Post No.: 0498
There are a vast array of bioethical quandaries related to medical matters – some are rare situations that few will ever face but some will affect many people one day sooner or later and are therefore worth thinking about now. Simple things on the face of it can turn out to be extremely ethically complicated when we actually explore and query them.
In collaborative reproduction and parenting, which parent(s) should hold the most rights regarding a baby – the biological parents, the gestational/surrogate mother, or the social parents who will raise the baby? Should babies – or eggs, sperm, womb space or other parts of our bodies for that matter – even be capitalistically bought and sold on markets like commodities?
An egg or sperm donor/trader may have given eggs or sperm under the agreement that her/his anonymity would be preserved – but any resultant child was never a signatory to such an agreement so would this child be entitled to know the identities of her/his biological parents nonetheless? A child may need to know her/his genetic heritage to understand her/his own genetic health risks, or to prevent accidental inbreeding if she/he falls in love with another person who was born from the same donor/trader.
While we’re on the topic of donors – should relatives ever be able to override the wishes of someone who consented to having her/his organs donated upon her/his death? And are ‘saviour siblings’, who are children who are born primarily to donate a life-saving organ or cell transplant for a sibling who has an otherwise fatal disease, ever ethical?
At the end of life, when do we make the switch from trying to keep someone alive to ensuring they receive a good death? And at what point is someone authorised, as a legal surrogate, to make medical decisions on behalf of another person? A coma or permanent vegetative state might be relatively obvious but what about less black-or-white levels of mental capacity?
How do we decide on the definition of ‘dead’? We can scientifically and medically determine when the irreversible loss of consciousness, total brain activity, or blood flow, has occurred, but this still won’t tell us which definition to use to determine the life/death status of the person as a whole. And how long is long enough to say that someone is ‘irreversibly’ gone? Also, even if someone is still deemed alive, what if keeping them alive means them living with major brain damage and very limited functionality? Is the purpose of medicine to try to save a life at all costs regardless of the quality of life, or is it sometimes better to end life support for patients at a certain point?
There’s actively killing someone versus passively letting them die (including withholding or withdrawing life support from them), and intentional versus unintentional death. There’s futility and the opportunity costs to consider. Science cannot answer these questions so it becomes a philosophical, social policy and political issue. So perhaps democratic consensuses would give us answers? But voting outcomes don’t always lead to justice (just like voting about something that effectively discriminates against minority groups, or partisan voting leading to an acquittal in an impeachment trial regardless of the facts of a case!)
Defining the exact point of death is important for stopping health insurance claims and starting life insurance claims, applying inheritance laws, and when organs can be harvested from a donor, for instance. On the naïve face of it, the distinction between life and death seems clear and trivial, but certain cases will demonstrate that this line is not so clear-cut.
If, because of future technologies, brains can be recovered after being declared as ‘brain dead’ then is it ever ethical to harvest a person’s organs whilst they’re in this state? An acceptable solution could be to get everyone to, in advance and when conscious and competent, decide for themselves how they’d like their own fuzzy death to be defined in a legal document, or to at least sign a power of attorney to give this decision to someone else when the time comes. But what if someone failed to do this or what if it’s a young infant – who then gets to decide for these people? End-of-life care for an adult is relatively more straightforward than for a young child who cannot understand the options and signal her/his own desires to others.
If it’ll ever work and isn’t just quackery – not everyone can afford cryonics to freeze their bodies until future science hopefully finds a cure for their terminal conditions, which raises the issue of whether it’s ethically okay that only those who can afford certain technologies can prolong their hopes of living longer? Cryopreservation might even change our concept of death and letting a deceased person go, and tempt some to be prematurely euthanised so that they can undergo cryonics in a less-deteriorated state.
There is also the dilemma of hope (trying to continue with aggressive treatments that might not work and will cause a lot of pain in themselves) versus acceptance (living the last days in less pain). Overall, we should respect the wishes of the patient, but this can get tricky when it involves demands placed on other people such as medical professionals. You can ask for what you want, but why should other people serve that wish of yours if they disagree with it?
Post No.: 0416 explored what negative and positive rights mean. As a conscious and mentally capable person – when, if ever, is it right to obligate a physician to assist one in voluntary active euthanasia or physician-assisted suicide/death? This is a dilemma between a physician’s duty to save or prolong a life, and her/his duty to alleviate a patient’s pain or suffering – such as when a terminally ill patient who feels enormous suffering believes that death is better than carrying on. Relieving suffering (beneficence) and prolonging life aren’t always aligned interests – for many individuals, on an individual basis, there exists things that are worse than death (such as perhaps living with locked-in syndrome). Misaligned or conflicts of interests in any kind of context, not just medical, will always bring up dilemmas and ethical questions.
