5/1/02

LC020501

LIFE AND TIMES "THE ETHICS PROJECT" IS MADE POSSIBLE BY A GRANT FROM RALPH TORNBERG.

VAL>> ON LIFE AND TIMES TONIGHT --

JESS>> A MOTHER WANTS HER NEXT BABY TO BE A BOY SO THE CHILD WILL NOT INHERIT HER RISK OF CANCER, BUT IS THAT REASON ENOUGH FOR DOCTORS TO INTERFERE WITH NATURE?

JOY PABLO>> I HAD A TOTAL MASTECTOMY DONE OF THE LEFT SIDE.

PHILIP BRUCE>> THEN HER CANCER RETURNED TWICE.

DR. JAROSLAV MARIK>> IT WOULD BE EASY TO GIVE HER A BABY BOY WHO IS EXTREMELY UNLIKELY -- NOT IMPOSSIBLE BUT EXTREMELY UNLIKELY -- TO INHERIT THE CANCER OF THE BREAST.

VAL>> A CONVICTED FELON GETS A HEART TRANSPLANT WHILE HE'S SERVING TIME IN A CALIFORNIA STATE PRISON, BUT SHOULD DOCTORS GIVE A SOCIAL PREDATOR THE GIFT OF LIFE AND AT TAXPAYERS' EXPENSE?

JESS>> TONIGHT A LOOK AT THE WORLD OF MEDICAL MIRACLES. MODERN SCIENCE OFFERS THE HOPE OF A LONGER, BETTER LIFE, BUT IS MEDICAL TECHNOLOGY MOVING FASTER THAN OUR ABILITY TO GRASP THE CONSEQUENCES?

VAL>> TONIGHT WE'LL EXPLORE MEDICAL ADVANCES ON "THE ETHICS PROJECT", A LIFE AND TIMES SPECIAL.

LIFE AND TIMES TONIGHT IS MADE POSSIBLE BY THE FOLLOWING FOUNDATIONS:

THE L.K. WHITTIER FOUNDATION
DEDICATED TO IMPROVING THE QUALITY OF LIFE BY SUPPORTING INNOVATIVE ENDEAVORS IN THE FIELDS OF MEDICINE, HEALTH, SCIENCE AND EDUCATION.

AND THE CALIFORNIA ENDOWMENT
THE STATE'S LARGEST HEALTH FOUNDATION SUPPORTING ORGANIZATIONS THAT DIRECTLY IMPROVE THE HEALTH AND WELL-BEING OF CALIFORNIA'S DIVERSE COMMUNITIES. THE CALIFORNIA ENDOWMENT, A PARTNER FOR HEALTHIER COMMUNITIES.

VAL>> GOOD EVENING, I'M VAL ZAVALA.

JESS>> AND I'M JESS MARLOW.

TONIGHT WE'RE LAUNCHING SOMETHING NEW, A SERIES OF PROGRAMS DEALING WITH REAL LIFE ETHICAL DILEMMAS. WE'RE BEGINNING WITH THE ETHICS OF MEDICINE AND WE'VE ASSEMBLED SOME OF THE BEST MINDS AROUND TO HELP US UNDERSTAND THE TOUGH CHOICES THAT OFTEN COME WITH MEDICAL BREAKTHROUGHS.

VAL>> IMAGINE A DAY WHEN DOCTORS CAN FORECAST AN ILLNESS THIRTY OR FORTY YEARS BEFORE A PERSON ACTUALLY GETS SICK. IT COULD SAVE YOUR LIFE, BUT WHAT IF AN INSURANCE COMPANY USED THAT SAME INFORMATION TO DENY COVERAGE TO SOMEONE DESTINED TO SUFFER FROM CANCER OR HEART DISEASE? THAT'S THE FOCUS OF TONIGHT'S ETHICS PROJECT. WHO DRAWS THE LINE BETWEEN RIGHT AND WRONG IN THE BRAVE NEW WORLD OF MEDICINE?

>> "NOW, ONLY SECONDS OLD, THE EXACT TIME AND CAUSE OF MY DEATH WAS ALREADY KNOWN.

>> NEUROLOGICAL CONDITION, 60 PERCENT PROBABILITY. MANIC DEPRESSION, 42 PERCENT PROBABILITY. ATTENTION DEFICIT DISORDER, 89 PERCENT PROBABILITY. HEART DISORDER, 99 PERCENT PROBABILITY. EARLY FATAL POTENTIAL. LIFE EXPECTANCY, 30.2 YEARS."

JESS>> THAT'S HOLLYWOOD'S FICTIONAL TAKE ON THE NOT TOO DISTANT FUTURE. TONIGHT OUR GUESTS WILL TRY TO SEPARATE THE FACTS FROM FICTION.

DR. JOYCELYN ELDERS SERVED AS AMERICA'S SURGEON GENERAL UNDER PRESIDENT BILL CLINTON. SINCE LEAVING IN 1995, DR. ELDERS HAS RETURNED TO HER HOME STATE, ARKANSAS. SHE'S A RETIRED PROFESSOR OF PEDIATRIC MEDICINE AND REMAINS A STRONG ADVOCATE FOR CHILDREN.

ALEXANDER CAPRON IS PROFESSOR OF LAW AND MEDICINE AT THE UNIVERSITY OF SOUTHERN CALIFORNIA. HE SERVES ON THE PRESIDENT'S NATIONAL BIOETHICS ADVISORY COMMISSION AND IS CO-DIRECTOR OF THE PACIFIC CENTER FOR HEALTH POLICY AND ETHICS AT USC.

MARK HIEPLER IS A VENTURA COUNTY ATTORNEY WHO SPECIALIZES IN PATIENTS' RIGHTS. HIEPLER'S LEGAL VICTORIES INCLUDE A RECORD-SETTING $89 MILLION DOLLAR JUDGMENT ON BEHALF OF HIS LATE SISTER WHO DIED OF CANCER AFTER AN INSURANCE COMPANY DENIED HER WHAT COULD HAVE BEEN LIFE-SAVING TREATMENT.

