Lesson 4:

Globalization and Pluralism: Challenges to Ethics

Globalization is the word used to describe the growing interdependence of the world's economies,
cultures, and populations, brought about by cross-border trade in goods and services, technology, and
flows of investment, people, and information. Countries have built economic partnerships to facilitate
these movements over many centuries. But the term gained popularity after the Cold War in the early
1990s, as these cooperative arrangements shaped modern everyday life. The wide-ranging effects of
globalization are complex and politically charged. As with major technological advances, globalization
benefits society as a whole, while harming certain groups. Understanding the relative costs and benefits
can pave the way for alleviating problems white sustaining the wider payoffs (PIIE, 2019).

I. GLOBALIZATION

Globalization can be defined as the continuing world-wide economic integration, recently facilitated by
emerging information technologies, that has also affected the environment, culture, and political of
different groups of people. "Globalization is just a phenomenon and not just a passing trend. It is the
international system that replaced the cold war system. Globalization is the integration of capital,
technology and information across national borders, in a way that is creating a single global market and,
to some degree, a global village.’ - On Thomas Friedman’s Lexus and the Olive Tree For Friedman, the
challenge of globalization for everyone is how to come up with a creative response to the conflict
between the Lexus and the Olive Tree:

- Lexus (referring to the luxury tine of Toyota), representing the "drive for prosperity and development,
brought about by globalization

-Olive tree, representing the identity and traditions, brought by the ancient forces of culture, geography,
tradition, and community.

It is the world-wide integration of government policies, cultures, social movements, and financial
markets through trade and the exchange of ideas. Globalization emphasizes the increasing trans-border
or transnational relations, which are occurring in the contemporary world.

In other words, whereas individuals usually have most of their interactions and affiliations in the past
with others who share the same territorial space, there is massive mushrooming of interactions and
affiliations across these territories today because of globalization brought about by the escalation of
global relations.

Globalization has renovated the globe from a collection of separate communities interacting
infrequently into a virtually one multi-faceted community. Politically, economically, and culturally
therefore, communities across the world now function in what is fundamentally a shared space although
divided into artificial political condominiums called nation-states. Transnational relations made possible
by globalizing forces and processes have opened up new forms of social bonds and responsibilities.

In a globalized era, peoples and communities across the world have become culturally connected, the
distinction between the global and the local has become progressively blurred and actions and events in
one locality carry with it the potential to breed transnational and trans-generational impacts. It is
precisely for these reasons that moral reflection about our responsibilities and obligations in a globalized
age has become an imperative.

Issues in Globalization

"Globalization is deeply controversial, however, proponents of globalization argue that it allows poor
countries and their citizens to develop economically and raise their standards of living, while opponents
of globalization claim that the creation of an unfettered international free market has benefited
multinational corporations in the western world at the expense of local enterprises, local cultures, and
common people. Resistance globalization has therefore taken shape both at a popular and at a
governmental level as people and governments try to manage the flow of capital, labor, goods, and
ideas that constitute the current wave of globalization."

From Sylvain Ehrenfield ("Ethical Dilemmas of Globalization," in Ethical Culture,

http:/ethicalfocus.org/ethical- dilemmas-of-globalization/):
• "Protectionism"- a.k.a., "economic nationalism"- belief that international institutions (e.g., WTO, IMF,
WB) adversely affect national interest, makes the country subservient to multinational corporations

"Anti-globalist"- accuse international institutions for being "undemocratic," ignoring environmental

issues, promoting unjust labor practices (e.g., child labor, workplace safety), increasing inequality and
further impoverishing the poor.

