A Companion to Bioethics - 2009 - Kuhse - What Is Bioethics A Historical Introduction

Part I: Introduction

• A Companion to Bioethics: Edited by Helga Kuhse and Peter Singer, second edition, © 2009 Blackwell Publishing Ltd. ISBN: 978-1-405-16331-6

1. What Is Bioethics? A Historical Introduction

Historical Context

• Since the 1960s, ethical problems in health care and biomedical sciences have gained significant public attention.

• Innovations such as dialysis machines, artificial ventilators, and organ transplants allow for the survival of patients, raising ethical questions.

• Reproductive technologies, like in vitro fertilization, challenge traditional parent-child relationships and ethical norms.

• Advances in modern contraceptives, prenatal testing, and abortions empower women to make choices regarding family planning.

• Ethical concerns also include the power and decision-making authority of doctors, highlighting issues surrounding patients’ rights.

Emergence of Bioethics

• The rise of bioethics coincides with new ethical dilemmas in health care, challenging the traditional doctors’ decision-making authority.

• Van Rensselaer Potter originally coined the term "bioethics" to refer to ecological survival rather than medical ethics.

• The modern usage of bioethics focuses on ethical issues stemming from health care and biomedical sciences.

Distinction from Medical Ethics

Medical Ethics Overview

• Traditionally centered on the doctor-patient relationship and professional virtues.

• Focused on relationships between medical professionals, sometimes perceived as protecting their interests over patients'.

Bioethics as a Distinct Field

• Bioethics takes a critical, reflective approach beyond traditional boundaries:

  • Seeks understanding rather than adhering to a strict code of conduct.

  • Questions fundamental ethical concepts such as value of life and personhood.

  • Addresses public policy and the influence of science on society.

Historical Background of Medical Ethics

Early Influences

• Medical ethics has roots predating Hippocrates in ancient civilizations with basic values dictating care provided by laity and non-professionals.

• Code of Hammurabi set early legal standards for medical practice (c. 1750 BC), showing an awareness of medical consequences.

• Ancient ethical principles often presented through oaths, such as the Hippocratic Oath, which focused on beneficence and nonmaleficence.

Transition to Modern Ethical Practices

• The Hippocratic Oath not only established important ethical principles, such as

• Beneficence: Doctors should benefit patients.

• Nonmaleficence: Doctors must avoid causing harm.

• The historical discourse transitioned from ancient practices to Christian-influenced ethics emphasizing compassion and charity, evidenced by religious figures’ writings and the establishment of hospitals in the name of care.

Nursing Ethics

Evolution of Nursing Ethics

• Nursing ethics emerged in the 19th century with figures like Florence Nightingale, who established ethical standards in patient care emphasizing the character of nurses.

• Over the decades, nurses have shifted their ethical focus towards patient care over strict adherence to doctors' orders.

Influence of Feminism

• The feminist movement in the late 1960s empowered nurses to advocate for patient-centric care rather than strict compliance with medical orders.

• Feminist philosophers, such as Nel Noddings, redefined ethics emphasizing relational care.

The Growth of Modern Bioethics

Formation and Issues

• The mid-20th century saw formalization of bioethics with works like Joseph Fletcher’s Morals and Medicine and the influence of the civil rights movement, influencing ethical discussions in health care.

• The field expanded significantly during the 1960s and 1970s, addressing issues like abortion, euthanasia, and medical resource allocation.

Institutional Development

• By the late 1960s, the need for ethical oversight led to the establishment of institutions such as the Hastings Center focused primarily on bioethical research and discussions.

• Bioethics evolved into an interdisciplinary field encompassing law, economics, and public policy, becoming an essential component of medical and nursing education.

Globalization of Bioethics

Current Challenges

• Although bioethics has its roots in developed nations, current efforts are focused on widening its scope to address health ethics in developing countries.

• The 10/90 problem in medical research highlights the disparity in attention toward diseases affecting poorer populations.

• Recent efforts, such as the establishment of Developing World Bioethics Journal, reflect a growing commitment to these issues.

Ethical Implications

• The question emerges about the obligations of wealthier nations and organizations toward addressing global health disparities.

• Foundations, like the Gates Foundation, pursue equality in global health initiatives, targeting critical diseases prevalent in poorer regions.