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