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Members of the Washington elite try to nod knowingly in these days of budget cruches when asked about the "tough choices" that lie ahead, but few go out on a limb. The Hastings Center, with characteristic nonpartisan temerity, took up a tough choice recently in Briarcliff Manor. The project: "Assisted Reproduction and the Allocation of Health Resources." The charge: to assess the meaning and nature of procreation, infertility, and genetic relationships; to regard access to infertility treatments as a case study in just distribution of health care resources; and to consider the implications of mandating health insurance coverage for infertility therapy.

The discussion of procreation turned on a word I haven't heard and am unlikely to hear from the mouth of a politician: "fructification." A child, like a fruit, extends the line of its forebears, is constituted by the stuff of its parents, and yet exists as a distinct whole. In procreating, parents bestow parts of themselves as gifts to their partners, to their child, and to the world. The psychological trauma of infertility can be severe because procreating, childbearing, and parenting are natural, profound desires belonging to personhood and human flourishing (the limb creaks).

The emotional pain of infertility does not in itself, however, establish a constitutional or even a moral obligation on the part of the government to provide technologies, such as drug therapies, artificial insemination, and in vitro fertilization, to infertile couples and individuals. Nor does it automatically justify federal intervention in the insurance industry. Consider, as the project did, the following: Would mandated coverage for infertility treatment restrict the freedom of companies to select policies tailored to fit their needs, and would it unduly raise insurance costs for all Americans, most of whom are fertile? Who decides who is eligible for infertility treatment benefits, who, in other words, is a "fit parent"? Is infertility really a medical condition? How should we compare fertility with other "health care" priorities such as nutrition, prenatal care, sports medicine, elective abortion, and organ transplantation? Tough choices. We're still "studying the problem."

"Ethical, Legal, and Policy Issues in Maternal-Fetal Relations," a second Hastings Center project that analyzes parenting, continues. As the media emphasizes conflict, with pictures of mothers jailed for substance abuse and stories of forced caesareans, the project looks for less confrontational means to mediate the unique relationship of a woman and her fetus-to-be-child. The project hopes to create a forum to improve dialogue and understanding in this difficult area. A recent meeting in Berkeley, California, addressed our moral responsibility to prevent harm to the fetus and the implications, if any, of this responsibility for the controversy surrounding elective abortion, the moral relevance of the illegality of substance abuse, problems of double agency for doctors who collect evidence of wrong-doing in their offices, and the pros and cons of using the law as a means of coercion.

The project on "The Ethics of Animal Experimentation" also feels the political climate heating up. Animal rights groups and their opponents grow more vocal and, in some cases, more violent. Media accounts of raids, bombs, and threats occur with increasing frequency, and some members of the Center's project have joined the fray. With no concern for physical safety, project members have challenged the positions of Peter Singer, Tom Regan, and R. G. Frey. Leon Kass and Hans Jonas, drawing on Genesis and the writings of Heraclitus, respectively, presented accounts of the human good that justify but also limit the human use of animals. In the coming year, the project will turn from its metaphysical and moral research to the construction of concrete guidelines that specify the ethical use and abuse of animals in scientific experimentation. Issues the project will take up include the use of pound and purpose-bred animals, pain research, the "stacking" of surgical procedures on a single animal, recognizing animal pain, and the composition and functioning of Institutional Animal Care and Use Committees.

The Other World, the Old World

The influence of religion on biomedical ethics has declined. Although notable exceptions exist, theologians, by and large, seem less interested in the field. The staff members of the new Hastings Center project on "Religion and Bioethics" believe that bioethics has lost something important and that questions of substantive ends, of the good human life, and of the "nature and destiny of man" call for deeper discussion. In an upcoming one-year project, the Center will explore the reasons for the departure of theologians from the field and seek ways to revivify interest in theological medical ethics.

In another effort to broaden our bioethics community, an extension of the Center's international program will launch new collaborative efforts with East European colleagues. The Center will support scholars coming to Briarcliff, help publish reports and articles from Eastern Europe, and hold an annual European conference, which, this year, will take place in Hungary. The new program affords the Center an opportunity, at a time of remarkable political change, to pursue questions about the rights of the individual and about institutional responses to personal and professional needs, to learn from bioethicists in Europe, and to appreciate the political principle that makes possible the discussion of autonomy, beneficence, and other notions central to biomedical ethics: glasnost.
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Title Annotation:biomedical ethics, Hastings Center projects
Author:Gauri, Varun
Publication:The Hastings Center Report
Date:Mar 1, 1989
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