Menschen mit Down-Syndrom, Eltern & Freunde e.V.

ENCYCLOPÆDIA BRITANNICA 

 Bioethics

The issues of abortion and euthanasia are included in one of the fastest growing
areas of applied ethics, that dealing with ethical issues raised by new
developments in medicine and the biological sciences. This subject, known as
bioethics, often involves interdisciplinary work, with physicians, lawyers,
scientists, and theologians all taking part. Centres for research in bioethics have
been established in Australia, Britain, Canada, and the United States. Many
medical schools have added the discussion of ethical issues in medicine to their
curricula. Governments have sought to deal with the most controversial issues by
appointing special committees to provide ethical advice.

Several key themes run through the subjects covered by bioethics. One, related
to abortion and euthanasia, is whether the quality of a human life can be a reason
for ending it or for deciding not to take steps to prolong it. Since medical science
can now keep alive severely disabled infants who a few years ago would have died
soon after birth, pediatricians are regularly faced with this question.

The issue received national publicity in Britain in 1981 when a respected pediatrician was
charged with murder, following the death of an infant with Down's syndrome.
Evidence at the trial indicated that the parents had not wanted the child to live
and that the pediatrician had consequently prescribed a narcotic painkiller. The
doctor was acquitted. #

The following year, in the United States, an even greater
furor was caused by a doctor's decision to follow the wishes of the parents of a
Down's syndrome infant and not carry out surgery without which the baby would
die. The doctor's decision was upheld by the Supreme Court of Indiana, and the
baby died before an appeal could be made to the U.S. Supreme Court. In spite of
the controversy and efforts by government officials to ensure that handicapped
infants are given all necessary lifesaving treatment, in neither Britain nor the
United States is there any consensus about the decisions that should be made
when severely disabled infants are born or by whom these decisions should be
made.

Medical advances have raised other related questions. Even those who defend the
doctrine of the sanctity of all human life do not believe that doctors have to use
extraordinary means to prolong life, but the distinction between ordinary and
extraordinary means, like that between acts and omissions, is itself under attack.
Critics assert that the wishes of the patient or, if these cannot be ascertained,
the quality of the patient's life provides a more relevant basis for a decision than
the nature of the means to be used.

Another central theme is that of patient autonomy. This arises not only in the
case of voluntary euthanasia but also in the area of human experimentation,
which has come under close scrutiny following reported abuses. It is generally
agreed that patients must give informed consent to any experimental procedures.
But how much and how detailed information is the patient to be given? The
problem is particularly acute in the case of randomly controlled trials, which
scientists consider the most desirable way of testing the efficacy of a new
procedure but which require that the patient agree to being administered randomly
one of two or more forms of treatment.

The allocation of medical resources became a life-and-death issue when hospitals
obtained dialysis machines and had to choose which of their patients suffering
from kidney disease would be able to use the scarce machines. Some argued for
"first come, first served," whereas others thought it obvious that younger patients
or patients with dependents should have preference. Kidney machines are no
longer as scarce, but the availability of various other exotic, expensive lifesaving
techniques is limited; hence, the search for rational principles of distribution
continues.

New issues arise as further advances are made in biology and medicine. In 1978
the birth of the first human being to be conceived outside the human body
initiated a debate about the ethics of in vitro fertilization. This soon led to
questions about the freezing of human embryos and what should be done with
them if, as happened in 1984 with two embryos frozen by an Australian medical
team, the parents should die. The next controversy in this area arose over
commercial agencies offering infertile married couples a surrogate mother who
 would for a fee be impregnated with the sperm of the husband and then surrender
 he resulting baby to the couple. Several questions emerged: Should we allow
 omen to rent their wombs to the highest bidder? If a woman who has agreed to
 ct as a surrogate changes her mind and decides to keep the baby, should she be
 llowed to do so?

The culmination of such advances in human reproduction will be the mastery of
genetic engineering. Then we will all face the question posed by the title of
Jonathan Glover's probing book What Sort of People Should There Be? (1984).
Perhaps this will be the most challenging issue for 21st-century ethics.