FREE ESSAY ON MEDICAL ETHICS

MEDICAL ETHICS

Medical Ethics ? Bioethics comprise every possible aspect of health care, medical, moral,
social, political, religious, legal and financial? (Weiss 3). This includes the questions
raised by new research. It takes a look at the results of that research that is used on
patients. It takes into consideration contemporary ideas of personal freedom and human
dignity. It deals with growth in medical services available in the United States and the
sky rocketing cost. Bioethics also deals with the medical advances in technology that has
reshaped traditional medical ethics. Medical ethics have changed drastically over a
period of years. From old commandments to new commandments, guidelines that provide
structural framework, classic experiments that challenge that framework, or even how
things are defined in medical ethics. ?Medical progress goes on, and the perils of
progress must be heeded? (Leone 165). Changing times have in turn changed our codes of
ethics. There are five old commandments of ethics and five new commandments of ethics.
These commandments come from many years of heavily advised dictates from various people.
A commandment by definition is, ? ... a dictate or a strongly advised piece of advice?
(Halsey 201). The first traditional commandment is, ? Treat all human life as of equal
worth? (Singer 190). This statement is very difficult to follow; almost no person
believes this statement whole-heartedly. The statement makes more sense on paper or just
being heard, but its application in life is almost impossible to ensure. In comparison to
the first old ethic, the first new ethic states, ?Recognize that the worth of human life
varies? (Singer 190). This statement allows for variation and livability in society. It
gives way for someone to say, if a person is a vegetable, has no vital capabilities, this
person?s life is of no worth anymore. Without this sort of change in today?s advancing
civilization, it would make it ethically wrong to ?pull the plug? (Rothstein 1698.) The
next commandment of old ethics is, ? Never intentionally take innocent human life?
(Singer 192). If a doctor or any health care professional just stood by during the birth
of a child and both the child and the mother were dying, how could that doctor stand
there and watch both the mother and the infant die without taking some method of action.
However, if that physician were to save either patient while sacrificing the life of the
other, that health care professional would be considered unethical and scorned by the
standard of this ethical commandment. In comparison, the new commandment states, ?Take
responsibility for the consequences of your decisions?(Singer 195). By the token of this
declaration a physician can make a choice based on his/her best judgment, yet; be held
accountable for their actions. This gives a doctor the power to use his/her best judgment
and knowledgeable skills, to do what they believe is best for the patient. This statement
allows for a person?s right to free will, even a person who is a Christian may more fully
agree with this statement just for the pure reason that they want to believe more in
God?s promise of free will in their life. Commandment number four states,? Be fruitful
and multiply? (Singer 198). This biblical injunction has been a part of Christian ethics
for thousands of years. ? Augustine said that sexual intercourse without procreation `
turns the bridal chamber into a brothel?? (Singer 198). Some laws in America concerning
contraceptives survived until the mid- 1960?s when the Supreme Court declared them
invasion of privacy (Madsen 325). The revised commandment number four, ?Bring children
into the world only if they are wanted? (Singer 199), allows for population control as
well as prevention of children who were never wanted and not loved. From 1930 when the
population was two billion to today where the population is over five billion and is
expected to rise above eleven billion by the middle of the next century. With these kinds
of statistics revised dictates, such as this fourth one, are essential. The final of
these five old commandments state, ? Treat all human life as always more precious than
any non-human life? (Singer 201). If we compare a severely defective human infant with a
non-human animal, a dog or a pig, for example, we will often find the non-human to have
superior capacities, both actual and potential, for rationality, self-consciousness,
communication, and any other that can plausibly be considered morally significant?
