PHI 227 Biomedical Ethics

Definitions and background information

1. Therapeutic vs. nontherapeutic interventions
   1. Therapeutic: curing a disease or restoring the patient to the best state of health possible.
   2. Nontherapeutic or enhancement genetic engineering: to improve on a healthy body.
2. Somatic-cell vs. Germ-line interventions
   1. Somatic-cell interventions:
      1. Introduce changes into non-reproductive cells
      2. The genetic changes are not passed to the future generations
   2. Germ-line interventions:
      1. Introduce changes into reproductive cells
      2. The changes are passed to the new generations
3. The Human Genome Project
   1. Started in the 1980s
   2. Label and map all the human genetic code
   3. Once a gene has been located, it is hoped that tests can be developed for its presence
   4. Limitations
      1. Location of the genes only
      2. Organization and how messages are transmitted are still little known.



Genetic testing

1. Advantages
   Can be used to get information about a medical condition that runs in a family and its inheritance Gives prospective parents the chance to make an informed choice about whether or not to have children.
2. Disadvantages ` Possibility of discrimination
   1. Insurance
   2. Employment
   Possibility that parents will forego having children who are likely to be affected with minor but tolerable and treatable conditions. Knowledge of one's genetic make-up may cause a person distress Stigmatization of those who are diagnosed as carrying genes that are thought to predispose one to crime, or alcoholism, overlooking the fact that environment plays a role in these types of behavior.



Somatic-cell genetic therapy

1. Advantages Treatment for genetic disorders such as cystic fibrosis
2. Disadvantages The virus that is used to carry the new gene may have undesirable effects It may still be passed to future generations Patients may build resistance to the new gene
3. Moral issues: it is the least objectionable of genetic interventions Some say it is playing God



Germ-line genetic therapy

1. Advantages Modifications are permanent Therapy is concluded More precise than somatic-cell therapy
2. Disadvantages It is risky: scientists do not know how genes interact, removing a gene may have undesirable effects,e.g.,
   1. People who have only one copy of the gene for sickle-cell anemia are protected against malaria
   2. People who carry one copy of the gene for cystic fibrosis are protected against cholera
   Any mistakes will be passed to the future generations It is expensive
3. Moral issues Arguments in favor of germ-line gene therapy
   1. Health care professionals are under the obligation to use the best available methods to treat their patients
   2. Parents have the right of access to available technologies
   3. Freedom of inquiry
   Arguments against
   1. Risks outweigh benefits
   2. Pressure to use it for enhancement
   3. Outside the scope of medicine whose mission is to save lives, cure diseases, and relieve suffering.
   4. Risk of degenerating into eugenics
   5. The new generations will have not participated in the original decision and may not agree with it



Questions about the readings

1. Executive Summary: Cloning Human Beings
   
   1. The National Bioethics Advisory Committee members distinguish between "cloning human beings" and "cloning a human being." What is the difference?
   2. Why are the members of the committee careful to distinguish the two?
   3. Why do they think that allowing the cloning of a human being is not wise?



2. Kass, "The Wisdom of Repugnance"
   
   1. What does Kass object to the majority of bioethicists?
   2. Is the repugnance against cloning an argument? If not, what is it?
   3. To what does Kass compare the repugnance to cloning? Is the analogy justified?
   4. What are the dangers of cloning according to Kass?
   5. Is it possible to ensure that Kass's predictions do not come true? How?



3. Brock, "Cloning Human Beings: An assessment of the Ethical Issues Pro and Con"
   
   1. What rights, according to Brock, would be violated by cloning? Banning cloning?
   2. According to Brock, what is the only way in which a clone's right to an open future is taken away?