Ethical issues in nanomedicine

Ethics in Nanomedicine

The term "nanomedicine" is mainly a reference to the scientific technology called nanotechnology which is used to enhance or sustain health at a small level. This technology is being used in medical domains: such as the processes involved in the production of tissue in the human body; the transportation of drugs that help in the DNA treatment; as well as, studies that concentrate on the diagnostic instruments and procedures. The single most important merit that this form of health sustenance has over other medical procedures is its volume. Its volume is as small as a fragmented particle and this particle influences the duration of the effect of the serum and has a very specific design of deposition. Both these aspects allow the nanosize medicines to be used in smaller amounts but have a greater healing and treatment effect. The utilization of nanomedicine has also helped in managing efficient and timely transportation of medicine to different places through the use of accurate directions. Even though nanomedicine and nanoparticles are being utilized in more and more medical procedures for effective treatment, there has been very little research done on the negative effects that they might have on the health of the people and the environment if they are exposed to them. Another significant area of research in nanomedicine is effective policy making for developing this technology along with social, economic, political and institutional ethics. There already have been cases where the breathing in of nanoparticles has led to serious lung damage. One of the other known problems is that the consistent nature of the nanoparticles, along with their physical and chemical attributes, and the environmental structure can in conformity lead to toxicological reactions. Nanotoxicological stats even though are at this time inadequate but if studied more could be significant in bringing a new dimension to the medicinal studies and industries; it could be of great help to the medical boards in explaining the instruments being used while finding a way to stabilize or equalize the pros and cons of its use which in effect will lead to an increased utilization of these instruments without causing any harm to the human and/or ecological health.

Explanation of problem

The initiation of nanotechnology, even though, was in the realm of scientific literature and theory but it has swiftly become an integral part of medical studies and research. Nanomedicine and technology is now being regularly and popularly tested for various applications in numerous pharmaceutical and biotechnology organizations as well as government corporations. Even the Food and Drug Administration (FDA) in United States has stepped into the realm of testing the nanotechnology and numerous particle-supported treatments and instruments have been approved or are currently being tested. Also, nanomedicine has been approved for the human testing of the treatment of cancer after numerous clinical successes (Service, 2005; Gordon, 2005). This is why we can see big corporations and numerous counties as well as governments investing in nanomedicine from the national funds; like the National Cancer Institute (NCI) that had recently invested $144 million in the cancer nanotechnology proposal which will be the financial aid for several cancer nanotechnology institutions (Service, 2005; National Cancer Institute, 2004]. One of the major reason for this massive investment is the belief of numerous medical experts that with the path that nanotechnology is on right now; it will expand and perhaps in the next few years provide the most efficient and effective methods of diagnostic trials and studies; be applicable in the synthetic biological configurations that help in the healing and adjustment in the tissue structures; help eradicate cancer cells as well as transportation of drugs/medicines (Kubik, Bogunia-Kubik, Sugisaka, 2005). The influence and consequence of the development of nanotechnology will perhaps be of the same magnitude as that of the DNA innovation. The current path of investments in nanotechnology will make it an $18 billion industry by end of 2014 (Hunt, 2004).

The social response to the incorporation of nanomedicine has been somewhat parallel. Even though there are ecologists who have spoken of the hazards that nanotechnology can have towards the environment, there has not really been a breaking out revolt against it (Friedman and Egolf, 2005). Numerous studies have shown that most people are not aware of the use of nanotechnology and seem to have no preference (Friedman and Egolf, 2005). With the exception of Michael Crichton, who in his article Prey, criticized the use of nanotechnology the media has posed a very balanced stance by presenting both the pros and cons of the use of nanotechnology (Friedman and Egolf, 2005; Crichton 2002).

It has been one of the major talks amongst scientists and government administrators to make the common public aware of the pros and cons and the use of nanotechnology to avoid any aggressive reactions like those that occurred in Europe and America over the genetically modified (GM) provisions (Friedman and Egolf, 2005). Its is important to consider and candidly confer the social and moral problems that could occur due to the use of nanomedicine to the public because it was the absence of these talks that led to the negative response to the genetically modified foods (Friedman and Egolf, 2005; Mills and Federman, 2005).

Nanomedicine is no different from the numerous other technologies that are facing the ethical issues related to the social and environmental damages along with parading pre-defined institutional boundaries that might be the consequence of their use. Nanomedicine faces one new dimension of problems, however, which is the probable increase in human performance from its use which was an evident feature in a TV series Jake 2.0 (Grunwald, 2005; Sheremeta, 2004). The fact of the matter is that scientists are still trying to figure out the standard physical and chemical attributes of the nano-particles which is why there are still many managerial, communicative and minimal risks problems in the trials and testing of this phenomenon on humans (Davis, 2006; Oberdrster, Oberdrster and Oberdrster, 2005). Even though, recent tests and application of the nanomedicine have not led to serious ethical or social and institutional concerns but the potential risks of the increased use of nanoparticles and their effect on the eco-system and human societies has raised a concern for the restructuring of the present procedures. But before discussing ethical concerns of nanomedicine, we will briefly discuss the phenomenon itself.

