Article Review for SPB571

Reference Heading Title: Biotechnology, Human Enhancement and the Ends Author: Edmund Pellegrino, Date# $% &ovem'er (%%) " edicine!

Personal Heading Name: *a+udin Bin *ai' Date Submitted# (, -cto'er (%1$ Source: *he .enter of Bioethics and humans dignity, *rinity /nternational 0niversity Article1s 0R2: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 By Edmund Pellegrino, " edicine!

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. n short, no boundary between morally valid and invalid uses of biotechnology can be established without at least a working definition.

n this essay, my operating definition of enhancement will be grounded in its general etymological meaning, i.e., to increase, intensify, raise up, e!alt, heighten, or magnify. "ach of these terms carries the connotation of going "beyond" what e!ists at some moment, whether it is a certain state of affairs, a bodily function or trait, or a general limitation built into human nature. "nhancement is, as #owler says, "A dangerous word for the unwary," but its use in some form seems inescapable.$ #or this discussion, enhancement will signify an intervention that goes beyond the ends of medicine as they traditionally have been held.

#or 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 re&uired to regain health. To be sure, specialists in other fields are necessary if even the modest promises of biotechnology are to be reali'ed. They will provide the basic scientific and technical e!pertise from which biotechnological enhancements will emerge. (ut physicians are crucial in the actual use of this technology with individual human beings.

)ome 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- +$, 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 +., 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. /evising treatments for them is a legitimate and desirable individual and social good. 0ere, the physician functions in his time-honored role as healer. 0e has a moral obligation to stay informed and educated in the use of the new technologies.

The ethical &uestions are related to the means by which these new treatments are developed and applied. 1enetic manipulations, cybernetics, nanotechnology, and psychopharmacology are in themselves not intrinsically good nor bad morally. 2rocedures, 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.

3ithin the traditional ends of medicine, the primary intention is the use of biotechnology to treat physical or mental disease. There is no &uestion that the cure or amelioration of a disease process will also result secondarily in enhancement of the patient4s life. 0ere the enhancement lies in the restoration of health or relief of symptoms undermined by disease. The patient feels "better" and regains functional capacity. 0e 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 therapy5not "beyond" therapy but a result of it. This is different from enhancement as a primary intention. 0ere we start with someone who has no disease or obvious bodily

malformation. )he is considered "normal" in the usual sense of that term. 6et the person feels dissatisfied with her portion in life. )he feels unfulfilled, at a social disadvantage or competitively deficient in some mental or physical bodily trait. )he 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. )ome ends5like the desire for healthy, bright, and lovable children5are understandable. f the means that bring these states about do not themselves dehumani'e their sub7ects, they might be within the legitimate ends of medicine, particularly preventative medicine.

8n 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 en7oy the adrenalin surge of seeing how far the human body and mind can be pushed. "nhancement of this kind becomes an end in itself far beyond the healing ends of medicine in any traditional sense.

)ome would e!tend the term "patient" to anyone unhappy, in any degree, with his body, mind, soul, or psyche. This would "medicali'e" every facet of human e!istence. 3ere physicians to accept enhancement of this kind as their domain, the social conse&uences 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 commerciali'ed and industriali'ed. 9esearch resources would be channeled away from therapy per se. The gap in access to therapy between those able to pay for the doctor4s time and those who cannot would e!pand. To make physicians into enhancement therapists is to make therapy a happiness nostrum, not a true healing enterprise.

8n the other hand, if any significant number of physicians were to decide that enhancement, as an end in itself, is not the physician4s responsibility, enhancement therapy could become a field of its own "beyond" medicine. 0ow these new therapists would relate to patients and physicians is unclear. 3ould they be simply those physicians willing to cooperate: 3ould they be persons in other fields5like sports trainers, psychologists, naturopaths, who would attend to their own special spectrum of enhancement re&uests: 3hat would these enhancement therapists do when serious, mysterious, or potentially lethal side effects appeared:

t is likely that outright re7ection of enhancement would encounter strong resistance. )atisfaction of personal desires, freedom of choice, and "&uality life" have, for many, become entitlements in a democratic society. #ew will want restrictions placed on their choice of enhancement. 2eer pressure, the drive of a competitive society, and market pressures will convince many physicians and ethicists that resistance is futile.

