BIOETHICS

What are the general goals of

bioethics?
• As a discipline of applied ethics and a particular way of
ethical reasoning that substantially depends on the
findings of the life sciences, the goals of bioethics are
manifold and involve, at least, the following aspects:
1. Discipline:

• Bioethics provides a disciplinary framework for the

whole array of moral questions and issues surrounding
the life sciences concerning human beings, animals, and
nature.
2. Inter-disciplinary Approach:

• Bioethics is a particular way of ethical reasoning and

decision making that:
• (i) integrates empirical data from relevant natural sciences,
most notably medicine in the case of medical ethics, and

• (ii) considers other disciplines of applied ethics such as

research ethics, information ethics, social ethics, feminist
ethics, religious ethics, political ethics, and ethics of law in
order to solve the case in question.
3. Ethical Guidance:

•Bioethics offers ethical guidance

in a particular field of human
conduct.
4. Clarification:

• Bioethics points to many novel complex cases, for

example, gene technology, cloning, and human-animal
chimeras and facilitates the awareness of the particular
problem in public discourse.
5. Structure:
•
• Bioethics elaborates important arguments
from a critical examination of judgements
and considerations in discussions and
debates.
6. Internal Auditing:

• The combination of bioethics and new data that stem

from the natural sciences may influence−in some cases
−the key concepts and approaches of basic ethics by
providing convincing evidence for important
specifications,
• - for example, the generally accepted concept of
personhood might be incomplete, too narrow, or
ethically problematic in the context of people with
disability and, hence, need to be modified accordingly.
In other words,
• Bioethics is concerned with a specific area of human
conduct concerning:
• - the animate (for example, human beings and animals)
and - inanimate (for example, stones) natural world
against the background of the life sciences and deals
with the various problems that arise from this complex
amalgam.
BIOETHICS IS MULTIDISCIPLINARY
• Bioethics is not only an inter-disciplinary field but also
multidisciplinary since bioethicists come from various
disciplines, each with its own distinctive set of
assumptions.

• While this facilitates new and valuable perspectives , it

also causes problems for a more integrated approach to
bioethics.
a. The Origin of the Notion of
Bioethics
• It is commonly said that the origin of the notion of
bioethics is twofold:
• (i) the publishing of two influential articles;
• - Potter’s “Bioethics, the Science of Survival” (1970),
which suggests viewing bioethics as a global movement
in order to foster concern for the environment and
ethics, and
• - Callahan’s “Bioethics as a Discipline” (1973), in which
he argues for the establishment of a new academic
discipline, and
• (ii) discussions between Shriver and Hellegers about the
need for an institute in which researchers should
examine and analyse medical dilemmas by appealing to
moral philosophy (1970).
• This institute was created in 1971 as the Joseph and
Rose Kennedy Center for the Study of Human
Reproduction and Bioethics, and is now known as the
Kennedy Institute of Ethics (see, also the Institute of
Society, Ethics, and the Life Sciences, 1969).
• - Sass (2007) is right in claiming that the German theologian Fritz Jahr
published three articles in 1927, 1928, and 1934 using the German
term “Bio-Ethik” (which translates as “Bio-Ethics”) and forcefully
argued, both for the establishment of a new academic discipline, and
for the practice of a new, more civilized, ethical approach to issues
concerning human beings and the environment.
• Jahr famously proclaimed his bioethical
imperative:
• “Respect every living being, in principle, as
an end in itself and treat it accordingly
wherever it is possible,” (1927: 4).
c. The Origin of Bioethics as a
Phenomenon
•The notion of bioethics and the
origin of the discipline of
bioethics and its
institutionalization in academia
is a modern development.
The phenomenon itself….

