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Regenerative medicine has gained prominence in the field of bioethics through the emergence of human embryonic stem cell research. This area of research has generated extensive public, political and bioethical debate, which has focused almost exclusively on two issues: the moral status of human embryos and the duty to care for the sick and vulnerable. This preoccupation, especially on the question of moral status, has not only dichotomised the debate around two fundamentally incommensurable positions, it has come at the cost of other important issues being largely ignored. In highlighting some of the bioethical and regulatory deficiencies of this impoverished approach, the authors draw on recent developments in the experimental use of autologous stem cell treatments to argue for a more inclusive approach to the ethics of regenerative medicine. The authors conclude with some reflections on the normative role of bioethics and its limitations in shaping public policy.

Lysaght and Campbell note the promise of regenerative medicine and call for a broader philosophical and public discourse that extends beyond questions surrounding the moral status of embryos. While this is a laudable aim, it fails to confront the pernicious, controlling and suffocating impact that religion has had on debates surrounding stem cell research, regenerative medicine and science more broadly. While bioethics should privilege tolerance and pluralism, it also has an important role in activism and as a critic of positions and institutions that seek to dominate and control public discourse.

Human embryonic stem cells are pluripotent and can produce the entire range of major somatic cell lineage of the central nervous system and thus form an important source for cell-based therapy of various neurological diseases. Despite their potential use in regenerative medicine, the progress is hampered by difficulty in their use because of safety issues and lack of proper protocols to obtain purified populations of specified neuronal cells. Most neurological conditions such as spinal cord injury and Parkinson's disease involve damages to projection neurons. Similarly, certain cell populations may be depleted after repeated episodes of attacks such as the myelinating oligodendrocytes in multiple sclerosis. Motoneurons are the key effector cell type for control of motor function, and loss of motoneurons is associated with a number of debilitating diseases such as amyotrophic lateral sclerosis and spinal muscular atrophy; hence, repair of such neurological conditions may require transplantation with exogenous cells.

Lysaght and Campbell appropriately point out that, while bioethicists have concentrated too much on philosophical issues surrounding human embryos, problems such as stem-cell tourism and unproven treatments should also draw attention. In addition, there remains the ethical issue surrounding the fact that people have too many expectations on regenerative medical technologies. To solve this problem, bioethicists are intimately involved in science communication. Ethicists require management skills, which enable them to mediate between two parties: specialists and laypeople. Such management skills also include coordination capabilities to close the gap between the two groups with different background knowledge and culture. Thus, bioethicists simultaneously play the role of a mediator and science communicator. Yet, interactive communication between specialists and laypeople is not easily accomplished, and biotechnology literacy, including regenerative medicine literacy, remains a pressing issue.

This book has explored the science and ethics behind stem cells, as well as the excitement and optimism within the scientific community about the role stem cells would someday play in treating human disease. It has revealed many intersecting voices expressing the hopes and dreams of the afflicted, as well as the cautions of those following their moral compass on the use and commercialization of human embryos in research and medicine. The first extraction of human embryonic stem cells brought new excitement into an old medical agenda. Whether it was through embryonic stem cells, induced pluripotent stem cells, or nuclear transfer, the enthusiasm among cell biologists was palpable. This book has also emphasized the two distinct parts of the stem cell research translational program: regenerative medicine and personalized medicine.

This epilogue reflects on the ways in which the biomedical odysseys documented in the book open up important questions about the contours of experimentality and the proliferating hopes generated by transnational regenerative medicine. It returns to the metaphor of “cutting edge” in order to illuminate how the experiences of Chinese neurosurgeons and their foreign patients deepen our understanding of the multiple and material ways in which hope transforms technology, travel, and the political economies of health care and medical research in a digitally mediated world. Many of the fetal cell pioneers mentioned in the preceding chapters died during the decade that the author spent researching and writing this book. Their poignant yet grueling encounters with the experimental demand our acknowledgment of the complex ways in which hope endures online and through bodily engagements on the cutting edge of regenerative medicine.

This response is made in reply to commentaries provided on our paper entitled “The Ethics of Regenerative Medicine: Broadening the Scope beyond the Moral Status of Embryos” in which the authors argue for a broader and more inclusive approach to the bioethical debates surrounding regenerative medicine. The authors’ thanks go to the commentators for their thoughtful responses.