• "There is much talk about free trade. We must remember that every free trade agreement is a
negotiated document. It involves all kind of bargaining about different products and tariffs. For example,
for the North America Free Trade Agreement, NAFTA, the results were uneven. US corn producers
benefited, while textile workers have not. Mexican farmers were devastated by US corn imports, and
their textile workers lost out. Part of the reason is textile products from China and US subsidies for
agriculture. It is estimated that the growth in Mexico and Latin America has benefited the upper 30%
but the bottom gained little."- Ehrenfield, "Ethical Dilemmas of Globalization,'

More Issues with Globalization

Although generally seen as downright good especially by economists, globalization, unfortunately, also
has a dark side. Author Gail Tverberg enumerates some reasons why globalization is not living up to
what was ideally expected of it, and is, in fact out very major problem today.

a. Globalization uses up finite resources more quickly.

b. Globalization increases world carbon dioxide emissions.

c. globalization makes it virtually impossible for regulators in one country to foresee the worldwide
implications of their actions.

d. Globalization acts to increase world oil prices.

e. Globalization transfers consumption of limited oil supply from developed countries to developing
countries.

f. Globalization transfers jobs from developed countries to less developed countries

g. Globalization transfers investment spending from developed countries to less developed countries.

h. With the dollar as the world’s reserve currency, globalization leads to huge US balance of trade
deficits and other imbalances.

i. Globalization tends to move taxation away from corporations, and onto individual citizens

j. Globalization sets up a currency “race to the bottom” with each country trying to get an export
advantage by dropping the value of its currency.

k. Globalization encourages dependence on the other countries for essential goods and services.

l. Globalization ties countries together, so that if one country collapses, the collapse is likely to ripple the
system, pulling many other countries with it.

Ethical Challenges of Globalization

While the aforementioned deals with the economic aspect of globalization, current neo-political
globalization, when dealing with ethical implications, also has adverse effects.

a. It concentrates wealth in the hands of the few, leaving majority in the condition of poverty.
Globalization has actually caused radical inequality, a deepening of exclusions brought about by
inequalities that present the world to be a fragmented space where some benefit at the expense of
others. Critics describe globalization as a process driven by progressive capitalist countries to perpetuate
their economic and political domination.

b. From the consequentialist standpoint, the moral argument against globalization is that it fails to
maximize happiness for the greatest number of people.

c. From a deontological standpoint, globalization is condemnable on the account that exploited

populations are treated as means to an end and not as an end in themselves.

d. States are in effect increasingly losing their sovereignty and seen as morally condemnable
intrusiveness of international economic organizations, characterized by lack of accountability to the
people openly affected by the policies of monetary organizations and tendency to impose agonizing
conditions on indebted governments.

e. Problem of handling the global environment in order to prevent a global ecological collapse, a scene
that threatens humanity with the threat of annihilation.

Globalization and Business Ethics

Business Ethics is a form of applied ethics that examines moral principles concerning business
environment involving issues about corporate practices, policies, business behaviors, and the conducts
and relationships of individuals in the organization.

With globalization, come various ethical issues such as duplication of products, child labor, money
laundering, environmental issues, and many other business malpractices. Additionally, sundry business
crimes have existed such as cybercrimes, sexual harassments in workplaces, and intellectual property
and patent thefts.

Ethics and Human Rights

• Particular moral codes (based on one's culture, religion, or other social grouping) are absolute for
member of the group - Are they?

Search for Universal Values

There are quite a number of moral questions and problem arising from globalization, that is, from global
interdependence and interconnection. To address these ethical problems, social scientists and
philosophers suggest that the time has come for the world to develop a global ethic, that is, a set of
universally accepted principles that could provide the foundation for regulating global interactions.

A set of shared ethical values and standards is central for the cohesion of society and for global justice
and peace. A shared set of moral values and principles will make for peace and harmony at the global
level. However, it seems improbable to ascertain normative principles that will be persuasive across
cultures. In spite of these ethical variations across various cultures, it is still very much possible that
basic and fundamental values hold for every society. Developing universally accepted principles, ex.
Global ethics for administering transnational interactions, is possible, for instance, through the process
of intercultural dialogue.

II. PLURALISM in general

It is a philosophical theory that there is more than one basic substance or principle, whether it be the
constitution of the universe, of the mind and body, the sources of truth, or the basis of morality.

