What if you were in a terrible car accident, and sustained life threatening injuries to your heart. In an effort to save you, doctors went to extreme measures, and implanted a left ventricular assist device, also referred to as an LVAD. What is an LVAD you ask? Well, it is a surgically implanted heart pump that is attached to one of the main pumping chambers of the heart and the aorta. The pump is attached to a tube that extends to the outside of your body, and attaches to a battery pack that you must carry around for the rest of your life. However, despite the fact that the LVAD has “saved” your life, what if you were paralyzed? What if you had burns over your body as a side effect of the accident? What if your body was altered in such a way that you no longer had the same quality of life as you did prior to the accident?
As bioethicist Katrina A. Bramstedt said, “Anytime you create new forms of life support, you create the possibility for new ethical dilemmas.” With the development of LVADs, a host of new ethical dilemmas have surfaced, especially for older patients who are actually affected negatively by the implantation of the LVAD. These cases typically deal with the debate about euthanasia. And in those cases, one can argue that the patient entered into the surgical procedure under fully informed consent (or at least as much consent as one can have in today’s society), and therefore they should not be granted the right to request that the pump be turned off by a physician because they were aware of the risks going into the procedure, and desired the continuation of their lives. But what about those that did not provide consent? Patients that were admitted as a result of emergencies, and then awoke to find their lives significantly altered, and saved only by the implantation of an LVAD.
Are these individuals allowed to then make the choice of whether they would like to end their lives? Perhaps this is simply a small detail in the greater argument of euthanasia, but then again maybe this difference is all that is needed to justify their request for their own death.
http://www.washingtonpost.com/wp-dyn/content/article/2008/04/23/AR2008042303534_pf.html
Saturday, April 26, 2008
Thursday, April 24, 2008
DNA Tests Violate 5th Amendment?
In 1974, a man who came to be known as BTK strangled a family of four. He continued to kill for the nest 17 years claiming 6 more victims. However, he went silent after that, disappearing. He reappeared in 2004, hinting that he was about to strike again. Police managed to zero in on a man named Dennis Rader as their primary suspect. They had been able to obtain genetic samples from the crime scenes, and they hoped to link this DNA to Rader. Unfortunately they could not get DNA from Rader himself. However, Rader's daughter had had a pap smear in college, and the authorities subpoenaed it to obtain DNA. In the end, they used this as well as further evidence to convict Rader.
Most people see this as a triumph of genetic technology. However, privacy advocates see it as a dangerous trend that is continuing to violate our rights to privacy. When Rader's pap smear was subpoenaed, she was not consulted. Beyond violating her right to privacy, I believe that these actions also violated the 5th amendment. Since the evidence was something that only a family member could provide, the authorities would have had to get permission before using the evidence.
Most people see this as a triumph of genetic technology. However, privacy advocates see it as a dangerous trend that is continuing to violate our rights to privacy. When Rader's pap smear was subpoenaed, she was not consulted. Beyond violating her right to privacy, I believe that these actions also violated the 5th amendment. Since the evidence was something that only a family member could provide, the authorities would have had to get permission before using the evidence.
Tuesday, April 22, 2008
Lost In Translation?
We often discuss the ethics of medical experimentation. However, there are ethics involving human health beyond just the simple experimentation. Many do not have direct access to most studies in order to learn about the progress that has been made. The same holds true for scientific journal articles that can be very important to an individual’s health. The great majority of the population relies on journalists to honestly relay this information to them in terms they can understand.
But what happens when this is lost in translation? A famous case of this is a 1990’s story by Gina Kolata in which she speaks of a possible cancer cure. The study to which she refers, in which a cure for cancer had been found in mice, had been published months before and there was even a previous New York Times article on the topic. What was her motive for writing the article? Well, at a dinner earlier she overheard Nobel laureate James Watson say, “Judah’s going to cure cancer in two years!” This created a front pages story, where as the original was buried away in the inside of the paper. Her language in combination with the placement of the article seemed to create a rush of people to believe that a cure for cancer had been indeed found.
Was it ethically correct for her to write this article? She must have known that it would be misleading, as did the editors when they put it on the front page of the New York Times, the journalistic standard for the world. She had no incentive to write the story other than financial gain, a front- page story, and ONE new quote. It seems her motives were not sincere, in that she didn’t want to tell the public what they needed to know but instead chose to mislead them for her own gain. She even received a million dollar book deal on the topic. So my question is, do journalists, as simple “translators” have a moral responsibility that is unique to them, as doctors and researchers do? I personally do believe so.
But what happens when this is lost in translation? A famous case of this is a 1990’s story by Gina Kolata in which she speaks of a possible cancer cure. The study to which she refers, in which a cure for cancer had been found in mice, had been published months before and there was even a previous New York Times article on the topic. What was her motive for writing the article? Well, at a dinner earlier she overheard Nobel laureate James Watson say, “Judah’s going to cure cancer in two years!” This created a front pages story, where as the original was buried away in the inside of the paper. Her language in combination with the placement of the article seemed to create a rush of people to believe that a cure for cancer had been indeed found.
Was it ethically correct for her to write this article? She must have known that it would be misleading, as did the editors when they put it on the front page of the New York Times, the journalistic standard for the world. She had no incentive to write the story other than financial gain, a front- page story, and ONE new quote. It seems her motives were not sincere, in that she didn’t want to tell the public what they needed to know but instead chose to mislead them for her own gain. She even received a million dollar book deal on the topic. So my question is, do journalists, as simple “translators” have a moral responsibility that is unique to them, as doctors and researchers do? I personally do believe so.
Monday, April 21, 2008
Genetic Discrimination: Good or Bad?
After reading Alana’s research essay, Alex and I (not surprisingly) debated whether genetic discrimination is good or bad. As Alana’s paper suggests, genetic discrimination does not actually exist, meaning that the arguments proposed for and against genetic discrimination are completely theoretical and hypothetical. Whereas Alex believes that genetic discrimination would not necessarily result in a negative outcome, I disagree and contend that genetic discrimination can cause great harm.
As Alex suggests, the act of discrimination in itself is not immoral; the ethicality of discrimination and whether it is moral or immoral depends on the intent and source of the discrimination. By Alex’s view point, insurance companies stand to make a profit and have a right to assess the risks of acquiring a specific customer. Furthermore, insurance companies have no obligation to help people acquire medical care. Although I agree completely with Alex that genetic discrimination is a positive action from the viewpoint of the firm, I feel that genetic discrimination greatly harms the public.
As we all know, health insurance helps countless people afford expensive medical treatments and procedures that they would otherwise not be able to afford. Subsequently, as a result of health insurance, not only are many lives saved, but the quality of many lives is drastically improved. If people were denied health insurance, two problems would arise. First, because fewer people would be able to acquire health insurance, the quality of their health and subsequently the quality of their lives could be compromised. Secondly, people who are allowed to apply for health insurance would have to pay larger payments in order to compensate for the smaller number of consumers.
For arguments sake, however, let us assume that “healthy” individuals (those that do not have “diseased” genes) continue to apply for health insurance while “diseased” individuals cannot obtain health insurance. Currently, according to American laws, if a “diseased” individual without healthcare were to go to the hospital in need of healthcare, doctors would have an obligation to care for the patient regardless of whether the patient could afford the treatment. If the patient had health insurance, the doctor would receive the appropriate payment for his services. If the patient did not have health insurance, however, and could not afford the procedures, the doctor essentially loses a profit. In such a scenario the existence of genetic discrimination creates a negative externality that can severely harm physicians. Even if the government were to step in and provide more health insurance (beyond Medicare and Medicaid), although the doctors would benefit, the economy could suffer; in order to increase finances, the government would need to siphon money from some other program or raise taxes, two situations that could be avoided if people were allowed health insurance.
Although I concede that genetic discrimination from some view points (namely the viewpoint of insurance companies) is a good thing, I believe that genetic discrimination from the point of view of a patient and from the point of view of a physician has negative consequences. I realize that genes are not completely deterministic and that the degree of genetic discrimination may not be as great as I portray it, but nonetheless patients would feel violated and immorally treated if they were denied health insurance on the basis of their genes.
Quarantines in the US
Idea from http://www.wired.com/medtech/health/news/2007/06/quarantine_law:
After reading about the quarantines of XRS-TB carriers in Africa, I wanted to find out more about the quarantine laws in the US. This recent article stated that the meat of our quarantine laws has not changed from the 19th century, when quarantines were much more common because of the prevalence of some dangerous infectious diseases and because of the lack of medicine to treat some diseases.
Now the controversy is over whether our government should be allowed to gain more access to flight information in order to potentially inform people if they have been infected with something. Though the ACLU has some problems with the government having access to this information and the airline companies are worried that the increased bookkeeping will drastically increase their functioning costs, I think that the government has a right to demand these records in an effort to protect it's people.
Even though it is never the best idea for a government to have all the information on all of its citizens, in this case the government would only be able to access the information if the crisis arose. It's a win-win situation: if they need to know who was on a flight and this information would help more people, they could get it, but otherwise no one's privacy is invaded. The problems will arise in enforcing the restriction of access to flight information, but I feel that airlines will have an economic incentive to protect their passengers' privacy. I think that if the enforcement is in the airlines' hands it will go much smoother than if it is in the government's hands.
On the Legality of Waterboarding
War is undoubtedly one of the largest fronts under which unethical practices are carried out. Historically, both prisoners and soldiers have unwillingly and unknowingly been used as human guinea pigs, testing anything from nuclear fallout to mustard gas. While we would like to think the mistakes of the past are long gone, such ethically questionable practices still exist today. Take for example the case of waterboarding. Waterboard is a process wherein a prisoner is strapped to a board and has water poured into their mouth and breathing passages. This simulates the experience of drowning and elicits a gag reflex instantaneously, causing severe psychological pain to the victim. The experience is so severe and real that some victims could no longer take showers or walk in the rain. Although waterboarding does not necessarily cause permanent physical damage, it can lead to lung or brain damage or death.
Currently, President Bush is defending the use of waterboarding in obtaining information from captives. Although torture is illegal according to the Geneva Conventions, Bush's administration has redefined what constitutes torture to exclude waterboarding, rendering it lawful (it is now an 'enhanced interrogation technique'). The use of torture to obtain information can be a tricky issue. In times of war, if one side is using torture to obtain information and the other side is not, the side using torture will naturally gain an information advantage. However, this should not be an issue in modern times, when the U.S. has the strength to lead the world without resorting to practices such as waterboarding. In fact, the U.S. has been setting a worldwide example for over 200 years by habitually treating captives with humanity and dignity. There's no reason why this should change now.
Articles:
http://www.catholic.org/diocese/diocese_story.php?id=27616
http://www.guardian.co.uk/world/2008/apr/18/usa.terrorism
Currently, President Bush is defending the use of waterboarding in obtaining information from captives. Although torture is illegal according to the Geneva Conventions, Bush's administration has redefined what constitutes torture to exclude waterboarding, rendering it lawful (it is now an 'enhanced interrogation technique'). The use of torture to obtain information can be a tricky issue. In times of war, if one side is using torture to obtain information and the other side is not, the side using torture will naturally gain an information advantage. However, this should not be an issue in modern times, when the U.S. has the strength to lead the world without resorting to practices such as waterboarding. In fact, the U.S. has been setting a worldwide example for over 200 years by habitually treating captives with humanity and dignity. There's no reason why this should change now.
Articles:
http://www.catholic.org/diocese/diocese_story.php?id=27616
http://www.guardian.co.uk/world/2008/apr/18/usa.terrorism
Lemon Organs
Previously, the term “lemon” has been applied primarily to used cars that the buyer only discovers to be of an unsatisfactory quality after the purchase has occure. Well what if you receive a transplanted organ that turns out to be not exactly what you signed up for?
This is exactly what happened to the four people who received 15-year-old Alex Koehne’s pancreas, liver, and two kidneys. Alex’s parents agreed to donate Alex’s organs when they discovered that his death was imminent. It was originally believed that Alex died of bacterial meningitis, but only upon autopsy did Alex’s parents and doctors discover that his actual cause of death was a rare form of lymphoma. Subsequently, the two people who received Alex’s liver and pancreas died of the same lymphoma, and the two people who received his kidneys are being treated for the disease.
