Lecture 1

Bioethics as a science.
History of bioethics

It is worth noting right away that the problem of defining bioethics has not been
fully resolved. It is obvious from the name that it is an interdisciplinary science. It
generally reflects the 21st century trend towards integrating knowledge that touches
upon human studies issues. How is bioethics built interdisciplinary ?

On the one hand, the name contains the word "ethics". Ethics is a philosophical
science, the object of which is morality as a form of social consciousness. Ethics
analyzes the nature of morality, its internal structure, as well as the historical stages of
its formation. Ethics implements various approaches, pursuing the goal of analyzing
values and conflicts of values. It should be emphasized separately that moral
experience is universal, but moral values are constantly changing. If we are talking
about bioethics, it arises at the junction of socio-humanitarian knowledge and the
development of biomedical sciences.
Bioethics is an interdisciplinary field of knowledge, an academic discipline , and
a social institution that emerged as a response to the complex anthropological and
ethical problems generated by the rapid progress of biomedical science and practice.
It is also worth noting the ecological aspect of bioethics. Bioethics as a science of
survival: not everything that is technically possible is morally correct, for the sake of
the future of humanity it is necessary to control human intervention in the environment.
The authorship of the term "bioethics" is controversial. For example, B. Yudin
insists that the history of bioethics should be counted from the moment of the
publication of Fritz Jahr's article "Bioethics: Reflections on the Ethical Relationship of
Man to Animals and Plants" (1927), where the term "bioethics" was used in connection
with the relationship of man to animals. Jahr introduces the term "bioethical
imperative", which requires treating every living being not as a means, but as an end
(paraphrasing Kant's famous categorical imperative).
 In the literature, there is a widespread position that the modern meaning of the
term "bioethics" should be counted from the 70-80s of the 20th century. In particular,
they point to the works of the American Van Rensselaer Potter. In his 1988 book,
Potter connects bioethics with the science of survival, which assumes the unification of
biological knowledge and universal human values.
Bioethics, according to Potter, is a special kind of knowledge that answers the
question of how to use biomedical data, how to achieve good. Potter linked bioethics
with the tasks of saving humanity. There are several ideological foundations of
bioethics. Among them are anthropocentrism and biocentrism, which differ in a
number of points at once: • by the type of cognitive attitude; • by the pragmatic attitude;
• on the psychology of perception of the living.

Anthropocentrism assumes that the focus is on the human being and his needs,
and only humans are capable of having values, and therefore humans have a moral duty
only to humans.
Biocentrism assumes a broader interpretation, according to which humans have a
moral duty to all living beings on earth, are called upon to protect all living things, and
the focus is on "bios", that is, life. All living things on earth have meaning, and not only
pragmatically, but also morally.

What and how does bioethics study?

It is worth emphasizing once again that bioethics is a combination of the system

of biological knowledge with the knowledge of the system of human values to identify
problems associated with the danger to the survival of humanity in the man-made
world.
Bioethics has its own subject – the problems generated by the development of
biomedicine. Bioethics is thus a set of principles warning about the negative
consequences of biomedical technologies not only for humans, but also for society as a
whole.
Bioethical issues concern four main groups of problems:
1) problems associated with the beginning of human life and the development of
reproductive
technologies;
2) problems of death and dying;
3) problems of the possibility of intervention in the physical and mental
human integrity;
 4) problems of conflicts between the interests of individuals and the interests of
society and states in matters of health protection.

It is important to consider how bioethics works as a social institution. In this

aspect, bioethics implies the study of the social, legal and ethical consequences of new
medical technologies. In addition to a strictly scientific understanding, bioethics is a
way of public discussion of these problems.

What methods does bioethics use?

Descriptive research is a study based on the description of real relationships,

surveys, opinions, and positions of actors. In this sense, bioethics is a systematic study of
human behavior within the framework of life and health sciences, conducted in the light
of moral values and principles.
Bioethics is primarily a question of how people actually behave when they find
themselves in a real biomedical situation. The historical example of the first dialysis
machine in a Seattle clinic shows how doctors refused to put patients on a waiting list
for this procedure on medical grounds alone. A special platform was created where
representatives of different knowledge made a decision in a joint discussion. Current
bioethics (in the second half of the 20th century) moved even further from considering
specific cases.
Normative study is a study based on traditional moral values, rules and norms.
Bioethics involves a systematic study of the moral parameters (including moral
assessment, decisions, behavior, guidelines, etc.) of the achievements
of biological and medical sciences with the involvement of various ethical
methodologies in an interdisciplinary field.
These norms have different sources: religious education, academic traditions,
everyday ideas. Bioethics records these ethical principles and helps to apply them to
different subjects of medicine.