• Can mean any of several things:

- The bare fact that there are many sets of beliefs and practices

- The attitude that recognized above, but on top of that maintains an openness to the differences and a
desire for engagement and understanding across this diversity

- The current era: contact between multifarious, cultural, political, religious persuasions

a. Moral Pluralism

Also known as ethical pluralism and value pluralism, it is the idea that there can be conflicting moral
views that are each worthy of respect. It thus implies that there are some values which may be equally
correct and fundamental, and yet in conflict with each other. Moreover, moral pluralism proposes that
in many cases, such incompatible values may be incommensurable, in the sense that there is no
objective ordering of them in terms of importance.

b. Against Moral Pluralism

Although at first glance, it seems to be flawless and attractive, moral pluralism is definitely not immune
to valid criticisms when philosophically analyzed. For one thing, it fails to stipulate what to do when two
or more of its values or theories indicate inconsistent practical imperatives.

Not only is it ethically irresponsible, it is also morally impotent. It gives us no moral standard, and offers
us no moral power. Moral pluralism leaves us either concluding that (1) there is no real solution to
ethical
dilemmas or (2) all possible answers are acceptable as long as they have underlying fundamental values.
The second implied conclusion is very much moral relativism.

Some thus explain that the popularity or pluralism and relativism in the globalized age are accompanied
by substantial moral collapse today. Pluralism in belief and pluralism in morals in today’s time go
together and the outcome is disastrous.

Imagine: Think of the unwanted girl children left exposed to die on the hillsides of Ancient Greece. Think
of the human sacrifices to the fish deity in ancient Polynesian religion. Think of the murder and gang
rape carried out by practitioners of Satanism. Are we to believe that these all spring from differing
insights in to the same ultimate reality as the pluralists claim? Think of the Sawi tribes people in
Indonesia, savage cannibals and ruthless killers, from whom treachery was the highest virtue.

“Moral pluralism can never control or even rival our natural sloth and greed. The terrorist groups have
morality which is determined by their political goals. If you believe in your cause as the most important
thing on earth, you will bomb, maim, and kill in order to achieve your goal. And the casualties? These
are regrettable but inevitable. Many ancient religions included the idea of human sacrifice: if these still
existed, would this practice be tolerated? Certainly not.” (McGrath, n.d.)

Thus we can identify negative social consequences of moral pluralism. Superficially, it has certain
plausibility to a liberal-minded public; yet, on closer scrutiny, it has its darker side.

Lesson 5

Ethics and Religion in a Globalized World Religious ethics concerns belief and practices of what is good
or bad, right or wrong, virtuous or vicious, from a religious point of view. A Christian ethic, for instance,
may be based on radical teachings of the religious leader Jesus Christ about loving one’s neighbor, being
a Good Samaritan, loving one’s enemies, being guided by the Father’s Will, and the like. For some, the
religious response is what is really needed concerning the challenges posed by globalization and other
contemporary issues.

Religion and Ethics

Ethics- may be defined as a system of moral principles which affect how people make decisions and lead
their lives. Ethics is concerned with what is good and right for persons and society.

Religion- is defined as “people’s beliefs and opinions concerning the existence, nature, and worship of a
deity or deities, and divine involvement in the universe and human life. Religion denotes the belief in. or
the worship of a god and the worship or service to God or the supernatural. The term supernatural
means “whatever transcends the powers of nature or human agency”. The term religion is sometimes
used interchangeably with faith, creed, belief system, or conviction.

Religion is also viewed as an organized collection of belief, cultural systems, and worldviews that relate
humanity to an order of existence. Many religions possess Holy Scriptures, narratives, or sacred
accounts that aim to explain the origin and meaning of life and the universe.

Some submit submit that the difference between religion and ethics is about the disparity between
revelation and reason. In some measure religion is based on the idea that God reveals insights about life
and its meaning. These divine insights are compiled in texts such as the Bible, Torah, Koran, etc., and
introduced as revelation. From strictly humanistic perspective, ethics is based on the tenets of reason.
That is, anything that is not rationally provable cannot be deemed justifiable. This definition of ethics,
however, does not necessarily exclude religion or a belief in God, for it is also a common belief that
human reason, designed also for ethical discernment, is a gift from a natural God. Indeed many ethicists
emphasize the relationship, not the difference, between ethics and religion.

Religion’s Role in Ethics

Religion is necessary for the continued survival of morality as an integral part of human life, especially, in
a globalized world.

