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[59] Moreno J.D., Protectionism in research involving human subjects, in: National Bioethics Advisory Commission,Ethical and Policy Issues in Research Involving Human Participants, op. cit., vol. 2, pp. I1-I21. [60] National Commission on the Protection of Human Subjects of Biomedical and Behavioural Research, Research Involving Children: Report and Recommendations, Washington, D.C.: Department of Health, Education and Welfare, 1977; Id., Research Involving Those Instituzionalized as Mentally Infirm: Report and Recommendations, Washington, D.C.: Department of Health, Education and Welfare, 1978. [61] National Commission on the Protection of Human Subjects of Biomedical and Behavioural Research, Research Involving Children: Report and Recommendations, op. cit., p. xx. [62] National Commission on the Protection of Human Subjects of Biomedical and Behavioural Research, The Belmont Report: Ethical Principles for the Protection of Human Subjects of Biomedical and Behavioural Research, Washington, D.C.: Department of Health, Education and Welfare, 1978, Part C (Applications), no. 2. [63] Menezo Y.J., Sakkas D., and Janny L., Co-culture of the early human embryo: factors affecting human blastocyst formation in vitro, Microscopy Research Techniques 1995, 32: 50-56; De Silva M., Culturing human embryos with and without glucose, Fertility and Sterility 1998, 69: 970-971; Conway-Myers B.A., Co-culture update: creating an embryotrophic environment in vitro, Seminars in Reproductive Endocrinology 1998, 16:175-82; Wiemer K.E., Cohen J., Tucker M.J., and Godke R.A., The application of co-culture in assisted reproduction: 10 years of experience with human embryos, Human Reproduction 1998, 13(Suppl 4): 226-238; Menezo Y., Veiga A., and Benkhalifa M., Improved methods for blastocyst formation and culture, Human Reproduction 1998, 13(Suppl 4): 256-265; Mahadevan M.M., Optimization of culture conditions for human in vitro fertilization and embryo transfer, Seminars in Reproductive Endocrinology 1998, 16: 197-208; Cooke S., Quinn P., Kime L., Ayres C., Tyler J.P., and Driscoll G.L., Improvement in early human embryo development using new formulation sequential stage-specific culture media, Fertility and Sterility 2002, 78: 1254-1260; Blake D., Svalander P., Jin M., Silversand C. and Hamberger L., Protein supplementation of human IVF culture media, Journal of Assisted Reproduction and Genetics 2002, 19: 137-143; Boiso I., Veiga A., and Edwards R.G., Fundamentals of human embryonic growth in vitro and the selection of high-quality embryos for transfer, Reproductive Biomedicine Online 2002, 5: 328-350. [64] Loza Arredondo M.C. and Hicks, J.J., Influencia del medio tubario y uterino en el desarrollo embrionario [Influence of tubal and uterine milieu in the embryonic development], Ginecologia y Obstetricia Mexicana 1990, 58: 245-250; Pulkkinen M.O., Oviductal function is critical for very early human life, Annals of Medicine 1995, 27: 307-310; Barnes F.L., The effects of the early uterine environment on the subsequent development of embryo and fetus, Theriogenology 2000, 53: 649-658; Diaz-Cueto L. and Gerton G.L., The influence of growth factors on the development of preimplantation mammalian embryos, Archives of Medical Research 2001, 32: 619-626. [65] Cohen J., Elsner C., Kort H., Malter H., Massey J., Mayer M.P., and Wiemer K., Impairment of the hatching process following IVF in the human and improvement of implantation by assisting hatching using micromanipulation, Human Reproduction 1990, 5: 7-13; Hardy K., Apoptosis in the human embryo, Review of Reproduction 1999, 4: 125-134; Alikani M., Calderon G., Tomkin G., Garrisi J., Kokot M., and Cohen J., Cleavage anomalies in early human embryos and survival after