Slide 1: A.K.CHHABRA
ASHA INTRODUCTION : INTRODUCTION The term "bioethics" was coined in 1970 by Van Rensselaer Potter ,
Bioethics is the philosophical study of the ethical controversies brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, philosophy, and theology. WAYS TO BIOETHICS : WAYS TO BIOETHICS one is asdescriptive bioethics - the way people view life and their moral interactions and responsibilities with living organisms in life.
other is prescriptive bioethics - to tell others what is good or bad, what principles are most important; or to say something/someone has rights and therefore others have duties to them.
Both these concepts have much older roots, which we can trace in religions and cultural patterns that may share some universal ideals. MEDICAL ETHICS : MEDICAL ETHICS -Medical ethics is primarily a field of applied ethics, the study of moral values and judgments as they apply to medicine
-bioethics tends to be understood narrowly as an applied professional ethics, whereas bioethics appears to have worked more expansive concerns, touching upon the philosophy of science and the critique of biotechnology. Still, the two fields often overlap and the distinction is more a matter of style than professional consensus. VALUES IN MEDICAL ETHICS : VALUES IN MEDICAL ETHICS Six of the values that commonly apply to medical ethics discussions are:
Beneficence - a practitioner should act in the best interest of the patient.
Non-maleficence - "first, do no harm
-Autonomy - the patient has the right to
refuse or choose their treatment. Slide 6: Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
Dignity - the patient (and the person treating the patient) have the right to dignity.
Truthfulness and honesty - the concept of informed consent has increased in importance. INFORMED CONSENT : INFORMED CONSENT -Informed consent in ethics usually refers to the idea that a person must be fully-informed about and understand the potential benefits and risks of their choice of treatment.
Patients can elect to make their own medical decisions, or can delegate decision-making authority to another party.
If the patient is incapacitated, laws around the world designate different processes for obtaining informed consent, typically by having a person appointed by the patient or their next-of-kin make decisions for them.
The value of informed consent is closely related to the values of autonomy and truth telling. CONFEDENTIALITY : CONFEDENTIALITY Confidentiality is commonly applied to conversations between doctors and patients. This concept is commonly known as patient-physician privilege.
Legal protections prevent physicians from revealing their discussions with patients, even under oath in court.
Confidentiality is challenged in cases such as the diagnosis of a sexually transmitted disease in a patient who refuses to reveal the diagnosis to a spouse, or in the termination of a pregnancy in an underage patient, without the knowledge of the patient's parents. DOUBLE EFFECT : DOUBLE EFFECT Some interventions undertaken by physicians can create a positive outcome while also potentially doing harm. The combination of these two circumstances is known as the "double effect."
The most applicable example of this phenomenon is the use of morphine in the dying patient. Such use of morphine can ease the pain and suffering of the patient, while simultaneously hastening the demise of the patient through suppression of the respiratory drive. Cloning : Cloning What is cloning? : What is cloning? Cloning is the process of making genetically identical organisms from a single parent
Developments in genetic engineering, and especially cloning, show some promising ideas, but also raise some concerns Slide 13: Dolly (1996-07-05 – 2003-02-14), a Finn Dorsett ewe, was the first mammal to have been successfully cloned from an adult cell,
She was cloned at the Roslin Institute in Scotland claims that Dolly the Sheep had pathologies resembling accelerated aging.
Dolly's death in 2003 was related to the shortening of telomeres
Ian Wilmut argue that Dolly's early death due to respiratory infection was unrelated to deficiencies with the cloning process. Pro-Cloning : Pro-Cloning Cloning stem cells would help provide the treatment to some diseases. Doctors may be able to replace tissues that have been lost to the disease or, in the case of chemotherapy, the treatment with the cloned stem cells
Cloning individual organ tissue can lead to increased organs available for transplantation Slide 15: Cloning could also help provide scientists with a better understanding of some genetic diseases
The cloning of genetically modified farm animals can have agricultural and industrial advantages
For instance, genetically modified cows can produce milk with certain drugs inside for mass production Anti-Cloning : Anti-Cloning Cloning, especially cloning humans, would eventually lead to the loss of genetic diversity, which has helped us survive
If all people have the same type of genes, then the human race, as a whole, is left very weak against certain diseases
Many people believe that cloning is, effectively, playing God. Slide 17: Cloning would lead to a different type of human, a type of human that is property of the original host, property which can be sold to anyone else. Selling human life, any human life is inhumane and unethical
It could conceivably undermine the basic elements of a loving family because it changes the way in which a child is created. Slide 18: AIDS: issues involving disclosure, privacy, discrimination, insurance coverage
Euthanasia: What is the right to die? How does withdrawing or withholding treatment differ from physician assisted suicide? Who has the right to decide when and how a person dies? Should doctors be held legally responsible if they assist a patient's death? What laws should be passed to protect doctors and patients. ABORTION : ABORTION An abortion is the termination of a pregnancy by the removal or expulsion of an embryo or fetus from the uterus, resulting in its death.