Other recent organ transplant mishaps include a man who received a cancerous lung, and people who have received organs infected with West Nile Virus, hepatitis C, and even HIV.
How can this have happened?
The organization that organizes organ donation in the United States, the United Network for Organ Sharing, requires that all organs be screened for cancer, HIV, and other infections prior to donation. In addition, the Center for Disease Control mandates tests for HIV, hepatitis, syphilis, and other bacterial or viral infections on organs from “high-risk” individuals, as well as having a doctor determine from medical records whether the organ donor might have cancer.
Most organ transplants are safe: out of the 230,000 transplants performed between 1994 and 2006 on 64 recipients developed cancer because of receiving a “lemon” organ, as I have termed it.
However, there is always the possibility of some cancer or infection going undetected. I would urge hospitals to increase the strictness of their organ donor standards, as they are free to do. Such a move would benefit everyone because the minor inconvenience of running a few more tests and doing a more thorough background check is far smaller than the hassle of getting entangled in endless lawsuits over whose fault it is that someone received a “lemon” organ.
Sources:
http://blogs.discovermagazine.com/discoblog/2008/04/08/organ-transplants-gone-horribly-awry/
http://discovermagazine.com/2008/apr/16-how-do-transplant-patients-wind-up-with-deadly-diseased-organs
This is exactly what happened to the four people who received 15-year-old Alex Koehne’s pancreas, liver, and two kidneys. Alex’s parents agreed to donate Alex’s organs when they discovered that his death was imminent. It was originally believed that Alex died of bacterial meningitis, but only upon autopsy did Alex’s parents and doctors discover that his actual cause of death was a rare form of lymphoma. Subsequently, the two people who received Alex’s liver and pancreas died of the same lymphoma, and the two people who received his kidneys are being treated for the disease.
Other recent organ transplant mishaps include a man who received a cancerous lung, and people who have received organs infected with West Nile Virus, hepatitis C, and even HIV.
How can this have happened?
The organization that organizes organ donation in the United States, the United Network for Organ Sharing, requires that all organs be screened for cancer, HIV, and other infections prior to donation. In addition, the Center for Disease Control mandates tests for HIV, hepatitis, syphilis, and other bacterial or viral infections on organs from “high-risk” individuals, as well as having a doctor determine from medical records whether the organ donor might have cancer.
Most organ transplants are safe: out of the 230,000 transplants performed between 1994 and 2006 on 64 recipients developed cancer because of receiving a “lemon” organ, as I have termed it.
However, there is always the possibility of some cancer or infection going undetected. I would urge hospitals to increase the strictness of their organ donor standards, as they are free to do. Such a move would benefit everyone because the minor inconvenience of running a few more tests and doing a more thorough background check is far smaller than the hassle of getting entangled in endless lawsuits over whose fault it is that someone received a “lemon” organ.
Sources:
http://blogs.discovermagazine.com/discoblog/2008/04/08/organ-transplants-gone-horribly-awry/
http://discovermagazine.com/2008/apr/16-how-do-transplant-patients-wind-up-with-deadly-diseased-organs
State Autonomy vs. Protection of the Global Community
The avian flu virus has many different forms around the globe, as a result of mutations for adopting to different environment. The Indian avian flu virus has been found to be the most deadly (mortality rate of 80%.) Therefore, making the Avian Flu virus found in India available to the international community is crucial for developing a vaccine that can prevent epidemic outbreaks such as the Black Death during the fourteenth century. India, however, has refused to share this information to the global community for a good legitimate reason: the vaccines being developed has already been contracted out to the developed nations – most certainly not India. In May, 2007, India finally adhered to the request for the Avian Flu virus genetic information, but only after WHO (World Health Organization) made the promise to the government of India that they will sponsor creation of a global stockpile of pandemic vaccines that will be made available to developing nations as well. WHO criticized such move by India, claiming that “the public health security of the whole world [was] at risk” as a result of the Indian government withholding the genetic information of the most deadly form of Avian Flu virus in the world. On the other hand, the Indian government called upon the Convention on Biological Diversity which articulates the states’ autonomy over genetic information.
This specific case raises the question of individual rights vs. protection of the public (something we have been discussing with relation to vaccination) on a global and national scale. Does the international regulatory body such as WHO have the right to make it compulsory for nations to share information crucial for advancing research for medicines that will be used by the countries? Does the question of autonomy vs. sacrifice for the greater good have a different bearing on the national/global level versus the individual/micro-societal level?
Source: Caplan, Arthur L., and David R. Curry. "Leveraging Genetic Resources or Moral Blackmail? Indonesia and Avian Flu Virus Sample Sharing." The American Journal of Bioethics 7(2007): 1-2.
This specific case raises the question of individual rights vs. protection of the public (something we have been discussing with relation to vaccination) on a global and national scale. Does the international regulatory body such as WHO have the right to make it compulsory for nations to share information crucial for advancing research for medicines that will be used by the countries? Does the question of autonomy vs. sacrifice for the greater good have a different bearing on the national/global level versus the individual/micro-societal level?
Source: Caplan, Arthur L., and David R. Curry. "Leveraging Genetic Resources or Moral Blackmail? Indonesia and Avian Flu Virus Sample Sharing." The American Journal of Bioethics 7(2007): 1-2.
Tuesday, April 15, 2008
Concerns of Vaccination
In the year 2000, Hannah Poling of Athens, Georgia, received five routine immunizations to protect her against nine infectious diseases. After receiving the vaccine, Hannah became sick two days later and was diagnosed in 2001 as autistic. Hannah’s parents sued the government, claiming that the vaccines somehow caused the autism, and they reached a settlement.
This case, and in particular the settlement of the government, raises concerns about the relationship between childhood vaccines and autism. John Gilmore, the executive director of Autism United, said, “This decision gives people significant reason to be cautious about vaccinating their children.” Gilmore’s son faced the same predicament as Hannah, and he has sued the government as well.
Dr. Jon Poling, neurology resident at Johns Hopkins Hospital at the time and Hannah’s father, explained that Hannah was later found to have a mitochondrial disease. Such a disease can lie dormant until stimulated by a vaccination, which is what the government believed happened. Hannah’s mother acknowledged that this is a possibility, but there is no evidence that Hannah had this disease before the vaccines. She also explained that there is a second explanation for Hannah’s autism: the vaccines.
In either case, the vaccine did somehow either provoke or create Hannah’s autism. Whether directly or indirectly (by means of the mitochondrial disease), the government-required vaccines adversely affected Hannah’s development. Although there may be no direct proof that the vaccines causes autism, this does give one reason to question the safety and effects of vaccines, especially because such vaccines are given to every child in the country, and to many in the world. If there is a problem with a vaccine, particularly with a new vaccine where the long-term effects are unknown, an entire country of children could face debilitating side-effects. This is one of many concerns with the HPV vaccine and one reason why many parents are hesitant to allow their children to receive a relatively new vaccine. Even though cases such as Hannah’s are rare, they do exist, and do justify some concern over mandatory vaccinations.
This case, and in particular the settlement of the government, raises concerns about the relationship between childhood vaccines and autism. John Gilmore, the executive director of Autism United, said, “This decision gives people significant reason to be cautious about vaccinating their children.” Gilmore’s son faced the same predicament as Hannah, and he has sued the government as well.
Dr. Jon Poling, neurology resident at Johns Hopkins Hospital at the time and Hannah’s father, explained that Hannah was later found to have a mitochondrial disease. Such a disease can lie dormant until stimulated by a vaccination, which is what the government believed happened. Hannah’s mother acknowledged that this is a possibility, but there is no evidence that Hannah had this disease before the vaccines. She also explained that there is a second explanation for Hannah’s autism: the vaccines.
In either case, the vaccine did somehow either provoke or create Hannah’s autism. Whether directly or indirectly (by means of the mitochondrial disease), the government-required vaccines adversely affected Hannah’s development. Although there may be no direct proof that the vaccines causes autism, this does give one reason to question the safety and effects of vaccines, especially because such vaccines are given to every child in the country, and to many in the world. If there is a problem with a vaccine, particularly with a new vaccine where the long-term effects are unknown, an entire country of children could face debilitating side-effects. This is one of many concerns with the HPV vaccine and one reason why many parents are hesitant to allow their children to receive a relatively new vaccine. Even though cases such as Hannah’s are rare, they do exist, and do justify some concern over mandatory vaccinations.
Practicality vs. Morality?
I began wondering about practicality in relation to ethics and morality last class, in the discussion of destroying embryos to harvest stem cells. I am still pondering the question: if an action is unethical but practical, which takes precedent?
There were two situations that Alex, Mike and I were talking about the other day: 1) A train is going to crash, killing all 5 of its passengers. But you have the power to change its track thus saving the train and its 5 passengers, but in doing so, you will kill 1 person who is stuck on that track. Practically, you would change the track, thus saving 5 lives and killing one, rather than doing nothing where you save one life but kill 5. Ethically it is more complicated: by actually changing the track, are you murdering that 1 person? By doing nothing, are you murdering 5 people? To me it seemed that generally, most people would change the track, sacrificing one person to save 5 in the name of practicality.
Mike then informed us of a similar situation in which there are five people in need of organs, they will die if they don't receive them. There is one perfectly healthy man with all the needed organs, but he will die if he donates them all. Does the doctor kill the healthy man to harvest the organs to save the 5 lives? In this situation, it seems that ethics trumps practicality, because hardly anyone would advocate such an act.
How can these situations be applied to the destruction of embryos? It is practical to destroy the embryos because they are going to die anyways; it makes practical sense to use them for a greater cause. Ethically, it is quite different for all the reasons we have discussed.
I tend to lean towards practicality over ethics in realistic situations. I would not consider the doctor intentionally harvesting 5 organs from a healthy person a realistic situation. In certain situations, practicality must trump ethics.
There were two situations that Alex, Mike and I were talking about the other day: 1) A train is going to crash, killing all 5 of its passengers. But you have the power to change its track thus saving the train and its 5 passengers, but in doing so, you will kill 1 person who is stuck on that track. Practically, you would change the track, thus saving 5 lives and killing one, rather than doing nothing where you save one life but kill 5. Ethically it is more complicated: by actually changing the track, are you murdering that 1 person? By doing nothing, are you murdering 5 people? To me it seemed that generally, most people would change the track, sacrificing one person to save 5 in the name of practicality.
Mike then informed us of a similar situation in which there are five people in need of organs, they will die if they don't receive them. There is one perfectly healthy man with all the needed organs, but he will die if he donates them all. Does the doctor kill the healthy man to harvest the organs to save the 5 lives? In this situation, it seems that ethics trumps practicality, because hardly anyone would advocate such an act.
How can these situations be applied to the destruction of embryos? It is practical to destroy the embryos because they are going to die anyways; it makes practical sense to use them for a greater cause. Ethically, it is quite different for all the reasons we have discussed.
I tend to lean towards practicality over ethics in realistic situations. I would not consider the doctor intentionally harvesting 5 organs from a healthy person a realistic situation. In certain situations, practicality must trump ethics.
Monday, April 14, 2008
Continue study of AIDS vaccine that makes you even more likely to contract HIV?
I recently stumbled upon another article involving ethics and an AIDS vaccine. The author stated that he believed despite studies showing that a specific AIDS vaccine could have increased the risk of HIV in trial participants, we should forge ahead with research and not look back. I should not have been surprised to learn that the author was the controversy-stirring Arthur Caplan.
Over two years ago, Merck Pharmaceuticals and the National Institute of Health announced the creation of a breakthrough vaccine. This vaccine was marketed to be different and more effective than any other AIDS vaccine available. However, it was learned at the end of last year that the vaccine did not come close to achieving the claims set forth. In fact, after testing the vaccine on 3,000 trial participants, it was learned that some may have developed HIV and died because of the vaccine.
Caplan acknowledges that this is an ethical problem but quickly brushes it aside and says that we should not be deterred--greater risks are at stake if we do not come a solution through a vaccine, even if it means more deaths along the way.
Personally, for such a highly valued man of ethics, I feel as if Caplan throws away the ethical issues present much too easily. How can he dismiss so readily the deaths which were caused by this vaccine? The participants were of course told that the vaccine was experimental but were also lead to believe that the vaccine was almost certain to be beneficial, or at worst would have a neutral effect. Never did these participants imagine that such a vaccine might actually give them HIV.
