Bioethics

Bioethics
• Bioethics is the study of the typically controversial ethical issues
emerging from new situations and possibilities brought about by
advances in biology and medicine.
• It is also moral discernment as it relates to medical policy and practice.
• Bioethicists are concerned with the ethical questions that arise in the
relationships among life sciences, biotechnology, medicine, politics,
law, and philosophy.
• It also includes the study of the more commonplace questions of
values ("the ethics of the ordinary") which arise in primary care and
other branches of medicine.
• The term Bioethics (Greek bios, life; ethos, behavior) was coined in
1926 by Fritz Jahr, who "anticipated many of the arguments and
discussions now current in biological research involving animals" in an
article about the "bioethical imperative," as he called it, regarding the
scientific use of animals and plants.
• In 1970, the American biochemist Van Rensselaer Potter also used the
term with a broader meaning including solidarity towards the
biosphere, thus generating a "global ethics," a discipline representing
a link between biology, ecology, medicine and human values in order
to attain the survival of both human beings and other animal species.
Purpose and scope
• debates over the boundaries of life (e.g. abortion, euthanasia), surrogacy, the
allocation of scarce health care resources (e.g. organ donation, health care
rationing) to the right to refuse medical care for religious or cultural reasons.
• Bioethicists often disagree among themselves over the precise limits of their
discipline, debating whether the field should concern itself with the ethical
evaluation of all questions involving biology and medicine, or only a subset of
these questions
• Some bioethicists would narrow ethical evaluation only to the morality of medical
treatments or technological innovations, and the timing of medical treatment of
humans. Others would broaden the scope of ethical evaluation to include the
morality of all actions that might help or harm organisms capable of feeling fear.
Scope
• biotechnology, including cloning, gene therapy, life extension, human
genetic engineering, astroethics and life in space, and manipulation of
basic biology through altered DNA, XNA and proteins. These
developments will affect future evolution, and may require new
principles that address life at its core, such as biotic ethics that values
life itself at its basic biological processes and structures, and seeks
their propagation
Principles
• One of the first areas addressed by modern bioethicists was that of human
experimentation.
• The National Commission for the Protection of Human Subjects of
Biomedical and Behavioral Research was initially established in 1974 to
identify the basic ethical principles that should underlie the conduct of
biomedical and behavioral research involving human subjects.
• However, the fundamental principles announced in the Belmont Report
(1979)— namely, autonomy, beneficence and justice—have influenced the
thinking of bioethicists across a wide range of issues.
• Others have added non-maleficence, human dignity and the sanctity of life
to this list of cardinal values
• Another important principle of bioethics is its placement of value on
discussion and presentation.
• Numerous discussion based bioethics groups exist in universities
across the United States to champion exactly such goals.
• Examples include the Ohio State Bioethics Society[8] and the
Bioethics Society of Cornell.
• Professional level versions of these organizations also exist
Some Important Ethical Terms
• Morality: It is a system of moral values and conduct, which govern our decision
of right and wrong or good and bad.
• Empathy: The ability of one to understand and share the feelings of the other.
• Euthanasia: It refers to painless killing of any terminally ill patient suffering
from painful and incurable disease on demand of the patient and the court.
Removing all life support system from a patient in irreversible coma is also
termed as euthanasia.
• Autonomy is freedom from external control or influences, independence.
• Justice: It is the treatment or behavior, which is genuine, right, or just
according to the prevailing laws.
• Equality: State of being at par or equal in status or ideology or
opportunities.
• Beneficence: It is related to kindness, good, or charity for good.
• Non-maleficence: An act done to avoid harm or any act which would
not harm or violate the trust of others. In the case of physicians, it is
their act which will not harm the patient.
• Accountability: The condition where somebody is held responsible,
answerable, or accountable for an act.
Analyzing Ethical Issues
• The ethical principles consist of certain virtues such as autonomy, non-maleficence,
beneficence, and justice. Now the area has gained so much of momentum that before even
small experimental work, one needs to justify its rightness or wrongness. Analyzing the
ethical issues before starting any new experimental work would depend upon the
assessment of these points
• Consequences
• Rights and responsibilities
• Autonomy
• Virtue ethics
• Animal Rights
Biosafety and Biorisk
• rapid and dangerous adaptations in microorganisms especially for
developing resistance to antibiotics
• enormous biohazards and raises serious “biosafety” issues, i.e., scientific
practices, methods, and use of appropriate equipment in a biosafe
environment.
• The biosafety aspects have become very important in various conditions and
require many precautions in health-care systems as hospitals,
diagnostic laboratories, animal care systems, biological laboratories, and so on.
Ethics and Ethical Theories
• Environmental Ethics: For everything we are dependent on the environment. The environment
and ecosystem are very nicely balanced. Thus what would be the effect on the ecosystem once
genetically modified organisms are introduced? What would be the effect on biodiversity?
• Religious ethics: In this the religious commands are being followed. It involves obeying divine
commands and wills.
• Philosophical Ethics: In this before executing any decision, it requires evaluation of reasoning and
facts for ethical questions. Thus, all ethical decisions are taken upon evaluation of
rational and logical questioning:
– It tries to come up with theories explaining viewpoints.
– Provides guidance to decision making
– Solves conflicts of ethical decisions.
– Ethical theories help in guiding ethical questions.
Descriptive Philosophical Ethics

