Bioethics

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BIOETHICS

Why do medicine and health care require a high standard of


ethics?

Who should decide what is in a patient’s best interests?

Warmup Q Is abortion the same as killing babies?

uestions
Is it OK to sell our body parts, such as one of our kidneys,
like we buy and sell our material possessions, our cars, or
our mobile phones?
Should the state force people to adopt healthy lifestyles?
Objectives

BIOETHICS: MORAL CLINICAL CLINICAL ASSIGNMENT


DEFINITION WISDOM ETHICS ISSUES
Definition of Bioethics

Bioethics is the application of ethics to the field of medicine


and healthcare.
• Decisions Made in Clinical Settings
• Stem Cell Research
• Reproductive Technologies
• Human Subject Research
• Public Policy in Healthcare
• Allocation of Scarce Resource
• Expanding Field: Environment, Climate Change, Animal Rights, etc.
Bioethics Related Professions and Persons

Medical Hospital
Nursing Staff Judges
Doctors Administrators

Public Health
Bioethicists Citizens
Policy Makers
History
In some respects, bioethics has a very long history. Concerns about how doctor
s treat their patients go back to ancient times, with ethical codes like the Hippo
cratic Oath setting ethical norms; and in the nineteenth and early twentieth ce
nturies, the rapid expansion of the biological sciences began to raise new questi
ons about the possibilities for human progress and the potential conflicts betwe
en science and religion.
Moral Wisdom
Bioethical issues can be approached by Moral Wisdom and to h
ave a good grasp of it, a person should be aware of various ethic
al theories, principles, religion, culture, and laws. In practical bi
oethics, a person’s moral choice sometimes becomes a decision
only by consultation: listening to doctor, nurses, guardians, bioe
thicists, etc. And sometimes the cases remain undecided and end
up in courts before judges.
Moral Theories

Deontological
Consequentialism Utilitarianism
Theory

Virtue Ethics Communitarianism Libertarianism


Problems with Ethical Theories
A doctor is working in the Accident and Emergency Department of a
hospital. A homeless man is brought in with brain damage sustained i
n a road traffic accident. The doctor recognizes him; the man has no f
amily and is in reasonable physical, if not mental, health. The doctor
knows there is still time to save the man’s life. He also knows that if h
e does not start treatment, the man will suffer brain death and his orga
ns could possibly be used to improve the quality of or even save sever
al other people’s lives.
Utilitarian Vs. Deontologists
A Balancing Act – The Four Principles
Georgetown Mantra

Autonomy
Non-
maleficence
Beneficence

Justice
Religion
Culture and
Religion

Culture
Bioethics in Thailand

Bioethics is now being taught to Thai medical students emphasizing moral in


sights and principles found within Thai culture. These are to a large exte
nt Buddhist themes.
Veracity is always a duty for people in general and medical personnel in pa
rticular.
Falsehoods and deception cannot be morally justified simply on the groun
ds that we think it is good for another.
Buddhism also prohibits killing.
Continued…

The doctrine of kamma holds that joys and sorrows are the result of one's own pas
t actions. Kamma must run its course or will be manifest in a future life.
 Mercy-killing also violates the Buddhist psychology. A physician who kills subco
nsciously transfers his aversion to suffering to the one who embodies the suffering.
Buddhist justice is understood in terms of impartiality and equal treatment.
Compassion goes beyond justice to self-giving and self-denial. It is central to the
path to the attainment of highest human fulfillment.
Ethical Dilemmas

A CHOICE MUST BE MADE SIGNIFICANT CONSEQUENCES EACH OF THE TWO COURSES OF ETHICAL PRINCIPLES
BETWEEN TWO COURSES OF ARE ASSOCIATED WITH TAKING ACTION CAN BE SUPPORTED BY SUPPORTING THE UNCHOSEN
ACTION EITHER COURSE OF ACTION ONE OR MORE ETHICAL COURSE OF ACTION WILL BE
PRINCIPLES COMPROMISED
Ethical Dilemma Decision Making Process

