Biomedical Ethics

Question 1:
This essay revolved around many arguments, but mostly two main pro-life arguments. One includes the argument that it is wrong to kill a human being. A fetus is a human being, therefore it is wrong to kill a fetus. Abortion is the killing of a fetus, therefore abortion is wrong. Another argument involved is the argument that all human beings have a right to life. All fetuses are human beings. Killing a being with a right to life is wrong; therefore it is wrong to kill a fetus. Abortion is the killing of a fetus, therefore abortion is wrong. Through her destructive argument she is attempting to establish that even if the fetus is seen as a human being, it does not automatically have a right to use to body of a woman, and thus does not necessarily have a right to life.
Thomson immediately begins her essay by pointing out the reliance of pro-lifers on the premise that a fetus is a human being from the moment it is conceived. She does not believe this, giving the example that an acorn develops into an oak tree, but that it does not follow that the acorn is an oak tree just as the fetus would be considered a human being. She points out that this is a “slippery-slope argument” and moves on. Thomson broaches on other ideas such as the fetus could be a human being well before birth, and that pro-lifers often focus too much on constructing the argument that a fetus is a human being from conception and little else. Thomson settles with simply granting that the fetus is a human being from the point of conception, and moves on to form an argument. She starts again with a pro-life argument that every person has a right to life, which means the fetus does as well, and although the mother has a right to decide what happens to her body, the fetus’s right to life outweighs this. Thomson admits that this could be plausible, but proceeds to make a case involving a violinist. She develops a scenario where you were kidnapped, and a famous unconscious violinist has been hooked up to you by the Society of Music Lovers in order to save his life. By unplugging him from you, you would kill him, and by remaining hooked up to him for nine months he would survive. Thomson points out that it would be nice to help save his life, but questions your obligation to. She proposes that it could even be longer, such as 9 years or for the rest of your life. Then she brings up that because all persons have a right to life, and violinists are persons, the choice should be obvious. Even though you have a right to decide what happens to your body, the violinist’s right to life outweighs this, and thus you must remain hooked up to the violinist. This leads to her view on the exception of rape. In her example, you were kidnapped, and so you did not have a choice on the matter. Thomson points out that even so, this is unpleasant because “the question of whether you have a right to life at all, or how much of it you have, shouldn’t turn on the question of whether or not you are the product of rape.” (Thomson, 481) Still, Thomson says that people who oppose abortion on these grounds do not mention this or even the case in which the mother has to spend nine months in bed while pregnant. Even if the pregnancy went on for nine years, or even forever, some people would not even make an exception. Thomson points out that this is the mistake, since the right to life is not unproblematic. Thomson then goes on to examine what it is to actually have a right to life. She believes that nobody has a right against you to use part of your body, and that some people believe that the right to life means the right not to be killed. Thomson clarifies this in showing that the violinist may have a right to life, but this does not guarantee having a right to use another person’s body. This shows that the right to life cannot serve pro-lifers very well when developing their argument. Thomson brings up an example where a boy and his small brother are given a box of chocolates and the older boy takes the box and refuses to give his younger brother any of the chocolates, which is unjust seeing how the younger boy was entitled to half or at least some of the chocolates. Because in the violinist case you are not giving him a right to use your body, it would not be unjust to unplug yourself from him. By doing this, Thomson points out you may be doing what he has a right you shall not do, but you are not acting unjustly in doing this. She brings about an idea that “the right to life consists not in the right not to be killed, but rather in the right not to be killed.” (Thomson, 482) This goes back to the issue of abortion and the need for proof that the abortion is unjust killing. Thomson brings up the instance where a woman voluntarily indulges in intercourse, knowing of the chance of pregnancy, and then becomes pregnant. This woman could be seen as responsible for the fetus and human being it will inevitably become. Although this argument has merit, and could show that because the fetus is dependent on the mother and has a right to life, it still does not solve the instance in which an unborn person’s existence is due to rape. Thomson also brings up yet another example where if you open a window to let fresh air in and a burglar comes in that you have given the burglar a right to your house. This is obviously absurd, and Thomson realizes this, but still uses