“Morality cannot survive, in the long run, if its ties to religion are cut.” (Glenn C. Graber)
“The attempts to found a morality apart from religion are like the attempts of children who, wishing to
transplant a flower that please them, pluck it from the roots that seem to them unpleasing and
superfluous, and stick it rootless into the ground. Without religion, there can be no real, sincere
morality, just as without roots there can be no real flower. (Leo Tolstoy)

Cut-flowers thesis implies that those who believe that morality is a valuable human institution, and
those who wish to avoid moral disaster, should therefore make every effort to preserve its connection
with the true religion and the sound religious belief that forms its roots. As morality is currently in a
withering stage in this globalized era, its decline can be identified with the exorbitant secularization of
many things.

Basil Willey calls for urgent action to reunite religion and ethics. The outcome of de-Christianization
during the last three or four centuries “is what we see around us in the world today- the moral and
spiritual nihilism of the modern world, particularly of the totalitarian creeds”.

“The chaotic and bewildered state of the modern world is due to man’s loss of faith, his abandonment of
god and religion. I agree with this statement (cut-flower thesis), along with the ruin of the religious
vision there went the ruin of moral principles and indeed all values.” (W.T. Stace)

All these statements call attention to the prediction of the cut-flowers thesis which suggests that
morality cannot survive without religion. Some words of caution are need though: the cut-flowers thesis
does not say that a consequence of abandoning religion leads immediately to murder, rape, robbery,
drunkenness, sexual promiscuity, and the like. Nor does it say that the morality per se will soon cease to
exist if it ties to religion are cut. However, it does argue that to have a real ground or reason for moral
action, one must admit a religious or theological foundation.

THEISTIC ETHICS

Religions fundamentally endorse theism and theistic ethics or God- based morality. Theistic ethics
believes that a supernatural being called God is the foundation of morality. God is viewed as the true
source of moral laws, and as the only plausible cause of moral obligations which possess overriding and
binding character.

The theory holds that the truth of moral judgments depends on God’s will. In theism, “X is moral” means
“God wants us or a particular agent to do X”. As to how we can know God’s will, proponents admit
sources like revelation (Holy Scriptures), divinely guided by human reason, and God’s laws written in
man’s heart (conscience). The theory views ethics as necessarily linked to true religion and unlike other
ethical theories, theism considers faith in and obedience to God as necessary part o being truly moral.

1. Theistic Ethics Can Justify Moral Values While other ethical views can just postulate good moral
principles, only a theistic view can justify them.

a. Unless morality is grounded on the unchangeable nature of a morally perfect being, there is no basis
for believing in moral substitute.

b. If everything is relative, then there is no good reason why anyone ought to abstain from doing
anything he wishes to do.

c. Only in theism are all persons held morally accountable for their actions in the real sense.

d. Only the ethics rooted in Moral Law-Giver can be truly prescriptive in any objective sense of the word.

2. Theistic Ethics Can Explain Moral Accountability Theists believe that all people have this moral
experience of feeling morally obligated and that this sense of moral responsibility is connected to

God. This idea is consistent with the meaning of religion itself—religion being a compound of the Latin
re and ligare meaning to bind back. The bond involves the feeling of being morally obligated to live up to
some moral laws that press down on everyone which express God’s will and nature.

Morality is believed to be something above and beyond the ordinary facts of men’s behavior, and yet
quite definitely real, a real law, which none of us made, but which we find pressing on us. when we
admit moral law, we also affirm a moral lawgiver, for otherwise, it looks impossible to think of a moral
law that has moral force on our behavior.

Theists believe that Someone made the moral law so that moral rule is not just a disembodied principle
but a rule of Somebody. It accounts for the moral force of the moral law on our behavior, whenever we
break ethical rules, we offend Someone who himself created the law. Furthermore, theistic ethics
maintained that man’s life does not end at the grave and that all persons are truly held accountable for
all their actions. Its belief in an afterlife entails that evil and wrong will be expelled; righteousness and
virtue will surely be vindicated.

3. Theistic Ethics Has no Real Accountability in non-Theism With reference to theism, we can reasonably
say that there is no real moral accountability for one’s actions in non-theistic ideologies. In naturalism or
secularism, human life just finds its end in grave. Absent in non- theism is the so-called life after death of
theism where the final reward and punishment- that which accounts for the ultimate justice- will be
given. In this aspect, theism is extensively plausible and better than its non-theistic counterparts.