• - can be traced back, at least with any

certainty, to the Hippocratic Oath in
Antiquity (500 B.C.E.)…
medical ethics…
• - in the case of medical ethics (Jonsen 2008) and
possibly beyond if one considers the Code of
Hammurabi (1750 B.C.E.), which contains some written
provisions related to medical practice (Kuhse and Singer
2009: 4).
3. Sub-disciplines in Bioethics

• a. Introduction
• Bioethics is a discipline of applied
ethics and comprises three main
sub-disciplines:
• i) medical ethics,
• ii) animal ethics, and
• iii) environmental ethics.
• Even though they are “distinct” branches in focusing on
different areas—namely, human beings, animals, and
nature—they have a significant overlap of particular
issues, vital conceptions and theories as well as
prominent lines of argumentation.
• Solving bioethical issues is a complex and demanding
task. An interesting analogy in this case is that of a
neural network in which the neural knot can be
compared to the bioethical problem, and the network
itself can be compared to the many different links to
other vital issues and moral problems on different levels
(and regarding different disciplines and sub-disciplines).
• Sometimes it seems that the attempt to settle a moral
problem stirs up a hornets’ nest because many plausible
suggestions cause further (serious) issues. However, a
brief overview of the bioethical sub-disciplines is as
follows.
1. Respect for Autonomy

•Any notion of moral decision-

making assumes that
rational agents are involved
in making informed and
voluntary decisions.
• In health care decisions, our respect for the autonomy
of the patient would, in common parlance, imply that
the patient has the capacity to act intentionally, with
understanding, and without controlling influences that
would mitigate against a free and voluntary act.

• This principle is the basis for the practice of "informed

consent" in the physician/patient transaction regarding
health care.
Case 1
•
In a prima facie sense, we ought always to respect the
autonomy of the patient. Such respect is not simply a
matter of attitude, but a way of acting so as to recognize
and even promote the autonomous actions of the patient.
The autonomous person may freely choose values,
loyalties or systems of religious belief that limit other
freedoms of that person. For example, Jehovah's
Witnesses have a belief that it is wrong to accept a blood
transfusion. Therefore, in a life-threatening situation
where a blood transfusion is required to save the life of
the patient, the patient must be so informed.
• The consequences of refusing a blood transfusion must be
made clear to the patient at risk of dying from blood loss.Â
Desiring to "benefit" the patient, the physician may strongly
want to provide a blood transfusion, believing it to be a clear
"medical benefit." When properly and compassionately
informed, the particular patient is then free to choosewhether
to accept the blood transfusion in keeping with a strong
desire to live, or whether to refuse the blood transfusion in
giving a greater priority to his or her religious convictions
about the wrongness of blood transfusions, even to the point
of accepting death as a predictable outcome. This
communication process must be compassionate and
respectful of the patient’s unique values, even if they differ
from the standard goals of biomedicine.
Discussion
In analyzing the above case, the physician had a prima facie
duty to respect the autonomous choice of the patient, as
well as a prima facie duty to avoid harm and to provide a
medical benefit. In this case, informed by community
practice and the provisions of the law for the free exercise
of one's religion, the physician gave greater priority to the
respect for patient autonomy than to other duties.

However, some ethicists claim that in respecting the

patient’s choice not to receive blood, the principle of
nonmaleficence also applies and must be interpreted in
light of the patient’s belief system about the nature of
harms, in this case a spiritual harm.
• By contrast, in an emergency, if the patient in
question happens to be a ten year old child, and
the parents refuse permission for a life saving
blood transfusion, in the State of Washington and
other states as well, there is legal precedence for
overriding the parent's wishes by appealing to
the Juvenile Court Judge who is authorized by the
state to protect the lives of its citizens,
particularly minors, until they reach the age of
majority and can make such choices
independently.
• Thus, in the case of the vulnerable minor
child, the principle of avoiding the harm of
death, and the principle of providing a
medical benefit that can restore the child to
health and life, would be given precedence
over the autonomy of the child's parents as
surrogate decision makers
• (McCormick, 2008). (See Parental Decision Making)
2. The Principle of
Nonmaleficence
• The principle of nonmaleficence requires of
us that we not intentionally create a harm
or injury to the patient, either through acts
of commission or omission.
• In common language, we consider it
negligent if one imposes a careless or
unreasonable risk of harm upon another.
• Providing a proper standard of care that avoids
or minimizes the risk of harm is supported not
only by our commonly held moral convictions,
but by the laws of society as well (see Law and
Medical Ethics).
•
This principle affirms the need for
medical competence.
• It is clear that medical mistakes may
occur; however, this principle
articulates a fundamental commitment
on the part of health care professionals
to protect their patients from harm.
Case 2

