CHAPTER x Biomedical Ethics Learning Outcomes At the end of this chapter, you should be able to: 1. articulate what @ moral dilemma is in the medica] field; give examples of Possible medical moral dilemmas; and 3. apply at least one philosop her’s theory to a Particular issue in medical ethics, a Introduction Jean Vanier, the founder of L’Arche is inclusive of People with mental disabilities), reported in his 2008 book Living Gently in a Violent World that a few years hence, people with Down syndrome ie might not be born because they would have been aborted. Chorionic villus sampling later fulfilled Vanier’s prediction. National health services of European nations such as France, Denmark, and the United Kingdom Tecommend CVS as a form of prenatal testing done around 10 to 12 weeks of pregnancy. It is a sampling of placental tissue, chorionic villus, that allows the detection of birth defects, genetic diseases, and other disorders in the fetus. In 2014, 693 abortions (roughly 90 percent of those who tested Positively in CVS) was carried out in the United Kingdom.** John, a member of L’Arche with Down (a community that Soe ‘ond 5° Tim Stanley, "Down's: ‘Syndrome People Risk Extinction at The Hands Of Science, Fear 'norance," The Telegraph, 18 January 2016, 192 Scanned with CamScanner) CHAPTER X: BIOMEDICAL ETHICS syndrome puts it, “That doesn’t make us feel very welcome. | does it?” : Ethics can hardly keep up with the fast and confusing advancement in the fields of genetics, medicine, and pharmacology. An introductory book of ethics for college students cannot cover all the nuanced applications of the theories and available perspectives. The limitations can only permit learners an introductory but sound guide to navigate through these current and emerging developments. For such purposes “personalist biomedical ethics” is suggested. Personalist Biomedical Care At the turn of the 20th century, personalist theories emerged as a reaction to perceived depersonalization caused by the advent of science, technology, and totalistic systems in philosophy. Though different key thinkers give their own versions of personalism, a common affirmation is the centrality of the human person for philosophical thought. It posits the value of personhood as a center of life, experience, decisions, and actions. Biomedical ethics has a stable grounding if it holds the inviolable, inherent, and intrinsic value of the person, as well as his/her relational and communitarian realities. To better guide the introduction to such Personalist Biomedical Ethics, the birth, well-being, and death suitable for the human person are covered. a Ethics of “Prenatal Personhood” Heated discussion among ethicists always begins with the question: “When does human personhood begin?” Locally, the discussion is grounded on the Philippine constitution that upholds the protection of life of both the mother and that upholds the Preece philippine Medical Association 193 ee Scanned with CamScannerPart Il: SPECIAL TOPICS IN ETHICS also released a document signed by Dr. Bu C. Castro ang Dr. Oscar Tinio clearly assuming that the human person exists at the point of fertilization/conception. Even the culture supports such serious valuation of the unborn in that a pregnant (buntis) woman is also said to be nagdadalangtao or childbearing (literally humanbearing). Given such bedrock of certainties, the debate persists. For instance, if conception is considered as a process, there has to be a point of readiness for the body to be able to support the reality of the self as a person. Given that the body is not accidental to the integrality of the human being, does it not need this particular stage of readiness to be able to support personhood? Such questions, however, are not enough to disprove the claim that human personhood does not begin at the point of conception. At best, these considerations remain simply as questions for discussion; they are not proofs. A more nuanced position which holds that since it cannot be proved or disproved as factual that the human being begins to exist at the very point of human conception, nevertheless “the fertilized ovum or fetus ought to be treated as a human person.” This nuanced position passes on the burden of proof to those who raise such questions as to the personhood of fetuses. If one thinks about it more, a pragmatic support is also found in the fact that each one of the participants in the “ethical discussion of the start of personhood” all went through the same process of conception or fertilization in the womb of his/her mother. The issue cannot be made light of simply because it is a matter of Philosophical discussion. Scanned with CamScannerCHAPTER X: BIOMEDICAL ETHICS ectopic Pregnancy and the Princi of Double Effect rinciple James Keenan reported a discussion on the question of ectopic Pregnancy as carly as 1893.” An interesting point was raised in the discussion of the theologian named Aloysius Sabbetti (1839-1898). If the fetus is said to be where it should not be in the case of ectopic pregnancy (i.e., outside the womb) and is threatening the life of the mother, can it be treated as an unjust aggressor? A more precise nuanced is even arrived at by presenting it as a “materially unjust aggressor,” that is, even without intention simply because it js in the wrong place, the immature fetus is a grave threat to the life of the mother. It is likened to someone under the influence of drugs or alcohol who may be so drunk that clear intentions are no longer present but nonetheless severely threatens to kill. A better analogy is even presented in a case when the soldier who belongs to an invading army is detected by a sniper who is defending a particular territory. While unseen, the sniper is not intentionally threatened by the soldier but simply because he is in the place where he should not be, self-defense demands action (not excluding fatal shooting) on the part of the sniper. Given such logic of “self- defense” against a “materially unjust aggressor”, is abortion of the fetus acceptable? Ethicists who belong to the Catholic communion were given an instruction clearly defining — matter of faith for this particular Church ah it i ea eo te the cabgory of ui AEE oni als defined as questions involving fetal life. ; e an intrinsic evil act that is unacceptable in any direct and Context of Casuistry, (Washington DC: © Keenan, Jomes and Thomas Shanron, 7? 