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

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