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Mitochondrial Replacement Techniques

Examining Collective Representation in Emerging Technologies Governance

  • Symposium: Collective Representation in Healthcare Policy
  • Published:
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Abstract

In this article, I draw on research carried out in Europe, primarily in Germany, on patients’ and scientists’ perspectives on mitochondrial replacement techniques (MRTs) in order to explore some of the complexities related to collective representation in health governance, which includes the translation of emerging technologies into clinical use. Focusing on observations, document analyses, and interviews with eight mitochondrial disease patient organization leaders, this contribution extends our understanding of the logic and meanings behind the ways in which patient participation and collective representation in health governance initiatives take shape. My findings highlight the ways in which a commitment to a global mitochondrial disease patient community and a sense of patient solidarity influence expressions of support with regard to legalizing mitochondrial replacement techniques. My analyses illustrate how normative practices and expectations of participatory governance potentially foreclose opportunities for sustained collective patient engagement with the complex ethical, social, and political dimensions of emerging technologies and may silence diverse and potentially dissenting embodied and lived responses to the prospects of particular technological developments.

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References

  • Braun, K., A. Moore, S. Herrmann, and S. Könninger. 2010. Science governance and the politics of proper talk: Governmental bioethics as a new technology of reflexive government. Economy and Society, 39(4): 510–533.

    Article  Google Scholar 

  • Briscoe, R. 2013. Ethical considerations, safety precautions and parenthood in legalising mitochondrial donation. New Bioethics 19(1): 2–17.

    Article  Google Scholar 

  • Brosius, K. 2014a. Zur Perspektive von Betroffenen. Forum: Vorkern- und Spindeltransfer bei mitochondrialen Erkrankungen. Jahrestagung des deutschen Ethikrates 2014 | Fortpflanzungsmedizin in Deutschland: Individuelle Lebensentwürfe—Familie—Gesellschaft. [The perspective of affected individuals. Forum: Pronuclear and maternal spindle transfer in the case of mitochondrial disease. German Ethics Council Annual Symposium 2014 | Reproductive Medicine in Germany: Individual Life Concepts—Family—Society]. http://www.ethikrat.org/veranstaltungen/jahrestagungen/fortpflanzungsmedizin-in-deutschland. Accessed January 15, 2018.

  • Brosius, K. 2014b. Keimbahnmanipulation bei mitochondrialen Erkrankungen: Forum auf der Jahrestagung des deutschen Ethikrates 2014 [Germline manipulation in the case of mitochondrial disease. Forum at the German Ethics Council Annual Symposium]. Muskelreport 4. https://www.dgm.org/diagnosegruppe/mitochondriale-erkrankungen/meldungen/keimbahnmanipulation-bei-mitochondrialen. Accessed January 15, 2018.

  • Brown, P., R. Morello-Frosch, and S. Zavestoski. 2011. Contested illnesses: Citizens, science, and health social movements. Berkeley: University of California Press.

    Book  Google Scholar 

  • Castro, R. 2016. Mitochondrial replacement therapy: The UK and US regulatory landscapes. Journal of Law and the Biosciences 3(3): 726–735.

    Article  Google Scholar 

  • Conner, S. 2015. Scientist who pioneered ‘three-parent’ IVF embryo technique now wants to offer it to older women trying for a baby. The Independent, February 8. http://www.independent.co.uk/news/science/three-parent-embryos-an-ivf-revolution-or-a-slippery-slope-to-designer-babies-10031477.html. Accessed January 15, 2018.

  • Dimond, R. 2015. Social and ethical issues in mitochondrial donation. British Medical Bulletin 115(1): 173–182.

    Article  CAS  Google Scholar 

  • Dimond, R., and N. Stephens. 2018. Three persons, three genetic contributors, three parents: Mitochondrial donation, genetic parenting and the immutable grammar of the “three x x”. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 22(3): 240–258.

    Article  Google Scholar 

  • Dumit, J. 2006. Illnesses you have to fight to get: Facts as forces in uncertain, emergent illnesses. Social Science and Medicine 62(3): 577–590.

    Article  Google Scholar 

  • Englestad, K., M. Sklerov, J. Kriger, et al. 2016. Attitudes toward prevention of mtDNA-related diseases through oocyte mitochondrial replacement therapy. Human Reproduction 31(5): 1058–1065.

    Article  Google Scholar 

  • Epstein, S. 2003. Sexualizing governance and medicalizing identities: The emergence of ‘state-centered’ LGBT health politics in the United States. Sexualities 6(2): 131–171.

    Article  Google Scholar 

  • Ferretti, M.P. and V. Pavone. 2009. What do civil society organisations expect from participation in science? Lessons from Germany and Spain on the issue of GMOs. Science & Public Policy 36(4): 287–299.

    Article  Google Scholar 

  • Franklin, S. 1995. Science as culture, cultures of science. Annual Review of Anthropology 24(1): 163–184.

    Article  Google Scholar 

  • Franklin, S. 1997. Embodied progress: A cultural account of assisted conception. Oxon: Routledge.

