam itself cannot see a tension in anything. Scholars and interpreters, however, lend their advice on the controversial subject of permitted interactions among forms of life on the planet. No one person or view speaks on behalf of Islam, but the tradition should be celebrated for its diversity and the liveliness with which the debate plays out everyday. Islam is clear on the hierarchy of life question - saving a human life trumps a bacteria’s life. When weighing ethical imperatives in Islam, we recognize the larger ecological and sociopolitical environments in which we live too.

We also spoke with Rabbi Hain about bioethics.

Can you describe the origins of bioethics in the Jewish account of the biblical narrative?

In our tradition one commonly cited interpretation is that when each species was created, humans were set aside as special. Humans were charged with the purpose of dominion and advancement: they were to rule over the other animals and plants and also be responsible for the advancement of life in the world. Another interpretation is that when Adam and Eve were in the Garden of Eden, they were instructed not to interfere with the other life in the natural world. I think discussions about Jewish bioethics can be couched in these two components of the tradition.

Is there a need for reconciliation between the two interpretations if they’re handed down from the same text?

For me, I think bioethics is such a diverse field that either interpretation alone would fall short in explaining humanity’s best course of action. The nature of the dialogue about these topics is constantly evolving too. The responsibility is with all of us to weigh the merits of each argument fairly.

Our work presupposes a hierarchy of life. That is to say that the value of a human life is worth more than that of a bacterium because in the course of the treatment, bacteria will die. What can be said about this tension?

I think there would be a strong consensus that Judaism believes in a hierarchy of life in terms of the way this question is being framed with respect to your project. A distinction can be drawn between a whole, conscious living and breathing person and the conscience-lacking cells that might make up that person.

Survey on Methods of Treatment Summary

Background information on survey participants:

Our survey reached 50 people, 37% of which were between the ages of 40-65. The rest of the sample population included various age groups, each of which made up less than 37% of all responses.
The following pie chart represents the level of education of our participants:

Most of our respondents (69.7%) were not on an iGEM team, but the remaining 30.3% were on iGEM teams (particularly NYU Abu Dhabi, INSA-UPS_France, Groningen, and Greece). Stony Brook University helped gather many of our non-iGEM survey respondents. Out of all our respondents, 60.5% had a post-graduate degree (with 76.9% of this subset having a degree in Natural/Social/Physical Sciences.)

Patient feedback on receiving treatments

When we asked about the willingness of taking a treatment for any illness, 93% of the respondents said they would be willing to take some sort of a medication to treat an illness they may have. The other 7% opted to not take a medication; this could be due to a variety of reasons, such as perceived efficacy of available treatments for the illness, accessibility of the treatment, cost of the treatment and potential side effects of the treatment.
When we asked patients to select (all that apply) what types of treatment they would use for a life-threatening illness (like cancer), most patients, 97.7% agreed to using an oral medication. The second most popular choice was a topical medication, at 83.7% . The types of treatments mentioned in the survey include oral medications, topical medications, injections, surgery and intravenous shots.
We broke this question down by formulating a question for each type of treatment method, specifically asking the respondent to rank how willing he/she is to take the treatment method to remedy a life-threatening illness on a scale of 1 to 5 (1=least willing/not comfortable using) and 5=most willing/comfortable using). The questions were limited to the aforementioned types of treatments. Out of those types, oral medication received the highest percentage of 5s (76.5% ), whereas surgery received the lowest percentage ( 23.3% ). Although surgery may arguably be the most effective method compared to the rest that were mentioned, it is not a very comfortable procedure to undergo. We deduced that surgery therefore was not such a popular choice as oral medication because of the issue of comfort, but other factors may play into this result as well.
We decided to investigate the significance of other factors that may prevent people from taking medications to treat their illness. We asked the participants to rank the following factors against each other: efficacy, cost, accessibility, potential short term side effects, potential long term side effects, and invasiveness of the treatment. The graph showing these results is depicted below:
The graph shows that most people believe efficacy is the crucial factor when determining whether or not to use a medication. After that, potential long term side effects seems to be the next candidate on the list, followed by invasiveness, cost, accessibility, and short term side effects. Based on these results, we now have an idea of what aspects of our product to address and how to prioritize them accordingly.

The results of the survey we distributed to various iGEM teams and members of the local community indicate that many people would be amenable to oral administration of a cancer therapeutic. Notably, ingestion of some probiotics such as the one described by Danino et. al. in “Programmable Probiotics for Detection of Cancer in Urine” (2015), would enable colonization of colorectal hepatic metastases by E. coli. The receptivity towards an orally ingested probiotic for cancer treatment will be considered when designing an administration protocol for SilenshR.

Additionally, the results of the survey seem to indicate a preoccupation with the multifarious side effects of the pursued treatment avenue. While cancer is a deadly disease whose prognoses vary, the side effects of chemotherapy could prove daunting enough to discourage some patients from pursuing therapy. For this reason, we designed the SilenshR bacterium to be capable of specific targeting of cancerous tissue. The advancement of SilenshR beyond the haphazard systemic cytotoxicity of chemotherapy might offer cancer patients peace of mind and assurance when considering pursuing treatment.