Background and evolution of Bioethics

2019
 Define bioethics
 Explain the history and evolution of bioethics
 Describe ethical concepts
 Explain the ethical theories
• The study of the ethical and moral
implications of new biological discoveries and
biomedical advances (online free Dictionary)
• The study and consideration of what is right
and wrong in biological advances and
activities (Cambridge advanced Learner’s
Dictionary)
• A branch of ethics that studies moral values
in the biomedical sciences
• Word bioethics-invented by Sargent Shiver-in
search of an application of moral philosophy
to medical dilemmas
• In 1969 Van Rensselaer Potter, a medical researcher,
used the word ‘bioethics’ to describe the studying of
the link between human value and biological
knowledge
 Life-the human experience of joy and
tragedy, values and beliefs; (Mooney, 2009)
 The meaning attached to ‘life’ is central to
bioethics and rests in individual people
◦ i.e. Who lives? Who should benefit from what?
 Triggered by a series of public revelation of
gross abuses of human subjects unknowingly
coerced into participation in dangerous non
therapeutic research e.g.
◦ Tuskegee Syphilis study
◦ Willowbrook Hepatitis study
 Focused on psychiatric issues of civil
commitment and the patients right to refuse
treatment
 Led to a new patient-centred ethic i.e.
◦ often advocating patients genuine participants in
their care rather than only the objects of diagnosis
and treatment
 Reflected and responded to specific
contemporary critiques of biomedical practice
 Enhanced medical power over patients and
research subjects by legitimate medical
institutions and practice i.e.
◦ Consent form is a legal document
 Currently-the advancement of medical
technology have opened new responsibilities
among health care providers
◦ Decision making i.e. use of technology to prolong
life
 Rights
◦ Considered fair or morally acceptable by most
people (Cambridge advanced learner’s Dictionary)
 Human rights
◦ The basic rights and freedoms to which all humans
are entitled, often held to include the right to life
and liberty, freedom of thought and expression,
and equality before the law (online free dictionary)
 Value
◦ Personal beliefs about the truth, thoughts and
behaviour of a person
 Value clarification
◦ a method whereby a person can discover his or her
own values by assessing, exploring, and
determining what those personal values are and
how they affect personal decision making.
• Obligation
– having to do something as a result of a
commitment you have made or a duty you have to
fulfill.
• Rules
– a principle or regulation governing conduct, action,
procedure and arrangement
• Duty
– An act or a course of action that is required of one
by position, social custom, law, or religion
 Represent the grand ideas on which guiding
principles are based.
 Attempt to be coherent and systematic,
striving to answer the fundamental practical
ethical question i.e.
◦ What ought I do?
 These include
◦ Naturalistic
◦ Deontology
◦ Teleogy/utilitarian
• Natural Law
– Posits that man should live life according to an
inherent human nature.
– often linked to particular religious beliefs.
– Based on two presumptions
• An action is good if it is in accord with human nature,
bad if it is in contrary to that nature
• The nature of things can be discovered by reason
 Two principles important for health care are:
◦ Principle of double effect-four conditions need to
be met before an act can be justified
 The act itself must be morally good or at least
indifferent
 The good effect must not be achieved by means of bad
effect
 Only the good effect must be intended
 The good intended must be equal to or greater than
the evil
 The principle of totality
◦ Individuals can ethically dispose of their organs or
interfere with those organs’ ability to function on to
the extent that the wellbeing of the whole body
requires it
 Strength
◦ offers individual freedom from presumption
◦ Decreases the influence of confusion in the society
◦ Offers wholesome simplification reflecting aspects
of nature-without human artificiality
 However
◦ Life and existence not simplified deeply, no
adequate explanation
• Also known as consequencialism
• Morality of an act is determined solely by its
consequences
• Nothing is good or bad in itself-the results
matter (end justifies the means)
• An act is considered ethical if it produces or
is intended to produce the best long term
consequences when compared with other
available alternatives
 The best consequences for:
◦ Everyone (utilitarianism)-one should always act to
produce the greatest ratio of long-term happiness
over unhappiness for everyone (the greatest good
for the greatest number of people)
Self Study
◦ Self (Egoism )
◦ Some (Limited consequentialism)
 Strength
◦ Considers the majority when policies are made
 However
◦ Does not consider individual rights
 Also known as non-consequentialism
 Argue that some actions are right or wrong in
themselves and not because of the good or
evil results they produce
 Governing behaviour is duty
 When one acts from duty, the actions are
considered ethical
 Strength
◦ Considers one’s duty/obligation when carrying out
an action regardless of the consequences
 However
◦ By ignoring the consequences in assessing morality
the theory ignores a vital element of decision
making
 Pluralism-ethical position combining both
consequentialism and non-consequentialism
◦ combine the best elements and avoid the worst
pitfalls
 Every person has a right to equal use and
application of liberty
 Social and economic inequalities should
evolve in such a way that the greatest benefit
is accessed to the least advantaged and
attached to positions that are open to all in
equal and fair exchange
 Strengths
◦ Proposes equal treatment to all
 However
◦ Very difficult to determine who benefits scarce
resources