New Challenges in Bioethics: Medicine, Technology, and Justice

Article excerpt

All of us, as citizens and as family members, face striking challenges posed by the intersection of medicine, health care, and biotechnology. This is not news. What may be less well understood is that a broad range of professions will be called upon to respond to those challenges, including, but not limited to, health professionals and life scientists.

Two distinct sorts of challenges will be important in the foreseeable future. The first concerns the responsible use of the powers conferred by science and technology. The second deals with less exotic but no less important problems of access, distribution, and justice.

Responsibility requires the possibility of choice and action. A simple enough proposition: We can only hold a person ethically responsible for something if she or he had been able in some way, at some time, to intervene and alter the course of events. Whether one chooses to intervene or not is not the crucial factor; failing to act when one could have can, under the right circumstances; make a person fully worthy of moral praise -- or condemnation. What is crucial is the possibility exercising moral judgment and action.

TECHNOLOGY AND MORAL DILEMMAS

The key to understanding the grain of truth in the bromide "technology creates moral dilemmas" lies in appreciating the connection among moral responsibility, the possibility of intervention, and the need to choose whether and how to intervene. Many -- not all, but many -- of the ethical issues worthy of our attention in medicine and the life sciences arise because technologies create new possibilities to intervene and, hence, the need to make choices, sometimes very difficult ones.

The respirator, now ubiquitous in hospital intensive-care units, was, half a century ago, a novel machine intended to carry patients through the hours or at most a few days after surgery when their bodies were not able to breathe effectively on their own. Some patients, however, did not cooperate. With the respirator's help they could continue to breathe. Take the machine away, though, and breathing became an insurmountable, indeed lethal, challenge.

Ethical questions multiplied rapidly. When is continuing on a respirator in the patient's best interest? When, if ever, is it not? Who should decide whether to continue or discontinue respirator treatment: the physician? the patient? the patient's family? What if there are more patients able to benefit from the respirator than there are machines to go around: how should we allocate such a scarce, life-prolonging resource? Should we simply build all the respirators anyone could conceivably use? Would the money necessary to buy those machines and staff the ICUs needed to house them be better spent on other forms of therapy, on preventive care -- or, for that matter, on schools, accident-prevention programs, or for other social purposes? What if the resource itself were tragically scarce, such as hearts or lungs? We cannot increase the supply by scaling up production, yet the supply of transplantable organs falls far short of the need. How aggressive should we be in trying to increase the number of organs available for transplantation? How can we allocate fairly the organs that we obtain?

Scholars in medicine, science, philosophy, theology, and law began asking questions about the ethical implications of science and technology well before the interdisciplinary field of Bioethics coalesced. But coalesce it did. Most commentators date the birth of Bioethics to 1969. In that year, The Hastings Center was founded, devoted to the study of ethical issues in medicine and the life sciences. A few years later, the Kennedy Institute of Ethics was organized at Georgetown University. Nearly a quarter of a century later, scholars have dismissed a large number of possible answers to the litany of questions above, mostly because those answers were conceptually incoherent, irredeemably confused, or morally indefensible. …