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

What is Bioethics?

• $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$$$Clinical ethics$$- applying ethics to understanding and resolution of healthcare dilemmas

• $Research ethics$$$Research ethics$$- study of ethical issues in carrying out scientific research

  History of Bioethics, Normative Ethics, and Principlism

  History of Bioethics

  • $Hippocratic oath-$$$Hippocratic oath-$$ 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$$$Normative ethics$$- 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$$$Deontology$$- what is “inherently” right?

    • $Teleology$$$Teleology$$- what “good” will come from certain actions?

    • $Utilitarianism$$$Utilitarianism$$- 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$$$Principlism$$- approach in normative biomedical ethics where 4 key principles are used to resolve and better understand particular cases

  • $Respect for autonomy$$$Respect for autonomy$$

    • Respecting that individuals have the right to make their own decisions around their health

    • Clinicians can’t make these choices for patients

    • $Consent$$$Consent$$- informing patients of all aspects of treatment to enable them to make the most informed decision

  • $Non-maleficence$$$Non-maleficence$$

    • “Do no harm” to patients

    • Treatments shouldn’t lead to undue harm to a pt

    • Inform patients of risks if harm may occur

  • $Beneficence$$$Beneficence$$

    • 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$$$Justice$$

    • 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