Law and Bioethics

It is worth mentioning that bioethical issues are often reduced to legal ones. This
is partly due to the moral relativism inherent in the current era. Many believe that there
is no single ethical position, and if we can talk about generally accepted morality, then
only about what is enshrined in law
 In addition, law, as a basis for the ethical assessment of an act, can often record
only the ethical minimum. V. Solovyov distinguished law and morality on three points:
1) law is the lowest limit or minimum of morality;
2) law is a requirement for the external implementation of the minimum, whereas moral
interest refers to its internal existence in a person;
3) a moral requirement presupposes free fulfillment, while legally allows for direct or
indirect coercion.

Bioethics aims to ensure that existing laws acquire moral justification and
relevance in the current conditions of currently existing biomedical practices.
Bioethics seeks to regulate the system of human relations in the system of other
relations.
The example of the racial medicine exhibition in Dresden shows a clear
discrepancy between the law and the ethical coloring of biomedical practices. K. Jaspers
argued that the 20th century gave rise to a situation in which evil was legalized within
states and acquired support in legal documents. Consequently, normative regulation
alone does not solve the problems associated with biomedicine.
We can summarize four aspects of the relationship between law and bioethics:
1. The influence of legal traditions on the nature of bioethical thinking. Legal the
collision launches a bioethical discussion.
2. Bioethics as a source of development of law.
3. Bioethics as a mechanism of social control additional to law
4. Legal norm as an ethical norm (minimum level of morality).

Positions on the relationship between philosophy and science

It is quite clear, at first glance, why a course on bioethics is taught by

philosophers. Ethics is a section of philosophical knowledge, and questions about the
life and death of a person are traditional philosophical questions. But the history of the
development of thought shows that the functions of philosophy in relation to science
have changed.

There are several positions that interpret the ratio differently philosophy and
science:
• Natural philosophy: philosophy is the science of sciences, and any particular
science is applied philosophy. Philosophy is declared the queen of sciences, and the
general truths of philosophy are placed above the truths of natural science in their
epistemological status. Philosophy is primary in relation to science both from the point
of view of genesis and from the point of view of cultural significance (Schelling,
Hegel).
• Positivism: science, according to O. Comte, is philosophy itself. The sciences of
nature are fundamentally separated and independent from philosophy, and,
moreover, science should avoid any influence of metaphysics, remaining within
its own limits. This view is characteristic of the New Age, when science became
 isolated and came to the forefront of society, becoming a reference point for the
best knowledge.
• Anti-interactionism: there is a dualism in the relationship between philosophy and
science. Science and philosophy are absolutely culturally equal and sovereign, but
at the same time they are devoid of interconnection and mutual influence
(philosophy of life). The position is based on the fundamental division of the
sphere of knowledge into
natural sciences and humanities.
• Dialectics: between concrete scientific knowledge and philosophy there is internal
necessary and essential connection.

Philosophy and medicine

The functions of philosophy are changing today. Developed science does not
need philosophical intervention in all areas. At the same time, modern philosophy
interacts with science both in terms of the critical function and in terms of the
constructive function. Philosophy plays the role of a general heuristic.
Philosophy today is called upon to analyze scientific rationality. What does it mean to
study something? What are the limits of knowledge? What method leads to true
knowledge? What is a scientific law? What is a diagnosis in medicine? What is the
relationship between knowledge and intuition in making a diagnosis? Philosophical
reflection raises many complex issues concerning the sphere of medical action.

Philosophy, in relation to natural scientific theories, thus performs the function

of a deductive foundation and an interpretative matrix, facilitating the
understanding of the theory and its integration into the general background of
rational knowledge.

In addition, philosophy relates the vision of man accepted in society in a

particular period to the capabilities of modern man. How does man use knowledge
and technology? Does this use contribute to the good of humanity?

Situations when different visions of man, different statuses of knowledge,

different assessments of worldviews collide in society are a reason for interdisciplinary
interaction. Philosophy promotes understanding of the goals of specific sciences,
interpretation of its ambiguous results, assessment of the consequences of the
application of scientific knowledge.

