JETHS-Volume 2 Issue-II May-August 2015
Review Article
Introduction to Bioethics
Gade S.
________ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ___
FAIMER fellow,
Assistant Professor, Department of Physiology,
NKP Salve institute of Medical sciences & Research Centre Nagpur Maharashtra India
Email: shubhagade@gmail.com
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Abstract:
In recent decades medical education curricula have undergone many modifications for a variety of reasons. In spite of
these changes, ethics education has not received adequate attention in medical schools throughout the world. There is an
emerging need for introduction of teaching medical ethics as a consequence of several social and scientific reasons.
Bioethics has brought about significant changes in standards for the treatment of the sick and for the conduct of
research. The bioethical issues being addressed are numerous to count, but the flavor of bioethics in the early twenty-first century
can be conveyed by an exploration of the bioethical implications of genetic research, health care access reform, and stem cell
research.
The International Center for Health, Law and Ethics at the University of Haifa has initiated an international project, the
aim of which is to form a new, modern curriculum of medical ethics to be taught in medical schools all over the world. The need
for a modernized curriculum derives not only from the fact that many of the existent curricula are antiquated and completely out
of tune with the intricacies of recent scientific developments, but also from the safeguards which we require in the form of
educational innovations which will inseminate ethical values in our students, in spite of this materialistic age in which we live.
Key words: bioethical issues, principles of bioethics, nature and scope, modernized curriculum
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Medicine is one the time honored of inquiry into bioethical issues and have developed
professions that had a preexisting code of behavior rules and guidelines on how to deal with these issues
for its practitioners dating as far as the vedic and from within the viewpoint of their respective faiths.
Hippocratic era. The doctor patient relationship
which was fudiciary and paternalistic, since time Defining Bioethics:
immerorial has changed. In addition rising cost of
medical care, advances in medical sciences and Medical Definition of Bioethics:
technology pose new ethical dilemmas for a "The discipline dealing with the ethical
practicing physician. implications of biological research and applications
The ethical principles emphasize the especially in medicine. Bioethics includes the study of
clinician’s dual contract to patient and society. what is right and wrong in new discoveries and
Increased complexity for caring of patients in a techniques in biology, such as genetic engineering
consumer – satisfaction oriented society necessitates and the transplantation of organs."
learning of ethically driven decision process and New medicines, biomedical procedures, and
today Bioethics is at the centre stage of medical ways of altering plants and animals are bringing
education. benefits to millions of people. However, these same
"Bioethics" has been used in the last twenty innovations also have the potential to bring harms or
years to describe the investigation and a study of to raise other kinds of ethical questions about their
ways in which decisions in medicine and science appropriate use.
touch upon our health and lives and upon our society Bioethics looks at "what should be done"
and environment. Bioethics involves issues relating when dealing with or taking care of people and other
to the beginning and end of human life, all the way living creatures. Bioethics looks at questions about
from issues relating to in-vitro fertilisation and values and what matters in medicine, biological
abortion to euthanasia and palliative care. Bioethics research, care of people who cannot speak up for
has an impact on every level of human community themselves (the severely mentally ill, small children,
from the local nursing home to the huge international prisoners) and similar topics. The word is made up of
conferences on issues like the Human Genome(1). two parts: "bio" (from the Greek word for "life") and
The term Bioethics (Greek bios, life; ethos, "ethics", so it is the study of ethics as it relates to
behavior) was coined in 1926 by Fritz Jahr, who living things.
"anticipated many of the arguments and discussions It involves not just doctors, but patients, not
now current in biological research involving animals. just scientists and politicians but the general public.
Many religious communities have their own histories Bioethics is also concerned with questions about
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JETHS-Volume 2 Issue-II May-August 2015
Review Article
basic human values such as the rights to life and of life. Patients expect professionalism,
health, and the rightness or wrongness of certain effectiveness and quality, along with empathy,
developments in healthcare institutions, life reliability and devotion.
technology, medicine, the health professions and Health-care providers are detached from
about society's responsibility for the life and health of traditional concepts of idealistic medicine,
its members. adopting a contractual and consumer paradigm.