The absence of moral accountability in the philosophy of secularism reduces virtues, like those of
compassion and self-sacrifice, to hollow abstractions. Secularism fails to match theism in supplying this
necessary element for a sound moral foundation

4. The Euthyphro Dilemma The most common attack against moral theism is this famous philosophical
argument. In Plato’s writing, the ancient Greek philosopher Socrates asked an insightful question:

“Is a good thing good because God desires it? Or does God desire it because it is already good?”

If theists go with the latter view, which says God desires moral things because they are already good,
then good and bad are independent of God’s will- and thus moral theism is incorrect.

On the other hand, if theists answer that moral acts are good just because God desires them, then
cruelty, torture, and maltreatment would be good if God desires them.

(For proposed solutions for this dilemma, look for the article, “Countering Euthyphro Dilemma”)

Lesson 6

Applied Ethics

In this lesson, we will be learning Ethics in a real world scenario. We will be examining some major areas
in practical or applied Ethics. These are Bioethics, Business Ethics, and Environmental Ethics.

We will be learning how the discipline of Bioethics started, some major issues tackled in the discipline,
and some ethical issues related to it. In Business Ethics, we will gain some knowledge why ethics matter
in business, why it is necessary and appropriate, and also we will examine basic ethical issues in
business.

Environmental ethics is a very timely topic to discuss. In this lesson, we will look into the rationale of this
issue, some philosophical perspectives, and some ethical issues pertaining to environmental ethics.

A. BIOETHICS

Overview

The word ‘Bioethics’ comes from two words, “bio” which means ‘life’and “ethics”. Bioethics is a study of
ethics in relation to living things. The term ‘bioethics’ was first used in 1927 by Fritz Jahr, a German
scholar, in a journal article which argued for an extension of the Kantian principle of respect for persons
to all forms of life (Evangelista and Mabaquiao Jr., 2020). The word was first used in the US in 1970 by
Van Rensselaer Potter referring to “science of survival” in an ecological sense (Kuhse and Singer, 2009).
Bioethics has its roots in traditional medical ethics, and at present medical ethics is an integral part of
bioethics. Though it was stated as it is, bioethics is different from the way medical ethics is traditionally
applied. The earliest versions of the traditional medical ethics were contained in the Code of Hammurabi
and the Hippocratic Oath, which focused on specifying the moral virtues doctors should have, and how
doctors should behave towards their patients and fellow doctors. On the other hand, bioethics is a more
critical and reflective activity, analyzing the ethical dimensions of doctor-patient and doctor-doctor
relationships, and tackles deep philosophical questions on the nature of morality and moral personhood,
and the value of life and being human. It also evaluates public policies on health issues, allocations of
healthcare resources, and the direction of biomedical research.

Bioethics is multidisciplinary. Singer and Viens (2008) divided the concerns of bioethics into three broad
spheres: academic bioethics, public policy and law bioethics, and clinical ethics.

a. Academic Bioethics deals with issues concerning to the theoretical and practical aspects of medicine
affecting some considerations like special obligations or responsibilities of clinicians, what is good, right,
valuable, etc, in biomedical context and how one might go about providing systematic accounts of such
considerations.

b. Public policy and law bioethics focuses on issues dealing with the legality and extra-legality of
institutions can and should be involved in the regulation of clinical and research practices.

c. Clinical ethics deals with issues on “how the incorporation of bioethics into clinical practice can help
improve patient care”. These spheres are usually interconnected. For example, bioethical discussions on
the issues of abortion and euthanasia are concerned primarily on the determination of its morality
(sphere of clinical ethics). They also investigate into the moral justification and implications of legalizing
it (sphere of public policy and law bioethics). These discussions are usually informed by current medical
knowledge and developments in biomedical sciences (sphere of academic bioethics).

