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BIOMEDICAL ETHICS
What ends will or should the new technology serve?
What values should guide society’s adjustments?
By what standards should the assessment agencies assess?
What do we mean by the betterment of humanity?
What is a good person?
What is a good life?
What is a good community?
“THE NEW BIOLOGY”
1. Control of Death
2. Control of Life
3. Control of Human (genetic) Potential
4. Control of Human Achievement
Kass, Leon. (1971). The New Biology: What Price Relieving Man’s Estate? Science, 174(4011):779-788
“…we may be rapidly acquiring the power to modify and control the capacities and activities of men by direct intervention and manipulation of their bodies and minds.”
Kass, Leon. (1971). The New Biology: What Price Relieving Man’s Estate? Science,174(4011):779-88
[p. 779]
“THE NEW BIOLOGY”
“Biomedical technology may make it possible to change the inherent capacity for choice itself…humans can for the first time recreate themselves.””
Kass, Leon. (1971). The New Biology: What Price Relieving Man’s Estate? Science,174(4011):779-88
[p. 780]
“THE NEW BIOLOGY”
CONTROL OF DEATH
Heroic Medicine / Euthanasia
Infant Mortality
Organ Transplants / Stem Cells
Infectious Disease
Degeneration / Aging
What is Death ?
“The permanent end of all life functions in an organism or part of an organism”
“Cessation of all vital functions without the capability of resuscitation”
“The absence of life”
“The irreversible loss of all brain function”
CONTROL OF DEATH
HEROIC MEDICINE
Karen Ann Quinlan1975; mixed alcohol & tranquilizers; passed out; aspirated vomit
“persistent vegetative state”
Parents fought to remove life support
After removing support, she lived another 10 years
Terry Schindler-Schiavo1990; K deficiency; coma
Woke a few weeks late in a “locked state”
Receives food and water via gastic feeding tube
In 1998 Terri’s husband asked to have the food tube removed; parents fought; still pending
HEROIC MEDICINE
EUTHANASIA
0
10
20
30
40
50
60
70
80
90
Fundamentalists ModerateProtestants
LiberalProtestants
Catholics
Strong Moderate Minimal
[NORC, 1977-94; General Social Surveys Combined]
Per
cen
t A
ffir
mat
ive
Res
po
nse
s (%
)
40
50
60
70
80
90
0-11 yrs SomeCollege
4+ yearsCollege
HS graduate
Per
cen
t A
ffir
mat
ive
Res
po
nse
s (%
)
Strong
Moderate
Minimal
None
[NORC, 1977-94; General Social Surveys Combined]
EUTHANASIA
INFANT MORTALITY
YEARWHITE BLACK
Male Female Male Female
2001 6.2 5.1 15.5 12.5
1995 7.0 5.6 16.3 13.9
1990 8.5 6.6 19.6 16.2
1985 10.4 7.9 20.8 17.2
1980 12.1 9.5 24.2 20.2
US Infant Mortality by ‘Race’
[National Center for Health Statistics, 2001]
Which organs?
• Kidney• Heart• Liver• Lung• Pancreas• Intestine• Cornea• Skin• Bone• Bone Marrow
ORGAN TRANSPLANTS
Survival Rates --
98% kidney95% liver85% heart79% pancreas70% small intestine70% multi-organ65% lungs65% heart/lungs
ORGAN TRANSPLANTS
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 ‘00 ‘01
Patients on wait list at end of year Number of transplants
# of
pat
ient
s
[OPTN, December 31, 2002]
ORGAN TRANSPLANTS
UK Organ Donors[as of Dec 31, 2002]
< 0.30
0.30 - <0.60
0.60 - <0.70
0.70 - <0.80
0.80 - <0.90
0.90 - <1.0≥ 1.0
Registrants (millions)
[NHS, December 31, 2002]
ORGAN TRANSPLANTS
ORGAN TRANSPLANTS
Who Gets the Transplants ??
• Young, white, boys
• Wealthy individuals
• Shortage of available organs = lucrative black market trade
• Cycle of transplant access = rich to poor; black to brown to white; female to male
ORGAN TRANSPLANTS
Suggested Solutions• Education programs to elicit more donors
• Regulated transplant centers
• Use organs from executed prisoners
• Mandatory donation
• Futures market -- financial incentive donor’s kin
• Non-human sources
ORGAN TRANSPLANTS
FETAL TISSUES
Inner Stem Cell Mass
In Vitro Fertilized EggBlastocyst Stage
Undifferentiated CellsSpecialized Cells
neural cellsblood cells
muscle cells
• Undifferentiated cells that can be easily manipulated
• Cannot become a fetus
TreatableDisorders
Limb Amputations
Spinal Cord Injuries
Burns
Neurological Disorders
Heart Disease
Diabetes
• Understand human growth and development
• Pharmacology
• Restore any cell type
FETAL TISSUES
Spinal cord injuries Parkinson’s Alzheimer’s
FETAL TISSUES
INFECTIOUS DISEASE
1950 1960 1970 1980 1990 2000
Diphtheria 3.83 0.51 0.21 >0.005 >0.005 >0.005
Mumps - - 55.55 3.86 2.17 0.13
Measles 211.01 245.42 23.23 5.96 11.17 0.03
TB - 30.83 18.28 12.25 10.33 6.01
Syphilis 146.02 68.78 45.26 30.51 54.52 11.23
Gonorrhea 192.50 145.40 297.22 445.10 277.45 129.04
Infectious Disease Rates, US
[CDC Control & Prevention, (2001). Summary of notable diseases, Morbidity and Mortality Weekly, 50(53)]
* Cases per 100,000
Infectious Disease Rates
• same trends to not appear in all segments of US society
• same trends to not appear worldwide
• increased virulence of once ‘conquered’ diseases
• emerging pathogens
INFECTIOUS DISEASE
DEGENERATION
Worldwide Life Expectancy Rates (in yrs)
Andorra 83.49 Mozambique 31.30
Macau 81.87 Botswana 32.36
San Marino 81.43 Zambia 35.25
Japan 80.93 Lesotho 36.94
Singapore 80.42 Angola 36.96
* US life expectancy = 78.16 years** UK life expectancy = 77.14 years
[CDC, December 31, 2003]
Right to Die
Stem Cell Research
Health Care Benefits
Cost of Medical Care
Eldercare
SchiavoKevorkianUK Standards
Ronald ReganChristopher ReevesMichael J. Fox
Socio-economic divideChanging demographicNational Health Care ?
