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