There are three factors that affect the development of bioethics:

a. Developments in biomedical knowledge; in the field of genetics, and in the practice of medicine. This
includes, among others, the use of dialysis machines, artificial ventilators, modern contraceptives, and

the procedures of organ transplants, in vitro fertilization, prenatal testing, genetic enhancement, and
safe abortions (Khuse and Singer, 2009).

b. “The growing concern about the power practiced by doctors and scientists on the issues about
‘patients’ rights’ and the rights of the community as a whole to be involved in decisions that affect
them”.

c. Legal cases and events that have engrossed public consciousness and generated public ethical
discussions and debates, which have significantly contributed to the increasing interest in bioethics.

Bioethical Issues

1. Beginning-of-Life Issues These issues cover the classic moral problem of abortion and the various
reproductive issues brought by modern technology

Abortion

Abortion is defined as termination of pregnancy. Sometimes, they are done by natural process through
“spontaneous events (spontaneous abortion)” such as miscarriages, which generally involve no moral
issues. The kind with moral concern is called “induced abortions”, caused by intentional actions to
terminate pregnancy.

Ethical discussions on abortion revolve around the status of the fetus and the questions:

• Does it have moral standing?

• Under what conditions, if any, is abortion (induced) is morally justifiable?

• Does it achieve personhood? If so, at what stage?

• What constitutes personhood?

Assisted Reproduction

In a natural and normal process, a woman gets pregnant through sexual intercourse with her male
partner. In a right timing, the woman ovulates and her egg cell is fertilized by the man’s sperm cell.
However, some couples are unfortunate to end up being childless because they may not be successful in
one or more of the steps necessary in reproductive process. There are couples who desire to have
children without the need to adopt, thus, seeking the aid of technologies such as assisted reproduction
(AR), which was developed to respond to such needs. Assisted Reproductive Technology means
“techniques for creating a baby other than by sexual intercourse between a man and a woman. It
involve a married couple, others involve single or unmarried couples and utilize bodily products or
services of third parties (Purdy, 2009). The following are some of the usual types of AR technologies:

• Artificial insemination with the husband’s sperm (AIH)

• Artificial insemination with the donor’s sperm (AID)

• In vitro fertilization (IVF)

• Surrogacy

Some major ethical issues often raised regarding AR technologies are the following:

a. These reproductive technologies are unnatural

b. Artificial reproductive technologies threatens the institution of family

c. AR technologies perpetuates negative attitudes towards infertile women (Amarakone and Panesar,
2006).

d. It does not only promote the idea that childlessness is negative, it also promotes the view that
childlessness is an illness that requires a cure from medicine.

Cloning

According to Gregory Pence (2009), the word “clone” derives from the Greek word ‘klone’ or ‘twig’,
referring to plant reproduction process where a new plant is created asexually by planting a twig in a
nutrient-filled water. Cloning refers to reproduction of the genetic material of an ancestor-organism
without sex. The two main types are – reproductive cloning (somatic cell nuclear transfer or SCNT) and
therapeutic cloning (cloning for biomedical research).

Ethical issues arise opposing this medical technique. One issue has to do with the morally relevant status
of the embryo. This scientific technology involves the production, use, and destruction of viable
embryos. Accordingto Kantian perspective – a human embryo as a potential person should not be used
to achieve some further benefit, but instead, be treated as intrinsically valuable with moral rights of
their own. Another issue is that some ethicists considers therapeutic cloning as morally permissible, but
not reproductive cloning. Ninety-five to ninety-seven percent of animal cloning attempts end in failure,
and the scientists who cloned Dolly (the sheep) failed 276 times before they succeeded to produce a
single live-born clone of an adult sheep. Another point is that Dolly died at the age of six because of a
type of a lung disease that normally affects sheep at around age 11 or 12. Reproductive cloning can lead
to a birth of high number of disabled infants, many of whom would not be able to survive without
significant pain or suffering. Aside from these birth defects, other ethical issues concerning reproductive
cloning point to the kind of treatment received by the cloned child. A child who is created to replicate
the characteristics of a particular person will have to meet specific expectations (Pence, 2012). Such
expectations will limit the child’s future. A child created from the cell of Kobe Bryant will likely expected
to be a great basketball player, the child in this case is seen as “a product that has been copied from
another for a certain goal. It has not been created for the unique, priceless original that each child ought
to be.” This criticism is based on a Kantian idea that a child, like any human being, should be valued in
itself, and not be viewed as a commodity to be used for some particular purpose.

