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Article Review for SPB571
Reference Heading
Title: Biotechnology, Human Enhancement and the Ends Medicine.
Author: Edmund Pellegrino, MD
Date: 30 November 2004
Personal Heading
Name: Tajudin Bin Taib
Date Submitted: 26 October 2013
Source: The Center of Bioethics and humans dignity, Trinity International University
Article’s URL:http://cbhd.org/content/biotechnology-human-enhancement-and-ends-medicine
Course: SPB 571
Assignment: Article Review
Abstract
From the Articles titled Biotechnology, Human Enhancement and the Ends Medicine.
By Edmund Pellegrino,MD
The actual and promised capabilities of biotechnology have given prominence to a
possible new end of medicine, "enhancement." Almost every present-day commentator
underscores the difficulties, impossibility, or futility of any definition that seeks to distinguish
enhancement from therapy.1 Nonetheless, everyone eventually ends up using the term since no
viable substitute has yet appeared. In short, no boundary between morally valid and invalid uses
of biotechnology can be established without at least a working definition.
In this essay, my operating definition of enhancement will be grounded in its general
etymological meaning, i.e., to increase, intensify, raise up, exalt, heighten, or magnify. Each of
these terms carries the connotation of going "beyond" what exists at some moment, whether it is
a certain state of affairs, a bodily function or trait, or a general limitation built into human
nature. Enhancement is, as Fowler says, "A dangerous word for the unwary," but its use in some
form seems inescapable.2 For this discussion, enhancement will signify an intervention that goes
beyond the ends of medicine as they traditionally have been held.
For medicine, the treatment/enhancement distinction cannot be avoided since physicians will
play a central role whenever medical knowledge is used both to regain health and to go beyond
what is required to regain health. To be sure, specialists in other fields are necessary if even the
modest promises of biotechnology are to be realized. They will provide the basic scientific and
technical expertise from which biotechnological enhancements will emerge. But physicians are
crucial in the actual use of this technology with individual human beings.
Some physicians have already crossed the divide between treatment and enhancement, between
medically indicated use and patient-desired abuse. There is already a need for physicians to
reflect on the ethical implications of their involvement in the uses of biotechnology. This
reflection centers on these loci: (1) The use of biotechnological advancements in the treatment of
disease; (2) its use to satisfy the desires of patients and non-patients for enhancement of some
bodily or mental trait, or some state of affairs they wish to perfect; and (3) more distantly, in the
use of biotechnology to redesign human nature and thus to enhance the species in the future.
New treatments are the most promising use of biotechnology. They most closely conform to the
clinical and ethical ends of medicine. The list of target diseases is long. Devising treatments for
them is a legitimate and desirable individual and social good. Here, the physician functions in
his time-honored role as healer. He has a moral obligation to stay informed and educated in the
use of the new technologies.
The ethical questions are related to the means by which these new treatments are developed and
applied. Genetic manipulations, cybernetics, nanotechnology, and psychopharmacology are in
themselves not intrinsically good nor bad morally. Procedures, however, derived from the
destruction of human embryos, distortions and bypassing of normal reproductive processes, or
cloning of human beings, etc., are not morally permissible no matter how useful they might be
therapeutically.
Within the traditional ends of medicine, the primary intention is the use of biotechnology to treat
physical or mental disease. There is no question that the cure or amelioration of a disease
process will also result secondarily in enhancement of the patient’s life. Here the enhancement
lies in the restoration of health or relief of symptoms undermined by disease. The patient feels
"better" and regains functional capacity. He may be returned to his previous state of health, or
to an even better state. This kind of enhancement follows therapy and is part of the aim of
therapy—not "beyond" therapy but a result of it. This is different from enhancement as a primary
intention. Here we start with someone who has no disease or obvious bodily malformation. She
is considered "normal" in the usual sense of that term. Yet the person feels dissatisfied with her
portion in life. She feels unfulfilled, at a social disadvantage or competitively deficient in some
mental or physical bodily trait. She may want to augment a state to what she thinks is a normal
level, or she may want something approaching perfection.