1iven our society4s incessant search for satisfaction of all its desires in this world, many will argue that enhancement is part of the physician4s responsibilities5no matter what the profession thinks. The confluence of an ego-oriented culture sustained by social approval, peer e!ample, and clever advertising will produce a cascade of demand. 2hysicians will be drawn into enhancement practices for a variety of reasons. )ome 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. 8thers will argue that physician involvement is necessary to assure safety and to permit better regulation of abuses. "3hat better way to treat the whole person:" some may add. " sn4t 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 physician4s social contract. "nhancement will also appeal to the physician4s self-interest. A willing and paying clientele is certain to develop. 2atients 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. 2hysicians 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. ;oney can easily induce the physician to provide enhancement of dubious merit or marginal efficacy. ;ore specific, for e!ample, is the conflict that involves the team physician who is e!pected to do his part to produce a winning team. "nhancements of athletic performance are in worldwide use. Their deleterious side effects are well known. 3ho does the physician serve5the good of the patient, the success of the team that pays his salary, or his own infatuation with athletic success: #undamental &uestions 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 tran&uility.. The modern and post-modern emphasis will be on effective regulatory measures, better techni&ues, and competent practitioners5not ethical restraint. 9estraint 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 reali'ation of a higher &uality of life for all. Any restriction will be interpreted as a violation of the physician4s obligation to respect patient autonomy. ;any 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. <ounterarguments will be difficult given the powerful vectors of change in our cultural mores.

0opes for an earthly paradise are seemingly within reach for many people who no longer believe in an after-life. #or them, e!tracting the ma!imum from personal enhancement is a seductive substitute. 1 2arens, ". 1==>. " s better always good:" n* "., 2arens +"d.,, "nhancing human traits* "thical and social implications +pp. 1-$>,. 3ashington, /<* 1eorgetown ?niversity 2ress@eungst, ". 1==>. "3hat does enhancement mean:" n* "., 2arens +"d.,, "nhancing human traits* "thical and social implications +pp. $=-A=,. 3ashington, /<* 1eorgetown ?niversity 2ress. $ #owler, 0. @. 1=AB. A dictionary of "nglish usage. $nd "dition. 9evised by )ir "rnest 1owers. New 6ork, N6* 8!ford ?niversity 2ress. . Crammer, 2. 1==.. Distening to 2ro'ac. New 6ork* Eiking.

/ntroduction

The topics of the article are focusing and highlighting the enhancement of medicine in the modern life. The modern treatment no adays as the best treatments using the ne

technologies leading by the !enetic manipulations" cybernetics" nanotechnology and psychopharmacology and more. The ob#ecti$e of the article is to retains a healthier life using the ne treatments %iotechnology 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 &'( correspondences said yes to the modern medicine better than traditional medicine #ust because the modern medicine is a full-ser$ice resource for lab testing and eight *oss is a ne medical eight-loss solutions. )odern )edicine

eight loss program that+s prescription-based" doctor-guided and

affordable. Cefilwe, one of the respondent said" modern medicine is effecti$e because patients are gi$en medication ith specified doses. ,n )odern medicine test are done and treatment

procedures are carried out under safe and hygienic conditions. ,n modern medicine" side effects of medication are established established hereas in traditional medicine side effects of medication are

hereas in traditional medicine side effects of concoctions are not -no n. The topic as including the facts

of these articles should ha$e an professional audience because the topic

and the debates. )any of peoples no adays don+t care to read an article about the ne technologies" but they are rather to lea$e this treatment onto doctors and specialist at the hospitals. The important thing ith $ery smooth and better as relie$e the pain .uic-ly and fast-relie$e from the diseases ill pay the medical cost although the medical cost as

ay. They

increasing by the days. They also can choose $arious methods to cure their diseases ith the ne technology. From this article also using the medical+s ords" therefore the educated people can

only read this article and practicing to their life. The #ournal is appropriate for this article because

the topic is about human. So the topic

as focusing the ne

treatments and using the ne ay to retain as a facts as a

technology. So from this #ournal many of the people

ill be understand the best ords

their health. , also classify the article is a conceptual because many of the

ta-en from the research. An e/ample about the healing and enhancement for the athletes fact from the specialist. From this treatment e

ill use the concept to another treatment in this

life. The facts is" %iotechnology aims to target the causes of diseases and not the symptoms. And that+s hy biotechnology offers one of the strongest hopes for patients to treat diseases.