That being said, I do agree with Caplan that research should continue. However, I definitely think that more guidelines need to be put in place to ensure that a substantial "mishap" like this one does not occur again.
Source: http://www.msnbc.msn.com/id/22023841/
Over two years ago, Merck Pharmaceuticals and the National Institute of Health announced the creation of a breakthrough vaccine. This vaccine was marketed to be different and more effective than any other AIDS vaccine available. However, it was learned at the end of last year that the vaccine did not come close to achieving the claims set forth. In fact, after testing the vaccine on 3,000 trial participants, it was learned that some may have developed HIV and died because of the vaccine.
Caplan acknowledges that this is an ethical problem but quickly brushes it aside and says that we should not be deterred--greater risks are at stake if we do not come a solution through a vaccine, even if it means more deaths along the way.
Personally, for such a highly valued man of ethics, I feel as if Caplan throws away the ethical issues present much too easily. How can he dismiss so readily the deaths which were caused by this vaccine? The participants were of course told that the vaccine was experimental but were also lead to believe that the vaccine was almost certain to be beneficial, or at worst would have a neutral effect. Never did these participants imagine that such a vaccine might actually give them HIV.
That being said, I do agree with Caplan that research should continue. However, I definitely think that more guidelines need to be put in place to ensure that a substantial "mishap" like this one does not occur again.
Source: http://www.msnbc.msn.com/id/22023841/
Sunday, April 13, 2008
Prison for the Sick
A recent New York Times article describes one of the most frightening images one can imagine: a hospital where patients are imprisoned by “three fences topped with coils of razor wire,” guards and more; they are encouraged to enter the hospital, but as patient Siyasanga Lukas describes, “the only discharge you get from this place is to the mortuary.” The hospital the article describes is the Jose Pearson TB Hospital in Port Elizabeth, South Africa. The hospital is specifically for patients with drug resistant forms of TB, ranging from multi-drug resistant to the most serious type, XDR-TB, an “extensively drug-resistant” strain of TB that kills most of its patients, especially in countries in which HIV and AIDS are prevalent.
XDR-TB is spread mainly through the air when patients cough or sneeze; therefore patients with XDR-TB have a high probability of spreading the disease when in public places, or even in their own homes. But does this mean that government officials have the right to lock up these patients in a hospital, isolated from their families and the rest of society? Health officials in Port Elizabeth argue that, “infected people cannot be relied on to avoid public places;” an argument that does hold weight (as we saw in the US a couple of years ago when a patient with multi-drug resistant TB boarded a flight to another country). As Dr. Bongani Lujabe describes the situation, “XDR is like biological warfare. If you let it loose you decimate a population, especially in poor communities with a high prevalence of HIV/AIDS.”
Despite the reasoning of the hospital officials, I would argue that imprisoning patients in a hospital is not the solution. Imprisoning the patients causes future patients with the disease to hide their illness, furthering the spread of the disease by not seeking treatment. As outlined in the article, officials should strive to treat patients in their own homes, and turn only to confined hospitals as a last resort. As Mrs. Hansen, a patient that previously escaped from Jose Pearson Hospital, states, “[N]othing can replace your freedom.”
XDR-TB is spread mainly through the air when patients cough or sneeze; therefore patients with XDR-TB have a high probability of spreading the disease when in public places, or even in their own homes. But does this mean that government officials have the right to lock up these patients in a hospital, isolated from their families and the rest of society? Health officials in Port Elizabeth argue that, “infected people cannot be relied on to avoid public places;” an argument that does hold weight (as we saw in the US a couple of years ago when a patient with multi-drug resistant TB boarded a flight to another country). As Dr. Bongani Lujabe describes the situation, “XDR is like biological warfare. If you let it loose you decimate a population, especially in poor communities with a high prevalence of HIV/AIDS.”
Despite the reasoning of the hospital officials, I would argue that imprisoning patients in a hospital is not the solution. Imprisoning the patients causes future patients with the disease to hide their illness, furthering the spread of the disease by not seeking treatment. As outlined in the article, officials should strive to treat patients in their own homes, and turn only to confined hospitals as a last resort. As Mrs. Hansen, a patient that previously escaped from Jose Pearson Hospital, states, “[N]othing can replace your freedom.”
Moral Status and Embryos
I remember that a certain classmate of mine mentioned that even though embryos are members of the human species, they deserve no moral status. Curious. This raised multiple questions in my mind. For example, what is different about embryos from fully developed human beings? Does this mean that human beings have no inherent value? From where, then, is moral status derived?
The only answer that I have encountered to solve this problem was Peter Singer’s. He states that self-awareness ought to be the standard by which the value of beings are judged, for only those who are self-aware can suffer, and only those who can suffer may hold personal interests. Yet this idea does not seem to make much sense to me either. To argue that personal interests are the standard by which moral status is derived from is to say that there exists a moral hierarchy, in which beings ought to be treated based upon what kind of interests they happen to have, rather than who or what they are. This would vary not only among different individuals, but also at different times. The very nature of moral status is at odds with this argument. Moral status is not something that is dependent upon circumstance – rather, it is the presence of a certain trait that makes one deserving of respect, acknowledgment, and equal treatment, among many other things, due to one’s ability to be a moral being. Thus, because an embryo is a member of the human species (albeit underdeveloped) and has the capacity to make moral judgments (George), it ought to be treated the same as one would treat a fully developed human being, for both have the same moral status.
Of course, Singer’s argument may not be the same used by those who would argue against the existence of moral status among the embryo population. Therefore, it is here that I lay the gauntlet down, in the hope that the issue of moral status among embryos may be further discussed and clarified.
The only answer that I have encountered to solve this problem was Peter Singer’s. He states that self-awareness ought to be the standard by which the value of beings are judged, for only those who are self-aware can suffer, and only those who can suffer may hold personal interests. Yet this idea does not seem to make much sense to me either. To argue that personal interests are the standard by which moral status is derived from is to say that there exists a moral hierarchy, in which beings ought to be treated based upon what kind of interests they happen to have, rather than who or what they are. This would vary not only among different individuals, but also at different times. The very nature of moral status is at odds with this argument. Moral status is not something that is dependent upon circumstance – rather, it is the presence of a certain trait that makes one deserving of respect, acknowledgment, and equal treatment, among many other things, due to one’s ability to be a moral being. Thus, because an embryo is a member of the human species (albeit underdeveloped) and has the capacity to make moral judgments (George), it ought to be treated the same as one would treat a fully developed human being, for both have the same moral status.
Of course, Singer’s argument may not be the same used by those who would argue against the existence of moral status among the embryo population. Therefore, it is here that I lay the gauntlet down, in the hope that the issue of moral status among embryos may be further discussed and clarified.
Saturday, April 12, 2008
Killing the Seas to Fuel our Cars
Information taken from http://www.time.com/time/health/article/0,8599,1721693,00.html
Congress wants to produce 15 billion gallons of ethanol from corn by 2022. On the surface, this sounds like an environmentally-friendly idea to reduce our dependency on oil and other depleting natural resources. However, upon further inspection, such an increase in ethanol production actually has the potential to destroy our seas.
Increasing our ethanol production to 15 billion gallons means drastically increasing the amount of corn harvested in the US. That’s where the harm to the seas begins. Corn requires heavy fertilization, and a byproduct of that fertilization is nitrogen. The nitrogen from the fertilizer runs off the farms and into rivers and streams which eventually feed into the Gulf of Mexico. Streams have a natural ability to filter the nitrogen to an extent, but the amount of corn currently planted and which needs to be planted to meet the government’s goal exceeds the capability of the streams. The excess nitrogen runs into the Gulf of Mexico and becomes nourishment for algae. The more nitrogen run-off, the greater the amount of algae. Algae decomposition requires oxygen and therefore takes a large percentage of the oxygen in the Gulf, creating what scientists call a dead zone. Currently that zone is the size of New Jersey, but with the increase in corn and nitrogen-runoff (10-19%) the zone will increase to a level impossible to shrink.
I found this article interesting because it reveals a problem with a plan that seems like the solution to our energy problems. Corn, a natural product, contains the potential to fuel our nation. But, as it turns out, corn also has the potential to destroy our seas. So what do we do? We need to find some way to reduce our dependency on oil, coal, and natural gas, but even with new forms of “green” energy come problems. Although we will hopefully reduce our impact on the environment in many ways, we have no way to measure and even predict our potential effects.
Congress wants to produce 15 billion gallons of ethanol from corn by 2022. On the surface, this sounds like an environmentally-friendly idea to reduce our dependency on oil and other depleting natural resources. However, upon further inspection, such an increase in ethanol production actually has the potential to destroy our seas.
Increasing our ethanol production to 15 billion gallons means drastically increasing the amount of corn harvested in the US. That’s where the harm to the seas begins. Corn requires heavy fertilization, and a byproduct of that fertilization is nitrogen. The nitrogen from the fertilizer runs off the farms and into rivers and streams which eventually feed into the Gulf of Mexico. Streams have a natural ability to filter the nitrogen to an extent, but the amount of corn currently planted and which needs to be planted to meet the government’s goal exceeds the capability of the streams. The excess nitrogen runs into the Gulf of Mexico and becomes nourishment for algae. The more nitrogen run-off, the greater the amount of algae. Algae decomposition requires oxygen and therefore takes a large percentage of the oxygen in the Gulf, creating what scientists call a dead zone. Currently that zone is the size of New Jersey, but with the increase in corn and nitrogen-runoff (10-19%) the zone will increase to a level impossible to shrink.
I found this article interesting because it reveals a problem with a plan that seems like the solution to our energy problems. Corn, a natural product, contains the potential to fuel our nation. But, as it turns out, corn also has the potential to destroy our seas. So what do we do? We need to find some way to reduce our dependency on oil, coal, and natural gas, but even with new forms of “green” energy come problems. Although we will hopefully reduce our impact on the environment in many ways, we have no way to measure and even predict our potential effects.
Tuesday, April 8, 2008
Raising a Child with Prayers?
Ava Worthington died on March 2nd, 2008 as a result of bronchial pneumonia and a blood infection. Normally, such a case would be routine work -- give her a prescription of antibiotics, case closed. However, the complications come when her parents, fundamentalists from The Followers of Christ Church, refused to seek treatment for her, relying instead on prayer. This case is just one of at least 38 in which young children died of easily curable diseases as a result of parents who insist on prayer rather than conventional medicine.
Article: http://www.dailynewstribune.com/opinion/x808351426
Monday, April 7, 2008
Siamese Twins: Kill One or Let Both Die?
Post inspired by this article: http://www.cbhd.org/resources/healthcare/hollinger_2000-09-14.htm
In 2000, conjoined twins were born in England and their medical status generated much concern. This set was conjoined at the lower abdomen so that one of the girls, (lets call her Mary) was totally dependent on the other (Jodie) for cardiac and pulmonary support because the twins’ lungs and heart resided in Jodie’s part of the body. The dilemma came when doctors informed the parents that if they kept the twins conjoined, they would both die in 6 months, but if they separated them, Debbie would die instantly but Jodie could live for much longer. Difficult questions quickly arise: should the parents save Jodie by killing (should it be called that?) Mary? Should both lives be treated as intertwined, with potential lifespan as an arbitrary and inapplicable concern, so that both girls should live as long as possible without inciting the (unnatural or pre-term death of one of the girls? Who has the authority to decide this?
The author of the article that incited this post, Dennis P. Hollinger, presented five reasons as to why the parents should elect to do the surgery and should attempt to save Jodie’s life at the expense of a few more months of Mary’s life. I want to address his second point that because Mary would not be alive if she weren’t conjoined to her sister, it is justified to allow her to die by un-separating them because their connection is unnatural while separation, and thus its consequences, are natural. I think that Hollinger’s argument missed the crucial point that Mary has mental activity and thus she is an autonomous and legitimate person. Just because her organs are not hers (just like someone on life support or with organ transplants) does not mean that the benefits from those organs are illegitimate.
This case not only presents a very difficult and quite possibly a lose-lose situation but also a situation that, I feel, is mostly complicated because it has to juggle the divergent interests of the multiple parties. Until we determine clearly who is in charge of these situations and what capacity of control they hold, the continued complexities will compound and thus we must continue to try to sort out the debate of what is ethical and who, especially in difficult situations, has the authority to decide what’s ethical.