(Singer 201). This remark was made during the Baby Doe controversy of the Regan
administration. However, in Germany an organization called Lebanshilfe, an organization
for parents of intellectually disabled infants has adopted a set of Ethical Foundational
Statements one of which is, ?The uniqueness of human life forbids any comparison - or,
more specifically, equation - of human existence with other living beings, with their
forms of life or interests? (Singer 202.) The revised counterpart to this commandment
states, ? Do not discriminate on the basis of species? (Singer 202). This revised ethic
is the one most rejected; it contradicts the fact all human life is of worth and is more
sensitive in most people. This sets forth the same message that a sexist or racist would
hate, because you are not part of my group you are inferior. These ethical commandments
or dictates provide a framework for today?s unstable society. The American Medical
Association has devised a set of codes designed to guide researchers in their conduct
during experimentation. The American Medical Association?s Ethical Guidelines for
Clinical Investigation include:1. The voluntary consent of the human subject is
absolutely essential.2. The experiment should be such as to yield fruitful results for
the good of society, unprocurable by other methods or means of study, and not random or
unnecessary in nature. 3. The experiment should be so designed and based on the results
of animal experimentation and a knowledge of the natural history of the disease or other
problem under study that the anticipated results will justify the performance of the
experiment.4. The experiment should be so conducted as to avoid all unnecessary physical
and mental suffering and injury.5. No experiment should be conducted when there is an a
priori reason to believe that death or disabling injury will occur; except, perhaps, in
those experiments where the experimental physicians also serve as subjects.6. The degree
of risk to be taken should never exceed that determined by the humanitarian importance of
the problem to be solved by the experiment.7. Proper preparations should be made and
adequate facilities provided to protect the experimental subject against even remote
responsibilities of injury, disability or death. 8. The experiment should only be
conducted by scientifically qualified persons. the highest degree of skill and care
should be required through all stages of the experiment of those who conduct or engage in
the experiment. 9. During the course of the experiment the human subject should be at
liberty to bring the experiment to an end if he has reached the physical or mental state
where continuation of the experiment seems to him to be impossible.10. During the course
of the experiment the scientist in charge must be prepared to terminate the experiment at
any stage, if he has probable cause to believe, in the exercise of good faith, superior
skill, and careful judgment required of him, that a continuation of the experiment is
likely to result in injury, disability, or death to the experimental subject (Levine
171-74)Such codes form a conceptual framework for the protection of human subjects.
However, these guidelines are very vague for use in actual practice; clearly human
experimentation includes much more than just the technical aspects. It includes mental,
physical and emotional perspectives that can not be covered on a sheet of paper; the
purpose of a structured written set of guidelines is totally to provide a rulebook by
which researchers follow in order to be ethically correct. A researcher gains information
through experimentation and they must have these guidelines (McKenzie 287). An example of
how these guidelines can assist, but not be of complete structure would be the cancer
injections. The Sloan-Kettering Institute in New York is one of the country?s preeminent
cancer centers. During the 1950?s and 1960?s they conducted a series of experiments to
determine if there was a relationship between cancer and the immune system. The
experimental hypothesis was that, ? the immune system of cancer patients is depressed
with respect to that specific disease? (Levine 172). The scientists developed a program
to test the hypothesis; it was to inject malignant cancer cells into human subjects. We
do not know whether the volunteers were really being experimented on under strictly
voluntary conditions or not, but that is the problem with written guidelines, they work
on paper, but not necessarily in life (Levine 173). Must we experiment on human beings?
If so, what human experiment categories are ethically correct? Human experimentation
falls into three divisions, the first of which is, ? Experiments that the researcher
carries out on him or herself ? (Weiss 34). A traditionally excepted example of this was
conducted over one-hundred years ago by a scientist set on disproving the fact germs
cause disease, The way he decided to prove his idea was to swallow a beakerful of cholera
germs. However, he had a natural immunity to cholera; he did not become ill. It was
concluded that he had a natural immunity, because it was later proven that cholera is a
very harmful germ and if ingested it will cause a person to become ill (Weiss 35). The
second category states, ? Experiments carried out on the sick in the belief that the
experiment will help them, or on the healthy in the belief that the experiment will keep
them well? (Weiss 35). The classic procedure that demonstrates this category is the
experiment of the French scientist Lois Pasteur. In 1885, a distraught mother brought her
nine-year old son to Dr. Pasteur. A dog with rabies had bitten the boy, and the mother
had heard that Pasteur had developed a vaccine that prevented rabies in dogs. The mother
begged Dr. Pasteur to administer the vaccine; he was hesitant and then he obeyed the
mother?s wishes and injected the boy, the boy survived the deadly rabid dog bite (Weiss
35). The third group of ethical experimentation is,? Those conducted on the sick or
healthy with no intention of helping those people directly? (Weiss 36). These tests are
conducted to gain information at a later time. New prescription drugs and new-products
fall under this category. These research guidelines have been in existence for years upon
years and serve a very practical purpose, to protect everyone who may become sick or of
life threatening condition, with these guidelines a doctor can try to aide a person
within these specifications.The legal aspects of ethics are definitions. How things are
defined in ethical terms; a few of the more controversial definitions include brain
death, vital signs, death itself, and what a person or human being is. Brain death can be
defined as,? when no oxygen is reaching the brain? or more complexly as,? ... the
cessation of brain activity at both cortical and lower levels even though heart and
respiratory functions can be maintained mechanically...? (Madsen 324, Hudak 371.)