    Book  Google Scholar 

  • Franklin, S. and C. Roberts. 2006. Born and made: An ethnography of preimplantation genetic diagnosis. Princeton: Princeton University Press.

  • Giorgi, L., A. Vadrot, and J. Luce. 2011. Introduction. In Patient and professional organisation involvement in governing converging technologies in medicine, edited by J. Luce, A. Vadrot, and L. Giorgi. Deliverable 1.1 of the HealthGovMatters EU Project. Unpublished peer-reviewed research report submitted to the European Commission.

  • González-Santos, S.P. 2017. Shifting the focus in the legal analysis of the first MST case. Journal of Law and the Biosciences 4(3): 611–616.

    Article  Google Scholar 

  • Haimes, E., and K. Taylor. 2017. Sharpening the cutting edge: Additional considerations for the UK debates on embryonic interventions for mitochondrial diseases. Life Sciences, Society and Policy 13(1): 1.

    Article  Google Scholar 

  • Haimes, E., and K. Taylor. 2015. Rendered invisible? The absent presence of egg providers in U.K. debates on the acceptability of research and therapy for mitochondrial disease. Monash Bioethics Review 33(4): 360–378.

    Article  Google Scholar 

  • Hens, K., W. Dondorp, and G. de Wert. 2015. A leap of faith? An interview study with professionals on the use of mitochondrial replacement to avoid transfer of mitochondrial diseases. Human Reproduction 30(5): 1256–1262.

    Article  CAS  Google Scholar 

  • Herbert, M., and D. Turnbull. 2017. Mitochondrial donation—Clearing the final regulatory hurdle in the United Kingdom. The New England Journal of Medicine. 376(2): 171–173.

    Article  Google Scholar 

  • Herbrand, C. 2017. Mitochondrial replacement techniques: Who are the potential users and will they benefit? Bioethics 31(1): 46–54.

    Article  Google Scholar 

  • HFEA. 2008. Human Fertilisation and Embryology Act 2008 c. 22 Part 1 Mitochondrial donation Section 26. http://www.legislation.gov.uk/ukpga/2008/22/section/26. Accessed July 26, 2017.

  • HFEA. 2015. The Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015 No. 572. http://www.legislation.gov.uk/uksi/2015/572/contents/made. Accessed July 26, 2017.

  • International Mito Patients. n.d. https://www.mitopatients.org/about/mission. Accessed July 26, 2017.

  • International Mito Patients. 2015a. UK parliament to say ‘yes’ to mitochondrial donation. IMP News, February 15. https://www.mitopatients.org/news/item/64-uk-parliament-mito-donation. Accessed July 26, 2017

  • International Mito Patients. 2015b. Final legislative step taken in mitochondrion replacement debate. IMP News, March 14. https://www.mitopatients.org/news/archive-news-2015. Accessed July 26, 2017.

  • Jasanoff, S. 2005. In the democracies of DNA: Ontological uncertainty and political order in three states. New Genetics & Society 24(2): 139–155.

    Article  Google Scholar 

  • Kerr, A., S. Cunningham-Burley, and R. Tutton. 2007. Shifting subject positions: Experts and lay people in public dialogue. Social Studies of Science 37(3): 385–411.

    Article  Google Scholar 

  • Klopstock, T., B. Klopstock, and H. Prokisch. 2016. Mitochondrial replacement approaches: Challenges for clinical implementation. Genome Medicine 8: 126.

    Article  Google Scholar 

  • Kolata, G. 2016. Birth of baby with three parents’ DNA marks success for banned technique. New York Times, September 27. https://www.nytimes.com/2016/09/28/health/birth-of-3-parent-baby-a-success-for-controversial-procedure.html. Accessed July 26, 2017

  • Luce, J. 2012. Narratives of mitochondrial disease diagnostic pathways and research participation in Germany. In Patients’ and professionals’ experiences with converging technologies in health care, edited by J. Luce. Deliverable 2.1 for the HealthGovMatters EU Project. Unpublished peer-reviewed research report submitted to the European Commission.

  • Luce, J. 2010. Circulating knowledge, informing governance: Institutionalizing participation in health care and medical research in Germany. Paper presented at the American Anthropological Association Conference, November 21, in New Orleans, USA.

  • Luce, J., A. Vadrot, J. Hartley, and R. Pohoryles. 2012. HealthGovMatters 2009–2012: A brief synthesis report. Deliverable 6.2 for the HealthGovMatters EU Project. Peer reviewed research report submitted to the European Commission. http://cordis.europa.eu/result/rcn/57212_en.html.

  • The Lily Foundation. n.d. Our mission, aims & values. https://www.thelilyfoundation.org.uk/about-us-2/aims-and-values/. Accessed July 2, 2018.

  • Marcus, G. 1995. Ethnography in/of the world system: The emergence of multi-sited ethnography. Annual Review of Anthropology 24(1): 95–117.

