Biomedical Ethics and Philosophical Concepts
Human genetic enhancement is a method of changing gene sequences aiming to improve some qualities in human bodies with the help of genetic modification. Innovative strategies allow the modern population to take progressive steps towards disease treatment, susceptibility to various pathogens; to improve sport achievements and physical appearance. In the US, FDA has approved the first gene therapies and keeps supporting the development of new gene therapy products issuing guidance documents to set borders and set the structure of gene therapy. The major concerns of modern critics and analysts are if genetic enhancement is ethical when implemented on embryos and if such manipulations make these people treated as products. Genetic modification as an innovative way of disease treatment has to be developed but controlled by authorities; however, with the goal of doping and implementation on embryos, it must be forbidden and considered unethical.
Doping with gene products has to be forbidden as it can lead to unfair competition in sport. Some athletes can enhance their abilities and outcomes with the help of external sources. Gene doping is also hard to control and test as the sequence of genes can be both inherited and taken parenterally. López et al. expressed a negative position regarding the usage of gene products among healthy humans to improve sports performance and managed to develop detective methods in sports doping. Physicians face ethical obstacles in allowing sportsmen to use doping as they face the need of the patient to perform well and improve his abilities with the principle of nonmaleficence.
Germline’s genetic enhancement must be illegal because it faces unsolved issues as the moral rights of the embryo, the legal status of the enhanced individual, and the responsibility of people implementing the enhancement. Some authors claim that gene modification can lead to procreative beneficence, genetic disassociation, gender selection, and disability decrease. However, such authors do not consider the possible interaction of new genes with genetic sequence from birth. Gene therapy has to be controlled by the state and used for limited indications such as disorders impacting life quality.
Active and Passive Euthanasia
Euthanasia is a form of an assisted death by a physician, and it can be either active or passive. Active euthanasia occurs when a patient decides to die with the help of a doctor. Passive euthanasia is the withdrawal of the treatment by the physician leading a patient to death, and it is not practiced in the U.S. anymore. Active euthanasia can exist and correspond with ethical principles if occurred by the will of the patient in his clear consciousness and if allowed everyone to choose in the framework of their morale.
With active euthanasia, both patient and a doctor are still facing harsh ethical difficulties when deciding on life-ending interventions. The patient in clear consciousness has a right to decide for himself and relies on the principle of autonomy sharing with a doctor his opinion. The physician struggles between principles of nonmaleficence, beneficence, and informed consent, and autonomy. For the doctor, it is a fighting moment between making no harm to the patient and respecting his choice. The method of euthanasia is also facing various ethical questions. Yun et al. surveyed patients with cancer, their relatives, physicians, family caregivers, and the Korean population regarding the issue of five life-ending interventions: active pain management, removal of life-sustaining therapy, active euthanasia, passive euthanasia, and physician-assisted suicide. As a result, active pain control and removal of life-sustaining treatment were favored by all the surveyed groups, and with other methods, participants expressed various opinions. It is important to develop strategies respecting the rights of every human participating in the situation related to euthanasia method.
Some doctors and medical workers are struggling with euthanasia acceptance due to religious beliefs and meet obstacles with implementing the method. Several researchers investigated the complications hospice nurses face due to political ideology and religiously and identified these factors that directly impacted their negative attitude to the method. It is indeed hard to decide if any type of euthanasia is morally correct; however, it will be improper to take away the decision of personal life outcome from a patient. To achieve balance in conclusions regarding euthanasia, it is essential to develop strategies allowing both patients and medical workers to make a choice.
Bioethics of Engelhardt
Professor H. Tristram Engelhardt in his various works such as “The Foundation of Bioethics” and “Bioethics and Secular Humanism: The Search for a Common Morality” discloses the view of morality from a different side. Engelhardt claimed ethics faced multiple contradictions as the person always struggled between the right and the self-benefit, and between the explanation of morale and the motivation of making the right decision. It is hard to disagree that morale is always a hard choice made by the quintessence of a person’s immovable beliefs, benefits, and religion.
However, individuals’ perceptions and morale can be flexible when it is important to understand others. Some analysts claim that Engelhardt proposed too straight ideas limiting the abilities of people to share morale and comprehend each other. For instance, Shahram Ahmadi Nasab Emran stated content-full secular ethics is possible, and morale can unite people of various traditions, beliefs, and views. Indeed, if people have a will to shift their paradigm towards understanding the opinion of others, they can accept the morale of another person.
Jehovah’s witnesses, due to their religion, cannot accept a blood transfusion. However, some of them are willing to break the religious rule persuaded by doctors to save the life of their close ones. Engelhardt has developed a philosophy that deserves attention and rethinking; nevertheless, some of his philosophy’s aspects can be debated and proved wrong. People’s beliefs and perceptions can change and deviate due to the life experience and opinions of others.
Death by Dehydration
Patients have a full right to decide the specialties of their treatment, the confidentiality of the data regarding their disorders, and the outcome of their therapy. However, on some occasions, they can misinterpret or underestimate the actual flow of events. A 46 year-old-female with emphysema and hernia refused treatment at the hospital and decided to kill herself with dehydration. The patient refused to take any liquids and stated that she decided to die. Physicians tried talking to her disclosing the severity of her condition and the positive chances on life duration. Despite all the communication, the patient did not change her mind. On such occasions, it is essential to attract other specialists stating the objectivity of the decision-making: psychologists and psychiatrists and to refuse the decision of the patient.
Stating the clear consciousness of the patient is an important step leading to an understanding of the motives of the behavior. According to law legislation, the positive statement of two psychiatrists has to be done, along with an evaluation system of the patient, and a two-track approach. The other obstacles physicians face after the possible rejection of euthanasia request is treatment prolongation, proper communication with the patient, and the patient’s acceptance of the doctor’s advice. Most of the times patients misbehave and keep refusing treatment focusing on their initial idea. Patients with totally cured disorders or pathologies that may be led in remission cannot be accepted with a will to commit suicide. Medicine is tolerant towards active euthanasia when it has a certain aim as for terminal patients suffering from pain. Drawing a line between these two aspects is important for everyday doctor practice.
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“FDA Continues Strong Support of Innovation in Development of Gene Therapy Products.” U.S. Food & Drug Administration. Web.
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Yun, Ho Young, Kyoung-Nam Kim, Jin-ah Sim, Shin Hye Yoo, Miso Kim, Young Ae Kim, Beo Deul Kang et al. “Comparison of Attitudes Towards Five End-of-Life Care Interventions (Active Pain Control, Withdrawal of Futile Life-Sustaining Treatment, Passive Euthanasia, Active Euthanasia and Physician-Assisted Suicide): A Multicentred Cross-Sectional Survey of Korean Patients with Cancer, Their Family Caregivers, Physicians and the General Korean Population.” BMJ Open 8, no. 9 (2018): 1-12. Web.