Science in Christian Perspective
SUMMARY OF COMMENTS AND QUALIFICATIONS OF RESPONSES
TO THE OPINION POLL ON MEDICAL ETHICS
Mercy Hospital and Medical Center
San Diago CA 92103
From: JASA 27
(June 1975): 94-96.
(Questionnaire Published in June 1974 issue of Journal ASA.
|Responses to the
Opinion Poll Questionnaire
on Medical Ethics in Genetic Therapy and Engineering
Answers are rated as follows: 4 = always or most definitely, 3 = usually,
2 = occasionally, 1 = rarely, 0 = never
1. Should we continue present medical practice and extend help to everyone who desires it, regardless of the pollution of the human gene pool and resulting decrease in the quality of physical human life? 3.37
2. Should man attempt to control his own evolution, consciously and scientifically, instead of involuntarily by pressures from social mores, wars, etc. 2.38
In order to counteract the deterioration of our genetic heritage and correct present defects:
a. Should we pursue the development of eliminative eugenics
3. by altering psychic or mental defects, such as violent or criminal behavior, with the use of drugs or brain surgery? 2.04
4. by eliminating physical defects with organ transplants, artificial organs, or organs clonically grown from the same individual? 2.70
b. 5. Should we use genetic manipulation or therapy with viral agents, thoroughly tested and approved for use in humans, to supply missing or correct defective genes? 2.47
6. Should we avoid future defects by promoting genetic counselling of parents and prospective parents, advising them of the risks (based on amniocentesis and biochemical tests for genetic disorders) of genetic disease or defects in their potential children and allowing them to decide for or against abortion of their fetuses? 2.91
7. Would you seek or believe in a legal abortion if there were 1 chance in 2 that your baby would be seriously abnormal? 2.05
8. Should a convicted criminal having chromosome abnormalities linked with aggresive and antisocial behavior be subject to the same degree of capital punishment as one without such chromosome abnormalities? 2.54
9. Shall we legislate to eliminate defective genes by prohibiting their carriers to propagate? 1.13
10. Should we regard termination of pregnancies in the severely mentally retarded or in women carry0 fetuses having fatal and costly genetic diseases as moral, as well as legal? 2.10
11. Do you feel that a doctor should have the right to refuse to perform a legal abortion under any circumstances and regardless of the situation and needs of the patient? 3.47
12. When should a fertilized egg have its rights to life as a human being? at the moment of conception
3.12 at three-month gestation 2.72 at 41/2 months when life is detectable 3.15 when life outside the uterine environment is possible (after 6% months) 3.78
13. Should we allow the use of egg and sperm banks for artificial insemination with selection of characteristics of donors for potential children (genetic euphenics)? 1.77
14. Is adultery committed in artificial insemination of the egg of a wife with the sperm from a nameless donor under the consent of the husband? 0.94
15. Should artificial insemination be allowed in unmarried women who want to have children? 0.83
16. Is it ethical to choose the desired sex or characteristics for a child from 3 or more fertilized eggs and then implant that chosen one in the wife's uterus while destroying the others? 1.22
17. Is it moral for an unmarried woman to be implanted with the fertilized egg of a married couple unable to bear children and then carry their fetus to term, bearing this child for the married couple's family? 1.31
18. Is it ethical to develop human life outside of the uterine environment (test tube babies)? 1.15
19. What is your marital status? single 38 married 54 separated 1 divorced 2 widowed 0 engaged 5
20. How many children do you have, including adopted? none 54 one 6 two 15 three or more 25
21. What is your age? 18-29, 51 30 to 49, 43 50 or over, 6
Comments are listed by question number in order from greatest approval to greatest disapproval.)
11. (3.5) Yes, but not if a mother's life is at issue. A doctor should have the right to follow his own conscience, just as the patient should have. He can always refer the patient (who wants an abortion) to another doctor with no such scruples.
1. (3.4) This question uses a non-proven assumption that extending help to everyone who desires it inevitably must result in pollution of the human gene pool. However, we should not ignore such possible pollution and not encourage people with serious genetic defects to reproduce, while extending medical help to those in need. We cannot intelligently and consistently know what is best for another human being. If we ask God for guidance He will indicate what is best for the situation at hand.
6. (2.9) We should practice preventive measures when the future strength of our species is at stake. Elimination of individuals with defects would be inhuman but steps must be taken to avoid obvious defects in offspring. A genetic defect in the fetus is not adequate grounds for an abortion. Informed choice by the couple involved would be most appropriate. Genetic counselhug (preferably before conception), contraception, and sterilization should be preferred to abortion. The extent to which we practice must be controlled. Who can trust man to do anything unselfishly?
4. (2.7) Replacing defective body parts in individuals is not eugenic, although highly desirable. But shouldn't such desirability be expressed by the individuals needing such replacements?
8. (2.54) The linkage betwen chromosomal abnormalities and agressive behavior may be slight, coincidental, or non-existent. The relevant issue is whether the accused is sane or psychotic, not whether he has genetic defects. Perhaps he should be subject to a greater degree of capital punishment than one without genetic defects, since he is not safe on the loose or probably even in confinement. "Capital" should be eliminated from this question, since it raises a basic moral question on another topic.