prolonged culture in vitro, Human Reproduction 2000, 5: 2634-2643; Brison D.R., Apoptosis in mammalian preimplantation embryos: regulation by survival factors, Human Fertility (Cambridge) 2000, 3: 36-47; Hardy K., Spanos S., Becker D., Iannelli P., Winston R.M., and Stark J., From cell death to embryo arrest: mathematical models of human preimplantation embryo development, Proceedings of the National Academy of Sciences USA 2001, 98: 1655-1660; Porter R.N., Tucker M.J., Graham J., and Sills E.S., Advanced embryo development during extended in vitro culture: observations of formation and hatching patterns in non-transferred human blastocysts, Human Fertility (Cambridge) 2002, 5: 215-220. [66] Van den Abbeel E., Camus M., Van Waesberghe L., Devroey P., and Van Steirteghem A.C., Viability of partially damaged human embryos after cryopreservation, Human Reproduction 1997, 12: 2006-2010; Magli M.C., Gianaroli L., Fortini D., Ferraretti A.P., and Munne S., Impact of blastomere biopsy and cryopreservation techniques on human embryo viability, Human Reproduction 1999, 14: 770-773; Van Den Abbeel E. and Van Steirteghem A., Zona pellucida damage to human embryos after cryopreservation and the consequences for their blastomere survival and in vitro viability, Human Reproduction 2000, 15: 373-378; Edgar D.H., Jericho H., Bourne H., and McBain J.C., The influence of prefreeze growth rate and blastomere number on cryosurvival and subsequent implantation of human embryos, Journal of Assisted Reproduction and Genetics 2001, 18: 135-138; Machtinger R., Dor J., Levron J., Mashiach S., Levran D., and Seidman D.S., The effect of prolonged cryopreservation on embryo survival, Gynecological Endocrinology 2002, 16: 293-298; Guerif F., Bidault R., Cadoret V., Couet M.L., Lansac J., and Royere D., Parameters guiding selection of best embryos for transfer after cryopreservation: a reappraisal, Human Reproduction 2002, 17: 1321-1326. [67] Scott L.A., In vitro fertilization: technology and methods, Clinical and Laboratory Medicine 1992, 12: 411-428; Yeung W.S. and Ng E.H.,Laboratory aspects of assisted reproduction, Hong Kong Medical Journal 2000, 6: 163-168. [68] Wiemer K.E., Anderson A., and Stewart B., The importance of water quality for media preparation, Human Reproduction 1998, 13(Suppl 4): 166-172; Hall J., Gilligan A., Schimmel T., Cecchi M., and Cohen J., The origin, effects and control of air pollution in laboratories used for human embryo culture, Human Reproduction 1998, 13(Suppl 4): 146-155; Dumoulin J.C., Meijers C.J., Bras M., Coonen E., Geraedts J.P., and Evers J.L., Effect of oxygen concentration on human in-vitro fertilization and embryo culture, Human Reproduction 1999, 14: 465-469; Loutradis D., Drakakis P., Kallianidis K., Sofikitis N., Kallipolitis G., Milingos S., Makris N., and Michalas S., Biological factors in culture media affecting in vitro fertilization, preimplantation embryo development, and implantation, Annals of the New York Academy of Sciences 2000, 900: 325-335; Stringfellow D.A. and Givens M.D., Infectious agents in bovine embryo production: hazards and solutions, Theriogenology 2000, 53: 85-94; Catt J.W. and Henman M.,Toxic effects of oxygen on human embryo development, Human Reproduction 2000, 15(Suppl 2): 199-206; Guerin P., El Mouatassim S., and Menezo Y.,Oxidative stress and protection against reactive oxygen species in the pre-implantation embryo and its surroundings, Human Reproduction Update 2001, 7: 175-189; Farin P.W., Crosier A.E., and Farin C.E., Influence of in vitro systems on embryo survival and fetal development in cattle, Theriogenology 2001, 55: 151-170; Geber S., Sales L., and Sampaio M.A., Laboratory techniques for human embryos, Reproductive Biomedicine Online 2002, 5: 211-218; Schultz R.M. and Williams C.J., The science of ART, Science. 