HUMAN VALUES AND PROFESSIONAL ETHICS

Unit -II: Medical Ethics

Views of Charaka
Charaka is one of the ancient scholars of Ayurveda.His renowned work, the ‘Charak Samhita’
is considered an encyclopedia of Ayurveda. Acharya Charak minutely explains facts about
human anatomy, embryology, pharmacology, immunology and the mechanism of blood
circulation. His work contains detailed discussions about diseases and treatment including
diabetes, tuberculosis, heart disease etc, spread over many chapters and thousands of verses.

He emphasises the influence of the soul, mind and body connection. The concept of mind body
medicine and the importance of spirituality in physical and mental health first appears in his
text book which is dated around the second or third century BC. He also described an ethical
charter for medical practitioners two centuries prior to the Hippocratic oath.

Sushruta

A Sushruta, also spelled Suśruta, (flourished c. 6th century BCE), ancient Indian surgeon
known for his pioneering operations and techniques and for his influential treatise Sushruta-
samhita, the main source of knowledge about surgery in ancient India.

For Sushruta, the concept of shalya tantra (surgical science) was all-encompassing. Examples
of some of his groundbreaking operations include rhinoplasty (the repairing or remaking of a
nose), removal of a dead fetus, and lithotomy (surgical incision into hollow organs such as the
urinary bladder to remove stones, or calculi). He also developed many unique and practical
techniques to dissect the human body and study its structure.

The Sushruta-samhita also provides details on toxicology, paediatrics, pharmacology, and

other branches of the traditional system of Indian medicine known as Ayurveda. About surgery
in ancient India.

Hippocrates

Hippocrates of Kos was a Greek physician who lived from about 460 B.C. to 375 B.C. At a
time when most people attributed sickness to superstition and the wrath of the gods,
Hippocrates taught that all forms of illness had a natural cause. He established the first

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intellectual school devoted to teaching the practice of medicine. For this, he is widely known
as the "father of medicine."

Approximately 60 medical documents associated with his name, including the famous
Hippocratic oath, have survived to this day. These documents were eventually gathered into a
collection known as the Hippocratic Corpus. While Hippocrates may not have written all of
them himself, the papers are a reflection of his philosophies. Through Hippocrates' example,
medical practice pointed in a new direction, one that would move toward a more rational and
scientific view of medicine.

The four humors

Hippocrates is often credited with developing the theory of the four humors, or fluids.
Philosophers Aristotle and Galen also contributed to the concept. Centuries later, William
Shakespeare incorporated the humors into his writings when describing human qualities.

The humors were yellow bile, black bile, blood and phlegm, according to "The World of
Shakespeare's Humors," an exhibition by the National Institutes of Health (NIH). Each humor
was associated with a particular element (earth, water, air or fire), two "qualities" (cold, hot,
moist, dry), certain body organs and certain ages (childhood, adolescence, maturity, old age).

Moral Responsibilities of Medical Practitioners

It is a medical professional’s responsibility to hold him or herself to the highest medical ethics
standards. If you are seeking a nursing degree, or hope to become a physician, you must
understand medical ethics before being ready to provide care. Medicine requires some
challenging judgment calls, and holding yourself up to high medical ethics standards may help
minimize errors and foster trust, accountability, and respect between you and your patients.

Four ethical principles in medicine

The textbook titled “Principles of Biomedical Ethics” (orig. 1979) by Tom Beauchamp and
James Childress provided an early foundation for medical ethics and values for physicians and
others involved with practicing medicine. This textbook has provided the compass for
increased discussions about ethical issues at the clinical level for hears.

In addition to the following four basic ethical principles that Beauchamp and Childress define,
most professional medical societies/organizations have established medical ethical guidelines

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for their members in regard to every patient’s human dignity, privacy, confidentiality, and
patient rights.

The four main health care principled are:

1.Respect for autonomy.

Respect for autonomy is a norm in medical ethics that requires the respect for the decisions of
adults who have the ability to make sound decisions (self-determination). A determination of
someone’s decision-making ability can be gauged by their:

Intentionality (Is it believable he or she will follow-through with a decision?)Understanding

(Does he or she understand the situation and the consequences and implications of different
options?)

