Post No.: 0416
Bioethics relates to the ethical issues arising from, the ever-increasing, advances in biology and medicine. There are innumerable dilemmas when it comes to bioethics. These include issues related to informed (or misinformed) consent, weak/soft versus strong/hard forms of paternalism, abortion, the rights (and the limits of rights) of parents over their children, doctors/experts telling patients the truth regarding bad prognoses versus keeping their spirits up, euthanasia or denying life-saving treatment, autonomy and inequity.
One instance is how should autonomy or self-governance apply when someone is mentally incapacitated, and where should we draw the line to define whether someone is personally ‘capable’ or (has become) ‘incapable’? How about how should autonomy or self-governance apply when any person has been misguided (e.g. regarding the ‘dangers’ of vaccines)? Are lies okay and ‘fair enough in this cutthroat and competitive world’ as long as people make the final intentional decisions for themselves without coercion? (Is even coercion ‘fair enough in this cutthroat and competitive world’?!) Thus is a misinformed consent valid?
One could be told only the known benefits of something without these necessarily being lies or bull****, but not told the full known costs of it or any of the known alternative options. Is it ethical to only honestly answer (to the best of one’s own knowledge) the questions asked or must one also answer any questions that haven’t been asked but might be relevant and important for a customer or patient to know too? Is it okay to just state the equivalent of ‘may contain traces of peanuts’ everywhere just to legally protect one’s own fluffy back in all situations?
The timing and order of when things are told can also matter too, as well as the place where information is given – too much bad news at once can sometimes negatively impact a patient’s chance or rate of recovery. Maybe doctors should therefore first ask for consent on how a patient wants to be informed?
What about the autonomy of the provider her/himself in the case of a ‘conscientious refusal/objection’ – such as denying contraceptive, abortive or assisted-death assistance as a pharmacist, doctor or hospital, due to one’s individual religious or other beliefs, in jurisdictions where these products or procedures are otherwise legal? Whose rights should override whose if they conflict? Should it be the provider or the patient? Normally, if either party refuses a deal then there’s no deal but should this be different when it concerns medicine? Would autonomy and freedom invite discrimination (like a shopkeeper who’s free to choose to serve people from one group but not another)?
Should institutions, such as hospitals, have rights like individuals do, and if so, how far should they be allowed to go? (It’s a similar case with faith schools and religious education, or some parents being concerned that teaching LGBTQ+ issues in school might indoctrinate children into becoming LGBTQ or other. These are tricky and sensitive problems.) Is being sufficiently informed always enough – as in what if someone has no reasonable alternative, such as being told that there’s no other hospital nearby? Will we need to offer people more than one reasonable option to choose from?
Refusing to act against one’s personal strong moral commitments doesn’t mean one can impose one’s strong moral commitments onto others – but sometimes it can be difficult to separate one’s actions with those of other people. Is there a difference between a physician refusing to directly assist in someone’s suicide and refusing to refer such a patient to another physician who will? Would they nevertheless become an accomplice if they made a referral? So how far do people’s complicities go? Where does one’s responsibilities end and another person’s begin?
In a highly-interconnected social world, everybody is essentially contributing to everybody else’s activities and outcomes directly or indirectly. At a fundamental level in a closed system at least, energy isn’t created from nothing and doesn’t disappear into nothing. All energy to do or be anything must be transferred from one source to another hence independence in this world is an illusion – every thing and action is tightly interconnected with other things and actions. But where do we draw the lines to make our own personal actions culpable? For instance, it’s silly from your personal or individual perspective to blame the first ever hominid mammals for everything every subsequent human has ever done because if they didn’t exist or procreate then you couldn’t or wouldn’t have done all the things you’ve done today or will do. Or we cannot blame everything on the Big Bang! Yet we must draw arbitrary lines somewhere inbetween that moment and a more immediate/direct cause, because everything above the atomic level follows a strict unbroken chain of causality (if we are to follow the findings of science).
In bioethics, ‘negative rights’ are rights against others interfering with you in some way (e.g. you being experimented on without your consent, or harassed); whilst ‘positive rights’ are rights from others to assist you in some way (e.g. receiving medical help from a doctor, or being saved from drowning by a lifeguard). Now should even non-medical or non-protection profession bystanders be legally obligated to help a person in imminent danger when no danger is posed to the bystander? Is it always fine to be passive in preventing harm even if one isn’t actively causing harm – as in are people always a part of a problem if they’re not a part of its solution? Or how near to a problem must a person be before they are? And if they need to be close then is it okay for people to just deliberately stay far away or to bury their heads in the sand and be ignorant if ignorance could be used as a defence?
So should vaccines be made compulsory? Vaccines don’t just benefit the person who is inoculated but others too. But even though it’d be rationally beneficial for the health of communities overall, it could backfire against those with libertarian views. Still, who should decide on behalf of children – the doctors, parents or government?