2002, 296: 2188-2190; Cooke S., Tyler J.P., and Driscoll G., Objective assessments of temperature maintenance using in vitro culture techniques, Journal of Assisted Reproduction and Genetics 2002, 19: 368-375. [69] Trounson A.O., The derivation and potential use of human embryonic stem cells, Reproduction, Fertility and Development 2001, 13: 523-532; Gepstein L.,Derivation and potential applications of human embryonic stem cells, Circulation Research 2002, 91: 866-876; Amit M. and Itskovitz-Eldor J., Derivation and spontaneous differentiation of human embryonic stem cells, Journal of Anatomy 2002, 200(Pt 3): 225-232. [70] Schuldiner M., Yanuka O., Itskovitz-Eldor J., Melton D.A., and Benvenisty N., Effects of eight growth factors on the differentiation of cells derived from human embryonic stem cells, Proceedings of the National Academy of Sciences USA 2000, 97: 11307-11312; Niwa H., Molecular mechanism to maintain stem cell renewal of ES cells, Cell Structure and Function 2001, 26: 137-148; Ogawa M., Embryonic stem cell differentiation: the role of growth factors, Nippon Rinsho 2003, 61:401-405; Levenberg S., Huang N.F., Lavik E., Rogers A.B., Itskovitz-Eldor J., and Langer R., Differentiation of human embryonic stem cells on three-dimensional polymer scaffolds, Proceedings of the National Academy of Sciences USA 2003, 100: 12741-12746. [71] Leese H.J., Metabolic control during preimplantation mammalian development, Human Reproduction Update 1995, 1: 63-72; Devreker F. and Englert Y., In vitro development and metabolism of the human embryo up to the blastocyst stage, European Journal of Obstetrics, Gynecology and Reproductive Biology 2000, 92: 51-56; Gardner D.K., Pool T.B., and Lane M., Embryo nutrition and energy metabolism and its relationship to embryo growth, differentiation, and viability, Seminars in Reproductive Medicine 2000, 18: 205-218; Henderson J.K., Draper J.S., Baillie H.S., Fishel S., Thomson J.A., Moore H., and Andrews P.W., Preimplantation human embryos and embryonic stem cells show comparable expression of stage-specific embryonic antigens, Stem Cells 2002, 20: 329-337. [72] Per alcuni esempi di queste tecniche, si veda Van Blerkom J., Davis P., and Alexander S., A microscopic and biochemical study of fragmentation phenotypes in stage-appropriate human embryos, Human Reproduction 2001, 16: 719-729; e Cobo A., Rubio C., Gerli S., Ruiz A., Pellicer A., and Remohi J., Use of fluorescence in situ hybridization to assess the chromosomal status of embryos obtained from cryopreserved oocytes, Fertility and Sterility 2001, 75: 354-360. [73] Patrat C., Wolf J.P., Epelboin S., Hugues J.N., Olivennes F., Granet P., Zorn J.R., andJouannet P., Pregnancies, growth and development of children conceived by subzonal injection of spermatozoa, Human Reproduction 1999, 14: 2404-2410; Tesarik J. and Mendoza C.,In vitro fertilization by intracytoplasmic sperm injection, Bioessays 1999, 21: 791-801; Selva J., Assisted hatching, Human Reproduction 2000, 4:65-67; Hardy K., Wright C., Rice S., Tachataki M., Roberts R., Morgan D., Spanos S., and TaylorD., Future developments in assisted reproduction in humans, Reproduction. 2002, 123: 171-183; Al-Nuaim L.A. and Jenkins J.M.,Assisted hatching in assisted reproduction, British Journal of Obstetrics and Gynaecology 2002, 109: 856-862; Nagy Z.P., Oliveira S.A., Abdelmassih V., and Abdelmassih R., Novel use of laser to assist ICSI for patients with fragile oocytes: a case report, Reproductive Biomedicine Online 2002, 4: 27-31. [74] Wilding M., Fiorentino A., De Simone M.L., Infante V., De Matteo L., Marino M., and Dale B., Energy substrates, mitochondrial membrane potential and human preimplantation embryo division, Reproductive Biomedicine Online 2002, 5: 39-42; De