Bioethics addresses the main ethical, social and legal issues that characterize the current relationship between scientific practices and the normative aspect.
For each of the identified topics and challenges we will examine:
- how they emerged;
- what the current state of the debate is, including best practices for the scientist and for society;
- and what the new directions are, if any, in resolving some of the most acute controversies around the challenges.
Ethicsal dilemma:
- is it legal
- is it balanced
- is it right
While moral reasoning is my own reasoning.
Ethics vs Bioethics
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: they investigate what is morally good and bad, right and wrong Ethics simply asks the question: “Just because we can, does this mean that we should?”
This is a question for scientists, too.**ETHICAL THEORY…TO ACTION
Theory → Principle → Rule → Action
What is “Bioethics”?
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 illWhat is “Bioethics”?
• Term created by Van
Rensselear Potter
(oncologist), in 1970.
• VAN RENSSELAER POTTER
(1911-2001):What is Bioethics?
The term “bioethics” was introduced in
the 70’s by Van Rensselaer Potter for a
study aiming at ensuring the preservation
of the biosphere.
It was later used to refer a study of the
ethical issues arising from health care,
biological and medical sciences.
**It is a major area in applied ethics.**What is “Bioethics”?
He published:
• 1970 – the article
“Bioethics, the Science of
Survival” in Perspectives in
Biology and Medicine;
• 1971 – the book Bioethics:
Bridge to the Future.What is “Bioethics”?
• a new philosophy that sought to
integrate biology, ecology, medicine,
and human values;
• “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”.BIOETHICS
• Bioethics is the philosophical study of the
ethical controversies brought about by
advances in biology and medicine.
• Bioethicists are concerned with the ethical
questions that arise in the relationships among
life sciences, biotechnology, medicine, politics,
law, philosophy, and theology.Who study bioethics?
All parts of science must consider bioethics
“Just because we can, should we?”
deals with the questions relating to the appropriate use of
science advancements and new technologiesA classic bioethical decision
• One heart available who should get it?
17-year old girl 40-year-old school
70-year-old
principal
womanBioethics
The emergence of this new area of study has
been triggered by and a response to the new
scientific/technological developments in
biomedical and life sciences.
Medical ethics and nursing ethics are more
concerned with the ethics of the health care
professionals and their relationship with the
patient. Bioethics has a broader scope****Main topics in Bioethics
1. Death and dying
2. Pre-birth Issues
3. Issues in human reproduction
4. Human cloning
5. Stem cell research
6. The new genetics
7. Resources allocation
8. Organ transplant
9. Doctor-patient relationships
10. Experimentation with human subjects & animals****Bioethics
Examples of main ethical and legal issues on human
reproduction technologies:
– Procreation rights of infertile couples
– It is unnatural
– Inequality and exploitation
– Selling babies (maternal surrogacy)?
– The moral status of extra embryos left over from IVF
– Definition of parent-child relation
– Integrity of the family
– Best interests of the childReproductive Cloning
• Creating a genetically identical organism
• Many animals have been successfully clonedPreImplantation Genetic
Diagnosis (PGD)
• Diagnosing inherited genetic disorders “in
vitro”
• Choosing which embryos will be transferred to
the uterus based upon desired traits
• Gender decisions
• “Designer Babies?”Genetic Testing
• Individual risk assessment based upon a
person’s DNA profile
• DNA chip identifies genetic predispositions
• Potential for genetic discrimination
• DNA profiling? DNA banks?Transgenic Plants
• Engineered plants that contain novel genes
from other species
• Results in new characteristics that make
plants more desirable and useful to humans
• Are they safe to eat?
• How do they affect the ecosystem?Bioethics’ History
a) the public acknowledgment of the research
done, during World War II, by the Nazi
physicians;
b) the quick progress of biomedicine, posing
new ethical dilemmas;
c) the insufficiency of the traditional ethical
concepts to solve the problems raised by
biomedicine.Bioethics’ History
1946 – Nuremberg trials:
German physicians said that they had not
practised war crimes, but only obeyed to
orders;
the Nuremberg Code was approved, providing
the standards against which the practices of
Nazis involved in human experimentation
were jugged.Bioethics’ History
• December 1967: Christian Bernard performs the first heart
transplantation at Groote Schur in Cape City.