An abortion can occur spontaneously due to complications during pregnancy or can be induced.
Abortion as a term most commonly refers to the induced abortion of a human pregnancy, while spontaneous abortions are usually termed miscarriages. SOCIAL ISSUES : SOCIAL ISSUES : Sex-selective abortion
The advent of both sonography and amniocentesis has allowed parents to determine sex before birth. This has led to the occurrence of sex-selective abortion or the targeted termination of a fetus based upon its sex.
sex-selective abortion might be partially responsible for the noticeable disparities between the birth rates of male and female children in some places.
The preference for male children is reported in many areas of Asia, and abortion used to limit female births has been reported in Mainland China, Taiwan, South Korea, and India due to dowry system and other social evils. Slide 21: Unsafe abortion
Where and when access to safe abortion has been barred, due to explicit sanctions or general unavailability, women seeking to terminate their pregnancies have sometimes resorted to unsafe methods.
The World Health Organization (WHO) defines an unsafe abortion as being "a procedure...carried out by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both." Unsafe abortions are known colloquially as "back-alley" abortions.This can include a person without medical training, a professional health provider operating in sub-standard conditions, or the woman herself Slide 22: Fetus Rights:
Does a fetus have rights? If so, what are they and who is responsible for
representing the interests of the fetus?
Does a fetus have rights that supersede the mothers?
Can government step in to ensure the health of the fetus if the mother is not? What about embryos? BIRTH CONTROL : BIRTH CONTROL Birth control, sometimes synonymous with contraception, is a regimen of one or more actions, devices, or medications followed in order to deliberately prevent or reduce the likelihood of pregnancy or childbirth
"Contraception" may refer specifically to mechanisms that are intended to reduce the likelihood of a sperm cell fertilizing the egg. Birth control is commonly used as part of family planning. ISSUES : ISSUES Not all methods of birth control offer protection against sexually transmitted infections
HIV may be transmitted through contaminated needles which may be used in intravenous drug use, tattooing, body piercing, or injections
Health-care workers have acquired HIV through occupational exposure to accidental injuries with needles. Religious views : Religious views Religions vary widely in their views of the ethics of birth control.
In Christianity, the Roman Catholic Church accepts only Natural Family Planning,
Protestants maintain a wide range of views from allowing none to very lenient.
In Islam, contraceptives are allowed if they do not threaten health or lead to sterility, although their use is discouraged.
Hindus may use both natural and artificial contraceptives.
A common Buddhist view of birth control is that preventing conception is ethically acceptable, while intervening after conception has occurred or may have occurred is not. TO THINK…… : TO THINK…… Who has the right to decide? who should have children (and how many).
What measures should be taken to control the population of the world. GENE THERAPY : GENE THERAPY Gene therapy is the insertion of genes into an individual's cells and tissues to treat a disease, and hereditary diseases in which a defective mutant allele is replaced with a functional one.