A concise description of nanotechnology

Nanotechnology is the discipline and management of a particle-based material that has an assortment of 1-100 nanometer (nm) (National Nanotechnology Initiative., 2006), which is one billionth of a meter. To clearly see the magnitude of a nanometer we can see the size of other particles in the dimension of the nm for example the hydrogen particle is almost 0.1 nm; the DNA is in between 1-2 nm; a virus varies between 3-50 nm, while a red blood cell is 300 nm. Ultra fine particles (UFP) are also categorized as organically created nanoparticles. The examples of some of the common UFP are volcanic cinders, viruses or similar fumes, exhaust of the cars, electronic motors, and industrial plants (Oberdrster, Oberdrster and Oberdrster, 2005).

In a general overview the artificial or man-made nanomaterials do not share the physical or chemical attributes of the other scientific materials. The two properties of nanomaterials that greatly influence the biological endeavors are surface-area-to-mass ratio and physicochemical. The probability of biochemical contacts to increase with the use of nano-scale materials is because the chemical reactions mostly happen on the exterior shell of a material and the nano-particles, as compared to other scientific instruments, have a greater surface-area-to-mass ratio. Another plus that the nano-scale particles have is that the quantum mechanical traits of the fragments present in the nano-materials have a significant effect on the physicochemical attributes of the substance. This offers that substance an assortment of electrical, visual and magnetic traits that cannot be found in the other similar scientific materials. The size of the nm is variable from 1 and 100; hence, the traits that the nm has like the liquefying point, shade, and electronic directive will fluctuate accordingly (Oberdrster, Oberdrster and Oberdrster, 2005).

The fact that the nanomaterials have traits that are still pretty much unidentified and inimitable makes them applicable for use in numerous different spheres (National Nanotechnology Initiative, 2006). The nanomaterials that are regularly used in industries and medical spheres are fullerenes, C60 carbon shells, and quantum dots while other commonly used nanomaterials are the nano-tubes, straps, bars, brushes, chains and nano-shells. The fact that the nano-tubes are able to transfer one electron at a time makes them great electronic transmitters, fillers, chemical and biological antennas (Chang, 2005).

Thesis or Focus Statement or Question

Social and bioethics related to nanotechnology needs to be revealed since nanomedicine and nanoparticles are being utilized in more and more medical procedures for effective treatment, but there has been very little research done on the negative effects that they might have on the health of the people and the environment if they are exposed to them.

Underpinnings of the Issue:

The emphasis of all scientific researches and technologies should focus on the ethical and social principles that have been defined in numerous national, regional and international charters like; the American constitution and the Charter of Fundamental Rights in Europe. All these charters that have clearly defined the boundaries of what both the positive i.e. natural rights and negative i.e. The unjust exploitative rights of the people are and how no institution or research domains have the right or power to violate them (Dierkes, Hoffmann and Marz, 1996).

Based on the above fact, we have to consider all the concerns related towards security of an individual as well as his rights, societal principles and considerations, national strategies, the financial system and market of the country as well as the social-educational-traditional structure that might be put in jeopardy due to a scientific research of nanomedicine. Hence we have to carefully consider that the researchers who are investing their time and effort in to the nano-medical research are treated with value while still securing the human rights of the society i.e. awareness of and protection against the hazardous effects of nanoparticles on human and ecological health. We also have to consider the principle issues of integrity, unity and sovereignty and their role in the research studies (Dierkes, Hoffmann and Marz, 1996).

Even though the social, financial, political and moral issues are interlinked and inter-dependent features, they will be tackled separately in this review and the emphasis will be on the accurate implementation of the nanomedicine asset so that it can be utilized in a morally secure, autonomous and rightful way. For this to happen there have to be clear distinctions made amongst the following (Dierkes, Hoffmann and Marz, 1996):

Medicinal and non-medicinal topics;

Definite and ambiguous troubles or concerns;

The current, close and far-off future potentials;

The conventional and moderns theories of health and ailment

Even though these distinctions need to be made for progress, one must be prepared for the added troubles or concerns that might arise from each of these. The fact of the matter still remains that the people are bound to be affected by this technology whether that be straightforwardly through human testing or circuitously through exposure to nanoparticles. This is why it is vital that the public rights are understood and considered before any further experimentation is carried out and the people need to be made aware of the pros and cons of the nanotechnology so that they too can make choices and adopt precautionary efforts (Dierkes, Hoffmann and Marz, 1996).

Description of the Issues

Security and health

The security and awareness concerns amongst the people regarding the use of nanomedicine and have been raised with clear directives in numerous reports and surveys (Dierkes, Hoffmann and Marz, 1996). Even though every report that has been issued addressing this particular topic has used different strategies but they have all focused on the fact that there is very little information available on the use and side effects of the phenomenon of nanomedicine on both the public and ecological health. And all these reports propose that this has got to change because otherwise it would result in dire circumstances of resistance towards the use of nanotechnology. There has to clear difference made between what are the direct (to a patient of nanomedicine) and indirect (to an individual or atmosphere exposed to nanoparticles) effects of nanotechnology (Dierkes, Hoffmann and Marz, 1996).