Vos A. and Van Steirteghem A., Aspects of biopsy procedures prior to preimplantation genetic diagnosis, Prenatal Diagnosis 2001, 21: 767-780; Wells D. and Delhanty J.D., Preimplantation genetic diagnosis: applications for molecular medicine, Trends in Molecular Medicine 2001, 7: 23-30; Braude P., Pickering S., Flinter F., and Ogilvie C.M.,Preimplantation genetic diagnosis, Nature Review Genetics 2002, 3: 941-953; Bui T.H. and Harper J.C., Preimplantation genetic diagnosis, Clinical Obstetrics and Gynecology 2002, 45: 640-648, 730-732; Egozcue J., Santalo J., Gimenez C., Durban M., Benet J., Navarro J., and Vidal F., Preimplantation genetic screening and human implantation, Journal of Reproductive Immunology 2002, 55: 65-72. [75] Congregazione per la Dottrina della Fede, Istruzione sul rispetto della vita umana nascente e la dignità della procreazione Donum vitae (22 Febbraio 1987), I, 4, in: Acta Apostolicae Sedis 1988, 80: 70-102. [76] Giovanni Paolo II, Lettera enciclica Evangelium vitae (25 Marzo 1995), 63, in: Acta Apostolicae Sedis 1995, 87: 473. [77] Congregazione per la Dottrina della Fede, Donum vitae, I, 4, in: Acta Apostolicae Sedis 1988, 80, p. 82. [78] L'espressione "nel migliore interesse del paziente" è spesso usata nei colloqui quotidiani intorno al letto di degenza o nel contesto della ricerca biomedica. Tuttavia, se il "migliore interesse" non è esplicitato, il significato della affermazione risulta ambiguo e talvolta anche ingannevole. Per una utile discussione di questa espressione in differenti situazioni cliniche, si veda Daniels K.R., Blyth E., Hall D., and Hanson K.M., The best interests of the child in assisted human reproduction: the interplay between the state, professionals, and parents, Politics of Life Sciences 2000, 19: 33-44; Cotler M.P., The "do not resuscitate" order; clinical and ethical rationale and implications, Medicine and Law 2000, 19: 623-633; Ross L.F., Genetic testing of adolescents: is it in their best interest?, Archives of Pediatric and Adolescent Medicine 2000, 154: 850-852; Spencer K., The best interest principle as a standard for decision making in the care of neonates, Journal of Advanced Nursing 2000, 31: 1286-1292; Allmark P., Mason S., Gill A.B., and Megone C., Is it in a neonate's best interest to enter a randomised controlled trial?, Journal of Medical Ethics. 2001, 27: 110-113; Pham H.H. and Lerner B.H., In the patient's best interest? Revisiting sexual autonomy and sterilization of the developmentally disabled, Western Journal of Medicine 2001, 175: 280-283; Miller G.H., The psychological best interest of the child is not the legal best interest, American Academy of Psychiatry Law 2002, 30: 196-200; Mainous R.O., Conjoined twins: whose best interest should prevail? An argument for separation, Pediatric Nursing 2002, 28: 525-529; Wasserman D., Comment on "Whose best interest?" Judging and balancing the interests of conjoined twins, Pediatric Nursing 2002, 28: 530-531; e Hirsch N.J.,In the patient's best interest: a call to action, a call to balance, Bioethics Forum 2002, 18(1-2):24-29. [79] Kipnis K., Vulnerability in research subjects: a bioethical taxonomy, op. cit., pp. G5. [80] Per una discussione sulle pressioni culturali e sociali che condizionano la campagna sulle ESC e la terapia cellulare, si veda Frist B., The promise and peril of embryonic stem cell research: a call for vigilant oversight, Yale Journal of Health Policy, Lawand Ethics 2001, 2: 167-176; McLaren A., Human embryonic stem cell lines: socio-legal concerns and therapeutic promise, Comptes Rendus de Séances de la Société de Biologie 2002, 325: 1009-1012; Konsen A.H., Are we killing the weak to heal the sick? Federally funded embryonic stem cell research, Health Matrix Cleveland 2002, 12: 507-555; Bruce A., The