Bio medicine - Legal and Ethical Issues

Bio medicine - Legal and Ethical Issues

This session began with Ambrose Rachier giving an overview of his paper, dealing with some of the areas of interest in this area.

A well written paper no doubt, but he really was given insufficient time to tackle the issues to the extent that he would have liked.

Quotes:

• “If humans are cloned, will they have the normal rights that we have”?
• “Where do we draw the line between patient care and organ donation?”

Interesting Questions

• When is someone legally classified as dead (Californian case – Dr. Hotan Roozrah)?
• What happens when a sperm donor changes their mind? (Natalie Evanns v UK - where one donates sperm and later changes one’s mind, paternity should not be imposed and embryos resulting from such process must be destroyed).

Also thought provoking was his examination of some of the third world challenges to issues such as informed consent to medical trials. The challenges noted include:

High levels of illiteracy which are a barrier and question the integrity of the system/principle.

Therapeutic misconception

Gender inequality and equity.

Poverty

Thereafter, matters got rather more controversial with the presentation of a paper by Justice Michael Kirby

[The text of his paper can be found here]

[See also my earlier post on PGD, and subsequent post criticizing some aspects of his presentation]

Quotes:

• “Judge Richard Posner has said trouble with lawyers is they are the little children that were good at words but not math.”
• “We live in age of coalescence of math and science.”

He proceeded to inform us how Ambrose Rachier’s comments reminded him of some of the old ethical issues that bothered commentators in the 1970s, and now seem old fashioned and irrelevant.

He then touched on some of the ‘new’ ethical issues.

Pre-implantation genetic diagnosis (PGD).

Quotes:

• “In NZ, committee found problems with implementation of this in human beings!”
• “Worries on maori genome in NZ.”
• “Worries of rise of instrumentalist view!”
• “Do we need to postulate a perfect human being?”
• “What about elimination of grave serious human conditions/ailments”.
• “Our response to these issues is dependant on what rules we use to inform our ethical principles!”

Embryonic Stem Cells Research and Cloning.

This he said is encouraged by the belief that it is of the nature of the embryo and the cells within it, that it is omnipotent as the cells possess amazing abilities of adaptation as they eventually develop into full human beings.

He pointed out that dead heart tissues improved in early experiments.

Problems that arise in discussions on these ethical issues:

• Referred to UNESCO Committee of which he was a member, as an example of how the problems manifested themselves!
• He noted that there are radically different starting points for peoples responses!
• Catholic/Christian perspective – as human existence begins at the point of conception, cells in embryo are cells of a human life/ part of a human life!
• Christian (some other view) – human existence begins when first outline of spine.
• Others – the cells are simply fluid that will never become a full human
• Judaism – human life begins after 28 days!
• Muslim – human life begins towards end of third trimester
• Hinduism – human life begins after foetus lives but an hour, whereafter it is buried as full human with full burial rights.
• Others believe religion should not be considered when discussing these issues..
• At the UNESCO conference they agreed to disagree.

To illustrate how attitudes change over time he gave the example of Australia where:

• In 2002, Act passed banning cloning, not only to full term, but also therapeutic cloning
• In 2005, recommendation for amendment to permit therapeutic cloning
• In 2006, the amendment was passed, but only just (34-31)

In the UK – he said one of the current big issues was whether there should be a ban on hybrid developments? (using empty animal egg fertilised with human genetic material for genetic purposes?)

One of the concerns is the development and dissemination of viruses to which humans have no resistance.

HIV/AIDS

He noted that the ethical issues on cost of treatment and stated that second line therapies will be extremely expensive and out of reach of most in developing world.

He then indicated that there were some uhncomfortable facts that needed to be stated:

He stated that the countries of the commonwealth that have succeeded in curbing the AIDS pandemic are UK, Australia, Canada and NZ.

He then stated that the success was as result of lawmakers in those countried taking steps “that are not palatable to law makers in this part of the world”.

• Mass education including in schools.
• Reforming the law on prostitutes.
• Sterile injection equipment.
• Removal of laws against homosexuals

Questions – in 3^rd world homosexuality is a very minor source for transmission

- Where do the studies that see a racial component to transmission risk, fall?

- How does the situation where increase in teenage pregnancy, and legislative increase in the ease with which morning after pills are available in west does not have corresponding effect on HIV transmission.

Kirby’s suggested solutions:

Recommend benefit sharing – balance protection of IPR and access to health care

Views of religion cannot be source of bio ethical decisions on human beings.

On issue of PGD – look at work of NZ legal reform law foundation committee

Most important message (he says) – importance of tackling prevention in this part of the world, complete failure of prevention??? (criticised for consultation with the gay community).

Heather Sampson

Case in Boston (embryonic stem cell) – misconception/misunderstanding

Questions – in 3^rd world homosexuality is a very minor source for transmission

- Where do the studies that see a racial component to transmission risk, fall?

- How does the situation where increase in teenage pregnancy, and legislative increase in the ease with which morning after pills are available in west does not have corresponding effect on HIV transmission.