Key Issues in Bioethics

A Guide for Teachers

Ralph Levinson, Michael Reiss

• Publisher: Routledge
• Year: 2003
• eBook ISBN: 9781134489268
• Edition: 1
• Topic: Education
• Subtopic: Education General

Young people are increasingly being exposed to the huge and complex ethical dilemmas involved in issues such as genetic modification, animal rights and cloning, and they are bringing their views into the classroom. But how can teachers be sure they are sufficiently well-informed to help their pupils make sense of the diverse and emotive arguments surrounding these issues?

This book holds the answer. Written by leading ethicists, scientists and technologists, it offers a balanced and jargon-free guide to such highly debated topics as:

* cloning
* in vitro fertilisation
* genetic screening and genetic engineering
* farm animal welfare
* the use of animals in medical experiments.

Written specifically for the non-specialist teacher or lecturer, this book offers suggestions on how to approach the teaching of bioethics and provides useful sources of further information. It may also be of interest to undergraduates on science courses.

Part I
Ethics and education

1 Issues and scenarios

Ralph Levinson and Michael J. Reiss

Rationale

The publication of the first draft of the Human Genome Project has been hailed as a revolution surpassing the landing on the moon, and there is little doubt that many of the most pressing concerns in science are in biomedicine and associated reproductive technologies. The new biotechnologies raise huge ethical dilemmas that concern us all and the issues are being played out in the media, not least the tabloid press. Young people too are talking about complex ethical issues, such as GM foods, animal rights and cloning, and bringing their views to bear in the classroom. But are they merely arguing about popular misconceptions and myths that they hear through various media? How informed are we all about the scientific, ethical and social consequences that will affect most of us? Education must have a role. But how can teachers become sufficiently informed about the issues that surround such rapidly advancing technologies, where the legal and ethical implications are changing daily and testing even experts in the field?

Most of us are under-prepared for the challenges to our ethical and legal system that these technologies pose. The main voices heard are those of generic journalists, followed by the relatively few scientifically trained journalists, followed a long way behind by scientists and ethicists working in the field. The voices of those likely to be most affected – disabled people, ethnic groups, women, people with genetic conditions, gays and lesbians, those unable to have children – are all too rarely heard. If we are to understand and talk rationally about the ethical issues we need to know the views of people who have worked in these fields and thought deeply about these issues, the grounds for their beliefs and the controversies generated by differences in points of view. There is little unanimity here, which adds to the complexity.

This book develops informed conversations between ethicists, scientists and those who have a stake in these new technologies. These conversations come from articulate people who are passionately and intellectually committed to well-thought-out perspectives. The book is aimed at teachers and others who want an insight into the ethical and social arguments and the opinions of a wide spectrum of people.

What is bioethics?

For many centuries ethics has concerned itself with such questions as ‘What is right and what is wrong?’, ‘Should we always tell the truth?’, ‘When, if ever, is it right to kill someone?’ and ‘Is it fair that some people can buy better education for their children?’. Over the last few decades moral philosophers and others have realised how such questions generally assume that only human beings are objects of moral concern. With the rise in the environmental movement, the growing concern for the well-being of animals and the increasing importance of new biotechnologies, whether in medicine or agriculture, the term ‘bioethics’ is increasingly being used.

No single definition of the word ‘bioethics’ can be given. In the USA, for example, the term is still sometimes used as a synonym for ‘medical ethics’ (e.g. Shannon, 1993). In most countries, though, it is used (e.g. Gillon, 1998) to encompass all the questions about ethics in biology and medicine, including those that could not have been asked thirty years ago. It is in this latter, wider sense that the word is used in this book.

More important, perhaps, than agreement about how the word bioethics is used is an understanding of how bioethics is done. We hope that anyone reading the contributions in this volume will realise how wide are the demands on anyone who hopes to write well about bioethics. The science is important; an understanding of how ethical arguments can be constructed is important; an appreciation of the law is often needed; and an understanding of psychology and sociology helps too.

An example of how bioethical argument is constructed is provided by the recent debates over stem cell research. A brief discussion of this question also has the merit of indicating the role that religious arguments can play in bioethics. This is an important issue as there are some who would rather that religious views played no role in ethical thought, while there are others who believe that ethics is fundamentally underpinned by religion.

Doing bioethics – the example of the controversy over stem cell research

After a human egg and sperm join in fertilisation, an embryo begins to develop. By five days after conception, a hollow ball of cells has formed. The outer cell layer gives rise to the placenta. The inner 50 or so cells are known as pluripotent embryonic stem cells and go on to form the tissues of the developing embryo. Each of these embryonic stem cells can give rise to most cell types that make up an adult human body.