Absence of controlling influences that determine their action (Is he or she being influenced
somehow against choosing reasonably?)

In health care, it's vital for patients to have the right to make their own medical decisions after
getting information from their doctor. Physicians must respect the ability that patient's have to
learn about their health care, and make their own choices about what to do with regards to their
medical care. Doctors, nurses, and physicians learn about the healthcare ethics of autonomy,
and this should lead them to respecting the decisions and autonomy of their patients every day.

2.Beneficence

The principle of beneficence embodies the concept of the moral obligation to act in the best
interests of others.

This can be done either by:

Providing benefits

Balancing those benefits against potential risks/harms

Beneficence calls for the commitment to:

Protect and defend the rights of others

Prevent others from harm

Remove conditions that might cause harm

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Help those with disabilities

Rescue others in danger

Physicians must practice this in a clinical and medical setting every day by making choices
and judgment calls about how to benefit their patients. This element of healthcare ethics is
usually vital to medical schools, hospitals, and every place where medicine is practiced. The
idea that physician's main goal should be to benefit others shouldn't be surprising, but it is a
principle that can sometimes prove to be an ethical issue when the unique settings of health
care come to light.

3. Non-maleficence

Non-maleficence requires a commitment not to harm others in any way, based on the Latin
maxim primum non nocere (first do no harm) which is in the Hippocratic Oath that every doctor
must take.

A non-maleficent obligates one not to:

Kill

Cause pain or suffering

Incapacitate anyone

Cause anyone offense

The idea to "do no harm" is a vital element of medicine. Physicians face the ethical dilemmas
of how to avoid doing harm every day as they work. They must rely on resources to help them
understand the best way to proceed forward and hep patients using their medical education,
and their gut instincts.

4.Justice

Justice calls on us to fairly distribute benefits, risks, costs, and resources as best we know how.

To each individual, justice, ideally, should proffer:

An equal share

According to need

According to effort

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According to contribution

According to merit

The principle of justice means that every single person should be treated in the best possible
way by their doctor. Advocacy for patients who may have less than others is an important part
of justice. Ethical theories about justice in health care help doctors and nurses be prepared for
what could await them as they treat patients on a wide scale of wealth, education, and health.

Code of Ethics for Medical and Healthcare Professionals

Code of ethics clarifies roles and responsibilities within a profession and provides guidance to
the professional for addressing common ethical questions. The increasingly respected
designation of the Certified Professional in Healthcare Quality® and changes in the healthcare
industry have generated a new appreciation for the essential role of the healthcare quality
professional.

The Healthcare Quality Professional’s Commitment within the Profession

HEALTH DATA ANALYTICS. Healthcare quality professionals engaged in the work of data
analytics follow best practices for data management and statistical practice. They ensure that
the findings of data-driven inquiries are presented fairly, that work product is reproducible, and
that defects and biases are appropriately disclosed.

PATIENT SAFETY. Healthcare quality professionals advocate for policies and processes that
support a safe environment of care. They advocate for processes that demonstrate high
reliability, minimize defects, and mitigate harm to all stakeholders.

PERFORMANCE AND PROCESS IMPROVEMENT. Healthcare quality professionals

engaged in the work of performance improvement employ science-based best practices
developed within established quality frameworks.

POPULATION HEALTH AND CARE TRANSITIONS. Healthcare quality professionals

supporting complex populations advocate for wellness practices in addition to disease
management. They promote interventions that address the totality of a healthcare recipient’s
circumstances.

QUALITY REVIEW AND ACCOUNTABILITY. Healthcare quality professionals advocate

for coaching and mentoring to foster accountability. They promote transparent team-based non-
punitive approaches to mitigate problems and resolve disputes.

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REGULATORY AND ACCREDITATION. Healthcare quality professionals partner in good
faith with regulators, auditors, and inspectors to foster compliance with relevant standards and
regulations.

LEADERSHIP. Healthcare quality professionals are forthright and transparent with the teams
they lead. They encourage meaningful inter-professional relationships. They present
information using clear, accurate, and concise language. They recruit and mentor colleagues to
foster a coordinated and competent workforce aligned with the profession’s body of
knowledge.

