A question about ethics.

[251478]

Hello all. I just got out of one of my leadership classes where my teacher got on his soapbox about how doctors that refuse to perform certain procedures, such as abortions, should loose their license. His reasoning is that since abortions are legally allowed in America, doctors who practice here should be required to do them if requested by their patients, regardless of their personal beliefs. My question is this. What are the ethical and legal rules for doctors performing controversial procedures? Are we required to do whatever is asked of us as long as it is legal according to the government? How do personal ethics play into being a doctor? Thank you very much.

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[cpants]

Your teacher is wrong. You are not required to do abortions as a physician or a medical student.

 

[Excelsius]

Your teacher is wrong. You are not required to do abortions as a physician or a medical student.

Maybe you should qualify the circumstances. If you are a doctor specifically specializing in abortions and are paid to do this, I don't think you have any right to decide on your own which of your patients can get an abortion and which can't based solely on your personal beliefs. If someone is so strong against abortion (or evolution), then he/she should either not go into a field where abortions are standard or perhaps could stay away from medicine altogether. I don't mind if you are against abortions. But I don't think it is ethical for a single doctor to act as god and decide which patient is morally worthy of an abortion. Either don't do it at all or do it for everyone regardless of your beliefs, especially since it is legal. The laws for abortion will only get more lax over the next decade.

 

[Droopy Snoopy]

Just wanted to get in on the first page of what is sure to be a reasoned and level-headed discussion of the OPs question.

 

[GeraldMonroe]

Here's an ethical question that dovetails on the OP's question.

We had a 'clinical correlation' lecture by a fertility doctor where this M.D. lecturer explained how a single cell can be removed at the 8 cell blastocyst stage and genetically screened for defects. (possible only during in vitro fertilization, where the embryo is cultured in the lab for a few days before being implanted)

Anyways, after class I asked the doctor what she would do if the embryo was positive for a genetic disorder like Huntington's, which has a 100% chance of an eventual slow and excruciating death.

Anyways, if the embryo were positive for Huntington's, but the mother/patient still insisted on it being implanted, would she perform the procedure? The M.D. said she would, which I felt was highly unethical, but she argued that she had to respect the mother's autonomy.

This isn't necessarily a rhetorical question : I've spoken to women who may have to do IVF if they ever want to have a child. Some of the more religious ones have told me that they feel they are bound to implant every single embryo created using IVF, no matter what the flaw. In classes this year, we've covered hundreds of genetic defects that all cause horrible, crippling, lifelong disease with no effective treatments, so this bothers me. Usually, women have enough eggs that one could remove more and roll the genetic dice enough times to get embryos that have no untreatable crippling genetic diseases. It's not the choice between having no child and a child who's not going to have a real chance in life.

 

[cpants]

Here's an ethical question that dovetails on the OP's question.

We had a 'clinical correlation' lecture by a fertility doctor where this M.D. lecturer explained how a single cell can be removed at the 8 cell blastocyst stage and genetically screened for defects. (possible only during in vitro fertilization, where the embryo is cultured in the lab for a few days before being implanted)

Anyways, after class I asked the doctor what she would do if the embryo was positive for a genetic disorder like Huntington's, which has a 100% chance of an eventual slow and excruciating death.

Anyways, if the embryo were positive for Huntington's, but the mother/patient still insisted on it being implanted, would she perform the procedure? The M.D. said she would, which I felt was highly unethical, but she argued that she had to respect the mother's autonomy.

This isn't necessarily a rhetorical question : I've spoken to women who may have to do IVF if they ever want to have a child. Some of the more religious ones have told me that they feel they are bound to implant every single embryo created using IVF, no matter what the flaw. In classes this year, we've covered hundreds of genetic defects that all cause horrible, crippling, lifelong disease with no effective treatments, so this bothers me. Usually, women have enough eggs that one could remove more and roll the genetic dice enough times to get embryos that have no untreatable crippling genetic diseases. It's not the choice between having no child and a child who's not going to have a real chance in life.

I think you're a bit off base here. Is a life with Huntington's not worth living at all? Not only is that not for you as the doctor to decide, but that might not be the message you want to be imparting to the mother in this scenario, since either she or her husband has the disease. Most people will live life symptom free for 40 years before the disease starts. You can certainly educate the mother on Huntington's and the embryo's 100% chance of having disease, but in the end it is not for you to play God with her embryos. Your professor was right to respect the mother's autonomy. Also, if the mother is one of "the more religious ones" who insist on implanting all embryos, why would you screen her embryos in the first place?

 

[Excelsius]

Here's an ethical question that dovetails on the OP's question.

We had a 'clinical correlation' lecture by a fertility doctor where this M.D. lecturer explained how a single cell can be removed at the 8 cell blastocyst stage and genetically screened for defects. (possible only during in vitro fertilization, where the embryo is cultured in the lab for a few days before being implanted)

Anyways, after class I asked the doctor what she would do if the embryo was positive for a genetic disorder like Huntington's, which has a 100% chance of an eventual slow and excruciating death.

Anyways, if the embryo were positive for Huntington's, but the mother/patient still insisted on it being implanted, would she perform the procedure? The M.D. said she would, which I felt was highly unethical, but she argued that she had to respect the mother's autonomy.

This isn't necessarily a rhetorical question : I've spoken to women who may have to do IVF if they ever want to have a child. Some of the more religious ones have told me that they feel they are bound to implant every single embryo created using IVF, no matter what the flaw. In classes this year, we've covered hundreds of genetic defects that all cause horrible, crippling, lifelong disease with no effective treatments, so this bothers me. Usually, women have enough eggs that one could remove more and roll the genetic dice enough times to get embryos that have no untreatable crippling genetic diseases. It's not the choice between having no child and a child who's not going to have a real chance in life.

Not bad (except I'll assume a much more sinister disease, like AIDS). And I have answer to that:

1. In cases where the disease is going to be incurable and potentially contagious, then we should come up with laws that basically prevent any person from having a child that will endanger the rest of the public, at least as far as in vitro fertilization is concerned. Our laws are too far behind in technology.

2. In cases where there is no public danger, then we have to consider one very important factor: public charge. If you know for sure that the child has devastating disease with no known cures, then the question is: are the parents willing to pay for the costs out of pocket? Can they afford to? If not, then they should be notified that the insurance companies are going to be notified about the full status of the child and that insurance will likely be either denied or contain extremely high, preemptory premiums. This way you let the parents really think about making a decision like this. I don't agree that we all have to pay for a defective embryo just because certain couples choose to have very ill children because of their complete lack of science. Eventually, if we find that this second case still results in public charge because parents are unable to fulfill their agreement to care for their sick child, then there should be another law passed preventing embryos with certain diseases from ever maturing. Once it becomes a law, the doctors will not have to notify the parent about the given disease and simply select an embryo that is bereft of any major problems. This will be much easier on the parent as well.

Note that the point above IS ethical. You basically have a choice: you are free to wreck your car, but only if you are willing to pay for it. Trying to cure terminal illnesses is very heavy on the medical system. That's one of the reasons we all pay high premiums. Given then choice, we should not perpetuate our society with unhealthy individuals who are not only a public charge, but also are unable to contribute to the workforce in any meaningful way. Panda is pretty tough on this and I think he'd single-handedly get rid of all the defective "almost" zygotes.

 

[GeraldMonroe]

Interesting, two opposing views, excelsius versus cpants.