• It explains the actual moral viewpoints of the people; thus, it gives an

accurate estimation of people’s ethics. Opinion polls or questionnaire
evaluation are used to build a consensus of the view of the people.
However, these are not affected by facts and reasons so they may be
right or wrong
Normative Philosophical Ethics

• It explains the viewpoint, which people should have, and accordingly

the actions, which people should undertake (according to what ought
to be). It questions people ethics and guides us in difficult situations
about what should be done
• Ethical egoism: This theory states that morality is mere fulfilling our self-interest.
It criticizes the views associated with morality that
are in the way of personal self-interest. It
advocates that the actions are entirely dependent on desire and self-interest of the
people.
• Utilitarianism (or Consequentialism): This theory advocates the selection of moral
action, which in its consequence brings greatest happiness for the large number
of people.
• It works to decide the result or consequences of good action, which would
maximize happiness. Thus it deals with consequences of action, in that happiness
is judged because of some decision. Their supporters say that the theory aims to
do good for the human race as a whole including nonhuman animals
Deontology (Kantian ethics) German philosopher Immanuel Kant (1724–1804)
• According to this all people have rights and duties and they should follow
these. It states that the decision should come from inner
sense of duty without considering the consequences of action.
• Kantian views refrain from hiding the truth from patients who have terminal
cancer.
• “Act in such a way that you treat humanity, whether in your own person or in
the person of any other, never merely as a means to an end, but always at
the same time as an end” (Kant 1785/1968)
• Respect: Dignity of each and every human being should be respected,
and one person should not use the other person as a means to fulfill
one’s own desire.
• Universality: If something ethically right is applicable to us as an
individual, then it applies to others also, making it a universal
right. It should be respected and followed by everyone.
• The formula of ends: Rational agents should be treated as ends.
Virtue Ethics
• There are certain ethical virtues and any decision or action is considered
morally correct when taken considering the virtues. These promote
flourishing and well-being.
• Thus, any action with a right motive based upon good character or virtue is
considered morally right, for example, an action where treatment of a patient
is sponsored to gain publicity and honor. The action is right but morally it is
not good.
Issues
(1) problem of content, vague virtues are unable to give proper guidance
(2) problem of pluralism, competing conceptions of the good life complicate a
sound solution.
Feminist Bioethics
• The social and political background of feminist bioethics is feminism
and feminist theory with its major social and political goal to end the
oppression of women and to empower them to become an equal
gender
Medical ethics
• Medical ethics is the study of moral values and judgments as they
apply to medicine.
• As a scholarly discipline, medical ethics encompasses its practical
application in clinical settings as well as work on its history,
philosophy, theology, and sociology.
• Medical ethics tends to be understood narrowly as an applied
professional ethics, whereas bioethics appears to have worked more
expansive concerns, touching upon the philosophy of science and
issues of biotechnology
• Still, the two fields often overlap and the distinction is more a matter
of style than professional consensus.
Perspectives and methodology
• The field, once dominated by formally trained philosophers, has become increasingly
interdisciplinary, with some critics even claiming that the methods of analytic philosophy have
had a negative effect on the field's development.
• Many religious communities have their own histories of inquiry into bioethical issues and have
developed rules and guidelines on how to deal with these issues from within the viewpoint of
their respective faiths.
• The Jewish, Christian and Muslim faiths have each developed a considerable body of literature on
these matters.