31 Georgetown University Press: 1995), Evangelium Vitae, 58- 405 Scanned with CamScannerfae, | Part Il: SPECIAL TOPICS IN ETHICS ( intended form as a human action.” The case then of ectopic pregnancy occasions the principle of double effect. This principle is applied in the case of an action that is seen to have two results: one is known as good and hence that which we can only intend; another simultaneous effect is bad, however, but since we do not intentionally do it for that purpose, this can be considered as a mere by-product of the action. The bad effect is willed to not have occurred at all only if such an instance is possible. The originating act ought to be deemed good or at the very least morally neutral. Applying this to the case of ectopic pregnancy, it is unacceptable that the medical professional directly aborts the fetus; hence, his/her action of surgically cutting the fallopian tube that is clogged is a more tolerable option. Such a surgical intervention saves the mother but sadly also results in the indirect removal of the misplaced fetus. If personalist ethics is applied to biomedical issues, in this instance, the option that upholds the value of the fetus as that who “ought to be treated as a person” should be maintained. It may be considered that imputing aggression albeit materially (without intention) to a fetus is indicative of an objectification of one who is deserving of better consideration. Emmanuel Levinas, in his critique of just war, once said that his reservation regarding justification of wars is that in being justified one loses his/her conscience or conscientiousness- The same can be said here; a justified self-defense may push one to erringly shun that “the fetus ought to be treated as 4 person.” Scanned with CamScannerCHaAPT 1 ER X: BIOMEDICAL ETHIcs child-Bearing Enhance m Self-Improvement, and Ganda Well-being ‘he applicati i he applications inthe Fld of medicine have put forward won! ene st of enhancement of human bei Th who had difficulty in having children, for ae sow given options to better improve their chances of ae child. The Human Genome Project has promised versonally designed drugs that can better improve one’s health or recovery from sickness. Given the advancement of human genetic mapping, predispositions to particular sicknesses and syndromes can be detected the earliest (as discussed above even during the first 10 to 12 weeks of pregnancy). While these breakthroughs and applications are not evil in themselves, personalist ethics provide us with a larger view in considering the relational and communitarian dimensions of the human person. The cost of child-bearing techniques until now is exorbitantly high. While this may not be an issue for those who can afford them, the number of adoptees and children born in poor families deserve to also be considered in the decision. Is the cost of childbearing that benefits from the interventions available in high-end hospitals “acceptable in j il] indi f-reported ice” try that still indicate 40% sel ee a: | consideration of “common poverty? Perhaps the traditional good” is also in place in this instance. Jf there are so many i 4 they deserve priority over children who are orphans, don " ; such costly means especially if the cost of ae child can in effect support 2 or 3 children in g adulthood? . Another issue to be considered in fi Pee ee nother is: do wit e so-calle ; i ts has to ee childbearing enhancer of child-conceiving enhancements “spares.” Present technia! 197 Scanned with CamScannerPart Il: SPECIAL TOPICS IN ETHICS involve the harvesting of egg cells from the mother. Since it is impossible or costly to store these without fertilizing them, what are frozen in hospitals/clinics that give such services are human embryos or fetuses that are awaiting womb implantation. The 100% success of a single implantation is not yet reached so a number of fertilized eggs or embryos are frozen as “spares.” An important question that is occasioned by this process has to do with the “spares” that are left after a successful pregnancy up to the full term is achieved. Maintaining the principle that the fetus “ought to be treated as a human person,” a careful monitoring of the “spares” is in order. The Philippines has boasted recently of local doctors’ ability to engage in stem cell therapy. While stem cell research has reached developments that most no longer make use of human embryos, the history of this research betrays the fact that it does not exclude such methods. The absence of laws defining “spares” as deserving of treatment as human persons simply mean that the “spares” are not out of the reach of unconscientious therapists. Embryos in the first 14 days are known for their totipotency (multipotency), that is, germane in the “spares” are the cells that make up every organ in the human body including gray matter that is important for the brain. This is hardly negligible especially given the presence of massive monetary support for researches that address debilitating diseases such as Parkinson's and Alzheimer's that hit retired and financially influential first-world citizens. The awareness of these issues is too low and the temptation to enter into it too strong that the victimization and objectification of these “spares” may already be happening in our country, Other self-enhancements and general well-being improvements that are now available to those who can afford them ought to be evaluated also along the lines of Personalist ethics. While personal improvements such