Norman Daniels provides a different outlook on healthcare that questions the equality of health care and if it is distributed fairly.

One question that I asked myself while reading Daniels piece was whether certain social issues or conflicts (adventitious needs) warranted health care provision just as course of life needs are provided for. Should a nose augmentation be done if its purpose is not to enhance the ability to breathe, but to enhance self-esteem? Does not psychosocial or psychological issues warrant health care as well?

It is my opinion that certain procedures are more important than others and individuals who are in need of these procedures should receive the health care that is necessary to complete the procedure. If the disease or illness negatively affects normal opportunity range, then it is necessary to receive health care. I believe, however, that it is these differences and variances between individuals (effective opportunity) that constitute and allow that health care be just a little different amongst people. This does not mean that there should be a large variance in health care which will lead to unfair mistreatment and neglect of some patients over another, but it will make it so that all patients receive the healthcare that will most benefit their needs while giving all the opportunity to return to their normal opportunity range.

When comparing the lungs of a smoker and the lungs of an individual who is not a smoker, but has developed some type of lung disease, it is possible to see that these individuals are both in need of the same kind of health care. However, who should receive the better kind of care? Who should receive more attention? Who should be addressed first? Though many may say that the smoker placed these health issues on themselves and caused their disease or illness, it is only moral to provide healthcare to both these individuals. However, because no one is the same, the health care that is provided to both patients can vary in many ways. For example, the smoker may have been born with other health issues that make it more difficult to treat the lung problems the patient may suffer from. The other patient who developed the lung disease may also be an athlete and thus it is required that the kind of health care provided must also consider this health factor. Regardless of the extraneous issues that the patients may face, it is only moral and fair that these patients both receive health care that can allow the patients to return to their normal opportunity range.

Daniels also discusses there are some born with an advantage and a very lucky “natural lottery” (Daniels 465). Daniels indicates that health care addresses things that are not equally distributed; one person may never get sick, and another person must live their live on medication. I believe that this issue is one that undoubtedly must be cared for with health care, but the amount of health care that is provided depends on the severity of each case. Someone with constant allergies may need more care than someone who is allergic to animals. Alternatively, if someone is deathly allergic to cats, and another individual is allergic to multiple things but is not morbidly ill, the person with the possibly fatal allergy must be given more attention and health care in the case of a reaction.

Individual health care needs vary due to genes, location, family, and personal strengths, and many other factors. These factors do have a strong hand in deciding what kind of health care is most beneficial to a patient. I believe that it is moral to provide varying levels of health care if it means that all patients will be able to return to their normal opportunity range as Daniels describes.

Daniels, Norman. “Health-care needs and distributive justice.” Arguing About Bioethics. By Stephen Holland. London: Routledge, 2012. 457-471.

L.O Gostin is justified in saying that the current public health laws have two very important issues that need to be changed. I believe that these changes need to be made in order to offer all patients and even health care providers with their autonomy and a fair and just healthcare experience. The two changes Gostin suggested include adjusting the low amount of power that is not able to deal with the many health threats and risks. Also, Gostin suggests having clear rules and fair procedures to make decisions.

It is difficult to implement changes in the realm of health if the amount of power given is not adequate. Another question to consider is who should be given the power? Gostin discusses the division between state and law. The state holds more power in the realm of public health because public health issues can vary between states. The state tends to hold more power also because many of the powers that are required for public health legislation, such as police, inspection, quarantine etc. are already held by state officials and can differ drastically between states. Regardless of this, however, the federal government also has power in public health; for example the response to health risks that can affect many states at a time. This discussion in amount of power required for public health decisions can also be compared to public health issues in hospitals. The powerful debate lies between the importance of personal libertarianism versus the health of the public and the community.

Recently at Princeton University, there was an outbreak of meningitis B which has caused the death of some students. In fact, a student from Drexel who was in close contact with Princeton students died after being ill for approximately one week. To prevent the spread of this deadly meningitis disease, a high percentage of Princeton students were given a meningitis vaccine. This vaccine, however is not approved for use in the United States. The CDC and the FDA did allow the drug to be used. Through two doses of the vaccine will most likely protect the patient, the patient may still be able to spread the disease through close contact with others.

