TARGET DECK: MED::I::Philosophy of Medicine and Bioethics::01 - Introduction on Bioethics
Bioethics Module — Overview
Module Structure
The Bioethics Module addresses the main ethical, social, and legal issues that characterize the current relationship between scientific practices and the normative aspect.
The module is divided into two complementary parts:
- Part I — Exploration of arguments and methods used in bioethics; study of ethical issues and decision-making associated with the use of living organisms.
- Part II — Application of those tools to specific topics: issues raised at the beginning of life, by the caring relationship, and at the end-of-life decision-making process.
Shared Goal
Both parts aim to help students frame bioethical problems and apply rational argumentation to their solution.
Ethics
What is Ethics?
Definition
Ethics: the rules of conduct recognized in respect to a particular class of human actions, or a particular group or culture.
Who studies ethics? Moral philosophers investigate what is morally good and bad, right and wrong.
Core Question of Ethics
“Just because we can, does this mean that we should?” This is a question for scientists, too.
From Theory to Action
The ethical reasoning follows a hierarchical structure:
What is Bioethics?
Definition
Bioethics: a field of study concerned with the ethics and philosophical implications of certain biological and medical procedures, technologies, and treatments — such as organ transplants, genetic engineering, and care of the terminally ill.
Origin of the Term
| Detail | Info |
|---|---|
| Author | Van Rensselaer Potter (oncologist) |
| Year coined | 1970 |
| Lifespan | 1911–2001 |
Key publications by Potter:
- 1970 — Article: “Bioethics, the Science of Survival” in Perspectives in Biology and Medicine
- 1971 — Book: Bioethics: Bridge to the Future
Potter's Vision
Bioethics as “a new philosophy that sought to integrate biology, ecology, medicine, and human values”; concerned with “all the medical and natural issues that allow the survival of man in this planet, namely the preservation of an ecosystem that turns the planet inhabitable for human beings.”
Encyclopedia of Bioethics Definition (1995)
Warren Thomas Reich, Editor in Chief
“The systematic study of the moral dimensions — including moral vision, decisions, conduct, and policies — of the life sciences and health care, employing a variety of ethical methodologies in an interdisciplinary setting.”
Who coined the term "bioethics" and when?
Van Rensselaer Potter, oncologist, in 1970.
Anki cloze
The term “bioethics” was coined by {1:Van Rensselaer Potter} in {2:1970}, originally aiming at ensuring the preservation of the {3:biosphere}.
Bioethics vs. Medical Ethics
Scope Distinction
Medical ethics and nursing ethics are more concerned with the ethics of health care professionals and their relationship with the patient. Bioethics has a broader scope, emerging as a response to new scientific/technological developments in biomedical and life sciences.
The Universal Bioethical Question
“Just because we can, should we?” — applies to all parts of science.
Main Topics in Bioethics
- Death and dying
- Pre-birth issues
- Issues in human reproduction
- Human cloning
- Stem cell research
- The new genetics
- Resources allocation
- Organ transplant
- Doctor–patient relationships
- Experimentation with human subjects & animals
Ethical Dilemmas and Moral Reasoning
Blanchard & Peale — Three Questions
According to Kenneth Blanchard and Norman Vincent Peale (The Power of Ethical Management), when faced with an ethical dilemma, ask:
| # | Question | Focus |
|---|---|---|
| 1 | Is it legal? | Will you be violating criminal laws, civil laws, or company policies? |
| 2 | Is it fair? | Is it fair to all parties, both short-term and long-term? |
| 3 | How does it make you feel? | Are you proud of this decision? Would you want others to know? |
Win-Win Check Ask: Is this a win-win situation for those directly and indirectly involved?
What are the three ethical questions proposed by Blanchard and Peale?
- Is it legal?
- Is it fair to all parties?
- How does it make you feel about yourself?