search for truth and freedom: ethical issues surrounding human cloning and stem cell research, Journal of Law and Medicine 2002, 9: 323-335; Nippert I., The pros and cons of human therapeutic cloning in the public debate, Journal of Biotechnology 2002, 98: 53-60; Schmid R., Stem cells: a dramatic new therapeutic tool, Jounal of Gastroenterology and Hepatology 2002, 17: 636-642; FitzGerald K.T., Questions concerning the current stem cell debate, American Journal of Bioethics 2002, 2: 50-51; Baker R., Stem cell rhetoric and the pragmatics of naming, American Journal of Bioethics 2002, 2: 52-53; McGee D.B., The idolatry of absolutizing in the stem cell debate, American Journal of Bioethics 2002, 2: 53-54; MacDonald C., Stem cell ethics and the forgotten corporate context, American Journal of Bioethics 2002, 2: 54-56; London A.J., Embryos, stem cells, and the "strategic" element of public moral reasoning, American Journal of Bioethics 2002, 2: 56-57; e Rosenthal N., Prometheus's vulture and the stem-cell promise, New England Journal of Medicine 2003, 349: 267-274. [81] Congregazione per la Dottrina della Fede, Donum vitae, I, 1, in: Acta Apostolicae Sedis 1988, 80, p. 79. [82] Giovanni Paolo II, Evangelium vitae, 60, in: Acta Apostolicae Sedis 1995, 87, p. 469. [83] Council of Europe, Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine (Oviedo: April 4, 1997), Council of Europe, ETS no. 164, art. 18. [84] Si veda, tra gli altri, Hursthouse R., Beginning Lives, Oxford – Cambridge: Blackwell, 1987. [85] Dunstan G.R., The moral status of the human embryo: a tradition recalled, Journal of Medical Ethics 1984, 10: 38-44; Strong C., Ethics in Reproductive and Perinatal Medicine. A New Framework, New Haven – London: YaleUniversity Press, 1977; Green R.M., The Human Embryo Research Debates. Bioethics in the Vortexof Controversy, Oxford: OxfordUniversity Press, 2001. Per una critica dell'argomento del "valore simbolico", si veda Quinn K.P., Embryonic stem cell research as an ethical issue: on the emptiness of symbolic value, St. Thomas Law Review 2001, 13: 851-861. [86] Coloro che non ritengono che l'embrione umano in vitro sia già un soggetto titolare di diritti umani, ma affermano che esso «merita un rispetto speciale» e una «seria considerazione morale in quanto rappresenta una forma di vita umana che si sta sviluppando», sono disposti ad «approvare la ricerca sugli embrioni prodotti in sovrannumero nei tentativi di trattare la infertilità di coppia attraverso la IVF, ma disapprovano la creazione e la successiva distruzione di embrioni esclusivamente per scopo di ricerca. Secondo il loro pensiero, la pratica di creare embrioni per la ricerca strumentalizza e priva del suo significato la vita umana, e come tale dovrebbe essere proibita». (Robertson J.A., Symbolic issues in embryo research, Hastings Center Report 1995, 25[1]: 37-38, p. 37) [87] Pennings G. and de Wert G., Evolving ethics in medically assisted reproduction, Human Reproduction Update 2003, 9: 397-404, p. 398. La distinzione non può essere giustificata neppure assumendo che, prima dell'impianto, l'embrione umano non sia un soggetto titolare del diritto a non essere ucciso o danneggiato: «Se gli embrioni sono troppo poco sviluppati fisicamente per poter venire danneggiati, non dovrebbe risultare rilevante il fatto che i ricercatori usino degli embrioni in sovrannumero derivati dalla IVF piuttosto che crearli appositamente per la sperimentazione. In entrambi i casi, infatti, gli embrioni si trovano allo stesso stadio di sviluppo». (Robertson J.A., Symbolic issues in embryo research,a.c., p. 37) [88] Annas G., Caplan A., and Elias S., The politics of human embryo research: avoiding ethical gridlock, The New England Journal of Medicine 1996, 334: 1329-1332. [89] Pennings G. and de Wert