As the embryo continues to develop, its cells become increasingly differentiated. Most of them lose the capacity to develop into a wide range of cells. Instead they become specialised, functioning as a red blood cell, one of the cell types in bone, or whatever. However, even in adults some cells naturally retain a certain capacity to give rise to a variety of different cell types. For example, blood stem cells, located in bone marrow, can develop into red blood cells, platelets and the various sorts of white blood cells.

One way in which stem cells might be used is by what is generally referred to as therapeutic cloning. In therapeutic cloning a patient needing a transplant would have one of their ordinary cells removed – this could simply be a cell from the base of a hair or any other suitable tissue. This cell, or its nucleus, would then be fused with an egg cell from which the nucleus had been removed.

This resulting cell would then be stimulated to divide in the same way that the cell that gave rise to Dolly the cloned sheep was (see Chapter 4). If all went to plan, stem cells could then be isolated from this developing embryo and encouraged to develop into tissues. It is hoped that these tissues could then be used for transplantation. For example, a person with Parkinson’s disease might receive a transplant of neural cells.

The principal ethical argument in favour of therapeutic human cloning is easily stated. It is that this technology stands a good chance of reducing human suffering and enhancing happiness. Indeed, it has been estimated that over one-third of the people in the United States are affected by diseases that may be helped by stem cell research (Perry, 2000). It may be that such benefits will be found to result from other technologies, for example through using stem cells derived from adults or from umbilical cords. However, most scientists believe that adult stem cells are likely to be less valuable for research and in developing new treatments than are the pluripotent stem cells that can only be derived from human embryos (e.g. Royal Society, 2000).

The main ethical arguments against therapeutic human cloning centre on questions to do with the status of the human embryo. Different people see the status of the human embryo very differently. As the official UK government committee set up to report on human stem cell research put it:

A significant body of opinion holds that, as a moral principle, the use of any embryo for research purposes is unethical and unacceptable on the grounds that an embryo should be accorded full human status from the moment of its creation. At the other end of the spectrum, some argue that the embryo requires and deserves no particular moral attention whatsoever. Others accept the special status of an embryo as a potential human being, yet argue that the respect due to the embryo increases as it develops and that this respect, in the early stages in particular, may properly be weighed against the potential benefits arising from the proposed research.

(Department of Health, 2000, para. 17 of the Executive Summary)

The history in the twentieth century – and not just in Nazi Germany (e.g. Hornblum, 1998) – of what are now regarded as unacceptable instances of experimentation on human subjects means that the current very considerable hesitation about research on human embryos is not just understandable but, surely, to be welcomed. For many people the central question is the extent to which a human embryo with a relatively small number of cells that is, undoubtedly, completely incapable of feeling or thinking anything has some or all of the rights or respect due to the human newborn baby or adult into which it has the potential to develop.

Religious traditions hold varying views about the embryo’s value and status (House of Lords, 2002; Wertz, 2002) Most of the existing writing pertinent to stem cell research is of Jewish or Christian origin. Jewish views hold that a foetus outside the mother’s body does not have the same value as a fetus within her body. Traditionally a foetus was ‘water’ for the first 40 days. Most Jewish commentators speak of a mandate to heal and some would allow the creation of embryos in a Petri dish for research. In evidence submitted to the House of Lords the Court of the Chief Rabbi stated:

In Jewish law neither the foetus nor the pre-implanted embryo is a person; it is, however, human life and must be accorded the respect due to human life. Personhood, with its attendant rights and responsibilities begins at birth. Prior to birth, we have duties to both the embryo and the foetus, but these may, in certain circumstances, be overridden by other duties, namely those we owe to persons.

(House of Lords, 2002, p. 23)

According to Thomas Aquinas (following Aristotle and St Augustine), rational souls entered males at 40 days and females at 90 days; before that embryos had only a vegetative life force. No one would nowadays defend this gender difference but Aquinas’ view highlights an ongoing area of debate within the Christian churches: whether the embryo should be accorded, or has, full human status from the moment of conception or, in mainstream contemporary Protestant thinking, grows into personhood.

Most of the ethical questions concerning the status of the embryo have long been examined in the context of abortion (Reiss, 2002). Given that a widespread consensus on the moral status of the human embryo not only does not exist – and has probably not existed over many centuries of debate – but seems extremely unlikely to exist in the near future, the role of ethicists may be not so much to attempt to produce a definitive answer to the question of the status of the human embryo in the very early developmental stages at which therapeutic human cloning would take place, but more to help clarify arguments and indicate the implications of particular approaches.

