Looking at the Future of Translational Stem Cell Research and Stem Cell-based Therapeutic Applications: Priority Setting and Social Justice

  • Göran Hermerén
Part of the Stem Cell Biology and Regenerative Medicine book series (STEMCELL)


Two kinds of priority setting problems are discussed in this chapter: setting research priorities and setting priorities in health care. They are not unrelated, but the criteria are not the same. Focus is then, as the title suggests, on setting priorities in health care. The discussion is based in the assumption that in the future there will be stem cell based treatments of many current disorders, and we may have to choose within them or between them and other treatments, since resources are scarce. I argue that new standards are not needed for such problems; current criteria and standards can be used. Several problems in applying them are related to lack of clarity of distinctions, such as the one between vertical and horizontal priority setting, differences between different health care systems and the value premises used as starting point.

Taking a human rights-based approach as a point of departure, some relevant dimensions are outlined and incorporated into a model – to be used in the practical handling of priority setting problems. Problems of uncertainties and knowledge gaps are highlighted and their relevance to priority setting is explored. A take home message is that some of the problems in applying this model are not related to the value premises or dimensions of the model, but to the lack of knowledge of efficacy, costs, prevalence, patient needs etc. Cases of increasing difficulty are distinguished and illustrated. Fair access is not only a problem from a global point of view, it is also a problem in many countries, since wealth is unevenly distributed. Social justice aspects – discussed in the recent ISSCR guidelines – conclude this chapter.


Access Priority-setting Relevant dimensions Social justice Stem cell research and therapy 


  1. 1.
    Swedish Research Council, Instructions for reviewers, downloadable at
  2. 2.
    Fleischhauer K, Hermerén G. Goals of medicine in the course of history and today. A&W International, Stockholm 2006.Google Scholar
  3. 3.
    ISSCR, Guidelines for the Clinical Translation of Stem Cells, can be downloaded from
  4. 4.
    Sahlin NE, Brännmark J. Ethical theory and philosophy of risk: first thoughts. J Risk Res 2010; 13:149–61.CrossRefGoogle Scholar
  5. 5.
    Sahlin NE. Kan vi vara moraliska när vi är så irrationella? Kungl. vitterhets historie och antikvitets akademien, årsbok, 2009, 201–15.Google Scholar
  6. 6.
    Fleischhauer K. Aufbringung und Verteilung von Mitteln für das Gesundheitswesen. Regelungen und Probleme in Deutschland, Grossbritannien und den USA. Karl Alber: München, 2007.Google Scholar
  7. 7.
    European Convention for the Protection of Human Rights and Fundamental Freedoms, Rome 1950.Google Scholar
  8. 8.
    Council of Europe, Oviedo Convention. Oviedo, 4.IV.1997 (Strasbourg, European Treaty Series).Google Scholar
  9. 9.
    Ashcroft R. Making sense of dignity. J Med Ethics 2005; 31:679–82.PubMedCrossRefGoogle Scholar
  10. 10.
    Brownsword R, Beyleveld D. Human dignity in bioethics and biolaw. Oxford: Oxford University Press, 2002.Google Scholar
  11. 11.
    Macklin R. “Dignity” is a useless concept (2003). Br Med J 327:1419.PubMedCrossRefGoogle Scholar
  12. 12.
    Gewirth A. The community of rights. Chicago: University of Chicago Press, 1996.Google Scholar
  13. 13.
    Daniels N. Just health. Meeting health needs fairly. Cambridge: Cambridge University Press, 2008.Google Scholar
  14. 14.
    Hermerén G. Redskap finns och plattformen håller – men kunskapsunderlaget är bräckligt för prioriteringar i vården. [Tools are available and the ethical platform should be used – but there are many uncertainties in the information about costs and effects. [J Swedish Med Assoc] Läkartidningen 2009; 106:2702–3.Google Scholar
  15. 15.
    Slovic P. Perception of risk. London: Earthscan, 2000.Google Scholar
  16. 16.
    MacGregor DG, Finucane ML, Gonzalez-Caban A. The effects of risk perception and adaptation on health and safety interventions. In Martin WE, Raish C, and Kent B (Eds), Wildfire risk: human perceptions and management implications (pp. 142–155). Washington: Resources for the future. Michele S. Garfinkel, Drew Endy, Gerald L. Epstein, and Robert M, 2008.Google Scholar
  17. 17.
    Miller FG, Brody H. Clinical equipoise and the incoherence of research ethics. J Med Philos 2007; 32:151–65.PubMedCrossRefGoogle Scholar
  18. 18.
    Levine RJ. The “best proven therapeutic method” standard in clinical trials in technologically developing countries. AIDS Public Policy J 1998; 13:30–5.PubMedGoogle Scholar
  19. 19.
    Hermerén G. European values – and others. Eur Rev 2008; 16:373–85.Google Scholar
  20. 20.
    Priorities in health care. Ethics, economy, implementation. Final report by the Swedish Parliamentary Priorities Commission. Stockholm: SOU 1995, p. 5.Google Scholar
  21. 21.
    Rawls J. A theory of justice. London, Oxford, New York: Oxford University Press, 1971. Revised ed. Cambridge, Mass Harward University Press, 1999.Google Scholar
  22. 22.
    European Group on Ethics, Publications can be accessed and downloaded free of charge via
  23. 23.
    Global Forum for Health Research. 10/90 Report on Health Research 1999. Geneva, 1999.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Göran Hermerén
    • 1
  1. 1.Department of Medical EthicsBiomedical Centre, Lund UniversityLundSweden

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