What about rights for other animals, or even plants? Bioethics includes other life too. Science cannot objectively answer whether it’s right or wrong to eat meat. Why care about some animals (e.g. pandas) more than others (e.g. wasps)? Which animals are morally acceptable or unacceptable to be claimed or domesticated as pets or livestock? Lines appear arbitrarily drawn again. Meow.
So is it right to raise children as vegans, or possibly wrong not to? Where should we draw the line as to what resources are ‘for’ humans? If honey from bees isn’t for humans then are mushrooms from a forest not for humans too since many of them serve a symbiotic role with trees, for which trees serve lots of other life? Studying bioethics can make you suddenly question things you previously thought were clear-cut and ‘obvious’!
Taking genetic tests that test for one’s genetic probabilities for diseases is dilemmatic – knowing that you have a certain elevated risk could become self-fulfilling or it could help you to plan for or minimise its impact. It’s not just a personal and private choice either because knowing your own risk could reveal the risk of a biologically-related family member too – for example, if you wanted to test for your own breast cancer risk and found out it was high, then it would also reveal that your biological mother or sisters likely have a high risk too, even if they didn’t consent to such a test or wanted themselves or anyone else to know their own risk. Alternatively, should revealing one’s personal diagnoses to one’s biological relatives actually be mandatory to warn them of their own genetic risks? Who does a doctor owe a duty of care to in such cases? In bioethics, we must consider all stakeholders and the wider pictures too.
A foetus certainly cannot consent to antenatal testing, never mind what should happen if certain results are found. It might arguably be relatively more acceptable if testing (or artificially genetically modifying) for a disease risk, but less acceptable if testing (or artificially genetically modifying) for other things like their gender or some kind of cosmetic attribute. Another dilemma is that, the more people who abort foetuses exhibiting signs or prognoses of autism or Down syndrome, for instance, the harder it’ll be for those people who currently are or will be alive living with those conditions i.e. the rarer their condition is, the more marginalised they’ll become in society, and the less public and private investment will be spent on accommodating them socio-politically. It’s just like it won’t be worth building wheelchair ramps everywhere, or even designing good wheelchairs, if only a few people in the world used wheelchairs. Yet one might still want one’s own child to not have autism or Down syndrome and so choose abortion after genetically screening embryos.
It’s similar when someone reasons that they should have cosmetic surgery because the culture deems their natural features unattractive and therefore ‘needs’ changing, but they’ll only be reinforcing this culture by changing their face/body to match these perceived cultural ‘ideals’. Hence for reacting in this way to this cultural problem, they’ll actually become a part of the cultural problem too. From a game theory perspective, individuals might want to improve (or superficially ‘improve’ in this case) themselves but want most of their rival peers not to, otherwise they’ll just be considered ‘mediocre’ or ‘average’ (again) and the cosmetic procedures will just endlessly escalate; or it escalates because they think they need to constantly chase being ‘at least average’, which will logically keep pushing what’s supposedly the ‘average’ upwards unless everyone became exactly equal.
Regarding the abortion of a foetus whom/that has inherited a terminal disease that virtually guarantees the child-to-be a short and likely painful existence – answering on behalf of the child-to-be, would it be better to not be born or to live that short and painful life before dying? What about the difference in pain and loss to loved ones in each scenario, for most people would mourn longer over a baby who was born (and named) than over a never-born foetus? Do these other people not matter at all or should we try to minimise all suffering? What about the opportunity for medical science to advance for trying to keep every being alive rather than giving up on them? But then should scientific advancement be a justifiable reason for putting living beings through unnecessary pain? This bioethics issue includes animal testing too.
Is screening (or gene editing, which is increasingly possible) embryos for diseases or developmental conditions about minimising the suffering of a child or about curbing who’s different? That may not be the intention but it can be a foreseeable consequence nevertheless. Is screening embryos for eye colour, intelligence (if that’ll ever be straightforward) or anything else that isn’t a disease or developmental condition about attempting to maximise the potential of a child or about meddling with fire?
To eradicate diseases from this world – should all of our genetic and other information actually be made public rather than kept individually private?
If one lives in a place with low infant mortality, is giving birth to and raising more than two or three children inspirational parenting, or is it irresponsible and despicable after what we’ve now learnt about sustainability and the planet’s limited resources?
…Well that was a whole bunch of questions with few or no uncontroversial answers! That’s bioethics, and philosophy in general, for you. Science alone cannot answer all of the questions we’d like to have answered. The dilemmas presented in this post are hardly exhaustive, and new ones keep developing, but have hopefully served as an introduction to the crucial field of bioethics. It’ll hopefully get you pondering and discussing bioethics issues with others, and in an open and respectful way for understanding the various valid points of view.