• **July 1972: Tuskegee Study (**In 1932, the Public Health Service, working
with the Tuskegee Institute, began a study to record the natural history
of syphilis. It was called the “Tuskegee Study of Untreated Syphilis in
the Negro Male**) is publicised as a trial where natural history of syphilis**
was observed in 399 afro-American who died without treatment.
• 1973: The Belmont Report was written by the National Commission for
the Protection of Human Subjects of Biomedical and Behavioral
Research.
• 1973: Roe vs Wade: the US Supreme Court recognized a right to
abortion, 410. U.S. 113, followed from its decision recognizing a right to
privacy.
• 1975: Karen Quilan’s parents ask the administration of the hospital
where she was being taken care of, to turn off the machines that kept
her alive.
• 1978: Louise Brown was born, the world’s first baby to be conceived via
**in vitro fertilization (IVF)**1997:
Encyclopedia of Bioethics
(1978, 1995)
In the Introduction to the 1995 revised edition of the
Encyclopedia of Bioethics, Warren Thomas Reich, Editor in
Chief, defined bioethics as:
“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.”
This definition shapes the third edition, which continues the
broad topical range of earlier editionsBasic Bioethics Principles
The Four-Principle Approach
One of the most important approaches in bioethics is the
four-principle approach developed by Tom Beauchamp and
James Childress (Principles of Biomedical Ethics, 6th ed.,
New York: Oxford University Press,1978,1990, latest edition
2009).
The four-principle approach, often simply called principlism
or principialism, consists of four universal prima facie mid-
level ethical principles:
(1) autonomy, (2) non-maleficence
(3) beneficence and (4) justiceBasic Bioethics Principles
• AUTONOMY: respect for people’s rights
– Autonomy
– Dignity
• BENEFICENCE: Benefits must be
proportionate to risks
– _Potential harm = potential good_Basic Bioethics Principles
• JUSTICE: The even distribution of benefits
and risks throughout society
• NONMALEFICENCE: Do no harm
– Experiment must stop if causes harm_._Autonomy:
• Greek:
• autos “self” and
• nomos “rule,” governance,” or “law”
• Self-rule that is free from both controlling
interference by others and from certain
limitations such as an inadequate understanding
that prevents meaningful choice
(Beauchamp and Childress)BENEFICENCE
• Providing a benefit to another
• Principle of beneficence: a moral obligation
to act for the benefit of others
• Protect and defend rights of others
• Help persons with disabilities
• Rescue persons in dangerNONMALEFICENCE
• An obligation to not inflict harm on others
• First do no harm
• Distinct from Beneficence
• Obligations not to harm (rob or kill)
• Obligations to help others (rescue a drowning
child)JUSTICE
• Fair and just distribution of social burdens,
benefits, opportunities and allocation of
positions
• Justice and Distributive Justice: fair, equitable
and appropriate distribution determined by
social norms
• Access to Health Care
• Selection of Research subject populationPRINCIPLES, RULES, ACTION
Bioethics
• What could and should we do?
• Why?
• Case specific
• Depends on values of the individuals
• Some universal principlesFinding a Balance
• Focusing on whether or not “we could”
• Instead of whether or not “we should”
Weighing the advantages and disadvantages.
Acknowledging the responsibilities that must be
faced with the information that we have
acquired.EXAMPLES OF MORAL THEORY
Utilitarianism
• Consequence-based theory (Ends justify the means): the right action is
the action that maximises the total well being. For utilitarians, a couple (or a
single reproducer) has a significant moral reason to select the best child,
one with the lowest chance of disease and the best prospects for the best
life. Because utilitarians have a broad understanding of what makes a life
go well, which goes beyond prevention or treatment of disease, they have
no objections to genetic enhancement, if it promotes overall well being.
Kantianism or deontologism
• Why you do something matters…can you make something a universal
rule?
• The Golden Rule: the principle of treating others as one would wish to be
treated
Liberal Individualism: to protect the right to autonomy and the right of self-
determination
Communitarianism
• The good of the community
Ethics of Care:
focus on relationships involving care, responsibility, and trust