unit 12: intro to bioethics

Ethics

* *Ethos*
* **Moral principles that govern a person's behavior** or the conduct of an activity
* All our choices will have **consequences**
* **Set of rules** that society have to agree about living with other people
* Mostly based on choices bound by the **teachings of God**

moral aspects

All law should be created on ___

teachings of God

Laws should be based on the ___

Moral philosophy

Branch of philosophy that involves systematizing, defending, and recommending concepts of **right and wrong conduct**

Bioethics

* **“Medical Ethics” or “Clinical Ethics”**
* Ethical implications and applications of **health-related sciences**
* **“Ethics of life”**


* Professional ethics in **allied health**
* Philosophical study of ethical issues brought about by **advances in science and technology**
* Application of the basic principles of ethics to the new **possibilities opened by modern biology and biotechnology**
* Interdisciplinary study of **problems brought about by biological and medical progress** and its impact in the society and value system

bench-to-bedside “transnational pipeline”

### Bioethics

Its implications can run the entire length of ___

**Medical** Ethics, **Animal** Ethics, **Environmental** Ethics

### Bioethics: *History*

Generic term for 3 main sub-disciplines

* Benefit the sick
* Do not harm
* Preserve life
* Keep in strictest confidence patient info

### Bioethics: *History*

Doctors use their knowledge and power to:

* Address **perennial ethical problems, issues, dilemmas** confronting health care workers and their patients
* Address **legal problems** in healthcare with ethical concerns
* Address the **challenges of modern technology**


* Enhance **professional development and ethical values** of health care professionals

### Bioethics: *Why we study it*

**Respect for Autonomy**: Freedom of Choice

### Principles of Bioethics

* Considering **patient’s desires** within the bounds of accepted treatment
* Involving patients in **making decisions**
* **Patient is able to act** intentionally, with understanding, and without any controlling factors that would interfere against a free and voluntary act
* Considering patients’ **needs, desires, and abilities**
* Safeguarding patients’ **privacy**
* Basis of **Informed Consent**

**Non-Maleficence**: Do no Harm

### Principles of Bioethics

* Protecting patient from **harm**
* **No intentional harm or injury be don**e on the patient either through acts of omission or commission
* Knowing one’s own **limitations**
* Knowing when **delegation of patients’ care to trainees** is appropriate
* The __**passive way**__ of doing good
* you will not simply neglect doing anything bad, harm, or inflict suffering to others
* Fundamental **commitment** on the practitioner’s part

**Beneficence**: Do Good

### Principles of Bioethics

* **Core** of health care
* **Service** to the patient and the public at large
* Duty to **promote patient’s welfare**
* Competent and timely **delivery** of healthcare
* To always act in the **best interest** of the patient
* __**Active way**__ of doing good

**Justice**: Fairness & Equality

### Principles of Bioethics

* A form of fairness that implies that **goods in society are fairly distributed**
* Delivering healthcare **without prejudice or discrimination**
* **Shall not deny service** to patients due to __race, color, creed, gender, nationality__, etc

Clinical Ethics

### Areas in Bioethics

* Find **ethically acceptable course/s of action**
* Encourage **honest and respectable communication** among all patients
* Recommend **clinically and ethically acceptable solutions**
* Improve **institutional responses** to ethical dilemmas

Health Policy

### Areas in Bioethics

* **Government efforts** in managing health care for the public good

* Assure **access** to needed health care for all
* Incentivize curative **research**
* Protect health **quality**
* Control health care **costs**

### Areas in Bioethics: *Health Policy*

* A sound health policy should be able to:

Genetics

### Areas in Bioethics

* Challenged by the **increased collection and use of personal, medical, biological information**
* Privacy and securit
* Challenge on **autonomy**, particularly informed consent

Clinical Neuroethics

### Areas in Bioethics

* both dynamic and exciting
* Consciousness
* Deep brain stimulation
* Enhancement in clinical setting
* Pain
* Death

Precision Medicine

### Areas in Bioethics

* ethically **ambiguous**
* identify **biomarkers** that predict effectiveness in individuals

Reproductive Ethics

### Areas in Bioethics

* Provoke **social and legal controversy**

Assisted Fertility

### Areas in Bioethics: *Reproductive Ethics*

* Assisted Reproduction
* Surrogacy
* Genetic Manipulation

Restricting Fertility

### Areas in Bioethics: *Reproductive Ethics*

* Sterilization
* Contraception

Shared Decision-Making

### Areas in Bioethics

* Effective clinical encounters
* **Health care decision** is presented, discussed, deliberated, and negotiated **between the provider and patient**
* Physicians **tap their knowledge and combine it with their experience** in clinical judgment to provide a __balanced information__
* Evolved from **recognition of autonomy** and reflects **ethical medical practice**

Social Determinants of Health

### Areas in Bioethics

* Patients bring complex **social circumstances that are a consequence of their physical and social environment**, as well as access to resources