Prospects for the development of medicine

The concept, proposed by the American geneticist Leroy Hood, received name
4P-medicine:
• personalized • predictive
(predicting the likelihood of pathologies)
• preventive (preventing the development of diseases)
• participatory
 This concept is to first describe a personal model for a person in health and
disease based on genomic research, and then move from personal descriptions to
prediction and treatment, with the active participation of the patient in the process of
medical interaction.

It is the participatory aspect of medicine that is linked to social development

and therefore cannot be reduced to the natural science context. In this sense, the role
of citizen science in obtaining and using knowledge is increasing. Today's stage of
digitalization increases our involvement in the process of scientific development.

Discussion on the relationship between science and morality

Today bioethics deals with situations that do not strictly concern

specific communication between doctor and patient, but extends to all relationships
and permeates the whole society. In society, the boundaries of the clinic and
laboratory are destroyed. The modes of research and care are intertwined and
create new problems of a socio-humanitarian nature. Therefore, it is impossible to
speak of morality as a separate area of consideration of medical relations.
Morality has long been territorial and has not imposed external obligations on
the scientific community. In the science of the 20th-21st centuries, the relationship
between science and morality is changing. In science, the tasks of obtaining and
applying knowledge have long been solved separately. R. Oppenheimer, the
creator of the nuclear bomb, said that in modern science, the distinction between
danger and safety within the research process is disappearing. Consequently,
there is a need for social expertise and control of scientific achievements.

In the second half of the 20th century, scientists can no longer absolve
themselves of responsibility even for obtaining new knowledge. A significant part of
modern science lives off the support of technological applications. For example, any
genetic manipulations performed on the basis of a computer model are fraught with
the possibility of identifying effects that are not detectable during modeling. In this
case, it turns out that we actually learn what we create, and this inseparability of
obtaining knowledge and its application is one of the arguments in favor of the fact
that not only technology, but also knowledge itself is subject to moral evaluation.
The goals of science itself are now increasingly determined by external factors.
Therefore the question of whether truth can be prohibited in the name of saving
morality has no answer. Accordingly, the moral culture of a scientist is one of the
main components of scientific professionalism. Our task is to outline the spectrum of
bioethical situations, to indicate the moral guidelines on which bioethics builds
communication specialists with non-special
 Lecture summary

Bioethics is an interdisciplinary field of research and discussion that addresses the moral foundations and
issues of medicine and healthcare, as well as closely related contemporary scientific disciplines such as
biology, genetics, biotechnology, and consciousness studies. Medical bioethics or biomedical ethics
represents a significant point of philosophical inquiry. The formation and development of bioethics are
closely linked to the overall transformation of traditional ethics, as well as medical and biological ethics in
particular. This evolution can primarily be attributed to the heightened attention to human rights—
specifically patient rights in medicine—and the emergence of cutting-edge medical technologies, which give
rise to numerous urgent problems requiring immediate solutions in terms of both law and ethics.

Furthermore, the establishment of bioethics is shaped by the tremendous advancements in the technological
support of modern medicine and significant achievements in medical practice, made possible by
breakthroughs in transplantation, genetic engineering, the advent of new life-support equipment, and the
accumulation of practical and relevant theoretical knowledge. All these processes have intensified the moral
dilemmas faced by doctors, patients’ relatives, and healthcare professionals.

Questions arise regarding the limits of medical assistance: What boundaries should be maintained in
sustaining the life of an incurably ill person? Is euthanasia acceptable in modern society? When should the
moment of death be defined? At what point can a human embryo be considered a living being? Are abortions
permissible? These are just some of the questions confronting both physicians and society in light of the
current advancements in medical science.

Medical bioethics is a research field of an interdisciplinary nature that began to take shape around the late
1960s to early 1970s. The term "medical bioethics" was introduced by V.R. Potter in 1969. Today, its
interpretation is highly diverse. Sometimes, bioethics is equated with biomedical ethics, limiting its scope to
ethical issues in the doctor-patient relationship. In a broader sense, "medical bioethics" encompasses various
social issues and challenges related to the healthcare system, as well as humanity's relationship with animals
and plants. Additionally, the term "medical bioethics" indicates that it focuses on the study of living beings,
regardless of whether they are used in therapy. Thus, medical bioethics is aligned with the achievements of
modern medicine and biology in justifying or addressing the moral dilemmas that arise during scientific
research.