PROFESSOR CAPRON, WE'LL START WITH YOU. HOW LONG BEFORE DOCTORS ARE ABLE TO PREDICT A PERSON'S LIFESPAN AT BIRTH AND IS THAT A GOOD THING?

ALEXANDER CAPRON>> I ACTUALLY THINK IT'S FURTHER AWAY THAN THAT LITTLE CLIP FROM "GATTACA" WHICH SUGGESTS THAT'S NOT THE NEAR DISTANT FUTURE, BUT CERTAINLY THERE ARE WAYS OF PREDICTING PARTICULAR RISKS OF DISEASE AND THOSE THAT ARE CAUSED BY A SINGLE MUTATION ARE THE ONES WE CAN DO NOW. THE MORE COMPLEX THINGS, ATTENTION DEFICIT DISORDER WHICH WAS MENTIONED THERE, AND THE LIKE, THOSE ARE FURTHER OFF.

VAL>> AND MR. HIEPLER, AS AN ATTORNEY, ARE YOU AFRAID THAT EMPLOYERS AND ESPECIALLY INSURANCE COMPANIES, OR EVEN THE GOVERNMENT, MIGHT TAKE THIS DATA AND MISUSE IT?

MARK HIEPLER>> YEAH, THE CONCERN IS, RIGHT NOW WE HAVE 44 MILLION UNINSURED AMERICANS. IF INSURANCE COMPANIES CAN GET THIS INFORMATION AHEAD, THEY ARE IN THE BUSINESS OF ACCEPTING MONEY FOR RISK. THEY CAN EVENTUALLY ELIMINATE THE RISK AND CONTINUE TO ACCEPT THE MONEY, BUT ALLOW THE GOVERNMENT TO PAY FOR EVERYONE ELSE WHO MAY HAVE A NEED.

JESS>> DR. ELDERS, IS IT TIME NOW THAT CONGRESS OR OTHER AUTHORITIES OUGHT TO BEGIN SETTING LEGAL STANDARDS OVER WHO CAN AND WHO CANNOT HAVE ACCESS TO THAT INFORMATION?

DR. JOYCELYN ELDERS>> YES, THERE'S NO QUESTION. IT'S TIME FOR US TO BEGIN TO TALK ABOUT THIS, ABOUT ETHICS, THE LAWYERS, THE DOCTORS. IF WE DON'T TALK ABOUT IT, WE'LL BE DOING IT AND WE'LL HAVE NO STANDARDS BY WHICH TO JUDGE.

JESS>> AND THERE ARE NONE IN PLACE NOW?

DR. JOYCELYN ELDERS>> THERE ARE NONE IN PLACE NOW.

JESS>> THERE HAVE BEEN NEW ADVANCES IN REPRODUCTIVE TECHNOLOGY. TODAY SOME COUPLES CAN ACTUALLY CHOOSE THE SEX OF THEIR CHILDREN THROUGH MEDICAL ENGINEERING.

VAL>> BUT JUST BECAUSE IT'S POSSIBLE, SHOULD DOCTORS INTERFERE WITH A MATTER ONCE LEFT TO FATE? IT'S AN ETHICAL QUESTION CONFRONTING NOT ONLY PHYSICIANS BUT PARENTS. WHO'S RIGHT? YOU DECIDE. HERE'S PHILIP BRUCE.

>> SHE LIKES HAVING HER FINGERS AND HER HANDS RIGHT UP BY HER FACE. YEAH, ARE YOU GOING TO TALK?

PHILIP BRUCE>> ON THE SEVENTH FLOOR OF L.A.'S GOOD SAMARITAN HOSPITAL, JESSICA ANN KIRKPATRICK MILLER IS 22 HOURS OLD.

>> JESSICA IS OUR LITTLE MIRACLE BABY. SHE WAS CONCEIVED BY FERTILITY TREATMENTS AFTER TWO YEARS OF TRYING.

PHILIP BRUCE>> JESSICA HAS TWO MOMS, HER BIRTH MOTHER, JULIE, AND JULIE'S PARTNER, ANN. LIKE MOST PARENTS, THEY WANTED A HEALTHY BABY, A GIRL OR A BOY.

>> IT WAS INTERESTING WHEN WE DID THE FERTILITY TREATMENTS. ONE OF THE THINGS THEY OFFERED WAS ACTUALLY A SEX SELECTION.

PHILIP BRUCE>> GIVEN THE CHANCE TO CHOOSE THE SEX OF THEIR BABY, JULIE AND ANN TURNED IT DOWN.

>> WE JUST WANTED TO GET PREGNANT.

PHILIP BRUCE>> JUST DOWN THE HALL, THOMAS BLAKE LOGAN IS TAKING ONE OF HIS FIRST NAPS.

>> WE WANTED A BOY OR A GIRL. (LAUGHTER) EITHER ONE WOULD HAVE BEEN NICE. IT'S A LITTLE STRANGE. I'M NOT USED TO SAY "HE" YET.

PHILIP BRUCE>> HIS MOM, NICOLE, WOULDN'T BLAME ANY PARENT FOR PRE-SELECTING THE SEX OF A BABY, BUT IF SHE HAD THE CHANCE HERSELF, SHE'S NOT SURE SHE'D TAKE IT.

>> HOW WOULD YOU CHOOSE EVEN? I DON'T KNOW HOW YOU'D CHOOSE.

JOY PABLO>> ISABEL, YOU WANT TO TRY THIS IF IT'S RIGHT?

PHILIP BRUCE>> 34-YEAR-OLD, JOY PABLO, KNOWS EXACTLY HOW SHE WOULD CHOOSE. SHE SAYS IT'S NOT A SELFISH REQUEST. IT MAY BE A MATTER OF LIFE AND DEATH.

JOY PABLO>> SEE IF IT'S TOO HOT.

PHILIP BRUCE>> A YEAR AFTER SHE HAD HER DAUGHTER, ISABEL --

JOY PABLO>> I WAS DIAGNOSED WITH BREAST CANCER, STAGE 1. I HAD A TOTAL MASTECTOMY DONE OF THE LEFT SIDE.

