Bioethics Notes

Introduction to Bioethics

Bioethics is a discipline that bridges humanistic sciences (particularly ethics) and biological sciences. Ethics, or moral philosophy, systematically examines life's significant questions using critical reasoning, logical argument, and careful reflection.

Ethics Defined

• Ethics is a reasoned approach to understanding moral concepts, issues, and standards.
• Descriptive ethics studies morality using scientific methods, investigating actual beliefs, behaviors, and practices.

Branches of Ethics:

1. Normative Ethics: Seeks to justify moral standards, principles, rules, virtues, and theories to guide actions and judgments.
2. Metaethics: Focuses on the meaning and justification of basic moral beliefs.
3. Applied Ethics: Uses moral norms and concepts to resolve practical moral issues, such as the permissibility of abortion or the ethics of human cloning.

Bioethics

Bioethics is the largest subfield within applied ethics.

• It addresses ethical questions related to medicine, such as the morality of abortion, genetic testing, embryo selection, and human cloning.

The Birth of Bioethics

Origin

The term "bioethics" originated in the United States and was first used by Van Rensselaer Potter, an oncologist.

• Potter observed correlations between oncological diseases and human-caused environmental damage.
• In 1970, Potter wrote "Bioethics: The Science of Survival", suggesting bioethics as a bridge between biology (study of the living) and ethics.

Purpose

Bioethics was born out of the necessity to clarify scientific considerations through dialogue between scientists and humanists.

• Potter emphasized the impact of human modifications on the environment, influenced by the emerging field of ecology.
• Aldo Leopold's "Land Ethics" advocated for treating Earth as an organism to be protected, not exploited.

Early Models

Potter’s initial bioethics model did not gain widespread traction; concurrent focus shifted to clinical bioethics led by Andre Hellegers and Daniel Callahan.

Pre-history

Bioethical literature identifies a "Bioethics Pre-history" dating back to World War II.

• Ethical concerns arose regarding the atomic bomb and human experimentation, such as the Nazi experiments in concentration camps.
• The Nuremberg Code, developed from the Nuremberg Trials, established the Ethics Committee to protect the rights and well-being of research participants.
• Considered the first bioethics document, the Nuremberg Code differentiates between lawful experimentation, torture, and unregulated unethical experimentation and regulates person consent to experimentation.

Influences

The promotion of bioethics in the 1960s-70s was influenced by the Church and emerging ethical issues related to science and ethics.

• Introduction of the contraceptive pill raised questions about separating sexuality from reproduction.
• Isolation of DNA by Friedrich Miescher’s (identified in '53 by James Watson and Francis Crick) sparked debates on gene inheritance and intervention.
• Early organ transplants were considered experimental.
• Advances in resuscitative medicine led to questions about prolonging life and defining brain death ( coma depasse ).
• Limited dialysis machines raised issues of patient selection.
• The rise of intensive care led to discussions on futile medical care.

Unethical Human Experimentation

Bioethics birth was also influenced by USA newspapers exposing unlawful and cruel human experimentation.

• The Tuskegee Study of Untreated Syphilis (1932-1972) was conducted by the United States Public Health Service (PHS) and the Centers for Disease Control and Prevention (CDC) on African American men with syphilis.

  • The study aimed to observe the effects of untreated syphilis; participants were not informed about the experiment.

  • Medical advancements meant the disease was entirely treatable by the study's end.

  • Over 100 men died, 40 wives were infected, and 19 children were born with congenital syphilis.

• Despite the World Medical Association's Declaration of Helsinki (1964) requiring informed consent, the Tuskegee study protocols were not re-evaluated.

The Belmont Report

The Tuskegee Study scandal led to the drafting of the Belmont Report and the establishment of the Office for Human Research Protections (OHRP).

• Written by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, created due to the National Research Act of 1974.

  • The commission identified basic ethical principles for human subject research and developed guidelines.

  • It addressed the boundaries between research and medical practice, risk-benefit assessment, subject selection, and informed consent.

• The Belmont Report outlines bioethical principles, including autonomy, beneficence, nonmaleficence, and justice.

Bioethics in Summary

Bioethics serves to distinguish between what science allows and what ethics dictates regarding scientific and technological progress.

• Ethics involves argumentation and discussion, not scientific method demonstration and hypothesis falsification.
• In 1978, Warren Reich defined bioethics as "The systematic study of the moral dimensions - including moral vision, conduct, and policies - of the life and health sciences, using various ethical methodologies and with an interdisciplinary approach”.
• Bioethics systematically studies the moral dimensions of life and health sciences, including social and environmental health issues.

Bioethics Field

Bioethics encompasses:

• Clinical bioethics
• Environmental bioethics
• Animal bioethics
• Social bioethics

Core Bioethical Principles

The core principles of bioethics are:

1. Autonomy
2. Nonmaleficence
3. Beneficence
4. Justice

1. Autonomy

Is a person’s rational capacity for self-governance and self-determination.

• Respect for autonomy allows individuals to exercise self-determination.
• Autonomous persons have intrinsic worth due to their ability to make rational decisions and moral choices.
• Autonomy places restraints on actions; violations require strong justification.

Informed Consent

Choices must be fully informed to be considered autonomous.

• Informed consent requires patients to freely consent to or decline treatments with adequate information.
• Autonomy can be curtailed to prevent harm to others.

Paternalism

Paternalism overrides a person’s actions or decisions for their own good.

• Weak paternalism is permissible in cases where individuals cannot act autonomously (e.g., temporarily restraining severely depressed patients).

2. Nonmaleficence

Demands that we not intentionally or unintentionally inflict harm on others. The principle’s expression is: “Above all, do no harm.”.

• Health professionals must exercise “due care.