2. Sustenance-of-Life Issues

Organ Transplantation

Organ transplantation “is both a life-extending and life-saving medical procedure in which a whole or
partial organ (or cells in cell therapy) from a deceased or living person is transplanted into another
individual, replacing the recipient’s non-functioning organ with the donor’s functioning organ (Wright et
al., 2008). Ethical issues in this medical procedure has something to do with the procurement of organs
(Richards, 2009). Due to shortage of organs, which caused the deaths of some patients, there is a need
to

explore morally justifiable ways of increasing the rate of procuring organs for transplantation. However,
efforts made in this regard are hindered by several restrictions imposed in different countries. These
restrictions are primarily intended to protect the rights and welfare of possible donors and recipients
but some of these restrictions have been perceived to be “overprotective” and morally questionable.

Genetic Medical Procedures

Advances in genetics have generated new medical procedures for dealing with diseases attributable to
gene defects. Some of these procedures are genetic testing and screening, gene therapy, and genetic
enhancement.

Genetic testing and screening both aim to identify a certain genetic factor. Genetic testing is done on an
individual, whether he/she has the gene responsible for the disease suffered by his/her family members.
This is then to determine his/her chances of having the same disease in the future. Genetic screening is
done to determine the prevalence of a genetic factor in a population. It is done as a part of public health
program by the government to address health issues.

Gene therapy refers to the “correction or prevention of disease through the addition and expression of
genetic material that reconstitutes or corrects missing or aberrant functions or interferes with disease-
causing process”. This may be somatic, if the genetic intervention only affects the individual, or
germline, if the intervention will also affect the patient’s children.

Genetic enhancement refers to “genetic modifications which improve the functions of some system”.
The extent of this procedure is still being explored. Some believe that because of the success in some
animal

researches, it will also be possible in humans.

Healthcare Resource Allocation

Healthcare resources are “any goods and services that can reasonably be expected to have a positive
effect on health” (Buchanan, 2009). They include resources such as medical drugs, procedures, and
treatments. They also contain resources necessary for the normal growth and functioning such as
resources used for pollution control, shelter, and food. Resource allocation may be done in a macro and
micro level.

3. End-of-Life Issues

Euthanasia

Euthanasia is “the intentional ending of another’s life from a benevolent or kind motive” (Frey, 2010).
According to Dickens and Boyle (2008), “it is a deliberate act undertaken by one person with the
intention

of ending the life of another person to relieve that person’s suffering”. Euthanasia is commonly referred
to as “mercy killing “as it is done out of mercy for the suffering person.

The Doctrine of Double Effect. This doctrine provides condition which may morally justify an action that
has both positive and negative effects. Being the act of euthanasia has a positive effect (alleviation of
the patient’s suffering) and a negative effect (the patient’s death), some would argue that the following
conditions would morally justify the act: a) the act is not inherently morally good or evil; b) the negative
outcome is not a necessary means to achieve the positive outcome; c) the intent is directed solely at the
positive outcome; and d) there is a balance between the positive and the negative outcomes (Kluge,
2009).

Brain Death and Vegetative State

There are three major approaches to the definition of death: the cardiopulmonary, whole-brain, and
higher-brain approaches (DeGrazia, 2011 and Luper, 2009). According the cardiopulmonary approach
(“heart-lung” approach), a human person is dead when the cardiopulmonary organs (heart and lungs)
have permanently ceased to function. In the height of technology, medical devices such as respirators,
pacemaker, and other modern life-supports have been developed and it has been possible to maintain
the functionality of a person’s cardiopulmonary organs although the patient’s whole brain, due to
severe damages, permanently ceased to function. This occurrence caused to raise the question of
whether the patient in this state is still alive or already dead. The whole-brain approach claims that, the
patient in this “brain-dead” state, is already dead.