Guinea Pigging among Surrogate Mothers?
I never understood why any woman would volunteer to be a surrogate mother. Why would anyone carry another’s child? Or risk experiencing the mental or physical consequences of giving birth then having to give up the child that was inside one’s body for nine months? However, the same questions could be asked to any person giving up their body for human experimentation. Although these volunteers see financial incentives as their primary goal of becoming involved in surrogacy or human experimentation, there are other moral values that can come into play as well. For instance, Jennifer Cantor, a 34-year old woman with her own 8-year old daughter, claims that she gets pleasure from carrying a child, whether it is hers or not. She claims that there is no emotional attachment to the baby she gives birth to; she merely wants to help others who are unable to have children. In fact, there are an increasing number of American women – more since the attack on
The reasons for this dramatic increase during war time may be due to a number of causes. Perhaps the absence of the husband leaves women needing to find means of economic support. In fact, a surrogate mother can earn up to $20,000 to $25,000! However, as mentioned before, financial gains are often not the incentives for the surrogate mothers; noble values of benevolence and sympathy drive women like Jennifer Cantor to help other women find ways to have their own babies – those who derived from their own genes. Then, a question arises similar to the one raised concerning “guinea pigging” effect. Could the potential for “guinea pigging” and hence subtle coercion be eliminated by eliminating the financial incentives to surrogate mothers?
Malpractice suits
Malpractices suits are of grave concern in many fields of medicine. Obstetrics and gynecology is the biggest hitter, costing each OB/GYN $175,000 in malpractice insurance and are liable for malpractice up to 18 years after the delivered their final child. Many times, people take advantage of these malpractice laws in order to earn money on the physician’s behalf. Many choose to force their patients to sign waivers that remove their rights to file such a suit and if they fail to do so, then the doctor refuses his or her services to the patient.
The question lies in the ethical acceptability of such action. On one had, the doctor is trying to safeguard himself from unethical patients who just want to reek the most financial benefit. But what about those patients that he actually does harm, don’t they have a right to wreak the monetary compensation for his mistakes. But then, there is always the risk that the doctors will attempt to monopolize this malpractice risk and in order for any patient to get medical care they will have to sign off their rights without choice. After all, a doctor is just meant to help people and shouldn’t worry about the external risks or benefits, right?
Now, what an individual must decide is where the happy medium lies with this. Perhaps the papers should have disclaimers saying what is acceptable as a ground for a lawsuit and what isn’t. What do you think is a possible solution?
The question lies in the ethical acceptability of such action. On one had, the doctor is trying to safeguard himself from unethical patients who just want to reek the most financial benefit. But what about those patients that he actually does harm, don’t they have a right to wreak the monetary compensation for his mistakes. But then, there is always the risk that the doctors will attempt to monopolize this malpractice risk and in order for any patient to get medical care they will have to sign off their rights without choice. After all, a doctor is just meant to help people and shouldn’t worry about the external risks or benefits, right?
Now, what an individual must decide is where the happy medium lies with this. Perhaps the papers should have disclaimers saying what is acceptable as a ground for a lawsuit and what isn’t. What do you think is a possible solution?
Terri Schiavo, Revisited
The upcoming campus visit (tomorrow, April 8th, Frist 302, 7:30 pm if anyone is interested) of Terri Schiavo’s brother, Bobby Schindler, has gotten me thinking again about the issue of euthanasia, or mercy killing, and whose decision it should be. I’m sure you all remember the epic battle between Terri Schiavo’s husband, Michael, and her parents over her life. Eventually, Michael won the right to remove Terri’s feeding tube and she died in March 2005, after spending over ten years in a “persistent vegetative state.”
Many of the articles I have come across online characterize Terri’s death as “horrific” and indicate that she was “cruelly starved to death and dehydrated.” There is no doubt that Terri died from lack of food and water, as she was able to survive without any help beyond a feeding tube. The controversy lies in whether or not her death was “cruel.” Because Terri did not leave a living will, her loved ones bickered over whether or not she would have wanted to die based on vague recollections of things she had said. For me, personally, I remember how much it sucked to be stuck on the couch for a week after I had my appendix out, effectively not being able to feed myself because I couldn’t get up, and I can be sure that I would not want to live in a persistent vegetative state, so brain damaged that I was not aware of my own existence.
I believe that severely brain damaged people are not alive anymore in the sense that they are of course living because their organs are functioning, but they no longer possess that which makes them truly human. I do not particularly believe in souls per se, but I feel that every person attains personhood through having a mind that can think and learn and create new ideas in and of itself. If someone’s mind is dead, they are no longer alive.
From there, the decision between life and death could have been left in the hands of either her biological family or her husband. Because Michael Schiavo had already moved on to a new life and had children with another woman, I do not think he should have been the one to make the decision regarding Terri’s future. Terri’s family was willing to pay all medical expenses to keep Terri alive, so she would not have been a burden to Michael in any way. I definitely believe that Terri was already dead in the most crucial sense of the word and I think that removing her feeding tube was the right decision for Michael to make. However, I also think that it may have been better for her family to make that final decision because they still had a strong emotional attachment to Terri and were willing to take care of her as necessary. Who are we to dictate what someone else’s family should do in that instance?
Overall, I think that this was an incredibly difficult decision and Terri’s case was incredibly unfortunate and of course everyone would have been better off if Terri had either died on the day she fell ill, or had never fallen into her vegetative state in the first place. I think that Terri’s parents should have been able to make the decision regarding her future as they had a more vested interest in her well being as Michael had already separated himself from Terri significantly. However, as the right to make a decision was given to Michael, I believe that he did make an appropriate decision.
http://jewishworldreview.com/cols/hentoff040308.php3
http://www.princeton.edu/~soapbox/vol2no4/24murray.html
http://www.princeton.edu/~paw/archive_new/PAW05-06/09-0308/notebook.html
Many of the articles I have come across online characterize Terri’s death as “horrific” and indicate that she was “cruelly starved to death and dehydrated.” There is no doubt that Terri died from lack of food and water, as she was able to survive without any help beyond a feeding tube. The controversy lies in whether or not her death was “cruel.” Because Terri did not leave a living will, her loved ones bickered over whether or not she would have wanted to die based on vague recollections of things she had said. For me, personally, I remember how much it sucked to be stuck on the couch for a week after I had my appendix out, effectively not being able to feed myself because I couldn’t get up, and I can be sure that I would not want to live in a persistent vegetative state, so brain damaged that I was not aware of my own existence.
I believe that severely brain damaged people are not alive anymore in the sense that they are of course living because their organs are functioning, but they no longer possess that which makes them truly human. I do not particularly believe in souls per se, but I feel that every person attains personhood through having a mind that can think and learn and create new ideas in and of itself. If someone’s mind is dead, they are no longer alive.
From there, the decision between life and death could have been left in the hands of either her biological family or her husband. Because Michael Schiavo had already moved on to a new life and had children with another woman, I do not think he should have been the one to make the decision regarding Terri’s future. Terri’s family was willing to pay all medical expenses to keep Terri alive, so she would not have been a burden to Michael in any way. I definitely believe that Terri was already dead in the most crucial sense of the word and I think that removing her feeding tube was the right decision for Michael to make. However, I also think that it may have been better for her family to make that final decision because they still had a strong emotional attachment to Terri and were willing to take care of her as necessary. Who are we to dictate what someone else’s family should do in that instance?
Overall, I think that this was an incredibly difficult decision and Terri’s case was incredibly unfortunate and of course everyone would have been better off if Terri had either died on the day she fell ill, or had never fallen into her vegetative state in the first place. I think that Terri’s parents should have been able to make the decision regarding her future as they had a more vested interest in her well being as Michael had already separated himself from Terri significantly. However, as the right to make a decision was given to Michael, I believe that he did make an appropriate decision.
http://jewishworldreview.com/cols/hentoff040308.php3
http://www.princeton.edu/~soapbox/vol2no4/24murray.html
http://www.princeton.edu/~paw/archive_new/PAW05-06/09-0308/notebook.html
Silly Americans, ADHD is for Kids…Not
According to the American Academy of Child and Adolescent Psychiatry, approximately 15% of grade school children can be diagnosed with ADHD, which has lead to a sevenfold increase in the production of Ritalin between 1991 and 1998. Because there are no biological tests for ADHD, diagnosis largely depends on reports from parents and teachers. Unfortunately, accounts from parents and teachers may not be entirely accurate; how can they differentiate between an active, energetic child and one who suffers from ADHD?
Compared to other countries, the incidence of ADHD in the United States is especially high. In Japan, for example, ADHD has not achieved the label of a disorder like it has in the United States. The Japanese view the “symptoms” of ADHD as temporary childhood characteristics that all individuals eventually grow out of. Americans, on the other hand, do not share the same perception. In fact, most Americans view ADHD as permanent disabilities, meaning that children diagnosed with ADHD will carry the burden of ADHD for the rest of their lives.
I believe that the common misconception in America regarding ADHD revolves around our inability to accurately diagnose the “disorder” and our hastiness in turning to medications to correct problems. America has fallen into the trap of believing that ADHD is a common “disorder” thereby leading to its over diagnosis. Part of the problem with the high incidence rate of ADHD is that society fosters the diagnosis of the “disorder” by relying heavily on medications (Ritalin) to “cure” undesired traits associated with young children. ADHD may essentially serve as a scapegoat for parents to better control their children. This scapegoat will only continue to grow unless Americans remove the stigma that undesired childhood characteristics spell ADHD.
References:
Donovan, Denis M. “An Alternative Approach to ADHD.” The Harvard Mental Health Letter May 2000: 5-7.
Wednesday, April 2, 2008
It's a bird..it's a plane..it's a human-cow baby?
In Britain, they have recently created human-cow embryos using cow egg cells. They claim that their aim is not to make human-cow hybrids but to use such embryos for stem cells. This is part of the bigger goal of creating organs as part of the booming field of regenerative medicine. We don't, however, know what these human-cow embryos really could amount to. Based upon biological predictions, successful animal-human embryos of this sort could not be made but it has not been entirely investigated.
Scientists who advocate the fertilization of cow egg cells with human DNA do so for two reasons: one being that we must save human egg cells. Such cells are "precious" and have been destroyed too often in the process of research. Another reason is that they believe that the negative stigma surrounding the debate of stem cells lies mostly in the fact that human stem cells are being used. Arthur Caplan is quoted in the article (big surprise) as saying that he "sees no risk in making 'monsters' [aka human-cow embryos] this way."
Numerous complications can be seen with this method. Is it really true that all of the negative connotations associated with embryos used for stem cells would just disappear? Afterall, the embryo is still part human. It is unlikely in the highly controversial subject of stem cells that negative attitudes would dissipate. The ethical controversies of stem cell research are complex and therefore cannot be solved using a simple solution, such as removing the human egg cell component. In addition, it is likely that more ethical issues will be created in using animal and human embryos. Animal rights activists may have something to say about animal DNA being used for the production of stem cells. Others may simply fear the combination because it is "unnatural."
The question remains: should this type of experimentation be allowed even though we do not know the outcomes? Will it help solve the need for stem cells by eliminating some of the controversial aspects (such as destroying a potential human fetus)? Or instead, will more ethical issues arise?
http://news.yahoo.com/s/nm/20080402/sc_nm/cloning_cows_dc;_ylt=Ag0w0E0eYSI3G2F6JJBOy2eJhMgF
Scientists who advocate the fertilization of cow egg cells with human DNA do so for two reasons: one being that we must save human egg cells. Such cells are "precious" and have been destroyed too often in the process of research. Another reason is that they believe that the negative stigma surrounding the debate of stem cells lies mostly in the fact that human stem cells are being used. Arthur Caplan is quoted in the article (big surprise) as saying that he "sees no risk in making 'monsters' [aka human-cow embryos] this way."
Numerous complications can be seen with this method. Is it really true that all of the negative connotations associated with embryos used for stem cells would just disappear? Afterall, the embryo is still part human. It is unlikely in the highly controversial subject of stem cells that negative attitudes would dissipate. The ethical controversies of stem cell research are complex and therefore cannot be solved using a simple solution, such as removing the human egg cell component. In addition, it is likely that more ethical issues will be created in using animal and human embryos. Animal rights activists may have something to say about animal DNA being used for the production of stem cells. Others may simply fear the combination because it is "unnatural."
