Progressive Bioethics: The Future is Now

Four issues in bioethics that progressives can address now to make the world a cleaner, healthier and better place to live.

By Dr. Jonathan Moreno, Center for American Progress
Tuesday November 1, 2005

Recently scientists have asked us to imagine a world where genetically modified pigs can provide badly needed organs for transplants, the aging process can be slowed almost indefinitely and Alzheimer’s and Parkinson’s diseases can be cured by stem cell therapy using cells cloned from the patient’s own body. But how about also imagining a world where improved public sanitation, increased access to health care and greater focus on energy efficiency vastly improve the health of both individuals and the planet itself? Progressive bioethicists focus on advancing scientific research dictated by human needs and not political ideologies, and on better allocating existing technological resources to reflect the values of fairness and equity. Here are four issues in bioethics that progressives should concern themselves with now in order to ensure a better future.

1. Stem Cells

Stem cell research has the potential to help scientists develop cures for a whole host of diseases, and to better understand cell development. Embryonic stem cells can develop into any type of cell in the body, offering the possibility of treating a number of diseases and disabilities, including Parkinson’s, Alzheimer’s, diabetes, spinal cord injuries and heart disease. Through Somatic Cell Nuclear Transfer (SCNT) scientists can create embryonic stem cells that share the DNA of the patient, thereby reducing the chance of the patient rejecting the transplant of organs created from those stem cells. Unfortunately, embryonic stem cell research has been severely hampered by President Bush’s restrictions on the use of federal money for this research. These restrictions have not caused scientists to abandon the promise of stem cell research, but they have forced them to conduct that research with private and state money and without federally mandated ethical standards. Bush’s restrictions, therefore, have only succeeded in leaving scientists adrift, without any specific guidance on how to conduct research in an atmosphere ripe for abuse. For example, currently there is no federal requirement for informed consent from those who are asked to give their eggs, sperm or embryos for research, and no bar to creating a market for reproductive materials. Thankfully, the National Academies has produced standards to fill the ethical void left by President Bush’s policy, but without the support of the government these standards can only do so much. As progressives, we cannot accept the conservatives’ “bury our head in the sand” strategy, simply hoping the issue of stem cell research solves itself. Instead, we must allow research informed by sound ethical standards to ensure that the potential of stem cell research is realized in a moral and appropriate manner. Progressives should advocate expanded federal funding with mandatory standards for stem cell research.

2. End-of-Life Care

As the Terry Schiavo case so forcefully demonstrated, end-of-life care will be of great importance in the 21st century. As medical science has progressed to the point that we can sustain people with minimal brain activity, serious questions arise as to who can make end-of-life care decisions and what those decisions can be. The manner in which individuals choose to end their lives is a crucial aspect of how those lives are lived. Just as individuals should be allowed to live with dignity, their wishes with regard to medical treatment and end-of-life care must be respected. This right to make decisions concerning one’s own life is being threatened, however, by bills such as the recently introduced “Incapacitated Persons Act of 2005,” which allows the federal government to intervene in end-of-life care. These attempts by conservatives to interfere in end-of-life care – and even to deny people the authority to appoint close relatives to speak for them – are wrong; government should not politicize personal and family decisions about individual’s lives, whether those decisions are about medical care, religious beliefs or lifestyle choices. Furthermore, the issues surrounding end-of-life care must be better publicized, so that people can understand the importance of having a living will and discussing end-of-life care with their families and loved ones. Progressives cannot allow extremist ideology to outweigh individuals’ rights to make choices regarding the type of life they want to lead. Progressives should oppose the Incapacitated Persons Act and any similar measure at the federal or state level.

3. Access to Health Care

Good health is a right of any citizen in an industrialized nation. For many Americans, however, this right is being violated every day, while conservatives continue to defend a system of “managed care” that squeezes the middle class and caters to the rich. As of 2005, 45.8 million Americans lacked medical insurance, preventing them from receiving the basic medical care necessary to live a decent life. Tens of millions more lack enough health insurance to see them through a crisis. Half of all personal bankruptcies are due to a family member’s serious disease or accident. As we have seen recently in New Orleans, many hard-working Americans are one step away from catastrophe. The situation is even worse in developing countries – which comprise two-thirds of the world’s population – where over 50% of people do not have basic sanitation. Around 8 million children who die each year who could be saved by providing better sanitation and adequate medical care in developing countries. It is morally reprehensible to allow so many people to die when we have the technology and resources to save them if we allocated world resources better. The Bush administration, however, has proven loathe to provide aid to less fortunate countries, even being described as “stingy” by U.N. Undersecretary-General for Humanitarian Affairs Jan Egeland. A true world leader must work to ensure greater fairness in access to medical care and increased resources dedicated to disease prevention among the most vulnerable. An uncaring government that does not allow the poorest, both at home and abroad, to live a decent life ignores its responsibilities to its citizens and the world. So progressives ought to support universal health insurance and improved sanitation standards worldwide.

4. Global Bioethics

Today’s bioethics has mainly focused on issues in research, clinical medicine and access to health care in the U.S. As we move into an increasingly globalized world, however, bioethics needs to consider the obligations developed countries have to developing economies, and needs to incorporate environmental ethics into the bioethics agenda. Fairness and justice do not end at our nation’s border, and we cannot ignore the environmental impact of burgeoning technology. Controversies such as that over “golden rice” will multiply, confronting us with the dilemma of genetic modification versus traditional or “natural” food sources. Conflicts involving different moral frameworks will require progressive bioethicists to balance competing cultural viewpoints while remaining true to our own values. In the global community bioethics will also have to address global problems. The United States, with 5% of the world’s population, consumes 26% of the world’s energy. We cannot maintain this disproportionate consumption without risking an energy crisis. Human health cannot be separated from the health of our environment—the future will require not only cleaner water in developing nations, but also cleaner sources of energy in the developed world. Bioethics must determine how risks to human health from various energy sources should be assessed to allow both progress and sustainability. A truly progressive bioethics embraces the complexities, challenges and responsibilities of globalization, understanding that our actions and policies affect people in all corners of the world. These great responsibilities of the next century reflect the great opportunities we will have to create a safer and healthier world for everyone.

Jonathan Moreno, Ph.D., is a Professor of Biomedical Ethics and Director of the Center for Biomedical Ethics at the University of Virginia and a Senior Fellow at the Center for American Progress. He is the author of “Is There an Ethicist in the House?” (Indiana University Press, 2005), about the role of the bioethicist and various ethical issues from the bedside to public policy.