Medical Ethics: A Fetus as an Organ Farm Essay

The major agents in the case – patients, medical personnel and others.

Patient: Mr. Rondell

It was stated in the problem, that Rondell was adopted and hence, it is impossible to know about his biological family background. However, he has a rare tissue type that makes it impossible to find an apt donor for kidney transplant. In this advanced age of medical science, the facts are not corroborative one and it is easy to find a donor by doing clinical lab research and to find an apt donor that will match his kidney cell and DNA. However, the real issue is that to find a donor who could have identical blood, tissue culture as donors are limited in number and also it is very difficult in obtaining cadaver organs due to present laws affecting donors.

Medical Professional

Serious ethical issues are raised against the way in which organ is allocated for transplant from cadaver sources by hospitals in the world. There is general accusation that medical centers are allocating organs on priority basis to wealthy and rich people rather than to those who are in really danger situation and at the terminal end of their life.

According to Sumner, it is troublesome to demand health care practitioners to offer services that wound their moral principles. (p.266). In Canada, a physician may refuse to perform an abortion to a patient and likewise, a physician cannot compel a patient to undergo abortion. There exists a moral value in safeguarding the moral autonomy of both health care providers and patients. When there is a divergence of opinion arises as regards to morality of abortion, the quality of non-dogmatic reliability is particularly significant.

1In this case, surgeon’s opinion that replacement of fetus kidney is viable is to be ridiculed. Medical world has not yet known such type of invention as of date. Therapies for kidney replacement and dialysis witness acute impediments like immune-related issues and donor shortage. As such, a viable substitute for treatment of kidney failure is the need of the hour. One such viable alterative for kidney failure is the transplantation of fetal kidney and it is still in research stage. One of the research study performed by Sang –Soo Kim et al tried to prove transplantation of fetus kidney cells which would restructure functional kidney tissue and the developing phases kidney cells impacts the kidney reconstitution. In this study, fetal kidney cells of a rat were separated from rat fetuses and transplanted into the rats. After clinical observation for three weeks period, the research team has found that retrieved grafts had actually formed the kidney structures suggesting that there exists possibility of replacing fetal kidneys to restructure kidney tissues. Thus, this study corroborates the restructuring of kidney tissues by transplanting fetal kidney cells and has proved that fetal kidney cells renew kidney tissues. Thus, transplanting of fetal kidney cells is at the initial research phase and it will take much time to come to practical implementation of the same in human beings.¹

Mrs.Rondell

The contention of Mrs.Rondell is not scientifically hold true as the system of replacing of kidney from the fetus is yet to be developed. There is no proven technology that has been discovered to transplant the kidney of fetus to a living person. Further, Rondell is aged 28 and fitting a fetus kidney may make it still worse than the existing damaged kidney. Hence, the idea of removing the fetus kidney and replanting the same to Rondell looks more imaginary and utopian.

Junior Rondell

For infants and children, there is paucity for cadaver donors and as such only viable alternative seems to happen from other species. Further, transplanting the kidney of five year old child is not advisable as she is young and her healthy future is to be taken into account. Thus, it is wise to locate an aged kidney donor rather than a five year old child.

b) The major facts for the case

According to conservative view, ownership of human DNA is the measure for moral standing and even eggs (gametes) and sperms have human DNA in them and as such both adult and just conceived fetuses are deserving of moral respect. According to modified conservative opinion, eggs (gametes) are actually not to be deserved for moral protection as they contain only partial genetic ingredients and however, fertilized ova (zygotes) are to be protected as they contain DNA. According to Don Marquis, fetuses have worthful future similar to adult human beings and hence, should not be terminated. If law provides that murder or homicide of an adult is a crime, then killing or terminating a fetus is also analogues to homicide. However, critics of Marquis argue that both fetus and adult cannot be compared symmetrically as they have different valuables. Thus, to conservatives, abortion of a fetus is as equivalent to homicide or infanticide.

According to liberal view, abortion cannot be considered to be non-moral standing issue and can be practiced and consider that neither infanticide nor abortion is morally wrong. For core liberals, since fetus has no moral standing throughout its conception, abortion can be performed. For core conservatives, since the fetus has moral status from the day it is conceived and as such, abortion is to be forbidden.