The question remains: should this type of experimentation be allowed even though we do not know the outcomes? Will it help solve the need for stem cells by eliminating some of the controversial aspects (such as destroying a potential human fetus)? Or instead, will more ethical issues arise?
http://news.yahoo.com/s/nm/20080402/sc_nm/cloning_cows_dc;_ylt=Ag0w0E0eYSI3G2F6JJBOy2eJhMgF
Tuesday, April 1, 2008
Sex Selection in the US
This post was inspired by the article: "Some Asian Families in the US Choosing Sons" found on http://ap.google.com/article/ALeqM5jIOvYV1zOH5fKHW5lqNFlR3RhZ8AD8VOLE502
This article reveals that some Asian families are using sex selection techniques to increase their chances of having a son, especially if their first child is a girl.
The main problem highlighted in this article is that the sex selection techniques are simply a fetal ultrasound to discover the sex of the baby, and then abortion if it is a girl. I don't want to get into the ethics of abortion here, so I want to discuss the implications of sex selection in general.
There are ways of increasing the probability of having a child of particular gender, but suppose you could pick for certain. However, you could only pick if you already had a child of the opposite sex. Therefore, you could only pick a boy if you already had a girl and vice versa.
I wouldn't have a problem with this at all. There are practical reasons why a parents would want to have a balance, and there are also practical reasons why parents would want to have a boy (to carry on the family name, manual labor, etc.) There are also practical reasons why a family would want to have a girl if their first child was a boy. I don't agree with Sandel and May in their argument that such a selection would remove the humility of parenthood and their general argument about "openness to the unbidden". You are not choosing the child's traits, simply what gender they are. And it is not like the parents have full control. They would not be able to choose to have a family of four boys.
This article reveals that some Asian families are using sex selection techniques to increase their chances of having a son, especially if their first child is a girl.
The main problem highlighted in this article is that the sex selection techniques are simply a fetal ultrasound to discover the sex of the baby, and then abortion if it is a girl. I don't want to get into the ethics of abortion here, so I want to discuss the implications of sex selection in general.
There are ways of increasing the probability of having a child of particular gender, but suppose you could pick for certain. However, you could only pick if you already had a child of the opposite sex. Therefore, you could only pick a boy if you already had a girl and vice versa.
I wouldn't have a problem with this at all. There are practical reasons why a parents would want to have a balance, and there are also practical reasons why parents would want to have a boy (to carry on the family name, manual labor, etc.) There are also practical reasons why a family would want to have a girl if their first child was a boy. I don't agree with Sandel and May in their argument that such a selection would remove the humility of parenthood and their general argument about "openness to the unbidden". You are not choosing the child's traits, simply what gender they are. And it is not like the parents have full control. They would not be able to choose to have a family of four boys.
Monday, March 31, 2008
Universal Ethics: Oppression or Protection?
We the people of the United States are some of the most idealistic people in the world. In a country that was founded solely on principle, it is no wonder that it reflects in the way Americans view, with so much interest, the issues of poverty, disease, and discrimination in order to find possible solutions. Nevertheless, such beliefs have led to a moral quandary when figuring out how to apply our ethical views to foreign policy. The dilemma arises from the acknowledgment that the rights and morals what we feel obliged to respect are not always viewed or applied the same way in other countries.
How should we go about helping others when, as if often the case, help is not wanted? When widows are legally burned at the stake because their husbands died, what action should be taken? When an AIDS victim refusing treatment that could save him due to superstitious traditions, what should we do? The first thing to do would be to locate where we are on the objective-subjective scale of morality. Do we really believe that gender equality, the right to life, and other such ethical concerns are universally right or wrong? If not, then we can stop right here, for there would be no point in supporting these beliefs in other countries. Subjective morality implies that others, even if they hold beliefs conflicting with one’s own, are still right in their own special way. However, if we are to implement policy regarding things morally right and wrong, even in our own country, then we would have to admit to the presence of truth in certain moral beliefs, or else we might as well go our own way and the point of ethical debate and discussion would be nullified. If we do accept the premise that the truths we hold dear are indeed objective truths, then it follows that other countries ought to respect the same beliefs too, regardless of their government, culture, etc. However, it is difficult to reconcile this statement with the belief that the sovereignty of a country is something to be respected. Obviously it goes without saying that one government cannot legislate and enforce the moral compliance of a different nation.
The answer resides in the private sector of a nation. The government, acting as a public entity, has no jurisdiction in the actions and freedoms of a different country, but activist groups in the private sector have (most of the time) free reign to do what they please. Governments represent the legal structure of society, and since two different legal structures cannot interfere with each other’s business without warrant, government involvement is out of the question (excepting, of course, the extreme scenarios when certain governments severely transgress beliefs that are generally held by the world community). Therefore, it would be up to the individuals of society to promote the beliefs and values that they hold dear and believe all else are entitled to – in our case, the right to life, the right to free speech, etc. – which would allow each individual to be held accountable for oneself. The reason I bring this up is because violations of human rights occur worldwide (e.g. North Korea, Venezuela). However, when a particular group advocates change, often they are viewed as an intolerant group of people attempting to impose their beliefs on others (particularly advocates of democracy or nuclear power prevention). Many times, the politically correct concept of multiculturalism seems to supersede the importance of universal human values. However, if we are to live in a world that globally recognizes the truths we hold to be evident, then we need to first realize that the sharing of certain beliefs like free speech is not an unfair act of imposing one’s morals on another, but rather a protection of the rights that all humans ought to have.
How should we go about helping others when, as if often the case, help is not wanted? When widows are legally burned at the stake because their husbands died, what action should be taken? When an AIDS victim refusing treatment that could save him due to superstitious traditions, what should we do? The first thing to do would be to locate where we are on the objective-subjective scale of morality. Do we really believe that gender equality, the right to life, and other such ethical concerns are universally right or wrong? If not, then we can stop right here, for there would be no point in supporting these beliefs in other countries. Subjective morality implies that others, even if they hold beliefs conflicting with one’s own, are still right in their own special way. However, if we are to implement policy regarding things morally right and wrong, even in our own country, then we would have to admit to the presence of truth in certain moral beliefs, or else we might as well go our own way and the point of ethical debate and discussion would be nullified. If we do accept the premise that the truths we hold dear are indeed objective truths, then it follows that other countries ought to respect the same beliefs too, regardless of their government, culture, etc. However, it is difficult to reconcile this statement with the belief that the sovereignty of a country is something to be respected. Obviously it goes without saying that one government cannot legislate and enforce the moral compliance of a different nation.
The answer resides in the private sector of a nation. The government, acting as a public entity, has no jurisdiction in the actions and freedoms of a different country, but activist groups in the private sector have (most of the time) free reign to do what they please. Governments represent the legal structure of society, and since two different legal structures cannot interfere with each other’s business without warrant, government involvement is out of the question (excepting, of course, the extreme scenarios when certain governments severely transgress beliefs that are generally held by the world community). Therefore, it would be up to the individuals of society to promote the beliefs and values that they hold dear and believe all else are entitled to – in our case, the right to life, the right to free speech, etc. – which would allow each individual to be held accountable for oneself. The reason I bring this up is because violations of human rights occur worldwide (e.g. North Korea, Venezuela). However, when a particular group advocates change, often they are viewed as an intolerant group of people attempting to impose their beliefs on others (particularly advocates of democracy or nuclear power prevention). Many times, the politically correct concept of multiculturalism seems to supersede the importance of universal human values. However, if we are to live in a world that globally recognizes the truths we hold to be evident, then we need to first realize that the sharing of certain beliefs like free speech is not an unfair act of imposing one’s morals on another, but rather a protection of the rights that all humans ought to have.
Being pregnant... for fun?
According to a Newsweek article, Jennifer Cantor enjoys being pregnant. She says she likes the feeling of growing another life inside of her. However, she only has one child. All the others have been given away. In fact, none of them were even biologically related to her. Cantor is the vessel in which desperate couples plant their lab-fertilized eggs.
The concept of surrogate mothers challenges the very ideas of motherhood. What kind of traditional mother would bear a child for 9 months, and then simply give it away? These and other challenges were brought forward when the technology first became available. However, it has become more accepted as a last ditch measure for infertile couples to have a child. Nonetheless, there are still concerns about the practice.
Each surrogate is usually paid around $25000. This brings up issues we talked about in the beginning of the year: poorer women may be coerced by the high payments. In fact, Newsweek found that many surrogate mothers are the husbands of military men who are trying to supplement the family's income. However, unlike payments for clinical trials, there is much less of an ethical problem here. The technology for surrogate mothers is well-established and safe, so the risks are much less. I believe that surrogate motherhood is an ethically acceptable (although not exemplary) practice.
The concept of surrogate mothers challenges the very ideas of motherhood. What kind of traditional mother would bear a child for 9 months, and then simply give it away? These and other challenges were brought forward when the technology first became available. However, it has become more accepted as a last ditch measure for infertile couples to have a child. Nonetheless, there are still concerns about the practice.
Each surrogate is usually paid around $25000. This brings up issues we talked about in the beginning of the year: poorer women may be coerced by the high payments. In fact, Newsweek found that many surrogate mothers are the husbands of military men who are trying to supplement the family's income. However, unlike payments for clinical trials, there is much less of an ethical problem here. The technology for surrogate mothers is well-established and safe, so the risks are much less. I believe that surrogate motherhood is an ethically acceptable (although not exemplary) practice.
Limited Time Offer: Trade Your Fertility for a Gun Today!
Recently a new government policy has gained popularity in several districts in India. Officials in central Madhya Pradesh state’s Shivpuri district, a bandit infested region, has adopted the policy that attempts to increase vasectomy rates by offering to fast-track gun license applications—essentially asking men to exchange their fertility for guns. Officials view the policy as part of their new plan to “encourage people to have smaller families to ease poverty.” Last year officials offered a financial reward of 1,100 rupees ($27.5) in exchange for undergoing a vasectomy; eight men opted to undergo the procedure. Since the institution of this new policy, over 150 men have undergone a vasectomy, and another 100 are expected by the beginning of April. (AFP, 1).
Immediately, the incentive offered by officials presents multiple ethical issues. What happened to informed consent without undue duress? For men in the region, being licensed to carry a gun is equivalent to being given further power to protect their families from the large number of bandits that inhabit the region, the majority of which carry unlicensed weapons. So, from a theoretical ethics point of view, clearly the incentive prevents the patients from making an informed consent; but what about the perspective of practical ethics? Increased vasectomy rates will aid in controlling the over-population problem, and granting locals the ability to legally hold firearms will help them protect their families from harm. But is it really such a win-win situation, or are there further implications?
(Source: http://news.yahoo.com/s/afp/20080318/hl_afp/healthindiapopulationfamilyplanningguns_080318191739;_ylt=Auff5sE0i0RHO_LSdvQKhJOs0NUE)
Immediately, the incentive offered by officials presents multiple ethical issues. What happened to informed consent without undue duress? For men in the region, being licensed to carry a gun is equivalent to being given further power to protect their families from the large number of bandits that inhabit the region, the majority of which carry unlicensed weapons. So, from a theoretical ethics point of view, clearly the incentive prevents the patients from making an informed consent; but what about the perspective of practical ethics? Increased vasectomy rates will aid in controlling the over-population problem, and granting locals the ability to legally hold firearms will help them protect their families from harm. But is it really such a win-win situation, or are there further implications?
(Source: http://news.yahoo.com/s/afp/20080318/hl_afp/healthindiapopulationfamilyplanningguns_080318191739;_ylt=Auff5sE0i0RHO_LSdvQKhJOs0NUE)
A Pregnant Father
In the most recent issue of The Advocate, a LGBT magazine, Thomas Beatie, a transgender male, published an article entitled “Labor of Love: Is society ready for this pregnant husband?” Beatie was born a female yet decided to undergo chest reconstruction surgery and testosterone therapy in order to become a transgender male. He did, however, decide to keep his female reproductive organs. While undergoing testosterone therapy his body did not produce any eggs, but once he stopped the therapy he would be able to conceive and bear a child.