Neuroethics is concerned with the ethical, legal, and policy issues raised by the neurosciences and their applications in medicine and society. However, neuroscience sometimes involves other emerging biomedical technologies, such as genetics, regenerative medicine, and synthetic biology, which generate their own ethics and policy conundrums. When emerging biomedical technologies converge or collide in a single project, application, or product, challenges are compounded. These challenges may be mitigated by the development of shared models for ethical analysis focused not on the details of a particular technology but rather on the nature of the class of technologies, such as whether they are emerging, rapidly evolving, and ethically contentious. These challenges and characteristics, and a framework approach to managing them, are the focus of this chapter.

Donated cells are essential for the creation of human tissue engineered products. Informed consent by the donor is required under EU regulation. Because cell donation will be more likely if the cells's use is consistent with the donors' world views, the various values that donors attach to cells must be taken into account when designing the informed consent procedure. This chapter identifies four, sometimes contradictory, connotations of value: biological, financial, relational, and informational value. Respecting these different values may lead to different ethical precepts regarding cell donation. The chapter investigates how these values may influence cell donation for various tissue engineering purposes. It also indicates that consenting to cell donation assumes some characteristics of a contract. Giving preference to one type of cell value over other types of value may furthermore influence which relationships between the various stakeholders in tissue engineering are privileged, and consequently how the future development and regulatory framework of tissue engineering and regenerative medicine may have to evolve, and what the contents of the informed consent should be.

This Chapter looks at the role played by transmission of the archive through the body, drawing from performance studies, bioart, database aesthetics and history of science to look at what becomes of the archive in the era of genomic experimentation. Drawing on economics, the chapter establishes the role played by the archive within the digital economy showing how the archive evolved for each of the industrial revolutions that occurred since the 18th century. Additionally, the Chapter analyzes the role played by the archive in the development of smart objects within the internet of things. The case studies for this chapter include work by the Musée de la Danse; George Legrady; Natalie Bookchin; Eduardo Kac; Christine Borland; and Lynn Hershman Leeson’s Infinity Engine, in which the human being has become its own (a-)live archive, one that, through regenerative medicine, can be modified inside out.

In this dialogue, Dr. Rebecca Franklin and Dr. Frederick Jones, a stem cell biologist, discuss the prospects of cell reprogramming for producing therapeutic stem cells. The process of reprogramming an adult cell to its pluripotent stem cell origins, sometimes referred to as “dedifferentiation,” creates what are called induced pluripotent stem cells (iPSCs). The first evidence of this type of reprogramming from mouse cells was provided by Shinya Yamanaka and his colleagues at Kyoto University in Japan in 2006. Jones has invested considerable time reprogramming somatic cells to make them into embryonic stem cell-like cells (pluripotency). Franklin questions him about reversing the development of a differentiated cell, drawing on her knowledge of epigenetics and cellular biology. Here they talk about the possibilities for creating iPSCs from somatic cells that are more like their embryonic counterparts; oncogene expression and tumorigenesis in embryonic stem cells; and roadblocks to regenerative medicine involving iPSCs.

Stem cells, which are ‘immortal’ cells that divide indefinitely and produce many different cell types, are central to how our body develops and maintains itself. Embryonic stem cells can give rise to all cell types in the body, and there has been lots of interest since their discovery in the 1980s in using such cells to generate new tissues or organs to replace diseased or faulty ones. More recently has come the discovery of induced pluripotent stem cells, which are normal skin cells taken from a person and genetically modified or tweaked chemically to give them stem cell properties. There is now hope that both of these types of stem cells might be used in ‘regenerative’ medicine, for instance in producing pancreatic cells that secrete insulin which could be used to treat diabetes. Perhaps the most remarkable breakthrough in recent years has been the discovery that stem cells introduced into a 3D matrix that is infused with chemicals that stimulate the development of particular cell types, can spontaneously form ‘organoids’, which have many of the cell types and even structural features of human organs such as hearts, kidneys, intestines, and even eyes and brains. Organoids make it possible to study how human organs develop but also this area of science raises many ethical issues. For instance, currently human brain organoids can only grow to the size of an embryonic brain, but if in the future they could be induced to grow to adult brain size, could they develop feelings and thoughts?