The motives, ends, and means of enhancement as a primary intention are morally variable. Some
ends—like the desire for healthy, bright, and lovable children—are understandable. If the means
that bring these states about do not themselves dehumanize their subjects, they might be within
the legitimate ends of medicine, particularly preventative medicine.
On the other hand, many others will focus elsewhere, e.g., on the thrills of going farther, faster,
with more endurance in athletic competition. Alternatively, they might want to enjoy the
adrenalin surge of seeing how far the human body and mind can be pushed. Enhancement of this
kind becomes an end in itself far beyond the healing ends of medicine in any traditional sense.
Some would extend the term "patient" to anyone unhappy, in any degree, with his body, mind,
soul, or psyche. This would "medicalize" every facet of human existence. Were physicians to
accept enhancement of this kind as their domain, the social consequences would be dire. The
number of physicians needed would skyrocket; access by those with disease states would be
compromised; research and development would become even more commercialized and
industrialized. Research resources would be channeled away from therapy per se. The gap in
access to therapy between those able to pay for the doctor’s time and those who cannot would
expand. To make physicians into enhancement therapists is to make therapy a happiness
nostrum, not a true healing enterprise.
On the other hand, if any significant number of physicians were to decide that enhancement, as
an end in itself, is not the physician’s responsibility, enhancement therapy could become a field
of its own "beyond" medicine. How these new therapists would relate to patients and physicians
is unclear. Would they be simply those physicians willing to cooperate? Would they be persons
in other fields—like sports trainers, psychologists, naturopaths, who would attend to their own
special spectrum of enhancement requests? What would these enhancement therapists do when
serious, mysterious, or potentially lethal side effects appeared?
It is likely that outright rejection of enhancement would encounter strong resistance. Satisfaction
of personal desires, freedom of choice, and "quality life" have, for many, become entitlements in
a democratic society. Few will want restrictions placed on their choice of enhancement. Peer
pressure, the drive of a competitive society, and market pressures will convince many physicians
and ethicists that resistance is futile.
Given our society’s incessant search for satisfaction of all its desires in this world, many will
argue that enhancement is part of the physician’s responsibilities—no matter what the
profession thinks. The confluence of an ego-oriented culture sustained by social approval, peer
example, and clever advertising will produce a cascade of demand.
Physicians will be drawn into enhancement practices for a variety of reasons. Some will see only
good in it; some will accept it as "treatment" for the unhappiness and depression suffered by
those who are not everything they want to be. Others will argue that physician involvement is
necessary to assure safety and to permit better regulation of abuses. "What better way to treat
the whole person?" some may add. "Isn’t the patient the one who knows most about his own
good?" Assertions like these suggest that failure to provide enhancement may become a breach
of the physician-patient relationship or the physician’s social contract.
Enhancement will also appeal to the physician’s self-interest. A willing and paying clientele is
certain to develop. Patients will be more eager to pay for the enhancement of the lifestyle they
desire than for treatment of disease they did not want in the first place. Physicians can say they
are doing "good" for their patients even while doing well for themselves.
The possibility and probability of a serious conflict of interests on the part of the physician
cannot be ignored. Money can easily induce the physician to provide enhancement of dubious
merit or marginal efficacy. More specific, for example, is the conflict that involves the team
physician who is expected to do his part to produce a winning team. Enhancements of athletic
performance are in worldwide use. Their deleterious side effects are well known. Who does the
physician serve—the good of the patient, the success of the team that pays his salary, or his own
infatuation with athletic success?
Fundamental questions about how enhancement affects our concepts of the purposes of human
life and the nature of human happiness will be buried by more immediate demand for happiness,
fulfillment, and mental tranquility.3 The modern and post-modern emphasis will be on effective
regulatory measures, better techniques, and competent practitioners—not ethical restraint.