It's really a religious dispute. A purely rational individual would say "there's a high probability of the child with the disease having a miserable life, and being a burden on everyone. There is a low probability that the child will ever be healthy enough to be a productive contributor to society and to get to go on Spring Break drinking/sex binges and all the other things that healthy people enjoy.

However, if you believe that a superior being of some sort has set rules for our actions, then you may see things differently. You may say "well, despite the probabilties, it could work out. God could make the person with a severe genetic disease have a better life than the person without. I'm going to go ahead and mention an anechdotal account of one person who did really well but had a genetic disease, and ignore the 99 folks that lived painful and short lives while mentally handicapped. Furthermore, God created that human embryo, not I, so I have no right to 'play God' and to control the embryo's fate (presumably a person would say that while standing in front of the IVF microscope, and the rack of instruments needed to implant the embryo)"

Nearly all these moral debates seem to hinge on this fundamental difference in viewpoints. The exact same argument is used for pro-life versus pro-choice, and stem cell research. Whether to pull the plug on a comatose, brain-dead patient or to grant a terminally ill person euthanasia relies on a similar, mostly religious argument. Although, there are rational arguments one could make : pulling the plug on a comatose patient might be a bad move since very rarely the patient becomes conscious again. Euthanasia could be problematic because patients can become suicidal or be guilted by their relatives into feeling they are a burden. But the primary reason the voting public doesn't want those things is because terminating someone's life should be an act reserved for God.

And, I will say that while I'm making fun of the religious viewpoint, I do have to acknowledge that the rational one has a few 'minor' flaws. The biggest one is that if the ultimate fate of all of us is to end up as a decayed mass of tissue, and later nothing but dust, then it's kind of moot whether we try to be good people or not. A purely 'rational' person might do all the immoral things that they have a low probability of getting caught for. And the same applies to medicine : I'm sure there are many immoral things a physician can get away with, things that would make a physician's job easier. If one doesn't believe that it matters if one helps someone or not, one might be motivated to take actions that grab as much money for the least work as practical.

A simple example : what if one were a surgeon, and one knew of a technique that took 10 minutes of extra work, but lowered the risk of a particularly nasty complication by 0.1%. (1 in 1000, and one does thousands of surgeries) No governing agency requires the technique, and the surgeon gets paid the same either way. If one believed that the ultimate fate of all of us is to be a decayed cadaver, and no higher being, afterlife, or any other checks at all, one might rationally choose to skip the 10 minutes of extra work.

 

[cleoscat3]

Not bad (except I'll assume a much more sinister disease, like AIDS). And I have answer to that:

1. In cases where the disease is going to be incurable and potentially contagious, then we should come up with laws that basically prevent any person from having a child that will endanger the rest of the public, at least as far as in vitro fertilization is concerned. Our laws are too far behind in technology.

2. In cases where there is no public danger, then we have to consider one very important factor: public charge. If you know for sure that the child has devastating disease with no known cures, then the question is: are the parents willing to pay for the costs out of pocket? Can they afford to? If not, then they should be notified that the insurance companies are going to be notified about the full status of the child and that insurance will likely be either denied or contain extremely high, preemptory premiums. This way you let the parents really think about making a decision like this. I don't agree that we all have to pay for a defective embryo just because certain couples choose to have very ill children because of their complete lack of science. Eventually, if we find that this second case still results in public charge because parents are unable to fulfill their agreement to care for their sick child, then there should be another law passed preventing embryos with certain diseases from ever maturing. Once it becomes a law, the doctors will not have to notify the parent about the given disease and simply select an embryo that is bereft of any major problems. This will be much easier on the parent as well.

Note that the point above IS ethical. You basically have a choice: you are free to wreck your car, but only if you are willing to pay for it. Trying to cure terminal illnesses is very heavy on the medical system. That's one of the reasons we all pay high premiums. Given then choice, we should not perpetuate our society with unhealthy individuals who are not only a public charge, but also are unable to contribute to the workforce in any meaningful way. Panda is pretty tough on this and I think he'd single-handedly get rid of all the defective "almost" zygotes.

If costs were the only issue I may go so far as to agree with your viewpoint but I do have a couple of my own that I'm interested to hear your opinion on.

As far as immediately terminating an embryo because it has a terminal, incurable illness, I have two main problems with that.
1. Genetic diversity is not a bad thing. Tay Sachs and Sickle Cell Anemia are perfect examples of cases that genetic diversity has been beneficial with the mask of being terrible. To flat out outlaw the development of an embryo strictly based on genetic defect seems harsh. I'll admit that this is a relatively weak point as the only embryos involved would be those pursuing IVF but your rhetoric is more what I take question against.
2. Would this termination apply to those seeking screening for defects that are not terminal( Ex. Down Syndrome etc.)? More of a question then an arguement I know but there is more to come should it be answered.

 

[cleoscat3]

Interesting, two opposing views, excelsius versus cpants.

It's really a religious dispute. A purely rational individual would say "there's a high probability of the child with the disease having a miserable life, and being a burden on everyone. There is a low probability that the child will ever be healthy enough to be a productive contributor to society and to get to go on Spring Break drinking binges and all the other things that healthy people enjoy.

However, if you believe that a superior being of some sort has set rules for our actions, then you may see things differently. You may say "well, despite the probabilties, it could work out. God could make the person with a severe genetic disease have a better life than the person without. I'm going to go ahead and mention an anechdotal account of one person who did really well but had a genetic disease, and ignore the 99 folks that lived painful and short lives while mentally handicapped. Furthermore, God created that human embryo, not I, so I have no right to control the embryo's fate (presumably a person would say that while standing in front of the IVF microscope, and the rack of instruments needed to implant the embryo)"

Saw this after my last quote and I couldn't help but respond. Do you know what Huntington's Disease is? Cause if you did you would see that your differentiation has no basis.
(Disclaimer: I am a secular humanist)

 

[Lokhtar]

I think you're a bit off base here. Is a life with Huntington's not worth living at all?

It's a few cells. It's a choice between this set of cells and that set of cells. Obviously most will not make it to a child anyway.

 

[FutureInternist]

Your teacher is wrong. You are not required to do abortions as a physician or a medical student.

http://abcnews.go.com/Politics/WomensHealth/story?id=6977348&page=1

 

[GeraldMonroe]

Saw this after my last quote and I couldn't help but respond. Do you know what Huntington's Disease is? Cause if you did you would see that your differentiation has no basis.
(Disclaimer: I am a secular humanist)

Yes, I know, Huntington's disease causes no symptoms until a patient is in their 40s. My bad.

Down syndrome, any genetic disease that causes severe mental ******ation and cannot be fully treated, the severe untreatable hypercholesterolemias, the genetic diseases that cause the immune system not to work at all....there's a long list, actually, of things I think one should screen for and refuse to implant in the mother if the test result is positive. Most of these things are lethal enough that the resulting child could not breed in any case, rendering evolutionary arguments moot.

Also, evolution is over : most of us will be alive when full scale genetic editing is possible, and it will be technically possible to rewrite an embryo's genetic code, and eventually an adult's.

 

[cpants]

Interesting, two opposing views, excelsius versus cpants.

It's really a religious dispute. A purely rational individual would say "there's a high probability of the child with the disease having a miserable life, and being a burden on everyone. There is a low probability that the child will ever be healthy enough to be a productive contributor to society and to get to go on Spring Break drinking/sex binges and all the other things that healthy people enjoy.