Even though the main concern of researchers at this point is the direct effect that nanomedicine has on an individual but the fact of the matter is that there is, in essence, a very minuscule difference between the two effects which is why the scientist and researchers have to incorporate both risk situations in their research studies. Hence the risk assessment strategy should serve, as a protection, for both the human and ecological health as well as the harmless development of nanotechnology (Dierkes, Hoffmann and Marz, 1996).

The scientists, however, who are dealing with nanomedicine, still pay far more attention to the direct effects of the nanomedicines as opposed to the indirect exposures to nanoparticles. They tend to pay attention to whatever negative effects injecting nanomedicine in the body might have on the tissue cells because of unnecessary amassing, or easy transference to other parts of the body like the brain, or the structure of the cellular metabolism. They try to come up with the best forms of animal testing that could give them the closest reactions to what might happen in the human body. They tend to focus on the best possible ways to implement nanotechnology so that there are no dire effects with the sufficient amount of toxicological data (Dierkes, Hoffmann and Marz, 1996).

Some researchers and scientists have focused on the indirect exposure to nanoparticles and their effects on societies due to the nano pollutants in the water, air and soil and have tried to find a bridge between the fundamental human rights and safeties and the industry that is trying to expand its market (Wei, 2007).

The Dutch Health Council report was one of those that urged the scientist to thoroughly investigate both the negative and positive influences that nanotechnology might have directly and indirectly. The UNESCO report, however, was purely based upon the on the violations of the ethics and rights that the negative effects of nanotechnology inflict on a society, and how these need to be rectified soon (Wei, 2007).

Management of risks

The problems with calculating risks of nanomedicine are dependent upon its unpredictable nature. There is no sure way of knowing, recognizing, analyzing or administrating the risks in nanotechnology because there are still many who have restricted knowledge and understanding of the phenomenon. The long-term and short-term concern of nanotechnology are different and dependent upon numerous variables. Concerns are also raised by the difficulties of identifying, estimating and managing risks in an area where there are considerable uncertainties and knowledge gaps, and when the short-term and long-term risks may be different. All of these shortcomings have been discussed by different profit organizations and in several reports and researches (Wei, 2007).

The concern for creating unnecessary and untrue publicity and promotion for the nanomedicine has been a consequence of the rise in competition amongst researchers and the demand of financial support for the research studies. The false publicity is making nanomedicine come across as more of a success as a treatment then it actually is. This false publicity would give rise to false and unnecessary fears related to the phenomenon. This is why the researchers need to find a broader and a more flexible strategy for its implementation so that nanomedicine can adapt to the changing social, environmental, trade and national tactical patterns (Dierkes, Hoffmann and Marz, 1996).

Factors that cause or create the issues:

Concerns related to Bioethics

Safeguarding individual human rights

The laws and regulations involving the security of human rights that have been designed by organizations on both, international and national, spheres clearly explains the procedures that need to be followed when dealing with health care as well as medical research. These procedures include the steps to make sure that the volunteers for research are well aware of what is happening and can make an informed decision as to their consent for participation. It also includes what steps are needed to be followed if the participants of the research are, due to variable circumstances, incapable to make an informed decision (Wei, 2007).

The aforementioned regulations also include procedures that would safeguard the people as well as the ecological society as a whole against the negative effects of the use of nanomedicine as well as the unforeseen problems that might arise due to its unpredictable nature. These procedures will also include the risk prevention or precautionary methods of the short-term or long-term concerns, both medical and non-medical, of the application nanomedicine. Some of the vital concerns tackled in these procedures are the management of all the medical knowledge that is gained swiftly even though there are considerable doubts and disparities as to its authenticity (Wei, 2007).

Educated authorization

The ethical problem does not lie in getting the patients to oblige to a certain procedure; the problem lies in doing it in a way that patient is clearly and fully informed of what he is obliging to. The patient needs to comprehend his problem and the solution that is being provided to him for that problem and what would be its negative and positive impacts on him/her. The real challenge comes when this information has to be articulated or communicated within a domain of research that is consistently modifying and in a situation where one has got to carry out assumed analysis of several unidentified factors and intricacies. In these situations it might be difficult to clearly state what form of procedure would be most suitable and successful (Wei, 2007).

Intricate structures and augmented individual liability

The most amazing feature of nanomedicine is that it will reduce new dimensions and angles to treatments which will not only make them more precise and accurate but will also increase their level of speed and spectrum or degree of cure. Even though there is no way of knowing the exact extent or time of this occurrence but it will definitely make the whole treatment process a lot more advanced and successful. There is always the possibility of the discoveries of unique diseases. This increased velocity of treatment and increased individual responsibility is not a new ethical concern. This particular feature of nanotechnology would, in theory, offer more individual autonomy and liberty but side by side it will also raise the level of stress or burden on the individual because their preferences and selections will be the decisive factor. Some experts believe that this could also influence the fundamentals of well-being and ailment as well (Wei, 2007).

