BIOETHICS1 AND ETHICS

IN CANCER RESEARCH
RONALD LEE HANCOCK

INTRODUCTION
The following should be considered a personal viewpoint of ethical as-
pects taken from over fifty years of cancer research experience by the
writer (M.D./Biochemist) and includes some commonly known issues as
well as, perhaps, a few new ideas.

GENERAL CONCEPTS
One should generalize moral and ethical ideas since morality/ethics are
fuzzy sets that deal as biogradients in the evolution of the dawn of mind.
Thus, no absolutes exist for the ideas of right and wrong. Morals and
ethical behavior are involved with situations that are a function of time,
e.g., ethics of that era or considerations of the situation of that moment, etc.
Choices of moral behavior cannot be made in absolute terms, because
they cannot be put down as principles or rules of action. The reason for
this is that each individual according to his/her own philosophy/ theology
must elect a certain course of action, e.g., in the discussion here—to be
treated and live or not to be treated and die (in the most simplistic case).
However, in this writing commonly used attitudes towards ethics will
be used in attempting to discuss certain issues.

BIOETHICS
As a generalized principle, there may be rules in social settings of other
hominids, e.g., monkey interactions with dominate males and the respon-
sibility of rearing the young and adopting orphan baby monkeys, etc. that
leads to ethical behavior 2. Therefore, ethical behavior can be considered
to be a biogradient—a function of social behavior among all biological
organisms. An extension of this concept is to say that it is difficult to speak
in terms of human ethics when the problem includes at least one other

The Nevada Institute of Theoretical Medicine, 3670 Grant Drive, Suite 102, Reno, NV, 89509,
USA. / [email protected]
Last colaboration in Ludus Vitalis: “Biological inevitableness”, vol. XIII, num. 24, 2005, pp.
25-28.
Ludus Vitalis, vol. XIV, num. 25, 2006, pp.247-250.
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specie. In fact, the human attitude is to limit ethical problems to humans

and thus be blinded to holistic aspects.
The evolution of hominids has resulted in giving the human species the
power to selectively use other species, e.g., mice/rats in attempting to
ascertain the nature and treatment of cancer. This usage becomes, in itself,
a moral issue. Do we have the right to subject other species to these
experiments no matter how humanely it is carried out? In the realm of
cancer research, scientists are confronted with the task of squeezing out
small morsels of truth from “Mother Nature’ who tenaciously holds on to
these truths.
There are attempts to reduce the use of whole organisms by using
transplanted human tumors in nude mice. Nude mice have a mutation
which eliminates T-cells which gives a partial immune deficiency and
allows heterotransplants to be made 3. One can use tissue culture experi-
ments to do preliminary experiments, thus alleviating certain painful
procedures.
There are also attempts to reverse dysdiffentiated (cancer) cells back to
normal cells by inducing redifferentiation, e.g., butyric acid induces
erythroid differentiation of leukemic cells 4. Such attempts to eliminate
cancer from humans are being sought and can eventually be used for
treatment of cancer for all kinds of vertebrates.
Humans have evolved introspective capacities of the mind and thereby
have acquired the responsibility of ‘correct’ attitudes towards all life. The
more organisms become introspective, evolutionarily speaking, the more
there are moral responsibilities and ethical issues that arise.
With the powers of the human mind and its ability to select, the
remainder of the biological world is at the mercy of the human mind—
thus, the importance of a humanitarian based ethic and a humane treat-
ment of all life. What should be taught, in practical terms, is a respect for
life. For example, the realization that the pattern or array of electron
transport system components in a mitochondrial membrane with all of its
intricacies, which is a thing of biological beauty, can be destroyed if the
organism receives a piece of lead in a strategic place. Education should be
broadly taught that instills such concepts. This might stop a wide spectrum
of destructive action from Oakland, California gang activities to African
political genocide warfare. (It is understood that in reality a dichotomy
exists for this idea because of the juxtaposition in these two examples of
the lack of education and knowledge component for mitochondrial mem-
branes and the economic requirements that would allow for such an
education; nevertheless, the point is made.)
One can argue from a pure biological standpoint, that no specific
species should ethically be ‘better’ than another. Therefore, there is no
absolute reason, except a theological one, to select, say, human disease to
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be cured by mouse experiments or visa versa. Although, one could say that
the first law of biology—the survival of the individual (extended to sur-
vival of the species)— gives humans the right to protect and pursue the
survival of humans. The consequence would be to assure the continuation
of humans by getting rid of the plague and cancer, etc. This argument
enters into the realm of bioethics which can be considered on broader
terms than classical human ethics.