PHILIP BRUCE>> -- THEN HER CANCER RETURNED TWICE.

JOY PABLO>> IT'S BEEN REALLY HARD.

PHILIP BRUCE>> BUT AFTER SEVERAL ROUNDS OF CHEMOTHERAPY AND RADIATION, SHE'S NOW IN REMISSION. SHE WANTS TO HAVE ANOTHER CHILD SOMEDAY, A BOY WHO WON'T INHERIT HER RISK OF BREAST CANCER.

DR. JAROSLAV MARIK>> COME AND SIT DOWN, PLEASE.

PHILIP BRUCE>> DR. JAROSLAV MARIK IS DIRECTOR OF THE INSTITUTE FOR REPRODUCTIVE MEDICINE AND GENETIC TESTING. HE SAYS HE HAS THE TECHNOLOGY TO HELP JOY AND OTHERS LIKE HER WHO HAVE A STRONG FAMILY HISTORY OF BREAST CANCER.

DR. JAROSLAV MARIK>> IN HER SITUATION, IT WOULD BE EASY TO GIVE HER A BABY BOY WHO IS EXTREMELY UNLIKELY -- NOT IMPOSSIBLE BUT EXTREMELY UNLIKELY -- TO INHERIT THE CANCER OF THE BREAST.

PHILIP BRUCE>> DR. MARIK SAYS IF JOY HAS A DAUGHTER, THE CHILD'S RISK OF BREAST CANCER IS 75 PERCENT, BUT A SON'S RISK ONLY ONE PERCENT.

JOY PABLO>> I'D LIKE TO KNOW MORE ABOUT THE PGD. I KIND OF KNOW A LITTLE BIT.

PHILIP BRUCE>> PGD, OR PRE-IMPLANTATION GENETIC DIAGNOSIS, MAY BE JOY'S ANSWER. TO UNDERSTAND IT, TAKE A LOOK UNDER EMBRYOLOGIST JERRY HALL'S MICROSCOPE. FIRST HE ADDS SPERM TO AN EGG. THAT FERTILIZED EGG IS NOW AN EMBRYO. THE EMBRYO DIVIDES AND, AFTER THREE DAYS, HE REMOVES A SINGLE CELL TO TEST IT FOR THE PRESENCE OF A SPECIFIC DISORDER. BASED ON THOSE TEST RESULTS, PARENTS THEN DECIDE WHICH EMBRYO AND HOW MANY TO IMPLANT IN THE MOTHER. THE TEST CAN ALSO REVEAL WHETHER THE EMBRYO IS A DEVELOPING BOY OR GIRL.

DR. RICHARD PAULSON>> SO NOW THE QUESTION BECOMES, CAN YOU OR SHOULD YOU USE THIS TECHNOLOGY FOR GENDER SELECTION?

PHILIP BRUCE>> DR. RICHARD PAULSON IS DIRECTOR OF THE USC FERTILITY CENTER. HE SAYS PGD FOR MEDICAL SCREENING IS A WAY OF THE FUTURE.

DR. RICHARD PAULSON>> PGD IS STILL KIND OF IN ITS INFANCY. WE'RE SORT OF GETTING OUR FEET WET. IT'S NOT BEING DONE THAT COMMONLY, BUT I CAN EASILY SEE A TIME IN THE FUTURE WHEN IT WILL BE ROUTINE.

JOY PABLO>> WHEN YOU'RE A PARENT, YOU WANT WHAT'S BEST FOR YOUR CHILD, SO I'M JUST LOOKING FORWARD TO THE FUTURE.

DR. JAROSLAV MARIK>> WHAT'S WRONG WITH SOMEBODY LIKE JOY COMING HERE AND SAYING, "I WOULD LIKE TO HAVE A CHILD. I WOULD LIKE TO HAVE A CHILD WHO WILL NOT INHERIT THE CANCER OF THE BREAST. CAN YOU HELP ME?" IS THERE ANY ETHICS INVOLVED IN THAT, TO HELP HER?

JESS>> WE SPOKE EARLIER ABOUT DOCTORS INTERFERING WITH NATURE, BUT DOCTORS INTERFERE WITH NATURE WHENEVER THEY CURE AN ILLNESS OR PERFORM SURGERY. PROFESSOR CAPRON, THIS IS DIFFERENT WHEN YOU'RE TALKING ABOUT CHOOSING THE SEX OF YOUR CHILD. THAT'S, I GUESS, TOO MUCH INTERFERENCE WITH NATURE, SOME WOULD SAY.

ALEXANDER CAPRON>> WELL, THIS HAS BEEN POSSIBLE FOR QUITE A WHILE USING AMNIOCENTESIS, WHICH IS A WAY OF DIAGNOSING DISEASES AND SEX IN DEVELOPING FETUSES. THE DIFFERENCE HERE IS IT'S DONE BEFORE IMPLANTATION. SO FOR PEOPLE WHO WOULD BE BOTHERED BY ABORTION, BUT WHO DON'T HAVE THE SAME PROBLEMS WITH THE DECISION TO IMPLANT ONE EMBRYO RATHER THAN ANOTHER, IN SOME WAYS THIS MAY SEEM MORE APPEALING.

THE QUESTION IN MY MIND IS HOW FAR ONE GOES FROM SOMETHING WHICH IS DIRECTLY CONNECTED WITH A DISEASE, AGAIN SEX SELECTION FOR THE SO-CALLED X LINK DISEASES LIKE HEMOPHILIA, AS AN EXAMPLE, DISEASES THAT SHOW UP IN MEN BUT DON'T SHOW UP IN WOMEN, HAS BEEN A REASON WHY GENETICISTS AND OBSTETRICIANS HAVE BEEN WILLING TO DO EVEN SELECTIVE ABORTIONS FOR QUITE SOME TIME.

VAL>> SO DOES IT COME TO IT'S FINE TO CHOOSE THE SEX OF YOUR CHILD, DEPENDING ON WHY? IS IT A MATTER OF MOTIVATION THAT DETERMINES THE ETHICS?