Restraint or prohibition beyond prevention of abuses and harmful side effects is highly unlikely.
Those who restrict freedom of choice will be seen as a danger to the realization of a higher
quality of life for all. Any restriction will be interpreted as a violation of the physician’s
obligation to respect patient autonomy.
Many of us will take these to be specious arguments, which, if accepted, would make medicine
the handmaiden of biotechnology and erode its traditional role in treating the sick.
Counterarguments will be difficult given the powerful vectors of change in our cultural mores.
Hopes for an earthly paradise are seemingly within reach for many people who no longer
believe in an after-life. For them, extracting the maximum from personal enhancement is a
seductive substitute.
1 Parens, E. 1998. "Is better always good?" In: E., Parens (Ed.), Enhancing human traits:
Ethical and social implications (pp. 1-28). Washington, DC: Georgetown University Press;
Jeungst, E. 1998. "What does enhancement mean?" In: E., Parens (Ed.), Enhancing human
traits: Ethical and social implications (pp. 29-69). Washington, DC: Georgetown University
Press.
2 Fowler, H. J. 1965. A dictionary of English usage. 2nd Edition. Revised by Sir Ernest Gowers.
New York, NY: Oxford University Press.
3 Krammer, P. 1993. Listening to Prozac. New York: Viking.
Introduction
The topics of the article are focusing and highlighting the enhancement of medicine in
the modern life. The modern treatment nowadays was the best treatments using the new
technologies leading by the Genetic manipulations, cybernetics, nanotechnology and
psychopharmacology and more. The objective of the article is to retains a healthier life using the
new treatments Biotechnology but at the same time do not forget the traditional treatment to
enhance the better life. According to the debate about this topic,debate.org 67% correspondences
said yes to the modern medicine better than traditional medicine just because the modern
medicine is a full-service resource for lab testing and weight-loss solutions. Modern Medicine
weight Loss is a new medical weight loss program that’s prescription-based, doctor-guided and
affordable. Kefilwe, one of the respondent said, modern medicine is effective because patients
are given medication with specified doses. In Modern medicine test are done and treatment
procedures are carried out under safe and hygienic conditions. In modern medicine, side effects
of medication are established whereas in traditional medicine side effects of medication are
established whereas in traditional medicine side effects of concoctions are not known. The topic
of these articles should have an professional audience because the topic was including the facts
and the debates. Many of peoples nowadays don’t care to read an article about the new
technologies, but they are rather to leave this treatment onto doctors and specialist at the
hospitals. The important thing was relieve the pain quickly and fast-relieve from the diseases
with very smooth and better way. They will pay the medical cost although the medical cost was
increasing by the days. They also can choose various methods to cure their diseases with the new
technology. From this article also using the medical’s words, therefore the educated people can
only read this article and practicing to their life. The journal is appropriate for this article because
the topic is about human. So the topic was focusing the new treatments and using the new
technology. So from this journal many of the people will be understand the best way to retain
their health. I also classify the article is a conceptual because many of the words was a facts
taken from the research. An example about the healing and enhancement for the athletes was a
fact from the specialist. From this treatment we will use the concept to another treatment in this
life. The facts is, Biotechnology aims to target the causes of diseases and not the symptoms. And
that’s why biotechnology offers one of the strongest hopes for patients to treat diseases.
