Bioethics Debate Guide
From PhiloWiki
- Bioethics concerns the ethical questions that arise in the relationships between biology, medicine, cybernetics, politics, law, philosophy, and theology. Disagreement exists about the proper scope for the application of ethical evaluation to questions involving biology. Some bioethicists would narrow ethical evaluation only to the morality of medical treatments or technological innovations, and the timing of medical treatment of humans. Other bioethicists would broaden the scope of ethical evaluation to include the morality of all actions that might help or harm organisms capable of feeling fear and pain.
- Bioethics involves many public policy questions that are often politicized and used to mobilize political constituencies, hence the emergence of biopolitics and its techno-progressive/bioconservative axis. For this reason, some biologists and others involved in the development of technology have come to see any mention of "bioethics" as an attempt to derail their work and react to it as such, regardless of the true intent. Some biologists can be inclined to this line of thought, as they see their work as inherently ethical, and attacks on it as misguided.
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Autonomy
Since biological life (being a human being) is not the real, moral issue, then life is not intrinsically valuable or sacred simply because it is human life. The important thing is that one has biographical life – and this involves a person’s ability to state, formulate, and pursue autonomously chosen interests, desires, and so forth. If a person autonomously chooses to end his or her life or have someone else assist him or her in doing so, then it is morally permissible. Once should be free to do as one chooses as long as no harm is done to others.
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Equivalence
There is no morally relevant distinction, the libertarian view says, between active and passive euthanasia. Passive euthanasia is sometimes morally permissible. Thus active euthanasia is sometimes morally permissible. Keep this in mind when looking at the Smith & Jones case.
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Mercy
It is cruel and inhumane, it is said, to refuse the plea of a terminally ill person that his or her life be ended to avoid unnecessary suffering and pain. Allowing such a person to terminate his or her life is an act of mercy.
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Best Interests
If an action promotes the best interests of everyone concerned and violates no one’s rights, the libertarian view maintains, then that action is morally acceptable. In some cases, active euthanasia promotes the best interests of everyone concerned and violates no one’s rights. Therefore, in those cases active euthanasia is morally acceptable.
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The Golden Rule
Moral principles, it is argued, ought to be universalizable. In other words, if I don’t want to apply a rule to me, I shouldn’t apply it to others. Similarly, if I want someone to apply a rule to me, I ought to be willing to apply it to others. I.e. if I was given a choice between two ways to die: First, I could die quietly and without pain, at the age of eighty, from a fatal injection. Or second, I could choose to die at eighty plus a few days of an affliction so painful that for those few days before death I would be reduced to howling like a dog, with my family standing helplessly by. The former death involves active euthanasia, and if I would choose it under such circumstances, I should be willing to permit others to choose it too.
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For discussion
- How do our life experiences shape our view of bioethical issues? How do our opinions change as we mature physically, emotionally, intellectually, and spiritually?
- Do we have bioethical obligations to others: our offspring, parents, community members, non-humans?
- How are our religious beliefs and our bioethical perspectives interconnected?
- Can technology development and bioethics co-exist? If so, how? How will our bioethical perspectives evolve as technological advancements become even more developed? [Examples: assisted living devices such as artificial organs/limbs and life support, cloning, artificial insemination, synthetic genomics (Creation of life on a cell-to-cell basis), bioterrorism, individualized medicine.]
- What is the role of the government in bioethical issues? (Points to ponder: Definition of life/death, life support, euthanasia including assisted suicide, scientific advancements such as cloning, regulation of pharmaceuticals and illicit drugs)
- What impact do bioethical perspectives have on our society as a whole? (locally, nationally, and globally)
- Compare and contrast moral vs legal issues regarding bioethics.
