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A photo of Jeff Kahn.

Jeffrey Kahn heads the U's Center for Bioethics.

Asking the right questions

By Brenda Hudson

From eNews, May 19, 2005

Who decides if and when life support can be withdrawn from a terminally ill patient? As genetic testing becomes more advanced, how will this information be used and who will monitor that use? Should an embryo, prior to implantation, be genetically screened to be a matching donor for a critically ill sibling?

"Medical research often poses as many questions as [it] provides answers," says Jeffrey Kahn, director of the University's Center for Bioethics. And for 20 years, the center has been at the forefront in addressing these questions and shaping medical research and health care policy.

Established in 1985 as one of the country's first multidisciplinary bioethics centers, its work encompasses areas of health, law, and ethics. Bioethics faculty at the University collaborate with scientists conducting research, legal experts examining health law, public health educators developing health policy, and health care providers facing complex patient care issues. "Bioethics as a field came out of other disciplines, such as philosophy, law, and medicine," says Kahn, "so as a rule, we are used to examining issues across a wide range of perspectives."

Arthur Caplan, the center's first permanent director and a leading expert in bioethics, recalls that transplantation was among the pressing issues when the center was founded. Organs such as the heart and kidneys had been harvested at death for transplantation. In the 1980s, however, the question became: could you use living donors as a source for organs?

Bioethics resource center

If you have a bioethics question or wish to learn more about organ transplants, human cloning, genetic testing, and related topics, visit the Center for Bioethics's Resource Center. In addition to summaries on a variety of bioethics topics, the Web site allows you to e-mail a bioethics expert or request for an expert to speak at an event.

"We had to ask ourselves, was it ethical to hurt someone, to make someone (the living donor) worse off, in order to make someone else better?" says Caplan.

Researchers and surgeons at the University, leaders in transplantation for more than 30 years, worked together on ethics and clinical practice to arrive at some guidelines. "The closer the emotional relationship, the more living donation was considered acceptable," Caplan says. "It was generally agreed that relatives should be allowed to make this sacrifice." Other considerations around living donors included prohibiting the sale of organs, screening donors for psychiatric stability, and protecting potential donors who do not wish to donate--all new concerns that came out of medical advances in organ transplantation.

Bioethics at the State Fair

At the 2004 Minnesota State Fair, the Center for Bioethics asked 300 fairgoers the following questions (their response follows):

1. Should scientists use genetic engineering to make people "better than normal" (taller, smarter, stronger, or live for a very long time) or should we just use it to treat genetic diseases?

17% Yes
36% No
43% Only to treat genetic diseases
4% Undecided

2. Should society allow people to sell their kidneys [seeing that] 17 people die every day because of a shortage of organs to transplant?

52% Yes
47% No
1% Undecided

3. Should human embryos that are left over after assisted reproduction be used for medical research?

77% Yes
21% No
2% Maybe

To read the full list of public comments related to each question, see comments.

"In part, technology has driven bioethics debate and research," says Kahn. One example is the Human Genome Project, which completed its initial rough draft in 2003. The vast information it offers on health, disease, and behavior, says Kahn, also poses potential risks in terms of issues such as individual privacy infringement. Personal information from genetic testing could lead to problems obtaining life and disability insurance, or even employment.

Stem cell research is another area that poses ethics questions. "As the University's research on stem cells advances, so do the ethical challenges," says John Wagner, scientific director of clinical research of the Blood and Marrow Transplant Program and Stem Cell Institute. "Of course we want to move novel stem cell therapies forward as quickly as possible, but only [by] doing so in a thoughtful and ethical manner."

Many ethical questions can be anticipated and discussed well ahead of a controversial situation but others must be dealt with as they arise. "Our research here has the attention of the world and we must set the highest standards," says Wagner.

For more information, see the Center for Bioethics.

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