However, if you believe that a superior being of some sort has set rules for our actions, then you may see things differently. You may say "well, despite the probabilties, it could work out. God could make the person with a severe genetic disease have a better life than the person without. I'm going to go ahead and mention an anechdotal account of one person who did really well but had a genetic disease, and ignore the 99 folks that lived painful and short lives while mentally handicapped. Furthermore, God created that human embryo, not I, so I have no right to 'play God' and to control the embryo's fate (presumably a person would say that while standing in front of the IVF microscope, and the rack of instruments needed to implant the embryo)"

Nearly all these moral debates seem to hinge on this fundamental difference in viewpoints. The exact same argument is used for pro-life versus pro-choice, and stem cell research. Whether to pull the plug on a comatose, brain-dead patient or to grant a terminally ill person euthanasia relies on a similar, mostly religious argument. Although, there are rational arguments one could make : pulling the plug on a comatose patient might be a bad move since very rarely the patient becomes conscious again. Euthanasia could be problematic because patients can become suicidal or be guilted by their relatives into feeling they are a burden. But the primary reason the voting public doesn't want those things is because terminating someone's life should be an act reserved for God.

And, I will say that while I'm making fun of the religious viewpoint, I do have to acknowledge that the rational one has a few 'minor' flaws. The biggest one is that if the ultimate fate of all of us is to end up as a decayed mass of tissue, and later nothing but dust, then it's kind of moot whether we try to be good people or not. A purely 'rational' person might do all the immoral things that they have a low probability of getting caught for. And the same applies to medicine : I'm sure there are many immoral things a physician can get away with, things that would make a physician's job easier. If one doesn't believe that it matters if one helps someone or not, one might be motivated to take actions that grab as much money for the least work as practical.

Your assumptions aren't correct. I'm not overly religious, and the basis of my argument has nothing to do with God. I am both pro-choice and pro-euthanasia (if that is what the patient wants). I have a problem with you screening out embryos based on genotypes you do not like. This borders on the ideas of the eugenics movement. Frankly, I think screening embryos for any diseases or genetic traits should be outlawed. We interfere with natural selection at our peril. Maybe we shouldn't be doing IVF at all. There are plenty of children out there rotting in the care of the state who would love to be raised by an infertile couple.

In response to the higher cost of a child born with genetic diseases, how far do you really want to go with that? In theory we could require government permits for all pregnancies like China does for population control. We could improve the model by requiring parents to prove financial viability, and all pregnancies would be terminated if genetic abnormality was found. Personally, I'd rather live in a country where the government and my insurance company know nothing about my genes and have nothing to do with deciding which genes will be passed on to my children.

By the way, HIV transmission rates to the fetus are very low if appropriate prophylaxis is taken during pregnancy.

 

[cpants]

http://abcnews.go.com/Politics/WomensHealth/story?id=6977348&page=1

This change does not require you to perform abortions. You may be required to provide information about abortion or refer to an abortion provider, but not to provide the service yourself.

 

[GeraldMonroe]

I have a problem with you screening out embryos based on genotypes you do not like. This borders on the ideas of the eugenics movement.

Let's make sure we're on the same page here. Your profile states you are a medical student, so you presumably understand the basics. The human body uses a large number of molecular machine parts to do what it does. A genetic disorder breaks the machinery, and the ones "I don't like" tend to break very fundamental pieces of the machinery that are needed to make many systems work at all.

I'm not in favor of selecting for paint job, I'm in favor of selecting against someone having to live who can't even move because their skeletal muscles are missing a critical machine part.

Sure, we don't fully understand everything...but we do know enough about the body to say that a STOP codon in the middle of a critical part is bad, period.

 

[strv04]

Hello all. I just got out of one of my leadership classes where my teacher got on his soapbox about how doctors that refuse to perform certain procedures, such as abortions, should loose their license.

I think that doctors that perform elective abortions should lose their license for violating the ethic value of non-maleficence towards the unborn human they kill.

His reasoning is that since abortions are legally allowed in America, doctors who practice here should be required to do them if requested by their patients, regardless of their personal beliefs.

It was also legal in Nazi Germany to perform medical experiments on Jews without their consent.

It was legal in japan during ww2 to perform a live vivisection on Chinese prisoners. See http://en.wikipedia.org/wiki/Unit_731

Some of the worst crimes in human history have been committed by people "following orders."

Your teacher is a major tool, If I were you I would have walked out of the room and complained to the dean about such statements.

 

[cpants]

Let's make sure we're on the same page here. Your profile states you are a medical student, so you presumably understand the basics. The human body uses a large number of molecular machine parts to do what it does. A genetic disorder breaks the machinery, and the ones "I don't like" tend to break very fundamental pieces of the machinery that are needed to make many systems work at all.

I'm not in favor of selecting for paint job, I'm in favor of selecting against someone having to live who can't even move because their skeletal muscles are missing a critical machine part.

Sure, we don't fully understand everything...but we do know enough about the body to say that a STOP codon in the middle of a critical part is bad, period.

You include Down's Syndrome and mental ******ation as abnormalities which would be unethical to implant into mothers. I am guessing you haven't spent much time with Down's patients, because they can lead fulfilling lives and bring joy to themselves and others. Some are even able to hold jobs, get married, and have children. While you may judge this as a lesser quality of life than someone of normal intelligence, that really isn't your call to make. Even patients with SCID, floppy baby, and many other genetic problems can maintain some quality of life.

The point is, just because we CAN screen for certain genetic abnormalities, doesn't mean we SHOULD do it. It is certainly not unethical to implant any embryo created from a mother and father's gametes into that mother. I do think it is unethical to implant too many embryos, as in the octomom case, putting the mother and children at risk.

As far as evolution being over goes: No. Even if we do reach the day where we order up our baby's traits from a menu--truly a terrifying thought--evolution will still march onward. There will just be different selective pressures introduced into the equation. This would be an extremly bad thing for our society and our species. Reducing the amount of genetic variation is unhealthy for any population.

 

[GeraldMonroe]

Oh boy. Godwin's law, and we haven't even gotten to the second page yet. Actually, you're the second person to invoke it...cpants up above made a reference to the "eugenics movement", but I decided to let that one go and just pretend he meant the eugenics movement that was carried out in the United States.

I take it you see no difference between removing a fetus that is less developed than my cat (and usually simpler than a lab rat) from a consenting mother and marching conscious and aware humans to some hideous concentration camp to be slowly worked to death, starved, or gassed.

From a moral view for a person that believes in God, perhaps there is no difference in the end : but there's a very, very large real world, practical difference.

Please be intellectually honest about abortion, and try to stay away from rhetoric. Abortion is bad. Maybe it should be illegal. But it's not the same as a holocaust.

 

[cpants]

Oh boy. Godwin's law, and we haven't even gotten to the second page yet. Actually, you're the second person to invoke it...cpants up above made a reference to the "eugenics movement", but I decided to let that one go and just pretend he meant the eugenics movement that was carried out in the United States.

There's nothing wrong with invoking the eugenics movement, when the person you are having a discussion with actually subscribes to the ideas of the movement, namely screening out undesirable traits from future generations.

