Human life is lived out in the context of both a physical space and a time span. This biospace also has various quality aspects. Numerous issues affecting both were discussed in this chapter. New surgical and diagnostic techniques have proliferated in recent years, greatly increasing the number of treatable problems and simultaneously generating questions of facilities, cost, and appropriateness of treatment. If medical techniques are to become universally available, various new techniques must be found to reduce cost, people, and facility pressures. Some such new techniques being developed are those to do cell-level treatment by tailoring bacteria or DNA to produce new drugs and molecular machines, called nanomachines. It is hoped that such machines can effect repairs, conquer communicable diseases, reduce the need for surgery, and prolong life.

Genetic engineering may also be used to improve food supplies, reduce defects, and enhance many desirable traits. It may also be used to change plant and animal species or even human beings dramatically. Some benefits or difficulties with such technologies were considered, including the effect of changing technology on the right to life.

Finally, the space aspects of human life were considered, and it was pointed out that the creation of new living spaces on earth and off could both alleviate population pressures and supply new frontiers to prevent technical stagnation and postpone the totalitarianism of the efficient.

1. Explain the term "biospace".

2. What are some of the reasons that nonsurgical medical methods ought to be preferred over surgical ones? Give specific examples where one or the other choice may be necessary in the long term and others of situations where nonsurgical techniques ought to completely replace surgical ones.

3. Suppose you are in charge of an agency responsible for a medical insurance scheme run by the state. Which (if any) of the following treatments should the plan pay for, or not pay for, and why?

a. Open-heart surgery on an 85 year old, when average life span is 77. Does it make a difference if average life span is 150?

b. An experimental procedure (40 percent chance of success) to remove a tumour from the brain of an infant who has otherwise an 80 percent chance of dying within a year.

c. The surgery in b when without it the child would have impaired hearing and sight but otherwise live normally.

d. The surgery in b performed in another country at a cost higher than keeping a bed in a hospital in the home country for an entire year.

e. A sex-change operation for a patient who claims to be in great distress over being in the wrong kind of body.

f. Plastic surgery to remove small and harmless but unpleasant looking growths from the face of a teenage boy.

g. A liver transplant for a boy whose body has already rejected two livers and whose older brother died after unsuccessful surgery of the same type.

h. Sterilization (tubal ligations and vasectomies) for those who wished to have no further children but have no organic malfunction.

i. Tubal or ovarian repairs (30 percent success rate) for a woman who wanted to bear a first child.

j. Surgery in i for a woman who already had two children; five children; ten children.

k. An in vitro fertilization ("test-tube baby") for a couple who are infertile.

l. A new and experimental drug whose preliminary tests indicate may relieve some AIDS symptoms and postpone death as much as a year but whose safety and side effects are unknown. A year's supply is estimated to cost $30,000 per person.

m. A $30 000 pacemaker for an 85-year old woman.

n. Radiation treatments and/or costly surgery for an 80-year old man with prostate cancer.

4. Discuss the idea of dispersing a 100 percent effective (and otherwise known harmless) birth control agent in the water or atmosphere, with a state-licensed anticontrol agent being available.

5. Suppose it became possible to grow a clone in a nutrient vat from a person's own DNA and then transplant the cloned brain into a new, youthful body (all at great expense). Under what circumstances should this be allowed, if at all?

6. Suppose a simple, cheap chip implant became available that would allow the blind to regain their sight with a video device. What if some blind people do not wish the operation? Should they be required to have it, so as to reduce the burden of their care on society? Should their disability tax benefits be denied if they refuse it?

7. There is already a wide medical gap between the developed and underdeveloped nations of the world, including a substantial gap in life expectancy. What would happen if this gap widened to 100 years?

8. Ought longevity treatments, when they become available, be provided to everyone--including, say, the poor of third world nations--if the consequences are greatly increased population pressure, and possible famine? Even in countries with little such pressure, ought such treatments be limited to those who can "earn" them? Be sure to say what you mean by earn.

9. A hospital has a wealthy patient who has been comatose and on life-support systems for five years with no discernible change in condition. The man's family approaches the hospital and asks for the support to be removed so he can die in peace. The hospital refuses at first, citing the fact that brain waves are still present, though severely impaired. A family member cites the patient's own expressed desire for release from such a state, but can offer no written proof. What should be done?