it to get her point across that just because you know something has a possibility of occurring does not mean that you allowed it to happen. Thomson’s constructive argument that to deprive someone of what he has a right to is to treat him unjustly shows that the rape exclusion is not necessary. If a fetus is the result of rape, then according to the belief about unjust killing, they have no right to the use of their mother’s body, and thus aborting them is not unjust killing seeing how they are not being deprived of anything they have a right to. The pro-lifer cannot justify this if they believe that the right to life is the right not to be killed unjustly. They could say that the fetus has a right to life period, but this is again difficult to justify. Going back to what Thomson said earlier, it seems problematic to establish a fetus’s right to life based on whether or not they were the product of rape. What gives the fetus not conceived from rape precedence over the fetus who was conceived from rape? This is where the pro-lifers would have a difficult time justifying any argument, and may even have to provide exceptions to other circumstances, even when not discussing rape. Thomson also points out that there is a difference between something that “ought” to happen and something that needs to happen. She believes that a person can be selfish and callous if they refuse something, such as giving a sibling chocolate, or even allowing a fetus the use of their body. It does not follow, however, that the person is morally required to do such. She brings up the idea of being a “Good Samaritan” and how that is still not enough to justify not having a right to one’s own body. Thomson reiterates a common belief that a mother has a special responsibility for the child, but then counters this by pointing out that we do not have a special responsibility to anyone unless we assume it. If someone does not try to prevent pregnancy or does not attempt to obtain an abortion, then they have assumed responsibility for it. Her final view rests with her belief that abortion is not always permissible, despite her many attempts to prove circumstances in which it is. She believes that there are times where although a woman may have a right to an abortion, it is still indecent and morally wrong to do so. Thomson’s arguments are both convincing. By assuming that the fetus is a person, she sidesteps any argument that would involve the fetus being a person or not, which is smart. Her destructive argument that most pro-lifers believe that if we can prove that a fetus is a person (human being), then it obviously follows that abortion is wrong is false is successful through her use of various examples. Her violinist example showed that the fetus does not necessarily have a right to use your body without your consent. The example involving children and chocolate showed that the boy may be selfish by not giving his brother chocolate, just as the mother may be selfish by getting an abortion, but this doesn’t necessarily make either of them morally wrong. The example involving an open window compared to indulging in intercourse shows that foreseeable, unintended consequences do not always lead to responsibility. These arguments and the rest are all constructed beautifully, and delivered so well that her point is able to be made with ease. Another essay, written by Don Marquis, shows why abortion is immoral. He sets out to show that “abortion is, except in rare cases, seriously immoral”. (Marquis, 475) He bases his argument on the assumption that fetuses have a moral value in the same category of adults. Marquis begins by attempting to explain the wrongness of killing. He states that “the loss of one’s life is one of the greatest losses one can suffer”. (Marquis, 476) By killing someone, he believes that the killing inflicts a great loss of the victim, and this is wrong. He continues by arguing that by being killed one is deprived of all value of their future, and this is the ultimate wrongness of killing. His argument could begin with it is wrong to kill a human being with a valuable future. A fetus is a being with a valuable future, therefore it is wrong to kill a fetus. Abortion is the killing of a fetus, therefore abortion is wrong. Marquis also goes on to compare his argument to the best argument for the wrongness of inflicting pain upon animals. This argument shows that the suffering cause by the infliction of pain is what makes it wrong, and this leads to the conclusion that infliction of pain on animals is wrong. Both this argument and his abortion argument begin with an assumption concerning what it is wrong to do to a person, then look for something that makes the action wrong and recognize this to move on. Because these two structures are the same, Marquis believes that the abortion argument is sound if the animal abuse argument is. He admits that “this argument, if sound, shows only that abortion is prima facie wrong, not that it is wrong in any and all circumstances”. (Marquis, 478) He shows that abortion could be justified if “the loss consequent on failing to abort would be at least as great”. (Marquis, 478) He still believes that the presumption needs to remain that abortion is very seriously wrong. Marquis also touches on the issue of contraception being considered immoral by some. He shows how some argue that contraception could