However , modern outlook on abortion has changed and it holds that abortion can be legally performed but it depends upon the development stage of fetus and if fetus has attained moral standing ,then abortion will be considered immoral and vice-versa.

According to Wayne Sumner, a moderate, abortion cannot be permitted in a late stage fetus and can be performed at an early stage fetus before it attains moral standing. Some moderate are of the opinion that if fetus has the ability to survive outside uterus, then it has attained the moral standing. According to sentience theory, if fetus has the capability to feel, then it can be assumed that it has moral standing. Sumner theory supports the conservative notion of banning late-term abortions and moderate notion of permitting an early term abortion.

Mary Anne Warren advocates feminine liberal view and is of the view that abortion are to be encouraged and infanticide is to be prohibited as fetus cannot be considered as a person until it is born.

According to Susan Sherwin², the moral principle of pregnancy is that it occurs in women’s organ and has intense impact on lives of women. (Sherwin, pp.285-286).

Thomas Murray examines the notion of fetal rights versus maternal rights or fetal-maternal conflicts. He opines that a fetus is destined to be born and hence, harming it is to be avoided. According to him, both a fetus and already born child are one and the same.

The major moral issue raised

Ethics can be explained as the morals or codes of an individual or group. It deals with the systematic securitization of the methods and principles for differentiating from good from evil. Ethics may be explained as honesty, respect and fairness. Human are bestowed with creative, calculative and capable of deceiving others. [Boyl, 1990].

Ethics is an offshoot of philosophy which concerns with the morality of decisions made by individuals and actions and business deals concerned with them in a business atmosphere. Ethical philosophy tries to arrive at findings about right or bad behavior without depending on divinely inspired preaching. It ponders on what as a human being irrespective of caste one belongs can conclude on the moral correctness or wrongness of individual’s decisions and actions. Further, ethics also does not consider the moral rightness of laws. For instance, what is legally right in one state or in a country may be illegitimate in another state or country. [Longenecker, 1989]

Identification of the ethical issues:

Ethical behavior is specific to human being and it is what segregate us from other species.It is easy to practice ethics when one’s time is good and as long as fortune smiles. However, when times are tougher, pressure increases and vagueness exists and at this juncture, it is difficult to practice ethics.

An act can be defined as having moral or ethical consequences and it is an act which involves decision freely taken that will have negative or positive impact for others. Thus, a managerial ethics consists of the following;

• Utilitarianism – the greatest good for greatest number
• Justice and fairness
• Rights and duties

According to John Stuart Mill³ and Jeremy Bentham, a utilitarianism concept is concerned with moral action or decision which ends in the furthermost good for the maximum number of individuals.

According to Immanuel Kant,⁴ individuals have rights, either as citizens, humans or due to occupation of a position and these rights bestows some duties on others and the morality of a given decision or act can be gauged by an analysis of these duties and rights.

According to John Rawls, it is common in U.S. to equate justice with that of legality and there are some occasions where an action that may be legal does not appear just or fair.

