Medicine meets law


There are many benefits as the worlds of medicine and technology continue to merge, but the future of medicine also brings with it an array of ethical questions.

James Corbett, senior vice president of community health and values integration at Centura Health, said bioethics has reached the intersection of law, technology and medicine.

The growing field of genetic engineering will present many ethical questions as technology moves from science fiction into the real world, he said.

For example, genetically engineered mosquitoes could curb insect-borne viruses, but could also harm the food chain, Corbett said.

“What are the consequences?” he asked.

Genetic testing and engineering also have human implications.

The National Institutes of Health will not fund gene editing technology, he said, adding such engineering is seen almost universally as a line that should not be crossed.

“I’m not arguing there should be [a ban],” he said. “But there should be transparency, education, awareness and a full understanding of the unintended consequences.”

Honor at the end

End-of-life care is a growing concern as a large swath of the population ages, Corbett said.

“Only 30 percent of patients without an end-of-life directive have their wishes known and honored,” he said. “Conversely, 92 percent with an advanced directive have their wishes known and honored.”

There is a “moral obligation” as a community and a health system, Corbett said, to ensure patients’ last wishes are honored.

“Only 26 percent of adults in the U.S. have an advanced directive,” he said. “With the Silver Tsunami coming, we have a crisis we need to get our hands around.”

Opportunity for all

Corbett also addressed the lack of trust in health care among ethnic and economically challenged communities.

Additionally, while African Americans make up 12 percent of the population, they comprise only 5 percent of clinical trials, Corbett said. Hispanics are 16 percent of the population,  but represent only 1 percent of the trial population.

Often, economically disadvantaged trial participants can’t afford the medication they helped test, he said.

Corbett urged physicians to be aware of the financial pressures “that deflate your passion for your practice” and allow them to become “stuck … in the morass of the business of medicine.”

“Bravery in these changing times will be required,” he said.