Bioethics is the study of moral issues in the fields of biology and health.
Always complex and controversial, the field of bioethics has grown even more so with the advent of advanced technologies and treatments. The mechanical respirator and the heart-lung machine have blurred the line between life and death. The legalization of morningafter pills and the abortion drug RU-486, approved for use in the United States in 2000, have intensified the already volatile abortion debate. In vitro fertilization techniques to help infertile couples conceive raise a host of ethical issues including how couples should choose sperm or egg donors, and what to do with fertilized eggs not implanted. Ethicists are also concerned with how scarce and expensive advanced treatments, such as in vitro fertilization, organ transplants, and the antiretroviral AIDS treatments should be distributed throughout society.
The rapidly evolving field of genetic engineering in particular, is introducing some of the greatest challenges ever faced in bioethics, as humans develop the ability to affect changes to living matter that were beyond imagining in the past decade or two. Current areas in experimental genetics of interest to bioethicists include:
- Cloning. The year 1997 marked the birth of the first clone, a sheep named Dolly produced from a cell of an adult female sheep. Since then hundreds of animals have been cloned, including bulls, cows, mice, monkeys, and pigs. Even clones of clones have been produced. The cloning controversy is multifaceted, with much of the controversy centered on the potential technical feasibility of cloning humans, although animal rights activists and others are also concerned that a substantial majority of cloned animals surviving to birth have significant birth defects. Humans should never be exposed to such risks, argue opponents of human cloning research. Some opponents fear a future in which cloning technology is used by narcissistic parents to custom design their offspring, while proponents see human cloning as a potentially useful technique to treat infertility or avoid known hereditary traits for disease. Several U.S. states have banned human cloning.
- Stem cell research. Stem cells, which are undifferentiated cells that give rise to specialized cells throughout the body, are considered one of science's best tools for finding cures for many diseases, as well as for developing bioartificial blood, skin, and organs that will not be rejected by the body. Stem cell research is currently hampered by the controversy surrounding the source of the cells, which are sometimes culled from aborted fetuses or from embryos left behind after fertility treatments, or are produced using cloning technology. Some religious groups such as the Roman Catholic Church condemn the use of human embryos for research, and Congress has passed restrictions on federal funding of embryonic stem cell research.
- Gene patenting. Advances in genome research wrought by the Human Genome Project and others have led many individuals and institutions, public and private, to apply for patents on genes and gene combinations. Many fear the patenting of genes may make genetic testing of patients prohibitively expensive. Although it will be technically possible in the not-too-distant future to analyze patients' genomes in the primary care environment and provide them with information about their future disease risk, this technology will not be economically feasible if it requires payment of multiple license fees.
- Genetic testing. Controversial genetic tests in use for several decades allow parents to learn about genetic diseases like sickle-cell anemia prior to birth. An experimental technique known as preimplantation genetic diagnosis gives couples even more control, enabling genetic analysis of embryos created through in vitro fertilization before they are implanted in the uterus. Many fear this technique may one day be used not just to pinpoint genetic diseases, but also to choose embryos with more desirable attributes. Other genetics tests that pinpoint flawed genes, and predict one's drug responses and vulnerability to disease offer numerous potential benefits, but ethicists are concerned about how this information will be used. Employers or insurers may use such information to discriminate, for example.
A multitude of viewpoints exist regarding every area of health care influenced by bioethics. While some individuals believe bioethics results in legislation that unnecessarily impedes the progress of science (for example, it is costly and time consuming for researchers to comply with informed consent laws), most recognize the need for at least some bioethical guidelines (the costs of compliance pales in comparison to the safeguard of informed consent on human subjects). Some individuals believe the field of bioethics is increasingly important as research technologies develop with the potential to strip away human privacy, and even to alter the definition of human life. Private and public healthcare organizations have attempted to present ethical guidelines for practitioners. For example, the American Medical Association's Council on Ethical and Judicial Affairs sets ethics policy for the American Medical Association (AMA), and AMA's Institute for Ethics investigates how professional ethics can be integrated into health care. Other organizations such as the American Association of the Advancement of Science, take formal positions on various bioethical issues to guide health care practitioners and the general public. Also, the U.S. Department of Energy and the National Institutes of Health devoted 3% to 5% of their annual Human Genome Project budgets toward study of the bioethics of genetic information, making theirs the world's largest bioethics program.
Because many of the current technologic advances in health care, including the advances in genetics, offer tremendous risks in addition to potent opportunities to predict and treat human diseases, there is a need for practitioners to main a bioethical framework in their use of these technologies, if they are to adhere to their professional oaths.
Cloning—The production of an organism that is genetically identical to its parent.
Deoxyribonucleic acid (DNA)—The genetic material of all cellular organisms and most viruses. DNA carries the information needed to direct proteins. Each molecule of DNA consists of two twisted strands, called a double helix.
Embryo—The initial developmental stage of human offspring following conception. After the eighth week an embryo is classified as a fetus.
Gene—The basic unit of heredity found in the cells of all living organisms, from bacteria to humans. Genes determine the physical characteristics that an organism inherits, such as hair and eye color.
Genetic engineering—Altering the genetic structure of an organism to provide it with traits deemed useful or desirable.
Hippocratic Oath—An oath taken by physicians to observe the ethical standards of their profession.
Human Genome Project—An international scientific collaboration that seeks to understand the entire human genetic blueprint.
In vitro fertilization—Fertilization of an ovum by sperm outside the body, and subsequent implantation in the womb.
Patent—A grant issued in the name of the United States under the seal of the Patent and Trademark Office, that gives the applicant exclusive rights related to ownership.
Stem cell—An undifferentiated cell from which specialized cells develop.
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American Medical Association. The Council on Ethical and Judicial Affairs. 515 N. State Street, Chicago, IL 60610.(312) 464-4823. <http://www.ama-assn.org/ama/pub/category/2498.html>.
ANA, American Nurses Association, 600 Maryland Avenue, SW, Suite 100 West, Washington, DC 20024. (800) 274-4ANA. <http://www.nursingworld.org>.
American Society for Bioethics and Humanities. 4700 W. Lake, Glenview, Il 60025-1485. (847) 375-4745. Fax:(877) 734-9385. <http://www.asbh.org/>.
The American Society of Human Genetics. 9650 Rockville Pike, Bethesda, Maryland 20814-3998. (301) 571-1825. <http://www.faseb.org/>.
Center for Bioethics at the University of Pennsylvania, Suite 320, 3401 Market Street, Philadelphia, PA 19104-3308.(215) 898-7136. <http://bioethics.org>.
National Bioethics Advisory Commission, 6705 Rockledge Drive, Suite 700, Rockville, Maryland 20892-7979. (301) 402-4242. <http://www.bioethics.gov>.
National Coalition for Health Professional Education in Genetics. (410) 583-0600. <http://www.nchpeg.org>.
NSNA, National Student Nurses Association, 555 West 57th Street, New York, NY 10019. (212) 581-2211. <http://www.nsna.org>.
The International Society of Nurses in Genetics. <http://nursing.creighton.edu/isong>.
Human Genome Project Information. Ethical, Legal, and Social Issues. <http://www.ornl.gov/hgmis/elsi/elsi.html>.