Because his wife, Nancy, was infertile, the couple made the decision that Beatie would carry their child instead of a surrogate. Although Beatie was physically able to become pregnant, the couple met heavy resistance from society. Beatie wrote, “Doctors have discriminated against us, turning us away due to their religious beliefs. Health care professionals have refused to call me by a male pronoun or recognize Nancy as my wife. Receptionists have laughed at us.” The couple had to go through nine doctors in order to conceive because of the unwillingness of doctors to help Beatie conceive.
Beatie acknowledged the significance of his decision to become pregnant, writing, “Our situation sparks legal, political, and social unknowns.” Many in society do not know how to handle such a situation, and one doctor even questioned whether or not Beatie and Nancy were “fit to bring a child into this world” (Beatie); the doctor was so hesitant that he brought the issue to the ethics board of his hospital.
Beatie ends his article asking his readers to define for themselves what is normal. He will end up with society’s standard definition of a normal family, a mother, father, and child, but in an unconventional way (the pregnancy of the father, not mother). Beatie does nothing ethically wrong in this situation, his desire for a child simply challenges the conventions of society. His pregnancy makes many uncomfortable, just because this is venturing into uncharted territory. Unlike cases of genetic engineering where we can cite specific reasons as to why such procedures should not be allowed, a case like this, where both parents so desperately want a child that they are willing to whatever it takes, is difficult to find reasons to object. After the child, a girl due on July 3, 2008, is born, no one will know that anything out of the ordinary has happened within this family. It will be interested to follow this story to the birth of this couple’s daughter.
Because his wife, Nancy, was infertile, the couple made the decision that Beatie would carry their child instead of a surrogate. Although Beatie was physically able to become pregnant, the couple met heavy resistance from society. Beatie wrote, “Doctors have discriminated against us, turning us away due to their religious beliefs. Health care professionals have refused to call me by a male pronoun or recognize Nancy as my wife. Receptionists have laughed at us.” The couple had to go through nine doctors in order to conceive because of the unwillingness of doctors to help Beatie conceive.
Beatie acknowledged the significance of his decision to become pregnant, writing, “Our situation sparks legal, political, and social unknowns.” Many in society do not know how to handle such a situation, and one doctor even questioned whether or not Beatie and Nancy were “fit to bring a child into this world” (Beatie); the doctor was so hesitant that he brought the issue to the ethics board of his hospital.
Beatie ends his article asking his readers to define for themselves what is normal. He will end up with society’s standard definition of a normal family, a mother, father, and child, but in an unconventional way (the pregnancy of the father, not mother). Beatie does nothing ethically wrong in this situation, his desire for a child simply challenges the conventions of society. His pregnancy makes many uncomfortable, just because this is venturing into uncharted territory. Unlike cases of genetic engineering where we can cite specific reasons as to why such procedures should not be allowed, a case like this, where both parents so desperately want a child that they are willing to whatever it takes, is difficult to find reasons to object. After the child, a girl due on July 3, 2008, is born, no one will know that anything out of the ordinary has happened within this family. It will be interested to follow this story to the birth of this couple’s daughter.
Tuesday, March 25, 2008
A Second Look at Designer Babies: Selecting for Deaf Embryos?
The most common objection to genetic screening of embryos is the issue of “designer babies,” creating children with perfect intelligence, height, eye-colour, and so forth. The ethics of such a situation has gone back and forth several times over, but now Tomato Lichy and his wife Paula have now turned this issue inside out – they want a baby who is deaf.
Lichy and his wife are themselves both deaf, and to them being deaf is not a disability but rather a positive trait – something they see as “paralleling being Jewish or black.” In Lichy’s opinion, the absence of hearing opens one to the “deaf culture,” with its own unique aspects and benefits – such as deaf plays. Another deaf British couple added that: "it is important that our culture is passed on from one generation to another ... the threat of losing our culture would be devastating because we have so much to show and to give."
The problem is that a new bill making its way through the British government would prohibit the implantation of embryos which are “known to have a gene, chromosome, or mitochondrion abnormality involving a significant risk that a person with any serious medical condition must not be preferred to those that are not known to have such an abnormality.” The idea behind this bill is simple: to give the child the best chances of thriving and being happy. However, to the Lichys’, this bill is tantamount to racial discrimination.
The problem here is similar to that of whether disabled individuals can attain the same happiness and success that “non-disabled” individuals can achieve. I personally believe that whereas it may be true that disabled individuals may be hindered somewhat in their pursuit of happiness or success, the perceived hindrance is much more than it actually is. People who are able to hear look down on the deaf and imagine how difficult life must be for them – but this is a largely egocentric view; just because we cannot picture life without sound, we imagine that a life without sound must be that much more difficult for others. But, as the Lichys’ point out, deafness need not be a disability, especially since modern society is becoming more and more accommodating to the handicapped, and a second "culture" is opened up to their child.
The other side of this issue is what the unborn child would want for his future. Most people would shudder at the thought of their parents selecting them to be deaf, but again this is because we are accommodated to our current lifestyle – if we were born deaf, we probably would have a significantly different viewpoint. Thus, I think it is difficult to argue that the child would be unquestionably better off being born with or without hearing. As long as the Lichys’ are able to make a convincing case that being born deaf has its advantages – as I think they have done – they should be allowed to screen for deaf embryos.
Of course, this opinion will probably be heavily debated -- other thoughts on this matter?
http://www.tamilstar.com/news/health/article_6314.shtml
Monday, March 24, 2008
Necessary Coercion?
Source: http://www.nytimes.com/2008/03/21/us/21vaccine.html?_r=1&ref=health&oref=slogin
Several possible ethical problems arise. What about the child’s autonomy? Do the parents have a right to choose for their children whether to be vaccinated or not? What if this decision is misinformed? Do health officials – as the experts concerning vaccinations – have the right or obligation to ban exemptions?
I think that such exemptions to the requirement of vaccinations – accorded by individual request in 20 states including
The Good, the Bad, and the Organ Transplant Policies
Although organ transplants have the potential to save countless lives, that policies can appear subjective and organs are constantly in shortage leads to much conflict. Transplant policies often depend on such “requirements” as geographic location, age, expected life span, time on waiting list, quality of life, etc. but the emphasis placed on each of these “requirements” can vary. Furthermore, many of these “requirements” are not quantitative: how does one assign value to someone’s quality of life? Someone’s contributions to society? Someone’s potential future contributions to society? Which “requirements” should be valued most?
In addition to issues regarding transplant policy, the largest problem with organ transplants is the scarcity of donated organs. If donated organs were in surplus, issues regarding transplant policies would likely not exist as everyone on the waiting list would be able to receive the much needed organ. We have already discussed black markets and whether people should be allowed to sell their organs. Should the government, however, be allowed to dictate how people donate their organs? For example, should the government be allowed to require citizens to donate certain organs (i.e. a single kidney) to save people? The government already reserves the right to draft people during times of war and thus somewhat reserves the right to donate lives. Obviously many would be opposed to the government requiring that a person donate an organ but what about required blood donations? Or required bone marrow donations? Should the government provide incentives for people to donate their organs or would such a policy be viewed as coercion?
Although I do not feel the government should be allowed to dictate the actions of individuals, I feel the government should be allowed to provide incentives to organ donors and should be allowed to require annual blood donations. Countless lives could be saved if more people donated blood, and since people can constantly produce blood (unlike organs), they would be losing minimally if the government implemented policies requiring citizens to donate blood.
Source:
http://www.hhs.gov/asl/testify/t980618a.html
Sunday, March 23, 2008
Ethical Progress, or lack there of?
Both the international “Declaration of Helsinki” and “The Belmont Report” dictate that a physician may also play the role of researcher so long as that the two roles do not intertwine and that their patient’s best interest are still in mind. Many choose take both of these roles on but how many of them do so ethically? An old article in Time summarizes a Dr. Beecher’s review in the New England Journal Of Medicine of the atrocities in medical research at the time. He states that to most patients the full extent of the research was not explained, in other words, true informed consent was not obtained. In other cases, many patients did not know that they were research test subjects at all. Cases summarized include denial of medication to see the effects of a disease, melanoma cancer transplants to healthy patients, and removal of questionable organs to see if they truly served a function in the body, all on the pretense of benefiting the patient. The case of melanoma was supposed to provide the sick patient with antibodies from her mother, the person to whom the cancer was transplanted, but in the end both patients died from the cancer.
The question is, how far have we really come in the year 2008? Is this still an issue or have ethical boards reformed the practice of medical research to no longer include such problems? Unfortunately, we all know that the answer to this question is not the shining moment in human history. Ethical boards still exist that consistently make sure a doctor’s judgment is truly what is best for the patient and even with that, mishaps still occur, people are taken advantage of, and ethical debate on the topic continues. We still have miles to go before we reach a happy median between medical research and ethical righteousness.
http://www.time.com/time/magazine/article/0,9171,835950-2,00.html
The question is, how far have we really come in the year 2008? Is this still an issue or have ethical boards reformed the practice of medical research to no longer include such problems? Unfortunately, we all know that the answer to this question is not the shining moment in human history. Ethical boards still exist that consistently make sure a doctor’s judgment is truly what is best for the patient and even with that, mishaps still occur, people are taken advantage of, and ethical debate on the topic continues. We still have miles to go before we reach a happy median between medical research and ethical righteousness.
http://www.time.com/time/magazine/article/0,9171,835950-2,00.html
Friday, March 21, 2008
Should Behavior in Children Put Them Under Scrutiny for the Rest of Their Lives?
Gary Pugh, the director of the Scotland Yard and the new DNA spokesman for the Association of Chief Police Officers urged the necessity of a discussion over how far British officials should go in trying to identify future criminals. Future criminals? That’s right. Children can exhibit behavior at an age as young as five years old that may indicate a good chance of future criminal behavior. Gary Pugh is Britain’s most senior forensics expert, and he recommends that primary school children should be eligible to have their DNA added to a database if they exhibit behavior that indicates that they may become criminals later in life.
Pugh says that the suggested system is in line with criminological theory, which indicates that criminals often start by committing minor offenses that gradually escalate to more serious crimes. Scotland Yard criminologists are confident that they can identify such patterns in children.
This issue is as much a matter of bioethics as civil liberties. It raises the obvious objection that children who are identified as exhibiting these pre-criminal behaviors will be stigmatized for the rest of their lives. Perhaps they might even have “grown out” of their tendencies but may be instead led to a life of crime by a society that expected nothing more of them. Parental consent is an important factor here, and although teachers will have a lot of power to influence the rest of a child’s life, possibly unfairly, Pugh insists that the teachers will shoulder the responsibility of trying to alter the child’s behavior for the benefit of the child and the society at large.
Some parents and teachers feel that the cataloging of these children’s DNA is just the first step towards some sort of terrible futuristic police state. I can certainly understand both sides of the argument but I can definitely see the economic advantage of the plan. Violent crime alone cost England 13 billion pounds last year and preventing crime before it starts by identifying future criminals before they become a problem could greatly reduce both the crime rate and the amount of money poured into the system. But should we be more concerned with the monetary benefits or the societal drawbacks of this system? Only time will tell.
Source: http://www.guardian.co.uk/society/2008/mar/16/youthjustice.children
Pugh says that the suggested system is in line with criminological theory, which indicates that criminals often start by committing minor offenses that gradually escalate to more serious crimes. Scotland Yard criminologists are confident that they can identify such patterns in children.
This issue is as much a matter of bioethics as civil liberties. It raises the obvious objection that children who are identified as exhibiting these pre-criminal behaviors will be stigmatized for the rest of their lives. Perhaps they might even have “grown out” of their tendencies but may be instead led to a life of crime by a society that expected nothing more of them. Parental consent is an important factor here, and although teachers will have a lot of power to influence the rest of a child’s life, possibly unfairly, Pugh insists that the teachers will shoulder the responsibility of trying to alter the child’s behavior for the benefit of the child and the society at large.
Some parents and teachers feel that the cataloging of these children’s DNA is just the first step towards some sort of terrible futuristic police state. I can certainly understand both sides of the argument but I can definitely see the economic advantage of the plan. Violent crime alone cost England 13 billion pounds last year and preventing crime before it starts by identifying future criminals before they become a problem could greatly reduce both the crime rate and the amount of money poured into the system. But should we be more concerned with the monetary benefits or the societal drawbacks of this system? Only time will tell.
