News from the world of bioethics often produces a high-tech tangle of science: Stem-cell therapy ... reproductive cloning ... pre-implantation genetic diagnosis. Then a headline hits home: Hospitals Outline Smallpox Vaccination Plan.
The vaccination: To get it or not to get it?
To be safe in case of a biological war that seems increasingly possible? Or to risk needless side effects, illness, perhaps even death?
Bioethicist Ruth Faden takes the matter further: Should those who are healthiest have a duty to be vaccinated to keep the disease from spreading to those most apt to be harmed by it?
Faden, who directs the Phoebe R. Berman Bioethics Institute at Johns Hopkins University, has been thinking about the many implications of national smallpox vaccination for quite some time. It's her job to encourage the right people to take on such complex issues so that public policy can be both reasonable and ethical.
"One of the really big questions is the question of compensation," she says. "So what ought to happen if someone becomes ill from the vaccine?
"We've thought through a set of commitments for what we owe those who put their lives in harm's way on a military context or law enforcement context. But what are we going to do if people are in harm's way merely because they live in the United States and are the subject of hostile attacks? ... Do we want to fold what we ought to do with respect to smallpox into the model that already exists for children harmed as a consequence of traditional childhood immunization?"
Faden knows the final decisions will be made by politicians, the same group that voted for the victims' compensation fund after Sept. 11 without thinking clearly about its premise or consequences.
This is why she wants to get people talking about such issues now, why she has written newspaper articles about this proposed defense against bioterrorism. She wants knowledgeable discussion: On smallpox, on stem-cell therapy, on health care rationing, on genetic testing, on physician-assisted suicide, on HIV-AIDS, on informed consent, on the many pressing medical and scientific issues beginning to shape life in the 21st century.
And she's looking for all points of view -- just as she did nine years ago when she chaired the president's advisory committee on human radiation experiments. Faden says part of her role is to bring together many minds from many disciplines to consider the ethical fallout from scientific success.
