ETHICS AND MEDICINE

Medical ethics traces its roots back as far as ancient Greece, but the
field gained particular prominence in the late 20th century. Many of the
current issues in medical ethics are the product of advances in scientific
knowledge and biomedical technology. These advances have presented
humanity not only with great progress in treating and preventing disease but
also with new questions and uncertainties about the basic nature of life and
death. As people have grappled with issues on the frontier of medical science
and research, medical ethics has grown into a separate profession and field
of study. Professional medical ethicists bring expertise from fields such as
philosophy, social sciences, medicine, research science, law, and theology.

Issues in Medical Ethics. The advent of new medical and

reproductive technologies in recent years has complicated how ethical
decisions are made in medical research and practice. The following highlights
some of the most prominent issues in medical ethics: abortion, and cloning.

Abortion

In 1973, the United States Supreme Court decision in Roe v. Wade

made abortion legal. The Court’s decision sparked extensive controversy that
has continued into the 21st century. In general, abortion opponents believe
that life begins at conception and that a surgical abortion is the equivalent of
murder. Pro-choice advocates believe that abortion is a private matter
between the mother and her physician.

Abortion, termination of pregnancy before birth, resulting in, or

accompanied by, the death of the fetus. Some abortions occur naturally
because a fetus does not develop normally or because the mother has an
injury or disorder that prevents her from carrying the pregnancy to term. This
type of spontaneous abortion is commonly known as a miscarriage. Other
abortions are induced—that is, intentionally brought on—because a
pregnancy is unwanted or presents a risk to a woman’s health.

Induced abortion, the focus of this article, has become one of the most
intense and polarizing ethical and philosophical issues of the late 20th
century. Modern medical techniques have made induced abortions simpler
and less dangerous. But in the United States, the debate over abortion has
led to legal battles in the courts, in the Congress of the United States, and
state legislatures. It has spilled over into confrontations, which are
sometimes violent, at clinics where abortions are performed. This article
discusses the most common methods used to induce abortions, the social
and ethical issues surrounding abortion, and the history of the regulation of
abortion in the United States.

As noted earlier, abortion has become one of the most widely debated
ethical issues of our time. On one side are pro-choice supporters—individuals
who favor a woman’s reproductive rights, including the right to choose to
have an abortion. On the other side are the pro-life advocates, who oppose
abortion except in extreme circumstances, as when the mother’s life would
be threatened by carrying a pregnancy to term. At one end of this ethical
spectrum are pro-choice defenders who believe the fetus is only a potential
human being until it is viable. Until this time the fetus has no legal rights—
the rights belong to the woman carrying the fetus, who can decide whether
or not to bring the pregnancy to full term. At the other end of the spectrum
are pro-life supporters who believe the fetus is a human being from the time
of conception. As such, the fetus has the legal right to life from the moment
the egg and sperm unite. Between these positions lies a continuum of ethical
and political positions.

A variety of ethical arguments have been made on both sides of the

abortion issue, but no consensus or compromise has ever been reached
because, in the public policy debate, the most vocal pro-choice and pro-life
champions have radically different views about the status of a fetus.
Embryology, the study of fetal development, offers little insight about the
fetus’s status at the moment of conception, further confounding the issue for
both sides. In addition, the point when a fetus becomes viable is constantly
changing—with every passing year medical advances make it possible to
keep a premature baby alive at an earlier stage. The current definition of
viability is generally accepted at about 24 weeks gestation; a small
percentage of babies born at about 22 weeks gestation have been kept alive
with intensive medical care.

This combination of medical ambiguities and emotional political

confrontations has led to considerable hostility in the abortion debate. For
many people, however, the lines between pro-choice and pro-life are blurred
and the issue is far less polarized. Many women who consider themselves
pro-life supporters are concerned about possible threats to reproductive
rights and the danger of allowing the government to decide what medical
options are available to them. Similarly, many pro-choice individuals are
deeply saddened by the act of abortion and seek to minimize its use through
more education about, and use of, birth control.

Many people on all sides of the controversy feel the political debate
has led to a stalemate because it ignores the nuances of the issue. In
response, participants in the abortion debate find common ground in the
admission that the issue is surrounded by complicated, difficult questions
that require more than simplified pro-life or pro-choice rhetoric.

Cloning

A sheep named Dolly was successfully cloned from a cell of an adult

female sheep, according to a 1997 announcement by Scottish scientist Ian
Wilmut and his colleagues. In 1998 scientists in South Korea announced that
they had created an embryo from the cells of an adult woman, although they
had halted the embryo’s growth before it divided into four cells. These
events, and several other successful attempts at cloning mammals, have led
many scientists to believe that cloning humans may one day be possible.
This possibility has touched off a debate about the ethics of creating human
clones, the circumstances under which human cloning might be used, and
the possibility of using the technique to manipulate the traits of children.

But a number of potential benefits of cloning are often ignored in the

debate about its use for human reproduction, according to some scientists.
Cloning may one day be used xenotransplantation, the process of
transplanting animal organs into humans. Cloning techniques could be used
to create animals whose genes produce proteins that prevent the human
rejection of organs. These donor animals could provide organs, such as
heart, kidney, alleviating the shortage of available organs for medical
transplantations. Cloning techniques could create mammals that produce
milk containing a particular drug, revolutionizing drug development into an
efficient and cost-effective process. In agriculture, cloning may be used to
create livestock that are resistant to infectious diseases. Widespread
livestock slaughter caused epidemics such as foot and mouth disease or mad
cow disease could be eliminated, according to advocates of cloning.

The ethical issues relating to cloning are being taken up right now by
the National Bioethics Advisory Commission, which was created by President
Bill Clinton in 1995 and first met in October 1996. Most of the concerns
center on efforts to create clones of human beings. Some people might want
to make a human clone because they want to have a child with certain
characteristics. Most scientists seem interested in cloning in order to learn
what they can about how genes (the basic units of heredity) affect the
development of an organism from the embryo to adulthood.

Cloning achieves several purposes. First, it puts a nucleus (the part of a

cell that contains most of the cell's genetic information) that is differentiated
(specialized for a specific purpose) in charge of controlling the entire
development of an organism. This tells us the limits on nuclear change
during such development. Second, it puts a nucleus from one source into
cytoplasm (the semi-liquid material of a cell outside the cell's nucleus) from
another source, telling us things about the interaction of nucleus and
cytoplasm in development. This is important because it tells us how much
the cytoplasm of the egg contributes to development as compared to the
genes in the nucleus. As we learn more about development, it is becoming
clear that the cytoplasm plays a major role in the early stages of
development. Third, it creates genetically identical individuals.

All of these are important research aims in understanding genetics and

development and how to manipulate organisms. Reasons not to clone are
generally due to the expense, technical difficulties, and, in the case of
cloning people, the ethical issues involved.

for Ethics

JESSIE L. LABISTE JR.

BSED 4A