Ethics tied to medical advances

Leading expert underlines that public must be made aware of implications of scientific breakthroughs

By Nick Malkoutzis - Kathimerini English Edition

As more women in Greece opt for plastic surgery and Britain debates whether to allow human and animal embryos to be combined for medical research, the debate over how far medical science should go has picked up pace again.

Kathimerini English Edition put questions to one of the world’s leading experts on biomedical ethics, Dr Ruth Faden (recently in Greece as part of the Great Ideas* series of public lectures) about the implications of plastic surgery, other forms of biomedical enhancement and the boundaries governing medical research.

Aesthetic plastic surgery is one kind of biomedical enhancement. Biomedical enhancement is using biomedical means, including but not limited to surgery and pharmaceuticals, that draw on advances in such areas as genetics, neuroscience and nanobiotechnology toward the ends of altering humans to express or experience a desired characteristic or trait.

In recent years, much of the activity has occurred in the neurosciences and psychopharmacology, for example the use of drugs developed to treat attention deficit disorder to enhance the attention span or the use of drugs to treat narcolepsy to increase the capacity of people to function effectively on less sleep. We can expect to see many more such examples in the future as well as the likelihood that advances in cell engineering and genetics will create opportunities for the development of more enhancement interventions down the line.

Breakthroughs in science and technology often raise ethical and social challenges. Society is best served when these challenges are anticipated in advance, giving society ample opportunity to think through these implications and frame reasoned policy and social responses.

The purpose of marketing is to generate demand, either for a new product or for a new version of an existing product. Part of that process is to persuade the public of the value of a product, thereby generating a sense of need for that product. This is hardly a new phenomenon.

Not always. It is very difficult to determine what constitutes the “normal range” of a human characteristic or trait and what constitutes an enhancement beyond or above “normal.” Consider height, for example. The average height of humans has increased significantly over time and has been attributed in part to increased nutrition. Was increased nutrition an enhancement? What about growth hormones today? Similarly, should taking Viagra for erectile dysfunction associated with a serious illness be considered ‘medical treatment,’ whereas taking Viagra for sexual limitations associated with advanced age ‘enhancement’?

I see the issues as ones that need to be widely and honestly discussed in society, with a realistic appreciation of the way science and the market proceeds and the options available for oversight and regulation.

Much the same fears were raised for technological advances in earlier times – that the bicycle or automobile would make us lazy and soft, for example. I am more concerned with the prospect that advances in biomedicine will widen rather than narrow already existing unjust inequalities in well-being between privileged and disadvantaged people. Also, I am worried that biological inequalities – in resistance to disease or cognitive capacity, for example – have the potential to be more pernicious than economic ones.

What role embryonic stem cell research will play in the general election is yet to be seen although it is likely to play less of a role than it did four years ago. Senator McCain who is the presumptive Republican nominee, did vote in favor of a stem cell bill that would have permitted federal funding for research in which stem cell lines were to be derived from embryos created for in vitro fertilization but which couples (who generated the embryos) no longer need for infertility treatment and now wish to either donate to research or otherwise destroy them. Both candidates for the Democratic nomination (Senators Clinton and Obama) also voted for this same bill.

Although recent advances in the science suggest that down the road the role for such research may be less significant, most scientist still believe that embryonic stem cell research continues to be useful in the effort to secure important advances as quickly as possible.

In the case of embryonic stem cell research, it is likely that limitations on funding associated with moral concerns have slowed the pace of science.

* The Great Ideas series is organized by the Fulbright Foundation in Greece with the support of the Stavros Niarchos Foundation and the US Embassy. For more information, visit www.stavrosniarchosfoundation.org or www.mosaiko.gr.