DR. JOYCELYN ELDERS>> WELL, YOU KNOW, I THINK IT REALLY IS PROBABLY MORE THAN THAT. WHAT MOST PARENTS WANT IS JUST A HEALTHY CHILD. BUT IF YOU'RE TALKING ABOUT SOMEONE MAKING A PRE-SELECTION BECAUSE OF A DISEASE OR BECAUSE OF FEAR OF BREAST CANCER OR WHATEVER, THEN I THINK THAT THAT BECOMES A LITTLE BIT DIFFERENT THAN JUST "I WANT A BOY" OR "I WANT A GIRL".

JESS>> BUT THE MOTHER WHO'S PRESSURED TO HAVE A BOY BY A HUSBAND WHO SAYS, "I WANT A BOY."

DR. JOYCELYN ELDERS>> WELL, YOU KNOW, I THINK MOST FATHERS, IF THEY GET A GIRL, THEY LOVE THEM JUST AS MUCH.

VAL>> WELL, LET'S SAY THEY'VE ALREADY HAD, SAY, THREE GIRLS AND THEY WANT A FOURTH CHILD AND THE ONLY REASON THEY WANT A FOURTH IS BECAUSE THEY WANT A BOY. THAT'S NOT SEXIST.

JESS>> OR VICE VERSA. LIKE JERRY LEWIS SAYING, "THINK PINK" BECAUSE HE HAD THESE BOYS. (LAUGHTER)

ALEXANDER CAPRON>> WELL, YOU KNOW, THE QUESTION, I THINK, IS WHETHER WE BELIEVE THIS IS SOMETHING THAT ONLY AN INDIVIDUAL CAN DECIDE ABOUT, THAT THERE SHOULD BE MEDICAL STANDARDS, THE DOCTOR SHOULD OR SHOULDN'T DO IT. THE VIEW AMONG MOST FERTILITY DOCTORS, UP UNTIL NOW, HAS BEEN THAT THEY WILL NOT USE SEX SELECTION JUST AS A SOCIAL PREFERENCE. BUT THEY RECOGNIZE THAT PEOPLE WILL TRY TO GET AROUND THAT IN VARIOUS WAYS, AS DO PEOPLE WHO DO AMNIOCENTESIS, AND WHO REPORT PEOPLE COMING IN SAYING THEY HAVE A FAMILY DISEASE, THEY DO THE WORKUP AND THEN, IF IT TURNS OUT IT'S A GIRL, THEY END UP ABORTING THE GIRL, ALTHOUGH LOGICALLY THEY WOULD ONLY BE SCREENING TO AVOID AN ILLNESS IN MEN.

JESS>> BUT IF HOSPITALS AND PHYSICIANS DENY THIS SERVICE TO A COUPLE, IS THERE A LEGAL ISSUE HERE?

MARK HIEPLER>> IT DEPENDS, BUT WHEN YOU --

JESS>> -- COULD YOU SUE AND INSIST THAT THEY BE GIVEN THIS TECHNOLOGY?

MARK HIEPLER>> PROBABLY NOT. AGAIN, ANYTHING EXPENSIVE, AN INSURANCE COMPANY DOESN'T WANT TO PAY FOR. SO THE TRIVIAL DECISION POSED TO DR. ELDERS OF, YOU KNOW, I'VE GOT THREE BOYS AND THREE GIRLS, I'D LIKE TO NOW HAVE ANOTHER BOY, IS GOING TO COME DOWN TO A POCKETBOOK DECISION. THE FAMILY'S GOING TO HAVE TO PAY FOR THIS. AN INSURANCE COMPANY ISN'T GOING TO COVER IT TO BEGIN WITH. THEY DON'T COVER --

ALEXANDER CAPRON>> -- JUST BECAUSE SOMEONE IS WILLING TO PAY FOR IT DOESN'T MEAN THAT IT'S RIGHT.

VAL>> PRECISELY.

ALEXANDER CAPRON>> AND, IN FACT, MOST FERTILITY SERVICES HAVE NOT BEEN PAID FOR BY INSURANCE. THE INSURANCE COMPANIES HAVE BEEN VERY SLOW TO COVER IT, SO MOST OF THIS HAS BEEN DONE AS PATIENT PAYMENT AND BECAUSE WE DON'T HAVE ANY FEDERAL RESEARCH DOLLARS. THIS IS THE ONE AREA, UNLIKE, SAY, HEART TREATMENT OR CANCER OR WHATEVER, WHICH HAS NOT BEEN DRIVEN BY THE ACADEMIC CENTERS AND BY THE NATIONAL INSTITUTES OF HEALTH BECAUSE WE'VE HAD A BAN ON ANY FEDERAL FUNDING FOR ANYTHING THAT HAS TO DO WITH EMBRYOS.

THEREFORE, THE WHOLE FERTILITY FIELD HAS BEEN FUNDED BY PATIENT DOLLARS, WHICH GIVES AN EXTRA IMPETUS TO DOCTORS BEING AGREEABLE IF PEOPLE COME ALONG AND START SAYING, "I WANT THIS, I DON'T WANT THAT". WE KNOW FROM STUDIES FOR YEARS THAT, IF PEOPLE COULD CHOOSE THE SEX OF THEIR CHILD, AN OVERWHELMING MAJORITY WOULD CHOOSE MALES AS THE FIRST CHILD. AND IF THEY DON'T HAVE A SECOND CHILD, THEN WE GET INTO THIS KIND OF IMBALANCE OF HAVING MANY MORE BOYS THAN GIRLS.

VAL>> BUT DR. ELDERS, IS THERE SIMPLY A CLEAR-CUT MORAL ISSUE THAT THE SEX SHOULD BE LEFT TO LUCK, NATURE, GOD, WHATEVER?