 

[GeraldMonroe]

You include Down's Syndrome and mental ******ation as abnormalities which would be unethical to implant into mothers. I am guessing you haven't spent much time with Down's patients, because they can lead fulfilling lives and bring joy to themselves and others. Some are even able to hold jobs, get married, and have children. While you may judge this as a lesser quality of life than someone of normal intelligence, that really isn't your call to make. Even patients with SCID, floppy baby, and many other genetic problems can maintain some quality of life.

The point is, just because we CAN screen for certain genetic abnormalities, doesn't mean we SHOULD do it. It is certainly not unethical to implant any embryo created from a mother and father's gametes into that mother. I do think it is unethical to implant too many embryos, as in the octomom case, putting the mother and children at risk.

As far as evolution being over goes: No. Even if we do reach the day where we order up our baby's traits from a menu--truly a terrifying thought--evolution will still march onward. There will just be different selective pressures introduced into the equation. This would be an extremly bad thing for our society and our species. Reducing the amount of genetic variation is unhealthy for any population.

I mistyped something about Huntington's disease, and you will see I fixed it in my edited posts above.

As for Down syndrome : actually, my sister has down syndrome, and is doing about as well as a kid with it does. For now, she has gotten lucky and does not have leukemia or heart disease or one of the other laundry list of horrible fates that will probably eventually claim her no matter what I do. While I love her, had she been one clump of cells with the disease, and another clump without it, I would choose the clump without it. I think that if humans have a soul, God will move that soul into the child who is actually born. And there is a choice : my mother does not have the resources to have two children, because the one with Downs is a large burden. Had she not had the one with Downs via an early abortion, she could have had a healthy child and the total number of living humans would be the same. Hence, such anti-abortion arguments as "1 million children are never born" are simply not correct.

For Downs, SCID, floppy baby, ect there is a very, very large probability that they won't be successful. The chance of a normal child becoming self-sufficient, having their own kids, helping society and their parents, and the rest is at least 10 times higher.

As for evolution being over : I'm sorry you do not understand biology as well as a medical student should. You do not seem to realize how easy it will be to find the faulty genes once we have a full database of the genetic codes of a few thousand people. Nor do you realize that most useful genetic diversity is for MHC and other immune system alleles, which we can easily select for, and make sure each gene edited baby has a 'unique combination' of such alleles.

 

[GeraldMonroe]

There's nothing wrong with invoking the eugenics movement, when the person you are having a discussion with actually subscribes to the ideas of the movement, namely screening out undesirable traits from future generations.

Except that the 'eugenics movement' involved tying handicapped women to chairs, drugging and forcibly sterilizing them. Further, as genetic tests for the actual faulty alleles did not exist, it was not possible for the eugenics movement to ever accomplish it's stated goals because recessive alleles are what cause faulty genes to perpetuate from generation to generation.

My ultimate goal would be to harm no one. If an embryo had a bad gene, one would simply fix it by replacing it with a good copy, using a more advanced version of existing genetic engineering techniques. (I'm aware that we can't quite do that because current gene swapping techniques fail more often than they succeed, and you would need a stock of several hundred embryos to get one good one with the desired genetic changes. Some day the tools will be good enough that you could take a blastocyst, and edit out a few hundred genes that are known to cause disease)

No embryo would get flushed, and it would be no different than the same gene therapy you'd try on an SCID kid, except you'd do it at the beginning in a much smoother and more effective manner.

Until that is possible, though, I think it's ethical to remove more eggs and make more embryos, check all of them, and to implant the embryo that is clean of major diseases and has a good allele mix for the lesser stuff. (aka fewer risk factor genes for Parkinson's, ect)

 

[cpants]

I mistyped something about Huntington's disease, and you will see I fixed it in my edited posts above.

As for Down syndrome : actually, my sister has down syndrome, and is doing about as well as a kid with it does. For now, she has gotten lucky and does not have leukemia or heart disease or one of the other laundry list of horrible fates that will probably eventually claim her no matter what I do. While I love her, had she been one clump of cells with the disease, and another clump without it, I would choose the clump without it. I think that if humans have a soul, God will move that soul into the child who is actually born. And there is a choice : my mother does not have the resources to have two children, because the one with Downs is a large burden. Had she not had the one with Downs via an early abortion, she could have had a healthy child and the total number of living humans would be the same. Hence, such anti-abortion arguments as "1 million children are never born" are simply not correct.

For Downs, SCID, floppy baby, ect there is a very, very large probability that they won't be successful. The chance of a normal child becoming self-sufficient, having their own kids, helping society and their parents, and the rest is at least 10 times higher.

You are correct here, but this is not the argument you are making about IVF. You have stated that it is unethical for a physician to implant an embryo with Down's Syndrome. I respect a woman's right to choose abortion for any reason, including Down's diagnosis. You should respect a woman's right to keep or implant a Down's embryo if that is her preference.

As for evolution being over : I'm sorry you do not understand biology as well as a medical student should. You do not seem to realize how easy it will be to find the faulty genes once we have a full database of the genetic codes of a few thousand people. Nor do you realize that most useful genetic diversity is for MHC and other immune system alleles, which we can easily select for, and make sure each gene edited baby has a 'unique combination' of such alleles.

I don't know why you continue to be condescending, it doesn't make you more convincing...especially when you are the one who is showing stunning ignorance of the complexity of genetic and environmental intearctions and the benefits of genetic diversity for the survival of a species. Some science fiction dream of a full understanding of the complete human genome from mapping a few thousand people is just that, a dream. Most diseases we face are multifactorial including many different genetic, epigenetic, and environmental factors. Genetic diversity is not must useful just for MHC classification, it is useful for the species as a whole to adapt to different environmental changes. You need to retake population genetics.

 

[Crazyday]

The funny thing is that all these pro-life religious people don't believe in abortion and believe in "God's plan" and everything, then they go and get IVF and genetic screening. This amazes me to no end.

Following the logic of "God's plan", if you can't have a child for some natural reason, then that's God's plan and you should abide by it. If you would have a child with a severe genetic disorder, say leukodystrophy or some other disorder that is almost always fatal after 1-2 years of life, that is also part of God's plan.

That's how I see it. I just find irony in the whole situation.

Now, on the topic of using IVF to implant a baby with a severe genetic disorder, I think it is the mother's right to choose, not the physicians'. It is up to the belief and wants of the patient, and if they believe they are following their own moral precepts by having one of their embryos with a severe defect implanted, then so be it.

 

[GeraldMonroe]

I don't know why you continue to be condescending, it doesn't make you more convincing...especially when you are the one who is showing stunning ignorance of the complexity of genetic and environmental intearctions and the benefits of genetic diversity for the survival of a species. Some science fiction dream of a full understanding of the complete human genome from mapping a few thousand people is just that, a dream. Most diseases we face are multifactorial including many different genetic, epigenetic, and environmental factors. Genetic diversity is not must useful just for MHC classification, it is useful for the species as a whole to adapt to different environmental changes. You need to retake population genetics.

Sorry. It's just that your argument is a restatement of "the human body is too complex for scientists to understand it, therefore natural medicine is the only way to go." It's the same argument quacks use to stay in business.

Fact is, if we had a few thousand complete copies of the genome, we could use software to break out each gene into a list of known alleles. If an allele is only present in under 0.1% of the human population and our software indicates that the code has a stop codon, odds are extremely high we can safely edit that gene out. Further, if we do a quick computer search, and find that every person with that allele has a certain set of clinical symptoms, bam, we've discovered a new genetic disease. Most of the current uncertainty is because we don't have complete copies of human genomes to compare. I'm convinced that most of the 'mysterious' genetic diseases are only a mystery because our current maps are too low resolution to spot the faults.

