Bioethics

1. Bioethics Dr. Chan Ho Mun Associate Professor of Philosophy Dept of Public & Social Administration City University of Hong Kong June 26, 2006

2. What is Bioethics? • The term “bioethics” was introduced in the 70’s by Van Rensselaer Potter for a study aiming at ensuring the preservation of the biosphere. • It was later used to refer a study of the ethical issues arising from health care, biological and medical sciences. • It is a major area in applied ethics.

3. The emergence of this new area of study has been triggered by and a response to the new scientific/technological developments in biomedical and life sciences. • Medical ethics and nursing ethics are more concerned with the ethics of the health care professionals and their relationship with the patient. Bioethics has a broader scope.

4. Some historical examples • Abortion • Contraception • Kidney dialysis machine (Who had the priority?) • Organ transplant, artificial ventilator, and brain death • In virtro fertilization (IVF) • Cloning and stem cell research • Genetic engineering

5. Main topics in Bioethics • Death and dying • Pre-birth Issues • Issues in human reproduction • Human cloning • Stem cell research • The new genetics

6. Resources allocation • Organ transplant • Doctor-patient relationships • Experimentation with human subjects & animals • (The above list is not exhaustive.)

7. Human Reproductive Technologies (HRT) • Contraception: sex without procreation • HRTs: procreation without sex

8. Types of HRTs: • Artificial insemination by husband (AIH) • Artificial insemination by donor (AID) • In virtro fertilization (IVF) • Egg donation • Embryo donation • Surrogacy

9. Ethical considerations (see references 6,7, 10): • Procreation rights of infertile couples • It is unnatural • Inequality and exploitation • Selling babies? • The moral status of extra embryos left over from IVF • Definition of parent-child relation • Integrity of the family • Best interests of the child

10. Human Cloning • Two techniques: • Embryo splitting • Nuclear substitution • Embryo splitting • The clone is usually used for tests of abnormality, and will be destroyed subsequently.

11. Nuclear Substitution • What is the relationship between the nuclear donor and the clone? • The same person? • (Technologically-aided and birth delayed) identical twins? • Siblings? • Parent-child? • Should a homosexual be allowed to use the technology to obtain his/her own child?

12. Is it moral alright for parents to clone their beloved children who die young? • Should it be used as an infertility treatment or gene therapy if it is safe? • No third party is involved. • According to the parent-child ordinance in HK, whoever gives birth to a baby is its mother, and the husband who goes through the infertility treatment with her is his father. • Yet, human cloning has been banned by the HRT Ordinance.

13. Stem Cell Research • Stem cells: undifferentiated, multi-potent, precursor cells, capable of developing into virtually any body tissue. • Three types of stem cells: • Embryonic stem cells (ESC) • Fetal stem cells • Adult stem cells

14. Three main sources: • Adult bone marrow • Miscarried or aborted embryos/fetus; extra embryos left over from IVF • Embryos from therapeutic cloning • Potential Treatments: • They may be used to replace damaged organ tissues (e.g., cardiac tissues), repair irreversible injuries (e.g., spinal cord injuries), or cure diseases (e.g., Parkinson’s and Alzheimer’s diseases).

15. ESC is most promising for treatment, and therapeutic cloning can avoid the problem of immunological incompatibility. • Ethical issues: • Destroying an embryo to harvest ESC is equivalent to killing a child to obtain his organs. • Left-over from IVF are already there. • Therapeutic cloning: The embryo is not created for reproduction. • How about the wellbeing of many patients who may be cured by ESC research?

16. The New Genetics • Gene testing • Create unnecessary psychological distress • Discrimination by employers and insurance companies • Confidentiality and Privacy • Social stigmatization

17. Prenatal Screening • Sex selection: Gender discrimination and imbalance of sex ratio unless it is done solely for therapeutic purpose. • Discrimination: Lives of the disable are not worth living.

18. Genetic Engineering • Is it a form of eugenics? • Germ-line changes, unlike somatic modification, can pass onto the next generation and be with us forever. So germ-line changes could be very risky. • Is genetic enhancement moral? • See reference 10.

19. Doctor-patient relationships • Who has the final authority in medical decision making? The patient, the family or the individual? • Three models: • Individualism • Familism • Medical Paternalism • See references 1-3.

20. Organ Transplant and Resources Allocation • One what criteria should organs be allocated to patients for transplantation? (See reference 5) • What is a just distribution of healthcare resources? (See reference 4)

21. References • 1. Chan, Ho Mun, “Sharing Death and Dying: Advance Directives, Autonomy and the Family” Bioethics, Vol. 18, No. 2, 2004, pp.87-103. • 2. Chan, Ho Mun, “Informed Consent Hong Kong Style: An Instance of Moderate Familism”, Journal of Medicine and Philosophy, Vol. 29, No. 2, 2004, pp.195-206. • 3. 陳浩文 “末期病人的決策倫理：三個模式的比較”, 《中外醫學哲學》III：4 (2001年12月)：頁45-55。

22. 4. Chan, Ho Mun “Justice is to be Financed Before It is to be Done: A Confucian Approach to Hong Kong Public Health Care Reform”, in R. Z. Qiu (ed.), Bioethics: Asian Perspectives, Dordrecht, Netherlands: Kluwer Academic Publishers, 2004, pp.207-228. • 5. Chan, Ho Mun, Cheung, Germain, and Yip, Ada, “Selection Criteria for Recipients of Scarce Donor Livers: a Public Opinion Survey in Hong Kong”, (co-authored Germaine Cheung and Ada Yip), Hong Kong Medical Journal, Vol. 12, No. 1, 2006, pp. 40-46.

23. 6. 陳浩文、陶黎寶華、馮應謙 “從民意及倫理角度看香港應否全面禁止代母懷孕” 倪慧芳、劉次全、邱仁宗 主編 《21世紀生命倫理學難題 》 北京：高等教育出版社：頁246-261。 • 7. 陳浩文、陶黎寶華 “對香港應否全面禁止代母懷孕的道德探索”《價值與社會》第一期：1997年：頁137-155。 • 8. Kuhse, Helga and Singer, Peter, A Companion to Bioethics, Oxford: Blackwell, 1998.

24. 9. Holland, Stephen, Bioethics: A Philosophical Introduction, Cambridge: Polity Press. • 10. Tao, Julia, “What’s wrong with creating designer babies?”, in Julia Tao and Hektor H T Yan (eds), Meaning of life. Singapore: McGraw Hill Education, 2006, pp. 317-335. • 11. Veatch, Robert M. The Basics of Bioethics 2nd ed., Upper Saddle River, N.J.: Prentice Hall, 2003.