Method of the Module
For each identified topic or challenge, the module examines:
- (a) How it emerged
- (b) The current state of the debate, including best practices for scientists and for society
- (c) New directions, if any, for resolving acute controversies
Resources (available at virtuale.unibo.it):
- Slides
- PDF articles
- Links to electronic resources (websites, reports, bibliography)
Bioethics History
Drivers of the Field’s Emergence
Three Historical Triggers
a. Public acknowledgment of research conducted by Nazi physicians during World War II
b. Rapid progress of biomedicine posing new ethical dilemmas
c. Insufficiency of traditional ethical concepts to solve problems raised by biomedicine
Key Historical Milestones
| Year | Event |
|---|---|
| 1946 | Nuremberg Trials — German physicians claimed they only “obeyed orders”; the Nuremberg Code was approved as the standard against which Nazi human experimentation practices were judged |
| 1967 | December — Christian Barnard performs the first heart transplantation at Groote Schur, Cape Town |
| 1972 | July — The Tuskegee Study is publicised: started in 1932 by the Public Health Service with the Tuskegee Institute, it observed the natural history of syphilis in 399 African-American men who died without treatment |
| 1973 | The Belmont Report written by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research |
| 1973 | Roe vs. Wade — US Supreme Court recognizes the right to abortion (410 U.S. 113) based on the right to privacy |
| 1975 | Karen Quinlan — parents request discontinuation of life-support machines |
| 1978 | Louise Brown born — world’s first baby conceived via IVF |
Tuskegee Study
A landmark example of bioethical failure: 399 African-American men with syphilis were observed without treatment from 1932 until the scandal was made public in 1972. A major driver for the Belmont Report.
What was the Nuremberg Code?
A set of standards approved after the 1946 Nuremberg Trials, providing ethical principles against which Nazi human experimentation practices were judged.
Anki cloze
Louise Brown, born in {1:1978}, was the world’s first baby conceived via {2:in vitro fertilization (IVF)}.
Anki cloze
The Tuskegee Study began in {1:1932} and was publicly exposed in {2:1972}; it observed the natural history of {3:syphilis} in {4:399} African-American men who died without treatment.
Basic Bioethics Principles
The Four-Principle Approach (Principlism)
Developed by Tom Beauchamp and James Childress in Principles of Biomedical Ethics (1st ed. 1978; latest ed. 2009, Oxford University Press).
The Four Prima Facie Principles
- Autonomy
- Non-maleficence
- Beneficence
- Justice
Principle Breakdown
| Principle | Core Meaning | Key Details |
|---|---|---|
| Autonomy | Respect for self-rule | Free from controlling interference and from limitations preventing meaningful choice |
| Beneficence | Acting for the benefit of others | Benefits must be proportionate to risks; protect rights, help those with disabilities, rescue those in danger |
| Non-maleficence | Do no harm | Obligation to not inflict harm; distinct from beneficence; experiment must stop if it causes harm |
| Justice | Fair distribution | Equitable distribution of social burdens, benefits, opportunities; access to health care; selection of research subjects |
Etymology: Autonomy
From Greek: autos (“self”) + nomos (“rule,” “governance,” or “law”) → self-rule (Beauchamp & Childress)
Mnemonic — "A BNJ" (principlism)
Autonomy · Beneficence · Non-maleficence · Justice “A Brave Nurse’s Job”
What are the four principles of Beauchamp and Childress's principlism?
Autonomy, Beneficence, Non-maleficence, Justice.
Anki cloze
In bioethics, {1:non-maleficence} means the obligation to not inflict harm on others — summarized as “{2:first, do no harm}.”
Anki cloze
The four-principle approach in bioethics is often called {1:principlism} and was developed by {2:Beauchamp and Childress}.
Applied Bioethics — Specific Issues
Human Reproduction Technologies
Main Ethical and Legal Issues
- Procreation rights of infertile couples
- Accusations of being “unnatural”
- Inequality and exploitation
- Selling babies (maternal surrogacy)?