Sure, it wouldn't be perfect, and occasionally you might 'edit out' a gene that turns someone into a super-genius. But it's much, much, much better than what nature does, because nature is blind and puts mutations in random locations.

Epigenetics only plays a small role between generations, most of it is just a way for a cell to maintain a 'memory state' of what it currently does.

As for maintaining genetic diversity : the reason we would do that is mostly to maintain disease resistance. And that's pretty straightforward : make a list of all available MHC alleles. Cross the ones off the list that tend to be connected to auto-immune disease and allergies. Out of the remaining, clean ones, give each genetically edited embryo a random set.

Oh, environmental changes : irrelevant for humans, because we can use tools, and we can make protection better than anything nature has the ability to give us, even with new mutations.

 

[strv04]

The funny thing is that all these pro-life religious people don't believe in abortion and believe in "God's plan" and everything, then they go and get IVF and genetic screening. This amazes me to no end.

Following the logic of "God's plan", if you can't have a child for some natural reason, then that's God's plan and you should abide by it. If you would have a child with a severe genetic disorder, say leukodystrophy or some other disorder that is almost always fatal after 1-2 years of life, that is also part of God's plan.

That's how I see it. I just find irony in the whole situation.

Of course your finding irony in the whole situation. You're declaring hippocrisy on a group of people based on your sterotypes and incomplete perception of their morality. Meanwhile your personal morality has no issues with either of these things (abortion vs IVF).

Please be intellectually honest about abortion, and try to stay away from rhetoric. Abortion is bad. Maybe it should be illegal. But it's not the same as a holocaust.

Actually on a number basis the practice of abortion in the united states since 1973 has killed about 4 times as many people as Germany killed in the holocaust. So yeah it isn't the same as the holocaust, it's much worse. Dismissing arguments with based on tone or lumping it as "rhetoric" (whatever that means) is not a good way to prove your point.

 

[Crazyday]

Of course your finding irony in the whole situation. You're declaring hippocrisy on a group of people based on your sterotypes and incomplete perception of their morality. Meanwhile your personal morality has no issues with either of these things (abortion vs IVF)

Personally, I would never have an abortion or promote IVF for myself or my spouse. Even though I'm technically not religious, I do believe in a "plan", and if something is meant or isn't meant to happen, then I leave damn well enough alone. The difference between me and these so called religious types is that I don't try to make someone else follow my conception of what is right and wrong. We are all human and have the natural ability to make our own choices on right and wrong, and I respect each persons' right to make their own decisions regarding morality.

I think someone else that fights abortion usually believes that God has a "plan" for each child (which is what many of them cite), and yet they screen and do all sorts of things to alter the very "plan" that they cite as truth.

I don't see how that's being stereotypical at all. Could you clarify?

 

[Excelsius]

Of course your finding irony in the whole situation. You're declaring hippocrisy on a group of people based on your sterotypes and incomplete perception of their morality. Meanwhile your personal morality has no issues with either of these things (abortion vs IVF).



Actually on a number basis the practice of abortion in the united states since 1973 has killed about 4 times as many people as Germany killed in the holocaust. So yeah it isn't the same as the holocaust, it's much worse. Dismissing arguments with based on tone or lumping it as "rhetoric" (whatever that means) is not a good way to prove your point.

You have yet to say anything meaningful here. It saddens me that medschools are so good at screening out GPAs and but are almost completely impotent in screening out extremists, especially from a profession where these don't belong.

 

[Excelsius]

...
A simple example : what if one were a surgeon, and one knew of a technique that took 10 minutes of extra work, but lowered the risk of a particularly nasty complication by 0.1%. (1 in 1000, and one does thousands of surgeries) No governing agency requires the technique, and the surgeon gets paid the same either way. If one believed that the ultimate fate of all of us is to be a decayed cadaver, and no higher being, afterlife, or any other checks at all, one might rationally choose to skip the 10 minutes of extra work.

Why 10 minutes then? Skip the whole surgery. In fact, why even become a surgeon? If one believes in a higher being deciding for everyone, then one should not become a surgeon and interfere with god's divine plane. That's just hypocritic and facetious. And anyone claiming that doing surgery IS god's diving plan, then I can say with equal success that terminating a sick embryo is god's divine plan as well. So stick to one only, please. Multiple choice test and you can bubble in only one answer. (I am talking generally here, I know you don't have extreme views on this.)

 

[Excelsius]

If costs were the only issue I may go so far as to agree with your viewpoint but I do have a couple of my own that I'm interested to hear your opinion on.

As far as immediately terminating an embryo because it has a terminal, incurable illness, I have two main problems with that.
1. Genetic diversity is not a bad thing. Tay Sachs and Sickle Cell Anemia are perfect examples of cases that genetic diversity has been beneficial with the mask of being terrible. To flat out outlaw the development of an embryo strictly based on genetic defect seems harsh. I'll admit that this is a relatively weak point as the only embryos involved would be those pursuing IVF but your rhetoric is more what I take question against.
2. Would this termination apply to those seeking screening for defects that are not terminal( Ex. Down Syndrome etc.)? More of a question then an arguement I know but there is more to come should it be answered.

Well, let's make a distinction here. Healthy genetic diversity is good. Unhealthy genetic diversity is not. Some lions in Africa are suffering from various diseases because they do not have strong immune systems. They are not too fertile either. Is there genetic diversity? Of course. Is it healthy? No. Healthy diversity means that the diversity creates a trait which increases the probability of the survival of the individual or the community. Your argument is a bit misplaced. If a person with Down syndrome was born in the wild, he would die very soon. But because our society chooses to pay for extreme weaknesses, we are in fact lowering the quality of our gene pool (assuming the ill person reproduces).

As I said, if you are willing to pay for your child's Down syndrome treatment, then by all means, have it. If you can't afford it, then you should not have it. I sure do not want to pay my money for that. I'd much rather invest that money in helping a completely healthy child from an underprivileged background who might otherwise die. Is this the Almighty's plan? To make you have a sick child, retain it, and spend all your money for a useless cause (sometimes braindead) while letting a perfectly healthy, innocent child suffer and die of hunger? It is not wonder that sometimes I get angry at the far religious right who make no sense at all.

 

[Excelsius]

Personally, I would never have an abortion or promote IVF for myself or my spouse. Even though I'm technically not religious, I do believe in a "plan", and if something is meant or isn't meant to happen, then I leave damn well enough alone. The difference between me and these so called religious types is that I don't try to make someone else follow my conception of what is right and wrong. We are all human and have the natural ability to make our own choices on right and wrong, and I respect each persons' right to make their own decisions regarding morality...

Did you understand what was discussed above? You have a right to do whatever you want, as long as you pay for it. But if you choose to have a sick child, then you should not expect the society to pay for your child's treatment in any way. If you can't afford it, then the society has the right to say whether it is willing to pay to care for your child or not. I assure you, the society, even the so called religious right, will not pay for your child, given the private choice. As such, the society can tell you whether you can have that child or not, simply because once you do have the child, we will for sure have to pay for it. It's just ethics. No one will be able to let the child die because you can't afford it. Maybe the government should take away these children for whom it pays. Perhaps then the assault will stop. I don't know how else to explain this.

