Bioethics

From a religious standpoint, is modern biotechnology to be interpreted as “playing God” or as collaborating in the on-going work of creation? ~Dr. Gurinder Shahi

The above question expresses an important ongoing bioethical debate. Within many religious traditions, ultra conservatives often see modern biotechnology as playing God. In-vitro fertilization (IVF), genetic engineering, and other medical interventions have been argued to be playing God. Along this line of argumentation, Jehovah’s witnesses do not accept blood transfusions, for example. However, other less conservative individuals of major religious traditions see humans as co-creators. That is, God endowed man with the mental capacity and resources to address new problems in novel ways. Francis Collins, for example, is an evangelical Christian and head of the Human Genome Project who reconciles modern science and Intelligent Design (see Language of God).

In certain cases, the line of what is acceptable to members of various religious traditions becomes hazier. For example, In-vitro fertilization (IVF) with donated oocytes allows infertile women to become pregnant in their sixth decade of life (see Dr. John Jain’s work at USC). I tend to agree with the co-creator camp. However, I feel that certain biotechnological innovations are unethical, as in the above case. What do you think?

Business ethic vs. human ethic

YouTube video Private Medicine is evil? raises a number of criticisms about the private healthcare system in America. Of particular interest to me is the argument expressed in the closing statement: “Profits for human life in my mind is evil.” What I think he means here is not necessarily that people and organizations shouldn’t profit for helping people, but rather that not helping those who cannot afford care is wrong. It’s important to distinguish between his explicit statement here and his larger argument. The narrator’s problems are that 1) large private corporations have been socially irresponsible, and 2) when financial incentives are the driving force of healthcare, glaring disparities often arise.

I tend to agree that universal healthcare is a more socially responsible approach (while some large corporations such as the Bill & Melinda Gates Foundation, have taken seriously their responsibility to give back to society, not all large corporations have been so altruistic) but I believe that present capitalistic values hinder the enactment of such a policy in America and elsewhere. A big concern of mine is the effect of the exportation of American capitalism on foreign cultures and economies—particularly when private approaches are not partnered with public entities that protect the health and economic interests of all those impacted. This is somewhat different from the argument for universal healthcare, as described above, but the underlying skepticism about capitalistic enterprises rings true in the case of providing quality of care in developing countries as well. With western values the way they are today, there is a tension. If we want to move towards a more socially responsible society, business ethics cannot replace the more overarching human ethics.

Healthcare Financing in Texas: Case Study

An article in the NYTimes illustrates part of the problem with healthcare financing in America today. Dee Dee Dodd is a 38 year old woman who lives on a country road in Hays County, Texas. Among the working poor, the Dodd family makes too much money to qualify for Medicaid under stringent Texas laws (if a working parent of two or more makes more than $3696 a year, he or she is ineligible). With between 150-250% of the federal poverty limit, the Dodd family cannot afford private health insurance. Ms. Dodd was diagnosed as a “brittle diabetic” ten years ago when her weight fell to 82 pounds. Years of low access to health care had weakened her and led to preventable side effects like esophageal ulcers. Additionally, repeated episodes of ketoacidosis were life-threatening. In one 18-month period, Ms. Dodd accumulated over $191,000 in unpaid hospital bills for emergency room visits and time spent in the intensive care unit. As a result, Ms. Dodd was classified as a “frequent flier,” or a repeat patient whose disease and expenses could be decreased with more regular medical care. The Seton Family of Hospitals enrolled Ms. Dodd in their charity program, where she now receives free primary care. The use of a $3,200 insulin pump and access to an endocrinologist and home counseling have helped reduce the severity of Ms. Dodd’s ailments. Her health has improved, her medical bills have been cut, and the hospital’s costs have been cut as well. In 18 months, her care cost Seton $104,697—significantly less than the previous period when Ms. Dodd was not a part of Seton’s charity program.

For individuals with chronic conditions, better care not only decreases disease, but may also decrease patient and hospital costs. Seton's charity program is among others that have taken novel approaches to curb hospital costs in Texas. Recognizing the many problems with healthcare financing in America today, states are taking the lead on developing plans that better address health/financial/ethical complexities. One recent example is Massachusetts’ plan to have 99 percent of adults covered by health insurance. With healthcare financing on the state and national agenda, it will be interesting to see how things change within the next decade.

Terrorist incidents: has public awareness increased response preparedness?

Among the man-made disasters, one has received increased attention in the minds of the western world: terrorist incidents. One BBC video clip entitled “The Power of Nightmares,” argues that in the past, politicians offered dreams to the people. As people have lost faith in these ideologies, politicians are seen increasingly as managers of public life rather than as visionaries. Instead of offering dreams, politicians have restored a sort of prominence by promising to protect us from nightmares: Dreadful dangers we do not see or understand… international terrorism with vast networks. The journalist in the clip argues that such threats have been exaggerated and distorted by politicians.

There is a definite need in society to have infrastructures in place for multi-sectoral responses to devastations if and when they occur. The threat of terrorist incidents is a relatively new challenge that theoretically requires a number of the same considerations as other large scale threats (for example: war, natural disasters, and severe weather). Because there is a prospect that terrorist incidents could result in mass casualties or devastation to socioeconomic functioning, such threats do need monitoring, surveillance, and rapid response. Currently, new policy measures and military activities have taken steps towards responding to the threat of terrorism. While such steps are proactive, I have many concerns with the breadth and depth of our approaches. Most importantly, I am of the mind that this should be one of our lesser concerns in terms of potentially devastating threats. While on the agenda, disease outbreaks and natural disasters receive less public attention than terrorism and may in reality pose more of a threat to American citizens.

As is the case for other threats, public awareness is one way to better response capabilities within the population. As a basic example, educating individuals what to do if an earthquake is felt, and what provisions to have within the home have increased earthquake preparedness. But what has been the benefit of widespread public attention to terrorist threats? Politicians’ image is developed as our protectors from terrorism and the media cashes in, but what other (and whose) interests are served? Are we as individuals better off due to the media exposure, for example?

***With tremendous public awareness about terrorism, are we more prepared if something happens, or has a culture of fear pervaded our society? ***

I will close this week’s blog by encouraging you to watch a hilarious 16 second clip entitled “fear of terrorism.” Cheers.

You know the world is going crazy when...

"You know the world is going crazy when the best rapper is a white guy, the best golfer is a black guy, the tallest guy in the NBA is Chinese, the Swiss hold the America's Cup, France is accusing the U.S. of arrogance, Germany doesn't want to go to war, and the three most powerful men in America are named Bush, Dick, and Colon."

- Chris Rock