Source: http://www.guardian.co.uk/society/2008/mar/16/youthjustice.children
Tuesday, March 11, 2008
Ok son, meet your mom, your other mom and your dad...
Last month, it was published that Newcastle University successfully created an embryo..with three parents. DNA was taken from a man and two women. The theory behind this endeavor is to eliminate mitochondrial-related disorders (such as epilepsy, liver failure, muscular dystrophy, etc) which the mother passes onto the child. The nucleus from an already formed embryo was transplanted into another donor egg. The scientists claim that the donor egg does not contribute DNA which affects the babies appearance--but what else will it affect? So far only minimal after-effect tests have been conducted in mice.
There are certainly ethical issues to be considered in this case. Should we be manipulating the process of life in such a manner? Since the formation of the first human beings, one sperm and one egg have united to form the zygote which leads to new life. Has this new manipulation of mother nature gone too far? The ethicist Josephine Quintavalle in the article worries that the procedure will be "risky" and is a "step towards designer babies." I too agree that since this is such a novel procedure that the risks will undoubtedly be tremendous. What if the babies are born with extreme deformities? What are their rights? Also, psychologically, I believe that there are issues present. How will a child react to knowing that he or she has two mothers and a father? Will he or she feel like an outcast? Practical implications arise--who is the biological mother? I found this article interesting since its research findings are quite novel and unprecedented. As with any unprecedented process, we must come up with a new protocol. This seems as if it will be easier said than done in this case.
source: http://news.bbc.co.uk/2/hi/health/7227861.stm
There are certainly ethical issues to be considered in this case. Should we be manipulating the process of life in such a manner? Since the formation of the first human beings, one sperm and one egg have united to form the zygote which leads to new life. Has this new manipulation of mother nature gone too far? The ethicist Josephine Quintavalle in the article worries that the procedure will be "risky" and is a "step towards designer babies." I too agree that since this is such a novel procedure that the risks will undoubtedly be tremendous. What if the babies are born with extreme deformities? What are their rights? Also, psychologically, I believe that there are issues present. How will a child react to knowing that he or she has two mothers and a father? Will he or she feel like an outcast? Practical implications arise--who is the biological mother? I found this article interesting since its research findings are quite novel and unprecedented. As with any unprecedented process, we must come up with a new protocol. This seems as if it will be easier said than done in this case.
source: http://news.bbc.co.uk/2/hi/health/7227861.stm
Monday, March 10, 2008
The Sin of Bioethics
From: http://green.yahoo.com/news/nm/20080310/hl_nm/pope_sins_dc.html
The Vatican published a list this past weekend of new sins and “modern evils.” Many focused on the environment, such as not polluting, but the Archbishop Gianfranco Girotti told a Vatican newspaper that he sees bioethics as the most potentially dangerous area for sin. “[Within bioethics] there are areas where we absolutely must denounce some violations of the fundamental rights of human nature through experiments and genetic manipulation whose outcome is difficult to predict and control,” said the Archbishop. The Vatican does not support stem cell research “that involves destruction of embryos and has warned against the prospect of human cloning.” I find it very interesting that it is possible to call areas of bioethics sins, because essentially that is claiming that God deems areas within bioethics as unholy and causing separation from God. By not condoning the destruction of embryos and cloning, the Vatican is saying that God is against these acts. Calling those acts sins makes it hard to argue against for them. Especially if you are Catholic, how can you support these areas in bioethics? And what makes them so wrong that even God is against them? I understand the religious perspective that the destruction of any life is wrong, but I still feel that it is perhaps too strong for the Archbishop to label such acts sins.
The Vatican published a list this past weekend of new sins and “modern evils.” Many focused on the environment, such as not polluting, but the Archbishop Gianfranco Girotti told a Vatican newspaper that he sees bioethics as the most potentially dangerous area for sin. “[Within bioethics] there are areas where we absolutely must denounce some violations of the fundamental rights of human nature through experiments and genetic manipulation whose outcome is difficult to predict and control,” said the Archbishop. The Vatican does not support stem cell research “that involves destruction of embryos and has warned against the prospect of human cloning.” I find it very interesting that it is possible to call areas of bioethics sins, because essentially that is claiming that God deems areas within bioethics as unholy and causing separation from God. By not condoning the destruction of embryos and cloning, the Vatican is saying that God is against these acts. Calling those acts sins makes it hard to argue against for them. Especially if you are Catholic, how can you support these areas in bioethics? And what makes them so wrong that even God is against them? I understand the religious perspective that the destruction of any life is wrong, but I still feel that it is perhaps too strong for the Archbishop to label such acts sins.
A Deadly Diagnosis
In the UK, a baby was born healthy despite the fact that doctors had diagnosed him with a rare brain disorder that could lead to a condition of deafness and blindness. Sounds rather heartwarming until the fact pops up that the doctors, because of their diagnosis, had actually recommended the abortion of the baby. I believe this is an example of doctors stepping too far out of bounds in their practice for two reasons. First of all, doctors in general should not be giving out recommendations of death. It is the doctor’s duty to save lives, not take them. Secondly, physical defects should not be a standard by which to judge the worth of a human life. To say that the infant in the womb should be aborted because he will be born without arms or because she is mentally-retarded is to say that those living today with those defects have a duty to die.
There are a few arguments in support of the doctors’ recommendation. It could be said that the abortion is a matter revolving around the utility of the child, and that the abortion would prevent the child from having to suffer in the world. However, this reason has two major flaws. The first is that humans have no right to presume how much suffering a fellow being is undergoing and then act upon it. One cannot say to the other, “I noticed that your pet has been a great inconvenience to you, so I took the liberty to kill it for you and end your dependence on its needs.” Though others can certainly try to help their neighbors in times of suffering, the decision to act upon it ultimately lies within the jurisdiction of the afflicted only (unless the afflicted has compromised autonomy). The second flaw is that those already living with the handicapped condition cannot be assumed to be in suffering per se; in fact, some probably enjoy life to a greater extent than those who do not understand what it means to handicapped! Their right to live is their own, and ought not to be decided by others – so too, unborn infants who might have the condition should not be aborted because of it.
Another argument that it would be unfair to the parents to have to such a burden to take care of. This is terrible logic. It is a violation of the inherent right to life all humans have to kill someone due to the inconvenience they place on others. Should we kill all the handicapped and elderly? The answer (unless you are Peter Singer) would surely, and hopefully unanimously, be “Of course not.” Almost all of us understand that physical characteristics are no standard to measure the worth of a life.
How then can the doctors be justified in their potentially deadly recommendation? I would propose that they were not at all. Anyone disagree?
http://www.citizenlink.org/CLtopstories/A000006639.cfm
There are a few arguments in support of the doctors’ recommendation. It could be said that the abortion is a matter revolving around the utility of the child, and that the abortion would prevent the child from having to suffer in the world. However, this reason has two major flaws. The first is that humans have no right to presume how much suffering a fellow being is undergoing and then act upon it. One cannot say to the other, “I noticed that your pet has been a great inconvenience to you, so I took the liberty to kill it for you and end your dependence on its needs.” Though others can certainly try to help their neighbors in times of suffering, the decision to act upon it ultimately lies within the jurisdiction of the afflicted only (unless the afflicted has compromised autonomy). The second flaw is that those already living with the handicapped condition cannot be assumed to be in suffering per se; in fact, some probably enjoy life to a greater extent than those who do not understand what it means to handicapped! Their right to live is their own, and ought not to be decided by others – so too, unborn infants who might have the condition should not be aborted because of it.
Another argument that it would be unfair to the parents to have to such a burden to take care of. This is terrible logic. It is a violation of the inherent right to life all humans have to kill someone due to the inconvenience they place on others. Should we kill all the handicapped and elderly? The answer (unless you are Peter Singer) would surely, and hopefully unanimously, be “Of course not.” Almost all of us understand that physical characteristics are no standard to measure the worth of a life.
How then can the doctors be justified in their potentially deadly recommendation? I would propose that they were not at all. Anyone disagree?
http://www.citizenlink.org/CLtopstories/A000006639.cfm
Sunday, March 9, 2008
Brain Enhancement
This is a response to the NY Times article "Brain Enhancement is Wrong, Right?" professor Zwicker sent us on March 9.
Personally, I do not see the use of Adderall and similar drugs as a form of genetic brain enhancement. I think there is a distinct line between use of drugs like Adderall and Provigil and brain enhancing genetic engineering.
The key difference between, say Adderall use and steroid use, is that I do not think that society is pressured into using drugs like Adderall to perform better, whereas plenty of professional athletes have felt that pressure. Furthermore, I really do not see the abuse of Adderall as something that is extremely serious. Is it cheating? I really don't think so. There doesn't seem to be a discrepancy between the students using Adderall and the non-users, whereas there is certainly a gap when talking about steroids and sports. The same can be accomplished by someone who has good time management and work ethic and someone who takes Adderall. Yet steroids and HGH actually change your body to levels that would be impossible to get to otherwise. When a classmate gets a good grade on an exam or paper, do we instantly accuse them of using Adderall? No. Adderall does not actually modify your brain in any way, it simply keeps you awake so that you can learn more with the same brain. If people want to put in this extra work, let them.
Personally, I do not see the use of Adderall and similar drugs as a form of genetic brain enhancement. I think there is a distinct line between use of drugs like Adderall and Provigil and brain enhancing genetic engineering.
The key difference between, say Adderall use and steroid use, is that I do not think that society is pressured into using drugs like Adderall to perform better, whereas plenty of professional athletes have felt that pressure. Furthermore, I really do not see the abuse of Adderall as something that is extremely serious. Is it cheating? I really don't think so. There doesn't seem to be a discrepancy between the students using Adderall and the non-users, whereas there is certainly a gap when talking about steroids and sports. The same can be accomplished by someone who has good time management and work ethic and someone who takes Adderall. Yet steroids and HGH actually change your body to levels that would be impossible to get to otherwise. When a classmate gets a good grade on an exam or paper, do we instantly accuse them of using Adderall? No. Adderall does not actually modify your brain in any way, it simply keeps you awake so that you can learn more with the same brain. If people want to put in this extra work, let them.
Saturday, March 8, 2008
"Gardasil Boys": Should there be a mandate for the HPV vaccine for boys?
I would have greatly enjoyed hearing about Arthur Caplan’s opinions regarding the mandate of the HPV vaccine. Although I did not attend the lecture, I suppose that he touched upon the ethics regarding the possible mandate requiring all females to have the HPV vaccine in an effort to control cervical cancer. But what about the boys?
The article presented in the New York Times publicizes the potential approval of the HPV vaccine for the male population. But wait—isn’t the HPV vaccine only for girls? Immediately, the images of young girls participating in athletic activities while accomplishing their goals and simultaneously chanting together “One less!” flashes through our minds (see the article for further description). Although Merck has created this image in an effort to market the vaccine, in reality HPV is an STI; in other words, HPV infects both males and females.
So instantly, the issue that Arthur Caplan spoke about arises: Should there be a mandate requiring both males and females to have the HPV vaccine? My response would be no; I believe that any such mandate would violate the issue of autonomy. Some may argue that the vaccine could potentially eradicate cervical cancer and other diseases related to HPV such as genital warts (if it is developed to that point), so wouldn’t you want to eradicate HPV in the same way society is working to eradicate diseases such as polio and tuberculosis?
Yes, I agree that tuberculosis and polio are horrible diseases. Yes, I agree that cervical cancer is a horrible disease. But no I don’t think society has any right to force any individual to take the HPV vaccine. Although these diseases are transmitted through person-to-person contact, the characteristic of HPV that sets it apart is choice. In most cases, you choose to have sexual intercourse, whereas you have no control over whether or not a stranger with a drug-resistant strain of tuberculosis chooses to board a plane to Europe and sneeze on as many people as he can. The right to choose is what sets HPV apart, and it is this same right that we would be violating if we were to institute any sort of mandate requiring individuals to have the HPV vaccine.
Article: http://www.nytimes.com/2008/02/24/fashion/24virus.html?_r=2&oref=slogin&oref=slogin
Monday, March 3, 2008
Removing Life Support: Whose Decision Should It Be?
