In an age when medical technology is improving with increasing rapidity, the availability of new treatments is developing almost as quickly. With advances, however, come dilemmas — scientific, financial and especially moral. These conundrums are likely to multiply as groups with vastly different viewpoints and resources battle over the direction of health policy. Mot conflicts result from one of the five possible issues below.
1. Protecting Human Subjects in Clinical Trials
This issue has generated considerable debate since 1999, when 18-year-old Jesse Gelsinger died while participating in a gene therapy trial at the University of Pennsylvania. The institution was widely criticized for failing to disclose crucial information on informed consent documents, relaxing criteria for accepting volunteers and enrolling volunteers who were ineligible. The episode prompted new standards as a result of the harsh spotlight that was cast on the clinical trial world. The issue, of course, is complicated, because patients — especially suffering patients — are willing to try something new, even when physicians acknowledge that a complete side-effect profile isn’t known. In order for any clinical trial to be as safe and legal as possible, everything from payment to potential side effects must be laid out in front of the patient.
2. Affordability
As more research and development is accomplished, medical treatment becomes increasingly expensive. Hence the question bouncing around revolves around the idea of how expensive is too expensive. How do we develop the "best" treatments, but charge affordable amounts so as to not exclude any one particular group from a healthcare improvement?
3. Privacy
Protecting patient privacy is a growing concern thanks to technology that is making it possible to decode the human genome. But as scientists become adept at deciphering a person’s genetic composition, it is increasingly likely that compromising information about a person’s future health is going to become available. For instance, it may become possible to know that a five-year-old is going to develop serious heart disease later in life, but does a prospective employer have the right to know that? How will this knowledge affect the individual’s ability to obtain a job, insurance or a mortgage? Should such information be available to insurers and others? Many are pondering rules to be put in place regarding this controversy.
4. Stem Cell Research
It is somewhat ironic that a scientific area of research based on trials and data could be reconfigured into an emotional issue. The debate, of course, pits people who believe the research may one day find cures for diseases against others who say it violates human life. Is it ethical to gain from one only to essentially kill that person while helping others?
5. Defending the United States Against Bioterrorism
Security is hugely important, and public fears over terrorism are unlikely to diminish. In response, the federal government wants Project Bioshield to spur the development of treatments, including preventive medications and vaccines, that would be available in sufficient quantities to protect the largest possible number of people. But Project Bioshield also raises ethical problems, experts say. For starters, the investment will be large and probably will grow over time. At a time when deficits are growing, generous funding for bioterrorism research suggests that funding for other public health priorities — such as diseases— may suffer. Is the fight against bioterrorism worth halting research for other treatments?
