Manon van Daal holds a master’s in Philosophy and Bioethics from Vrije Universiteit Amsterdam, The Netherlands. Currently, she is a PhD candidate at the University Medical CenterUtrecht (NL). Her research focusses on the ethics of tissue engineering and regenerative medicine with a special focus on gender issues. Manon has taught courses in bioethics and ethics of regenerative medicine at UMC Utrecht and Vrije Universiteit Amsterdam. She is also involved as an expert at the Dutch Helpdesk on Regenerative Medicine.

Could you describe the main ethical challenges INKplant is facing?

One of INKplant’s main objectives is to develop personalized regenerative therapies for the whole society. In the light of the growing awareness that medicine should be inclusive to a diverse range of people, it is important to scrutinize who will benefit from cutting-edge regenerative technologies as INKplant develops, and how these personalized approaches can be inclusive.

Emerging technologies like regenerative implants could increase health inequities. For example, it is argued that there is a possible danger that 3D printing for tissue engineering purposes will only be accessible for the happy (wealthy) few and will further widen the health gap between rich and the poor. Both the health burdens and the fruits of technological innovation are known to be distributed unequally among populations and within societies.
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Since patients in need of implants, like those developed in INKplant, live all around the world, the design and use of these technologies need to allow for global dissemination and accessibility to be inclusive. This requires a low-cost available solution.

However, such regenerative implants, are currently still highly expensive and difficult to implement. For example, products for tissue engineering, such as 3D printers with the ability to print implants with fine resolutions are likely to be too costly for those living in low and middel income countries.

Additionally, it is costly to ensure that such implants be routinely used in all clinical contexts and medical staff needs to be trained to handle such complex regenerative procedures. Reimbursement and fair pricing may therefore broaden access to these new technologies.

Although the price of these implants could be low due to mass production, the implants in question are personalized which makes mass production almost impossible. Even if the price is low, the question still exists whether the lowest price is affordable for disadvantaged patients.

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How do you see the role of 3D printing in the medical industry and what excites you about the future of regenerative medicine?

As ethicists, we primarily focus on the ethical implications of innovations. However, I must admit my enthusiasm for the potential of 3D printing to enhance the personalization of regenerative technologies. Each individual is unique, we all have different bodies and experiences. The ability to provide tailored care that aligns with people's lives is truly exciting to me.

What would you say have been UMC Utrecht's best achievements within INKplant?

One of our accomplishments thus far has been the successful inclusion of diverse stakeholder groups in our user acceptance study. We conducted multiple focus groups, comprising of patients with traditional implants, experts affiliated with INKplant or involved in similar regenerative technologies, as well as Dutch and Spanish parents of children with cleft palate.

Since INKplant focuses on multiple use cases, we are proud that we were able to engage such a diverse range of individuals.

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Could you give examples of how this department has influenced ethical discussions about biomedical advancement?

The department has studied various biotechnologies over the past years and has developed an approach to scrutinize the ethical implications of new biotechnologies. This approach, called ethics parallel research, enables to open up ethical discussions for stakeholders already in the early phases of development, we apply this approach also to INKplant.

Another accomplishment is that our department is a World Health Organization Collaborating Center, meaning that we contribute to the ethical assessment of policy documents and recommendations on various topics such as innovative technologies.

What are the main goals you are hoping to meet with this European project?

Our main goal is to improve the wellbeing of everyone in need of implants in the best way as possible, regardless their background, gender, age, etc. So these new implants are safe and accessible for everyone.

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