(europabio.org).According to the OECD definition, The application of science and technology to
living organisms, as well as parts, products and models thereof, to alter living or non-living
materials for the production of knowledge, goods and services.”So by using the Biotechnology
can make a human’s lice healthier for longer because 50% of all medicines will come from
biotech. Although ethical discussions of biomedical enhancements, have forged links with
contemporary problems in the philosophy of mind, normative ethics and philosophy, they have
far rarely benefited from a substantive engagement with the philosophy of biological science. It
is this gap that the present special issue is designed to fill. Broadly speaking, its aim is to
consider how biological theory can advance ethical debates and policy discussions surrounding
genetic engineering and human’s enhancement. This involves more than simply ensuring
consistency with current empirical work in the life sciences its means appreciating the relevance
of conceptual and methodological problems in biology for ethical debates that arise in
connection with the new biosciences. Although there are many forms of biomedical
enhancement, in this special issue we emphasize genetic engineering for substantive reasons
beyond mere manageability. Few other medical interventions trigger such powerful moral
intuitions’ and are treated with such ethical and regulatory caution as modifications of the human
genome.
The big problems being addressed in this article are the physicians was described the new
treatments and enhancement to the various definitions. They also don’t use both of the medicines
(modern medicine and traditional medicine) to retain their patients. So this is wrong and make
the patient will be unhappy about this treatments. Besides the very high cost of the modern
medicine, they will be afraid and depression suffered for those who are not everything they want
to be. The solution is being proposed from this article by using the modern treatment are most
promising use of biotechnology and will be better ways to treat the diseases nowadays. So the
patients should not worry to trying this method. Many of the athletes in this world were using the
new technology on the thrills of going farther, faster with more endurance in athletic
competition. They also take adrenalin to push the energy and the body. They also take vitamins
and inject the hormone to stay energetic and fit for this competition. Some of them also take
drugs to win this competition. So we will choose the best way about the new technologies which
enhancement of this kind becomes an end in itself far beyond the healing ends of medicine in a
traditional sense. The improvement of biomaterials for use as hip replacements and scaffolds for
tissue engineering have been made through the development and association of new alloys,
ceramics and polymers which can mimic the physical properties of tissues surrounding the
implanted site. Nowadays a hip joint implant is always a carefully designed composite material
comprising for example a femoral titanium core with high tensile strength.
I choose this article because many of people don’t know how to enhance the healthier
body by using the biotechnology. Otherwise its more compatible with our life and more about to
retain our life. I have found some of people afraid and worries by using this methods will effect
their body. Some of them also can’t pay the cost. So from reading this article, we will know
many things about the modern medicine are the better way to retain our health. We will be
enjoying our life by using both of the treatments. Sometime traditional could help such as eating
some herbal it’s also will heal our diseases. But on the other hand, traditional medicine shouldn’t
be excluded from some treatment especially in the countries where modern drugs are expensive
and are not available. I like this article very much because there are many things I should know
and share to my friends. Before reading this article was a victim to the commercial herbal
products. After I eat this product, I am just know from my friend the products are contains high
percentage of the drug so can make me feel so higher and buy it again. I should said thanks for
the Modern Technology for make me feel more safety. Richardson said while such
developments may benefit society in important ways, such as by boosting workforce
productivity, their use also had "significant policy implications" to be considered by
governments, employers, workers and trades unions."There are a range of technologies in
development and in some cases already in use that have the potential to transform our
workplaces - for better or for worse," she said. Human physical and cognitive enhancements are
primarily developed with sick or disabled people in mind, as medicines or therapies to help them
overcome mental or physical disorders. But experts say drugs and other forms of enhancement
are being used increasingly by healthy people who want to benefit from the boost they can give
to performance.Barbara Sahakian, a professor of clinical neuropsychology at Cambridge
University who contributed to the report, said for example that modafinil, a generic drug
prescribed for sleep disorders such as narcolepsy, is often used by academics or business leaders
travelling to conferences who need to be at the top of their game when delivering a speech."They
take (sleep) medications on the plane to fall asleep, and take modafinil to wake up when they get
there," she said.Other stimulants such as Novartis's Ritalin and Shire's Adderall, prescribed for
conditions like Attention Deficit Hyperactivity Disorder, are also used by healthy people to
increase focus. One issue with this kind of use is the lack of long-term safety studies of such
drugs in healthy people, the experts said, so there may be unknown risks ahead. Other problems
include whether cognitive enhancers are fair. Is it cheating to go into a job interview or exam
having taken a drug to boost your mental focus? Research from the Massachusetts College of
Liberal Arts in the United States has estimated that up to 16% of students in the U.S. use
cognitive enhancers to improve performance in exams or for particular essays or projects. The
report also pointed to visual enhancement technologies, such as retinal implants, that could be
used by the military, night watchmen, safety inspectors or gamekeepers. Technologies to
enhance night vision or extend of the range of human vision to include other wavelengths such
as ultra-violet light could become a reality relatively soon, it said. Sahakian suggested that for
drivers or pilots, such enhancements could reduce fatigue and lower the risk of fatal accidents.
