Bioethics

Bioethics a brief introduction

1. Bioethics
Dr. N. Yuvaraj
Assistant Professor
AchariyaArts and Science College
Villianur, Puducherry

2. Bioethicscanbedefinedasthatdisciplinedealingwithethical
issuesraisedbynewdevelopmentsinmedicineandbiologicalscience.
Inthepast(about50yearsago),bioethicswasusedtosolve
simpleethicalproblemsusingHippocratespostulatesandChristian
humanism.
Withadvancesintechnologyandculturalrevolution,thetraditional
approachesofbioethicsfailtoaccountforcertaincomplexevents.
Bioethics,asaseparateformalfieldofstudyisroughlyaround25
yearsold.

3. Modernapproachestobioethicsarederivedfromdisciplineslike
philosophy,theology,medicineandlaw.
Thefourcardinalprinciplesthatunderlinebioethicsare
1.confidentiality,
2.beneficence,
3.justiceand
4.autonomy.

4. Medicineandotherbenefitsofsciencehavereachedmanysocial,
culturalandreligiously-diversegroups.
Acceptanceofthesebenefitshavetriggeredwidevarietyof
responses,andhasgeneratedgoodpublicinterest.
Threeissuesinvolvingbioethics:
1.Presymptomaticgenetictesting,
2.prenataldiagnosis,and
3.Genetictesting

6. Pre-SymptomaticGeneticTesting
Genetictestingforhereditarysusceptibilitytodiseaseisnew
andthepossibilityofearlydiagnosishaschangedtheadvent
ofgenetictesting.
Presymptomaticmoleculardiagnosisisimportantinidentifying
carriersinpopulations,whichcouldenableustostop
manifestationofdiseasepriortoitsoccurrence.

7. Moleculardiagnostictestsareavailableforseveraldiseases,such
asHuntington’sdisease,cysticfibrosisandsickle-cellanemia.
Thishasbeendubbedasgeneticprophecy.Theinformationgained
bymoleculartestingcouldbealsomisused.
Ethicaldifficultiesduetomolecularpresymptomatictestingarise
atthreedifferentlevels,
1.insocietyorsocialissues,
2.inemploymentand
3.ininsurance.

8. 1.SocialIssues
Genetictestingmayleadtodiscriminationandstigmatization.
InIndia,religionshavestrongholdoverusanddiseasesare
consideredaspunishmenttoevildeedscommittedinthepastor
previousbirth.
Marriageisanimportantinstitutioninoursociety.
Matesaredrawnfromendogamouspopulationsbelongingtothe
samecasteandreligion.

10. Individualsaffectedorcarrierswouldbelookeduponbyour
socialsystem.
Moleculartestingcanrevealinformationaboutrelativesofan
affectedindividual.
Hemaynotwishtoknowabouttheirgeneticstatusofthe
diseasebecausethismayleadtoexcommunicationand
discriminationofhealthyindividuals.

11. 2.Employment
Denialofemploymentonthebasisofinformationgainedby
genetictesting,iscauseofseriousethicalconcern.
TheexampleofanAmericanfirm,whichscreenedblack
employeesforthepresenceofsickle-cellanemiaisveryapthere.
Interestofanemployerliesininvestingintotheexpansionof
businessratherthanonequipmentforthesafetyofaspecific
employee.
Thebetteroptionfortheemployerissackingtheemployee,
citingreasonsotherthangenuine.

12. Re-employmentmightnotbepossiblewithanewemployerforthe
samereasons.
3.Insurance
Insurancecompanieshavestartedtothinkinadirectionwherea
personpredisposedtoaparticulardiseasemaynotbeabletohave
insurancecover.
Theinsurercouldgoforatestwithouttheknowledgeofthe
customerandbasingontheresultsofthetestinsurancepolicycould
besoldorwithdrawn.

13. PrenatalDiagnostics
Prenataldiagnosisistheidentificationofdiseaseofthefetus.
Thethreemainpurposesofprenataldiagnosisare:
1.toinformandprepareparentsforthebirthofanaffected
infantifany;
2.toallowinuterotreatmentforpostnataltreatment,ifrequired;
3.toindicateterminationofanaffectedfetus.
Asoftoday,terminationofaffectedfetusdominatesoverits
management.

14. Technologytodayiscapableofdetectingadisease/disorders
ofthefetustowhichitis,goingtobesusceptibleinthe
future,fromthemother’sbloodstream.
Wecanwelllistoutmanydiseasestheunbornchildislikely
tobebornwith.
Informationgainedfromabatteryoftestsmayaffectthe
childinadmissiontoschoolandcollege,employmentandsocial
standing.

15. Stepstobetakentowardsproperuseofprenataldiagnosismust
betakenaftercarefulanddeliberateconsideration.
Thefetusandabortionaresensitiveissues.
Ethicaldiscussiononthesetopicsisexhaustive.
Muchscholarshiphasbeendevotedhereandinthewest.
Ithasbecomeamajorpoliticalargument.

16. (a)Humanhazard:
Howsafearethoseinvolvedinmanipulatinggenomes?
1.Theevaluationorriskinvolvedinworkingwithvectors,
2.properdisposaloflaboratoryby-productsand
3.criticalevaluationofthemanipulatedorganismisneeded.

17. (b)Ecologicalhazard:
Modifiedorganismscanbesourcesofinstabilityinanecosystem.
Thedisturbancemaybeobservedaftercertaindamageoritmay
gounnoticed.
Fore.g.ifinsulin-producingbacteriacouldgainentryintohuman
intestines,thiswouldwellmeanaman-madeproblem.
Thesecondaspectisecologicalhazardsofmonitoredorganism,
whichcanbesourcesofinstabilityinanecosystematvarious
levels.Someeffectsmaybebeyondhumanobservation.

18. Genetherapyisaneffectivewaytocorrectgenedeficienciesby
replacingdefectivegeneorsupplementingit.
Biblicalsayinggoes‘Godmademaninhisownimage’.
Howfarismanjustified‘playingGod’,tamperingwithhumangenes.
InIndia,sofaragenetherapytrialhasnotbeenreported.
Therearemanyunresolvedissuestocurrentlyavailablegene
therapiessuchas
1.safetyandstabilityofthevectors,
2.behaviorofthegeneaftertransfection,etc.

20. CONCLUSION
TheseissuesofbioethicsseemtohavelittlerelevanceinIndia.
Beingadevelopingcountry,unemployment,hungerandpovertyhold
priority.
However,bioethicalissuesshouldnotbeignored.
GeneticdiseasesinIndiahavenotdrawnmuchattentionandthe
geneticistisconfinedtothefourwallsofthelaboratory,unawareof
theprevailingsituations.

21. Ononeendofthespectrumitistheliberal,affluentandthe
educatedclasswhereasontheotherilliterateandpoor.
Ofcourse,thereisasizablemiddleclasstoo.
Takingdecisionscanaffecteachofthesegroupsindifferentways.
Riskandbenefitshavetobeweighedkeepinginviewallthese
groups.
Thestudyofresponsestotopics,likeprenataldiagnosisand
geneticstesting,cangatheruptoprovideuswithmuchinformation.