Intermediary exploitations

Experts also believe that studies should focus on the level of information that is accessible, and the circumstances that allow accessibility, to the intermediaries specifically the insurance agencies and managers. This again is not a new concern but if one wants to, in the long run, implement the conventional structure of insurance that is found on the values of unity and mutual unawareness then one has got to make sure that the latest and accurate healing mechanisms of nanomedicine do not challenge and weaken it; and, hence restrict the accessibility that these intermediary actors have to the information (Wei, 2007).

Non-medical and Medical treatments

There is a very indistinct and unclear division between the medical and non-medical concerns and/or treatments which is another concern for many experts. Non-medical are mainly treatments that are not related to the medical health of the individual but do require medical mechanism for their application. Most non-medical treatments are driven by the individual's own wants or desires e.g. plastic surgery for the enhancement of an already present and proper facial feature. Of course this example given can very clearly be distinguished from a medical treatment but there are other non-medical treatments where the difference is not so evident (Wei, 2007).

Many experts believe that the use of nanomedicine will overlap numerous medical and non-medical treatments and in effect lead to many ethical and social problems. This form of application or execution of nanotechnology could potentially become a burden for both the individual and the state at large. The government and the societies will have to work harder to maintain the distinctions within a society and prevent the sphere of medicine to become a phenomenon of the service sector driven by anybody or everybody's preferences (Wei, 2007).

The general public accessibility

Another rising ethical concern from numerous experts has been the level of accessibility and the amount of finances required for an individual to attain solid and proper medical treatments. If the individuals or certain communities feel deprived of opportunities or standards that will allow them accessibility to health-care facilities then they would feel discouraged and rate themselves as part of the substandard society. This also raises questions about the general bias and inequality towards certain groups or individuals. Experts feel that future researches should also incorporate these aspects and also side by side concentrate on the ways with which these individuals then tackle this deficiency in their lives and what are their alternatives (Wei, 2007).

Social ethical concerns of nanomedicine

The domain of social ethical concerns of nanomedicine encompasses the spheres of issues related to the general public, as well as, the aspects of management and the roles of organizations (Wei, 2007).

Debates on democratic values

The principle of pluralism

The principle of pluralism is mainly a trait that reflects the conventionalism of the structure of western civilization and the aspects of reciprocal reverence and acceptance. This acceptance towards the theories, ethics and laws of the different cultures and schools of thought is what is needed, in the experts' opinion, when the topic of health care and its impacts, both negative and positive, are discussed, especially in the debate of nanomedicine (Wei, 2007).

In a society where pluralism of the standard of living and principles and values is already assumed to exist, it is also common to see respect for the customs and organizations as well. If there is potential for a massive change in the traditions, customs or lifestyles of people within a society that is when the phenomena of social and ethical pluralism is needed along with a heavy discussion on the changing aspects of the culture through clear cut communication and interaction. Nanomedicine is perhaps one feature that can cause such a massive change and for any sort of communication to occur, people, researchers and scientists too need to first gain absolute knowledge of those features (Wei, 2007).

This is one of the major reasons why experts have over the years stressed on the need for the growth and spread of the moral principles within many spheres including the domain of medicine. They have emphasized on the mutual respect of human rights, multiculturalism, debates and patience from both the medical, as well as, the public sectors. It might seem like this emphasis takes away from the real analysis and study of the technology, while in fact, it is this very recipe that promotes thorough assessment of the technology and provides reliable basis for all the conclusions that can be made (Wei, 2007).

Communal exchange of ideas

The communal exchange of ideas and opinions is an imperative force to any research, especially within a democratic system of government, as it not only lets the people know about what is going on in the world of technology but also lets them contribute ideas and possible solutions that could help the overall process. However, this level of contribution or input can only be scrutinized for the optimum time. In other words, it has to be analyzed when it would be best to involve the public and for this all the elements like the method of articulation, the rules of confidentiality, the frequency of the contribution, the amount of information revealed, the dimensions or spectrum that the public is allowed to contribute in, etc. play a major part in the communicative design. Experts believe that the communication dealing with nanomedicine should focus on how the use of this technology will help the society at large (Wei, 2007).

This, of course, cannot be achieved without a certain level of mutual faith, dependence and assurance between the scientists, researchers and the layman. Once this confidence is built then there can be numerous candid discussions on the deficiency or gaps in knowledge, reflections on the purpose of the democratic setup, analyze what can, cannot, should and/or should not be permissible in accordance with both the human rights as well as the experimental rights of a scientist and also allow the designation of the part that the media and peripheral forces play in the whole process (Wei, 2007).