But she also raised the question of whether employers keen to squeeze more productivity out of a
workforce might coerce workers into using enhancements against their will."Imagine you're a
bus driver bringing children back on a journey to the UK overnight and your boss says you have
to take cognitive-enhancing drug because there are risks to the children if you don't stay awake,"
she said. "Is that acceptable? These are the kinds of things we have to grapple with."
The article does build upon the appropriate prior research choosing the right way to take
a modern medicine. The approach and execution is not correct because many of the facts is
hiding from the writer’s questions. He should give more examples to prove the best treatment.
He also condemn by the one side, the physicians and I think is not fair. Many of the peoples are
involving this problem. The European Resuscitation Council (ERC), in the ethics section of its
Guidelines for Resuscitation, states that patients '… do not have an automatic right to demand
treatment; they cannot insist that resuscitation must be attempted in any circumstance. Futility
exists if resuscitation will be of no benefit in terms of prolonging life of acceptable quality'. The
ERC notes that the decision to forego attempts at resuscitation is '…usually made by the senior
doctor in charge of the patient after appropriate consultations…' but that '…in matters of
acceptability of a certain quality of life, the patient's opinion should prevail'. The ERC states that
the influence of the family notwithstanding, 'it should be made clear to them that the ultimate
decision will be that of the doctor. It is unfair and unreasonable to place the burden of decision
on the relative'. The ERC endorses a higher degree of physician paternalism than do authorities
in the United States. It suggests that the patient should determine the threshold of acceptable
quality of life and the physician should determine whether this outcome is achievable. However,
the statement refers to circumstances where there is 'no benefit' expected. The more challenging,
and perhaps more common, situations are ones in which a small or very small chance of benefit
exists. What probability of achieving the desired outcome is sufficient so that patients' quality of
life assessments are determinative? Who should set this threshold and through what process?
Here, it is not clear how physicians and patients should proceed and there is significant
variability in European practice on this point.
Ideal health care decisions are a product of a joint process by which physicians discuss a
range of options understood as evidence-based, or at least as professionally normative, and then
assist patients in identifying the option that the patient assesses as most beneficial. The
identification of options for patients to consider is not the result of a process that is value-free,
despite some commentators arguing that physicians should be relegated to decisions that are
purely objective or value neutral. Good decision making will continue to depend on clinical
interpretation, judgment, and expertise, despite patients' decision making authority and their
access to both generic and individualized medical information. In fact, nearly every decision of
clinical relevance contains a value dimension, and since physicians are in a covenant with
society, they are empowered by society to make these decisions with fairness, fidelity and
parsimony. This empowerment does not come through an obtuse process, but through a publicly
accountable process of education, training, certification and licensure. Inevitably, situations arise
in which physicians must be responsible to professional norms for the patient's good. While
accommodating the dynamism in the patient–doctor relationship, physicians must maintain their
professional, ethical obligation based on the principle of non-maleficence and, as a rule, not offer
interventions that have low utility, high burden, and that will not likely alter prognosis. The
challenge is defining the details of this domain in a publicly accountable way and in the setting
of moral and technological modernity.