The Healthcare Quality Professional’s Commitment to the Profession

BODY OF KNOWLEDGE. Healthcare quality professionals support the body of knowledge

through careful study and application of evidence-based practices. They protect the integrity
of the processes and procedures within the body of knowledge, guide colleagues outside of the
profession to use quality tools effectively, and consult on the appropriate application of quality
tools. They seek to fully understand how quality tools and processes apply to the healthcare
industry. They contribute to the body of knowledge and to the evidence that supports evolving
best practices.

LIFELONG LEARNING. Healthcare quality professionals develop their skills through

continuing education, certification, professional experience, and training. They remain current
on industry trends. They seek new ways to apply the body of knowledge to emerging problems.

MENTORING. Healthcare quality professionals advance the profession through mentoring,

publishing, and volunteering. They help colleagues at various stages of their career to master
the translation of quality tools to everyday practice. They share best practices about the
application of the body of knowledge and foster a safe environment for collaboration and
learning.

Euthanasia

Euthanasia, also called mercy killing, act or practice of painlessly putting to death persons
suffering from painful and incurable disease or incapacitating physical disorder or allowing
them to die by withholding treatment or withdrawing artificial life-support measures. Because
there is no specific provision for it in most legal systems, it is usually regarded as either suicide
(if performed by the patient himself) or murder (if performed by another). Physicians may,
however, lawfully decide not to prolong life in cases of extreme suffering, and they may

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administer drugs to relieve pain even if this shortens the patient’s life. In the late 20th century,
several European countries had special provisions in their criminal codes for lenient sentencing
and the consideration of extenuating circumstances in prosecutions for euthanasia.

The opinion that euthanasia is morally permissible is traceable to Socrates, Plato, and the
Stoics. It is rejected in traditional Christian belief, chiefly because it is thought to contravene
the prohibition of murder in the Ten Commandments.

Ethical Obligation to Animals

The Norwegian National Committee for Research Ethics in Science and Technology (NENT)
have a set of ethical guidelines for the use of animals in research:

1.Ethical guidelines for animal research

There is a wide range of ethical assessments regarding animals used in research. There are
general opinions that animals do have a moral status and how they are treated should be
subjected to ethical consideration; some of the positions include:

2.Animals have intrinsic values that must be respected

Animals can feel pain and their interests must be taken into consideration.

Our treatment of all animals/lab animals reflects on our attitudes and influences us on our moral
beings.

3.Respect Animal Dignity

Researchers must have respect towards the animals' worth, regardless of their value and the
animals' interests as living, sentient creatures. Researchers have to have respect when choosing
their topics/methods, and when expanding their research. Researchers also have to supply care
that is adapted to needs to each laboratory animal.

4.Responsibility for considering options (Replace)

When there are alternatives available, researchers are responsible for studying those
alternatives for animal experimentation. When there are no good alternatives available,
researchers have to consider if the research can be postponed until a good alternative are
developed. While being able to justify the experiments on animals, researchers then have to be
accountable for the absence of alternative options and the urge to obtain the knowledge
immediately.

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5.The principle of proportionality:

Responsibility for considering and balancing suffering and benefit: Researchers have to
consider both the risks of pain and suffering that laboratory animals will face and assess them
in the value of the relationship to the research of animals, people, and the environment.
Researchers have a responsibility on whether or not the research will have improvements for
the animals, people or the environment. All of the possible benefits of the study has to be
considered, substantiated and specified in both the short and long run. This responsibility also
entails the obligation to consider both the scientific quality of the experiment and whether or
not the experiment will have relevant scientific benefits. Suffering can only be caused by
animals if there is a counterbalance of substantial and probable benefits for animals, people or
the environment. Since there are many methods of analyzing the harm and the benefits,
research institutions have to provide training on suitable models and researchers have the
responsibility to use the methods of analysis when planning any experiments on animals.

6.Responsibility for considering reducing the number of animals (Reduce)

Researchers have the responsibility to consider whether or not it's acceptable to reduce the
number of animals that an experiment's plan on using and include the number necessary to both
the scientific quality of the experiments and the relevance to the results only. Before the
experiment, researchers have to conduct reading studies and consider alternative designs and
perform the calculations that are needed before beginning an experiment.