Samuel Golubchuk has recently been stirring up a great debate between doctors, lawyers, judges, and family members -- all without moving or talking. The 84-year old man was shown to have minimal brain activity when doctors decided to end his life support treatment. However, this sparked protest from his children, who claimed to see improvement in their father, including response to their presence.
The problem is that in Manitoba, where this case is unfolding, the College of Physicians and Surgeons of Manitoba's policy dictates that physicians have full discretion of when patients should be taken off life-support. Even though physicians are directed to consult the family, they are allowed to stop treatment even if the family disagrees. In some cases, treatment might be stopped immediately. Physicians are not even given any guidelines for determining when life support should be removed, as there are “far too many scenarios and technology is always changing,” according to Dr. Bill Pope, Registrar with the College.
Such a right clearly overextends the power which should be given to any physician. Physicians are supposed to be bound by the principle of beneficence – to do no harm. The decision to end life support should not be in their hands; in my opinion this is tantamount to euthanasia. Ideally it should be the family members or a third party deciding when to remove life support. However, there is an issue in this too; just like the issue of therapeutic misconception, family members may cling to the impossible hope of recovery and refuse to remove life support, diverting space and resources which could be used for other patients. Or perhaps they themselves do not want to be the ones making the decision to end life support. In light of this, perhaps it would be best to not have the decision lie solely in the hands of one party, or to formulate more rigid guidelines for when life support is to be removed.
Source: http://en.epochtimes.com/news/8-2-21/66337.html
Plastic Surgery in Asia
With the invention of plastic surgery, wealth has increasingly become correlated with beauty. In addition to buying more clothes, better-looking cars, and more “hip” hairdos, people could now change the shape of their chin, nose, and eyes. During the recent years,
Designing babies as blood sources for older siblings
Surprisingly enough I have managed to find a use of genetic modification and designer babies that I find completely repulsive and shameful. A two-year-old British infant by the name of Joshua Fletcher suffers from a severe blood disorder called Diamond Blackfan Anemia. This disease can result in Joshua’ death. Although a matching blood transfusion would save his life, none of his current family members are an appropriate match. His family is begging for an in vitro specialist to create them a child carrying the gene that will make for a proper match to Joshua. Twelve embryos will be created and then screened to find the appropriate target. Then stem cells will be harvested for treating Joshua prior to their implantation into his mother’s uterus.
I find it terrible that a child is being created solely for the purpose of saving his or her brother. It is one thing to modify a child to make them better but imagine this child growing up, knowing that he isn’t loved as much and the only reason he is on this earth is because his older brother needed a blood transfusion? If anything, I think they should just use the stem cells and not actually create a life. This makes the procedure purely medical and allows it serve only as a treatment. Since I don’t consider the stem cells a viable life form, there is no harm done to anyone else and Joshua reaps benefits.
http://news.bbc.co.uk/2/hi/health/3902407.stm
I find it terrible that a child is being created solely for the purpose of saving his or her brother. It is one thing to modify a child to make them better but imagine this child growing up, knowing that he isn’t loved as much and the only reason he is on this earth is because his older brother needed a blood transfusion? If anything, I think they should just use the stem cells and not actually create a life. This makes the procedure purely medical and allows it serve only as a treatment. Since I don’t consider the stem cells a viable life form, there is no harm done to anyone else and Joshua reaps benefits.
http://news.bbc.co.uk/2/hi/health/3902407.stm
Psychiatry and Bioethics: A Threatening Discrepancy
A 2006 journal article entitled “When psychiatry and bioethics disagree about patient decision making capacity (DMC),” by P.L. Schneider and K.A. Bramstedt, explains a situation in which an 81-year-old veteran, previously diagnosed with chronic paranoid schizophrenia, was found living alone in his non-functional car and was admitted to the Veterans’ Administration Medical Center. He refused subsequent treatment and was analyzed by two different standards to determine if he was capable of making an informed refusal.
The first standard, and the standard that carried more weight, was the psychiatric evaluation, which based its questions on whether or not this man was a danger to himself and others and whether he could take care of himself on a daily basis. He passed this part of the evaluation. However, the second standard, which was the bioethical standard, asked whether he understood his medical condition and the consequences of refusing treatment. The man did not think that the doctors had told him about any medical condition, he failed to understand what schizophrenia was or what the consequences of this untreated disease were, and he could not give coherent reasons as to why he did not want treatment.
I believe that this situation poses grave medical problems and it highlights one of the key flaws of the health care system. As much as it matters that an individual will not hurt other people and will not immediately die without treatment, I think that the bioethical concerns should be more important that the psychiatric ones. This man, homeless, alone, and reclusive, was not living a healthy life and he was in no position to make medical decisions for himself. I think that we should revise the legal standards for when we can detain people because of psychiatric illnesses and we should include the bioethical concerns in the standard psychiatric questions asked.
The first standard, and the standard that carried more weight, was the psychiatric evaluation, which based its questions on whether or not this man was a danger to himself and others and whether he could take care of himself on a daily basis. He passed this part of the evaluation. However, the second standard, which was the bioethical standard, asked whether he understood his medical condition and the consequences of refusing treatment. The man did not think that the doctors had told him about any medical condition, he failed to understand what schizophrenia was or what the consequences of this untreated disease were, and he could not give coherent reasons as to why he did not want treatment.
I believe that this situation poses grave medical problems and it highlights one of the key flaws of the health care system. As much as it matters that an individual will not hurt other people and will not immediately die without treatment, I think that the bioethical concerns should be more important that the psychiatric ones. This man, homeless, alone, and reclusive, was not living a healthy life and he was in no position to make medical decisions for himself. I think that we should revise the legal standards for when we can detain people because of psychiatric illnesses and we should include the bioethical concerns in the standard psychiatric questions asked.
The FDA: A Complete and Utter Lack of Discipline
In 2004, a Texas urologist named James Vestal was shown to have violated the rules for FDA drug-trials numerous times in his studies for Eligard, a prostate cancer drug. Over the next three years, Vestal continued to perform drug trials until he received a letter from the FDA starting disciplinary action. Even so, Vestal was still not forced to stop running trials, although he voluntarily stopped while in negotiations with the FDA.
Vestal’s violations included using an unqualified and unconfident study coordinator, Jennifer Lawton, whose prior experience was limited to drawing blood and working as a lab technician. Ms. Lawton explained to Vestal repeatedly that she did not feel comfortable carrying out the duties assigned to her and she spoke to a supervisor and even went to the drug company itself and spoke to representatives. However, her concerns went unrecognized and she eventually just left her position. In Vestal’s lab, investigators found frozen, unlabeled vials of urine and two-week old samples that were supposed to be sent out on a daily basis. One of the FDA investigators said that Vestal’s lab was “the worst mess” she had seen in her 12 years as a researcher.
What many people, myself included, are wondering is why does it take the FDA so long to prevent doctors from performing further drug trials blatant violations of policy are discovered? As the article states, “the clinical drug trial industry is poorly regulated and riddled with conflicts of interest, Bloomberg News reported in 2005.” Even our dear friend Arthur Caplan was appalled at the Vestal case and said that the time he was allowed to continue researching was far too long. Although the FDA is trying to speed up the disciplinary process, no one really has a good idea of how many researchers who are being investigated by the FDA are still doing drug trials.
Even after Vestal was demoted to the position of sub-investigator, the FDA still failed to follow up on him and make sure that he was following the rules. This situation screams to me that the current system of drug-trials regulations is heinously overdue for an update. The FDA needs to revamp its evaluation and investigation process immediately. The sheer number of drug trials that are being carried out unsupervised is unconscionable and allows drugs that are potentially unsafe to be marketed on the basis of unreliable trial results.
Source: http://www.bloomberg.com/apps/news?pid=20601109&sid=a3iFD.rCBpA8&refer=home
Vestal’s violations included using an unqualified and unconfident study coordinator, Jennifer Lawton, whose prior experience was limited to drawing blood and working as a lab technician. Ms. Lawton explained to Vestal repeatedly that she did not feel comfortable carrying out the duties assigned to her and she spoke to a supervisor and even went to the drug company itself and spoke to representatives. However, her concerns went unrecognized and she eventually just left her position. In Vestal’s lab, investigators found frozen, unlabeled vials of urine and two-week old samples that were supposed to be sent out on a daily basis. One of the FDA investigators said that Vestal’s lab was “the worst mess” she had seen in her 12 years as a researcher.
What many people, myself included, are wondering is why does it take the FDA so long to prevent doctors from performing further drug trials blatant violations of policy are discovered? As the article states, “the clinical drug trial industry is poorly regulated and riddled with conflicts of interest, Bloomberg News reported in 2005.” Even our dear friend Arthur Caplan was appalled at the Vestal case and said that the time he was allowed to continue researching was far too long. Although the FDA is trying to speed up the disciplinary process, no one really has a good idea of how many researchers who are being investigated by the FDA are still doing drug trials.
Even after Vestal was demoted to the position of sub-investigator, the FDA still failed to follow up on him and make sure that he was following the rules. This situation screams to me that the current system of drug-trials regulations is heinously overdue for an update. The FDA needs to revamp its evaluation and investigation process immediately. The sheer number of drug trials that are being carried out unsupervised is unconscionable and allows drugs that are potentially unsafe to be marketed on the basis of unreliable trial results.
Source: http://www.bloomberg.com/apps/news?pid=20601109&sid=a3iFD.rCBpA8&refer=home
Saturday, March 1, 2008
Euthanasia: Humane Treatment for Man and Animals
Euthanasia, or mercy killing, has been a hotly debated issue for several years. We have always greatly valued human life and have always placed it as paramount, superseding the wellbeing of animals and the environment. This great emphasis on the uniqueness of human life largely stems from religious beliefs that man has a soul but other animals do not. Disregarding this distinction, humans are just like animals, and if it is humane to put a suffering animal to sleep, why is it immoral rather than humane to put a suffering person to rest?
I believe that in certain circumstances euthanasia should be allowed. I believe such situations should involve a terminally ill patient whose chance of survival is miniscule and whose death is going to be slow and painful. Furthermore, the patient should demonstrate a clear desire to depart on his own terms to reduce the suffering of his family as they watch him painfully perish. By using medicine to ease the patient into the eternal sleep, the patient controls the end to his life and can depart peacefully rather than violently. Why should someone not have the ability to control their life? Do we have the right to deny someone the right to pass away calmly? Would it not be torture to refuse to humanely end someone’s life and instead make them live through pain and suffering?
I value human life, and I am by no means trying to degrade the gift of life by saying people should be allowed to give it away when they please. As I alluded to, there should be strict stipulations as to when euthanasia would be the humane course of action. What amazes me is that society accepts putting animals to sleep yet bellows against the same practice in humans. Most people would argue that humans are superior to animals, citing our superior intelligence and existence of souls as key distinguishing characteristics. I feel that neither of these classifications, however, should affect the moral implications of euthanasia. Although humans may be more intelligent than animals, claiming that intelligence makes us superior stems from our own biases. In reality, each animal is uniquely adapted, and no one animal can be said to be better than others; such an assertion would be like saying that a specific person is better than all others due to an arbitrary quality. Regardless of whether humans are superior, we still have the same biological functions as animals, and more importantly, we both can feel pain and pleasure. Furthermore, both humans and animals try to avoid pain and seek pleasure. This base similarity would suggest that if putting an animal in pain to sleep is humane, then putting a person in pain to rest should also be humane. The other noteworthy distinction between humans and animals would be that humans have souls. Obviously, if humans did not have souls, humans and animals would be even more equivalent and then euthanasia in certain contexts should be more acceptable. The larger problem would thus appear to arise when assuming humans do have souls. My understanding of the soul is that it is independent from body and mind and that its main purpose relates to the afterlife. Why would having a soul, however, prevent someone from being able to die peacefully under their own desire? One may argue that suicide would be a sin and that sins harm the soul and thus people should be prevented from euthanasia. Who are we to judge, however, what is and is not a sin? Would God not view the person’s situation and recognize his suffering and his family’s suffering? If one wants to argue that suicide is always a sin then is giving up the will to live also a sin? If suicide in certain circumstances (euthanasia) is not a sin, then how is the soul affected? When someone dies, their physical body and mind may perish, but the soul remains unharmed. Therefore, even if a person has a soul, how does that argument suggest euthanasia is inhumane?
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