DR. JOYCELYN ELDERS>> WELL, YOU KNOW, I THINK THAT -- I DON'T KNOW HOW TO ANSWER THAT QUESTION, TO TELL YOU THE TRUTH. YOU KNOW, IN THE COUNTRIES THAT, YOU KNOW, LIKE ABORT THE GIRLS SO THEY COULD HAVE BOYS, WHAT IT'S DONE IN MANY CASES HAS GIVEN MORE POWER TO THE WOMEN BECAUSE THERE ARE FEWER WOMEN. SAY IN JAPAN, WOMEN ARE BEGINNING TO HAVE MORE POWER. AND COUNTRIES LIKE INDIA, IF THERE ARE FEWER WOMEN, THEY'VE GOT THE POWER NOW. (LAUGHTER) SO IT'S NOT ALL BAD, BUT MORALLY, AGAIN, I THINK MOST PARENTS --

VAL>> -- DOES IT SIT RIGHT WITH YOU, THOUGH, MORALLY?

DR. JOYCELYN ELDERS>> I WANT A HEALTHY CHILD.

VAL>> VERY GOOD. WELL, THERE IS A CHANCE FOR THOSE OF YOU AT HOME TO SOUND OFF ON TONIGHT'S ETHICS PROJECT. LOG ON TO KCET.ORG, THE WEBSITE IS THERE, AND TAKE PART IN OUR CYBER POLL. THE QUESTION OF THE EVENING: "IS IT ETHICAL FOR PARENTS TO CHOOSE THE SEX OF THEIR UNBORN CHILD?" WE'LL KEEP TABS ON THE RESPONSES AND YOU'LL SEE THE RESULTS ON THE AIR ON TOMORROW'S LIFE AND TIMES.

JESS>> NOW LET'S TALK ABOUT CLONING. SCIENTISTS IN GEORGIA CLAIM THEY HAVE CLONED A CALF FROM A PIECE OF MEAT, AND A COMPANY IN SAN FRANCISCO WANTS TO CURE BALDNESS BY FINDING A WAY TO DUPLICATE HUMAN HAIR. THAT KIND OF TALK MAKES SOME PEOPLE NERVOUS AND SOME ENVIOUS, AND PRESIDENT BUSH IS AMONG THOSE WHO ARE A BIT NERVOUS ABOUT IT. HE WANTS TO BAN ANY FORM OF HUMAN CLONING BEFORE IT EVER GETS STARTED.

GEORGE W. BUSH>> ALLOWING CLONING WOULD BE TAKING A SIGNIFICANT STEP TOWARD A SOCIETY IN WHICH HUMAN BEINGS ARE GROWN FOR SPARE BODY PARTS AND CHILDREN ARE ENGINEERED TO CUSTOM SPECIFICATIONS, AND THAT'S NOT ACCEPTABLE.

VAL>> ALL RIGHT, IS THE PRESIDENT RIGHT?

DR. JOYCELYN ELDERS>> YOU KNOW, I THINK CLONING IS GOING TO CONTINUE. YOU KNOW, WE TALK ABOUT CLONING HUMANS, CLONING FOR REPRODUCTIVE PURPOSES AS HE TALKED ABOUT, BUT CLONING IS TAKING PLACE IN OTHER COUNTRIES. THE UNITED STATES CAN SIT BACK AND SAY, WELL, I'M NOT GOING TO BE INVOLVED IN IT, JUST SAY NO. BUT THEN IF YOU SAY NO TO THAT, THEN YOU CANNOT BE INVOLVED. YOU'RE NOT INVOLVED IN MAKING THE DECISIONS ABOUT WHAT'S RIGHT AND WHAT'S WRONG. YOU CAN'T GET INVOLVED IN THE ETHICS AND I THINK WE NEED TO BE INVOLVED IN IT.

ALEXANDER CAPRON>> JOYCELYN, I THINK I DISAGREE WITH THAT BECAUSE, IF YOU LOOK, THE EUROPEAN UNION HAS PASSED LAWS AGAINST REPRODUCTIVE CLONING, THE JAPANESE ARE AGAINST IT, THE CHINESE HAVE EVEN SAID THAT THEY DON'T WANT IT. I DON'T KNOW WHAT THE INDIANS HAVE DONE YET. IT'S NOT THAT RELEVANT FOR AFRICA AND LATIN AMERICA RIGHT NOW BECAUSE I DON'T THINK THERE ARE BIG PUSHES TOWARDS IT.

WE, IN FACT, DON'T HAVE ANY FEDERAL STATUTE ON CLONING. RIGHT NOW, THERE'S A DEBATE IN THE UNITED NATIONS ABOUT AN INTERNATIONAL TREATY THAT WOULD BAN CLONING. IF WE WANT TO BE A PARTICIPANT IN THAT, WE REALLY NEED TO GET OUR ACT TOGETHER. THE REASON THE FEDERAL GOVERNMENT HAS NOT PASSED A STATUTE IS BECAUSE OF THE DEBATE NOT ABOUT REPRODUCTIVE CLONING, WHICH JUST ABOUT EVERYBODY SEEMS TO BE AGAINST, EVEN THE NATIONAL ACADEMY OF SCIENCES --

VAL>> -- AND WE SHOULD EXPLAIN, REPRODUCTIVE IS SIMPLY ANOTHER WAY TO MAKE A HUMAN BEING, AS OPPOSED TO THERAPEUTIC CLONING WHICH IS A WAY TO ACTUALLY TREAT A DISEASE OR DO SOMETHING MEDICALLY.

ALEXANDER CAPRON>> RIGHT, OR TO DO -- I THINK THE WORD "THERAPEUTIC" IS A LITTLE BIT OF AN OVERSTATEMENT. IT'S MORE RESEARCH CLONING.

VAL>> RESEARCH CLONING, OKAY.

ALEXANDER CAPRON>> BUT THE PROBLEM THERE IS THAT CONSERVATIVES IN CONGRESS DO NOT WANT TO HAVE A STATUTE THAT SAYS OKAY TO RESEARCH CLONING, BUT A BAN ON REPRODUCTIVE CLONING, BECAUSE WHAT THAT MEANS IS, IT'S ALL RIGHT TO CREATE EMBRYOS AS LONG AS YOU DESTROY THEM AND, OF COURSE, THAT'S UNACCEPTABLE TO THAT POINT OF VIEW. ON THE OTHER SIDE, PEOPLE WHO THINK THAT THE RESEARCH WILL PAY OFF IN TERMS OF DEVELOPING TREATMENTS FOR DISEASE OR UNDERSTANDING DISEASES BETTER ARE UNWILLING TO SAY LET'S HOLD OFF ON THAT FOR THE MOMENT AND JUST DO STEM CELL RESEARCH THAT DOESN'T COME FROM CLONED EMBRYOS.