Gene therapy using an Adenovirus vector. A new gene is inserted into an adenovirus vector, which is used to introduce the modified DNA into a human cell. If the treatment is successful, the new gene will make a functional protein. Slide 28: . Gene therapy using an Adenovirus vector. A new gene is inserted into an adenovirus vector, which is used to introduce the modified DNA into a human cell. If the treatment is successful, the new gene will make a functional protein Problems and ethics : Problems and ethics Short-lived nature of gene therapy
Immune response - Anytime a foreign object is introduced into human tissues, the immune system has evolved to attack the invader. The risk of stimulating the immune system in a way that reduces gene therapy effectiveness is always a possibility.
there is always the fear that the viral vector, once inside the patient, may recover its ability to cause disease
Chance of inducing a tumor (insertional mutagenesis) - If the DNA is integrated in the wrong place in the genome,
Religious concerns - Religious groups and creationists may consider the alteration of an individual's genes as tampering or corrupting God's work. TO THINK…… : TO THINK…… Gene therapy:
What are the potential ramifications of somatic and germ-line gene therapy?
Should genes be tinkered with and if so what limits should be placed on this type of technology. ANIMAL RIGHTS : ANIMAL RIGHTS Animal rights, also known as animal liberation, is the idea that the most basic interests of animals should be afforded the same consideration as the similar interests of human beings. Animal rights advocates approach the issue from different philosophical positions, but they agree that animals should no longer be regarded as property, or used as food, clothing, research subjects, or entertainment, but should instead be viewed as legal persons and members of the moral community. Slide 32: The idea that the use of animals by human beings — for food, clothing, entertainment, and as research subjects — is morally acceptable springs mainly from
idea that animals are inferior, because they lack rationality or language, and as such are worthy of less consideration than human beings, or even none.
idea that individual animals have no separate moral identity Slide 33: Animal rights Issues:
-Is animal testing acceptable when it benefits humans?
-What animals should be tested on and which should not
-Does animal research be justified by its benefits to mankind? ARTIFICIAL INSEMINATION : ARTIFICIAL INSEMINATION Artificial insemination (AI) -process by which sperm is placed into the reproductive tract of a female for the purpose of impregnating the female by using means other than sexual intercours.
It is used as primarily to treat infertility .
but is increasingly used to enable women without a male partner (i.e. single women and lesbians) to become pregnant and to produce children by using sperm provided by a sperm donor.
Modern techniques for human AI were first developed for the dairy cattle industry to allow many cows to be impregnated with the sperm of a bull with traits for improved milk production.
A pregnancy resulting from artificial insemination is no different from any other pregnancy except that there may be a slight increased likelihood of multiple births rather than singleton babies if drugs are used by the woman for a 'stimulated' cycle. Slide 35: because of the introduction of artificial fertilization techniques, a new problem has arisen: what to do with extra embryos produced to give appliers more chances of success.
in vitro fertilization shows a noticeable percentage of failures,,
the spontaneous abortion rate after implantation is very high.
It is easy to guess the doom of unused or "surplus" embryos: freezing with no time limit, waiting for future implantation or other "uses" such as experimentations and the creation of a reserve of transplantable organs and tissues,
that is to say they will be eliminated; if they were implanted, they would undergo the so-called selective fetal reduction, namely a selective eugenetic abortion to choose the "best" children only. SURROGACY : SURROGACY Surrogacy is a method of reproduction whereby a woman agrees to become pregnant and deliver a child for a contracted party.
- Mother-child relationship
- Compensated Surrogacy
-Higher maternal death rate
-Less medical facilities ORGAN DONATION : ORGAN DONATION Xenotransplantation,
BLACK MARKET ORGAN DONATION
Physical exploitation -the operations in question are quite risky, and, taking place in third-world hospitals or "back-alleys," even more risky.
Legalization of Trade Controversy surrounding research : Controversy surrounding research Opponents of the research argue that embryonic stem cell technologies are a slippery slope to reproductive cloning and can fundamentally devalue human
argue that a human embryo is a human life and is therefore entitled to protection.
supporters of embryonic stem cell research argue that such research should be pursued because the resultant treatments could have significant medical potential.
It is also noted that excess embryos created for in vitro fertilization could be donated with consent and used for the research. ARTIFICIAL LIFE : ARTIFICIAL LIFE Artificial life is a field of study and an associated art form which examine systems related to life, its processes, and its evolution through simulations using computer models, robotics, and biochemistry.
There are three main kinds of alife named for their approaches: soft from software; hard, from hardware; and wet, from biochemistry.
Artificial life imitates traditional biology by trying to recreate biological phenomena.