Considering the two issues that Gostin points out in his discussion of public health, one can question the morality in the decision of the CDC and FDA to make some students take the unlicensed vaccine. Was it the right decision? Was their level of power used in this situation used correctly? Did the students have a right to choose to take the vaccine or not? Such questions demonstrate that the amount of power given by some institutions is extremely confusing with regards to public health. There is ambiguity in the amount of power the FDA and CDC have, and the amount of autonomy the students SHOULD have. Did the students know this vaccine was not a drug that was approved for use in the US? The fact that this drug was only approved in 3 countries—Canada, Australia, and Europe, show that there are some risks of this drug that US health administrations were still discussing.

As Gostin pointed out, another issue is that public health statues do not give clear standards or indicate how decisions should be approached to ensure they are fair. Was it fair to give a vaccine that was not approved for US use, in the hopes of preventing other deaths, but simultaneously risking the infection of other students and also risking the life of the person receiving the vaccine? Has this happened before, and were the same decisions made? Will it happen again, and the same decision will be made? Probably not, because each situation varies so that different questions need to be asked and different ideas and issues need to be discussed. As Gostin indicates, these issues cause public health laws to be difficult to understand and difficult to implement.

Gostin, L.O. “Public Health Law in an age of terrorism: rethinking individual rights and common goods.” Arguing About Bioethics. By Stephen Holland. London: Routledge, 2012. 374-385.

Hayes, Ashley. “Philadelphia meningitis death tied to Princeton outbreak.” CNN 18 Mar. 2014 [Philadelphia] . Web. 22 Mar. 2014.

The debate over whether an adult patient deserves autonomy, or deserves their autonomy to be respected is a never-ending struggle. Many issues may serve to prevent adults from having their own autonomy, such as the patient’s mental stability, the patient’s ability to verbalize their wishes, and the patient’s age. In order to adhere to the “best interest standard” that Robert M. Veatch discusses, a surrogate must make the decisions regarding the patient’s health plans for the best interest of the patient. As Veatch indicates, this form of deciding what option best suits a patient’s health and life is “complex and subjective” (Veatch 319), especially if the wishes of the patient is not known by the surrogate. There is also a great deal of fog when deciding who can best act as a surrogate and decide the best health option for the patient.

So how does this work for a child? Who serves as their decision-maker; the state, the health-care provider or the parent? And what is the “best interest standard” in their case?

Many obese teens and their parents may be desperately searching for a solution to the problem of obesity and may turn to bariatric surgery. Many families may see this decision as a morally good decision and may support their child in their efforts to live a better life wholeheartedly. As specified by Veatch, well-being will be maximized after bariatric surgery because it would improve psychological, social, aesthetic, and even occupational well-being (Veatch 321).  However, the decision to participate in this life-changing procedure does not reside with the patient or the family, but with the pediatricians, dieticians, social workers, and surgeons that may be involved in the patient’s life. Thus, if these outside individuals did not believe that the patient was “ready” or prepared to partake in this new journey, the patient will be regrettably barred from the procedure. Considering that the patient is able to communicate their desires, shouldn’t their autonomy be respected? Why is the autonomy that stems from a rational decision that is made by true beliefs not respected? And this decision will be made to improve the lives  of the children who want to participate in this surgery, so why won’t doctors allow it?

Circumcision is also another much debated topic that can make one think about where decisions may lie. Circumcision is known to have many benefits such as the prevention of STI’s and the decrease in HIV transmission. Many parents opt to provide their sons with circumcisions at birth and may assume that their sons may not be upset with the decision, however, Frank, an individual from Los Angeles is upset that he had to undergo the painful circumcision and that he did not have an option to say yes or no. While a newborn, the surrogate who can make the decisions tends to be the mother and father and if they choose to perform circumcision, it is because they believe they are practicing good paternal and are hedonistically serving their child’s best interest. However, the child may grow up and not think so. So is it moral that the autonomy of this decision stays with the parent even though the child may not agree with this decision later on? James F. Childress explains that some health care providers may make a decision disregarding patients autonomy believing the patient will “ratify the coercive or deceptive treatment on her behalf, thanking the professional,” (Childress 311).

