THE UNIVERSITY OF THE WEST INDIES ST.

AUGUSTINE

ASSIGNMENT NO: 2 NAME: The medical doctor is confronted with a spectrum of new ethical challenges as we enter the 21st Century, which the authors of the Hippocratic Oath would not have anticipated. Discuss COURSE CODE: PRMG6016 NAME: ETHICS FOR PROJECT MANAGER COURSE LECTURER: Prof Winston Suite

STUDENT NAME: LELON ABREY SAUL

FACULTY OF ENGINEERING

ID: 80011576

DATE: November 27, 2012 i

ABSTRACT
This essay discusses the spectrum of new ethical challenges confronted by the medical doctor as we enter the 21st Century, which the authors of the Hippocratic Oath would not have anticipated. During the discourse I emphasized the ethical issues affecting euthanasia, abortion, stem cell research, organ transplant and human genetics engineering. Finally, I conclude even though these medical procedures, more especially, organ transplant, stem cell research and human genetics engineering are highly desirable and beneficial, society should regulate the conduct and practice of doctors and researchers, since some may be inclined to engage in unethical conduct. Notwithstanding the ethical issues discussed, the benefits that are derived from the addressed medical procedures outweigh the cost.

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CONTENTS
Abstract Introduction Discussion Hippocratic Oath Euthanasia Abortion Stem Cell Research Organ Transplant Human Genetics Engineering Conclusion Reference ii 1 1 1 2 3 4 5 6 7 8

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INTRODUCTION
This essay offers a discussion on the spectrum of new ethical challenges confronted by the medical doctor as we enter the 21st Century, which the authors of the Hippocratic Oath would not have anticipated. Interestingly, the Hippocratic Oath regulates the ethical conduct of physicians. As a result, some physicians aided by a stubborn society either refuse to save lives or blatantly refuse to terminate a patient's life when death is imminent, life is painful and burdensome and the sufferer had requested to be aided in the termination of his/her life. The position taken by many doctors is shaped by a religious construct which is influenced by Greek mythology that totally ignores the principle of double effect. The principle provides specific guidelines to determine when it is ethically permissible for a human being to engage in conduct in pursuit of a good end with full knowledge that the conduct will also bring about bad results."1 Therefore, in my discussion, I will present an overview of the Hippocratic Oath and examine how this instrument impinges on the patient's rights and the intent of the "not so Aesculapian" to rid the world of debilitating diseases and promote better health for all.

DISCUSSION
Overview of Hippocratic Oath
The Hippocratic Oath is one of the oldest binding documents in history. It bears the name of Hippocrates the so called father of medicine who lived in early 5th Century BC in Greece. Although written in ancient Greece the document is held scared by many doctors to this day. The original document
1

MPA 8300, Leadership Ethics-The Principle of Double Effect. Available Online: www83.homepage.villanova.edu/.../double%20effect.html. Accessed November 26, 2012.

advocates that doctors act in the best interest of their patients, offer free tuition, not to commit abortion or aid in the death of their patients and moreover they were not to disclose any information about the patient's illness. "The Hippocratic Oath is an expression of ideal conduct by physicians."2 Over the years the oath has been amended to accommodate modern medicines. Nevertheless, many proffered that the Hippocratic Oath is inadequate to address realities of huge scientific, social, economic and political changes. More specifically, issues such as abortion, doctor assisted suicide, stem cell research, organ transplant and human genetic engineering were unheard of at the time of Hippocrates; hence, the irrelevance of the Oath.

Euthanasia
There is no doubt that euthanasia is illegal in keeping with the spirit and intent of the Hippocratic Oath. Notwithstanding Hippocrates's position on this issue I submit that society is obliged to respect the desire of a quadriplegic or anyone who is terminally ill and is desirous to painlessly end his/her life with the assistance of a physician. In absence of medicine to reverse debilitating illnesses such as Lou Gehrig's disease, an honourable doctor will carry out the wish of his conscious patient who has communicated his desire to die. Like Dr. Kevorkian, I am convinced that doctor assisted suicide is a noble task that seeks to relieve patients of their suffering, however, the act inevitably killed the person. It must be borne in mind that the end of the patient suffering is the good effect, paradoxically; death which is the bad effect is the mean to the good effect. It is pellucid that there is no gray area in doctor assisted suicide. Undoubtedly, this service has relieved many terminally ill patients of agony and certainly caused less stress on the health care system. I am saddened by the fact that
2

Tyson, Peter (2001) The Hippocratic Oath Today. Nova. Available Online:www.pbs.org/wgbh/nova/body/hipprocratic

many do not recognise the value of doctor assisted suicide. Following the death of Terri Schiavo in March 2005, thirteen days after the Florida High Court ordered the removal of the life support system that would have kept her alive for fifteen years in a comatose state, President George Bush said "where there are serious doubts and questions, the presumption should be in the favour of life."3 Interestingly, there was never any doubt about Terri Schiavo's health, it was long determined by the court appointed doctors that she was in a permanent vegetative state and would not recover. Regrettably, it was the voice of special interest and not that of the patient's voice as expressed by her husband prolonged her agony for fifteen years. Indisputably, the action taken by the Court was most ethical since it finally brought an end to the suffering of Terri Schiavo, her family and eased the stress on the health care system.