7.Responsibility for minimizing the risk of suffering and improving animal welfare
(Refine) Researchers have the responsibility to assess the expected effect on laboratory
animals. Researchers have to lessen the risk of suffering and provide excellent animal welfare.
Suffering includes pain, hunger, malnutrition, thirst, abnormal cold/heat. fear, stress, illness,
injury, and restrictions to where the animal can't be able to behave naturally and normally. To
find out what is a considerable amount of suffering, a researcher's assessment should be based
on which animal suffers the most. Considering the animals is the deciding factor if there are
any doubts about regarding the suffering the animals will face. Researchers have to consider
the direct suffering that the animal might endure during an experiment, but there are risks
before and after the suffering, including breeding, transportation, trapping, euthanizing,
labelling, anesthetizing, and stabling. This means that all the researchers have to take into
account the needs of periods for adaptation before and after an experiment.

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8.Responsibility for maintaining biological diversity

Researchers are also responsible for ensuring that the use of laboratory animals don't disrupt
or endanger biological diversity. This means that researchers have to consider the consequences
to the stock and their ecosystem as a whole. The use of endangered species has to be reduced
to a minimum. When there is credible and uncertain knowledge that the inclusion of animals
in research and the use of certain methods may have ethically unacceptable consequences for
the stock and the ecosystem as a whole, researchers must observe the precautionary principle.

9.Responsibility when intervening in a habitat

Researchers have a responsibility for reducing the disruption and any impact of the natural
behaviours of the animals, including those who aren't direct test subjects in research, as well as
the population and their surroundings. Most research and technology-related projects, like the
ones regarding environmental technology and surveillance, might impact the animals and their
living arrangements. In those cases, researchers have to seek to observe the principle of
proportionality and to decrease possible negative impact(see guideline 3).

10.Responsibility for openness and sharing of data and material

Researchers have the responsibility for ensuring the transparency of the research findings and
facilitating sharing the data and materials from all animal experiments. Transparency and
sharing are important in order to not repeat the same experiments on animals. Transparency is
also important in order to release the data to the public and a part of researchers' responsibility
for dissimulation. Negative results of the experiments on animals have should be public
knowledge. Releasing negative results to other researchers could give them more on the
information about which experiments that are not worth pursuing, shine a light on unfortunate
research designs, and can help reduce the number of animals used in research.

11.Requirement of expertise on animals

Researchers and other parties who work and handle live animals are required to have adequate
and updated documentation expertise on all animals. This includes knowledge about the
biology of the animal species in question, and willingly be able to take care of the animals
properly.

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12.Requirement of due care

There are many laws, rules, international convention, and agreements regarding the laboratory
animals that both the researchers and the research managers have to comply with. Anyone who
wants to use animals in experiments should familiarize themselves with the current rules.

Ethical Issues in Relation to Health Care Professionals and Patients

Every day, patients, families and healthcare professionals face ethical and legal decisions.
These difficult dilemmas may concern medical treatments, practices, hospital management and
other matters that arise in the healthcare industry. Ethical issues in healthcare can require an
immediate response, such as making decisions for patients when they are not able to do so, or
can involve a prolonged, carefully considered decision, such as the debate over the right to
abortion or assisted suicide. The actions taken in ethical issues in healthcare clearly distinguish
between what is right and wrong, and often, many of the actions taken today can have lasting
effects on healthcare in the future.

There are numerous ethical challenges clinical leaders, health practitioners and patients face in
healthcare. Some examples of common medical ethical issues include:

1. Patient Privacy and Confidentiality

The protection of private patient information is one of the most important ethical and legal
issues in the field of healthcare. Conversations between a physician and a patient are strictly
confidential, as is information about an individual’s medical condition. Specific provisions of
the Health Insurance Portability and Accountability Act, or HIPAA, define exactly what
information can be released and to whom.