10. Does it make any difference to your answer in question 9 if:

a. the hospital desperately needs a liver for another patient who will surely die without it and the comatose man's liver is a perfect tissue match?

b. the man's family suggests it will give a large sum of money to the hospital--enough to allow a new surgery to be established wherein many lives can be saved in a year?

c. the comatose patient is a Nobel scientist; the prime minister of Canada; a convicted rapist?

11. Discuss the pros and cons of establishing an organ bank of spare body parts for transplants. If it is done, should it be public, non-profit, or commercial?

12. If genetic engineering could triple intelligence, should the requisite treatments be compulsory?

13. Which, if either, genetic-engineering project should be undertaken: (a) enhancement of domestic animals to enable them to perform menial tasks or (b) the development of "subhumans" for the same reasons. Explain.

14. Suggest several other new environment-enhancement technologies in addition to those discussed in the chapter.

15. What are some ways in which the human environment might be engineered, other than those discussed in the chapter? (Good and bad, pros and cons.)

16. Discuss the pros and cons of building new habitat (a) on the ocean floor, (b) in the Russian or Canadian north, (c) in the Sahara desert, (d) on the Moon, or (e) in outer space.

17. Which has a higher priority: (a) plant and animal genetics with the end of improving food supply or (b) human genetic research with the end of repair, selection, or improvements? Explain.

18. You are a nurse in an elementary school in a close-knit rural community and become aware of various medical and other problems. Which of the following do you report to the authorities? Explain your answers.

a. A child who often has severe bruises and lacerations on the arms, legs, and buttocks. The child seems not to be under any stress and has a reputation for clumsiness. You must weigh the consequences of not reporting a possible case of child abuse against those of becoming a false accuser.

b. A child who brings no lunch to school and who is always hungry. You know that the parents care for the child but have very little money. Yet the child may be apprehended and taken from them if you report this case.

c. A child with a medical condition (spine curvature, poor eyesight or hearing) that is debilitating but not life-threatening but that the parents cannot afford to have treated or refuse to have treated for religious reasons.

19. You are a hospital nurse with many years of experience on duty with a doctor who is a recent medical school graduate. An emergency patient comes in and the doctor orders tests but leaves one out that you know ought to be done. Do you order the test, exceeding your authority, if (a) the doctor has by now gone home and cannot be reached or (b) you bring it to her attention and she dismisses your concern as unimportant.

20. Discuss the problems of medical diagnosis as they relate to cost, time, facilities, and the possibility of a malpractice suit.

21. What authority ought the state have to (a) permit, (b) require, or (c) forbid various medical procedures? To what extent ought this to be done in defiance of, say, the religious beliefs of the patients, or their parents? Be specific and give an ethical argument to justify your conclusions.

22. Suppose that advanced medical technology made a fetus able to be maintained outside the womb from the moment of conception to the normal end of gestation.

a. What effect would this have on the abortion debate?

b. Should public funds pay to allow infertile couples to use this technology to have children?

c. Should public funds pay for women to use this technology in order to avoid the inconvenience of pregnancy?

d. Should such technology be required for all births and pregnancy be forbidden as too hazardous?

23. The harmful effects of poisonous substances such as tobacco and alcohol are well documented. In view of this, discuss the implications of forbidding advertising in such products. Is the value of free speech more important than the value of deprecating the use of such products?

24. Which is preferable, to attempt to prevent trafficking in mind-altering drugs altogether or to make such drugs legal and freely available and treat the consequences? There are ethical, medical, and economic issues here. You might start with alcohol and tobacco and go from there.

25. One way of reducing medical costs is to transfer some techniques and responsibilities from expensive doctors to other less-expensive medical personnel. Discuss the benefits and limitations of this from ethical, medical, and economic standpoints. In particular, consider the potential responsibilities of nurses, nurses' aides, orderlies, technicians, and other hospital staff.

26. It was remarked in the text that a potential advantage of colonizing space is the survival of humanity in the event of global nuclear conflict. Is this really the case, or would such colonies themselves be added as targets? Indeed, would the very existence of such colonies make nuclear conflicts more or less likely?