As infants and children may have the right to autonomy but their autonomy can be overshadowed and disregarded for the decisions of a better informed, more rational surrogate such as a physician and doctor, one can begin to wonder who really deserves to be the voice of the child. In a situation when a child is on life support but has a bleak chance of survival or a good life, does the parent decide to keep their child alive? Should the physician decide to allow the patient to rest at peace? And who is making the “best choice” for the patient?

References:

Childress, James F. “The place of autonomy in bioethics.” Arguing About Bioethics. By Stephen Holland. London: Routledge, 2012. 311.

Veatch, Robert M. “Abandoning Informed Consent.” Arguing About Bioethics. By Stephen Holland. London: Routeledge, 2012. 317-328.

http://www.cnn.com/2011/HEALTH/04/14/teens.circumcision.ep/index.html

http://www.cnn.com/2011/HEALTH/06/22/surgery.obese.teens/index.html

http://www.medicinenet.com/circumcision_the_medical_pros_and_cons/article.htm#what_has_been_the_medical_view_of_circumcision

A physician will never prescribe more medicine to an individual who was hospitalized for an overdose. So why would more genetic enhancement be the solution for negating or eliminating genetic enhancement from prior generations?

In the essay “Human genetic enhancements: A transhumanist perspective” Nick Bostrom exemplifies the many great benefits that genetic enhancements can bring. Bostrom refers to the increase in intelligence, health, life span (Holland 105), the reduction of diseases (Holland 106,113) and the ability to gain new human capabilities (Holland 105, 112). In other words power. In Bostrom’s eyes, genetic enhancement provides power. However, this ‘power’ can cause larger problems that will affect the balance of society and can even cause health risks that have not yet been resolved or discussed.

The balance of society can be greatly affected with the introduction of widespread genetic enhancements. Through the access to genetic enhancements, “ inequities grow much larger thanks to genetic interventions that only the rich can afford, adding genetic advantages to the environmental advantages already benefitting privileged children (Holland 112). Bostrom believes that “…the increase in unjust inequalities due to technology is not a sufficient reason for discouraging the development and use of the technology,” (Holland 113).  However, this access to genetic enhancements for certain communities will undoubtedly affect the balance in society. Some may be unable to provide themselves or their children with the “gift” of genetic enhancement, just as some families are unable to send their children to private schools.  The poor and underprivileged will not only be fighting against poverty, but  these individuals will be subject to being ridiculed and mistreated because they are of “average” height, build, intelligence, etc. simply because they could not afford genetic enhancements. And yes, these differences will undoubtedly bring about societal issues, let’s not forget about slavery, the Holocaust, and the massacres in Sudan, which all erupt because individuals feel superior in comparison to others.  Society will split into parts, with the rich and genetically enhanced on one side, breeding amongst themselves, and with those that cannot afford or utilize this technology in another group.

Genetic enhancement is believed to be of value to human health. Bostrom also incorrectly supposes that “If we become healthier, we are personally better off and others are not any worse off,” (Holland 111). However, this statement contains a great deal of false assumptions. One would think that at least the healthier individuals are better off and can benefit. However, those that are “healthier” can catch a virus or infection which their bodies will not be able to combat because of the lack of exposure to these illnesses and thus they may end up more sick than the “less healthy” individuals. If the antigens in our body are not exposed to any sort of illness, it will be unable to act strongly enough to fight off a common cold, fever, etc and thus the individual will remain sick. (More about antigens).  Those that will be unable to utilize genetic enhancements to “improve” health may lose resources that provide medicine and treatments because these resources may be changed in order to cater to the new illnesses of the genetically altered humans.

Genetic enhancement also caused the premature death of the cloned sheep Dolly. So we increase the value of human health, by diminishing life span?

As stated by Darren Shickle, “Two wrongs don’t make a right”: rather than use a man-made solution to a man-made problem, it is better not to create the problem in the first place. If difference was accepted (or even appreciated), then there would be no prejudice to eliminate tendency of mankind to pursue short-term advantage without considering the long-term consequences.” Why combat problems that come from genetic enhancements, such as medical illnesses and shortened life span, by providing more genetic enhancements? If  an individual does not want his genetically enhanced unnatural height to pass to an offspring, him or his offspring will have to undergo even more genetic engineering to reverse the former procedure?

