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BIOMEDICAL ETHICS

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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 ... – PowerPoint PPT presentation

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Title: BIOMEDICAL ETHICS


1
BIOMEDICAL ETHICS
What ends will or should the new technology serve?
What values should guide societys 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?
2
THE NEW BIOLOGY
3
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
4
THE NEW BIOLOGY
Biomedical technology may make it possible to
change the inherent capacity for choice
itselfhumans can for the first time recreate
themselves.
p. 780
5
CONTROL OF DEATH
Heroic Medicine / Euthanasia
Infant Mortality
Organ Transplants / Stem Cells
Infectious Disease
Degeneration / Aging
6
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
7
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
8
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 Terris husband asked to have the food
tube removed parents fought still pending
9
EUTHANASIA
NORC, 1977-94 General Social Surveys Combined
Percent Affirmative Responses ()
10
EUTHANASIA
NORC, 1977-94 General Social Surveys Combined
Percent Affirmative Responses ()
0-11 yrs
Some College
4 yearsCollege
HS graduate
11
INFANT MORTALITY
US Infant Mortality by Race
YEAR WHITE WHITE BLACK BLACK
YEAR Male Female Male Female
2001 6.2 5.1 15.5 12.5
1995 7.0 5.6 16.3 13.9
1990 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
12
ORGAN TRANSPLANTS
Which organs?
  • Kidney
  • Heart
  • Liver
  • Lung
  • Pancreas
  • Intestine
  • Cornea
  • Skin
  • Bone
  • Bone Marrow

13
ORGAN TRANSPLANTS
Survival Rates --
98 kidney 95 liver 85 heart 79
pancreas 70 small intestine 70
multi-organ 65 lungs 65 heart/lungs
14
ORGAN TRANSPLANTS
OPTN, December 31, 2002
15
ORGAN TRANSPLANTS
UK Organ Donors
as of Dec 31, 2002
Registrants (millions)
NHS, December 31, 2002
16
ORGAN TRANSPLANTS
17
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

18
ORGAN TRANSPLANTS
Suggested Solutions
  • Education programs to elicit more donors
  • Futures market -- financial incentive donors kin
  • Use organs from executed prisoners
  • Regulated transplant centers
  • Non-human sources
  • Mandatory donation

19
FETAL TISSUES
  • Undifferentiated cells that can be easily
    manipulated
  • Cannot become a fetus

20
FETAL TISSUES
TreatableDisorders
  • Understand human growth and development
  • Pharmacology
  • Restore any cell type

21
FETAL TISSUES
Spinal cord injuries
Parkinsons
Alzheimers
22
INFECTIOUS DISEASE
Infectious Disease Rates, US
Cases per 100,000
1950 1960 1970 1980 1990 2000
Diphtheria 3.83 0.51 0.21 gt0.005 gt0.005 gt0.005
Mumps - - 55.55 3.86 2.17 0.13
Measles 211.01 245.42 23.23 5.96 11.17 0.03
TB - 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)
23
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

24
DEGENERATION
Worldwide Life Expectancy Rates (in yrs) Worldwide Life Expectancy Rates (in yrs) Worldwide Life Expectancy Rates (in yrs) Worldwide Life Expectancy Rates (in yrs) Worldwide Life Expectancy Rates (in yrs)
Andorra 83.49 Mozambique 31.30
Macau 81.87 Botswana 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
25
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 Nationa
l 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
26
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

27
CONTROL OF LIFE
28
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?
  • Whos responsible for a defective baby?

29
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

30
HUMAN POTENTIAL
Negative Eugenics
-- identify eliminate unwanted genetic traits
  • Ultrasound
  • Chorionic villi testing
  • Amniocentesis
  • Genetic counseling
  • Sterilization

31
HUMAN POTENTIAL
Ultrasound
  • uses sound waves
  • detects visible defects

32
HUMAN POTENTIAL
Amniocentesis
  • Combined w/ultrasound
  • fetal waste products

33
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

34
HUMAN POTENTIAL
Genetic Counseling
35
HUMAN POTENTIAL
Sterilization
Carrie Buck case
36
HUMAN POTENTIAL
Positive Eugenics
37
HUMAN POTENTIAL
Cryobanks
38
HUMAN ACHIEVEMENT
Neurological, psychological and physiological
manipulation
  • Mood altering enhancing medications
  • Cosmetic endrochronology

39
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

40
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

41
HUMAN ACHIEVEMENT
Growth Hormone
  • given to normal but small kids
  • add 6 height, 50 muscle mass
  • recombinant DNA technology

42
HUMAN ACHIEVEMENT
43
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 ?

44
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

45
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
46
BIOMEDICAL ETHICS
What ends will or should the new technology serve?
What values should guide societys 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?
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