Bioethics: A Crash Course

Last night I attended a lecture on bioethics. Coming into it, I had my doubts about the topic, but this was mainly because I knew so little about it. I suppose I figured that it was just sensitivity training for the new age, but I was quickly drawn in to the conundrum that the lecture presented. In actuality, I learned, the field of bioethics presents some incredibly complicated scenarios for which there are no easy answers. In fact, due to the subjective nature of societal ethics, it would seem that there are no right answers, nor really wrong ones either. Furthermore, combined with what I know about behavioral economics and the science of decision making, the best approach I could reason for many of these questions leads to conclusions that are unsettling in appearance, but practical in application.

In our fiercely independent individualist society, the questions posed at the turn of the previous century in the realm of bioethics seem like no-brainers. Who would dream of neutering individuals if they were deemed imbecilic? The fear, at the time, was that these mentally unfit individuals would breed and contaminate society. Eugenics was a popular idea at the time, even endorsed by President Theodore Roosevelt, and laws that called for the neutering of unfit individuals (repeat criminals and mentally deficient people) were adopted by many states. The practice continued up until 1979. Nowadays, we gasp in horror at the thought of such a thing happening. Who has that kind of authority?

The questions don’t get any easier to answer. In liberal society, we fiercely defend an individual’s control over their personal domain, but at what point does one man’s domain affect another, and at what point does a child’s domain separate from its parent’s? Why do we allow male circumcision, but not female circumcision? What makes abortion legal, but culling your born children murder? As genetic engineering becomes a possibility, is it ethical to manufacture your perfect child? What is perfect? There are no easy answers.

One case that is particularly striking is that of a deaf couple with one child who is also deaf. Their goal is to have another child, and they want to give that child the best chance they can to also be born deaf. The reason for this is because they want the child to grow up in their deaf society. Now, if one views deafness as a defect, we might consider these parents to be quite sick in the head. However, it is clear that these parents embrace their condition and want the same for their child. Is it right for them to determine the outcome of their child’s life to the extent that they have a life-changing disability? Does the fact that they do it before conception change anything? Everyone has a different answer.

How about obvious genetic diseases? Is it right for parents to cull out possibilities of conditions that will impede their child’s ability to have a normal, healthy life? One community of potential genetic disease carriers (the name of the disease escapes me, but it is a very select population) is fighting to prevent gene mappers from identifying the gene that causes their disease. It is one that strikes people down in their middle age quite swiftly and traumatically, so why would you want to prevent people from knowing they are a carrier? There are obvious social stigmas associated with diseases as grave as this one. Why, with people now privy to such information, it would affect one’s ability to live a normal life (up until the point that the disease kicks in, at least). And believe me, most people just want to be normal.

From a business perspective, if you knew your chances of getting a genetic disease was low, you might skimp on the amount of insurance you buy whereas someone who was high risk would purchase more. But that skews the balance of how insurance is supposed to work. Insurance is a pooled risk venture, but if only the high risk people bought insurance, the whole system would fail. These are only some of the problems introduced by learning about your genetic makeup. As the future approaches and times change, we will be forced to adapt to the new knowledge and how it affects old business. Once again, there are no easy answers.

As I listened to the lecture, I was constantly stumped by the compelling questions that could go either way, depending on if you listened to the individual or their society. One audience member asked the speaker what the purpose of ethics was. This was the question that had been brewing in my own head. I was searching for answers, but I did not know what approach to take. All the speaker could do was acknowledge that ethics lead to wildly inconsistent conclusions. There is no hard and fast rule when it comes to these decisions. This did not satisfy me.

The last response from the audience for the night was the one that really set off a spark for me. It was from a fellow behavioral economics buff who cited a study where parents who had to decide to euthanize their child experienced more grief than when the doctor made the decision for them. Everything started falling into place inside my head. The answers were not nice.

Individualism is a pillar of Western society; we make our own damn decisions. We don’t consider overpopulation. We don’t consider welfare. We don’t think of our neighbors. We rarely think of the environment. We just do what makes us happy. There are countries around the world where things are different; people submit many daily decisions to the will of the state. Chinese parents cannot grow their family to their heart’s desire. They do so to their state’s desire. We over here in the West see that as (to put it lightly) a huge bummer. Still, they may be onto something.

Taking into consideration the level of grief experienced when one makes their own decisions, we might find it more emotionally economical to have the decision made for us by some authority. However, the freedom to make that choice is exactly what we hold dear in our society. So we are left with the true question: will we ever forfeit our ability to choose, knowing that we may very well be happier that way?