27. Research the use of frozen embryos in livestock breeding programs. Now consider their use in human reproduction. Suggest several situations in which they could be employed, and then consider the ethical, legal, and any other problems that arise from this technique. On balance, is this a useful and desirable technique?

28. Research and discuss the issue of patenting new life forms developed in the laboratory. What stand have the courts taken thus far? To what extent do you think new life forms ought to be patentable? Answer for plant, animal, and human-derived genetic material.

29. Research the use of animal organs in human transplant cases. What are the advantages and disadvantages to such work from a medical and ethical point of view?

30. Under what circumstances, and for what groups of people ought the law to mandate periodic checks for the use of drugs? When the law itself does not so mandate, should employers do it themselves?

31. A number of Canadian Aboriginals still make their living as trappers. In response to the concern of animal rights activists, Great Britain proposed new legislation mandating the labelling of Canadian furs with a warning that the animals may have been caught in leg-hold traps. The intended effect of the law was the elimination of such trapping in Canada. Critics respond that a secondary effect would be massive unemployment among one of Canada's poorest groups. Discuss the ethics of this situation, giving particular attention to the relative rights of the trappers and the animals.

32. In the course of the discussion on scarce medical resources, the text made the statement: "Neither is it easy to argue that a woman has any fundamental right to bear children." Develop an argument for or against such a right. Can your argument be applied to support or deny (as the case may be) a parallel right to not bear children? Why or why not?

33. Which is a higher priority, and why--to spend public money on researching the causes of AIDS or to spend it on cancer research?

34. Determine how much money your government puts into research on prostate cancer and breast cancer. Now, what are the incidences of both in men and women, respectively? Do expenditures match? Should they?

35. Which is more important, and why--space exploration, or poverty relief? Or, is there a link between spending on one and not the other?

36. Ought a state to permit (to encourage?) the use of suicide to reduce medical costs and keep the population down? If you say "no," how do you deal with those who are terminally ill, in great pain, and costing the state large sums of money to maintain alive? If you say "yes," how do you deal with the young and healthy who commit suicide and leave behind small children and a destitute spouse? In either situation, how would you deal with the case if the potential suicide were a renowned cancer researcher on the verge of a significant breakthrough?

37. Research the contention that population pressures are the result of poverty, and that raising the standard of living will eliminate these pressures.

38. Suppose that a government determines its territory has become overpopulated to the point where its people are at risk from starvation. Is an enforced birth control program justifiable?

39. Suppose that a government determines its territory has become underpopulated to the point where its national identity is at risk of extinction. What measures can it legitimately take to increase its population?

40. Propose and defend against the alternatives a solution of your own for (a) the problem of medical scarcity (b) population pressures on food supplies and living space.

Asimov, Isaac. Science Past--Science Future. Garden City, NY: Doubleday, 1975.

Drexler, K. Eric. Engines of Creation. Garden City, NY: Anchor Press, 1986

Drexler, K. Eric and Peterson, Chris. "Nanotechnology". Analog, (Mid-December 1987): p48-60.

Fjermedal, Grant. The Tomorrow Makers. New York: Macmillan, 1986

Geisler, Norman L. Ethics: Alternatives and Issues. Grand Rapids, MI: Zondervan, 1971.

Henry, Carl F. H. Christian Personal Ethics. Grand Rapids, MI: Eerdmans, 1957.

Kelly, Northrup. Legal Issues in Nursing. St. Louis, MO: C.V. Mosby, 1987.

Kenny, Martin. Bio-Technology--The University-Industrial Complex. New Haven, CN: Yale University Press, 1986.

Minsky, Marvin. The Society of Mind. New York: Simon & Schuster, 1986.

Montgomery, John Warwick. Human Rights and Human Dignity. Grand Rapids, MI: Zondervan, 1986.

Naisbitt, John. Megatrends. New York: Warner Books, 1984.

Toffler, Alvin. The Third Wave. New York: Morrow, 1980.

Internet resources:

Biotechnology Information Centre. <http://www.nal.usda.gov/bic/> (1998 04 27)