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Case scenarios
Case Study: Baby Jane Doe
- On 11 October 1983, an infant known to the public only as ‘Baby Jane Doe’ was born in New York and subsequently transferred to the State University of New York (SUNY) Hospital in Stony Brook. Baby Jane Doe suffered from multiple defects including spina bifida (a broken and protruding spine), hydrocephaly (excess fluid in the brain), and, perhaps worst of all, microencphaly (an abnormally small brain). A CAT scan indicated that part of her cerebral cortex was missing altogether. The parents were told that without surgery, the infant would die within two years; with surgery, she would have a fifty-fifty chance of surviving into her twenties – but even then she would be severely mentally retarded and physically impaired, paralyzed, epileptic, unable to leave her bed, and there would be a continuous high risk of such diseases as meningitis. In the face of all this, the parents chose not to authorize the surgery.
Case Study: Barney Clark’s Key
- On 2 December 1982, Barney Clark became the first human to receive a permanent artificial heart. The retired Seattle dentist seemed ideally suited for the new procedure. He was dying of a heart disease that did not respond to other treatments and, at sixty-one, he was considered too old for a conventional transplant. Otherwise he was in good physical condition. Psychologically, he also seemed right: Margaret Miller, a social worker on the implantation evaluation committee at the University of Utah, where the operation was performed, commented, ‘He had a very strong will to live, had an intelligent, thorough understanding of his disease and what his option was, was a flexible person, and had a loving, supportive family.’ Barney Clark’s ‘option’, while no doubt preferable to death, was not without its drawbacks. Unlike a transplant, the artificial heart would not leave him fully mobile. For the rest of his life he would be tethered to a bulky compressor by two six-foot hoses. So everyone involved was uncertain about what the quality of his life would be, either in terms of physical discomfort or in terms of restrictions upon his activities. One of the attending physicians, interviewed on television, was asked about this. ‘Will he have a good life? That’s not for us to say,’ he responded. ‘Barney Clark will be the judge of that.’ The implantation received an enormous amount of publicity, almost all of it ecstatic over the new technology. However, buried among the enthusiastic newspaper and magazine articles hailing the great breakthrough was one small item that struck a different note. It was reported that Barney Clark had been given a key that he could use to turn off the compressor if he should wish at any time to cease living tied to the machine. “If the man, suffers and feels it isn’t worth it any more, he has a key that he can apply, said Dr. Willem Kolff, head of the University of Utah’s Artificial Organs Division, inventor of the artificial kidney, and founder of the artificial heart program. I think it is entirely legitimate that this man whose life has been extended should have the right to cut it off if he doesn’t want it, if life ceases to be enjoyable, he added. The operation won’t be a success unless he is happy. That has always been our criteria – to restore happiness.” He never used the key. Fifteen weeks after the history-making operation, Barney Clark died. But although he never used it, the fact that he was given the key is significant for our social stance regarding voluntary death. What to think about: A person commits suicide if: that person intentionally brings about his or her own death; others do not coerce him or her to do the action; death is cause by conditions arranged by the person for the purpose of bringing about his/her own death.
Case Study: Mercy Killing
- Distinction made in traditional medical ethics. The intentional termination of the life of one human being by another – mercy killing – is contrary to that for which the medical profession stands and is contrary to the policy of the American Medical Association. The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is imminent is the decision of the patient and/or his immediate family. The advice and judgment of the physician should be freely available to the patient and/or his immediate family. Moral judgments expressed here:
- Mercy-killing is clearly condemned
- It is contrary to that for which the medical profession stands. But at the same time, allowing patients to die (ceasing treatment) is condoned, at least in some circumstances. Even if he may not kill a patient, a physician may nevertheless sometimes allow death by standing by and ‘doing nothing’. So if it sometimes all right to allow a patient to die, the question arises, when is it all right? The AMA provides four conditions all of which must be satisfied before cessation of treatment are permissible.
