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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?.

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slide1

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?

slide2

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

“THE NEW BIOLOGY”

slide3

Kass, Leon. (1971). The New Biology: What Price Relieving Man’s Estate? Science,174(4011):779-88

“THE NEW BIOLOGY”

“…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.”

[p. 779]

slide4

Kass, Leon. (1971). The New Biology: What Price Relieving Man’s Estate? Science,174(4011):779-88

“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.””

[p. 780]

slide5

CONTROL OF DEATH

Heroic Medicine / Euthanasia

Infant Mortality

Organ Transplants / Stem Cells

Infectious Disease

Degeneration / Aging

slide6

CONTROL OF DEATH

What is Death ?

“The absence of life”

“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 irreversible loss of all brain function”

slide7

HEROIC MEDICINE

Karen Ann Quinlan

1975; mixed alcohol & tranquilizers; passed out; aspirated vomit

“persistent vegetative state”

Parents fought to remove life support

After removing support, she lived another 10 years

slide8

HEROIC MEDICINE

Terry Schindler-Schiavo

1990; 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

slide9

Moderate

Protestants

Liberal

Protestants

Fundamentalists

Catholics

Moderate

Strong

Minimal

EUTHANASIA

[NORC, 1977-94; General Social Surveys Combined]

Percent Affirmative Responses (%)

slide10

None

Moderate

Strong

Minimal

EUTHANASIA

[NORC, 1977-94; General Social Surveys Combined]

Percent Affirmative Responses (%)

0-11 yrs

Some

College

4+ yearsCollege

HS graduate

slide11

INFANT MORTALITY

US Infant Mortality by ‘Race’

[National Center for Health Statistics, 2001]

slide12

ORGAN TRANSPLANTS

Which organs?

  • Kidney
  • Heart
  • Liver
  • Lung
  • Pancreas
  • Intestine
  • Cornea
  • Skin
  • Bone
  • Bone Marrow
slide13

ORGAN TRANSPLANTS

Survival Rates --

98% kidney

95% liver

85% heart

79% pancreas

70% small intestine

70% multi-organ

65% lungs

65% heart/lungs

slide14

90,000

80,000

70,000

60,000

# of patients

50,000

40,000

30,000

20,000

10,000

‘92

‘93

‘94

‘95

‘97

‘98

‘99

‘01

‘91

‘96

‘00

Number of transplants

Patients on wait list at end of year

ORGAN TRANSPLANTS

[OPTN, December 31, 2002]

slide15

< 0.30

0.30 - <0.60

0.60 - <0.70

0.70 - <0.80

0.80 - <0.90

0.90 - <1.0

≥ 1.0

ORGAN TRANSPLANTS

UK Organ Donors

[as of Dec 31, 2002]

Registrants (millions)

[NHS, December 31, 2002]

slide17

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
slide18

ORGAN TRANSPLANTS

Suggested Solutions

  • Education programs to elicit more donors
  • Futures market -- financial incentive donor’s kin
  • Use organs from executed prisoners
  • Regulated transplant centers
  • Non-human sources
  • Mandatory donation
slide19

In Vitro Fertilized Egg

Blastocyst Stage

Inner Stem Cell Mass

Undifferentiated Cells

Specialized Cells

blood cells

neural cells

muscle cells

FETAL TISSUES

  • Undifferentiated cells that can be easily manipulated
  • Cannot become a fetus
slide20

Limb Amputations

Neurological Disorders

Spinal Cord Injuries

Heart Disease

Burns

Diabetes

FETAL TISSUES

TreatableDisorders

  • Understand human growth and development
  • Pharmacology
  • Restore any cell type
slide21

FETAL TISSUES

Spinal cord injuries

Parkinson’s

Alzheimer’s

slide22

INFECTIOUS DISEASE

Infectious Disease Rates, US

* Cases per 100,000

[CDC Control & Prevention, (2001). Summary of notable diseases, Morbidity and Mortality Weekly, 50(53)]

slide23

INFECTIOUS DISEASE

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
slide24

DEGENERATION

[CDC, December 31, 2003]

* US life expectancy = 78.16 years

** UK life expectancy = 77.14 years

slide25

CONTROL OF DEATH

Schiavo

Kevorkian

UK Standards

Right to Die

Ronald Regan

Christopher Reeves

Michael J. Fox

Stem Cell Research

Socio-economic divide

Changing demographic

National Health Care ?

Health Care Benefits

2/3 $$ last month

Rationed care

Utah plan

Cost of Medical Care

Eldercare

Changing demographic

From kids to parents

Isolation

slide26

CONTROL OF LIFE

“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
slide27

Sperm sample

Hormone injected

Fertilization of egg

Pregnant mother

Insertion of embryo into uterus

Suction device

Nutrient solution

Blastocyst

Recovered eggs

CONTROL OF LIFE

slide28

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?
slide29

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
slide30

HUMAN POTENTIAL

Negative Eugenics

-- identify & eliminate unwanted genetic traits

  • Ultrasound
  • Chorionic villi testing
  • Amniocentesis
  • Genetic counseling
  • Sterilization
slide31

handheld transducer

HUMAN POTENTIAL

Ultrasound

  • uses sound waves
  • detects visible defects
slide32

HUMAN POTENTIAL

Amniocentesis

  • Combined w/ultrasound
  • fetal waste products
slide33

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
slide34

HUMAN POTENTIAL

Genetic Counseling

slide35

HUMAN POTENTIAL

Sterilization

Carrie Buck case

slide36

HUMAN POTENTIAL

Positive Eugenics

slide38

HUMAN ACHIEVEMENT

Neurological, psychological and physiological manipulation

  • Mood altering & enhancing medications
  • Cosmetic endrochronology
slide39

HUMAN ACHIEVEMENT

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
slide40

HUMAN ACHIEVEMENT

Valium

  • most widely prescribed drug worldwide in the 60s & 70s
  • marketed to our desire for a ‘good life’
  • prescribed for anxiety, depression, insomnia, and anxiety
  • caused depression, anxiety, and insomnia
slide41

Growth Hormone

HUMAN ACHIEVEMENT

Growth Hormone

  • given to normal but small kids
  • add 6” height, 50% muscle mass
  • recombinant DNA technology
slide42

Hypothalamus

Antidiurectic

Hormone

Adrenal

Cortex

Adrenocortotropic Hormone

Kidney

Tubules

Oxytocin &

Prolactin

Thyroid

Stimulating

Hormone

Pituitary

Thyroid

Oxytocin

Gonadotropic Hormone

Mammary

Glands

Growth

Hormone

Gonadotropic

Hormone

Testis

Uterine

Muscles

Ovary

Bone

HUMAN ACHIEVEMENT

slide43

Rational or Rationed Medicine ?

Derek Roberts

Peter Singer

BIOMEDICAL ETHICS

  • Control of infertility, increase in life expectancy, reduction in infant mortality , reduced infectious disease = diminished limits on population growth
  • Should everyone have access to care, regardless of ailment ?
slide44

Rational or Rationed Medicine ?

Derek Roberts

Peter Singer

BIOMEDICAL ETHICS

  • $4,700 per person per year paid for health care
  • increases at 6X the rate of inflation per year
  • High deductibles for families - $2,000
  • Racial divide in access, regardless of income
slide45

BIOMEDICAL ETHICS

Rational or Rationed Medicine ?

Derek Roberts

0 = costs nothing, gives back alot

3 = costs a little, gives back some

7 = society sustains them beyond what they pay back

Peter Singer

10 = costs from the start, not possible to pay back

slide46

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?