ETHICS
The ethics of allowing patients to die arises when considering the quality
of death issue and this, in turn, arises because of the fact that cancer many
times results in a lengthy debilitating and pain-inducing situation that
eventually leads to death. Thus, when cancer is compared to a disease with
a short term prognosis, such as a massive myocardial infarction, the quality
of death, i.e., dying of a heart attack, is better when considering the
amount of suffering incurred.
The development of chemotherapy has allowed victims of cancer to
choose, in many instances, to live or to die within a relatively short period
of time. The development of alkaloids, such as morphine, has allowed the
reduction in pain/ pain recognition, which alleviates a great deal of
suffering by terminal diseases such as cancer, albeit leading the victim into
drug dependency. The moral dilemma of ‘to treat or not to treat’ cancer
cases is done on an individual basis between a physician and a patient.
Take for example, a prostate cancer case in a sixty year old man who has
not received a total prostatectomy. This usually allows a relatively slow
but progressive course of the disease. However, such a case might develop
a brain metastasis within five years and an ensuing death at sixty-five
instead of living with treatment to perhaps eighty or ninety. Yet, the
patient with a prostatectomy/chemotherapy might also die of metastasis.
Thus, the art of the application of ethical reasoning is required for each
individual case. These are common ethical considerations confronting
medical oncologists today as they attempt to treat their patients. And these
issues are involved in larger issues such as theories of progress and the
significance of life.
With the advent of chemotherapy, such as the early use of the war gases
sulfur mustard and nitrogen mustard for treatment of leukemia, it seemed
a moral duty for physicians to treat patients, where no treatment was
previously available. Such treatment is thought by some theologies to be
an intervention of ‘God’s will’. Modern day chemotherapeutic ‘cocktails’
are capable of curing acute lymphacytic leukemia. It becomes a moral issue
for society in attempting to deal with beliefs of ‘no treatment’ vs. ‘treat-
ment’.
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SUMMARY
Bioethics/ethics is, in mathematical terms, a fuzzy set and a function of
time. Therefore it has no absolutes. Two of the biggest questions that arise
from a generalized ethical behavior in cancer research are as follows.
Firstly, in basic cancer research, do we have the right to subject other
species to experimental efforts simply because we have the ability to do
so? Secondly, in clinical cancer research, is the moral dilemma that many
times faces the clinical oncologist—do we have the right/option not to treat
a victim of cancer (given that the option is available, i.e., an appropriate
chemotherapeutic agent exists, etc.) in attempting to extend that person’s
life? The choice for society in assessing the ‘correct’ course of action
involves a broad array of philosophical questions including euthanasia.

NOTES

1 The writer uses the terms bioethics and ethics as follows. Bioethics includes
ethical/moral attitudes that arise among diverse biological forms, including,
of course, those involving man. For example, an anthropologist might discuss
a moral issue when speculating on social structure involving another homi-
nid besides Homo sapiens such as Homo neanderthalensis or habilis or some prior
non-Homo species. Therefore, bioethics is the more general set that includes
the set termed classical human ethics.
2 Hancock, Ronald Lee, “Towards a generalized biotheology,” Ludus Vitalis
(submitted).
3 Kato, T., Hancock, R.L., Mohammadpour, H., McGregor, B., Manalo, P.,
Khaiboullina, S., Hall, M.R., Pardini, L., and Pardini, R.S. (2002), “Influence of
omega-3 fatty acids on the growth of human colon carcinoma in nude mice,”
Cancer Lett. 187: 169-177.
4 Witt, O., Sand, R., and Pekrun, A. (2000), “Butyrate-induce erythroid differen-
tiation of human K562 leukemia cells involves inhibition of ERK and activa-
tion of p38 MAP kinase pathways,” Blood 95: 2391-6.