The experts believe that the contribution and mutual sharing of ideas between the scientist and the public is important in all sphere of technological advancements. These are some of the suggestions they made on how to raise the interest of the people to candidly discuss the phenomenon of nanotechnology and its effects: discussions and debates on what is believed to be the untied and accepted belief, studies that incorporate the public viewpoints as well as design the communication mechanisms that are not only available to the public but are simple to understand and use. This involvement is vital not only for the social recognition and approval of the phenomenon of nanomedicine but it also allows the execution of nanomedicine under a structure that has from the time of initiation given apt attention to the social and ethical responsibilities (Wei, 2007).

Organizational and political ethics

The fact of the matter is that nanomedicine is also a segment of numerous other domains of research and technical advancements that are in need for updated and modern organizational structures to bridge the requirements of the public, the government, the financial system and the medical research facilities. The study of the domain of nanomedicine is hence multidimensional and its conclusions mainly depend upon what field is being chosen for the analysis along with the tactics or strategies adopted, finances, copyrights, etc. The main concern for the experts now is to make sure that the public gets to contribute on the decisions that are made for its economy on the global sphere in correspondence to the development and application of nanotechnology (Wei, 2007).

The Individual Right and Government

The basic rights of all people includes the security of self-respect, honor and independence, sovereignty, safeguard of the confidentiality and security of the personalized information, as well as, the unawareness and unawareness privileges (Wei, 2007). There are numerous conferences held and laws made to make everyone aware of these rights and the consequences of their defiance. However, it has to made clear that because of these specific and limiting human rights, it may seem that the freedom of experimentation and research is discriminated against and is restricted, but this is not the case. All experimentations and researches are encouraged. With the studies of nanotechnology the experts feel that privacy cannot possibly be a solid fixture when more and more stored data is used as the basis for numerous researches. They suggest that there has to be a distinction between the necessary information and the information that is completely non-medical in nature and the government should make policies where the human rights and stored information can still be protected irrespective of whether it is being used as the basis for research or not (Wei, 2007).

Structural and authoritarian issues

It has to be understood that the technical growth, expansion and progress is not an isolated fixture and does indirectly and inevitably has its effect even if its not really being implemented. All the studies and analysis that are done on the phenomenon of prospective technology have to be kept note of to avoid repetition of mistakes or flaws. Experts are still trying to figure out the designation of this particular responsibility and the steps that would ensure that these analyses included the ethical responsibilities (Wei, 2007)?

The numerous aspects of the technical advancements include the logical and appreciative privileges, financial support, health securities of patient and non-patients, managerial techniques, etc. All these aspects are dealt with at different levels at different organizations and their main purpose is that the enhancement of lifestyles as well as proper resource allocation and use (Wei, 2007).

As discussed before, nanomedicine has a part in numerous other spheres outside the domain of medicine and some of these spheres have a direct impact on the human and ecological well-being e.g. military mechanisms and agri-food. The consequences and aftermaths of these impacts are not independent of the field of medicine though; this is because the legislative restrictions are applied to various extents that go beyond the experimentation of newly discovered drugs and incorporate the impacts of technical expansions as a whole. The political input is needed when decisions have to be made bearing in mind the associations that the implementation of technological advancement and human rights have or share at the time (Wei, 2007).

Copyright concerns

The use of dangerous materials like the biomaterial for the purpose for medical expansion and experimentation has become a main ethical and financial concern for numerous experts. The copyright legislature is basically an attempt by government organizations to parallel the effects of the numerous interests that exist within a society. These copyrights will protect the interest, rights and financial investments of the researchers and producers in the medical industries and allow them to reap and benefit from the profits earned while other lawmaking bodies will have to represent the rights of the societies and the individuals. There have arguments made on the copyright of a new product if it can be applicable to both the medicinal and experimental domains. All the copyright laws need to address the moral rights in their copyrighting procedures before issuing the use of a new technology in surgery especially if these technologies include tissues and nanomaterials simultaneously (Wei, 2007).

Analysis of the issue from three ethical frameworks:

In this section we will analyze the ethical concerns highlighted in the preceding section from three ethical frameworks. These three ethical frameworks are as follows:

Prima Facie Framework

Care and Responsibility

Justice and Social Contract

Framework 1: Prima Facie Framework

Beauchamp and Childress (2001) assert that the fact that nanotechnologies, particularly nanomedicine, gives great hope to the health of people, makes it a strong prima facie case. Nonetheless the debate on nanomedicine ethics needs to be considered more profoundly. He divides the current issues into four distinct categories and believes that these categories are prima facie bounded. These categories are as follows:

Individual right and freedom;

Beneficence;

Non-maleficence; and Justice

In our analysis of nanomedicine ethics from prima facie framework, we will follow the bioethical theory presented by Beauchamp and Childress. This is because it presents the relevant principals related to the ethical issues of nanomedicine. They believe that every new ethical problem in nanomedicine is bound to cause further assessments of reforming the ethics and principles under which medicine is being practiced. This is because the ethical dilemmas and the ethical principles have a dialectical connection with one another. This form of connection might cause some researchers to present an altered viewpoint of the ethical dilemma at hand. They further propose that assessment of an ethical dilemma is actually a procedure instead of rigid application of morals and values. In line with the theory presented by Beauchamp and Childress, one can utilize practical ethical dilemmas with nanomedicine to evaluate the ethical values that are being threatened. The end result would be a transformed version of ethical principals. This is due to the dialectical connection amid ethical principles and problems in practice (Beauchamp and Childress, 2001).

