Physicians have always been confronted with life-and-death choices—having to make difficult decisions is part of the responsibility of being a doctor. But the predicaments that doctors find themselves in today are the subject of more interest and controversy than ever before, simply because advances in modern medicine over the past few decades have given rise to situations that no one would have expected in an earlier era.
Consider this scenario: A woman, heartbroken over her husband’s death, chooses to have his memory live on in the form of a son. She pays to have fertility doctors, using cloning techniques and in vitro fertilization, impregnate her with an embryonic clone of her deceased husband. She gives birth to his genetic twin nine months later. Should fertility doctors be allowed to offer this type of service?
This scenario, of course, is entirely hypothetical. Scientists are not able to clone human beings—yet. In February 1997, researchers in Scotland announced that they had cloned a sheep they named Dolly. Another lab has reported success in cloning mice. But scientists do not currently have the capability to clone humans. Nevertheless, Richard Seed, a retired physicist, announced in January 1998 that he intends to set up a clinic to clone humans. He estimates that as many as 10,000 infertile couples would be interested in cloning themselves as a way of having children. If scientists can clone humans, they will probably also be able to clone persons who have recently died. So the ethical ramifications of the above scenario are worth considering. Would cloning a child or spouse who has recently died be ethical? What kind of life could the cloned child expect to have? Would the government be justified in outlawing such a practice?
Human cloning may seem like the stuff of science fiction. But then again, the idea that conception could take place outside the womb—through the now common procedure of in-vitro fertilization—also once struck people as fantastic. The birth of the first test-tube baby, Louise Brown, in 1978, shocked the nation. Physicians, ethicists, and religious leaders immediately questioned whether it was morally acceptable to use technology to help create life. Other advances in reproductive technology—sperm and egg donation, the freezing of human embryos, and the ability to implant only those embryos that have the most desir- able genetic traits—have contributed to this unease, and the ethics of reproductive technologies are still hotly debated today, even as more and more couples turn to these techniques in the hopes of having a child.
The history of organ transplants also demonstrates how quickly controversial medical procedures can move from theory to reality. The notion that doctors could take organs from one body—either a corpse or a living donor—and transplant them into someone else once struck many people as ludicrous, even repugnant. Yet, in a relatively short time (organ transplants have been a common medical procedure only since 1983, when the immunosuppressant drug cyclosporin was developed) most people have come to view organ transplants as medical marvels that have saved thousands of lives rather than as something out of Frankenstein.
However, the ethical issues surrounding transplant technology have certainly not been fully resolved. For example, in 1990, human rights advocates were horrified to learn that in 1984, shortly after the development of cyclosporin, the Chinese government legalized the harvesting of organs from the bodies of executed prisoners. Many condemned the practice on the grounds that prison officials do not obtain the prisoner’s consent to donate organs, and that the Chinese government illegally sells the organs for profit. Yet some argued that as long as the prisoners were going to die anyway, their organs might as well be used to save others. Thus, while organ transplants have saved thousands of lives, they have raised moral questions involving the use of the dead in order to help the living. This problem—that lifesaving technologies can easily be abused—is a common theme in medical ethics.
In addition to creating new problems for medical ethicists, medical advances may also exacerbate ones that already exist, such as the ages-old dilemma of when, if ever, a doctor should acknowledge that a patient has been lost to death. Suffering patients who sincerely wish to die have always been a problem for doctors, who must choose whether to respect the patient’s wishes or to follow their own professional obligation to preserve life. Yet the euthanasia debate did not become a major issue in America until the 1970s, when it became clear that artificial respirators and other technologies could prolong a person’s bodily existence even after his or her mind had ceased to function.
Faced with these medical advances, many people said they would rather die than risk being hooked up to a machine. Doctors were forced to debate whether ending a patient’s life was ever the right thing to do, and this debate continues today. In November 1997, Oregon legalized physician-assisted suicide, but only for terminally ill patients. Then, in 1999, the notorious euthanasia doctor Jack Kevorkian received a twenty-five-year prison sentence for administering a lethal injection to a terminally ill patient who asked for help in ending his life. These seemingly contradictory developments indicate that while some Americans will accept physician-assisted suicide if it is strictly regulated, as in Oregon, most fear putting too much power over death in the hands of doctors. Much like organ transplants, physician-assisted suicide is a procedure that some people regard as beneficial, but that can easily lead to abuse.
Advances in medical technology are constantly expanding the scope of what medicine can accomplish; the purpose of medical ethics is to determine what medicine should accomplish. The question facing many doctors and patients is whether medical ethics can keep up with the rapid pace of technology. Arthur Caplan, head of the Center for Bioethics at the University of Pennsylvania, believes they can. “Medicine and science do move quickly,” he writes in his book, Moral Matters: Ethical Issues in Medicine and the Life Sciences, and he stresses the need for doctors and ethicists to constantly evaluate new medical technologies to ensure that they are used in morally appropriate ways. But he rejects the idea that biotechnology is out of control: “The only reason medicine and science can leap ahead of our ethics is if we choose to allow that to happen.” Others believe that recent developments in medicine are cause for alarm. “In little more than a generation, our definition of life and the meaning of existence is likely to be radically altered,” writes Jeremy Rifkin, a prominent opponent of cloning and genetic engineering, “Our very sense of self and society will likely change during what I call the emerging Biotech Century.” The authors in Medical Ethics: Current Controversies debate the changing world of medical ethics in the following chapters: Should Physicians Ever Hasten Patients’ Deaths? What Ethics Should Guide Organ Transplants? Are Reproductive Technologies Ethical? What Ethics Should Guide Biomedical Research?
Did this raise a question for you?