 

[GeraldMonroe]

Why 10 minutes then? Skip the whole surgery. In fact, why even become a surgeon? If one believes in a higher being deciding for everyone, then one should not become a surgeon and interfere with god's divine plane.

What I meant is that if you don't believe a higher being is keeping score at all, then you have no way of justifying some ethical decisions. I have to believe that if I make a choice to help someone else by taking the extra 10 minutes, in some way it will matter in the end. Even though me and the patient will be a decayed cadavers, and later dust, I have to believe that my choices were recorded somehow, and that in some way it was better to be good than bad. A big difference between thinking a higher being might be tracking what I do, and it might matter if I did my best to help others, and believing that God created an entire universe only to require that each of us follow a rigid plan He set.

So my ethical principle is : any actions I take, I should be willing to experience the consequences of said actions if they were done to me. Thus, I don't have a problem with euthanasia for terminal patients, because if I were dying painfully, I would want to be put to sleep. If I were a defective human embryo, I wouldn't mind being aborted, because I would never experience anything in the first place. (since an embryo has no higher level functions, if God could put your mind in the perspective of the embryo, you would not experience anything at all) This simple and basic principle is how I would answer every ethical question out there. The only wrinkle is that occasionally, other people but the patient are involved. That's why even a 'painless murder' is morally wrong in this simple ethical system, because while the murder victim might not experience anything but an unexpected moment of whatever death is like, the families and relatives of the victim would go through an immense amount of pain.

This is why there's a difference between abortion and the holocaust. If my mind were made to experience the lives of every aborted fetus, I would be back here after an instant of nothingness, because those millions of fetuses never developed awareness. If I had to experience the horror of every person who died in the holocaust and the pain of all the survivors, I would be in for millions of years of sheer torture. (11 million people times the long horrible experiences of increasing discrimination followed by being rounded up and taken to camps, ect...I think most of the murdered people probably endured at least a year of pain before the germans finally killed them. If God existed, and wanted to punish Hitler, that would an effective way He could do it)

 

[devilpup]

This is an intriguing subject.

A paradigm often used to rationalize screening is the treatment-enhancement distinction, but this creates many ethical dilemmas like many of you have pointed out. A standpoint one can take is the freedom of pain principle- screening should be done only when the illness/disorder would inhibit the individual’s capacity to derive pleasure or avoid pain. If anyone cares to analyze this principle addressing precisely this issue, read up the article on page 48-51 of the Ivy Journal of Ethics.

 

[GeraldMonroe]

A standpoint one can take is the freedom of pain principle- screening should be done only when the illness/disorder would inhibit the individual’s capacity to derive pleasure or avoid pain.

What about the parent's capacity to derive pleasure or avoid pain? I suppose this is hard to define, since some parents would be in pain if their child doesn't become a tall, good looking high school jock and scholastic genius. Still, a mentally ******ed child might not be deprived of pleasure or be in much pain, but the burden on the child's family would be immense.

 

[devilpup]

What about the parent's capacity to derive pleasure or avoid pain? I suppose this is hard to define, since some parents would be in pain if their child doesn't become a tall, good looking high school jock and scholastic genius. Still, a mentally ******ed child might not be deprived of pleasure or be in much pain, but the burden on the child's family would be immense.

The principle applies to the condition of the fetus. However, it seems the principle, in regards to the parents, is not violated as long as they realize what they are getting themselves into. I think its fair to say parents can derive pleasure from having a child even with disabilities (e.g. down syndrome, autism etc.). You hear about it often times when parents refer to their disabled child as a "gift".

Now this would not apply to parent with a child suffering from Epidermolysis Bullosa (EB) where there is clearly no way for the child to avoid the pain or a manner of deriving pleasure from life. I doubt a parent could derive pleasure from such experience?

 

[GeraldMonroe]

Another wrinkle, devilpup : some diseases have a massively increased chance of causing the patient to experience less pleasure and more pain.

For instance, Down syndrome increases the risk of leukemia 20x or more. Leukemia is a terrible way to die. Also, heart disease and other deficits. Just like there might be a way for 1 in 100 kids with EBS to experience some kind of livable life.

I guess I'm really arguing with a preconceived idea, here. I think it's terrible for a child to be born with some innate defect, as the world is competitive enough as it is. A woman has hundreds of usable eggs but will only ever have a small number of kids. 2-5 is about the practical limit in today's society, and mortality effectively limits the number of surviving kids women can have in other societies. So those 5 kids might as well be made from the best egg and sperm available. This is also a reason for abortion : women will often abort if they become pregnant by a man they change their mind about. A woman's kids might as well be using sperm from a man who will care for them. (I vaguely recall that a woman has even more eggs than merely breeding years * 12, because the primary follicle normally secretes hormones to kill rival follicles. I think that this can be overridden with fertility drugs)

 

[strv04]

You have yet to say anything meaningful here. It saddens me that medschools are so good at screening out GPAs and but are almost completely impotent in screening out extremists, especially from a profession where these don't belong.

Mentioning the +20 million dead due to abortion since 1973 makes one an extremist now a days?

You and I are a good example of the huge cultural divide occurring in America these days. The culture in this country has not been this divided since 1861. I am equally as sad over medical schools admitting so many people who have more respect for the choices of the strong over the life of the weak.

 

[GeraldMonroe]

strv04 : are those 20 million fetuses really dead, or are they alive today as children conceived later, who would otherwise be dead due to a lack of parenting resources? As upset as this act may make you, I'm just as upset by 'pro-lifers' equating abortion to the holocaust.

 

[tiedyeddog]

Mentioning the +20 million dead due to abortion since 1973 makes one an extremist now a days?

You and I are a good example of the huge cultural divide occurring in America these days. The culture in this country has not been this divided since 1861. I am equally as sad over medical schools admitting so many people who have more respect for the choices of the strong over the life of the weak.

Are you seriously a medical student? The country wouldn't be so divided if more people could learn to have differences of opinion yet still respect other's choices. I'm all for your protesting people having abortions but at least acknowledge that your peers in the medical community, who do perform abortions, are intelligent human beings and should be treated with some amount of respect. (Go ahead and state that they don't treat the unborn with respect, we get it.)

You have yet to clarify why it is not hypocritical for a couple to believe in not killing a fetus with a genetic disease under the premise that it is "God's will the fetus has the disease" yet the couple sought IVF in the first place. Is it not God's will that the couple is infertile?

 

[strv04]

I'm just as upset by 'pro-lifers' equating abortion to the holocaust.

This shouldn't upset you if you consider fetuses to not actually be alive.

If fetuses aren't alive then me equating abortion to the holocaust is a silly as a nut equating a nocturnal emission to global nuclear war. Not upsetting but kinda funny and sad.

If fetuses are actually living human beings then I can see how the comparison is upsetting. Killing in a gas chamber is not much different then killing in the nice clinic down the road as far as the end outcome is concerned. One victim can speak and has a life story, one victim cannot speak yet and has yet to write their story. In the end they are both still victims.

I don't follow the first part of your post, but I don't remember children dying constantly due to lack of parent resources prior to 1973. I do recall a lot of good coming from people with tough upbrings/circumstances through history.