In a historical context, medical ethics exists in four main models:

1. Hippocratic Model (e.g., "Hippocratic Oath," "On the Law"): The primary ethical requirement
articulated by Hippocrates is "do no harm," the moral essence of which serves as a fundamental medical
guarantee for protecting human life. This leads to the following tenets:
a) A physician's actions must benefit the patient;
b) Maintenance of medical confidentiality;
c) Respect for human life.
Hippocrates laid the groundwork for paternalism in medicine.
2. Paracelsus Model: This model defines the moral relationship between physician and patient based on
the principle of "do good." It emphasizes ethical principles such as humanism, compassion, and
beneficence. Paracelsus viewed the purpose of healing as an act of love for others. Love is the
foundation of medicine; the physician's strength lies in their heart, and healing should be guided by God
and supported by the physician's experience. Paracelsus introduced suggestive therapy as an effective
component of treatment, highlighting the importance of the patient's faith in the physician.
3. Deontological Model: This model emerged in the late 18th to early 19th centuries and emphasizes moral
integrity in medical practice. The deontological model comprises a set of mandatory rules governing the
relationships between healthcare providers and patients, their relatives, colleagues, and administration. It
is based on the principle of "duty," meaning that the morality and professionalism of healthcare
providers hinge on their readiness and ability to fulfill the ethical demands imposed by society. Today,
there are moral guidelines for each medical specialty. Medical deontology plays a significant role in
nursing, as nurses serve as assistants to physicians (subordinate roles) while also independently assessing
patient needs and nursing care. This duality requires them to exhibit ethical behavior and a high level of
 cultural competence. Soviet surgeon N. Petrov remarked that a good nurse should be valued and
respected, though not all physicians recognize this. The highest moral duty of a nurse is selfless service
to people, which is inseparable from high spirituality and a compassionate heart.
4. Biomedical Model: This model is based on the principle of respecting human rights and dignity. It
implies a transformation in the nature of the relationships between healthcare providers and patients,
particularly overcoming paternalism in medicine and adopting new relational models based on patient
autonomy and respect for their rights (informational, collegial, and consultative models). The main
principles of the biomedical model include autonomy.

Patient autonomy, informed consent, "do no harm," confidentiality, and truthfulness are key principles in
medical ethics. The ancient Indian medical oath "Charaka Samhita" (1st millennium BCE) states that a
physician must care for the patient's life, refrain from disclosing information about the patient and their relatives,
and maintain personal cleanliness and health, directing all efforts towards the primary goal of healing people.

In ancient Rome, the idea of medical ethics was refined by the famous Galen, who, as a follower of Hippocrates,
sharply criticized self-interest and envy among physicians. Another notable Eastern physician, Avicenna (Abu
Ali Ibn Sina, 980–1037), also developed his own ethical code, urging physicians to be responsible for their
professional duties and to prioritize communication, as the physician's words can also heal.

Based on the teachings of Hippocrates, Galen, and Avicenna, and influenced by Christian ethics, the deontology
of medieval medicine was established. Later, medical ethics was supplemented by principles of humanism,
justice, and others.

Both the Helsinki Declaration (1964) and the Nuremberg Code (1947) are well-known and respected documents
that have contributed to medical ethics.

International Documents on Bioethics: As medical bioethics evolved, it gained significant international status,
evidenced by the establishment of numerous international structures and organizations, the conduct of
international conferences and studies, and the adoption of several key international documents addressing
various bioethical issues. Among the most important international bioethical documents are:

 Nuremberg Code (1947)

 Geneva Declaration (International Physician's Oath) (WMA, 1948)
 International Code of Medical Ethics (WMA, 1949)
 Helsinki Declaration (WMA, adopted in 1964, latest revision in 2013)
 Lisbon Declaration on Patients' Rights (WMA, 1981)
 Declaration on the Promotion of Patients' Rights in Europe (World Health Organization, 1994)
 Council of Europe Convention on Human Rights and Biomedicine (1997), formally titled "Convention
on the Protection of Human Rights and Dignity of the Human Being with regard to the Application of
Biology and Medicine" (with subsequent additional protocols)
 Universal Declaration on the Human Genome and Human Rights (UNESCO, 1997)
 Recommendations to Ethics Committees Reviewing Biomedical Research (WHO, 2000)
 Universal Declaration on Bioethics and Human Rights (UNESCO, 2005)
 Recommendations of the Council of Europe Regarding research conducted on biological materials of human
origin (2006).