Bioethics

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Bioethics

• Dr. Chan Ho Mun
• Associate Professor of Philosophy
• Dept of Public Social Administration
• City University of Hong Kong
• June 26, 2006

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What is Bioethics?

• The term bioethics was introduced in the 70s
  by Van Rensselaer Potter for a study aiming at
  ensuring the preservation of the biosphere.
• It was later used to refer a study of the ethical
  issues arising from health care, biological and
  medical sciences.
• It is a major area in applied ethics.

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• The emergence of this new area of study has been
  triggered by and a response to the new
  scientific/technological developments in
  biomedical and life sciences.
• Medical ethics and nursing ethics are more
  concerned with the ethics of the health care
  professionals and their relationship with the
  patient. Bioethics has a broader scope.

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Some historical examples

• Abortion
• Contraception
• Kidney dialysis machine (Who had the priority?)
• Organ transplant, artificial ventilator, and
  brain death
• In virtro fertilization (IVF)
• Cloning and stem cell research
• Genetic engineering

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Main topics in Bioethics

• Death and dying
• Pre-birth Issues
• Issues in human reproduction
• Human cloning
• Stem cell research
• The new genetics

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• Resources allocation
• Organ transplant
• Doctor-patient relationships
• Experimentation with human subjects animals
• (The above list is not exhaustive.)

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Human Reproductive Technologies (HRT)

• Contraception sex without procreation
• HRTs procreation without sex

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• Types of HRTs
• Artificial insemination by husband (AIH)
• Artificial insemination by donor (AID)
• In virtro fertilization (IVF)
• Egg donation
• Embryo donation
• Surrogacy

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• Ethical considerations (see references 6,7, 10)
• Procreation rights of infertile couples
• It is unnatural
• Inequality and exploitation
• Selling babies?
• The moral status of extra embryos left over from
  IVF
• Definition of parent-child relation
• Integrity of the family
• Best interests of the child

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Human Cloning

• Two techniques
• Embryo splitting
• Nuclear substitution
• Embryo splitting
• The clone is usually used for tests of
  abnormality, and will be destroyed subsequently.

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• Nuclear Substitution
• What is the relationship between the nuclear
  donor and the clone?
• The same person?
• (Technologically-aided and birth delayed)
  identical twins?
• Siblings?
• Parent-child?
• Should a homosexual be allowed to use the
  technology to obtain his/her own child?

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• Is it moral alright for parents to clone their
  beloved children who die young?
• Should it be used as an infertility treatment or
  gene therapy if it is safe?
• No third party is involved.
• According to the parent-child ordinance in HK,
  whoever gives birth to a baby is its mother, and
  the husband who goes through the infertility
  treatment with her is his father.
• Yet, human cloning has been banned by the HRT
  Ordinance.

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Stem Cell Research

• Stem cells undifferentiated, multi-potent,
  precursor cells, capable of developing into
  virtually any body tissue.
• Three types of stem cells
• Embryonic stem cells (ESC)
• Fetal stem cells
• Adult stem cells

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• Three main sources
• Adult bone marrow
• Miscarried or aborted embryos/fetus extra
  embryos left over from IVF
• Embryos from therapeutic cloning
• Potential Treatments
• They may be used to replace damaged organ tissues
  (e.g., cardiac tissues), repair irreversible
  injuries (e.g., spinal cord injuries), or cure
  diseases (e.g., Parkinsons and Alzheimers
  diseases).

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• ESC is most promising for treatment, and
  therapeutic cloning can avoid the problem of
  immunological incompatibility.
• Ethical issues
• Destroying an embryo to harvest ESC is equivalent
  to killing a child to obtain his organs.
• Left-over from IVF are already there.
• Therapeutic cloning The embryo is not created
  for reproduction.
• How about the wellbeing of many patients who may
  be cured by ESC research?

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The New Genetics

• Gene testing
• Create unnecessary psychological distress
• Discrimination by employers and insurance
  companies
• Confidentiality and Privacy
• Social stigmatization

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• Prenatal Screening
• Sex selection Gender discrimination and
  imbalance of sex ratio unless it is done solely
  for therapeutic purpose.
• Discrimination Lives of the disable are not
  worth living.

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• Genetic Engineering
• Is it a form of eugenics?
• Germ-line changes, unlike somatic modification,
  can pass onto the next generation and be with us
  forever. So germ-line changes could be very
  risky.
• Is genetic enhancement moral?
• See reference 10.

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Doctor-patient relationships

• Who has the final authority in medical decision
  making? The patient, the family or the
  individual?
• Three models
• Individualism
• Familism
• Medical Paternalism
• See references 1-3.

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Organ Transplant and Resources Allocation

• One what criteria should organs be allocated to
  patients for transplantation? (See reference 5)
• What is a just distribution of healthcare
  resources? (See reference 4)

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References

• 1. Chan, Ho Mun, Sharing Death and Dying
  Advance Directives, Autonomy and the Family
  Bioethics, Vol. 18, No. 2, 2004, pp.87-103.
• 2. Chan, Ho Mun, Informed Consent Hong Kong
  Style An Instance of Moderate Familism, Journal
  of Medicine and Philosophy, Vol. 29, No. 2, 2004,
  pp.195-206.
• 3. ??? ????????????????, ??????III4
  (2001?12?)?45-55?

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• 4. Chan, Ho Mun Justice is to be Financed Before
  It is to be Done A Confucian Approach to Hong
  Kong Public Health Care Reform, in R. Z. Qiu
  (ed.), Bioethics Asian Perspectives, Dordrecht,
  Netherlands Kluwer Academic Publishers, 2004,
  pp.207-228.
• 5. Chan, Ho Mun, Cheung, Germain, and Yip, Ada,
  Selection Criteria for Recipients of Scarce
  Donor Livers a Public Opinion Survey in Hong
  Kong, (co-authored Germaine Cheung and Ada Yip),
  Hong Kong Medical Journal, Vol. 12, No. 1, 2006,
  pp. 40-46.

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• 6. ???????????? ?????????????????????
  ??????????? ?? 21????????? ??????????246-261?
  
• 7. ???????? ??????????????????????????1997??
  137-155?
• 8. Kuhse, Helga and Singer, Peter, A Companion to
  Bioethics, Oxford Blackwell, 1998.

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• 9. Holland, Stephen, Bioethics A Philosophical
  Introduction, Cambridge Polity Press.
• 10. Tao, Julia, Whats wrong with creating
  designer babies?, in Julia Tao and Hektor H T
  Yan (eds), Meaning of life. Singapore McGraw
  Hill Education, 2006, pp. 317-335.
• 11. Veatch, Robert M. The Basics of Bioethics 2nd
  ed., Upper Saddle River, N.J. Prentice Hall,
  2003.