 

[devilpup]

I guess I'm really arguing with a preconceived idea, here. I think it's terrible for a child to be born with some innate defect, as the world is competitive enough as it is.

yep, it can be a terrible thing, but simply screening against what the majority deems as a defect is too simplistic. Ideally a reasonable compromise should be made.

At the extreme, I would hate to see the nazification of embryos in our near future.

 

[Crazyday]

This shouldn't upset you if you consider fetuses to not actually be alive.

If fetuses aren't alive then me equating abortion to the holocaust is a silly as a nut equating a nocturnal emission to global nuclear war. Not upsetting but kinda funny and sad.

If fetuses are actually living human beings then I can see how the comparison is upsetting. Killing in a gas chamber is not much different then killing in the nice clinic down the road as far as the end outcome is concerned. One victim can speak and has a life story, one victim cannot speak yet and has yet to write their story. In the end they are both still victims.

I don't follow the first part of your post, but I don't remember children dying constantly due to lack of parent resources prior to 1973. I do recall a lot of good coming from people with tough upbrings/circumstances through history.

End outcomes do not always redeem the method taken to achieve that outcome. In the case of taking Jewish people to concentration camps and torturing them, all while stripping them of all sense of humanity and feeling, then putting them in gas chambers to die together...this is not the same as abortion; don't even try to compare them.

If we're going to say end outcomes are all that matters, well the end outcome is that we all die. Abortion doesn't matter, the Holocaust didn't matter, nothing we do matters. The end result is we all die.

No, it is not the end that matters. It is the method to achieve that end. In the case of abortion, a person that would abort a baby would probably take poor care of the child in any case. It may be risen in a family that would neglect its needs, that would abuse it, maybe it would have a severe genetic disorder that would make it live a horrible pain stricken life, maybe it would...

Need I go on? To me, myself, and I, and to any spouse to which I would impregnate, I am strongly against abortion and would never allow it. That doesn't mean that I trust other people to raise their child with the same diligence and care, that I understand every other persons' individual situation which is unique for each person. That doesn't mean I necessarily condone abortion, but I'm not going to try to make that decision for anyone else.

Sure, there are some outliers that come from tough family lives etc. There might be more that turn out to be social rejects, psychotic criminals, nobodies...

 

[strv04]

I'm all for your protesting people having abortions but at least acknowledge that your peers in the medical community, who do perform abortions, are intelligent human beings and should be treated with some amount of respect.

I don't believe I have insulted anyone's intelligence if I have please accept my apologizes. However it seems my intelligence and admission to medical school has be questioned several times now in this thread. I will not apologize for not respecting their moral choices. I would never voluntary work with a provide that participates in the practice of abortion. At the same time I would respect that provider just as I would respect any fellow professional in the professional setting. Anyone who can make it to medical school is obviously an intelligent human being. However intelligence is not wisdom.

You have yet to clarify why it is not hypocritical for a couple to believe in not killing a fetus with a genetic disease under the premise that it is "God's will the fetus has the disease" yet the couple sought IVF in the first place. Is it not God's will that the couple is infertile?

This situation presumes that by using IVF the couple is voluntary aborting some of the embryos as commonly happens in the procedure. This should not sit well with their moral belief that abortion is wrong. Right?

Wrong. Using natural means 20-50% of pregnacies fail. Using the argument presented above that would mean that trying to become conceieve using the tools "God" gave the couple is akin to volunatrely aborting 20-50% of their children. The differnece is the chocie. The couple wants to conceieve using natural or medical assited methods. Not every attempt will be successful but thats life, sure its sad but noweher is somebody saying hey I don't want this kid lets end it. Now what would be hipocritical would be using IVF and then reducing the number all the while claiming to be against abortion. That would be hippocritical but thats not what this imaginary moral couple is doing.

 

[GeraldMonroe]

I don't follow the first part of your post.

Dick and Jane have sex. Jane gets pregnant, and tells Dick. Dick says he won't help raise the kid, and that he's dead-beat broke. Dick leaves to go to another woman.

Jane goes to the abortion clinic, and has an abortion when the fetus is smaller and simpler than the lab rats the drugs she is given were tested on. She goes and eats a hamburger afterwards, taken from a cow that was also much, much, much smarter than her fetus.

Jane meets Bob. Bob is a nicer guy, although not as sexy as Dick. Jane and Bob get married. It takes a little longer, but eventually Jane gets pregant, and has a child, Sue, who will grow up to be a happy little girl in a loving family.

In a religious dictatorship to the South, Jane2 has sex with Dick2. Dick2 is a dick, and Jane2 wants an abortion. But she can't have one, because the religious dictatorship means that she has no control over a tiny parasitic lifeform inside her body. But, she's free to drink away her sorrows at the local bar, subjecting the fetus to damage from ethanol.

Jane2 is pregnant, and eventually is forced to give birth to Bill, who she does not love. Jane2 treats Bill like the whiny burden he is, and tries to scrape by working at the local MegaMart while raising Bill in a trailer. One day, Jane2 meets Bob2, a nice guy. Alas, Bob2 dumps her the moment he learns that Jane2 has another man's baby, because he does not want to work to take care of another man's child. Plus, the kid is kind of a drag, and Bob2 can't take Jane2 out to the local bars all night and then back to his place to have sex, because she doesn't want to leave Bill alone. Bob2 leaves to look for another woman.

In the long run, Jane and Jane2 have the same number of children. Sue grows up to be a happy idealistic pediatrician serving the underserved in Boston. Bill gets used to crime, as he resents how the world treats him, and goes on to become a competent drug dealer until he is eventually caught and imprisoned.

Thus, for every child who is aborted (20 million or whatever), sufficient ecological space for a new child is created. Abortion gives women the ability to massively increase the odds that a child becomes "Sue" rather than "Bill".

Sure, you're going to jump in and say that it could easily go the other way. "Sue" might end up being a xanax abusing college co-ed who stars in numerous Girls Gone Wild videos before marrying a frat boy. "Bill" might go to Harvard medical school and become a world reknowned pathologist. But the ODDS are that it doesn't work that way, and study after study confirms this. The income, social status, and IQ of the parents has a gigantic impact on how the kid usually turns out.

 

[Crazyday]

I don't believe I have insulted anyone's intelligence if I have please accept my apologizes. However it seems my intelligence and admission to medical school has be questioned several times now in this thread. I will not apologize for not respecting their moral choices. I would never voluntary work with a provide that participates in the practice of abortion. At the same time I would respect that provider just as I would respect any fellow professional in the professional setting. Anyone who can make it to medical school is obviously an intelligent human being. However intelligence is not wisdom.



This situation presumes that by using IVF the couple is voluntary aborting some of the embryos as commonly happens in the procedure. This should not sit well with their moral belief that abortion is wrong. Right?

Wrong. Using natural means 20-50% of pregnacies fail. Using the argument presented above that would mean that trying to become conceieve using the tools "God" gave the couple is akin to volunatrely aborting 20-50% of their children. The differnece is the chocie. The couple wants to conceieve using natural or medical assited methods. Not every attempt will be successful but thats life, sure its sad but noweher is somebody saying hey I don't want this kid lets end it. Now what would be hipocritical would be using IVF and then reducing the number all the while claiming to be against abortion. That would be hippocritical but thats not what this imaginary moral couple is doing.

Yes, this much is apparent.

If it is God's plan to have a failed pregnancy (and 20-50% is a bit radical, I'd like some citation on this), then that is God's plan through and through.