0europabio.org1.According to the 23CD definition" The application of science and technology to li$ing organisms" as ell as parts" products and models thereof" to alter li$ing or non-li$ing

materials for the production of -no ledge" goods and ser$ices.4So by using the %iotechnology can ma-e a human+s lice healthier for longer because 56( of all medicines ill come from ith

biotech. Although ethical discussions of biomedical enhancements" ha$e forged lin-s

contemporary problems in the philosophy of mind" normati$e ethics and philosophy" they ha$e far rarely benefited from a substanti$e engagement ith the philosophy of biological science. ,t

is this gap that the present special issue is designed to fill. %roadly spea-ing" its aim is to consider ho biological theory can ad$ance ethical debates and policy discussions surrounding

genetic engineering and human+s enhancement. This in$ol$es more than simply ensuring consistency ith current empirical or- in the life sciences its means appreciating the rele$ance

of conceptual and methodological problems in biology for ethical debates that arise in connection ith the ne biosciences. Although there are many forms of biomedical e emphasi7e genetic engineering for substanti$e reasons other medical inter$entions trigger such po erful moral

enhancement" in this special issue beyond mere manageability. Fe

intuitions+ and are treated ith such ethical and regulatory caution as modifications of the human genome.

The big problems being addressed in this article are the physicians as described the ne treatments and enhancement to the $arious definitions. They also don+t use both of the medicines 0modern medicine and traditional medicine1 to retain their patients. So this is the patient rong and ma-e

ill be unhappy about this treatments. %esides the $ery high cost of the modern

medicine" they ill be afraid and depression suffered for those ho are not e$erything they ant to be. The solution is being proposed from this article by using the modern treatment are most promising use of biotechnology and ill be better ays to treat the diseases no adays. So the

patients should not orry to trying this method. )any of the athletes in this orld ere using the ne technology on the thrills of going farther" faster ith more endurance in athletic

competition. They also ta-e adrenalin to push the energy and the body. They also ta-e $itamins and in#ect the hormone to stay energetic and fit for this competition. Some of them also ta-e drugs to in this competition. So e ill choose the best ay about the ne technologies hich

enhancement of this -ind becomes an end in itself far beyond the healing ends of medicine in a traditional sense. The impro$ement of biomaterials for use as hip replacements and scaffolds for tissue engineering ha$e been made through the de$elopment and association of ne ceramics and polymers alloys"

hich can mimic the physical properties of tissues surrounding the

implanted site. No adays a hip #oint implant is al ays a carefully designed composite material comprising for e/ample a femoral titanium core ith high tensile strength. , choose this article because many of people don+t -no body by using the biotechnology. 2ther ise its more compatible retain our life. , ha$e found some of people afraid and ho to enhance the healthier

ith our life and more about to ill effect ill -no ill be

orries by using this methods e

their body. Some of them also can+t pay the cost. So from reading this article" many things about the modern medicine are the better

ay to retain our health. 8e

en#oying our life by using both of the treatments. Sometime traditional could help such as eating

some herbal it+s also ill heal our diseases. %ut on the other hand" traditional medicine shouldn+t be e/cluded from some treatment especially in the countries here modern drugs are e/pensi$e

and are not a$ailable. , li-e this article $ery much because there are many things , should -no and share to my friends. %efore reading this article products. After , eat this product" , am #ust -no as a $ictim to the commercial herbal

from my friend the products are contains high

percentage of the drug so can ma-e me feel so higher and buy it again. , should said than-s for the )odern Technology for ma-e me feel more safety. 9ichardson said de$elopments may benefit society in important ays" such as by boosting hile such or-force

producti$ity" their use also had :significant policy implications: to be considered by go$ernments" employers" or-ers and trades unions.:There are a range of technologies in

de$elopment and in some cases already in use that ha$e the potential to transform our or-places - for better or for orse": she said. ;uman physical and cogniti$e enhancements are

primarily de$eloped ith sic- or disabled people in mind" as medicines or therapies to help them o$ercome mental or physical disorders. %ut e/perts say drugs and other forms of enhancement are being used increasingly by healthy people ho ant to benefit from the boost they can gi$e

to performance.%arbara Saha-ian" a professor of clinical neuropsychology at Cambridge <ni$ersity ho contributed to the report" said for e/ample that modafinil" a generic drug

prescribed for sleep disorders such as narcolepsy" is often used by academics or business leaders tra$elling to conferences ho need to be at the top of their game hen deli$ering a speech.:They ta-e 0sleep1 medications on the plane to fall asleep" and ta-e modafinil to a-e up hen they get there": she said.2ther stimulants such as No$artis=s 9italin and Shire=s Adderall" prescribed for conditions li-e Attention Deficit ;yperacti$ity Disorder" are also used by healthy people to increase focus. 2ne issue ith this -ind of use is the lac- of long-term safety studies of such

