THE PRESENT STATE OF MEDICAL ETHICS
Dr. DAVID COOK Whitefield Institute Green College, Oxford
ISSUES OF LIFE
FERTILITY
1 in 7 are unable to have children
1/3 is the result of a problem in the male.
1/3 is the result of a problem in the female
1/3 is the result of no physical problem
‘Man trouble’
Two major problems: the ‘delivery system’ and ‘quality control’.
‘the delivery system’
overcome by artificial insemination but in order to do so, sperm must be obtained.
Sperm obtained by the act of masturbation.
Therefore problem of the Roman Catholic viewpoint: does this masturbation count as an act of procreation or not .
Who is the father ? The biological or social father ?
Since the Warnock Report it is the social father.
‘quality control’ overcome by screening but is this screening a form of adultery?
not sexual adultery, but certainly interference.
‘Women trouble’
Two major problems: the ‘delivery system’ and ‘quality control’.
‘delivery system’
: blocked fallopian tubes can lead to the use of Gamete inter Fallopian Transfer (GIFT) treatment.
transfer of eggs involved - where are they obtained ?
used to be aborted foetuses - now illegal.
who is the mother ? - Biological or social ?
‘quality control’
: drugs to induce superovulation (26 eggs).
this leads to higher rate of twinning - Mandy Allwood.
use of fertility clinics where only three eggs are chosen.
but again may twin if 3 eggs twinned, reduced to two - selective reduction.
problem of misinformation - only 40% successful, as in ‘take home’ rate.
normally 10 ‘cycles’ of treatment needed @ £2 000 - total cost of treatment £20 000. How does one pay for this? Only feasible for middle class or above ?
what happens to ‘spare’ embryos/sperm - research ? Diane Blood case who has the right to use the sperm ?
Surrogacy
Further problems here over who is the mother ?
three options
-
woman who supplied the egg,
the surrogate
or the social mother.
Post Warnock Report in law the surrogate is the mother in order to discourage surrogacy.
Who has a ‘right’ to a child ?
Is it married couples, single parents or those in a stable relationship ?
Does sexual orientation have a bearing ? Oxford does not treat lesbians, London will. A need for consistency ?
Does age have a bearing ? Should a post-menopausal be treated ?
When is a child, a child ?
What is conception ? (popularly taken as fertilisation, scientifically moment of introduction.)
At the development of the spinal cord ?
When movement starts ?
24 weeks - so the Government
When the first breath of life is taken ?
When the child becomes independent of parents - i.e. can sustain him/herself independently ?
Genetic engineering
Where do we stop? Tomatoes > Dolly the Sheep > humans ?
What do we use genetic engineering for ?
How do we screen ? Do we discriminate if we do not screen everyone ? Should or must be screened ?
What if we discover a controlling gene for disease, do we remove it ? What if it were a gene for homosexuality?
If we could control gender, we could exert population control. In India abortion is legal up to 40 weeks, sex screening takes place at 36 weeks.
The control of information - will genetic testing for diseases come to effect things like taking out a mortgage ? Who should have access to the results ?
Possession of the gene does not necessarily mean that it will happen i.e. a heart attack gene does not necessarily mean a heart attack will take place.
ISSUES OF DEATH
Euthanasia
Since 1961 suicide is a legal act but aiding in a suicide is still illegal.
The right to die vs the right to be killed. Example of Cox case.
Dr. Cox administered lethal dose of potassium chloride to a patient who wished to die, and noted this action in his medical records.
Discovered by nurse who reported him. But the body had been cremated and so no physical evidence was available.
Cox charged with attempted murder instead of murder ‘one’ - given a suspended sentence.
Second example: Tony Bland case:
After a car accident Tony Bland was left brain dead, but not brain stem dead. (‘Death’ in the U.K. is indicated by the brain stem ceasing to function. Brain dead = part of the brain is dead.)
After four years in this state, Tony’s father requested that Tony’s life be ended. The presiding Doctor was told that he would be charged for murder if he did so.
Two options existed:
Feeding Tony Bland intravenously counts as a medical treatment, treatment can legally be withdrawn. Could this principle be applied beyond those in a PVS - neo-natal, handicapped?
It is not in Tony’s best interests to be kept in PVS, therefore treatment should stop.
A question of action, omission, or withdrawal.
An illustration: if there is a collapsing building one can either knock it down - take action - or one can allow nature to take its course and the building will collapse precisely because it is a ‘collapsing’ building - omission of action - or one can put in some structural supports and then later decide to remove them - withdrawal of treatment..
Whose body is it anyway ?
Argument by autonomy
but de facto the body is the family’s (in the case of organ donorship, the family can overrule the dead person’s written consent on a donor card.)
The slippery slope argument:
voluntary euthanasia will lead on to compulsory. Compare with the ‘progress’ of abortion. In 1967 abortion was legal only under strict conditions, 1997 it is available on demand.
Human nature naturally pushes back the boundaries.
Notes by MSS without reference to David Cook
Any errors due to MSS