Using your logic, a person aborting a child is also using the tools God gave them to abort their child. If you're able to use tools, as you are claiming, to modify God's plan, then aborting is now legal using your reasoning.

Assuming the element of morality is nonexistent except in the tense that disrupting God's plan by artificial means is immoral, then using IVF to circumvent infertility or to choose a "healthy" child is surely disrupting God's plan, and is surely immoral. Aborting a child is also disrupting God's plan, and is immoral under this context. The only morally neutral action is to have a child using the means given to your body by God, and to accept whatever the outcome. Choosing a healthy or superior child, or using tools to bypass infertility, or having an abortion, are all immoral as they disrupt the plan of God.

A person claiming that abortion is immoral while they use IVF and other "correct" tools to modify God's plan; that person is a hypocrite, for they violate the very principle they claim to be morally wrong.

 

[Excelsius]

...

You have yet to clarify why it is not hypocritical for a couple to believe in not killing a fetus with a genetic disease under the premise that it is "God's will the fetus has the disease" yet the couple sought IVF in the first place. Is it not God's will that the couple is infertile?

...
A person claiming that abortion is immoral while they use IVF and other "correct" tools to modify God's plan; that person is a hypocrite, for they violate the very principle they claim to be morally wrong.

Exactly.

...
This situation presumes that by using IVF the couple is voluntary aborting some of the embryos as commonly happens in the procedure. This should not sit well with their moral belief that abortion is wrong. Right?

Wrong. Using natural means 20-50% of pregnacies fail. Using the argument presented above that would mean that trying to become conceieve using the tools "God" gave the couple is akin to volunatrely aborting 20-50% of their children. The differnece is the chocie. The couple wants to conceieve using natural or medical assited methods. Not every attempt will be successful but thats life, sure its sad but noweher is somebody saying hey I don't want this kid lets end it. Now what would be hipocritical would be using IVF and then reducing the number all the while claiming to be against abortion. That would be hippocritical but thats not what this imaginary moral couple is doing.

It is not easy to quickly understand exactly what you are trying to say here. Try to organize your thoughts better. Anyway, I did spend a bit extra time deciphering your message, and it seems that you completely misunderstood the point made above by several posters. We are not saying "Why do "god's plan" believers choose IVF when some of the embryos are in fact dying in that procedure." You did not get that right. What we are saying is that if you believe only in God's plan, then you should stick to the tools that God gave you. I don't care if you think the amount of sacrificed embryos is the same in IVF as in natural conception - I don't know enough about this to comment - but it is completely irrelevant. If you believe in god's plan, then you have no right to go to a doctor and ask him to play god. If god is willing, you will eventually conceive. If he is not, then you won't. However, if you choose to run to a doctor to help you out, then you are a hypocrite and have zero credibility about your beliefs. It is immoral to impose your will on others when you yourself choose to have an exception just because it is personally convenient for you. You were the one to invoke Godwin's law. Well, as McCain would say, my friend, here is a flashback for you: Your willingness to think that it is ok to ask a third party to play god for you and yet you believe that only god can do what you request is very similar to Hitler, gang members, and maniacs who are deeply religious but think that certain people deserve to die because god wouldn't want them alive anyway. So they create these artificial "exemption" clauses only for themselves becuase they think they have the right to it and it enables them to justify any act they want that would otherwise not sit well with their beliefs. This, my friend, is called a delusion. So please, do us a favor, either don't dare to condone IVF or rid all of us from the "god's plan" spiel.

I could go further and question your entire reasoning to become a doctor. Maybe I should? As far as I am concerned, you have to justify your becoming a doctor because you have no right to interfere in god's plan. Let him decide who dies, who suffers, and who prospers. Let the lord liquidate them all. You mind your own business.

 

[251478]

I appreciate all of the intense debate on this thread. I did not mean for this to become an argument over abortion, that was just the example my teacher used, but my original question still stands. As doctors, what are we legally required to do for our patients? I understand that we must provide life saving care, but where is the line drawn that allows us to say no to a procedure? What are the current Conscience Protection Regulations, what do they specify and where can I read them? I will be starting med school next semester and will learn most of this then, but I am curious now. Also, what is the actual Hippocratic Oath that most doctors take because there are multiple versions online.

 

[GeraldMonroe]

Also, what is the actual Hippocratic Oath that most doctors take because there are multiple versions online.

Depends on the school. The original Hippocratic Oath has serious problems that make it inappropriate for modern physicians. See here : http://www.pbs.org/wgbh/nova/doctors/oath.html

So different schools have different versions of the 'modern' oath, although there's one written in 1964 by Louis Lasagna that is fairly commonly used. Read it here : http://www.pbs.org/wgbh/nova/doctors/oath_modern.html

 

[DoctorPardi]

You include Down's Syndrome and mental ******ation as abnormalities which would be unethical to implant into mothers. I am guessing you haven't spent much time with Down's patients, because they can lead fulfilling lives and bring joy to themselves and others. Some are even able to hold jobs, get married, and have children. While you may judge this as a lesser quality of life than someone of normal intelligence, that really isn't your call to make. Even patients with SCID, floppy baby, and many other genetic problems can maintain some quality of life.

The point is, just because we CAN screen for certain genetic abnormalities, doesn't mean we SHOULD do it. It is certainly not unethical to implant any embryo created from a mother and father's gametes into that mother. I do think it is unethical to implant too many embryos, as in the octomom case, putting the mother and children at risk.

As far as evolution being over goes: No. Even if we do reach the day where we order up our baby's traits from a menu--truly a terrifying thought--evolution will still march onward. There will just be different selective pressures introduced into the equation. This would be an extremly bad thing for our society and our species. Reducing the amount of genetic variation is unhealthy for any population.

Something to consider with Downs is the financial aspect of IVF. It costs tens of thousands of dollars for this procedure. They generally implant more than one embryo. They usually know they all will not survive, they do so to lower costs, so they do not have to do it over and over again until it works (costing thousands more each time).

A down's embryo has something like a 60-70% chance of NOT making it to term in a normal pregnancy. So while Downs syndrome patients can live full lives, they are the minority of down's embryo's that make it out of the womb at all.

I am not advocating for any position but simply bringing this point up for consideration.

 

[rock_climber]

Fact is, if we had a few thousand complete copies of the genome, we could use software to break out each gene into a list of known alleles. If an allele is only present in under 0.1% of the human population and our software indicates that the code has a stop codon, odds are extremely high we can safely edit that gene out. Further, if we do a quick computer search, and find that every person with that allele has a certain set of clinical symptoms, bam, we've discovered a new genetic disease. Most of the current uncertainty is because we don't have complete copies of human genomes to compare. I'm convinced that most of the 'mysterious' genetic diseases are only a mystery because our current maps are too low resolution to spot the faults.

Sure, it wouldn't be perfect, and occasionally you might 'edit out' a gene that turns someone into a super-genius. But it's much, much, much better than what nature does, because nature is blind and puts mutations in random locations.

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you're right - nature is SO stupid when it comes to evolution. i mean how long has nature even been trying? it seems like it's really been phoning it in for the past few millenia.

wow, you have a VERY simplistic idea of how both genetics, epigenetics, evolution, and bioinformatics works. can't wait for the "disease finder" program you describe to be released for my iphone! i can solve every human disease while i have a coffee at starbucks!