Normative ethics or philosophical ethics is prescriptive in nature. Normative ethics search for norms with the authoritative standards of what ought to be. [Colliers Illustrated Encyclopedia, 1990]. Normal Ethics is having two schools namely teleological and deontological ethics. Aristotle preached Teleological ethics which explains that the integrity of an action is solely decided by its consequences whereas a deontological ethics deals with the morality of an action which solely based on its motives or its intrinsic or it being in harmony with some principle or rule and either not wholly or solely on some results. [Krutines& Gewirtz,1984]. Beneficence is the “first code “of ethics and refers to carry out good and avoid evil”. For instance, when an accident victim rushed to a hospital with severe injuries, a physician will start treatment in the overall interest of the patient without consulting or even overriding patient’s wishes. Thus, the principle of beneficence is accorded more priority over patient’s autonomy. Nonmaleficence refers to doing no harm. [Munson, 2004, p.772]. It is just other side of beneficence. This is pertinent to medical profession. For instance, to decide whether to offer chemotherapy continuously to a patient to have long life despite of exhausting process of radiation, to make decision as to withhold or withdraw life supporting machines including artificial respiratory system for patient under comma stage. [Butts&Rich., 2005]. Autonomy of ethics emphasizes that morality is distinct from God and even deity must observe the rules of ethics. Ethical egoism means prescriptive principle that all individuals must to act from their own self-interest. Virtue ethics emphasize on assisting people to inculcate good character and attributes like generosity and kindness. This will help them to make right decisions in their life later. Principle versus consequences: Principles can be defined as generalized rules and its applications are in wide range. Consequence is one where an action can be gauged as good or bad in relation to some goal, standard or end. Modernity can be explained as a transformation from the past through a course of cultural and social changes. Thus, modernity refers to transformation of life from the past which was traditional in nature to that of modern present life. Moral life means leading life with holiness and love. It may be defined as a process of becoming realistically human. Motif for making ethical decisions: According to Hollinger, there are three types of motifs. They are the deliberative motif, the perspective motif and the relational motif. Deliberative motif states that reasoning may be moral guide since God implanted conscience with all human. The prescriptive motif concerns with explicit principles, rules or moral actions that are originated from divine revelation. Relational motif stresses that Bible does not present any particular direction but a common orientation for the moral life. Hollinger in his book also deals with bible in ethical decision making. According to him, contemporary Christians stay particularly enculturated rationalists in their approach to decision making. Hollinger also deals with “Pluralism and Christian Ethics”. He deeply explores what is the cultural context especially in U.S.A so that Christian ethics can be implemented. He also discusses about the agenda for setting tactics and agenda to achieve this. He also explains “the replica of Christian sway” and nine approaches to find out remedial and preventive actions and necessary individuals to implement structural actions. [Hollinger,2002].

According to Aristotle, one should be virtuous and should do virtuous things. Aristotle ethics were later incorporated in the Catholic Church’s moral doctrine.⁵ Aristotle emphasized more on character traits rather than on obligations or rules. Aristotle termed moral qualities as virtues and it could be learned by practice only as it could not be taught.

The idea of moral standing occupies a major role in ethics, particularly, in discussion about abortion. If there is no moral standing, then there will be no moral obligation. According to Kant, “the reasonableness of humans bequeaths moral standing on humans as ends-in-themselves.” Thus, according to Kant, moral standing and rationality are two sides of a coin.

It is to be observed that public policy is not forever enough either in not taking out organs when there is probable objection or to honor desires to donate as it is evidenced from the Florida State law which provides removing tissues from prisoners executed even without the consent either the prisoners or their relatives or their legal representatives.

The current public policy is relying on voluntary participation in organ donation and sourcing on the part of both the probable donors and the medical profession. The public policy with respect to organ procurement has been framed mainly to protect the free choice and autonomy

The present law should be amended giving right to the guardians or family members of the deceased for taking a decision on organ donation which will go long way in maximizing the chance for free choice and increasing the supply of required organs and tissues from cadaver sources mainly for harvesting of human organs for transplantation purpose. ⁶

The system of getting prior approval from donor or from his family acts as a barrier for free flow of organ for transplantation as this cater only 15 to 20 % of the donors who have lost their life in accidents. To source the required number of organs, the legislation should be changed that government can take the organs on the death of a citizen to be transplanted to needy and only if there is any refusal or averse by individual for such organ removal, then government may be prevented to remove the same on their death. Thus, law would presume as if there exists consent for organ donation in case death and this increases the chances of availability of organs for transplantation. However, this could be more costly and difficult to achieve or administer.

• Should Mrs.Rondell agree to transplant the kidneys of a deliberately conceived and aborted fetus?

No. The transplantation of either fetal kidney or fetal Kidney cell into the damaged kidney is yet to be demonstrated and to be clinically proved. Hence, Mrs. Rondell should not agree for a deliberately conceived and aborted fetus. Further, Rondell is under dialysis and even if they agree to have a fetus to be planted to Rondell, the fetus may have some inherent medical health defects as Rondell kidney is severely damaged and he is under dialysis. Thus, if Mrs.Rondell conceives, the fetal may have inherent health disorders that may again create complication for Mr. Randell after kidney transplantation.

• How should surgeon respond?