drugs in healthy people" the e/perts said" so there may be un-no n ris-s ahead. 2ther problems

include

hether cogniti$e enhancers are fair. ,s it cheating to go into a #ob inter$ie

or e/am

ha$ing ta-en a drug to boost your mental focus> 9esearch from the )assachusetts College of *iberal Arts in the <nited States has estimated that up to ?&( of students in the <.S. use cogniti$e enhancers to impro$e performance in e/ams or for particular essays or pro#ects. The report also pointed to $isual enhancement technologies" such as retinal implants" that could be used by the military" night atchmen" safety inspectors or game-eepers. Technologies to a$elengths such

enhance night $ision or e/tend of the range of human $ision to include other

as ultra-$iolet light could become a reality relati$ely soon" it said. Saha-ian suggested that for dri$ers or pilots" such enhancements could reduce fatigue and lo er the ris- of fatal accidents. %ut she also raised the .uestion of hether employers -een to s.uee7e more producti$ity out of a or-force might coerce or-ers into using enhancements against their ill.:,magine you=re a

bus dri$er bringing children bac- on a #ourney to the <@ o$ernight and your boss says you ha$e to ta-e cogniti$e-enhancing drug because there are ris-s to the children if you don=t stay a a-e": she said. :,s that acceptable> These are the -inds of things e ha$e to grapple ith.: The article does build upon the appropriate prior research choosing the right ay to ta-e

a modern medicine. The approach and e/ecution is not correct because many of the facts is hiding from the riter+s .uestions. ;e should gi$e more e/amples to pro$e the best treatment.

;e also condemn by the one side" the physicians and , thin- is not fair. )any of the peoples are in$ol$ing this problem. The 3uropean 9esuscitation Council 039C1" in the ethics section of its !uidelines for 9esuscitation" states that patients =A do not ha$e an automatic right to demand treatmentB they cannot insist that resuscitation must be attempted in any circumstance. Futility e/ists if resuscitation ill be of no benefit in terms of prolonging life of acceptable .uality=. The

39C notes that the decision to forego attempts at resuscitation is =Ausually made by the senior doctor in charge of the patient after appropriate consultationsA= but that =Ain matters of

acceptability of a certain .uality of life" the patient=s opinion should pre$ail=. The 39C states that the influence of the family not ithstanding" =it should be made clear to them that the ultimate decision ill be that of the doctor. ,t is unfair and unreasonable to place the burden of decision

on the relati$e=. The 39C endorses a higher degree of physician paternalism than do authorities in the <nited States. ,t suggests that the patient should determine the threshold of acceptable .uality of life and the physician should determine the statement refers to circumstances hether this outcome is achie$able. ;o e$er"

here there is =no benefit= e/pected. The more challenging" hich a small or $ery small chance of benefit

and perhaps more common" situations are ones in

e/ists. 8hat probability of achie$ing the desired outcome is sufficient so that patients= .uality of life assessments are determinati$e> 8ho should set this threshold and through ;ere" it is not clear ho hat process>

physicians and patients should proceed and there is significant

$ariability in 3uropean practice on this point. ,deal health care decisions are a product of a #oint process by hich physicians discuss a

range of options understood as e$idence-based" or at least as professionally normati$e" 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 $alue-free" despite some commentators arguing that physicians should be relegated to decisions that are purely ob#ecti$e or $alue neutral. !ood decision ma-ing ill continue to depend on clinical

interpretation" #udgment" and e/pertise" despite patients= decision ma-ing authority and their access to both generic and indi$iduali7ed medical information. ,n fact" nearly e$ery decision of clinical rele$ance contains a $alue dimension" and since physicians are in a co$enant society" they are empo ered by society to ma-e these decisions ith

ith fairness" fidelity and

parsimony. This empo erment does not come through an obtuse process" but through a publicly accountable process of education" training" certification and licensure. ,ne$itably" situations arise

in

hich physicians must be responsible to professional norms for the patient=s good. 8hile

accommodating the dynamism in the patientCdoctor relationship" physicians must maintain their professional" ethical obligation based on the principle of non-maleficence and" as a rule" not offer inter$entions that ha$e lo utility" high burden" and that ill not li-ely alter prognosis. The ay and in the setting

challenge is defining the details of this domain in a publicly accountable of moral and technological modernity.