The term "artificial life" is often used to specifically refer to soft alife. Artificial life studies the logic of living systems in artificial environments.
The goal is to study the phenomena of living systems in order to come to an understanding of the complex information processing that defines such systems CRITICISM : CRITICISM Alife has had a controversial history.
John Maynard Smith criticized certain artificial life work in 1994 as "fact-free science".
However, the recent publication of artificial life articles in widely read journals such as Science and Nature is evidence that artificial life techniques are becoming more accepted in the mainstream, at least as a method of studying evolution. BIOPIRACY : BIOPIRACY It is a negative term for the appropriation, generally by means of patents, of legal rights over indigenous knowledge - particularly indigenous biomedical knowledge - without compensation to the indigenous groups who originally developed such knowledge .
Biopiracy allegedly contributes to inequality between developing countries rich in biodiversity, and developed countries served by pharmaceutical industry exploiting those resources. Slide 43: The Rosy Periwinkle, while native to Madagascar, had been widely introduced into other tropical countries around the world well before the discovery of vincristine.
This meant that researchers could obtain local knowledge from one country and plant samples from another.
The locally known medical properties of the plant were not the same as the medical properties discovered and commercially used by Eli Lilly.
The use of the plant as a cure for diabetes was the original stimulus for research, but cures for cancer were the most important results. BODY MODIFICATION : BODY MODIFICATION Body modification (or body alteration) is the permanent or semi-permanent deliberate altering of the human body for non-medical reasons, such as:
sexual enhancement; a rite of passage; aesthetic reasons; denoting affiliation, trust and loyalty; religious reasons; mystical affiliations; shock value; and self-expression.
It can range from the socially acceptable decoration (e.g., pierced ears in many societies) to the religiously mandated (e.g., circumcision in a number of cultures), and everywhere in between.
Body art is a modification of any part of the human body for artistic or aesthetic reasons. Types of body modification : Types of body modification Anal stretching
Body piercing –
Breast implants –
Circumcision - the partial or full removal of the male foreskin
Dermal anchoring similar to transdermal implants
Eyeball tattooing - Injection of a pigment into the cornea.
Ear piercing Contd. : Contd. Nullification involves the voluntary removal of body parts. Fingers, Penis (penectomy), Testicles (castration), Clitoris, Labia or Nipples.
Scarification - cutting or removal of dermis with the intent to encourage intentional scarring or keloiding
Silicone injection Tongue splitting - bisection of the tongue similar to a snake's
Tooth filing 
Transdermal implant - implantation of an object below the dermis, but which exits the skin at one or more points
Trepanation  Slide 47: leading to charges of disfigurement and mutilation.
causes body dysmorphic disorder, other mental illnesses, or as an expression of unchecked vanity
health risks man with conspicuous tattoos and other body modifications Face Transplants : Face Transplants Slide 50: Face transplants can help people who have suffered severe burn damage or the effects of oral cancer recover some semblance of a normal face
The face would be removed from someone who has recently died
Skin is the hardest organ to transplant Basic Information Problems : Problems The cocktail of drugs that has been developed to keep the body from rejecting the face could easily lead to cancer or kidney failure.
Additionally, the face could still reject leaving the recipient with no options and death very likely to occur
The problem also arises that the person with this newly transplanted face could remind or haunt the family and friends of the recently deceased donor CYRONICS : CYRONICS Cryonics is the low-temperature preservation of humans and animals that can no longer be sustained by contemporary medicine until resuscitation may be possible in the future.
Human cryopreservation is not currently reversible.
In the United States, cryonics can only be legally performed on humans after pronounced legally dead
Absolutely irreversible death has also been called information-theoretic death,
which implies destruction of the brain to such an extent that the original information content can no longer be recovered. Old Age Pregnancy : Old Age Pregnancy Slide 54: A 66 year-old Romanian woman recently gave birth to a baby girl, becoming the oldest mother
Doctors used in vitro fertilization, and the sperm and egg from other (younger) people to get her pregnant
To save her girl, doctors preformed a cesarean section 33 weeks into the pregnancy and removed a 3.1 pound premature baby.