2/3 $$ last monthRationed careUtah plan
Changing demographicFrom kids to parentsIsolation
CONTROL OF DEATH
“Test-Tube Babies”
• In vitro fertilization
• 1978; Edwards & Steptoe
• Baby Louise Brown
• Common practice today especially for older women
• Not sanctioned by the Catholic church
CONTROL OF LIFE
Hormone injected
Recovered eggs
Suction device
Nutrient solution
Sperm sample
Fertilization of egg
Blastocyst
Insertion of embryo into uterus
Pregnant mother
CONTROL OF LIFE
• What to do with cast off cells?
• What are the legal rights of embryos?
• When used, what are the rights of the surrogate mother? Who are the surrogates?
• Who’s responsible for a defective baby?
CONTROL OF LIFE
HUMAN POTENTIAL
• 6% of consultations with doctors are related to genetic disorders
• 26% of all institutional beds are occupied by patients with genetic disorders
• 8.5% of all infant deaths are the result of a single gene defect
• Over 600 single gene defects are known, another 800 suspected
• On average, we all carry 6-8 defective genes
Negative Eugenics
• Ultrasound
• Chorionic villi testing
-- identify & eliminate unwanted genetic traits
• Amniocentesis
• Genetic counseling
• Sterilization
HUMAN POTENTIAL
Ultrasound• uses sound waves • detects visible defects
handheld transducer
HUMAN POTENTIAL
Amniocentesis
• Combined w/ultrasound
• fetal waste products
HUMAN POTENTIAL
Chorionic Villi Testing
• Microscopic projections lining the outermost layer of the embryonic sac
• same genetic material as fetus
• sampled at 10-12 weeks gestation
• fast turnaround time
HUMAN POTENTIAL
Genetic Counseling
HUMAN POTENTIAL
Sterilization
Carrie Buck case
HUMAN POTENTIAL
Positive Eugenics
HUMAN POTENTIAL
Cryobanks
HUMAN POTENTIAL
HUMAN ACHIEVEMENT
Neurological, psychological and physiological manipulation
• Mood altering & enhancing medications
• Cosmetic endrochronology
Valium• diazepam
• addictive potential high - 2 wks
• birth defects -’floppy child’ syndrome
• ‘for relief of psychic tension and its somatic symptoms’
• females outnumber users 2.5 to 1
HUMAN ACHIEVEMENT
Valium• most widely prescribed drug
worldwide in the 60s & 70s
• prescribed for anxiety, depression, insomnia, and anxiety
• caused depression, anxiety, and insomnia
• marketed to our desire for a ‘good life’
HUMAN ACHIEVEMENT
Growth Hormone
Growth Hormone• given to normal but small kids
• add 6” height, 50% muscle mass
• recombinant DNA technology
HUMAN ACHIEVEMENT
AdrenalCortex
Thyroid
Testis
OvaryBone
UterineMuscles
MammaryGlands
KidneyTubules
Hypothalamus
Pituitary
Adrenocortotropic Hormone
ThyroidStimulating
Hormone
Gonadotro
pic H
ormone
Go
nad
otr
op
ic H
orm
on
e
Gro
wth
Ho
rmo
ne
Oxytocin
Oxytocin & Prolactin
Antidiurectic
Hormone
HUMAN ACHIEVEMENT
BIOMEDICAL ETHICS
Derek Roberts
Peter Singer
Rational or Rationed Medicine ?
• Should everyone have access to care, regardless of ailment ?
• Control of infertility, increase in life expectancy, reduction in infant mortality , reduced infectious disease = diminished limits on population growth
Derek Roberts
Peter Singer
Rational or Rationed Medicine ?
• increases at 6X the rate of inflation per year
• $4,700 per person per year paid for health care
• High deductibles for families - $2,000
• Racial divide in access, regardless of income
BIOMEDICAL ETHICS
Derek Roberts
Peter Singer
Rational or Rationed Medicine ?
0 = costs nothing, gives back alot
3 = costs a little, gives back some
7 = society sustains them beyond what they pay back
10 = costs from the start, not possible to pay back
BIOMEDICAL ETHICS
What ends will or should the new technology serve?
What values should guide society’s adjustments?
By what standards should the assessment agencies assess?
What do we mean by the betterment of humanity?
What is a good person?
What is a good life?
What is a good community?
BIOMEDICAL ETHICS