September 2007 - Restrictions on Alcohol Consumption

Archaeological and written evidence testify that human beings have been consuming alcohol for at least 10,000 years. Although attitudes towards such consumption have varied greatly from one society to another and over time, it has always been seen as having both beneficial and harmful effects. Achieving an appropriate balance between the two has been a major issue for both political and medical ethics.

In some societies it has been considered that the harmful effects outweigh the beneficial to such an extent that a total ban on consumption has been decreed and enforced. The protection of both potential consumers and other members of society against the moral, physical and social damage caused by excessive alcohol consumption overrides the freedom of individuals to decide for themselves whether they can enjoy the benefits without harming themselves or others.

In most other societies, a variety of measures have been implemented to minimize the harmful effects while allowing the beneficial ones to be experienced. Legislators and law enforcement officials have always faced difficult challenges in determining and enforcing general laws and policies in this matter. Although their primary concern is the protection of others from harm caused by those under the influence of alcohol (for example, laws against drinking and driving), there seem to be increasing efforts in many countries to discourage alcohol consumption because of its harmful effects on the health of individual consumers (for example, restrictions on advertising of alcoholic beverages).

The detrimental effects of alcohol on both individual and public health have long been recognized by the medical profession. Physicians have had to deal with illnesses caused or exacerbated by alcohol consumption, and counselling moderation or even abstinence has been one of their major health promotion strategies. In recent years medical associations have been vigorously advocating public policies that restrict access to alcoholic beverages. Here medical ethics intersects with political ethics insofar as the worthy objective of health promotion is considered to justify coercive measures to restrict one's freedom to engage in harmful behaviour.

For many years the WMA's only policy on alcohol was its Statement on Alcohol and Road Safety (revised and updated in 2006). In 2005 the WMA adopted a comprehensive policy on alcohol in its Statement on Reducing the Global Impact of Alcohol on Health and Society. Here the WMA urges National Medical Associations and all physicians to encourage public authorities to adopt and implement legislation and educational measures designed to help reduce the harmful effects of alcohol consumption on health and society.

Several National Medical Associations have been very active in their opposition to alcohol abuse. For example:

• The American Medical Association has developed numerous Policies on Alcohol covering such topics as availability, promotion, taxation and labelling of alcoholic beverages; drinking and driving; referral and treatment of alcoholic patients; and education about alcohol consumption.
• In 1998 the Australian Medical Association produced a Position Statement, Alcohol Consumption and Alcohol Related Problems that contains a large number of recommendations for achieving a reduction in the incidence of hazardous and harmful levels of alcohol consumption.
• The British Medical Association has assembled a collection of Resources on Alcohol Misuse including BMA policies and reports on topics such as drinking and driving, and alcohol and young people.

The World Health Organization has also put together a list of Resources on Alcohol Drinking that includes a 2006 report from the WHO Collaborative Project on Identification and Management of Alcohol-Related Problems in Primary Health Care: Report on Phase IV: Development of Country-Wide Strategies for Implementing Early Identification and Brief Intervention in Primary Health Care.

June 2007 - The Ethics of Stem Cell Research

During the past decade a great deal of scientific research activity has been devoted to human stem cells. Considerable progress has been made in deriving and replicating cell lines and in understanding cell biology. The ultimate goal of this activity is to develop therapeutic applications of this knowledge, but it is still uncertain how successful this quest will be.

From the outset stem cell research has raised ethical issues over and above those associated with other types of medical research. The principal cause of ethical uncertainty and conflict has been the use of human embryos as the source of stem cells for research. Despite claims that adult stem cells may be equally suitable for therapeutic purposes, there is a strong consensus among scientists working in this field that embryo stem cells are better suited for research purposes. However, since the derivation of these cells requires the destruction of the embryo, the question arises whether or not such research is fundamentally unethical.

Proponents of embryo stem cell research are not insensitive to the special ethical status of the human embryo and there has been substantial agreement on certain limitations to such research. Ethical guidelines and national legislation generally prohibit the creation of embryos for research, allowing research only on embryos created but no longer wanted for reproductive purposes. The consent process for the donation of embryos for research is usually very rigorous. Some countries restrict the embryonic cell lines that their researchers are allowed to use to ones that have been derived in accordance with strict ethical requirements. The introduction of human stem cells into animals is either forbidden or severely limited.

The ethical issues of stem cell research have been widely discussed by medical associations and scientific organizations, including the following:

• In 2006 the WMA Assembly adopted a Statement on Assisted Reproductive Technologies that deals in part with stem cell research:
  • Due to the special nature of human embryos, research should be carefully controlled and should be limited to areas in which the use of alternative materials will not provide an adequate alternative.
  • Views, and legislation, differ on whether embryos may be created specifically for, or in the course of, research. Physicians should act in accordance with national legislation and local ethical advice.
  • Cell nuclear replacement may also be used to develop embryonic stem cells for research and ultimately, it is hoped, for therapy for many serious diseases. Views on the acceptability of such research differ and physicians wishing to participate in such research should ensure that they are acting in accordance with national laws and local ethical guidance.
• The WMA is currently considering a Proposed Statement on Stem Cell Research for possible adoption at its October 2007 Assembly in Copenhagen.
• In 2003 the American Medical Association adopted a policy on Cloning-for-Biomedical-Research that reads in part: "While the pluralism of moral visions that underlie this debate must be respected, physicians collectively must continue to be guided by their paramount obligation to the welfare of their patients. In this light, cloning-for-biomedical-research is consistent with medical ethics. Every physician remains free to decide whether to participate in stem cell research or to use its products."
• The Australian Medical Association has expressed support for embryonic stem cell research.
• The British Medical Association is likewise in favour of embryonic stem cell research: "The BMA supports the use of carefully controlled research, including research using human embryos where necessary for the development of tissue for transplantation and the development of methods of therapy for mitochondrial diseases."
• The International Society for Stem Cell Research website includes a number of ethics-related documents, such as The Ethics of Human Embryonic Stem Cell Research.
• The U.S. National Institutes of Health website provides a useful set of resources on this topic: Bioethics Resources on the Web - Stem Cell Research.