The claim that physicians are empowered to make some normative, value-based
decisions, rests in part on a high level of physician fidelity and a low level of clinical practice
variability. It is clear that these conditions do not fully exist. Inappropriate clinical variability
may be attributable to physicians' personal characteristics such as gender, ethnicity and religion,
as well as to biased physicians responses to patients based on the patients' gender and ethnicity,
among other factors.[11] If society will empower and entrust physicians, then physicians must
improve objectivity and consistency in value assessments made during clinical care.Efforts to
improve inter-physician consistency in the use of ineffective and marginally effective
interventions should be coupled to efforts to better educate the public about interventions that are
disproportionately harmful, about palliative options, and to reshape public misconceptions about
the omnipotence of modern medicine. These efforts will allow physicians to more robustly
protect patients from harms by clarifying sanctioned domains of physicians and serves societal
interests to have communally responsible use of resources. It will also bolster trust and
confidence by the public of physicians.
The article does throw an exclusive new idea which is proven enhancement/treatments
by using the both methods. The article’s was shortcoming and limitations with a new issues and
problems by using the variety modern medicines treatments. This articles do not domain covered
all important aspects and issues because its only give the answer to basic knowledge about the
modern treatments. Medicine has always been both a business and a profession. Chaucer wrote
about it. So did George Bernard Shaw. A business exists for the purpose of making money, to
earn which it provides a product or service. A profession exists for the purpose of providing a
service, for which the professional is paid. Balance is the key. From antiquity, humans have
required certain services from individuals who, in order to provide that service, must gain the
most intimate knowledge of the person's mind, body, and even soul. Societies have tendered
those individuals who provide such essential services with a large level of trust and have
designated them as "learned professionals." Historically, these are only physicians, lawyers,
religious leaders, and (sometimes) teachers. The patient, client, religious believer, and student
must trust the professional to use that personal information for their benefit and not to exploit it.
My favorite medical ethicist, Dr. Edmund Pellegrino of Georgetown University (Washington,
DC), defined the essential characteristic of a learned professional some years ago by saying that
"at some point in the professional relationship, when a difficult decision is to be made, you can
depend on the true professional to efface his own self-interest." Dr. George Lundberg, Editor of
MedGenMed.(2004) Finally, I think the best way to write this article nowadays is well-organize
the FAQ from the testimonial respondent. It will be clear to show how important to use the
Modern Medicine.
REFFERENCE
1.EDMUND PALLEGRINO (original article),2004 Biotechnology, Human Enhancement and
the End of Medicine,
2.Biotechnology,applications and benefits,2013,www.europabio.org
3. C. C. PERRY, in “Chemistry of advanced materials: An overview.” In Biomaterials, edited by L. V. INTERRANTE and M. J. HAMPDEN-SMITH (Wiley-VCH, New York, US, 1998), p. 499
4.D. D. ATEH, P. VADGAMA and H. A. NAVSARIA, “Handbook of Nanostructured Biomaterials and Their Applications in Nanobiotechnology,” Vol. 1, Chapter 12, Biocompatibility of Materials, edited by H. S. Nalwa (American Scientific Publishers, 2005), p. 411
5. Kate Kelland, Human Enhancements At Work Pose Dilemma’s Report,November 2012,U.K
Reuters.
6. J.T.Berger, Redefining the Domains of Decision Making by Physician and Patient Int J Clin Practi 2011:65(8):828-830
SPB571STRUCTURE AND FUNCTION
ARTICLE REVIEW
PREPARED BY
NAME MATRIC NUMBER
TAJUDIN BIN TAIB 2011696204
GROUP : TEDPS6A
ATTENTION FOR:
PN. SARINA BINTI MOHAMAD
SPB571STRUCTURE AND FUNCTION
ARTICLE REVIEW
PREPARED BY
NAME MATRIC NUMBER
TAJUDIN BIN TAIB 2011696204
GROUP : TEDPS6A
ATTENTION FOR:
PN. SARINA BINTI MOHAMAD