Medical Ethics

Medical Ethics

Introduction I am interested in combining ethics/philosophy with medicine. In this article I give my opinion and raise questions (more questions than answers) about the borderline between these disciplines. Where should the line be drawn and should there be limits on medical research set by ethical considerations? In this short article, I consider the impact that ethics could and should have when considering euthanasia, IVF, circumcision and genetic modifications.

Methodology: I like asking awkward questions! For example: Why do we allow the following medical procedures to occur when the benefit is entirely questionable? The borderline between progressing medical science and ethical constraints is a fascinating conundrum – where should we (as a society) draw the line? What am I willing to fund by using my taxes? Private medicine will go where the money is. The state-funded health service should focus only on procedures to ‘benefit’ society. What does that mean? How much should be spent to keep someone alive? For how long? What quality of life? I start from the presumption that government-funded research is cash-limited and that someone has to choose between various research proposals. On what basis do they make these decisions? That is the question for this article to consider. More questions than answers, but to help people think about these decisions and the factors to take into account – the questions to ask themselves when deciding whether to pursue a particular research proposal – Is this good value for money? Is the likely outcome worth the investment? (ignoring the probability of success).

Euthanasia This is defined as ending someone’s life earlier than it would have ended through ‘natural causes.’ This an issue concerning the decision as to whether to prolong or end life. Prolonging life is often possible with improving medical techniques, but at what ‘cost’? For example, machines can take over the patient’s breathing (Artifical lungs), but then the patient is permanently tied to a machine. So what is their “quality of life” if they are tied permanently to a machine?

There are two main purposes of medical intervention – Either cure the problem or palliative care. If there is no cure, then it is about prolonging life – but at what cost? There are two basic situations where this would be an issue – terminally ill and “enjoyable” life.

If someone is going to die as a result of the illness and the last period of life will be in extreme pain/discomfort/inability to enjoy life, then should their life be ended early? What factors make up an enjoyable life? What is their quality of life? Social interaction or being asleep most of the day? How much pain is tolerable when too much pain-killing means sleeping all the time? Too little pain-killing means intolerable pain? Would you rather sleep or be in pain? How to measure this objectively or subjectively?

If the person believes that their life is not ‘enjoyable’ but they are not suffering from a terminal illness, then there are two situations – either they have no capability to kill themselves owing to disability, in which case, do we assist them? Alternatively – short-term suicide thoughts. Most people who try to commit suicide do not actually want to succeed, it is often just a cry for help. Objectively they have plenty to live for but subjectively they feel that (at that moment in time) they don’t want to live any longer. Should we assist them knowing they could turn their life around and discover reasons to live in the future? But if we help them commit suicide then it would be too late.

In vitro fertilization (IVF) 2/3/4 person babies, who are the biological parents? There are possibly three mothers: There is a biological mother (the provider of the egg), the womb or birth mother and the psychological mother (the woman who looks after the child after birth – ‘female’ role model). There are possibly two fathers: The biological father (provider of the sperm) and the psychological father (the man who looks after the child after birth – ‘male’ role model). People could, of course, make their own private arrangements to achieve the same outcomes, but when the medical research funds are directed towards these aims, then the ethical concerns of government should prevent these children being created in this manner. If the biological mother and father are unable to conceive in the natural manner and need the help of IVF, then there are no moral or ethical concerns as all three mothers are the same person and the two fathers are also the same person. It is only when other people are involved that ethical concerns arise. Of course, it is really sad when parents want to have children and cannot do so. However, artificially creating children using other people in these combination babies is not fair to the child in confusing the child as to the true nature of who their real mother and father are.

Circumcision This is normally defined as removing parts of the most sensitive section of the penis in men or removing part of the clitoris in women. These procedures are normally done to very young children, who have no choice in the matter (typically before ten days old). The arguments in favour of male circumcision include dubious extremely unlikely benefits many decades after doing it, including preventing penile cancer, premature ejaculation and even (absurdly!) HIV. There are significant risks associated with this unnecessary procedure including the loss of sexual pleasure, difficulty urinating and even occasionally the loss of all or most of the penis. Nowadays it is mainly for religious ritualistic reasons and should be illegal.

Female circumcision is normally illegal, as the sole reason is to reduce sexual pleasure. Male circumcision should also be illegal except in extremely rare specific medical conditions. The risk is completely unnecessary and all circumcision for non-medical reasons should be illegal. There is no logical or rational reason for continuing with male circumcision when female circumcision is already illegal. Barbaric medieval religious rituals have no place in modern society. All the other equivalent rituals have been banned (eg death penalty for homosexuality), why not this one?

Genetic manipulation Artifically changing the babies genes in order to create a ‘better’ baby. Some research indicates the possible elimination of genetic-based illnesses and disabilities. But who decides what characteristics are for the ‘best’? Given that the genetic code for humans is incredibly complicated, tampering with the base code will produce unexpected results. We are nowhere near understanding the purpose of every part of the genetic code, and (I believe) we will never fully understand it – the side effects from man-made drug-versions of natural remedies is an indication of our failure to understand the purpose of all of the ingredients. Leaving them out results in the side effects. ‘Frankenstein’ babies are the obvious outcome and the risk is way more than the benefits.

Conclusion The above medical techniques are all possible, but unrestricted medical research leads to unhelpful or dangerous outcomes. Medical research should be guided by ethical concerns and focused on the issues of "related to the best interests of the children and society". The above techniques in my opinion fail to achieve that aim and should not be invested in. What do you think? Why are these issues not being openly discussed before the research commences?