The claim that physicians are empo ered to ma-e some normati$e" $alue-based decisions" rests in part on a high le$el of physician fidelity and a lo le$el of clinical practice

$ariability. ,t is clear that these conditions do not fully e/ist. ,nappropriate clinical $ariability may be attributable to physicians= personal characteristics such as gender" ethnicity and religion" as ell as to biased physicians responses to patients based on the patients= gender and ethnicity" ill empo er and entrust physicians" then physicians must

among other factors.D??E ,f society

impro$e ob#ecti$ity and consistency in $alue assessments made during clinical care.3fforts to impro$e inter-physician consistency in the use of ineffecti$e and marginally effecti$e inter$entions should be coupled to efforts to better educate the public about inter$entions that are disproportionately harmful" about palliati$e options" and to reshape public misconceptions about the omnipotence of modern medicine. These efforts ill allo physicians to more robustly

protect patients from harms by clarifying sanctioned domains of physicians and ser$es societal interests to ha$e communally responsible use of resources. ,t confidence by the public of physicians. The article does thro an e/clusi$e ne idea hich is pro$en enhancement/treatments ith a ne issues and ill also bolster trust and

by using the both methods. The article+s

as shortcoming and limitations

problems by using the $ariety modern medicines treatments. This articles do not domain co$ered

all important aspects and issues because its only gi$e the ans er to basic -no ledge about the modern treatments. )edicine has al ays been both a business and a profession. Chaucer rote

about it. So did !eorge %ernard Sha . A business e/ists for the purpose of ma-ing money" to earn hich it pro$ides a product or ser$ice. A profession e/ists for the purpose of pro$iding a hich the professional is paid. %alance is the -ey. From anti.uity" humans ha$e ho" in order to pro$ide that ser$ice" must gain the

ser$ice" for

re.uired certain ser$ices from indi$iduals

most intimate -no ledge of the person=s mind" body" and e$en soul. Societies ha$e tendered those indi$iduals ho pro$ide such essential ser$ices ith a large le$el of trust and ha$e

designated them as :learned professionals.: ;istorically" these are only physicians" la yers" religious leaders" and 0sometimes1 teachers. The patient" client" religious belie$er" and student must trust the professional to use that personal information for their benefit and not to e/ploit it. )y fa$orite medical ethicist" Dr. 3dmund Fellegrino of !eorgeto n <ni$ersity 08ashington" DC1" defined the essential characteristic of a learned professional some years ago by saying that :at some point in the professional relationship" hen a difficult decision is to be made" you can

depend on the true professional to efface his o n self-interest.: /r. 1eorge Dundberg, "ditor of ;ed1en;ed.0G66H1 Finally" , thin- the best the FAI from the testimonial respondent. ,t )odern )edicine. ay to rite this article no adays is ho ell-organi7e

ill be clear to sho

important to use the

RE33ERE&.E

?.3D)<ND FA**3!9,N2 0original article1"G66H %iotechnology" ;uman 3nhancement and the 3nd of )edicine"

G.%iotechnology"applications and benefits"G6?J"

.europabio.org

J. C. C. F399K" in LChemistry of ad$anced materials: An o$er$ie .4 ,n (iomaterials" edited by *. M. ,NT399ANT3 and ). N. ;A)FD3N-S),T; 08iley-MC;" Ne Kor-" <S" ?OOP1" p. HOO H.D. D. AT3;" F. MAD!A)A and ;. A. NAMSA9,A" L;andboo- of Nanostructured %iomaterials and Their Applications in Nanobiotechnology"4 Mol. ?" Chapter ?G" (iocompatibility of ;aterials" edited by ;. S. Nal a 0American Scientific Fublishers" G6651" p. H?? 5. @ate @elland" ;uman 3nhancements At 8or- Fose Dilemma+s 9eport"No$ember G6?G"<.@ 9euters. ,! N.T.%erger" 9edefining the Domains of Decision )a-ing by Fhysician and Fatient ,nt N Clin Fracti G6??:&50P1:PGP-PJ6

SPB571
STRUCTURE AND FUNCTION

ARTICLE REVIEW
PREPARED BY

NAME

MATRIC NUMBER

TAJUDIN BIN TAIB

2011696204

GROUP : TEDPS6A

ATTENTION FOR: PN SARINA BINTI MO!AMAD

SPB571
STRUCTURE AND FUNCTION

ARTICLE REVIEW
PREPARED BY

NAME

MATRIC NUMBER

TAJUDIN BIN TAIB

2011696204

GROUP : TEDPS6A

ATTENTION FOR: PN SARINA BINTI MO!AMAD