It was her third attempt at carrying a pregnancy to full term after starting fertility treatment in 1995 Slide 55: There is no age limit in place in Romania for fertility treatment.
The European Union, which Romania hopes to join, usually restricts the treatment, but the actual age limit varies from country to country How Old is too Old to Give Birth? : How Old is too Old to Give Birth? Iliescu was receiving fertility treatment because she was no longer able to produce eggs…because of her age
Any woman over the age of 40 who gets pregnant constitutes a high risk pregnancy because the health risks, to both the mother and the baby, skyrocket at that age
Iliescu lost one fetus early in the pregnancy, and “gave birth” to one still born baby. And even though the surviving girl was only a few weeks premature, she was “born” at a dangerous 3.1 pounds But too old to be a Parent? : But too old to be a Parent? When Iliescu’s girl becomes a teenager, Iliescu will be 80
There is doubt about whether the elder parent will be alive long enough to see their child graduate from high school, let alone college
Some say that no one complains when old men, such as Tony Randall and Strom Thurmond, become fathers. Note, however, that both of these men have died since having their children. www.msnbc.com What are GM crops? : What are GM crops? Plants which have been genetically altered to express a desirable trait (Perry 2003)
Increased nutritional value Who makes sure GM foods are safe? : Who makes sure GM foods are safe? Government agencies regulate GM food
GM foods in the United States are required to be labeled only if the nutritional value is changed or a new allergen is introduced. Possible Risks of GM Foods : Possible Risks of GM Foods Insects might develop resistance to pesticide-producing GM crops
Herbicide-tolerant crops may cross-pollinate weeds, resulting in "superweeds" CONTRAVERSIES ON GM CROPS : CONTRAVERSIES ON GM CROPS Exploitatio of farmers by American biotech companies :-shift in agri. Towards biotech.companies.
GM crops C.P. had a putative effect on biodiversity.
Decline in wild life:-UK-GM Sugarbeet ,rapeseed are withdrawn from ues in 2004.
Interogression of transgene in wild population.
Golden Rice –eleviate vitamin A deficiences. Slide 62: Golden rice is a variety of rice (Oryza sativa) produced through genetic engineering to biosynthesize beta-carotene, a precursor of pro-vitamin A in the edible parts of rice
-Neither variety is available for human consumption
-Opposition from environmental and anti-globalisation activists
-Green peace oppose all GM crops and said that golden rice is a Trojan horse that will lead to more widespread use of GM crops Possible Risks for GM Foods : Possible Risks for GM Foods Certain gene products may be allergens, thus causing harm to human health
Only 2%Briton are food
There may be unintended harm to wildlife and beneficial insects Photo courtesy of T. W. Davies, Cal. Acad. of Sciences. A Biblical Perspective : A Biblical Perspective It is important to recognize the intrinsic value
of the environment as God’s handiwork (Vautin)
We should choose what is best for all of humanity, rather than a few American companies
Biotech companies should use extreme caution, performing enough research to become as certain as possible that the product does not harm those who consume it. Transgenic plants : Transgenic plants Is the transgenic plants capable of growing outside a cultivated area.
Can the transgenic plant pass its genes to local wild species and are the offspring also fertile.
Does the introduction of transgene confer a selective advantage to the plant or to hybrid in the wild.
Outcrossing leads threat to env.
Possible escape route;SMART BREEDING TO THINK….. : TO THINK….. What rights due consumers have?
What rights do farmers have to grow GM crops?
who decides whether food is safe? OTHER ISSUES : OTHER ISSUES Transhumanism -"human enhancement", is an international, intellectual and cultural movement supporting the use of science and technology to enhance human mental and physical aptitudes, and overcome undesirable and aspects of the human condition, such as disability, suffering, disease, aging, and involuntary death. Slide 68: DEHUMANIZATIOMN
ENVIRONMENTAL ISSUES TO THINK….. : TO THINK….. :
How do we decide between conservation and economic interests.?
How much land should be allocated to other species and to parks?
Should industries be responsible for damage done to the environment by them (pollution)? CONCLUSION : CONCLUSION Thus, the task of true bioethics is to deepen and propose the truth about man, and to offer facts and guidelines for action directed also to the ones who are responsibles for culture and common well.