What is Bioethics? + History of Bioethics, Normative Ethics, and Principlism

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What is Bioethics?

• $Bioethics$- a field that helps us to better understand, analyze, and respond to ethical quandaries faced in medicine and medical research   * study of value-laden issues in health and biomedicine   * Multi-disciplinary field drawing on philosophy, theology, law and social sciences
• $Clinical ethics$- applying ethics to understanding and resolution of healthcare dilemmas
• $Research ethics$- study of ethical issues in carrying out scientific research

  ## History of Bioethics, Normative Ethics, and Principlism

  ### History of Bioethics   * $Hippocratic oath-$ set of rules about ethical practice   * parts of these have changed     * Do not prescribe lethal substances → this has also changed     * Do not perform abortions → this has changed       * Change is based on medical progress  & changing philosophy on abortion     * Keep patients’ privacy     * Maintain high moral character → clinicians posting on social media?     * Do not perform proper surgery without proper training   * Bioethics as an academic discipline is somewhat new     * Arose w/ scientific medicine     * Based on ethical issues in mid-20th century       * Nazi and Japanese medical experiments in WWII       * Tuskegee syphilis experiment         * study abt syphilis in black men, people wanted to see if it went untreated         * Researchers withheld available treatments from them   * 1960s forward- bioethics solidified as an academic field in response to these problems   * Now bioethics is in     * Academic departments     * grad/undergrad/professional programs     * Clinical ethics in hospitals     * Institutional review boards

  ### Normative Ethics   * $Normative ethics$- a branch of philosophy concerned with the formulation of criteria for what is morally right and wrong     * Based on philosophical theory     * Need to make generalizable principles guiding ethical behavior     * Different approaches       * $Deontology$- what is “inherently” right?       * $Teleology$- what “good” will come from certain actions?       * $Utilitarianism$- what actions will do the “most good” for the greatest number of people?     * Critiques       * doesn’t take into account specific cultural contexts bc different cultures/social groups have distinct beliefs about what is “moral”       * Can be exclusionary/problematic

  ### Principlism   * $Principlism$- approach in normative biomedical ethics where 4 key principles are used to resolve and better understand particular cases     * $Respect for autonomy$       * Respecting that individuals have the right to make their own decisions around their health       * Clinicians can’t make these choices for patients       * $Consent$- informing patients of all aspects of treatment to enable them to make the most informed decision     * $Non-maleficence$       * “Do no harm” to patients       * Treatments shouldn’t lead to undue harm to a pt       * Inform patients of risks if harm may occur     * $Beneficence$       * Acting in best interests of a patient’s health; striving to “do good” on their behalf       * Best interests may have some level of risk     * $Justice$       * Ensuring medical decisions are fair       * Ensuring distribution of scarce medical resources is fair across populations       * Making difficult decisions about how to best distribute limited resources

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