And with genetic enhancements, just as new Iphones and Ipads are presented to society each day, new human norms will be presented each day. No one will feel “good enough” because there is a new genetic procedure that can make then 10 times as fast, 100 times as smart, and 1000 times as strong. Our natural baselines will be looked upon as elementary and substandard.

Plastic surgery can be addictive and also life-threatening. I have no doubt that genetic enhancements will do the same thing, and government regulations may not be of much use.

There will never be a way out of the compelling “power” of genetic enhancements. This won’t make anything right.

Bostrom, Nick. “Human genetic enhancements: a transhumanist perspective.” In Arguing about Bioethics, edited by Stephen Holland, 105-115. New York: Routledge, 2012.

Shickle, Darren. “Are “Genetic enhancements” really enhancements?” Cambridge Quarterly of Healthcare Ethics 9, no. 3 (September 8, 2000): 342-52.

McPherson, Jerry. Disabled World. http://www.disabled-world.com/artman/publish/genetic-engineering.shtml.

Medline Plus Trusted Health Education for You. NIH. “Immune System.” http://www.nlm.nih.gov/medlineplus/ency/article/000821.htm

Are personality, identity, and social relations dictated by the environment, or is it an entity that is controlled solely on genes? Are those entities partly controlled by environment and partly controlled by genes? This profound question has continually peered its head into the conversation of many hot topics and discussions. This question has even found its way into the medical topic of cloning. As David Elliott claims, “…it is not clear that the cloned individual, like any other natural twin, needs to see her individuality as importantly connected to her genome, or even to phenotypic similarities with others” (p 158). Some individuals feel that cloning diminishes a sense of uniqueness in both the clone and the cloned person. Proponents against cloning also say that the lack of genetic variability creates a non-unique genome which will “impose limitations on an individual’s capacity for self-development, leading to a sense of disempowerment and personal inadequacy” (p.159) and that this lack of self-development affects human worth. In Elliott’s view, genetics is not the strongest factor that decides personality, identity and social relations. Thus creating clones from the genes of a donor does not restrict an individual, or clone from “feeling non-unique” (p.158). Therefore the idea that not having a “felt identity being psychologically damaging is not plausible” thus this is not a strong reason against cloning (p 158).

Though Elliott presented a few points that did have a sense of validity, there were a few points I want to argue against. Elliott argues that if biological similarities that persist between the cloned individual and the clone can reduce individuality and limit self-development, then the same could be said about twins and triplets. He also explains that environment is a better determinant of identity than genetics due to the data that demonstrates that separated twins show more divergent personalities. However, I believe that he omitted the myriads of data that demonstrate how twins that are separated tend to grow up with similar traits, likes, and dislikes. He cannot argue that genetics does not play a strong role in identity and thus he cannot argue that clones, who have similar genes, will develop different personalities and unique characters based on environment. Mikayla Stern-Ellis and Emily Nappi, two young girls from northern and southern California were shocked to find that they were half sisters, they both shared a sperm donor from Colombia. Having lived in different environments from birth up until their undergraduate career in college, it is remarkable to see how strong a role genetics plays in behavior. These sisters grew up in different parts of California, yet have very similar features such as a cleft chin, thick, curly hair, same skin tone, and same smile. Both also have similar interests in the sciences. And even more, they both ended up at Tulane University thousands of miles away from California. It is easy to say that their genes played a very strong role in their identity and personality. (Watch Video Here)

Elliott also omitted the fact that clones will more than likely be in the same environment as the cloned person and therefore their environment will similarly mold their personalities. Thus, there is a factor of developing very similar personalities since they are in the same environment and have identical genes. Elliott therefore cannot argue that uniqueness will not be threatened.

The argument that cloning will inhibit uniqueness is actually a very strong argument against cloning in that the large similarities between the cloned person and the clone will limit self-development and may feel of less worth. In my opinion, Elliott is missing pieces of data in his counter-argument to support cloning.

Elliott, David. “Uniqueness, individuality, and human cloning.” In Arguing about Bioethics, edited by Stephen Holland, 149-62. New York: Routledge, 2012.