However, brain death can be put into more than thirty sets of criteria. (Infopedia) Death
can be defined in two ways in the ethical standpoint, first as,? The cessation of life;
the ceasing to exist? or as ? the total stopping of circulation of blood and cessation of
animal and vital functions? (Singer 21). Death is a very important definition in ethics,
with all of our technological advancements we can sustain a person artificially and we
need to be able to tell when all hope is lost or a person is dead. A vital sign is,?
Temperature, pulse, and respiration?s in a person? (Du Gas 158). A vital sign can be,?
... increasing anoxia; the pupils become dilated and fixed. Low blood pressure and
elevated temperature, and rapid respiration rate are often seen also as a sign for a
nurse in a recovery situation? (Wagman 337) Medical progressions have significantly
increased life expectancy and have also improved quality of life in numerous ways. From
organ transplants that save thousands of lives to new machines that can detect
life-threatening problems. Organ donors provide the very rare and greatly needed, very
rare matches needed for organ transplants. ? Cadaver donors grant permission to donate
their organs after they have died. Sometimes permission is granted by the family of the
deceased after their relative has died? (Weiss 18). Cadaver donors make up over three
fourths of the donors (Hudak 370). There are also the living donors. As the name
indicates, a living related donor is a donor from within the family. The possibility of
having a HL-A compatible donor, a tissue match, from within the family should be explored
for every potential recipient. The possible combinations include: A 4-antigen match, also
called an HL-A identical match, which would have to be a sibling of the potential
recipient; a 3-antigen match, which is uncommon since the antigens are usually inherited
in pairs or haplotypes; and a 2-antigen match, which is the most frequently seen
compatibility. The presence of four completely different antigens is considered a
complete mismatch, and is not a desirable situation for a transplant to be performed,
since no similarity exists between the tissues (Hudak 370).Once a potential donor is
identified, he/she has a thorough medical evaluation to determine that he/she is free of
other disease, that he/she has two kidneys, and that donation could no obvious way
jeopardize his/her well being. Once this evaluation is successfully completed, a living
relative transplant may be performed (Hubak 370). A second type of medical advance is, ?
Emission Tomography- this allows doctors to tell in which parts of the brain blood is and
is not flowing? (Singer 43). If blood is not flowing to the cortex, then- even though the
brain stem might still be functioning and so the patient would not be brain dead and
would also never regain consciousness. (Singer 43) This allows a doctor to conclude
whether a patient has a chance to recover from a vegetative state or not. Doctors use
this technique to assess if surgery would be a possibility or whether this person has no
chance of survival; they can establish a base for a family so that they can make
appropriate decisions. Invitro fertilization is another form of medical advance that has
changed the thinking of traditional ethics. Invitro fertilization is when sperm is taken
from a male donor and an egg is taken from a female donor; the sperm is then implanted
into the egg and then placed into the women?s uterus. There are many ethical standpoints
on invitro fertilization, whether it is right to create a child by manipulating mother
nature and using medical technology. Should we use medical science to change what comes
naturally in nature (Wall 467)? Also, is invitro fertilization a safe method, on many
occasions more than one sperm is placed into the egg, creating multiple pregnancies? With
the recent birth or the sextuplets it leaves some in the medical community wondering
whether we have gone to far. ? When you have multiple births you have greater risk for
complications, it leaves me wondering if the risk is worth it or not?? (Jones R.N.) ?
More progress has been made in medical science in the first seventy years of this century
than in the entire previous history of man - and the door to knowledge has hardly begun
to open? (Collin 164). With so many new inventions and technologies being developed every
day the more each person needs to be aware of how our medical ethics are being changed
and what is being done to cope with those changes. Do new codes, dictates or
commandments, and guidelines required to provide a structure in the medical community
need to be developed? What types of precautions are being taken to check out the
experiments being performed? Medical ethics are not just an important factor they are an
essential factor in our changing contemporary society. The future of this generation?s
children and grandchildren depend on what specifications are being made in the present.
.
Bibliography
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