2. Transmission of Diseases

The recent global outbreak of the Ebola virus put a renewed emphasis on the right of healthcare
providers to protect themselves from communicable diseases, whether by direct or indirect
contact with an infected patient. Ethical and legal questions arise when a patient’s health history
is not provided to the medical staff.

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3. Relationships

Sexual relationships between medical practitioners and patients or between medical staff are
strictly forbidden at a healthcare facility. Sexual harassment can be harmful to all involved,
including the facility, so the code of ethics should be explicit about this.

4. End-of-Life Issues

Terminally ill patients may have specific wishes about the way they want their lives to end.
Families may struggle with the decision to end life support for a loved one. Healthcare
practitioners and clinical leaders need to be prepared to handle end-of-life issues as well as
problems encountered in dealing with elderly patients who may not be able to make rational
decisions on their own.

5.Patient confidentiality –

A confidential relationship between physicians and their patients is essential. Confidentiality

helps create a setting of trust in which a patient can share their private feelings and personal
history, enabling a physician to form a diagnosis. Patient information should be available only
to the physicians and other healthcare personnel as required. A healthcare worker may be
violating a patient’s confidentiality by disclosing medical information to others who should not
have access to it.

6.Informed consent

Informed consent means providing an in-depth understanding of the risks and benefits of a
treatment to a patient. This allows the patient to decide whether or not they wish to undergo a
procedure. Informed consent is based on the principle that patients should have autonomy over
the treatment they receive. Healthcare providers should have a document providing proof the
patient has full knowledge of the risks, benefits and possible consequences of a particular
treatment.

7.Physician-assisted Suicide (PAS) and euthanasia –

Euthanasia refers to the process of a deliberately ending a patient’s life in order to relieve them
of suffering. It is illegal in most countries but is still a hotly debated ethical issue surrounding
whether it should or should not be legalised. PAS is the practice of providing a competent
patient with a prescription for medication that will end their life. In this case, the patient would
have to self-administer the medication, directly or through a machine

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Human Cloning

Cloning is a very interesting and new concept developed with the huge technological
advancements made in the field of science. The cloning of the animals is becoming common.
Dolly, a cloned sheep was the first cloned animal. The questions of bioethics come into picture
over here as cloning human beings is the next step to be taken in the field of cloning. The
cloning of human beings and the question of bioethics is the main focus of the study. To
understand the topic and the concept of ethics, first of let’s understand what cloning is and how
it is actually done.

In common terms, cloning is asexual reproduction accomplished by introducing the nuclear

material of a human somatic cell into a fertilized or unfertilized oocyte whose nucleus has been
removed or inactivated to produce a living organism(at any stage of development) with a
human. In biological terms, Cloning is the creation of an organism that is an exact genetic copy
of another. This means that every single bit of DNA is the same between the two.

How is cloning done?

You may have first heard of cloning when Dolly the Sheep showed up on the scene in 1997.
Cloning technologies have been around for much longer than Dolly, though.

How does one go about making an exact genetic copy of an organism? There are a couple of
ways to do this: artificial embryo twinning and somatic cell nuclear transfer. How do these
processes differ?

1. Artificial Embryo Twinning

Artificial embryo twinning is the relatively low-tech version of cloning. As the name suggests,
this technology mimics the natural process of creating identical twins.

In nature, twins occur just after fertilization of an egg cell by a sperm cell. In rare cases, when
the resulting fertilized egg, called a zygote, tries to divide into a two-celled embryo, the two
cells separate. Each cell continues dividing on its own, ultimately developing into a separate
individual within the mother. Since the two cells came from the same zygote, the resulting
individuals are genetically identical.

Artificial embryo twinning uses the same approach, but it occurs in a Petri dish instead of in
the mother's body. This is accomplished by manually separating a very early embryo into
individual cells, and then allowing each cell to divide and develop on its own. The resulting

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embryos are placed into a surrogate mother, where they are carried to term and delivered.
Again, since all the embryos came from the same zygote, they are genetically identical.

2. Somatic Cell Nuclear Transfer

Somatic cell nuclear transfer, (SCNT) uses a different approach than artificial embryo
twinning, but it produces the same result: an exact clone, or genetic copy, of an individual. This
was the method used to create Dolly the Sheep.