5. (2.47) Only if there is absolutely no possibility that the viral genes will be transmitted and enter the human gene pool. If the germ cells can be affected by the viral agents, the individual should be sterilized as an agreed-upon condition of treatment. Are we prepared to accept the possibility of failure and unpleasant results should such action be unsuccessful?
2. (2.38) This question uses a non-proven assumption that man is evolving rather than degenerating. In a general way man should attempt to control his own evolution. The main concern is over the specific methods to be used and whether they will be adequately tested and verified. Voluntary selection of mates is already practiced. All techniques to be used scientifically will suffer from the inability of some committee to foresee the future, choose the optimal characteristics for that future and then select those characteristics of man which make him best fitted for the future. Not only do human beings make too many errors but they are totally incapable of being entrusted with such an important task. Corruption would set in, some greedy ones would seek to use methods for their own gain. The question needs clarification; it presents a poor alternative and indicates a lack of understanding of solutions. At present, the best we can hope for in controlling human evolution is some reduction in genetic disease, which would be highly desirable.
10. (21) We are not fit to judge; we are not sufficiently knowledgeable to understand all the past, present, and future circumstances. Sterilization should be considered and he subject to approval by the legal guardian, if the mother is incapable.
7. (205) If this question had indicated a better chance for future pregnancies, some answers would have been different. Avoidance or prevention of conception is preferred to abortion when this great a risk of serious genetic abnormality is known before conception.
3. (2.04) No: for violent or criminal behavior; yes: for psychoses, if possible. A psychosis is defined as a psychological malfunction secondary to a biochemical abnormality. Criminal behavior that is not the result of a psychosis is considered to be secondary to a defect of the character and cannot be considered a psychic or mental defect of any sort. Drugs or brain surgery do not eliminate mental defects, mental illness or violent behavior; they merely reduce the intensity of emotional arousal, making the patient groggy. But such results may be preferable to violent behavior. Drugs and surgery are not advanced enough to use as control in eliminative eugenics. A number disagreed that these procedures are eugenic at all, since eliminative eugenics is the breeding only of persons with desirable characteristics,
13. (1.8) Only for a woman from her own husband (as in the case of his having a vasectomy and storing sperm should they decide to have a child later). There are countless permutations and combinations possible in the genes of the human chromosomes. We have no guarantee that the best combinations are contained in the sperm from ideal or selected donors in the bank.
17. (1.3) Yes, if there is no damage to the fetus from a rejection reaction or other type of incompatibiity. Trauma on the carrier forbids this procedure. It is very unwise. Not at this time. This would cause all concerned a lot of problems. "Unmarried" should not be a factor. Not a problem if there was a shortage of children in the world, but since many starve each day in this world, couples unable to have children of their own should adopt. There are too many people already.
16. (1.2) Not when fertilized eggs are considered human. It is discrimination! It is foolish. It is not ethical to choose from eggs; leave this aspect to God.
18. (1.15) If a healthy baby could be produced - no objection, but it is very unlikely that the "human being" will survive until full term. Only if a woman cannot carry her child to term herself. For research or reimplantation to donor woman (mother) with husband. Not at present because of the extremely high probability of teratogenesis. No, because people cannot be trusted to be unselfish, and someone will surely try to manipulate such an operation for his/her own gains. Why? With overpopulation already? Consider the consequences?
9. (1.13) No, because it is highly probable that every Individual in the world has several defective genes. One generation of such legislation would be the last generation. Prohibitions may be difficult to enforce, but government could provide positive incentives for the patient and his caretakers to use voluntary sterilization, contraceptives, etc.
14. (0.9) Technically, adultery is not committed in artificial insemination (especially with consent of the husband), since adultery is intercourse between two who are not each other's spouse. Instead of "adutery" in the question, it should read, "Is it morally wrong to Then the answer is, "yes." (The greatest disparity in response by the age groups was evoked by this question. The under-30 group tended more to feel that adultery would be committed: 1.3 vs. 0.6 for the 30and-older group.)
15. (0.8) Definitely not; a family should have two parents. Yes, with proper safeguards that the woman is carefully chosen, sane, and capable of taking care of the child.
There was general disagreement as to when a fertilized egg should have its rights to life as a human being. Although none of the four points in time were agreed upon by a majority, most (36%) respondents thought that time should be at conception, and in second place, at the other extreme, 29% thought that time should be when extra-uterine life is possible.
Professor Tom Dent, Chairman of the Department of Biology, Gordon College, Wenham, Mass., who polled freshmen biology majors, the Gordon faculty and staff, reported that the most common verbal response was that these questions can't he answered simply with a number. Helpful suggestions for improvement of the questions were made by those who wrote comments and explanations for their responses, especially the two Canadian members and a Chapman College (Orange, CA) class, following their seminar on genetics and biological engineering. Thanks to all who responded with their thoughts, time, and 10C postage stamps. I was helped in my own thinking on some of these problems.