In the course of caring for patients, there are

situations in which some type of harm seems
inevitable, and we are usually morally bound to
choose the lesser of the two evils, although the
lesser of evils may be determined by the
circumstances.
•For example, most would be
willing to experience some pain
if the procedure in question
would prolong life.
• However, in other cases, such as the case of a patient
dying of painful intestinal carcinoma, the patient might
choose to forego CPR in the event of a cardiac or
respiratory arrest, or the patient might choose to forego
life-sustaining technology such as dialysis or a respirator.
• The reason for such a choice is based on the belief of the
patient that prolonged living with a painful and
debilitating condition is worse than death, a greater
harm.
• It is also important to note in this case that this
determination was made by the patient, who alone is the
authority on the interpretation of the "greater" or
"lesser" harm for the self. (See Withholding or Withdrawing Life-
Sustaining Treatment).
Discussion
•
There is another category of cases that is
confusing since a single action may have two
effects, one that is considered a good effect, the
other a bad effect.
• How does our duty to the principle of
nonmaleficence direct us in such cases?
• The formal name for the principle governing this
category of cases is usually called the principle
of double effect.
• A typical example might be the question as to how to
best treat a pregnant woman newly diagnosed with
cancer of the uterus.
• The usual treatment, removal of the uterus is
considered a life saving treatment.
• However, this procedure would result in the death of the
fetus.
• What action is morally allowable, or, what is our duty?
• It is argued in this case that the woman has the right to
self-defense, and the action of the hysterectomy is
aimed at defending and preserving her life.
• The foreseeable unintended consequence (though
undesired) is the death of the fetus.
There are four conditions that usually apply to the
principle of double effect:
• 1.The nature of the act. The action itself must not be intrinsically
wrong; it must be a good or at least morally neutral act.
• 2.The agent’s intention. The agent intends only the good effect,
not the bad effect, even though it is foreseen.
• 3.The distinction between means and effects. The bad effect must
not be the means of the good effect,
• 4. Proportionality between the good effect and the bad effect. The
good effect must outweigh the evil that is permitted, in other
words, the bad effect.
• (Beauchamp & Childress, 1994, p. 207)
• The reader may apply these four criteria to the case above, and find that the
principle of double effect applies and the four conditions are not violated by
the prescribed treatment plan.
3. The Principle of Beneficence

• The ordinary meaning of this principle is that health

care providers have a duty to be of a benefit to the
patient, as well as to take positive steps to prevent and
to remove harm from the patient.

• These duties are viewed as rational and self-evident and

are widely accepted as the proper goals of medicine.
• Â This principle is at the very heart of
health care implying that a suffering
supplicant (the patient) can enter into a
relationship with one whom society has
licensed as competent to provide medical
care, trusting that the physician’s chief
objective is to help.
• The goal of providing benefit can be applied both to
individual patients, and to the good of society as a
whole.

• For example, the good health of a particular patient is

an appropriate goal of medicine, and the prevention of
disease through research and the employment of
vaccines is the same goal expanded to the population at
large.
• It is sometimes held that nonmaleficence is a constant
duty, that is, one ought never to harm another
individual, whereas beneficence is a limited duty.

• A physician has a duty to seek the benefit of any or all

of her patients, however, a physician may also choose
whom to admit into his or her practice, and does not
have a strict duty to benefit patients not acknowledged
in the panel.
• This duty becomes complex if two patients
appeal for treatment at the same moment.