For the whole-brain approach, a person is dead when the entire brain (both higher and lower brains)
permanently ceases to function. The brain has two major portions; 1) the “higher brain”, which is
responsible for consciousness and for the coordination and control of voluntary muscle movements; and
the 2) “lower brain”, which is responsible for spontaneous respiration and for the activation and
deactivation of consciousness without affecting its contents. A person whose entire brain has
permanently ceased to function, but is still breathing with the help of life-support, is what has been
called as “brain-dead” patient. According to Shemie (2009), “Brain death is defined as the absence of all
brain function demonstrated by deep coma and permanent loss of capacity for consciousness, loss of
the ability to breath and absence of all brain stem reflexes”.

On the other hand, “higher-brain” approach claims that a person is already dead when the upper brain
has permanently ceased to function, even though the lower brain continues to function. In this
condition, the patient is in “persistent vegetative state”, which means that the patient is no longer
conscious but can still breathe on his/her own. The higher-brain approach has strong supporters who
continue to argue that patients whose upper brain has permanently ceased to function, those under
persistent vegetative state, should be included in those regarded as brain dead, or “dead persons”
(McMahan, 2009). The implication of this inclusion is that it would then be morally permissible to get
organs of those in persistent vegetative state for transplantation or euthanize them.

4. Information and Research Issues

This area of bioethics covers the obligations of healthcare professionals and the rights of patients
regarding medical information andconduct of research involving human subjects.

Truth-telling and Informed Consent

The practice of truth-telling in medicine has three reasons (Herbert et al. 1997). The first reason is based
on the Kantian principle of respect for person, second reason is utilitarian in nature, and the third reason
lies within the covenant of trust between the doctor and the patient.

It is a moral obligation to tell the truth, but despite of this, it is traditionally believed that doctors are
morally justified to deceive or tell a lie to their patients in certain circumstances. The ethical dilemma
lies whether the doctor should inform the patient of a critical condition and lessen his hope, or
deliberately mislead him and improve the chances of survival by instilling hope. Given their knowledge
and expertise, doctors are in a better position to know what is best for their patient. There are cases
that doctors find it more beneficial not to tell the truth to their patient, and this is called medical
paternalism. The reason for this is that: a) the doctor have a duty to act in the patient’s best interest
(even if the patient does not know his/her best interest are); and patients are incapable of making
medical decisions because of the technicality (Amarakone and Panesar, 2006).

Informed consent is considered not just a moral but also a legal requirement in treating patients.
Related to truth-telling, it becomes an important component in the validity of the consent given by the
patient.

Since, for a consent to be informed and thus valid, the patient must be properly told the truth and must
clearly understand the truth regarding his/her medical condition. Giving treatment without informed
consent will cause the doctor liable for negligence, assault, or medical malpractice.

Confidentiality

One of the oldest codified obligations of health care professionals is the ethical duty to keep the
patient’s information confidential. Doctors are required to swear under the Hippocratic Oath that,
“...Whatever I see or hear in the lives of my patients, whether in connection with my professional
practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things
to be private.”

The obligation of confidentiality prohibits medical professionals and health care providers from
disclosing patient’s case to others without permission, and encourages the providers and health care
systems to take precautions to ensure that only authorized access to patient’s information occurs.

The Use of Humans for Research

“On August 20, 1947, the International Medical Tribunal in Nuremberg, Germany, delivered its verdict in
the trial of 23 doctors and bureaucrats accused of war crimes and crimes against humanity for their
roles in cruel and often lethal concentration camp medical experiments. As part of its judgment, the
court articulated a 10-point set of rules for theconduct of human experiments that has come to be
known as theNuremberg Code. Among other requirements, the code called for the “voluntary consent”
of the human research subject, an assessment of risks and benefits, and assurances of competent
investigators. These concepts have become an important reference point for the ethical conduct of
medical research. Yet, there has in the past been considerable debate among scholars about the code’s
authorship, scope, and legal standing in both civilian and military science. Nonetheless, the Nuremberg
Code has undoubtedly been a milestone in the history of biomedical research ethics.

In 1964, the Declaration of Helsinki was created, which set another guidelines, adopted by the 18th
World Medical Association (WMA) Assembly. The declaration consisted of 32 principles which stresses
on informed consent, confidentiality of data, vulnerable population, and requirement of a protocol,
scientific reasons for the study, to be reviewed by the ethics committee.