Transcript Sheridan/HD2004/NewBiologyWEB

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
“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]
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]
Kass, Leon. (1971). The New Biology: What Price
Relieving Man’s Estate? Science,174(4011):779-88
CONTROL OF DEATH
Heroic Medicine / Euthanasia
Infant Mortality
Organ Transplants / Stem Cells
Infectious Disease
Degeneration / Aging
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”
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
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
EUTHANASIA
Percent Affirmative Responses (%)
[NORC, 1977-94; General Social Surveys Combined]
90
80
70
60
50
40
30
20
10
0
Fundamentalists
Catholics
Strong
Moderate
Protestants
Moderate
Liberal
Protestants
Minimal
EUTHANASIA
Percent Affirmative Responses (%)
[NORC, 1977-94; General Social Surveys Combined]
90
Strong
80
Moderate
Minimal
70
None
60
50
40
0-11 yrs
HS graduate
Some
College
4+ years
College
INFANT MORTALITY
US Infant Mortality by ‘Race’
YEAR
WHITE
BLACK
Male
Female
Male
Female
2001
1995
1990
6.2
7.0
5.1
5.6
15.5
16.3
12.5
13.9
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
[National Center for Health Statistics, 2001]
ORGAN TRANSPLANTS
Which organs?
•
•
•
•
•
•
•
•
•
•
Kidney
Heart
Liver
Lung
Pancreas
Intestine
Cornea
Skin
Bone
Bone Marrow
ORGAN TRANSPLANTS
Survival Rates -98%
95%
85%
79%
70%
70%
65%
65%
kidney
liver
heart
pancreas
small intestine
multi-organ
lungs
heart/lungs
ORGAN TRANSPLANTS
[OPTN, December 31, 2002]
90,000
# of patients
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
‘91
‘92
‘93
‘94
‘95
Patients on wait list at end of year
‘96
‘97
‘98
‘99
‘00
‘01
Number of transplants
ORGAN TRANSPLANTS
UK Organ Donors
[as of Dec 31, 2002]
Registrants (millions)
< 0.30
0.30 - <0.60
0.60 - <0.70
0.70 - <0.80
0.80 - <0.90
0.90 - <1.0
≥ 1.0
[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
• Futures market -- financial incentive donor’s kin
• Use organs from executed
prisoners
• Regulated transplant centers
• Non-human sources
• Mandatory donation
FETAL TISSUES
• Undifferentiated cells that can be
easily manipulated
• Cannot become a fetus
In Vitro Fertilized Egg
Blastocyst Stage
Inner Stem Cell Mass
Undifferentiated Cells
Specialized Cells
blood cells
neural cells
muscle cells
FETAL TISSUES
Limb
Amputations
Spinal Cord
Injuries
Neurological
Disorders
Heart Disease
Burns
Diabetes
Treatable
Disorders
• Understand
human growth and
development
• Pharmacology
• Restore any cell
type
FETAL TISSUES
Spinal cord injuries
Parkinson’s
Alzheimer’s
INFECTIOUS DISEASE
Infectious Disease Rates, US
* Cases per 100,000
1950 1960 1970 1980 1990 2000
Diphtheria
Mumps
Measles
TB
3.83
0.51
0.21
-
-
55.55
3.86
2.17
0.13
23.23
5.96
11.17
0.03
211.01 245.42
>0.005 >0.005 >0.005
-
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
[CDC Control & Prevention, (2001). Summary of notable diseases, Morbidity and Mortality Weekly, 50(53)]
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
DEGENERATION
Worldwide Life Expectancy Rates (in yrs)
Andorra
Macau
83.49
81.87
Mozambique
Botswana
31.30
32.36
San Marino
81.43
Zambia
35.25
Japan
80.93
Lesotho
36.94
Singapore
80.42
Angola
36.96
[CDC, December 31, 2003]
* US life expectancy = 78.16 years
** UK life expectancy = 77.14 years
CONTROL OF DEATH
Right to Die
Schiavo
Kevorkian
UK Standards
Stem Cell Research
Ronald Regan
Christopher Reeves
Michael J. Fox
Health Care Benefits
Socio-economic divide
Changing demographic
National Health Care ?
Cost of Medical Care
2/3 $$ last month
Rationed care
Utah plan
Eldercare
Changing demographic
From kids to parents
Isolation
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
CONTROL OF LIFE
Sperm
sample
Hormone
injected
Fertilization
of egg
Pregnant
mother
Insertion of embryo
into uterus
Suction
device
Nutrient
solution
Recovered eggs
Blastocyst
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?
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
HUMAN POTENTIAL
Negative Eugenics
-- identify & eliminate unwanted
genetic traits
• Ultrasound
• Chorionic villi testing
• 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 ACHIEVEMENT
Neurological, psychological and
physiological manipulation
• Mood altering & enhancing
medications
• Cosmetic
endrochronology
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
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
HUMAN ACHIEVEMENT
Growth Hormone
Growth Hormone
• given to normal but small kids
• add 6” height, 50% muscle mass
• recombinant DNA technology
HUMAN ACHIEVEMENT
Hypothalamus
Adrenal
Cortex
Kidney
Tubules
Pituitary
Thyroid
Mammary
Glands
Testis
Uterine
Muscles
Ovary
Bone
BIOMEDICAL ETHICS
Rational or Rationed
Medicine ?
Derek
Roberts
• Control of infertility,
increase in life expectancy,
reduction in infant
mortality , reduced
infectious disease =
diminished limits on
population growth
Peter
Singer
• Should everyone have
access to care, regardless
of ailment ?
BIOMEDICAL ETHICS
Rational or Rationed
Medicine ?
Derek
Roberts
• $4,700 per person per
year paid for health care
• increases at 6X the rate of
inflation per year
Peter
Singer
• High deductibles for
families - $2,000
• Racial divide in access,
regardless of income
BIOMEDICAL ETHICS
Rational or Rationed
Medicine ?
Derek
Roberts
0 = costs nothing, gives
back alot
3 = costs a little, gives
back some
Peter
Singer
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?