• Some criteria of urgency of need might be

used, or some principle of first come first
served, to decide who should be helped at
the moment.
Case 3

One clear example exists in health care where the principle of

beneficence is given priority over the principle of respect for patient
autonomy. This example comes from Emergency Medicine. When the
patient is incapacitated by the grave nature of accident or illness, we
presume that the reasonable person would want to be treated
aggressively, and we rush to provide beneficent intervention by
stemming the bleeding, mending the broken or suturing the
wounded.
Discussion
•
In this culture, when the physician acts from a
benevolent spirit in providing beneficent treatment that
in the physician's opinion is in the best interests of the
patient, without consulting the patient, or by overriding
the patient's wishes, it is considered to be
"paternalistic." The most clear cut case of justified
paternalism is seen in the treatment of suicidal patients
who are a clear and present danger to themselves.
• Here, the duty of beneficence requires that the
physician intervene on behalf of saving the patient's life
or placing the patient in a protective environment, in
the belief that the patient is compromised and cannot
act in his own best interest at the moment. As always,
the facts of the case are extremely important in order to
make a judgment that the autonomy of the patient is
compromised.
4. The Principle of Justice

•Justice in health care is

usually defined as a form of
fairness, or as Aristotle once
said, "giving to each that
which is his due."
• This implies the fair distribution of goods in
society and requires that we look at the role
of entitlement.
• The question of distributive justice also
seems to hinge on the fact that some goods
and services are in short supply, there is not
enough to go around, thus some fair means
of allocating scarce resources must be
determined.
• It is generally held that persons who are
equals should qualify for equal treatment.

• This is borne out in the application of

Medicare, which is available to all persons
over the age of 65 years.
• This category of persons is equal with
respect to this one factor, their age,
but the criteria chosen says nothing
about need or other noteworthy factors
about the persons in this category.
In fact, our society uses a variety of factors as
criteria for distributive justice, including the
following:
• 1. To each person an equal share
• 2. To each person according to need
• 3. To each person according to effort
• 4. To each person according to contribution
• 5. To each person according to merit
• 6. To each person according to free-market
exchanges
• (Beauchamp & Childress, 1994, p. 330)
 A. Evaluate this case using the 4 principles in Bioethics:
• 1. The Case of Joe

• "Joe" is a 62 year old building contractor who has been in an ICU for the past 10
weeks. Per chart notes, he is not improving sufficiently to warrant hope for
recovery. The best that can be hoped for now, says his critical care physician, is
discharge to a long-term acute care hospital (L-TACH). The prognosis does not
include any likelihood of return to baseline, or to home. The situation is dire, and
Joe seems to "get it". On the Saturday of Joe's tenth week in ICU, he mouths a
message to his nurse, and then to the physician who is summoned, and then to
an ethics consultant also. "Stop everything. Give me something. I want to die."

• Four commonly accepted principles of health care ethics, excerpted from

Beauchamp and Childress (2008), include the:
• 1. Principle of respect for autonomy,
• 2. Principle of non-maleficence,
• 3. Principle of beneficence, and
• 4. Principle of justice.
Topics for Reporting
• 1. Artificial Insemination (Gaudiel)
• 2. Cloning/Genetic Engineering (Quibete)
• 3. The Use of non-medicinal Drugs/enhancement (Villaceran)
• 4. GMO (Arce)
• 5. Organ Transplant (Libre)
• 6. Surrogacy (Idong)
• 7. Abortion/Contraceptives (Monte)
• 8. Euthanasia (Suicide) (Dolaota)
Oral Report
Written Report
• Written Report
1) Introduction
• 2) Body (Analysis)
• a) Four Principles of Bioethics
• B) Normative Ethics (Consequentialism, Deontology, Virtue Ethics)
3) Conclusion/Summary
Personal Evaluation/Reflection
Font: Times New Roman (12)
Paper: A4
Spacing: 1.5
Bibliography/References
Pages: minimum of 10