Another Side of the Medical-Moral Issue

Ralph. L. Read, M.D.

As a physician, I have been involved in some of the technology discussed in "Reproductive Technology and Surrogate Motherhood." The attitudes of the speakers were thought provoking and were often startling, as ethical theory has not been a significant focus of medical education and medical practice in the past. Violation of ethics, rather than the structuring of an absolute ethical system seems to claim the more publicized attention of the medical community.

Pragmatic Concerns

In medicine, the emphasis remains on the pragmatic concerns of knowledge, competency, technique, and the most positive possible result for the individual patient. The physician makes his judgements in the field. The physician learns his ethics the same way almost everyone else does, learning from his family and his colleagues. He watches how problems are either solved or ignored. He sees what other doctors can do or cannot do in the no man's land of powerful technology, compassion, and law suits.

Most of the speakers applied a general system of principles to all ethical problems. The comments applied to organ transplants and other medical technologies as well as to surrogacy and reproductive technologies. Despite their various perspectives, all the speakers concluded that surrogate motherhood was not of benefit to society, however much it may seem to benefit some. The speakers emphasized the many possibilities for exploitation of the poor, minorities and women. I think we do have reason to be uneasy. However, a voice was missing. This is the voice of technology, the voice of the physician dealing with patients who come to him for solutions to their problems.

Ethical Dilemma

Reproductive technologies such as amniocentesis and ultrasound were not mentioned by the participants of this symposium. These techniques are commonly used. Has there been an ethical dilemma about their use?

They frequently provoke ethically challenging decisions. For instance, the knowledge that she is carrying a severely deformed fetus may present a woman with a critical ethical dilemma. The very same procedure opens the possibility of timely medical intervention which can improve the health or save the life of the unborn, of the newborn. Again, the very same procedures open the possibility of selecting the sex of the baby. Is this ever ethical? What about the scenario of familial sex-linked diseases? Science and technology generate and categorize knowledge. Medicine applies this knowledge and these techniques on an individual basis. Each patient is the individual.

Technology Cuts Both Ways

Technology is a word that cuts both ways. Technology hasn't evolved in order to give man something to morally grapple with. Technology does this, of course, but it evolves as a means of bettering the quality of life. Modern medical technology allows the dead to serve the living--allows them to give the gift of life or sight.

When I was in medical school, children who were born with no brain (and would eventually die) were allowed to die. Then, patients with terminal cancer and severe pain were treated, but when treatment failed or no treatment was available, they were given morphine for the pain, a lot of morphine--a doctor who did that today would surely be sued. And he would lose. Were these doctors playing god? Or were they just being compassionate and practical and doing exactly what they would want done for them, if the situation was reversed?

For every ethical dilemma, there are a lot of solutions people are afraid to mention, not because these solutions are impossible, but because they know that honesty will get them in big trouble. Blanket ethical declarations and laws do not provide any easy answer except "Don't." Laws do not provide the solution to the most difficult problems encountered in medicine. Laws are never kind or compassionate. The individual seems to get lost in the words of ethical pronouncements and laws.

Recidivistic?

The seminar raised a lot of questions that were very difficult to answer, unless you were raised on (or choose) some brand of dogma that will fill in the blanks for you. The panel's "Just say 'No!'" approach to technology's two-edged offerings strikes me as being both unrealistic and recidivistic. Their answer is too-easy, and in one physician's opinion, not entirely ethical. Uniformly condemning surrogate and reproductive technology because of the potential misuse is neglect of available technology, and this is malpractice.