To be or not to be

Developments in technology, as indicated, have led to ever more pressing questions about who should be born and who should not be born. Decisions of this nature are invariably complex and painful but it is possible to take seemingly contradictory viewpoints at the same time. When asked about animal experimentation, for example, people may express the view that they feel concerned about the use of such animals in medical experiments but assert that they have benefited from treatment that has involved medicines first tested on animals. We might be opposed to genetic selection of embryos for life-threatening conditions but empathise with parents who want to use this procedure. In so many instances the way we respond to a dilemma in the context of society as a whole can contradict a decision we might come to at a personal level.

‘Informed decision-making’ is a phrase frequently used in educational circles but we should recognise that the more we are informed about something the more difficult it can be to make a particular decision. Once we consider extra factors, what seems like a simple decision can become enormously difficult. A mother, for example, may agree to be tested in early pregnancy to check if the embryo tests positive for a disabling genetic condition. Of itself, this appears innocuous. But how would the mother’s decision be influenced if she was told that the test carries a risk that might result in a miscarriage? And what would she do if informed that the medicines and technology becoming available can, in any case, ameliorate this genetic condition? When the effect on family and siblings are considered, the decision may be even more difficult. But these consequences and the weighing of risks against benefits are not the only ways of thinking about these concerns. If you believe abortion is wrong no matter what the outcome of the test, then why have the test in the first place? Well, it may help you prepare for the baby if she does have a genetic condition but why take the chance if the test might be in error? Or if you know the test is highly accurate and very rarely results in a miscarriage would you be more likely to try it?

In Chapter 9 Marilyn Strathern discusses the ways meanings have changed in relation to the term surrogacy. Developments in the Human Genome Project also have significant implications for language use. For some, the genetic code is analogous to information on a disc that can be cut and spliced to correct harmful genes (Ridley, 1999). Identify the villain gene, correct it and disabling conditions can be eradicated. The danger, as perceived by others, is that for disabling genetic conditions the gene becomes the focus of attention rather than the individual, community or society more generally. Very few genetic conditions result in a straightforward expression of genotype to disease. Evelyn Fox Keller has written about the problematic ‘glow of the geneticists’ spotlight . . . [which allows] neither time nor space in which the rest of the organism, the surplus economy of the soma, could exert its effects’ (Fox Keller, 1995, p. xv). How we talk about ourselves and our genes can have an impact on the ethical decisions we make. This is why we believe students should have the space to be able to listen to, discuss and engage in bioethical issues in school so that they can gain insights into some of the complexities.

The chapters in this book are designed to generate debate rather than supply consensus and the authors explore issues from diverse and, sometimes, adversarial perspectives. But the authors justify the positions they take and it is this reasoning, involving insights into the emotions, values and feelings that people bring to consideration of ethical dilemmas, that we feel should be the message of this book.

Organisation of the book

We have structured the book into seven parts. The first three chapters make up Part 1. These three chapters (including this one) deal with generic issues. They outline the boundaries of the controversies, examine the nature of ethical debate and discuss issues to do with teaching in this area.

Ethical debate is at the heart of Parts 2 to 7. Each chapter in these sections focuses on current issues where the ethical dilemmas are considerable and arise from developments in technology. Parts 2, 3, 4 and 5 deal with developments in biomedicine. Parts 6 and 7 examine the ethical issues surrounding the treatment of farm animals and the use of animals for medical experiments. Each of Parts 2 to 7 includes contributions from experts coming from very different positions who debate the issues.

In Part 1, Chapter 2 is by Michael Reiss and discusses how we reach ethical conclusions. It looks at the scope of ethics and at how ethical arguments can validly be conducted. In particular, Reiss looks at whether it is sufficient only to look at what the ethical consequences of an action would be or whether certain actions are right or wrong at least to some extent independently of their consequences. Reiss then goes on to examine the more recent contributions that feminist and virtue ethics have made, before discussing the way in which bioethics seeks to take account of the interests of non-humans and of future generations. The chapter concludes that while there is no single way in which ethical debates about bioethics can unambiguously be resolved, that does not mean that all ethical arguments are equally valid. Reiss maintains that ethical conclusions need to be based on reason, to take into account well established ethical principles and to rest, so far as possible, on consensus. Education and debate also play important roles, helping to enable people to clarify their own thinking, express their views and participate in the democratic process.

Chapter 3 by Ralph Levinson discusses why and how bioethics should be...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Key Issues in Bioethics
• Contributors
• Part I: Ethics and Education
• Part II: Cloning
• Part III: In Vitro Fertilisation
• Part IV: Genetic Screening
• Part V: Genetic Engineering of People
• Part VI: Farm Animal Well-being
• Part VII: Animals for Medical Experiments