Medical technology has created new dilemmas
Bioethics Principles: (e.g. procreation, euthanasia, intensive care,
Early founders of bioethics put forth four principles medical genetics and bio-technology), while at
Nonmaleficence - One should avoid causing
which form the framework for moral reasoning. the same time causing previous ethical
resolutions to become obsolete (e.g. definition of
harm. The healthcare professional should not death, family composition).
harm the patient. All treatment involves some Specialization and sub-specialization in medicine
harm, even if minimal, but the harm should not have encouraged technicality at the expense of
Justice - Benefits and risks should be fairly
be disproportionate to the benefits of treatment. patient-physician relationship and
communication skills, thus creating a growing
distributed. The notion that patients in similar gap between physicians and their patients and
Beneficence - One should take positive steps to
positions should be treated in a similar manner. between medicine and society at large.
Growing social concern, suspicion and demand
help others. Considers the balancing of benefits for closer inspection on medical activities is
of treatment against the risks and costs; the filling this gap. The demand has materialized in
healthcare professional should act in a way that the form of ample litigation, increased health-
Autonomy - one should respect the right of
benefits the patient related legislation and formulation of
international declarations, conventions, charters
individuals to make their own decisions by etc., creating new ethical and legal frameworks
respecting the decision making capacities of and new obligations for the practicing physician.
autonomous persons; enabling individuals to The need to adhere to ethical norms in scientific
make reasoned informed choices. research and experimentation (human cloning,
These 'Four Principles' have been one of the pharmacology etc.) remains a constant challenge.
most widely discussed issues in Biomedical Ethics
with arguments for and against them. The authors' Nature and Scope of Bioethics
claim has been tested by research conducted in At the core of bioethics are questions about
different cultures and societies(2). medical professionalism, such as: What are the
obligations of physicians to their patients? and What
Why do we need bioethics? are the virtues of the "good doctor"? Bioethics
Bioethics understood and practiced along the explores critical issues in clinical and research
lines of Socratic conception is needed to improve medicine, including truth telling, informed consent,
medical decision making by health care staff, in confidentiality, end-of-life care, conflict of interest,
teaching in medical schools and for personal nonabandonment, euthanasia, substituted judgment,
developments. rationing of and access to health care, and the
This thesis is based on two assumptions: withdrawal and withholding of care. Only minimally
1) we are all affected directly or indirectly by affected by advances in technology and science, these
decisions in and concerning health care and core bioethical concerns remain the so-called bread-
medical research, and-butter issues of the field.
2) there is room for improvement of these The second mission of bioethics is to enable
decisions from an ethical point of view.(3) ethical reflection to keep pace with scientific and
medical breakthroughs. With each new technology or
In recent decades medical education curricula have medical breakthrough, the public finds itself in
undergone many modifications for a variety of uncharted ethical terrain it does not know how to
reasons. In spite of these changes, ethics education navigate. In the twenty-first century—what is very
has not received adequate attention in medical likely to be the "century of biology"—there will be a
schools throughout the world. There is an emerging constant stream of moral quandaries as scientific
need for introduction of teaching medical ethics as a reach exceeds ethical grasp. As a response to these
consequence of several social and scientific monumental strides in science and technology, the
Health-care consumers emphasize nowadays not
processes: scope of bioethics has expanded to include the ethical
questions raised by the Human Genome Project, stem
only the need for health but the need for quality cell research, artificial reproductive technologies, the
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JETHS-Volume 2 Issue-II May-August 2015
Review Article
genetic engineering of plants and animals, the familial disclosure. With the advent of commercial
synthesis of new life-forms, the possibility of genetic testing centers, patients will soon have easy
successful reproductive cloning, preimplantation access to genetic tests independent of the practice of
genetic diagnosis, nanotechnology, and clinical medicine, without the benefit of genetic
xenotransplantation — to name only some of the key counseling services, professional psychological
advances. support, or adequate, and possibly accurate, clinical
Bioethics has also begun to engage with the information. The Internet, for example, will likely
challenges posed by delivering care in bring universal access to any genetic test as it
underdeveloped nations. Whose moral standards becomes available (5)
should govern the conduct of research to find
therapies or preventive vaccines useful against What is its Impact?