as the intake of glutathione for aesthetic improvements can hardly 198 Scanned with CamScannerc HAPTER X: BIOMEDICAL ETHIcs be branded as evil or bad, ethici that is peddled by such “self. concerting are the products that purport be beneficial for them, the contributing to the view that children are |; should follow the designs deemed relevant by objectification affects personal regard betweer to intolerance of personal di ists warn of the objectification ‘actualization” products, Most question should be raised: “Is it ike projects that y parents?” This n them and leads ferences between family members. Other products or techniques (including surgery) that sell self-enhancements should be countered or balanced with an appeal to personal growth that is not only physical. Bodily aesthetic or self-actualization directions ought to be inclusive of interior values such as kindness, solidarity, and compassion. While a moneyed person may have access to such services or products, justice and the traditional concept of common good demand a mitigation evaluation) of these commer Extraordinary M (individual as well as communal cialized self-enhancements. leans, Euthanasia, and the Significance of a Living Will A brief examination of the view that is consistently Euthanasia or mercy another human being and is thu: in the Philippines. The value inviolable for personalist ethi intentional killing of a non- to be improved to ensure tI end of life ethical issues continues personalist in orientation. killing is the direct murder of s unacceptable at this point e given to persons is inherent and ics that it excludes the direct and -aggressor. End of life care ought he dignified dying that is worthy management and hospice care, of human persons. has suffer, should be explained clearly, Particularly for those made reachable and available, country. especially for the poor in this 199 Scanned with CamScannerPart Il: SPECIAL TOPICS IN ETHICS A distinction, however, should be made between euthanasia and the termination of “extraordinary means” that simply allow the process of dying to take its course, The stoppage of extraordinary means, without which the sick person is simply allowed to have a dignified death, is not Passive euthanasia. Extraordinary means are additional or artificial ways that extend the life of a person, e.g., respirator, If the chances of recovering are deemed by doctors as slim and the family no longer has the means to continue the costly use of these means, taking away the respirator does not mean the sick person who can no longer breathe on his own. The Process of death in this instance is permitted to follow its course, and the person is simply allowed to go through the process of a dignified death. The writing of a living will is, therefore, relevant to give guidance to loved ones in the remote possibility that an accident or sickness renders someone “brain dead,” comatose, or in a persistent vegetative state. Personal autonomy is given Priority even in such instances that the living will (that is left behind) is significantly considered. Is the person open to organ donation and to what extent of organ harvesting for the life of other persons is permissible? Hospitals put up DNR (do not Tesuscitate) cards in accordance with a patient’s living will (else the wishes of the next of kin is followed). Again, DNRs are different from euthanasi CPR (cardiopulmonary resuscitation) or other means of resuscitations in the event of a fatal crash of the patient. DNR allows for dignified death, The writing of living wills permits the resolution of confusion that may arise in families - Personalist ethics also . It is the rescinding of 200 Scanned with CamScannerCHa 4 PTER X; BlomevicaL ETHIcs Conclusion The current breakthroy i researches in medicine and ee a ie nity to lose sight of what is of utmost ase te, te inherent, inviolable, and inalienable value of peerkood, Each and every human being is unique insofar as he/she is an expression of a depth that is ever a source of creativit; willfulness, and decision. Ne , Man in his/her freedom is the very height of his/her being. How he/she uses that freedom in biomedical issues is not only a concern about the limits of how far he/she can go but is first and foremost a question of who he/she is or what is he/she to become given his/her biomedical decisions. The questions of ethics applied in this field are not only about the treatment of patients and clients; they inquire first and foremost about humanity that involves us all, including medical practitioners themselves. “Treating the embryo as a human person” not only ensures the dignity and value of the fetal life that is being studied; the principle engages the medical practitioners and researchers themselves. Such an approach in biomedical ethics raises the question about the kind of humanity that is endorsed by the research and built up in the very study that is conducted. Using the advancements in medicine to improve the well-being of persons may be very attractive but also misleading if we treat physicality as an end in itself. An integral personhood involves not only external or bodily .d person includes his/her entirety improvements. An actualize include tire that is satisfaction not only regarding his/her exteriority or physicality but a deeper interior kind of happiness too. Sustaining respect for the person until death moves be ans from euthanasia that may be marked by See ea 4 the process of death. This does not ae pat igni ff dying and pain management are coe A ie omy. aie to secure in these end-of-life concerns. utonomy of the 201 Scanned with CamScannerPART Il: SPECIAL TOPICS IN ETHICS human person is respected in hospitals that the living wi) is of utmost importance and “DNR” posts are ensured to be consistent with them. Death, being the very end of life for the human person, is included in the very reality of Personhood that dignity ought to be maintained until then. Scanned with CamScanner