Surgeons are well aware about the truth that there exists a vast gap between demand and supply of organ for transplantation purposes. Most of States in America are still to recognize “brain death ‘and this has led to chaos on the part of the public and physicians as to whether and when organ donation is most fitting. Further, due to advancement in medical science, now it is possible to offer transplantation of organs to even very young, very old, those ailing with serious medical complications and the mentally ill.

• Does the technical feasibility of Mrs.Rondell’s suggestion enter into your moral deliberations?

I strongly feel that Mrs. Rondell suggestion to have an abortion and to use the fetal kidney to rejuvenate Rondell’s kidney is not practicable as such medical phenomenon is at the initial stage. Further, terminating a fetal also involves the following moral deliberations.

According to Don Marquis, fetuses have worthful future similar to adult human beings and hence, should not be terminated.

Mary Anne Warren advocates feminine liberal view and is of the view that abortion are to be encouraged and infanticide is to be prohibited as fetus cannot be considered as a person until it is born.

According to Susan Sherwin, the moral principle of pregnancy is that it occurs in women’s organ and has intense impact on lives of women (Sherwin, pp. 285-286).

Thomas Murray examines the notion of fetal rights versus maternal rights or fetal-maternal conflicts. He opines that a fetus is determined to be born and hence, harming the same is to be avoided. According to him, both a fetus and already born child are one and the same.

I strongly feel that terminating a fetus is as equivalent as to homicide or murder and hence, I would suggest that Mrs.Rondell should not accept the proposal on the moral grounds.

• Would your decisions in this case be the same if Mrs. Rondell instead had volunteered their 5-year old daughter as a Kinney donor? Why and why not?

Both legislatures and courts were worried in safeguarding the independence and free will of living donor’s particularly mentally incompetent persons and children. The peril of coercing the living donors like young children against their will to undergo hazardous surgery of uncertain benefit as well as the necessity to safeguard against clandestine removal of organs and tissue influenced mostly in the mindset of those accountable for formulating public policy as regard to organ procurement. Thus, no clandestine or coercive tactics are perused in harvesting of organs and this is made possible through introduction of The Uniform Anatomical Gift Act in U.S.A. Thus, both for cadaver and for living sources of donation of organs, it is ensured that there exists individual autonomous and free will. Hence, Mrs.Rondell should not volunteer her 5-year old daughter to be the donor for her husband taking into consideration of the future of her daughter on moral grounds.

Biblioraphy

1. Arthur L. Caplan, “Requests Gifts and Obligations. The Ethics of Organ Procurement. ”The Ethics of Health Care (1992):145-151.
2. Hollinger Dennis P. Choosing the Good: Christian Ethics in a Complex
3. Kant, I. Foundations of the Metaphysics of Morals. Indianapolis.Bobbs-Merrill, 1959.
4. Mill, J.S. Utilitarianism. Indianapolis: Bobbs-Merrill, 1957.
5. Sang-Soo Kim et al. Kidney Tissue Reconstruction by Fetal Kidney Cell Transplantation. Stem Cells Vol 25 (6) (2007) pp.1393-1401. [Database on-line]; Web.
6. Sherwin, S. No Longer Patient. Philadelphia: Temple University Press, 1992.
7. Wicclair, M. “Conscientious Objection in Medicine,” Bioethics 14(2000):205-227.
8. World.Ada: Baker Publishing Group, 2002.

Footnotes

1. Sang-Soo Kim et al. Kidney Tissue Reconstruction by Fetal Kidney Cell Transplantation. Stem Cells Vol 25 (6) (2007) pp.1393-1401. [Database on-line];
2. Sherwin, S. No Longer Patient. Philadelphia: Temple University Press, 1992.
3. Mill, J.S. Utilitarianism. Indianapolis: Bobbs-Merrill, 1957.
4. Kant, I. Foundations of the Metaphysics of Morals. Indianapolis.Bobbs-Merrill,1959.
5. Hollinger Dennis P. Choosing the Good: Christian Ethics in a Complex
6. Arthur L. Caplan, “Requests Gifts and Obligations. The Ethics of Organ Procurement. ”The Ethics of Health Care (1992):145-151.