Ethical Concerns Regarding Human Cloning

Compared to other technologies that might be used to address reproductive limitations and
organ and tissue shortages, these potential harms of human cloning appear to outweigh the
potential benefits at this time.

A. Physical harms introduced by cloning

It is important to note that techniques used for cloning humans could potentially endanger the
developing individuals. At present, this cannot be assured with any degree of certainty with
human cloning. Somatic cell nuclear transfer has not yet been refined and its long-term safety
has not yet been proven. The possibility of genetic or cellular conditions, and perhaps an array
of illnesses associated with cloning, is of great concern. While the demise of countless
amphibian, lamb, and mouse foetuses may be disturbing, similar wastage and mortality among
human foetuses is unacceptable. Moreover, we might have significant concerns about offering
such technology to women as a mechanism to facilitate reproduction given the potential harms
from the expected high miscarriage rate.

The risk of producing individuals with developmental anomalies is serious and precludes
human cloning for the time being. Producing disabled human clones would give rise to an
obligation to seek better understanding of— and potential medical therapies for— the
unforeseen consequences that could arise from human cloning.

B. Psychosocial harms introduced by cloning

Human cloning has the potential to introduce psychosocial harms to individuals. If a person
with known genetic predispositions and conditions is cloned, the cloned child’s genetic
predispositions and conditions will, due to the very nature of cloning, also be known to a certain
extent. For the most part, environment will also play a significant role. Presently, a child’s
genetic predispositions can be predicted to varying degrees if the parent’s genetic

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predispositions have been determined. Knowledge of a child’s genetic predispositions raises
concerns about the autonomy and best interests of the child. Knowledge of genetic information
holds great significance to an individual. The harm of pre-empting the child’s future choice in
knowing or forgoing knowledge of his genetic status and the danger of abrogating the child’s
right to privacy with respect to this status must be weighed carefully.

Foregoing choice in learning one’s genetic predispositions may seem trivial compared to the
concerns about identity raised with human cloning. If raised by the clone-parent, a clone-child
could see what he or she has the potential to become. In this respect, human clones would differ
dramatically from monozygotic twins who develop simultaneously. The timing of development
is a key difference between monozygotic twins and human clones. Having insight into one’s
potential may cause enormous pressures to live up to expectations (or inappropriately relieve
pressure to do so), even more so than those generally experienced by children.

Presumably, a person would clone him or herself or another individual because that person has
desirable characteristics that would be reflected in the clone. For example, the person who
cloned a sports star presumably would hope that the clone-child develops into another sports
star. A sports star’s clone-child unable to live up to these expectations could be dubbed a failure
unable to capitalize on his or her genetic gift. Moreover, although the clone-child of a sports
star might feel more confident of his or her abilities from the outset, other clone-children may
feel limited by their genetic lot. If a clone-child saw that he or she was likely to develop certain
diseases or had failed at certain tasks, his or her undertakings might be bounded by what the
clone-parent had done. Therefore, cloning might limit the clone-child’s perception of self and
increase external pressures. Human cloning may diminish, at least psychologically, the
seemingly unlimited potential of new human beings and may exacerbate disturbing motivations
for having children.

C. The impact of human cloning on family and society

In addition to concerns about individual privacy and identity, the implications of cloning for
family and broader social relationships remain uncharted. What would be the consequence to,
say, the father daughter relationship if the daughter and wife were genetically identical? Would
a woman have a normal mother-daughter relationship with her clone?

These examples illustrate that the family unit might be quite different with the introduction of
cloning. As one philosopher wrote, “cloning shows itself to be a major violation of our given

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nature as embodied, gendered, and engendering beings— and of the social relations built on
this natural ground.”

Additionally, some problems are technical and legal in nature. For instance, birth cousins could
be genetic siblings, and this might result in a need to revisit laws governing marital eligibility.
Also, the courts have had difficulty sorting out parental rights in cases of assisted reproduction.
In one case, a court found a child conceived using assisted reproductive technologies to have
no parents despite having eight individuals from which to choose.

