Ethical Principles, Individual Rights, and Medical Practices

By Macklin, Ruth | National Forum, Fall 1989 | Go to article overview

Ethical Principles, Individual Rights, and Medical Practices


Macklin, Ruth, National Forum


Ethical Principles, Individual Rights, and Medical Practices

Attention to the ethical aspects of medical practice has exploded in the past twenty years. Because of the development of high-technology devices and procedures, much of that attention has focused on the more dramatic ethical problems in medicine. Premature infants weighing as little as 700 grams at birth (about one and one-half pounds) can be kept alive in the neonatal intensive care unit. But they face the prospect of severe lung damage from artificial ventilation, as well as extensive neurologic impairment resulting from brain hemorrhage. Is there a moral imperative to prolong the lives of such infants? Or should the "quality" of those lives somehow be balanced against the value of preserving life? Furthermore, who should make these decisions? Should parents of imperiled newborns always have the final say, or may parental authority be overridden when their decisions are clearly against the best interest of the child?

The ability to transplant organs, such as kidneys, hearts, and livers, has saved the lives of many people who otherwise would have died. Yet despite the success of this surgical procedure, organ transplantation poses the difficult problem of allocating scarce resources. There are always more patients with kidney, liver, or heart failure than there are available organs for transplantation. What is the most just way of distributing these genuinely scarce medical resources? What criteria should be used for selecting recipients of organs? And should patients who have failed one transplant remain on the list to receive a second, or even a third organ?

Scientific advances in molecular biology have led to the ability to combine genetic material in new ways--the technique known as "gene-splicing." There are already a number of diagnostic tools, as well as genetically engineered products--such as synthetic human growth hormone--and many more are on the horizon. But controversy exists about whether it is ethically permissible to perform the type of gene therapy that would alter genes passed on to patients' offspring and future generations. And even deeper reservations have been voiced over the use of genetic engineering to enhance "normal" people, as opposed to remedying recognized genetic defects. Would it be wrong to develop genetic techniques that could make people taller, smarter, stronger, and more attractive?

As a final example of technological advances that have produced new ethical dilemmas, consider artificial modes of reproduction. The ability to fertilize human eggs in a dish (in vitro) as well as in the traditional way, and the possibility of freezing human embryos for later use, have led to a host of questions that never had to be faced earlier. Is it permissible to do research on human embryos? What should be done with frozen embroys that the couple who produced them no longer wants? How should the traditional medical requirement of obtaining informed consent apply to the disposition of embryos, a woman's donation of her eggs for use by another woman, or the vexing practice of surrogate mother arrangements?

Dramatic issues typically command more attention than those perceived as ordinary or routine. But the ethical concerns raised by disability and handicap, chronic illness, and rehabilitative medicine, are no less important or difficult than those in the acute care setting. Although the need to make life-and-death decisions is less frequent outside the intensive care unit and the tertiary care hospital, caregivers as well as chronically ill or disabled persons and their families confront a range of ethical decisions about care and treatment. The ingredients of decision making, and the ethical principles available for resolving them, are no different in the areas of rehabilitation and long-term care from those in the more dramatic, attention-grabbing areas of medical practice.

But although moral principles exist to assist us in our efforts to resolve dilemmas that arises in practice, a conflict of principles is often the very source of those dilemmas.

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