- The patient’s death must not be part of the doctor’s or the medical staff’s intention
- The cessation of treatment is permissible only if ‘biological death is imminent’. (a fatal condition where there is no cure)
- Extraordinary means must be needed to keep the patient alive
- The right to make this decision is reserved to the patient and/or the immediate family
Case Study: Down’s Syndrome Babies
- In most cases, babies born with Down’s syndrome are in no immediate danger of dying; with only the normal pediatric care, they will proceed to a normal infancy. However, in some cases there may be an additional difficulty, an intestinal blockage that prevents food from passing through. Surgery may be required to remove the blockage; otherwise, the baby will die. At the time of the 1973 AMA statement, it had become fairly common in cases of this type for the parents and doctor to decide not to perform the operation. In these cases, the babies were allowed to die even though ‘biological death’ was not imminent.
Case Study: 89-Year Old Man
- An 89-year old man, hopelessly senile and hospitalized for a variety of maladies, contracts pneumonia. Seeing that further treatment is pointless, nothing is done for the pneumonia, and he dies. But pneumonia is treatable with penicillin. Therefore, it is not an extraordinary treatment that has been omitted. He could have been kept alive at least a little longer by ordinary means, but he was allowed to die.
- Another old man. Another old man, senile and with heart disease, is judged beyond hope. The doctor orders that if his heart should fail again nothing be done to interfere. But the permission of the family is not sought; this is considered to be a medical decision within the sphere of the physician’s authority.
Case Study: Quinlan & Schiavo
- Both women in permanent vegetative state, whose cases generated a protracted legal battle. In the Schiavo case, Vernon Robinson, a NC Republican said “There’s a difference between stopping extraordinary measures like turning a respirator off and not feeding or giving water to somebody.” Where do you stand on either case.
Case Study: Killing vs. Allowing to Die I
- Smith stands to gain a large inheritance if anything should happen to his six-year old cousin. Once evening while the child is taking his bath, Smith sneaks into the bathroom and drowns the child, and then arranges things so that it will look like an accident. No one is the wiser, and Smith gets his inheritance. Jones also stands to gain if anything should happen to his six-year-old cousin. Like Smith, Jones sneaks in planning to drown the child in his bath. However, just as he enters the bathroom Jones sees the child slip, hit his head, and fall face-down in the water. Jones is delighted; he stands by, ready to push the child’s head back under if necessary, but it is not necessary. With only a little thrashing about, the child drowns all by himself, accidentally, as Jones watches and does nothing. No one is the wiser, and Jones gets his inheritance. Now Smith killed the child, while Jones ‘merely’ let the child die. Did either man behave better, from a moral point of view? Is there a moral difference between them? Both men acted from the same motive – personal gain and both had the same end in view when they acted. Cases of euthanasia with which doctors are concerned are not like this at ll. They do not involve personal gain or the destruction of normal, healthy children. Doctors are concerned only with cases in which the patient’s life is of no further use to him, or in which the patient’s life has become a positive burden.
Case Study: Killing vs. Allowing to Die II
- Another example of killing and letting die. Although we do not know exactly how many people die each year of malnutrition and related health problems, the number is very high, in the millions. By giving money to support famine-relief efforts, each of us could save at least some of these people. By not giving, we let them die. Suppose there were a starving child in the room where you are now – hollow eyed, belly bloated, and so on – and you have a sandwich at your elbow that you don’t need. Of course you would be horrified; you would stop reading and give her the sandwich or, better, take her to the hospital. And you would not think this an act of supererogation: you would not expect any special praise for it, and you would expect criticism if you did not. Imagine what you would think of someone who simply ignored the child and continued reading, allowing her to die. Say that he indifferently watches the starving child die; he cannot be bothered even to hand her the sandwich. There is ample reason for judging him harshly; without putting too fine a point on it, he shows himself to be a moral monster. According to Foot: When we allow people in far-away countries to die of starvation, we may think that there is surely something wrong with us. But we do not consider ourselves moral monsters. On the other hand the man who was in the same room with the child and did not give him the sandwich can be called a moral monster. But why is there a difference. The obvious difference is that He lets someone die who is in the same room as him, while the people we let die are mostly far away. Yet the spatial location of the dying people hardly seems a relevant consideration.
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