The Observer, February 22, 2008
Volume XL, Issue 18
Bioethicists seek consistency as "justices" of medicine
Bioethicists, to a great extent, sit in the role of justices in medicine. Bioethicists cannot make recommendations based on personal opinion, but rather must defer to their interpretation of a case within the context of an ethical framework including, but not limited to, moral philosophy and the bioethics literature (similar to judicial case law).
The concept of "consistency" comes up frequently in both law and bioethics. For a ruling that deems something constitutional or bioethically sound to be valid, it should be consistent with all other related rulings. If consistency is lacking, the ruling is not necessarily invalid, but, by definition, there is some internal inconsistency with the underlying law and previous rulings that must be resolved. This is illustrated in the fact that of the many cases appealed to the level of the Supreme Court, the justices must put on the docket those for which different federal districts have handed down inconsistent rulings. As the justices of medicine, bioethicists must be rigorous when encountering analogous situations.
As an example to this concept, consider an ethical dilemma becoming increasingly common for in vitro fertilization (IVF): Couple A approaches the IVF clinic seeking help having their first child. IVF is a process by which sperm from the father fertilizes an egg from the mother in a laboratory and fertilized embryos are implanted in the mother for gestation. Couple A is not seeking IVF because of fertility problems (the most common reason) but rather because they want a baby girl…and specifically a baby girl, not a baby boy. During IVF, embryos can be screened for a number of genetic traits, including sex, and only those of a certain trait implanted. It is scientifically possible to choose the sex of a child, but is it ethical? The hospital turns the couple down, explaining that they cannot ethically allow parents to just go ahead and choose the sex of their baby, seemingly valuing one sex over the other.
Couple B approaches the very same IVF clinic. They, like Couple A, do not have any fertility problems. On the contrary, they are the proud parents of four boys. They too, however, seek a baby girl and only a baby girl. Why? They explain: They want five children, a mix of boys and girls. Any more would be too many for them to handle. They have done it the natural way four times, but this time, they really want to give their sons a sister. After all, it's good for boys to grow up with a sister in the house. The hospital agrees: it is not as if the parents are valuing one over the other; they just want to balance out their family and have had children naturally four times already.
From a bioethical perspective, both couples are asking for the same thing: the ability to choose the sex of a single child. There is no doubt from a practical perspective that the circumstances of the two couples are different, but the hospital's opinion that the situations are ethically different is flawed; it is a personal and to a certain extent a political opinion, not an ethical one. It is an inconsistency that must be resolved through examining what we actually believe about choosing the sex – or any other trait, for that matter – of a child. That discussion is for another day.
