Important Ethical Question example essay topic

But the case of the Siamese twins goes well beyond theological hair-splitting; whether their parents are Catholic or atheists, Buddhists or C of E, the twins put us all on the spot. Because, in law, their fate depends on the state and not the family; we are to judge who is to live and who is to die - or whether both should be condemned to a union that spells death. It is because their dilemma is ours to solve that Mary and Jodie raise the alarm - and threaten moral panic. Far from reassuring us that medical advances have allowed us to take a giant step in preserving life and improving our lot - ten years ago, Jodie would have stood no chance of survival - the twins' case has dramatized how unprepared we are for these advances. Like Tony Bland, whose persistent vegetative state was brought to an end in 1993 when the law lords ruled that his parents could legally disconnect his feeding tubes, Mary and Jodie have unconsciously ignited ethical debates from pub to hairdresser's salon. They bring us face to face with 2,000-year-old questions - about the sanctity of life, the value we attach to handicapped people, and the rights of the state against those of parents in determining a child's lot.

The plight of the twins and of their parents (who came here from the Mediterranean to take advantage of the expertise at St Mary's Hospital, Manchester) reminds us that, as a society, we must reach some consensus on ethical questions. To fail to do so condemns Mary and Jodie to a legal limbo that will give way to death - and condemns us to living a contradiction, whereby the same people who attack George Bush Jr's record on capital punishment and Turkey's disregard of human rights clamor for the right to experiment on embryos and pull the plug on a life-support machine. From the new anti-malarial vaccine that may save millions of lives in developing countries to the Lasik surgery that restores 20/20 vision to first-world square eyes, medical advances have ensured an extraordinary leap in our life expectancy, and in our expectations of the quality of that life. But the prospect before us is not an obstacle-free course, as Mary and Jodie tragically prove. Their extraordinary, conjoined body offers a flesh-and-blood symbol of the ethical minefield that is modem medicine.

It also exposes our inability to defuse those mines. Clinical research employing the randomized clinical trial has, traditionally, been understood to pose an ethical dilemma. On the one hand, each patient ought to get the treatment that best meets her needs, as judged by the patient in consultation with her doctor. On the other hand, the method most helpful to advancing our understanding about what treatments are indeed best able to meet patient needs is the randomized trial, which necessitates that each patient's care is decided not by physician judgment or patient choice but instead by random assignment.

The tension can be described as a conflict between the interests of individual patients who are sick today, and the interests of the group of people who will become sick in the future and would benefit from advances in medical understanding. How one ought to balance these important and often competing interests is an important ethical question that resists easy resolution. (1) Standard ethical guidelines require that the interests of the patient come first. This mandate would seem to imply that randomization of study subjects is not ethically permissible -- that each patient must receive that treatment that is best for her. Such a conclusion would spell the end for much clinical medical research as it is currently practiced. But this is not the conclusion reached by most researchers, physicians or bioethicist's.

Instead, the concept of equipoise is offered to dissolve the ethical tension. While there is some debate about what precisely we mean by equipoise, the basic point is this: if the physician and / or the medical community doesn't know which of the therapies being evaluated is best, then the patient is not wronged whichever therapy to which she is randomly assigned. The term equipoise captures this state of uncertainty as a metaphor. The physician or medical community is delicately poised at the center of a level seesaw; the reasons to believe therapy A is better than B are evenly balanced by the reasons to believe that B is better than A, thereby keeping the seesaw at an even keel.