Beauchamp and Childress (2001) assert that all cultures, throughout the world, have the capacity to adopt the four principle framework they have presented. This is because, according to them, these values are a component of the cross-cultural common morals (Beauchamp and Childress, 2001). They further assert that while these values are universally acknowledged; there is little consensus when it comes to the definition of good and bad, profit and loss. When different cultures are on the verge of adopting these principals, fascinating discussions and debates are held. Since all principals carry equal weight, the fact that certain principals that are given more emphasis actually has less to do with imbalance in the theory and more to do with the context of the given circumstances. Beauchamp and Childress (2001) consider these ethical principles to be bounded by prima facie. All four principals have got to be executed unless it is found that a particular principal is actually in conflict with another principle. According to Beauchamp and Childress (2001) some actions are immediately prima facie right, while others are immediately prima facie wrong. Representatives have got to then contemplate on a superceding ethical obligation (Beauchamp and Childress, 2001). The most accurate balance between correct and incorrect has got to be reached. This can be done by assessing the real responsibilities through careful evaluation of contending prima facie principles (Beauchamp and Childress, 2001).

By using the prima facie four principles (Individual right and freedom; beneficence; non-maleficence; and justice) presented by Beauchamp and Childress (2001), we will assess the situation of nanomedicine ethics.

The Principle of Respecting Individual right and freedom

Beauchamp and Childress (2001) assert that principle requires the respectful treatment in the following instances:

Revealing correct information,

Exploring and guaranteeing individual perceptive and voluntariness; and Encouraging independent decision-making.

This principle does not include, however, the following individuals:

People who are unable to act autonomously:

Children

Drug-oriented clients.

The Principle of Beneficence

Evil and harm ought to be removed or al least minimized;

Promote good, but first do-it-yourself;

Critical analysis of an action should be made and possible harms and benefits should be revealed beforehand

The Principle of non-maleficence

Mental and physical harm should always be avoided.

The Principle of Justice

Healthcare should be made affordable and accessible to all members of the society.

Beauchamp and Childress (2001) believe that while a strong prima facie case can be made for nanomedicine, the four dimensions of ethical framework specified above should be considered when relevant legislators and law makers sit down to draft federal and state policies.

Framework 2: Care and Responsibility

Heifetz (1996) asserts that care and responsibility are essential for effective implementation of nanomedicine technologies. Physicians and researchers need to not only respect the decision made by their patients but also protect them from possible harm. They in addition have got to make efforts to secure their physical and mental well being. Normally, care is believed to be an act of charity and/or kindness which extends beyond the realms of responsibility. However, Heifetz (1996) asserts that care essentially means fulfilling the responsibility entrusted upon the physician by the patient. Heifetz (1996) asserts that in the context of nanomedicine, care and responsibility means two things:

Cause no harm

Reduce the possible harms to minimal and increase the benefits to the maximum

Chambers (1996) provides a definition about care and responsibility. According to him care and responsibility is synonymous with the following:

Comprehensive medicine,

Social medicine,

Preventive medicine,

Community medicine,

Personal medicine,

Ambulatory medicine, and/or

Family medicine.

All of the above terms include care and responsibility on the part of the medical community. However, in the context of the new technologically developed medicines, such as nanomedicine, care and responsibility is the treatment that takes up longitudinal responsibility for the client disregarding whether there is absence or presence of disease (Chambers, 1996).

Charon (1994) described care and responsibility as a process instead of application of rules and regulations. This procedure primarily includes:

Health support;

Detection of people at extraordinary threat;

Premature identification of acute ailment;

Supervision of severe emergencies; and Capability to provide consistent care to the ill (Charon 1994).

Childress (1997) proposed a comprehensive definition of the scope of care and responsibility in bioethics and nanomedicine. Care and responsibility comprises the values used to deal with a patient from the initial exchange of the patient with the health care organization. These values include:

High quality:

Comprehensiveness,

Individualized,

Rapidly responsive,

Promptly accessible care

Patient-oriented,

Straightforward, and Founded on a solid background which comprises information (Childress, 1997)

Most of these definitions of care and responsibility are identical to those definitions provided by the researchers in the 1980's. For example Churchill (1987) provided the scope of care and responsibility in healthcare systems and included:

Taking initial evaluation;

Trying to resolve all of the problems being faced by the patient;

Organizing health-team and advisors and auxiliary experts;

Staying in touch with the patient; and Taking up sustained responsibility for care.