1. REVIEW CASE: FACTS 2. TWO OR MORE 3. ANALYSIS OF OPTIONS 4. DECISION: CHOOSING


OPTIONS OF ACTION OF ACTION BY MORAL ONE OPTION WITH
WISDOM JUSTIFICATION
Clinical Ethics

Best Interests of Dignity and Respect Confidentiality


Patients
Case Study : A man in his 60s, suffered from chronic respiratory failure, caused by bacteria
l pneumonia and is taken to the hospital for respiratory failure. An endotracheal intubation
was conducted. He has repeated the same kind of acute exacerbation, emergent hospitalizati
on, and assisted breathing three times. Two weeks later when his pneumonia had calmed do
wn and the situation became sustainable, tracheotomy was performed in the patient with co
nsent. The patient’s will was clear so that he could communicate with his family and medic
al staff well enough. Because of the repeated pneumonia and chronic obstructive pulmonary
disease, however, a noninvertible organic shift was caused in his lung cells, and it became c
lear that there was almost no possibility that he could live without wearing a ventilator. Thr
ee months later since he started to wear a ventilator, there is no progress in his breathing sys
tem. In this situation, the patient wrote down to request to stop the artificial breathing and ta
ke the tube out from him. Which meant that he requested to stop artificial breath treatment a
fter understanding completely that stopping artificial breath would lead to his death, and aft
er making a comparison that “it is better to die instead of getting the life extended in such si
tuation”.
Case Study : Mrs. TW, aged 37, is the mother of four daughters, the youngest
aged three years old. She is rather anemic, says she is often fatigued, and lives
with her husband in a modest rural home, supporting her family by growing cr
ops, feeding a few domestic animals, gathering firewood and taking some pro
ducts to the local market while her husband looks for work in the nearest town
. She comes to the local family planning clinic and asks Dr. JB to sterilize her,
because she feels that, on grounds of her health and the family’s few means, s
he cannot cope with another pregnancy and rearing another child. She says she
can pay for the procedure from her savings, but that Dr. JB must promise that t
he clinic staff will not inform her husband because he can be violent and has a
lways wanted to father a son. In the local culture, husbands expect to be consu
lted on their wives’ medical care, but this is not legally required.
Clinical Issues

Termination of
Assisted Organ
Pregnancy
Reproduction Transplantation
(Abortion)

Regenerative To Treat or Not


Euthanasia
Medicine To Treat?
Termination of Pregnancy (Abortion)

Right To Life

The Woman’s Right To Choose

Direct Abortion

Indirect Abortion
Case Study: Prenatal Diagnosis and Abortion

A 39-year-old Japanese woman, Naoko, who is in her 12th week pregnancy found her baby w
ith Down’s syndrome through the prenatal diagnosis. She was told by her doctor to decide if s
he still will give a birth or take an abortion. She has to make a decision by the 22nd week of h
er pregnancy when is the time limit, she can take an abortion. The doctor also explained that e
ven though she gives a birth, the baby would have a high risk of heart disease and may not liv
e long. Her husband is against to have the baby to hear that because he is afraid of raising a di
sabled-child and the discrimination by others to his other two children who are 7 and 4 years
old that they have a disabled sibling, while Naomi does not think about abortion at all speciall
y because she has experienced stillbirth 3 years before. Abortion with a reason of the baby’s d
isability or disease is illegal in Japan, however it is allowed to reasons as financial status and
physical condition of the mother. Overcoming the hard time of decision, they decided to have
a baby eventually. Unfortunately, the baby passed away 12 days after she was born for the hea
vy heart disease. However, Naoko felt more appreciation to her baby who was born by herself
even though she had heavy disease.
Assisted Reproduction

Artificial Insemination (AI)


In Vitro (In Glass) Fertilization
(IVF)
One Baby – Five Parents?

A baby could have five parents: the couple who ‘commission’ the child, but
do not provide either the eggs or the sperm (known collectively as gametes)
, the man and the woman who donate the gametes (and who may remain an
onymous) and the surrogate mother, in whom the embryo is placed and who
subsequently gives birth to the baby. Moreover, these techniques allow othe
r possibilities, such as a single woman becoming pregnant without having s
exual intercourse with the genetic father, a postmenopausal woman becomi
ng pregnant, using a donated embryo (and possibly being the surrogate mot
her for her own daughter), a female homosexual couple arranging the pregn
ancy of one partner, using donated sperm, and a male homosexual couple us
ing a surrogate mother to produce a child genetically related to one of them.
Questions: What Is the Family? How to make sure the welfare of the child?
Organ Transplantation

Health Brokers Regulated Market


Regenerative Medicine

Ethical Issue: The extraction of stem cells from a three to five-day-old embr
yo, or the creation of a cloned embryo through SCNT, inevitably entails the u
se of embryos solely as a means to advance research or therapy, and also enta
ils the destruction of the embryo once the cells have been extracted.
To Treat or Not To Treat?

Medical Futility
Case:

At the other end of life, an elderly person who has lost mental capacity m
ay be admitted to hospital with a severe stroke and a number of other seri
ous medical conditions which will make their ability ever to recover and l
eave hospital extremely unlikely. If they suffer a heart attack, should the s
taff attempt to resuscitate the patient?
Active Euthanasia

Euthanasia Passive Euthanasia

Physician-Assisted
Suicide (PAS)
Case Study

A woman was diagnosed with motor neurone disease (the same disease tha
t Stephen Hawking had). This is a condition that destroys motor nerves, m
aking control of movement impossible, while the mind is virtually unaffec
ted. People with motor neurone disease normally die within 4 years of dia
gnosis from suffocation due to the inability of the inspiratory muscles to c
ontract. The woman's condition has steadily declined. She is not expected t
o live through the month and is worried about the pain that she will face in
her final hours. She asks her doctor to give her diamorphine for pain if she
begins to suffocate or choke. This will lessen her pain, but it will also hast
en her death. About a week later, she falls very ill, and is having trouble br
eathing.
Assignment

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