- Moral status of extra embryos left over from IVF
- Definition of parent–child relation
- Integrity of the family
- Best interests of the child
Classic Bioethical Decision — Organ Allocation
One Heart Available — Who Should Receive It?
- 17-year-old girl
- 40-year-old school principal
- 70-year-old woman
This illustrates the tension between justice, beneficence, and autonomy.
Reproductive Cloning
Creating a genetically identical organism.
Many animals have been successfully cloned.
Preimplantation Genetic Diagnosis (PGD)
Info
- Diagnosing inherited genetic disorders in vitro
- Choosing which embryos to transfer based on desired traits
- Involves gender decisions
- Raises the question: “Designer Babies?”
Ethical Concern — PGD
The selection of embryos based on traits raises questions about eugenics, discrimination, and the moral status of embryos.
Genetic Testing
Info
- Individual risk assessment based on a person’s DNA profile
- DNA chip identifies genetic predispositions
- Potential for genetic discrimination
- Issues with DNA profiling and DNA banks
Transgenic Plants
Info
- Engineered plants containing novel genes from other species
- Produce new characteristics desirable and useful to humans
- Key questions: Are they safe to eat? How do they affect the ecosystem?
Moral Theories in Bioethics
| Theory | Core Idea | Bioethical Application |
|---|---|---|
| Utilitarianism | Consequence-based; ends justify means; maximize total well-being | Supports selecting embryos with lowest disease risk; no objection to genetic enhancement if it promotes overall well-being |
| Kantianism / Deontologism | Why you act matters; universalizability (Golden Rule) | Can an action be made a universal rule? Treat others as you wish to be treated |
| Liberal Individualism | Protect the right to autonomy and self-determination | Prioritizes individual rights over collective outcomes |
| Communitarianism | The good of the community | Collective interests may override individual rights |
| Ethics of Care | Focus on relationships involving care, responsibility, and trust | Emphasizes relational context over abstract principles |
What is the core claim of utilitarianism in bioethics?
The right action is the one that maximizes total well-being; the ends justify the means.
What distinguishes Kantianism from utilitarianism in ethical theory?
Kantianism focuses on the reasons/intentions behind actions and whether they can be universalized (the Golden Rule), not just outcomes.
Anki cloze
The ethical theory that focuses on relationships involving care, responsibility, and trust is called {1:Ethics of Care}.
Finding a Balance
Central Challenge of Bioethics
The focus should shift from whether or not “we could” to whether or not “we should” — weighing advantages and disadvantages, and acknowledging the responsibilities that come with scientific knowledge.
TLDR
Bioethics — Complete Summary
- Bioethics is the philosophical and systematic study of ethical controversies arising from advances in biology and medicine; term coined by Van Rensselaer Potter in 1970.
- Broader in scope than medical or nursing ethics; intersects biology, law, philosophy, theology, and politics.
- Core recurring question: “Just because we can, should we?”
- Historical triggers: Nazi experimentation (→ Nuremberg Code 1946), rapid biomedical progress, insufficiency of classical ethics.
- Key milestones: Tuskegee Study exposure (1972), Belmont Report (1973), Roe v. Wade (1973), Karen Quinlan case (1975), first IVF baby (1978), first heart transplant (1967).
- Four Principles (Beauchamp & Childress — Principlism): Autonomy, Beneficence, Non-maleficence, Justice — serve as prima facie mid-level ethical principles.
- Main bioethical topics: death/dying, reproduction, cloning, stem cells, genetics, organ allocation, doctor–patient relations, human/animal experimentation.
- Moral theories applied: Utilitarianism (outcomes), Kantianism (duty/universalizability), Liberal Individualism (autonomy), Communitarianism (collective good), Ethics of Care (relational values).
- The ethical reasoning hierarchy flows: Theory → Principle → Rule → Action.
- Blanchard & Peale’s three questions for dilemmas: Is it legal? Is it fair? How does it make you feel?
- Module method: for each topic, examine (a) how it emerged, (b) current state of debate, (c) new directions.