malaria, HIV, or Ebola—local standards or Western Bioethics has brought about significant
principles? And to what extent is manipulation or changes in standards for the treatment of the sick and
even coercion justified in pursuing such goals as the for the conduct of research. Every health care
reduction of risks to health care in children or the professional now understands that patients have a
advancement of national security? This population- right to know what is being done to them, and to
based focus raises new sorts of ethical challenges refuse. Every researcher now understands that
both for health care providers who seek to improve participants in their studies have the same rights, and
overall health indicators in populations and for review boards to evaluate proposed research on those
researchers who are trying to conduct research grounds are almost universal. (5)
against fatal diseases that are at epidemic levels in It would appear that the more time is spent
some parts of the world (4). on the teaching of ethics, the longer it stretches over
the whole course of the students in medicine, the
Current Issues in the Field: Bioethics in the Early better the results should be. However, even if such a
Twenty-First Century recommendation is universally accepted, it will not
The bioethical issues being addressed by the be strong enough to challenge and eliminate the
field are too numerous to count, but the flavor of problem of ineffectual teaching methods which are
bioethics in the early twenty-first century can be crying out for modernization and radical reform.
conveyed by an exploration of the bioethical
implications of genetic research, health care access The new curriculum.
reform, and stem cell research, arguably the most
pressing issue in the field to date. A medical ethics curriculum ought to reflect the
Advances in the science of genetics, changing faces of medicine and should govern the
including the Human Genome Project and the ability following fields, each having multiple sub-categories,
to find genetic markers for particular diseases, have with varying ramifications:
raised difficult ethical dilemmas. Two of the most
pressing issues are preimplantation genetic diagnosis A. The relationship between health-care providers
and the genetic testing of adults. With the technology and their patients.
to identify inherited diseases in the early embryo B. The choice of medical intervention for the
comes questions about which embryos ought to be individual patient.
implanted, which diseases constitute a legitimate C. The choice of public health interventions.
moral reason to discard an embryo or become the D. The evaluation of effects of health-care
criterion for embryo selection, which traits ought interventions.
parents be allowed to select or test for, and who E. The collaboration between teams engaged in
ought to have access to this technology and on what health care activities.
grounds. For example, while there might be F. The choice of goals and methods of medical
widespread support for testing embryos that might research.
carry the trait for Tay-Sachs disease or cystic fibrosis,
there are troubling questions about selecting embryos The International Center for Health, Law
on the basis of sex, nonlethal trisomes (such as and Ethics at the University of Haifa has initiated an
Down's syndrome), or aesthetic or character traits that international project, the aim of which is to form a
technology may someday be able to screen for. In new, modern curriculum of medical ethics to be
adult medicine, genetic tests already exist to detect taught in medical schools all over the world. The
mutations leading to some forms of inherited breast need for a modernized curriculum derives not only
cancer and to Huntington's disease. Here, questions from the fact that many of the existent curricula are
arise about privacy of health care information, antiquated and completely out of tune with the
psychological impact, stigmatization, lack of intricacies of recent scientific developments, but also
informed consent, health insurance access, and from the safeguards which we require in the form of
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JETHS-Volume 2 Issue-II May-August 2015
Review Article
educational innovations which will inseminate ethical
values in our students, in spite of this materialistic
age in which we live. The UNESCO Chair adopted
the idea and undertook the mission.
References:
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august2]avavilable fromhttp://www.bioethics.org.au/
Resources/ Bioethical%20 Issues.html.
2. Bioethics: Basic definition& principles- disabled
World [cited 2015 august2]avavilable from
http://www.disabled-
world.com/definitions/bioethics.php
3. teachibng Bioethics. Report from a seminar. November
2001. [cited 2015 august 20] availabble from
Bioethics.[cited 2015 august 20]available from
[http://www.encyclopedia.com/topic/bioethics.aspx
4. What is Bioethics [cited 2015 august 20]available from
http://www.bioethics.msu.edu/what-is-bioethics
5. What is Bioethics [cited 2015 august 20] available
fromhttp://www.bioethics.msu.edu/what-is-bioethics.
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