also be argued the same way he argues abortion. In other words, because contraception may be depriving future lives and thus future value, it must be wrong. Marquis shows this is not exactly true though. He states that it is not the same because “there is no non-arbitrarily identifiable subject of the loss in the case of contraception”. (Marquis, 476) He concludes his argument by stating his purpose of setting out an argument for the serious presumptive wrongness of abortion subject to the assumption that the moral permissibility of abortion stands or falls on the moral status of the fetus”. (Marquis, 476) He finishes with his thought that it is wrong to kill adult human beings, and it is not wrong to end the life of some arbitrarily chosen single human cell. Since fetuses can be seen as either of these, he proposes that there is a new problem that can be solved, but only once the fetal property is solved. Although Marquis has some good points, one could object to his argument by questioning if it is permissible to kill someone who does not have a valuable future, such as a lazy person, or a prostitute, and so on. It seems to follow from his argument that it is okay to kill a person like this. He would respond that yes it is permissible to kill beings without a valuable future, which is problematic because who is to say who has a valuable future? One could question if his argument was a subjective notion or an objective one, and ultimately there would need to be a hybrid of subjective and objective. Marquis would probably respond to the violinist case by saying it would be wrong to kill the violinist because he obviously has a valuable future if he is able to survive. He is a famous violinist, which presumably means he is wealthy and good at the violin. Even simply focusing on his profession as a violinist, it is obvious that he has a valuable future and thus it would be wrong to unplug him and kill him. One could argue that that is only letting him die, but ultimately the point would be that by unplugging him you are taking his chance of life and a valuable future away from him, which is wrong. This response would probably help the success of his argument by providing another example to support.
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Question 2: In our society, it definitely seems obvious that we want randomized clinical trials. They are beneficial when attempting to discover the solution to a medical problem or mystery, and are overall a helpful way to change therapeutic methods. Despite these benefits, according to Hellman and Hellman, randomized clinical trials are controversial due to the fact that “researchers participating in such studies are required to modify their ethical commitments to individual patients and do serious damage to the concept of the physician as a practicing, empathetic professional who is primarily concerned with each patient as an individual”. (Hellman and Hellman, 260)
Theoretical equipoise is present when evidence related to two different treatments is exactly balanced. The motivation for equipoise in the first place is to conceive of equipoise in a way that preserves a physician’s moral integrity and allow for good science. One would see this as necessary due to the fact that the patient’s best interests should always be put first with no exceptions, even when science is involved. Of course, this is not plausible due to the fact that the physician is forced to play two roles: a physician who acts in the best interests of the patient, and a scientist who is only concerned with answering scientific questions.
Freedman proposed another type of equipoise in response to this to show that individual views are not what determine the justification of a clinical trial. This type, known as clinical equipoise, is present if and only if there would be disagreement in the clinical community that is concerning the relative efficiency of the two trial arms. This is different from theoretical equipoise in that it occurs when the views of the community are balanced rather than only the physician. Clinical equipoise does not satisfy the moral foundation of acting in the patients best interest at all times, which could make it seem unworkable. Even so, one could say that the physician is not acting in a way that the clinical community would say falls below the patient’s best interest. This means that the original foundation of equipoise (acting in the patient’s best interest) would be lost. Although we could reject equipoise altogether, then we are back to square one in a sense and need other ways to satisfy what the physicians were attempting to do with the randomized clinical trials.
Hellman and Hellman believe that the moral foundation for clinical equipoise is definitely important, and should be taken seriously. They believe that “surely, other techniques can be developed to deal with both observer bias and patient selection” (Hellman and Hellman, 263) such as “matched pair analysis”. They still admit that their discussion of alternatives is “sketchy and incomplete”. (Hellman and Hellman, 263) They do not want to continue randomized clinical trials seeing how they pose such ethical dilemmas that must be dealt with by the physician/scientist. In concluding their essay, they urge readers to “develop and use alternative methods for acquiring clinical knowledge”. (Hellman and Hellman, 263)