Biomedical Engineering Reference
In-Depth Information
Traditionally, the ethics of medical care has given greater prominence to nonmaleficence
than to beneficence. This priority was grounded in the fact that, historically, medicine's capac-
ity to do harm far exceeded its capacity to protect and restore health. Providers of health
care possessed many treatments that posed clear and genuine risks to patients and that offered
little prospect of benefit. Truly effective therapies were all too rare. In this context, it is surely
rational to give substantially higher priority to avoiding harm than to providing benefits.
The advent of modern science changed matters dramatically. Knowledge acquired in
laboratories, tested in clinics, and verified by statistical methods has increasingly dictated the
practice of medicine. This ongoing alliance between medicine and science became a critical
source of the plethora of technologies that now pervade medical care. The impressive increases
in therapeutic, preventive, and rehabilitative capabilities that these technologies have provided
have pushed beneficence to the forefront of medical morality. Some have even gone so far as
to hold that the old medical ethic of
“Above all, do no harm”
should be superseded by the new
ethic
However, the rapid advances inmedical technology capabil-
ities have also produced great uncertainty as to what is most beneficial or least harmful for the
patient. In other words, along with increases in ability to be beneficent, medicine's technology
has generated much debate about what actually counts as beneficent or nonmaleficent treat-
ment. Having reviewed some of the fundamental concepts of ethics and morality, let us now
turn to several specific moral issues posed by the use of medical technology.
“The patient deserves the best.”
2.3 REDEFINING DEATH
Although medicine has long been involved in the observation and certification of death,
many of its practitioners have not always expressed philosophical concerns regarding the
beginning of life and the onset of death. Since medicine is a clinical and empirical science,
it would seem that health professionals had no medical need to consider the concept of
death: the fact of death was sufficient. The distinction between life and death was viewed
as the comparison of two extreme conditions separated by an infinite chasm. With the
advent of technological advances in medicine to assist health professionals to prolong life,
this view has changed.
There is no doubt that the use of medical technology has in many instances warded off
the coming of the grim reaper. One need only look at the trends in average life expectancy
for confirmation. For example, in the United States today, the average life expectancy for
males is 74.3 years and for females 76 years, whereas in 1900 the average life expectancy
for both sexes was only 47 years. Infant mortality has been significantly reduced in devel-
oped nations where technology is an integral part of the culture. Premature births no longer
constitute a threat to life because of the artificial environment that medical technology can
provide. Today, technology has not only helped individuals avoid early death but has also
been effective in delaying the inevitable. Pacemakers, artificial kidneys, and a variety of
other medical devices have enabled individuals to add many more productive years to
their lives. Technology has been so successful that health professionals responsible for the
care of critically ill patients have been able to maintain their “vital signs of life” for exten-
sive periods of time. In the process, however, serious philosophical questions concerning
the quality of the life provided these patients have arisen.