While discussion and resolution of these issues is not the province of physicians, the impact of
human cloning on family and society is an important factor for physicians to consider when
weighing the costs and benefits of cloning. Until more thought is given on a societal level
regarding how to construct familial relations in this context, physicians should not participate
in human cloning.

Problem of Abortion

Abortion is the ending of a pregnancy by removal or expulsion of an embryo or fetus. An

abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"
and occurs in approximately 30% to 40% of pregnancies. When deliberate steps are taken to
end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The
unmodified word abortion generally refers to an induced abortion.

Thomson assumes, just for the sake of argument, that the fetus is a person from conception.
She then tries to show that, even given that the fetus has a right to life, it does not follow that
abortion is morally impermissible.

The anti-abortion argument:

(1) All fetuses are persons.

(2) Every person has a right to life.

(3) Therefore, every fetus has a right to life.

(4) Therefore, abortion is wrong.

For the sake of argument, Thomson assumes that (1) and (2) are true. She then argues that (4)
does not follow from (3). From the fact that something has “a right to life” it does not follow

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that it is wrong to kill it. This much is easy to see, since most of us agree that it is not wrong
to kill in self-defence.

Last but not least in highly populated countries like China after one child conceived abortion
is mandatory and it is desirable after two children conceived in India especially for Hindus.

Ethical Issues Raised by New Biological Technology or Knowledge

Biotech healthcare is going through what every other emerging scientific discipline
experience – the challenge of defining its ethical boundaries. Research, costs, and privacy
issues spawn concerns that third-party payers, employers, providers, and policy makers will
face for years to come.
n an age when medical technology improves with increasing rapidity, the availability of new
treatments increases almost as quickly. With advances, however, come dilemmas — scientific,
financial, and especially moral. These conundrums are likely to multiply as groups with vastly
different viewpoints and resources battle over the direction of health policy.

As the first decade of the 21st century reaches its midpoint, Biotechnology Healthcare has
identified five topics that dominate ethical discussions of biotech medicine.1 These issues will
continue to generate controversy in the foreseeable future, forcing third-party payers, employer
and union purchasers, and health care providers to deal with the policy implications of some
or all of them for years.

1. Protecting Human Subjects in Clinical TrialsThis issue has generated considerable

debate since 1999, when 18-year-old Jesse Gelsinger died while participating in a gene therapy
trial at the University of Pennsylvania. The institution was widely criticized for failing to
disclose crucial information on informed consent documents, relaxing criteria for accepting
volunteers, and enrolling volunteers who were ineligible. The episode prompted a great deal of
soul-searching among researchers and regulators, and many universities began implementing
new standards as a result of the harsh spotlight that was cast on the clinical trial world.

2. Affordability

The rising cost of healthcare and the cost of medications in particular is a political hot potato
and will remain so. It’s certainly an economic issue if biologics are priced so high that some
patients are priced out of the market,” says Sean Nicholson, PhD, assistant professor of policy
analysis and management at Cornell University. “Perhaps an insurer may not cover a particular
therapy. If there’s nothing else the patient could take to save his or her life, or to improve
quality of life, that’s a dilemma.”

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3. Privacy

Talk about a Pandora’s box. Protecting patient privacy is a growing concern, thanks to
technology that is making it possible to decode the human genome. But as scientists become
adept at deciphering a person’s genetic composition, it is increasingly likely that compromising
information about a person’s future health is going to become available.

This creates enormous problems. For instance, it may become possible to know that a 5-year-
old is going to develop serious heart disease later in life, but does a prospective employer have
the right to know that? How will this knowledge affect the individual’s ability to obtain a job,
insurance, or a mortgage? Should such information be available to insurers and others? This is
a thorny problem destined to become only thornier.

4. Stem Cell Research

This one shouldn’t be a surprise. Stem cell research is anathema to the religious right and
worked its way into the recent presidential election.

To circumvent the funding roadblocks in some countries like USA and UK are looking past
ethical objections and taking serious steps to foster establishment of stem cell research centres.
In California, birthplace of the biotech revolution and a state hard hit by the dot-com collapse,
voters sized up the potential economic value of stem cell research and overwhelmingly passed
Proposition 71, which guarantees $3 billion in state funding over the next decade

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