JESS>> BUT CLONING JUST TO DUPLICATE YOURSELF OPENS UP A REAL CAN OF WORMS THAT BOTH OF YOU GENTLEMEN AS LAWYERS MUST HAVE SOME CONCERN ABOUT. TAKE A DIVORCE. WHO GETS CUSTODY OF THE CHILD THAT'S BEEN CLONED BECAUSE IT REALLY ONLY BELONGS TO ONE PARENT, RIGHT?

MARK HIEPLER>> THERE'S MANY LEGAL ISSUES AND YOU GO BACK TO MORAL ISSUES AND THE SANCTITY OF LIFE. HOW MUCH ARE WE GOING TO GET INVOLVED IN IT? I THINK THERE'S ONE CLEAR AREA ON THE REPRODUCTIVE SIDE. PEOPLE OF ALL FAITHS, OF ALL BELIEFS, HAVE SAID WE SHOULDN'T BE THERE, BUT MANY PEOPLE HAVE HAD CONCERN ABOUT THE SLIPPERY SLOPE. THAT IF YOU START ALLOWING IT ONE STEP BEYOND HUMAN, THEN YOU'RE GOING TO EVENTUALLY TAKE OVER AND PEOPLE ARE GOING TO BE PAYING TO CLONE THEMSELVES FOR SOME CRAZY REASON LIKE PEOPLE BUILT MONUMENTS TO THEMSELVES.

JESS>> EGO BEING ONE OF THEM.

MARK HIEPLER>> SURE, SURE.

ALEXANDER CAPRON>> WELL, ANOTHER REASON THAT'S FREQUENTLY CITED IS IF THERE'S A DEATH OF A RELATIVE. LET'S SAY A CHILD HAS DIED AND THE PARENTS ARE GRIEVING ABOUT THAT. THEY SAY, WELL, WE COULD TAKE A CELL FROM THAT CHILD AND CREATE A COPY OF THE CHILD. IN A WAY, IT'S A VERY UNDERSTANDABLE IMPULSE TO WANT TO GET SOMEONE BACK AND HAVE THEIR SPECIAL QUALITIES.

BUT THE PROBLEM IS THAT YOU AREN'T YOUR GENES. YOUR GENES ACT IN AN ENVIRONMENT. RIGHT FROM THE MOMENT OF CONCEPTION AND THROUGH THE PRENATAL PERIOD AND THEN EVERY DAY AFTER THAT, ALL THE ENVIRONMENTAL INFLUENCES DETERMINE WHO YOU ARE. THE NOTION OF LOCKING SOMEONE INTO A PREDETERMINED PATH, THAT BECAUSE LITTLE JOHNNY DID THIS, LITTLE JOHNNY NUMBER TWO IS GOING TO DO THE SAME THING, GO TO THE ZOO ON HIS THIRD BIRTHDAY, BECAUSE YOU WANT TO RECREATE, IS NOT THE NOTION OF HUMAN FREEDOM THAT IS INHERENT IN OUR BELIEF OF A LIBERAL SOCIETY.

DR. JOYCELYN ELDERS>> WELL, I THINK THIS IS WHY WE NEED TO START HAVING DISCUSSIONS ABOUT IT. RIGHT NOW, WE'RE JUST CLOSING THE DOOR AND WE'RE NOT EVEN TALKING ABOUT IT AND I THINK THAT'S HOW WE'RE GOING TO GET IN TROUBLE.

ALEXANDER CAPRON>> WELL, I'D LIKE TO CLOSE THE DOOR AND THEN TALK ABOUT IT (LAUGHTER) BECAUSE RIGHT NOW THE SCIENTIFIC RISKS, THE MEDICAL RISKS, ARE SO OVERWHELMING THAT, AS I SAY, EVEN THE NATIONAL ACADEMY OF SCIENCES, WHICH IS USUALLY NOT ONE TO SAY LEGISLATE AGAINST ANY NEW DEVELOPMENT, SAYS DON'T DO THIS, LET'S HAVE LEGISLATION TO STOP IT.

VAL>> NEXT TOPIC. IN JANUARY 2002, CALIFORNIA PRODUCED ITS OWN ETHICAL QUESTION IN MEDICINE. SHOULD A CONVICTED CRIMINAL GET AN ORGAN TRANSPLANT AT TAXPAYERS' EXPENSE?

JESS>> YOU MAY REMEMBER, A TWICE-CONVICTED FELON SERVING TIME FOR ROBBERY GOT A NEW HEART. THE SURGERY CAME AT A TIME WHEN 80,000 AMERICANS WERE ON THE WAITING LIST FOR NEW ORGANS AND MANY DIED BEFORE GETTING THEM. WHO DESERVES THE GIFT OF LIFE AND DO CRIMINALS WHO COMMITTED VIOLENT CRIMES QUALIFY? HERE'S A LOOK AT ONE MAN WHO DID.

>> THE OPERATION TOOK PLACE JANUARY 3 HERE AT STANFORD MEDICAL CENTER. A TEAM OF DOCTORS GAVE A 31-YEAR-OLD TWO-TIME FELON A NEW HEART.

>> HE CONTRACTED A FAIRLY RARE VIRAL INFECTION TO HIS HEART MUSCLE, SO AS A RESULT OF THAT, STARTED A NEGATIVE REACTION IN TERMS OF HIS HEALTH.

>> WITHOUT A TRANSPLANT, DOCTORS DETERMINED THE PRISONER WOULD DIE. MEANWHILE, DEBATE IS RAGING OVER WHETHER THERE SHOULD BE LIMITS PLACED ON THE TYPE OF TREATMENT AILING INMATES SHOULD GET.