Social Justice

### Areas in Bioethics: *Social Determinants of Health*

* draws our attention to **disparities** in health

it’s **zip code** ~~not genetic code~~

### Areas in Bioethics: *Social Determinants of Health*

* a person’s life as well as their social experiences have a **profound impact on their health**

Abortion

### Bioethical Issues

* Premature **ending of a pregnancy**
* Issue of intense moral and personal concern

Surrogacy

### Bioethical Issues

* **Assisted reproduction** of parents who are unable to conceive or bear children
* **Commercialization** of women’s bodies
* **Exploitation** of poor women
* Women’s bodies as **commodities**
* Rransforming a normal biological function of a woman’s body into a **commercial transaction**

Whole Genome Screening

### Bioethical Issues

* Complete genome
* Identifying the **order of nitrogenous bases** in genes, gene functions, and their involvement in disease
* Allows for **early determination** of a newborn’s predisposition to **certain disease**
* **Designing** humans
* Possibility of using genetic data to create new **biological weapons**
* New **racism**
* **Stereotyping** or stigmatization

Human Cloning

### Bioethical Issues

* Creating a new population of **genetically similar and identical naturally-occurring organisms**
* **Somatic Cell Nuclear Transfer**
* Individuals as **sources of organs**
* **Safety and efficacy** of procedures
* Use for **destructive embryonic stem cell research**
* Effects on **child/parent relationships**

Genetic Engineering

### Bioethical Issues

* Done on **animals and plant crops**
* **Transplantation** of a gene or DNA sequence from one organism to another **to produce desirable traits**
* **Alteration of genetic makeup** using __recombinant DNA technology__
* **Invasiveness** of procedure
* Potential **harm**

Gene Therapy

### Bioethical Issues

* **Modification or manipulation of gene expression** to alter biological properties of cells for **therapeutic purposes**
* **Replacement** of disease-causing gene with a healthy copy of the gene
* **Inactivation** of disease-causing gene that is not functioning properly
* **Introduction of new modified gene** to help treat disease

Plasmid DNA

### Bioethical Issues: *Gene Therapy*

* Studied to treat **cancer, genetic disorders, and other diseases**
* **circular DNA molecule** genetically engineered to carry therapeutic genes into human cells

Viral Vector

### Bioethical Issues: *Gene Therapy*

* Use of **viruses** which have the ability to deliver genetic materials into cells

Bacterial Vector

### Bioethical Issues: *Gene Therapy*

* **Modification of bacteria** to prevent them from causing disease and using these as vehicles to carry therapeutic genes

Human Gene Editing Technology

### Bioethical Issues: *Gene Therapy*

* **Disruption** of harmful genes
* **Repair** of mutated genes

Patient-Derived Cellular Gene Therapy Product

### Bioethical Issues: *Gene Therapy*

* **Removal** of cells from the patient and genetic modification of these cells through viral vectors and **then returning** the genetically modified cells to the patient

**Regenerative Medicine**: Stem Cell

### Bioethical Issues

* **Embryo** as a source of undifferentiated cells
* Use of **stem cells** to treat diseases
* Promotes **repair** of disease-stricken, dysfunctional, or injured tissue using stem cells or its derivatives
* Protection of the **reproductive interests** of women
* **Confidentiality** of donor information
* Forces us to choose between **preserving the life of the embryo and alleviating pain or suffering**

Eugenics

### Bioethical Issues

* Improving the human society or race
* Aims to __reduce human suffering__ by **“breeding out”** disease, disabilities and so-called undesirable characteristics from the human population
* Loss of **genetic diversity**
* Culturally-accepted improvement of gene that **may lead to extinction**
* Increased **vulnerability** to disease
* **Reduced** ability to **adapt**
* Horrible **abuses** committed in the name of eugenics through coercive policies
* How **new genetic knowledge** is used
* Subjectivity of **perfection**

Euthanasia

### Bioethical Issues

* Good death
* **Ending the life of an individual to cease pain or suffering**
* Assisted suicide or mercy-killing
* Done through **act of omission or driven by compassionate motives**
* Availability of **palliative care**
* **Decreased care** for the dying and terminally ill
* Exposure of **vulnerable people to more pressure** to end their lives
* **Sanctity** of life
* **Autonomy** and human rights
* **Doctor-patient relationship**

Organ Donation

### Bioethical Issues

* **Surgically removing a tissue or organ** from one person (donor) and **transplanting it** to another person (recipient)
* **Organ procurement**
* **Altruism** or commercial dealing
* Widening **gap** between organ supply and organ demand
* Use of living donors as **sources of organs**

Cryonics

### Bioethical Issues

* **Reversion** of death
* Aims to **stop body functions** indefinitely and **preserve** cell structure and body chemistry
* Resource allocation
* Possibility of **unnecessary suffering** on the part of a family to move on and accept death
* Unexpected harm or consequences
* Autonomy and rights of a person
* Non-maleficence

−196 °C or −320.8 °F

### Bioethical Issues: *Cryonics*

* Temperature, freezing to reanimate