by William Cutrer, MD, and Sandra Glahn, ThM
Imagine yourself sitting on an ethics board of your local hospital. You face the task of making a recommendation in this situation:
The patient, a teenage young woman, has atypical leukemia. All the usual therapies have failed and she awaits a suitable match for bone marrow transplantation. None are available and her death is imminent.
Remove a sample of the patient’s bone marrow, isolate her own stem cells, grow them in culture. Then destroy her own marrow and the cancer with chemotherapy and radiation, and inject her with her own “cloned” cells.
Derive a cloned cell line of matching marrow from banked adult stem cells, destroy her diseased marrow and blood lines, then transplant these “cloned cells.”
Derive a cloned cell line from fetal stem cells obtained through aborted fetuses.
Derive a cloned cell line from fetal stem cells obtained from a live born baby’s blood sample.
Inject the patient with a virus (viral vector) containing a corrective gene that will divide and conquer the cancer cells’ abnormal growth.
As you consider each of these options, how did you arrive at your opinion? What steps did you take mentally to come to the point of feeling that you could or could not recommend any or all of the choices? (At this writing, A is being done with some success; B is working for some specific types of cancers; with C—while researchers have obtained stem cells and clones, to date they have developed no successful treatments; D has been done by taking bone marrow from a baby and or/sibling, and culturing a cell line; E is still on the horizon.) Each offers some promise in the future and has been offered as possible solution to the life-threatening disease. Yet how do we determine the morality of each of these and other methods?
Initially, we will need to learn the for key vocabulary words of the ethicist, so we can converse intelligently in this arena.
These are the four key principles—the building blocks to ethical understanding and discussion:
Beneficence – Does it do good?
Nonmaleficence – Does it avoid doing harm?
Autonomy – Does it respect self determination— the patient’s right to decide for him- or herself?
Justice – Does it give what is right or due?
When you have an issue to consider, first “run it through” the grid of asking these four questions. Next, understand that these principles fall within three major systems—each of which have merit, and each of which can be viewed through a biblical world view.
Utilitarian Ethics – Does it do the most good for the most people?
Deontological Ethics—Does it conform to rule or law? In this case, does it violate God’s law?
Virtue-based Ethics—What would a person of virtue do in this situation?
If Virtue-based Ethics sounds a lot to you like “What would Jesus do?” you’ve got the right idea. And as long as we keep in mind the eternal perspective of God—that life extends beyond temporal existence, and suffering does not by definition end with mortal life—believers can contribute to the discussion using the Utilitarian Ethic.
As to Deontology, we have the word of God, and if God’s law declares something immoral, we have our ethical answer.
How then do we apply these principles and systems to the case in view? Were it now possible to clone bone marrow cells from the patient, from an adult, or from a fetus without sacrificing any life with the end goal of treating our test case, would it be ethical? Moral? Right?
Take Option A above and consider it in light of the four key principles. Then consider it through each of the three ethics systems. Do that with each option. What did you find?