The value of life is arguably in the worthwhile experiences we experience, not in merely being alive, but what makes a life worthwhile is personally subjective. Others though, believe in the vitalism, or sanctity, of life hence it is always wrong to intentionally end a human life in all cases, or in all but the most extreme cases, respectively.
Modern medicine or medical science is focused on saving lives, and huge strides have been made, and continue to be made, in treating a wide range of life-threatening diseases; and life expectancies have in turn increased. Death is regarded as something that is to be defeated – as if death needs to ultimately die itself(!) – and the default mode of most healthcare workers is to throw everything possible into treating patients right until the very end. But there’s possibly a risk of over-medicalising the final years of life at the expense of providing better palliative care that would provide a better quality of end of life. Maybe we therefore need to learn how to die a better death? Palliative care is advancing to alleviate suffering for the terminally ill, which helps people to die with dignity, yet if someone says that they’re suffering to the point of wishing to immediately die nonetheless then who is anyone else to say they’re not?
Most doctors, with their exposures and experiences of seeing lots of suffering and death, would rather not be saved or treated at all costs if they were a patient with a terminal condition, and would rather spend their last days at home surrounded with fluffy family than in hospital undergoing what would be harsh and often futile treatments. Conversely, for existential suffering or depression, a doctor, who has again seen many similar patients before, may arguably know better than a particular patient her/himself and know that the suffering will likely eventually pass given enough help and support if they just hang on rather than give up on life now. Some people however then worry about a slippery slope to non-voluntary or involuntary euthanasia for those incapable of deciding for themselves whether suffering or dying for them is best. Science and statistics may be used to determine ‘what most people would prefer’ but should this type of general consensus be applied to specific individuals who cannot decide for themselves?
A young child or person in a critical condition who cannot communicate cannot make such ‘do not resuscitate’ choices autonomously so should a parent/relative or medical professional decide such things on behalf of the patient? Parents will likely want their children to live as long as they can, whilst doctors, with experience of many such patients who’ve suffered (needlessly) before, will likely believe that the suffering is not in the best interests of the patient (and in many countries it’s the doctor’s knowledge and therefore decision that is deemed final). It is undoubtedly incredibly emotionally difficult from the perspective of a parent who actually has an infant with complex health issues to make such decisions compared to independent observers or medical professionals in a health service.
In a private healthcare system, if such a parent cannot afford the medical insurance or bills then their child’s fate is pretty much determined; whereas in a public healthcare system, there are opportunity costs because a life isn’t technically priceless in a finite resource world, unfortunately – the resources to try to prolong a life that has a poor prognosis and a likely poor quality of life even if it could be prolonged, could be spent on helping or saving, say, ten other people who have better prospects. There’d probably be fewer dilemmas in the world if everyone had infinite resources, but that’s not reality.
Yet if we try our best to save every person we can, even if there’ll be many (gruesome and painful) experiments and failures along the way and a lot of immediate opportunity costs – with every trial or experiment we will learn more and advance medical knowledge and medical technologies, which may then help future sufferers of the same complex issues to live longer and better qualities of lives. Of course we judge a person’s chances of survival, suffering and quality of life as they live according to the modern medicine of the time – but if we keep on giving up hope on those in critical conditions based on today’s medical science then we’ll never learn about how to better treat or even cure these complex conditions, or we’ll learn much more slowly. In other words, it might be a case of ‘a few people should suffer now for the sake of experimentation and learning so much that might benefit many more people in a similar situation in the future’? Nonetheless, the quandary is why these particular few people, especially if they cannot explicitly consent to such experiments because they’re perhaps in a coma?
COVID-19 certainly introduced or exposed a whole host of bioethical issues, such as how far the lockdown measures should go (these negatively affect people’s individual liberties and their mental health, livelihoods, children’s education and more), contact tracing technologies (privacy concerns), and even weighing the option of deliberate infection to reach community herd immunity as quickly as possible (although there were too many unknowns about the disease at the time to risk it). Different countries have attempted slightly different strategies, which have acted like a range of field experiments. In the aftermath, we’ll compare the results; although it can be hard to compare different countries on a clear like-for-like basis.
Meow. There may not be any crystal clear or objective answers but you can use the Twitter comment button below to tell us what you think about these tough medical dilemmas or if you can think of some other ones?