Biomedical Engineering Reference
In-Depth Information
natural cause of death or that death is ever a natural event that should
be welcomed. The concept of the natural, these authors have argued,
helps us to understand what to attempt and what not to attempt in
medical intervention, and it grounds the crucial distinction between acts
of commission and omission.
The second view draws from a tradition in medicine associated with
Lucretius and Francis Bacon that regards the physician as standing apart
from, and often in opposition to, nature. The natural is not normative;
it is merely the biological status quo, which will frequently be inimical
to the patient's health. In order to achieve the goals of medicine, the
physician must often treat nature as an adversary. The physician's justi-
fication for assisting and interfering with nature is understood in terms
of the balance of risks and benefits. With the growth and broad accept-
ance of modern surgical procedures, particularly organ transplantation,
this view, and the tradition it draws from, have become dominant. But
the first, more conservative view has made a modest comeback in recent
years in bioethics literature, if not in medical practice.
27
The two opposing views interpret the goals of medicine quite differ-
ently. For the first, the goals of medicine are as fixed as our nature; health
is linked in crucial ways to the natural and the biologically normal. The
idea of improving on nature is a contradiction of sorts. For the second
view, the goals of medicine are not fixed by the natural or the biologi-
cally normal, and the idea of improving on nature is perfectly intelligi-
ble. Proponents of this view exhort us to improve our capacities and
performance to the greatest extent possible, sometimes by reinforcing,
or, if necessary, by altering or suppressing what may be considered
natural processes and limits. In the recent bioethics literature, this
Promethean approach has been discussed primarily in the context
of various forms of enhancement—surgical, pharmacological, and
genetic—and in relation to aging.
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Not surprisingly, the two perspectives have different implications for
genetic engineering. The first one, drawing on the Hippocratic tradition,
counsels greater restraint, but how much and what kind of restraint
depends on how it understands the relationship between the genome and
nature. In one extreme view, the genome contains the full set of nature's
instructions for the individual, and any genetic alteration, whether
somatic or germ line, constitutes unacceptable interference with nature.