Brennan et al. (2002: pg 22) assert that ethical use of nanotechnology, a part of the biotechnology revolution, cannot be overemphasized due to the possible negative outcomes of its use. According to him, care and responsibility cannot be limited to those who practice medicine; in fact it should extend to include those in political offices; those in the manufacturing business and those on the research and development business. They believe that answering questions about whether the existence of nanotechnology and its most important branch, nanomedicine, is ethical itself is a monumental waste of time as we are way in too deep to pull ourselves out of it. They instead focused on the ethical aspects of the use of nanotechnology. They write:

The development of biotechnology has produced nothing short of a revolution in our capacity not only to manipulate living things from single plant cells to human nature itself, but also to manufacture new life forms almost 'from scratch'. This power to shape and create forms of life has sometimes been described as the power to 'play God'. In this sense the power is not radically different from powers which humans have always possessed and exercised. The dilemma of power is not whether to exercise it-we literally can't help ourselves-but how to exercise it."

They believe that care and responsibility should be based on the conventional ethical principles of medical practice. These ethical principles should act as a foundation for the rules and regulations of nanomedicine use in the practical world and nanomedicine research and development in the corporate and academic world (Brennan et al., 2002: pg 22).

All in all care and responsibility in the case of nanomedicine should include all those involved in it, either directly or indirectly. The corporations should not only follow the ethical guidelines of research and development but also make this technology affordable and accessible to a larger part of the population. The doctors should continue to follow the ethical guidelines of their profession and continue to provide optimum care to all their patients. The legislative bodies should draft laws by using a more balanced approach; while the law enforcement agencies should ensure that these laws are being implemented by all parties involved.

Framework 3: Justice and Social Contract

Dabbah (1999) asserts that the advancement of new technologies poses a vital ethical question about who deserves to benefit from this technology and who does not deserve to benefit from this technology? Injustice takes place when unnecessary load is asserted on someone and/or when a person is denied from his natural rights as a human being. He asserts that those who are equal should be treated equally is another notion about social justice. Then again this notion needs clarification since it stops short of defining who is equal and who is not. Also it does not clarify the conditions which make one superior to another. He asserts that inequalities/differences in medical treatment have been attributed to the following characteristics:

Experience,

Age,

Deprivation,

Competence,

Merit, and Social Position

Dabbah (1999) presents a four dimensional framework for proper execution of social justice and contract. He asserts the benefits and burdens of nanomedicine should be distributed along the following lines:

To every person an identical allocation;

To every person consistent with his/her individual need;

To every person consistent with his/her individual effort;

To every person consistent with his/her societal contribution; and to every person consistent with his/her merit.

Dabbah (1999) asserts that most healthcare professionals, law makers, social, political and environmental activists, along with social theorists differ drastically about the suitable aims/objectives and most advantageous process of nanomedicine. From time to time these disputes are simply instrumental since disagreement only exists in the achievement of objectives and not the objectives themselves. Dabbah warns that if a balanced social contract is not reached amid the consumer and the service givers than these debates will get more intense since quality of health, or lack of it, actually lead to a number of privileges in the current social institutions.

Dabbah asserts that debates on justice and social contract have primarily been limited to the organizational structure of the healthcare system; healthcare finances; spending of public resources; and balancing healthcare along with other social goals. The advent and subsequent advancement of biotechnology, particularly nanotechnology, has raised several ethical questions about access to this technology and the relationship between the people (as subjects) and the research institutions responsible for the growth and development of this technology.

Dabbah asserts that despite the fact that many theoretical frameworks have been offered towards resolution of the issues related to social contract and justice, the debate will continue to intensify. This intensification has less to do with the lack of rationale thought and more to do with the methodology with which research has been conducted in other areas of medicine. Public mistrust and apprehension is widespread, particularly amongst ethnic groups who feel that they are being used as subjects for research without their consent. Dabbah asserts that there is a need to extend the current debate on nanomedicine from the societal to the global level. Also there is a need to go to the root of the problem to resolve the public mistrust issue. Use of humans without giving proper information on the outcome of the experiment and asking for informed consent from the participants is the underlying cause of concern. This is the classic case of malfunctioned social contract amid the society and the research institution. No theoretical framework of ethics will be able to resolve the dilemma of injustice and breach of social contract of this magnitude, if it is not backed up by effective laws.

Furthermore, Dabbah asserts that there is a need for global interaction amongst all parties involved in order to draft a practical framework for use of nanomedicine and its research and development. He believes that nanomedicine will impact human health significantly and this cannot be attributed solely to the healthcare institutions and the corporate world. The legal, political, economic and social institutions are directly playing their roles in either encouraging the development of this technology or discouraging its development. This is occurring at the global level with international organizations playing the leading role in this regard. Therefore, neglecting the global aspect of this phenomenon will only come back and haunt us in the future. The theoretical framework needs to incorporate the views of different cultures and their classifications of justice and social contract by providing a framework of implementation at a macro level to which all can agree.