    Article  Google Scholar 

  • Morello-Frosch, R. et al. 2006. Embodied health movements: Responses to a “scientized world.” In The new political sociology of science: Institutions, networks, and power, edited by S. Frickel and K. Moore, 244–271. Madison: University of Wisconsin Press.

  • National Academies of Sciences, Engineering, and Medicine. 2016. Mitochondrial replacement techniques: Ethical, social, and policy considerations. Washington, DC: The National Academies Press.

  • Nuffield Council on Bioethics. 2012. Novel techniques for the prevention of mitochondrial DNA disorders: An ethical review. London: Nuffield Council on Bioethics.

    Google Scholar 

  • Palacios-González, C., and M. Medina-Arellano. 2017. Mitochondrial replacement techniques and Mexico’s rule of law: On the legality of the first maternal spindle transfer case. Journal of Law and the Biosciences 4(1):50–69.

    Article  Google Scholar 

  • Pohlschmidt, M. 2011. Muscular Dystrophy Campaign submission to the Human Fertilisation and Embryology Authority’s Call for Evidence: Scientific review of the methods to avoid mitochondrial disease. Non-confidential written evidence submitted to the panel. http://webarchive.nationalarchives.gov.uk/20160504162251/http://www.hfea.gov.uk/docs/Mitochondrial_Review_non-confidential_evidence_full_PDF_reduced.pdf. Accessed July 11, 2018.

  • Rabeharisoa, V., and Ó. O’Donovan. 2014. From Europeanization to European construction: The role of European patients’ organizations in the shaping of health-care policies. European Societies 16(5): 717–741.

    Article  Google Scholar 

  • Reardon, S. 2016. Reports of “three-parent babies” multiply. Nature. October 19. https://www.nature.com/news/reports-of-three-parent-babies-multiply-1.20849. Accessed January 15, 2018.

  • Sample, I. 2016. World’s first baby born from new procedure using DNA of three people. The Guardian. September 27. https://www.theguardian.com/science/2016/sep/27/worlds-first-baby-born-using-dna-from-three-parents. Accessed July 1, 2018.

  • Schicktanz, S. 2015. The ethical legitimacy of patient organizations’ involvement in politics and knowledge production: Epistemic justice as a conceptual basis. In The public shaping of medical research: Patient associations, health movements and biomedicine, edited by P. Wehling, W. Viehöder, and S. Koenen, 246–265. Oxon: Routledge.

    Google Scholar 

  • Schicktanz, S., M. Schweda, and M. Franzen. 2008. “In a completely different light”? The role of “being affected” for the epistemic perspectives and moral attitudes of patients, relatives and lay people. Medicine, Health Care and Philosophy 11(1): 57–72.

    Article  Google Scholar 

  • Scutti, S. 2017. Controversial IVF technique produces a baby girl—and for some, that’s a problem. CNN, January 18. http://www.cnn.com/2017/01/18/health/ivf-three-parent-baby-girl-ukraine-bn/index.html. Accessed January 15, 2018.

  • Smeets, H. 2013. Preventing the transmission of mitochondrial DNA disorders: Selecting the good guys or kicking out the bad guys. Reproductive BioMedicine Online 27(6): 599–610.

    Article  CAS  Google Scholar 

  • Taussig, K-S. 2005. The molecular revolution in medicine: Promise, reality, and social organization: Beyond nature & nurture. In Complexities: Beyond nature & nurture, edited by S. McKinnon and S. Silverman, 223–247.Chicago: University of Chicago Press.

  • UMDF. 2017. Mitochondrial replacement techniques position statement. http://www.umdf.org. Accessed January 15, 2018.

  • Varvaštian, S. 2015. UK’s legalisation of mitochondrial donation in IVF treatment: A challenge to the international community or a promotion of life-saving medical innovation to be followed by others? European Journal of Health Law 22(5): 405–425.

    Article  Google Scholar 

  • Wehling, P., W. Viehöder, and S. Koenen, eds. 2015. The public shaping of medical research: Patient associations, health movements and biomedicine. Oxon: Routledge.

  • Wellcome Trust. 2014. Response to the Science & Technology Committee: Mitochondrial donation. October. https://wellcome.ac.uk/sites/default/files/wtp057739.pdf. Accessed July 27, 2017.

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Acknowledgements

I would like to thank all participants in this study, members of the Mitochondriale Erkrankung Diagnosegruppe (formerly the Mito Team) of the German Society for People with Muscle Diseases and International Mito Patients for their openness and ongoing support, and Mount Holyoke College for the Research Support and Research Assistance Faculty Grants that have supported this work. I appreciate fully the meticulous work of Ricky Frawley and Rozalind Rideout, who contributed to the transcription and initial coding of the interviews. Comments from anonymous reviewers and the editors of this symposium helped me to explicate the complexities of my findings. The earlier project, HealthGovMatters, upon which this study builds, was co-funded by an FP7 Science in Society grant (229714).

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Correspondence to Jacquelyne Luce.

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Luce, J. Mitochondrial Replacement Techniques. Bioethical Inquiry 15, 381–392 (2018). https://doi.org/10.1007/s11673-018-9873-6

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