Issues in Biomedical Ethics

Biomedical ethics is an umbrella term describing the value-laden decisions related to all aspects of health and medicine. The subject includes hospital care, medical research, and the impact of advanced technology on the person. Although there are dozens of controversial topics regarding biomedical ethics, matters relating to life and death tend to rank most prominently.

End of Life

• A hospital ethicist spends a lot of time on End-of-life issues. Questions about whether certain forms of care should be provided to terminally ill patients are routinely addressed in hospitals across the nation.

  Two major ethical questions are associated with advancing age access to medical care and the status of a person with advanced dementia. Can a very elderly person be denied care deemed futile for sustaining a "meaningful" life? Can a person who lacks an integrated personality and conscious sense of self still be a person? These questions have far-ranging effects, including for people who may be in a persistent vegetative state, and the unborn.

Human Cloning

• Although a human has yet to be cloned, the subject of human cloning has captured the public imagination through movies and public debate after a series of high-profile animal clonings.

  The core issue with cloning, to some degree, is religious--if humans were made in the image and likeness of God, do mere mortals have the right to interfere? Gilbert Meilaender, a theological ethicist at Valparaiso University, addressed the National Bioethics Advisory Commission in 1997. He said "maintaining the connection between procreation and the sexual relationship of a man and a woman is good both for that relationship and for children."

  On the other side of the debate, researchers argue that the science learned from the cloning process will help advance medical knowledge in general. They also argue that cloning technology has uses beyond simply replicating individuals. For example, a person could clone a replacement organ without fear that the organ will be rejected upon transplant.

Genetic Screening

• For years, obstetricians have screened fetuses for conditions including Down Syndrome. However, advances in genetic technology now permit parents to select which embryo--carrying the most desired traits--is implanted for gestation.

  The "designer baby" issue raises several substantial questions. Should parents be permitted to choose what traits they prefer, including sex? Should "undesirable" traits, including certain hereditary conditions, be allowed to be bred out of the human genome? The National Deaf Children's Society issued a position paper stating, "the NDCS does not support the genetic screening of whole populations for genetic conditions, with the consequent risk of moving towards a society in which difference is no longer accepted or tolerated." However, an increasing number of parents are attracted to screening services. This tension is likely to increase as scientists are able to further refine the traits that can be selected before birth.

Stem-Cell Research

• In 2000, President George W. Bush issued an executive order banning the use of federal funds to create new embryonic stem-cell lines. This decision was the source of much debate, pitting research scientists against religious leaders and igniting a general public debate about bioethical matters.

  Most opponents of stem-cell research are actually opposed not to the research itself, but to the destruction of human embryos that this research requires. Some of this opposition is rooted in pro-life sentiment. But some philosophers believe that the destruction of embryos is an action that lessens the value of the embryo's existence because it is solely to benefit another. That would make a potential human merely an instrument of some other human's betterment.

Pandemic/Crisis Rationing

• What happens when a flu pandemic hits, or there is a mass disaster which pushes hospital resources well past the breaking point? Who lives, who dies, and who decides? In the aftermath of the 9/11 attacks, as New York City hospitals were flooded with casualties, doctors and hospital administrators had to make hard choices. Hospital ethics committees across the country are working toward a solution to the pandemic/crisis rationing question.

  Janet Stemwedel, an associate professor of philosophy at San Jose State University, wrote "on paper, when the scheme is laid out and you have as good a chance as anyone else of getting the vaccine ... it's hard to offer an alternative [to rationing] that would be more fair. In practice, when the lottery for resources is held, will the losers still endorse the results?" (See Reference 2 below)

  Stemwedel's point is the heart of this dilemma: No matter how fair a rationing scheme looks on paper, the suffering mob at the hospital door will accept nothing less than full treatment. As such, the way that hospitals choose to address the rationing issue will directly contribute to public health and safety when a pandemic or mass-casualty event occurs.