Dabbah thereafter points out some important questions that need to be answered before one can commence on the journey of enhancing the role of nanomedicine. Some of these vital questions are: what is an appropriate definition of health goals? What information should the international agencies use to draft their policies, rules and regulations? Should nanotechnology be designed to promote life expectancy or detention of diseases before they materialize? How the common man can be given access to nanotechnology? How can informed consent be implemented universally so as to reduce compulsion? Should equal opportunity be extended across borders or should it be pertain within national borders?

Dabbah (1999) believes that answering these questions at the global level is imperative and now is the time to push the global leaders to act quickly. Equal opportunity and access to healthcare facilities; informed consent; upholding of social contracts by all parties involved should act as cornerstones for the research and development and practical use of nanomedicine (Dabbah, 1999).

Personal Response:

believe that the use of nanotechnology does open new doors to innovative methods of identifying, healing, providing therapy and the precautionary methods to the various genres in the field of medicine.

The extent of my personal response given below is to a degree related to the ethical concerns that have been highlighted above related to the use of nanomedicine. As mentioned before, the vital aim of nanomedicine is to design methods of identifying, healing, alleviating physical agony, developing the living standards, providing therapy and the precautionary methods in the various fields of medicine.

Description and supporting rationale

Basic principles and human rights

As mentioned before, the rising interest in the application of nanomedicine raised the questions of the protection of the fundamental rights of human and the ecological setup. All the human rights are firmly embedded in the principle ideals of honesty, independence, confidentiality, sovereignty, justice, equality, pluralism and unity. It is not that the science and industrial sectors should not expand and experiment, but in doing so they have to be respectful of the lawful and reasonable human rights and environmental decorum. It is not a new method to analyze a new dimension of research with an assessment of both its positive and negative impacts.

One of the examples of this could be the Treaty (Article 152) where it was concluded that the law of secondary lawmakers amongst the industries and other sectors should be coherent with the overall public health policies that have been decided at the EU level and all provincial and district decision and activities should be complementary of the national strategies. It is also an imperative duty, as stated by the United Nations Millennium Development Goals, for the health providers to make accessible, offer and consistently provide inexpensive and reasonably sanitarian health care facilities as well as the biomedical equipments to all the ones who are dependent upon them and do so at a just and impartial level (Freitas, 2003).

Security

There is only one way that effective treatment and precautionary medicinal methods can be provided and that is if the negative effects of the nanomedicine and its development are brought under strict scrutiny. Once the negative effects and their eradication becomes a top priority then numerous processes can be adopted that will validate the positive influence of the nanoparticles and nano-products on the health of the patient as well as the overall environment and society (Freitas, 2003).

It is clear that the properties of nanomedicine are not all that clear yet. But it is very important that the properties and features and effects of these features of nanomedicine are recognized and understood quickly. The unpredictable nature of nanomedicine needs to be controlled and reduced so that the negative impact can be reduced. All studies from now on need to incorporate the updated designs so that risks can be managed and reduced in both the individual and societal nanomedicine developments (Freitas, 2003).

I believe that the responsibility to carry out the official analysis and designing the strategies should be the job of the relevant organizations and the related authorities so that both the integrity of the nano-medical research and the human/environmental rights are taken care of justly. All of the concerns like the endurance of the merchandise, its production, distribution and treatment of the excess litter should be addressed appropriately. In other words, nanomedicine and the safety precautions related to it should not be treated any differently from all the other medical instruments and products.

In my opinion, these organizations should also make an effort to design authentic, consistent and lucrative toxicology test structures of nanomaterials and make sure that all the experiments conducted in animals should incorporate the 3R ethics i.e. Refinement, Reduction, and Replacement. All the results produced, whether negative or positive, should be revealed explicitly so that the possible risks can be countered. I also think that the organizations overseeing the protection of rights of the people should handle the administration of the proper and safe use of the nanoparticle materials and implement the measure required for their proper use on an international scale. Also, all these organizations should have flexible structures that can adapt when unpredictable or unforeseen situation surfaces.

Proper management of risks am, however, aware of the fact that usually in a cutthroat competitive market it is not the priority of the organizations to share openly the risks and negatives of the products they are investing in. Nevertheless I also feel that if these risks are not recognized the public would not only loose confidence in nanomedicine but will also be discouraged to use due to the damages that will be assumed to be genuine.

I feel that the researchers should concentrate on collecting, and communicating, data and stats on the dire effects of the toxicology of nanoparticles on the human and ecological health, as this information is still very deficient. I also feel that all the safety and risk prevention methods adopted should be a collective effort of all the organizations involved (Freitas, 2003).

The requirement to find a bridge between the prospective technology analysis and their social effects

All the assessments that are done on the phenomenon of prospective technology should be concerned with the negative effects of nanotechnologies on the human and ecological health (Freitas, 2003). I believe that any analysis done on the prospective technology should include the safety or precautionary issues as well as the dire social effects. These effects should be given attention to in both developed and developing countries and should include the effects of the application of nanomedicine on the public, fiscal, lawmaking, justice, commerce, educative and organizational setups.