Abortion
Like euthanasia, abortion is another ethical issue that has confronted the medical doctor. According to Mayo Clinic "abortion is a procedure that uses various medications to end pregnancy."4 Since it was promulgated, the Hippocratic Oath was against this medical procedure. This was reiterated in International Code of Medical Ethics (1949) which states: "A doctor must always bear in mind the obligation of preserving human life from conception." This position is equally driven by religious zealots who are obsessed with their sacred books and its sanctity about life. I contend that this obstinate pro-life position has resulted in unnecessary maternal death and unwanted babies whose parents do not have capacity to care for them. Recently, Dr. Savita Halappanavar died in Galway, Ireland due to blood poisoning after doctors allegedly refused to terminate her pregnancy

Brain-damaged Terri Schiavo dies. Available Online:www.bbc.co.uk/2/hi/americas4398131.st Accessed on November 26, 2012. 4 Mayo Clinic. Medical Abortion. Available Online: www.mayoclinic.com/health/medical-lab. Accessed on November 26, 2012.

on ethical grounds when she was having a miscarriage.5 Ireland is a Catholic country and abortion for all intent and purpose is illegal. It is a tragedy for any society to deny abortion in cases of rape, incest or in situation where continued pregnancy endangers the mother's life. There is no valid reason not to allow a sane woman to determine the future of her unborn child. Why should society allow a victim of rape to bring forth a child fathered by the rapist? Likely, the mother of the child will hate her offspring since he/she is a constant reminder of the traumatic event she would have endured. Pro-choice activists strongly support the right to abortion and I endorse their position, since I am convinced that it is not a vice but a virtue. There is no merit in allowing the continuation of an unwanted pregnancy, more so, if the woman opted for termination. It is known that unintended and unwanted childbearing have negative consequences such as health issues for both mother and child, child abuse, juvenile delinquency, low birth weight and neurological defects.6 The ethical issue therefore, is not abortion, but allowing society to bear the cost of unintended and unwanted childbearing.

Stem Cell Research

Unlike euthanasia and abortion, stem cells research falls under a different realm of medical issues. "Stem cells are primal undifferentiated cells which retain the ability to differentiate into other cell types..(which) allows them to act as a repair system for the body, replenishing other cells as long as the organism is alive (McCulloch & Till, 2005)" Given their characteristics stem cells offer tremendous benefits in the areas of regenerative medicine and therapeutic cloning. Initially, stem cells were only derived from embryos, but today they are also derived from umbilical cord and placenta.
5

Savita report could determine Ireland's abortion policy. The Times of Management, November 27, 2012. Available Online:http:timesofindia.indiatimes.com. Accessed on November 27, 2012. 6 Russo, Nancy Felipe, Ph.D and David, Henry P. When Pregnancies are Unwanted. Psychology and Reproductive Choice. Available:www.prochoiceforum.org.uk/psy_ocr.pl. Accessed on November 26, 2012.

The initial source of stem cells have caused pro-life activists to rally against any research in this area. They contend that an embryo is a human life and to destroy it is sacrilegious. The fact is an embryo is not a human life; it merely represents a potential life since it is not embedded in the womb (McCulloch & Till, 2005). More importantly, as we wrangled over frivolous issues they are millions of people who continue to suffer from a vast array of diseases and sickness including: cancers, spinal injuries, and Alzheimer's among others that can be cured from stem cell research. For this reason, we ought to fast track stem cells research, since the potential benefits outweigh the cost. More specifically, the Hippocratic Oath compels physicians to apply all measures to benefits their patients; hence, it makes no sense to reject the potential benefits of stem cell research.

