BIOETHICS LECTURE 2

Contesting Values in Bioethics

• Harm Principle: The notion that one can act freely as long as their actions do not harm others.

  • Definition of Harm: Identifying harm can be complex; personal suffering such as emotional distress (e.g., heartbreak from a breakup) does not equate to a claim against others.

  • Interference with Rights: One way to assess harm is to determine if it interferes with an individual's rights or autonomy.

Autonomy in Bioethics

• Autonomy Defined: The idea of being one's own lawgiver, governing one's life based on personal values and goals.

• Link to Freedom: Autonomy is fundamental to liberal democratic societies that uphold individual rights, including freedom of speech and religion.

• Childress Perspective: Autonomy must be considered in ethical decision-making; failing to do so can lead to morally questionable situations (e.g., denying treatment against a patient's wishes).

Case Study: The Gelsinger Case

• Background: Jonathan Barron critiques bioethics by discussing the Gelsinger case where parents were pressured to allow risky medical treatments.

• Consequentialist Approach: Some argue that a cost-benefit analysis should guide ethical decisions (e.g., treating children for survival chances).

  • Critique: Others contend that doing so undermines autonomy, treating individuals as means to an end.

Moral Dimensions

• Paternalism in Bioethics: The ethical dilemma of acting for someone's own good against their expressed wishes (e.g., providing a blood transfusion against patient’s religious beliefs).

  • Doctor's Autonomy vs. Patient's Wishes: The conflict arises when a patient's decision is overridden for perceived benefits.

• Non-maleficence and Beneficence: Two principal commitments in bioethics; promoting good while preventing harm.

Core Principles of Bioethics

• Principlism as Framework: A balanced approach to ethics that considers autonomy, beneficence, non-maleficence, and justice.

Beneficence

• Definition: Actively doing good for patients, aligned with the ethical commitment to care.

Nonmaleficence

• Definition: Obligation to not inflict harm intentionally.

Justice

• Fair Distribution of Resources: Considerations for how scarce medical resources (e.g., during pandemics) should be allocated fairly (e.g., young vs. older patients).

Ethical Decision-Making Scenarios

• Extreme Cases: Example of a woman who ingests poison with a note indicating a wish to die.

  • Ethical dilemma: Whether to respect her autonomy or intervene to save her life can challenge the core principles of bioethics.

• Assessment of Autonomy: Patient's mental state must be evaluated to determine legitimate autonomy in decision-making.

• Professional Consequences: Doctors may face ethical conflicts between patient respect and personal liability.

Paternalism Types

• Soft Paternalism: Intervenes only until it can be established that individuals understand the risks (e.g., ensuring informed consent).

• Hard Paternalism: Intervenes regardless of personal understandings, based on the perspective that some choices are harmful.

Conclusion and Reflection

• Autonomy and ethical decision-making in medicine intersect with broader societal norms and personal liberties.

• Continuous evaluation of what constitutes legitimate autonomy is essential in various contexts such as health care.