G., Evolving ethics in medically assisted reproduction, op. cit., p. 398. See also Iglesias T.,IVF and Justice. Moral, Social and Legal Issues related to Human In Vitro Fertilisation, London: The Linacre Centre for Health Care Ethics, 1990. [90] Cf. Pennings G. and de Wert G., Evolving ethics in medically assisted reproduction, op. cit., p. 398. [91] ESHRE Task Force on Ethics and Law, The moral status of the preimplantation embryo, Human Reproduction 2001, 16: 1046-1048. [92] Ahmann J., Therapeutic cloning and stem cell therapy, National Catholic Bioethics Quarterly 2001, 1: 145-150; Shannon T.A., Human embryonic stem cell therapy, Theological Studies 2001, 62: 811-824; Hirai H., Stem cells and regenerative medicine, Human Cell 2002, 15: 190-198; Cai J. and Rao M.S., Stem cell and precursor cell therapy, Neuromolecular Medicine 2002, 2: 233-249; Lindvall O., Stem cells for cell therapy in Parkinson's disease, Pharmacological Research 2003, 47: 279-287. Strauer B.E. and Kornowski R., Stem cell therapy in perspective, Circulation 2003, 107: 929-934; Henningson C.T.Jr., Stanislaus M.A., and Gewirtz A.M., Embryonic and adult stem cell therapy, Journal of Allergy and Clinical Immunology 2003, 111(2 Suppl): S745-S753; Terai S., Yamamoto N., Omori K., Sakaida I., and Okita K., A new cell therapy using bone marrow cells to repair damaged liver, Journal ofGastroenterology 2002, 37 (14 Suppl):162-163; Partridge T.A., Stem cell route to neuromuscular therapies, Muscle and Nerve 2003 27: 133-141; Hassink R.J., Dowell J.D., Brutel de la Riviere A., Doevendans P.A., and Field L.J., Stem cell therapy for ischemic heart disease, Trends in Molecular Medicine 2003, 9: 436-441; Hochedlinger K. and Jaenisch R., Nuclear transplantation, embryonic stem cells, and the potential for cell therapy, New England Journal of Medicine 2003, 349: 275-286. [93] Una della prime dichiarazioni pubbliche che esprimono questa posizione è attribuita al Ethics Advisory Boarddell'allora U.S. Department of Health, Education and Welfare. Nel 1979 l'Advisory Board dichiarò che l'embrione umano ha «diritto ad un profondo rispetto; ma questo rispetto non comprende necessariamente i pieni diritti morali e legali attribuiti alle persone». (Citato in: Callahan D., The puzzle of profound respect, Hastings Center Report 1995, 25[1]: 39-40, p. 39). Se confrontato con il rispetto incondizionato che è dovuto ad una persona, anche il "profondo rispetto" che è accordato agli embrioni si configura come un rispetto relativo e non obbliga nessuno a rinunciare ad usare l'embrione umano come un mezzo per cercare nuove possibili vie per la cura delle persone affette da gravi malattie. [94] Cf. Pennings G. and de Wert G., Evolving ethics in medically assisted reproduction, op. cit., p. 398. [95] «Nessuno dovrebbe intraprendere ricerche sugli embrioni umani il cui scopo possa verire raggiunto attraverso l'impiego di altri animali o in qualche altro modo». (Department of Health and Social Security, Report of the Committee of Inquiry into Human Fertilization and Embryology, London: Her Majesty's Stationery Office, 1984, p. 63). Si veda anche Royal Commission on New Reproductive Technologies (Canada), Proceed with Care: Final Report of the Royal Commission on New Reproductive Technologies, Ottawa: Minister of Government Services, 1993, p. 630. [96] Per una rassegna equilibrata delle ricerche in corso sulle cellule staminali e sulla terapia cellulare, si veda: Cogle C.R., Guthrie S.M., Sanders R.C., Allen W.L., Scott E.W., and Petersen B.E., An overview of stem cell research and regulatory issues, Mayo Clinic Proceedings 2003, 78: 993-1003. [97] Giovanni Paolo II, Discorso al 18th International Congress of the Transplantation Society (29 Agosto 2000), in: Acta Apostolicae Sedis 2000, 92: 822-826, p. 826. |