Ethical boundaries and the Medical Revolution

Liam Fox/09/2000

Category: Health Service

An interesting survey recently asked the public which professions they most respected. While family doctors topped the polls, politicians were second last (with only journalists coming behind them). It is difficult to determine exactly what factors lie behind this sorry lack of regard for our elected representatives, but there is no doubt that politicians are seen to be increasingly obsessed with focus groups and short term headlines. This culture leaves little room for consideration of the wider forces which shape our society or how we should respond to the challenges and opportunities presented to us.

The advance of medical technology

In my own profession, medicine, the changes have been particularly profound. In the course of a single century, we moved from clean water as the main public health issue to Aids. We wiped out smallpox and developed new cutting edge drugs for infections and even cancer. Our tools of saws and scalpels gave way to penicillin and painkillers and ultimately MRI scanners and lasers.

Medical technology means that we can now transplant human corneas, hearts and kidneys. We have carried out successful limb grafts. With the Genome project, we are well on our way to identifying all the 80,000 genes in human DNA, so that we can predict not only sex (which we have learned to do already), but perhaps intellect and predisposition to disease. We will soon have the ability to manipulate our genetic structure, navigating the ever-more detailed map that is humanity itself.

The ingenuity by scientists and doctors seems almost boundless. There can be no doubt the enormous contribution that they have made to increase human knowledge and human well being. Human happiness and moral well-being are, of course, a different matter.

It is difficult to overestimate the impact that this medical revolution has had on the expectations and experience of our lives. We can live longer and more healthily. We can recover from diseases once thought incurable.

Medical ethics, morality and philosophy lag far behind

However the medical revolution has not only changed the way that we live, it has also altered the way in which we can think about life and living. Boundaries once thought unassailable have been broken down. We are now, with genetic research dealing with the very building blocks of life. Our perception of what it is to be human is, quite literally, being put under a microscope.

The medical revolution carries with it moral, ethical and philosophical consequences which must be confronted. Yet our ability to deal with the moral and technical issues raised by our scientific advances lags well behind the advances themselves.

Political leadership required

It is territory which politicians are not encouraged to enter. Deep emotions are stirred. We are accused of either "populism" or "scare-mongering". We are accused of "being moralisers". We are told that if we seek to limit science in any way we are guilty of condemning the ill and the disabled to further misery, or that we are threatening jobs and trade.

Yes the questions are sensitive, and yes, judgements are difficult. However, these cannot be excuses for failing to try to find answers.

Last year, I wrote a pamphlet entitled "Holding our judges to account". I argued then that our judges were being given an ever increased role in law making, not least as a result of the devolution Acts and the Human Rights Act. Recent cases where judges were, in effect, being asked to pronounce on difficult ethical issues is another example of this trend.

Lines must be drawn

We must beware the relativist's argument that, because different moral and ethical perspectives would lead us to draw our lines in the sand in different places, no lines can or should be drawn at all. The fact that different people make different judgements cannot justify no judgement whatever being exercised. This is an area in which it is impossible to remain morally neutral, irrespective of whether it would be politically expedient to do so. If we fail to consider where the ethical boundaries lie and shy away from setting them in a legislative framework, we are in effect saying that there are none at all.

There is genuine and deep-rooted political unease about many of the medical techniques that we can now employ. Euthanasia, genetic research, cloning and infertility treatment have all raised considerable public concern. We need to respond to that. The questions that the medical revolution raises are too important to be left to scientists and doctors alone. We must tackle them ourselves as a whole society.

I intend no disrespect to my own profession in saying that. However we must never forget that human knowledge is always developing, and also that it is far from infallible. There is always that danger of the unpredicted outcome or the unforeseen consequences. What might be regarded as a certain medical truth, or the most advanced available, can be discredited within only a few years. One need think only of Thalidomide to name but one of countless examples.

The current debate on the cloning of embryos poses a classic dilemma. Parliament currently allows embryonic cells to be used only in fertility or reproductive research. Technology will soon allow us to take embryonic (and adult) stem cells and "train" them to mimic many other cells which they can replace if the original cells are damaged. It may revolutionise treatment as varied as stroke or myocardial infarction. There are those who say that the ends justify the means whatever the moral consequences. Indeed, for those who have crossed the Rubicon and support the current legislative position permitting embryonic experiments, a move from fertility research to therapeutic cloning is hardly a quantum leap. Yet for those of us who never accepted the moral legitimacy of the current legislation it is merely the extension of an already unacceptable position. While entirely understanding the motives of these who argue for a change I will vote against it.

At the same time we must remember that there are some who have a very different agenda from those who seek only new medical therapies and about whom we must be vigilant. In America last year doctors succeeded in creating one human egg using cells from two different lovers, as well as a father. The press dubbed this a "three parent family". The director of one of the clinics involved was reported as saying that she has started on that line of work because she was "interested in redefining the family". Those who consider that the traditional family unit is the basic building block upon which a successful civil society depends can only react to such sentiments with the deepest dismay.

I have been impressed by the fact that the United States Department of Energy and National Institute of Health have devoted between three and five percent of their annual human genome project budget to consider the ethical, legal and social issues that are being raised. They claim that they have created the world's largest bioethics programme.

We would all accept that just because we can do something it does not follow that you should do it. Similarly just because science is capable of doing something does not mean it should be allowed to. We need to establish a moral and ethical framework within which to operate and we should be confident enough as a society to grasp this agenda back from the scientific community alone.

Guiding principles

There are certain principles we must follow. We must avoid being alarmist. Nothing scares people like ignorance -the fear of the unknown. Transparency and accountability must be watchwords. Our debate can only be a mature and considered one if it is also an informed one. Information must be freely available, explained in a way which makes its complicated concepts acceptable to the greatest number of people and free from the crass distortions, which, for a variety of motives, are all too common.

We must ensure that human privacy and dignity is protected. That means that we must decide for example whether insurance companies or employers should be entitled to genetic profiles, and legislate to protect individuals' privacy if we decide against that. We must in particular be careful to maintain respect for those who are already disabled or who suffer from incurable diseases. They should not be made to feel that their lives are inferior or valueless. When, as reported recently, a leading embryologist said that it will soon be a "sin" for parents to carry children with genetic diseases, our alarm bells should start to ring. For "sin" read "crime" in 1930s Germany and the idea becomes clearer.

There are of course global issues as well as those relating to individuals. Research is taking place all over the world. Yet, too often, globalisation is often confused with powerlessness. Scientists in other countries may experiment with particular kinds of research. Just because someone else is doing something does not mean we should do the same, nor does it mean that we should not impose robust regulations if we consider it appropriate for our society's philosophical or ethical framework.

This is a debate that is relevant to every one of us. I hope we will all become engaged in it. It is not an area for scoring Party points but that does not mean politicians should avoid it. On the contrary, this is an opportunity for the sort of informed debate the public wants and deserves. These are matters where the public is beginning to demand leadership. The Churches have considerable wisdom and insight to offer. They must not shrink from involvement either.

Above all though, these are issues that the scientific and medical communities must address publicly. Legitimate concerns should not be dismissed or sneered at. Experts should not hide behind techno-jargon and scientific gobbledegook. Public anxiety must be dealt with in an open and sympathetic way. Recent high profile cases have eroded the public's confidence in the judgement shown by the medical profession. It is important that confidence is restored and maintained. In order to achieve that, the public must be shown openly to its satisfaction that rigorous ethical guidelines are in place and that sound moral judgements are being made.

As the Conservative Party moves towards the next election our Medical Ethics Advisory Panel will consider the ethical dimensions of the health policies we are developing. It is a debate politicians, like the rest of us, cannot afford to duck.