>> IT'S NOT OUR ISSUE TO DEBATE. WE'RE BOUND BY LAW AND BY ETHICS TO PROVIDE WHATEVER MEDICAL CARE IS NECESSARY.

>> IN FACT, STANFORD MEDICAL CENTER'S BIOMEDICAL ETHICS COMMITTEE MADE THE DECISION THAT THE INMATE SHOULD GET A NEW HEART. IT'S CRITERIA? THE PERSON'S PSYCHOLOGICAL WELL-BEING AND ABILITY TO UNDERSTAND THE PROCEDURE.

BARBARA LINDBERG>> EVEN IF SOMEBODY SAID I WANT MY HEART TO GO TO A PRIEST OR, YOU KNOW, A SCHOOL TEACHER OR SOMETHING LIKE THAT, THERE'S NO WAY FOR US TO KNOW WHAT YOUR BACKGROUND IS.

>> PRISON OFFICIALS ESTIMATE THE OPERATION AND AFTERCARE COULD COST CALIFORNIA TAXPAYERS UP TO A MILLION DOLLARS.

JESS>> THE QUESTION IS, WHO DECIDES WHO GETS A HEART TRANSPLANT AND WHO DOES NOT? IS THE ISSUE FINANCIAL BECAUSE THAT PARTICULAR SURGERY COST A COUPLE HUNDRED THOUSAND DOLLARS AND MIGHT ULTIMATELY COST A MILLION DOLLARS OF TAXPAYER MONEY? OR IS THE ISSUE SIMPLY ONE OF FAIRNESS SINCE THERE ARE SO MANY PEOPLE WAITING FOR THEM? ONE FURTHER ISSUE IS THAT THIS MAN WAS A ROBBER. HE WAS NOT SENTENCED TO DEATH.

MARK HIEPLER>> WELL, HAVING BATTLED AN INSURANCE COMPANY ON BEHALF OF MY SISTER WHO HAD NO CRIMINAL PAST AND WAS A WONDERFUL MOTHER OF THREE, I HAVE AN EMOTIONAL REACTION --

JESS>> -- AND WAS SEEKING A TRANSPLANT? BONE MARROW?

MARK HIEPLER>> YEAH, SEEKING A TRANSPLANT AND IT WAS A COVERED BENEFIT. I HAVE AN EMOTIONAL REACTION THAT MANY PEOPLE IN PRISON ARE GETTING BETTER HEALTHCARE THAN PEOPLE WHO ARE IN HMO'S IN AMERICA RIGHT NOW.

JESS>> AND THE PRICE IS RIGHT.

MARK HIEPLER>> YEAH. BUT THE SECOND ISSUE, IS IT FAIR? UNDER CALIFORNIA LAW, A PRISONER GETS MEDICALLY NECESSARY CARE, DOESN'T HAVE TO FILE A LAWSUIT AGAINST THE PRISON DEPARTMENT TO GET IT, AND THAT'S WHAT THE LEGISLATURE HAS DETERMINED IS REASONABLE. THE SAD THING IS THAT THERE ARE SO MANY NON-CONVICTED FELONS THAT HAVE COVERED BENEFITS THAT HAVE PAID ALL THEIR LIFE FOR THEIR HEALTHCARE AND YET THEY'RE FIGHTING TO STAY ALIVE AND OTHERS ARE GETTING IT FOR NOTHING. THERE IS A FAIRNESS ISSUE AND IT IS A FINANCIAL ISSUE. IT DOESN'T BECOME AN ISSUE UNTIL IT COSTS SOMETHING.

VAL>> SO SHOULD WE PUT A MECHANISM IN PLACE TO PREVENT INMATES --

DR. JOYCELYN ELDERS>> -- ABSOLUTELY NOT.

VAL>> NO?

DR. JOYCELYN ELDERS>> NO. I FEEL THAT WE IN MEDICINE HAVE TO OFFER EVERY HUMAN BEING THE VERY BEST HEALTHCARE THAT WE HAVE AVAILABLE. THE PROBLEM IS, WE IN THIS COUNTRY, THE RICHEST COUNTRY IN THE WORLD, DO NOT OFFER UNIVERSAL ACCESS TO HEALTHCARE FOR ALL OF OUR PEOPLE. THE ONLY PEOPLE IN THE COUNTRY WITH THE CONSTITUTIONAL RIGHT TO HEALTHCARE ARE PRISONERS.

VAL>> BUT YOU CAN'T REALLY MEAN THAT. LET'S TAKE SOMEBODY ON DEATH ROW AND YOU KNOW THAT HE'S GOING TO BE EXECUTED IN SIX MONTHS. HE DOESN'T GET A HEART TRANSPLANT, RIGHT? SO YOU DON'T OFFER EVERYTHING.

ALEXANDER CAPRON>> THERE ARE PEOPLE ON DEATH ROW WHO SPEND A LOT OF TIME THERE AND WHO ARE EVEN RELEASED WHEN IT TURNS OUT THAT THEY WERE INNOCENT, OR THEIR SENTENCE IS COMMUTED. SO I DON'T THINK THAT WE CAN START SAYING THAT THE STATUTES WOULD PROVIDE ONE PENALTY FOR, SAY, ROBBERY AND NOW HAVE A NEW PENALTY WHICH IS THAT YOU WILL DIE WHEN YOU'RE DEPRIVED OF A TRANSPLANT TO WHICH YOU ARE OTHERWISE ENTITLED. THAT IS TO SAY, THE MECHANISM THAT DECIDES WHO GETS THE HEART IS ONE WHICH DOESN'T LOOK AT THAT FACTOR, BUT IT LOOKS AT ALL THE OTHER RELEVANT FACTORS AND HE CAME TO THE TOP OF THE LIST.

JESS>> HOW ABOUT THE ISSUE OF THOSE WHO ARE DENIED A TRANSPLANT BECAUSE OF LIFESTYLE? THOSE WHO HAVE USED DRUGS --

VAL>> -- OR LET'S SAY YOU SMOKE?