Organ Transplant
Notwithstanding the slow progress of stem cell research, organ transplant has successfully fulfilled the medical needs of several patients. "An organ transplant is a surgical operation where a failing or damaged organ in a human body is removed and replaced with a new one."7 A patient who is in need of an organ transplant is likely to be placed on a waiting list for a long period. Generally, there is a paucity of donors and this has caused medical institutions to imposed rigid criteria for selecting patients for receipt of organs. The criteria are based on equal access and maximum benefits. However, these criteria have attracted criticism since they appeared to be unfair and unjust. Further, a donor's wish may not be in keeping with the criteria for allocation. Nevertheless, I see no merit in giving priority treatment to someone who knowingly caused his/her organ(s) to be damaged due to personal lifestyle, over an individual who would have taken the necessary precaution to live a healthy life. Therefore, I proffer that an individual worth must be taken into
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Ethics of organ transplantation. Center for Bioethics. February, 2004.

consideration when making decisions concerning recipients of organ donation. This is of utmost importance since we should preserve the lives of our most valuable homo sapiens, rather than drug addicts, tobacco smokers and alcoholic who knowingly destroyed their health. Lamentably, organ transplant has given rise to unethical issues such braindead patients being kept alive for organ harvesting and most reprehensible, the selling of organs (Radcliffe, 1998). In some countries such as Indian and the Philippines, the poor and uneducated are coerced by their economic circumstances to sell their organs (kidneys) not knowing the consequences of their actions (Delmonico, et al, 2002). Given the aforementioned, I propose that organ donation be based solely on an altruistic system and efforts be made to criminalize organ trafficking.

Human genetics engineering

Most importantly, human genetics engineering has the potential to negate organ transplant, since repairs of defective genes and introduction of new characteristics are its main products (Michalch, 2005). Unfortunately, ethicists have called for the ban of germline engineering which aims at genes in embryos and sperms, since this procedure alters genes and affect future generations. Interestingly, germline engineering eliminates the probability of parents passing genetic diseases to their children.8 Like stem research, genetic engineering is the panacea for debilitating diseases such as diabetics, renal failure and cardiovascular diseases among others. Undoubtedly, the benefits of eliminating unwanted traits of future generations by manipulating genetic codes are much greater than the status quo which is characterized by hereditary and lifestyle sicknesses. Moreover, human genetic engineering has the potential to reverse the aging process, increase intelligence,
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Human Cloning and Genetic Modification. Association of Reproductive Health Professionals. Available Online: http://www.arhp.org/publications-and-resources/patient-resources/printed-materials/cloning. Accessed on November 27, 2012.

and grow organs. I am positive that no sane man would reject these benefits. However, the caveat is human genetic engineering should strictly involve only human genome; thus, eliminating the probability of introducing other forms of genetic codes into homo sapiens.

CONCLUSION
The authors of the Hippocratic Oath did not foresee the ethical issues that are confronted by doctors today. Hence, the Oath is inadequate; however this is not a license for physicians to engage in unethical conduct. When confronted with ethical issues like abortion, euthanasia among others the doctor should apply the principle of double effect when making decisions. Although stem cells research and human genetics engineering are highly desirable we should not allow unbridled research in these fields since they are overzealous researchers who may indulge in unethical conduct. Organ transplant is another area that is the subject of ethical discourse, since the underprivileged and uneducated in some countries sell their organs. This is reprehensible and therefore every effort should be made to discourage this practice. Nevertheless, these three areas have the potential to solve many of the health issues that are confronted by today's generations; hence, more research should be encouraged.

Reference
Brain-damaged Terri Schiavo dies. Available Online:www.bbc.co.uk/2/hi/americas4398131.st Accessed on November 26, 2012. Delmonico, Francis. L. Ethical Incentives - Not Payment - For Organ Donation. New England Journal of Medicine. Volume 346, #25. June 20, 2002. Ethics of organ transplantation. Center for Bioethics. February, 2004. Human Cloning and Genetic Modification. Association of Reproductive Health Professionals. Available Online: http://www.arhp.org/publications-andresources/patient-resources/printed-materials/cloning. Accessed on November 27, 2012. Michalck, Whitney. Biomedical Engineering Seminar. September 2005. Mayo Clinic. Medical Abortion. Available Online: www.mayoclinic.com/health/medical-lab. Accessed on November 26, 2012. McCulloch, Ernst A and Till, James E (2005). Perspectives on the properties of stem cells. Nature Medicine, Volume 11, #10. October, 2005. MPA 8300, Leadership Ethics-The Principle of Double Effect. Available Online: www83.homepage.villanova.edu/.../double%20effect.html. Accessed November 26, 2012. Radcliffe, Ovid. The case of allowing Kidney sales. Lancet. Volume 351(9120). pp1950-1952. June 27, 1998. Russo, Nancy Felipe, Ph.D and David, Henry P. When Pregnancies are Unwanted. Psychology and Reproductive Choice. Available:www.prochoiceforum.org.uk/psy_ocr.pl. Accessed on November 26, 2012. Savita report could determine Ireland's abortion policy. The Times of Management, November 27, 2012. Available Online:http:timesofindia.indiatimes.com. Accessed on November 27, 2012. Tyson, Peter (2001) The Hippocratic Oath Today. Nova. Available Online:www.pbs.org/wgbh/nova/body/hipprocratic