Introduction

A therapy can raise ethical issues because of:

1. ■ its nature – what kind of therapy it is

2. ■ its complexity

3. ■ the risks it entails

4. ■ the uncertainty surrounding estimates of risk and benefits in general or in the specific clinical situation

5. ■ its cost and/or cost-effectiveness

6. ■ the use to which it is being put.

Most stem cell and gene therapies that are likely to be developed will actualise some of these elements, for example initially most are likely to be costly. However, most will actualise them in ways that are not significantly different from complex surgical procedures or chemotherapy (at least in the foreseeable future). This could therefore be a very short chapter leading to the conclusion that stem cell and gene therapy raise no ethical issues that have not already been discussed extensively in the literature.

This conclusion might initially surprise some readers because it is so obvious that stem cell and gene therapy research has caused very significant and sustained ethical controversy. However, many of the intractable issues raised in these debates are of considerably less relevance to therapy than to basic research and they will mostly have been resolved at the policy level before the therapies move from research to therapy. Before clinical use becomes possible it will be decided, or in some cases has already been decided, whether there is something so problematic in deliberately making lasting genetic alterations or deriving stem cells from embryos that no therapy should be developed.