DR. JOYCELYN ELDERS>> I JUST THINK THAT WE CAN'T START HAVING THOSE KINDS OF ISSUES GETTING IN FRONT OF MEDICINE. JUST BECAUSE SOMEONE GOES OUT AND DIDN'T WEAR A HELMET ON A MOTORCYCLE AND HAS A HEAD INJURY DOES NOT MEAN THAT HE CAN'T GET THE VERY BEST HEALTHCARE THAT WE HAVE TO OFFER. I THINK WE HAVE TO OFFER EVERY PATIENT --

ALEXANDER CAPRON>> -- THE PERSON YOU DESCRIBED IS ACTUALLY THE ORGAN DONOR USUALLY. (LAUGHTER)

DR. JOYCELYN ELDERS>> BUT, YOU KNOW, WE HAVE LAWS THAT SAY YOU HAVE TO WEAR A HELMET IN SOME STATES.

JESS>> WOULD THIS ISSUE BE MOOT IF THERE WERE PLENTY OF ORGANS AVAILABLE FOR TRANSPLANT?

ALEXANDER CAPRON>> WELL, YOU'D STILL HAVE THE FINANCIAL ISSUE. I MEAN, I THINK THAT BOTH DR. ELDERS AND MARK HAVE MADE THE SAME POINT WITH WHICH I AGREE. WHAT MAKES THIS CASE SO UNBEARABLE IS THE NOTION THAT THERE ARE FORTY-SOME MILLION PEOPLE WHO DON'T HAVE ANY GUARANTEED ACCESS TO OUR HEALTHCARE SYSTEM. IF EVERYONE HAD ACCESS AND IF THE LEVEL OF CARE THAT THEY ALL HAD WAS ADEQUATE, THEN WE WOULD JUST BE FACING THE ISSUE OF THE SCARCITY OF THE ORGANS.

BUT HERE, A LOT OF PEOPLE CAN'T PUT DOWN THE QUARTER OF A MILLION DOLLARS AND THEY DON'T GET IN THE LINE AT STANFORD HOSPITAL TO EVEN COMPETE WITH THIS FELLOW IF THEY'RE THE MOST SUITABLE PERSON TO GET THE HEART. THAT IS A PROBLEM, BUT IT'S NOT A PROBLEM THAT YOU TAKE OUT BY CRITICIZING THE DOCTORS FOR TREATING THIS MAN. IT'S A PROBLEM WE DO SOMETHING ABOUT IN OUR WHOLE HEALTHCARE SYSTEM.

DR. JOYCELYN ELDERS>> YOU'RE ABSOLUTELY RIGHT. IT'S OUR FAULT THAT WE AS AMERICANS HAVE NOT DEMANDED THAT WE HAVE UNIVERSAL ACCESS TO HEALTHCARE FOR ALL OF OUR PEOPLE. THAT'S WHAT WE'VE GOT TO HAVE BECAUSE WE KNOW THAT PEOPLE DO NOT HAVE EQUAL ACCESS TODAY. YOU KNOW, YOU LOOK AT RACE, YOU LOOK AT POVERTY, YOU LOOK AT URBAN INNER CITY AREAS. YOU KNOW THAT OUR ACCESS IS NOT EQUAL.

VAL>> BUT WHAT YOU'RE PAINTING IS A UTOPIAN IDEA. OF COURSE, WE'D ALL LOVE TO HAVE ACCESS AND AFFORD THE BEST MEDICAL CARE FOR EVERYBODY, BUT WE DON'T. NEXT WEEK THIS DECISION MAY COME UP AGAIN. THEY'RE GOING TO HAVE TO CHOOSE. SHOULD IT GO TO THE INMATE OR SHOULD IT GO TO THE MOTHER WITH THREE KIDS?

MARK HIEPLER>> IF THE LEGISLATURE GOT INVOLVED, THERE'D BE A BALLOT INITIATIVE THAT WOULD PASS OVERWHELMINGLY THAT SAYS, IF YOU'RE A CONVICTED FELON, YOU DON'T GET A TRANSPLANT. I DON'T KNOW WHY THE LEGISLATURE HASN'T COME UP WITH A PROPOSITION TO DO THAT BECAUSE OF THE COST AND BECAUSE THERE ARE LIMITED RESOURCES. AT THE SAME TIME --

JESS>> -- AND BECAUSE IT'S A MORAL AND ETHICAL ISSUE, IS IT NOT?

DR. JOYCELYN ELDERS>> THE MORAL ISSUE IS THAT WE AS AMERICANS DON'T HAVE HEALTH INSURANCE FOR EVERYBODY, BUT AS FAR AS AN ETHICAL ISSUE AS TO THE DOCTORS TREATING THIS PATIENT, EVERY PATIENT SHOULD BE TREATED THE SAME ONCE THEY BECOME A PATIENT.

MARK HIEPLER>> I AGREE WITH DR. ELDERS ON THAT, THAT WE DO HAVE HEALTHCARE FOR EVERYBODY. IN FACT, THE PRISONER GETS HEALTHCARE BETTER THAN THOSE OF US THAT PAY OUR INSURANCE PREMIUMS AND HAVE TO BATTLE THEM WHEN THEY DON'T.

VAL>> AND THAT WILL HAVE TO BE THE LAST WORD. THANK YOU SO MUCH.

JESS>> DR. JOYCELYN ELDERS, PROFESSOR ALEXANDER CAPRON, MARK HIEPLER, THANK YOU FOR JOINING US TONIGHT. WE APPRECIATE IT.

VAL>> TOMORROW ON LIFE AND TIMES, A LOOK AT THE HAVES AND HAVE-NOTS OF SOUTHERN CALIFORNIA'S RED-HOT HOUSING MARKET. PLUS IF YOU WANT TO HEAR MORE ABOUT TONIGHT'S ETHICS PROJECT AND OUR FUTURE SPECIALS, LOG ON TO KCET.ORG AND CLICK ON "THE ETHICS PROJECT" ICON.

JESS>> NOW FOR ALL OF US HERE AT LIFE AND TIMES, HAVE A GREAT EVENING.

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