• In the case of many non-Western cultures, a strict separation of religion from philosophy does not
exist.
• In many Asian cultures, for example, there is a lively discussion on bioethical issues.
• Buddhist bioethics, in general, is characterised by a naturalistic outlook that leads to a
rationalistic, pragmatic approach.
• Buddhist bioethics, in general, is characterised by a naturalistic outlook that
leads to a rationalistic, pragmatic approach.
• Buddhist bioethicists include Damien Keown.
• In India, Vandana Shiva is a leading bioethicist speaking from the Hindu
tradition.
• In Africa, and partly also in Latin America, the debate on bioethics
frequently focuses on its practical relevance in the context of
underdevelopment and geopolitical power relations.
• Masahiro Morioka argues that in Japan the bioethics movement was first
launched by disability activists and feminists in the early 1970s, while
academic bioethics began in the mid-1980s. During this period, unique
philosophical discussions on brain death and disability appeared both in the
academy and journalism.
• Bioethics has also had its critics.
• Paul Farmer has pointed out that bioethics tends to focus its attention on
problems that arise from "too much care," for patients in industrialized
nations, while giving little or no attention to the ethical problem of too
little care for the poor.
• Farmer characterizes the bioethics of handling difficult clinical situations,
normally in hospitals in industrialized countries, as "quandary ethics."
• And he refers to bioethicists as "endlessly rehashing the perils of too
much care."
• He does not regard quandary ethics and clinical bioethics as
unimportant; he argues, rather, that bioethics must be balanced and give
due weight to the poor.
• Medical ethics shares many principles with other branches of
healthcare ethics, such as nursing ethics.
• A bioethicist assists the health care and research community in
examining moral issues involved in our understanding of life and
death, and resolving ethical dilemmas in medicine and science.
Biorisk
• Risk is the likelihood of the occurrence of an adverse event, thus biorisk is
the likelihood of the occurrence of serious infection due to
exposure to pathogenic microorganism or biohazards.
• The biorisk can be managed by risk assessment, effective biosafety
measures, and biocontainment .
• The major pathogenic agents responsible for these infections were Brucella
spp., Blastomyces dermatitidis, Chlamydia psittaci, Coccidioides
immitis, Coxiella burnetii, hepatitis B virus (HBV), Salmonella typhi,
Francisella tularensis, Mycobacterium tuberculosis, and Venezuelan
equine encephalitis virus
Assessment of Risk
• identification of the hazardous properties of a familiar infectious agent
or material
• The activities responsible for pathogen exposure to the person
• the chances of the exposure becoming a laboratory-associated
infection, and the ultimate consequences of infection.
Biohazards
The properties of an agent which make it potentially hazardous are
• infection capability,
• ability to cause diseases in human or animal host,
• its minimum infective dose
• Severity of the disease
• availability of vaccine
• availability of therapeutic modality to control it
• the probable route followed by it for transmission
• stability in the environment, and
• Host (animal–human or only human).
ELSI Research Priorities
• Genomic Research. The issues that arise in the design and conduct of
genomic research, particularly as it increasingly involves the
production, analysis and broad sharing of individual genomic
information that is frequently coupled with detailed health
information.
• Genomic Health Care. How rapid advances in genomic technologies
and the availability of increasing amounts of genomic information
influence how health care is provided and how it affects the health of
individuals, families and communities.
• Broader Societal Issues. The normative underpinnings of beliefs,
practices and policies regarding genomic information and
technologies, as well as the implications of genomics for how we
conceptualize and understand such issues as health, disease, and
individual responsibility.
• Legal, Regulatory and Public Policy Issues. The effects of existing
genomic research, health and public policies and regulations and the
development of new policies and regulatory approaches.