Bioethics
Dr. Chan Ho Mun
Associate Professor of Philosophy
Dept of Public & Social Administration
City University of Hong Kong
June 26, 2006
What is Bioethics?
The term “bioethics” was introduced in the
70’s by Van Rensselaer Potter for a study
aiming at ensuring the preservation of the
biosphere.
It was later used to refer a study of the ethical
issues arising from health care, biological and
medical sciences.
It is a major area in applied ethics.
The emergence of this new area of study has
been triggered by and a response to the new
scientific/technological developments in
biomedical and life sciences.
Medical ethics and nursing ethics are more
concerned with the ethics of the health care
professionals and their relationship with the
patient. Bioethics has a broader scope.
Some historical examples
Abortion
Contraception
Kidney dialysis machine (Who had the priority?)
Organ transplant, artificial ventilator, and brain
death
In virtro fertilization (IVF)
Cloning and stem cell research
Genetic engineering
Main topics in Bioethics
Death and dying
Pre-birth Issues
Issues in human reproduction
Human cloning
Stem cell research
The new genetics
Resources allocation
Organ transplant
Doctor-patient relationships
Experimentation with human subjects &
animals
(The above list is not exhaustive.)
Human Reproductive Technologies
(HRT)
Contraception: sex without procreation
HRTs: procreation without sex
Types of HRTs:
Artificial insemination by husband (AIH)
Artificial insemination by donor (AID)
In virtro fertilization (IVF)
Egg donation
Embryo donation
Surrogacy
Ethical considerations (see references 6,7, 10):
Procreation rights of infertile couples
It is unnatural
Inequality and exploitation
Selling babies?
The moral status of extra embryos left over from
IVF
Definition of parent-child relation
Integrity of the family
Best interests of the child
Human Cloning
Two techniques:
Embryo splitting
Nuclear substitution
Embryo splitting
The clone is usually used for tests of abnormality,
and will be destroyed subsequently.
Nuclear Substitution
What is the relationship between the nuclear
donor and the clone?
The same person?
(Technologically-aided and birth delayed) identical
twins?
Siblings?
Parent-child?
Should a homosexual be allowed to use the
technology to obtain his/her own child?
Is it moral alright for parents to clone their
beloved children who die young?
Should it be used as an infertility treatment or
gene therapy if it is safe?
No third party is involved.
According to the parent-child ordinance in HK,
whoever gives birth to a baby is its mother, and the
husband who goes through the infertility treatment with
her is his father.
Yet, human cloning has been banned by the HRT
Ordinance.
Stem Cell Research
Stem cells: undifferentiated, multi-potent,
precursor cells, capable of developing into
virtually any body tissue.
Three types of stem cells:
Embryonic stem cells (ESC)
Fetal stem cells
Adult stem cells
Three main sources:
Adult bone marrow
Miscarried or aborted embryos/fetus; extra
embryos left over from IVF
Embryos from therapeutic cloning
Potential Treatments:
They may be used to replace damaged organ
tissues (e.g., cardiac tissues), repair irreversible
injuries (e.g., spinal cord injuries), or cure diseases
(e.g., Parkinson’s and Alzheimer’s diseases).
ESC is most promising for treatment, and therapeutic
cloning can avoid the problem of immunological
incompatibility.
Ethical issues:
Destroying an embryo to harvest ESC is equivalent to
killing a child to obtain his organs.
Left-over from IVF are already there.
Therapeutic cloning: The embryo is not created for
reproduction.
How about the wellbeing of many patients who may be
cured by ESC research?
The New Genetics
Gene testing
Create unnecessary psychological distress
Discrimination by employers and insurance
companies
Confidentiality and Privacy
Social stigmatization
Prenatal Screening
Sex selection: Gender discrimination and
imbalance of sex ratio unless it is done solely for
therapeutic purpose.
Discrimination: Lives of the disable are not worth
living.
Genetic Engineering
Is it a form of eugenics?
Germ-line changes, unlike somatic modification,
can pass onto the next generation and be with us
forever. So germ-line changes could be very risky.
Is genetic enhancement moral?
See reference 10.
Doctor-patient relationships
Who has the final authority in medical
decision making? The patient, the family or
the individual?
Three models:
Individualism
Familism
Medical Paternalism
See references 1-3.
Organ Transplant and Resources
Allocation
One what criteria should organs be allocated
to patients for transplantation? (See reference
5)
What is a just distribution of healthcare
resources? (See reference 4)
References
1. Chan, Ho Mun, “Sharing Death and Dying:
Advance Directives, Autonomy and the Family”
Bioethics, Vol. 18, No. 2, 2004, pp.87-103.
2. Chan, Ho Mun, “Informed Consent Hong Kong
Style: An Instance of Moderate Familism”, Journal
of Medicine and Philosophy, Vol. 29, No. 2, 2004,
pp.195-206.
3. 陳浩文 “末期病人的決策倫理：三個模式的比
較”, 《中外醫學哲學》III：4 (2001年12月)：頁
45-55。
4. Chan, Ho Mun “Justice is to be Financed Before It
is to be Done: A Confucian Approach to Hong Kong
Public Health Care Reform”, in R. Z. Qiu (ed.),
Bioethics: Asian Perspectives, Dordrecht,
Netherlands: Kluwer Academic Publishers, 2004,
pp.207-228.
5. Chan, Ho Mun, Cheung, Germain, and Yip, Ada,
“Selection Criteria for Recipients of Scarce Donor
Livers: a Public Opinion Survey in Hong Kong”, (coauthored Germaine Cheung and Ada Yip), Hong
Kong Medical Journal, Vol. 12, No. 1, 2006, pp. 4046.
6. 陳浩文、陶黎寶華、馮應謙 “從民意及倫理角
度看香港應否全面禁止代母懷孕” 倪慧芳、劉次
全、邱仁宗 主編 《21世紀生命倫理學難題 》 北
京：高等教育出版社：頁246-261。
7. 陳浩文、陶黎寶華 “對香港應否全面禁止代母
懷孕的道德探索”《價值與社會》第一期：1997
年：頁137-155。
8. Kuhse, Helga and Singer, Peter, A Companion to
Bioethics, Oxford: Blackwell, 1998.
9. Holland, Stephen, Bioethics: A Philosophical
Introduction, Cambridge: Polity Press.
10. Tao, Julia, “What’s wrong with creating designer
babies?”, in Julia Tao and Hektor H T Yan (eds),
Meaning of life. Singapore: McGraw Hill Education,
2006, pp. 317-335.
11. Veatch, Robert M. The Basics of Bioethics 2nd
ed., Upper Saddle River, N.J.: Prentice Hall, 2003.