As a theologian and associate professor of Christian ethics at the Princeton Theological Seminary, Nancy Duff thought she had escaped the family business — her father was a physician, her mother an RN, her sister a nurse practitioner, her uncle an anesthesiologist, and her sister a biologist. But perhaps genes have had their say as she chose the most biological of theological paths — bioethics. Her resume lists “Issues in Biomedical Ethics” first in a roster of courses most frequently taught, and Duff has written articles on cloning, homosexuality, medical ethics, life support, and genetic research.
A native of Tyler, Texas, Duff graduated in 1973 from Austin College in Sherman, Texas, with a major in English and a minor in religious studies. She was ordained as a minister in 1977, receiving an M. Div. from Union Theological Seminary in Richmond, Virginia. After two years as a campus minister at her alma mater, she went for a Ph.D. in systematic theology at Union Theological Seminary in New York. Duff wrote her dissertation on ethicist Paul Lehmann, a central figure in the field of bioethics, whom she knew personally.
Duff teaches “Issues in Biomedical Ethics” to both seminary students and professionals in the ministry, chaplaincy, healthcare, law, research sciences, and social services beginning on Monday, September 25, at 6:30 p.m. in the Cooper Conference Room in Erdman Hall. The course covers reproductive health, cloning, stem cell research, mental health, and end-of-life issues as well as human and animal experimentation, abortion, and the distribution of healthcare. For more information or to register, contact the Center of Continuing Education at 609-497-7990 or visit www.ptsem.edu/ce.
Issues of biomedical ethics has the potential to affect everyone. It could become an urgent issue for any couple considering having a child through in vitro fertilization, any relative of a terminally ill person in great pain at the end of his life, and any voter deciding how high to rank a candidate’s embrace of — or opposition to — abortion, stem cell research, and the distribution of contraceptives to teen-agers. While individuals may struggle with pros and cons of a situation involving biomedical ethics, so do many industries and companies. Among pharmaceutical companies bioethical issues, and in particular cloning and human and animal experimentation, are front and center.
Research with human subjects. Drugs must jump through numerous hoops, including both animal and human testing, before achieving approval from the Food and Drug Administration. Research with human subjects is a risky but necessary part of the process, and today one of the primary ethical issues involves informed consent: How much knowledge do the experimenters have to give to the subjects about the safety of a drug, including potential, if rare, side effects? If there is slight chance that a drug could lead to horrendous consequences, how much do you tell the research subjects? What if the physicians or scientists have one understanding and patients have a more limited one?
Should prisoners be allowed to volunteer as human subjects? Ethicists ask, on the one hand, whether it is appropriate to take away that right, which has been abused in the past, and on the other, can prisoners be free to make that choice, or is there always an element of coercion?
The issue of coercion also comes up with experimentation on people from other cultures in other countries, for example, research on children with AIDS in Africa.
“There is so much authority in Western experts, physicians, and scientists when dealing with people from a poor country with little education,” says Duff. When these western men are talking to vulnerable African mothers, is it fair to say they are truly informed?
On the other hand, some people argue that standards should be lessened when experimenting on people in poorer countries for altruistic reasons. They claim that poor people could potentially get medical care as part of the research. Yet, says Duff, people used as human research subjects could never afford the kinds of treatments involving the research being done, so even if the drugs are successful, the people would never get the treatment. To further complicate matters, some governments argue that they should have the freedom to set standards in their own countries.
The United States has a glaring example of experimentation without informed consent. “Experiments involving human beings have a bad history,” says Duff. She points to the Tuskegee research project, in which researchers for the United States Public Health Service lied to the African-American men used as subjects for 40 years, between 1932 and 1972. The men were told they were getting treatment for syphilis, but instead of dosing them with penicillin, the experimenters were plotting the course of the disease.
African-Americans remain reluctant to volunteer due to the residual mistrust from that project. This is particularly unfortunate, says Duff, since a need exists for more experimentation with ethnic minorities and women, where diseases present differently.
Things are much safer today, and research institutions have institutional review boards to protect human subjects. Yet there are still ethical issues. What happens, for example, in a drug trial, when half the subjects are taking a placebo and half the drug, and the drug appears to be incredibly effective? Even though knocking out the control group ends the experiment, Duff says that “sometimes they stop early so that those taking the placebos can get the real things.”
Animal research. Animal experiments have a tremendous history of abuses, some of which have been addressed and made better. Today protocols for animal experiments must be approved by an IACUC, the Institutional Animal Care and Use Committee. Experimenters must show that the animals experience the least possible suffering, and if suffering is necessary, they must show that it will contribute greatly to knowledge. Finally, animals must be put down humanely at the end of the experiments.
“We have come quite far,” says Duff. “I personally agree that animals should be used in as limited use as possible, and we have to be diligent so that they don’t suffer.” On the other hand — and with ethical decisions there is always an other hand — sometimes, with good intentions, people have pushed regulations helping animals too far. “The regulations become bureaucratic,” says Duff, “and in some cases increase the suffering.”
Duff admires Peter Singer, who she says is sometimes unfairly maligned or misrepresented. She says that his philosophy — that you have to treat animals being fully cognizant of the fact that they do suffer — has propelled the animal rights movement. “I don’t agree with all Singer says,” says Duff, “but I credit him with the idea that you can’t responsibly allow any being to suffer without being called to give account for that.”
Cloning. Cloning is a less clear-cut issue, tied as it is to people’s beliefs about abortion. “I’m opposed to cloning for reproductive purposes,” says Duff, “because it doesn’t address a serious need that can’t be addressed in another way.” She is, however, in favor of cloning for therapeutic purposes, which is basically what occurs in stem cell research. Her reasoning is that such cloning can potentially address diseases and conditions responsible for an enormous number of human problems.
“Stem cells that can be harvested are called ‘totipotent,’ all powerful, and can become any cell in the human body,” says Duff. She describes a stem cell as a fertilized egg that is a few days old, somewhere between a blastocyst and an embryo, but not yet an embryo. In the human body, it is pre-implantation.
“At that early stage, if I have to make a choice of making someone with Alzheimer’s well or addressing a few-day-old pre-embryo, I would choose to heal the person with Alzheimer’s,” she says. “I wouldn’t say that of a certain stage of pregnancy, or of an infant, but at this stage, where some percentage of fertilized eggs are naturally miscarried, it is not the equivalent of a human being. But it is nascent human life, and we must treat it respectfully.”
Ethics is based very much on personal values. Although more people seem to favor stem cell research than favor abortion, Duff points out that “anyone who believes that full personhood and an individual human being begin at conception cannot be in favor of stem cell research.” Keeping in mind that opinions will vary and that part of the conversation will indeed be adversarial, she tries in class to present both sides.
Because Duff is a Christian ethicist, she will present a specific theological perspective, but she will also invite people from other traditions to share their perspectives. But more generally her approach is to urge her students to look at these ethical problems as a team, not leaving these decisions solely only on the shoulders of the physicians.
“I want this to be a genuine give and take, not demonizing,” she says. “People can state an opinion, but I want it to be done out of sense of understanding what the other person does, and why, and of fostering support for one another.”