PRELIM BIOETHICS

ETHICS
 The study of social morality and philosophical reflection on its norms and practices.
 Ethics is a field of knowledge that has developed over many years
 Is a practical and normative science.
 Study of human acts and provides norms for their goodness or badness.
 Also known as MORAL PHILOSOPHY.
 As practical science, deals with a systematized body of knowledge that can be used, practiced and applied to human actions.
 As normative science, establishes norms or standards for the direction and regulation of human actions.

Divisions of Ethics:
In analytic philosophy, ethics is traditionally divided into three fields: Metaethics, Normative ethics and applied ethics.

A. Metaethics

 Metaethics this is the investigation of where ethical principles come from.

 It asks: Where do ethical principles come from? What do they mean? How do we know that any exist? Are ethics merely social
conventions, or are they universal truths?
 Metaethics is one of the most important fields in philosophy.
 Metaethics studies the nature of ethical sentences and attitudes.
 This includes such questions as what "good" and "right" mean, whether and how we know what is right and good, whether
moral values are objective, and how ethical attitudes motivate us. Often this is derived from some list of moral absolutes, e.g. a
religious moral code, whether explicit or not. Some would view aesthetics as itself a form of meta-ethics.

B. Normative Ethics

 Normative ethics bridges the gap between metaethics and applied ethics.
 It is the attempt to arrive at practical moral standards that tell us right from wrong, and how to live moral lives.

BRANCHES OF NORMATIVE CONDUCT

1. Theory of Conduct
2. Theory of values

1. theory of conduct
 this is the study of right and wrong, of obligation and permissions, of duty, of what is above and beyond the call of duty,
and of what is so wrong as to be evil.

Theories of conduct propose standards of morality, or moral codes or rules. For example, the following would be the sort of
rules that a theory of conduct would discuss (though different theories will differ on the merit of each of these particular rules):
"Do unto others as you would have them do unto you"; "The right action is the action that produces the greatest happiness for
the greatest number"; "Stealing is wrong."
2. theory of value
 this looks at what things are deemed to be valuable.
 Suppose we have decided that certain things are intrinsically good, or are more valuable than other things that are also
intrinsically good. Given this, the next big question is what would this imply about how we should live our lives?
 The theory of value also asks: What sorts of things are good? Or: What does "good" mean? It may literally define "good"
and "bad" for a community or society.
 Theory of value asks questions like:
What sorts of situations are good?
Is pleasure always good? Is it good for people to be equally well-off?
Is it intrinsically good for beautiful objects to exist?

C. Applied Ethics

 Applied ethics applies normative ethics to specific controversial issues.

 Many of these ethical problems bear directly on public policy. For example, the following would be questions of applied ethics:
"Is getting an abortion ever moral?"; "Is euthanasia ever moral?"; "What are the ethical underpinnings of affirmative action
policies?"; "Do animals have rights?" The ability to formulate the questions are prior to rights balancing. Not all questions
studied in applied ethics concern public policy. For example: Is lying always wrong? If not, when is it permissible? The ability to
make these ethical judgments is prior to any etiquette.

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 Examples of applied ethics include:

* Abortion, legal and moral issues

* Animal rights
* Bioethics
* Business ethics
* Criminal justice
* Environmental ethics
* Feminism
* Gay rights
* Just war theory
* Medical ethics
* Utilitarian ethics
* Utilitarian Bioethics

Morality
 Morality is the belief or recognition that certain behaviors are either “good” or “bad”.
 Some morals are very easy to accept and only the fringes of society might question or reject them.
 These people on the fringes might be good or bad, the mere act of rejecting a socially accepted moral of the time is in no way an
indicator of the person’s goodness.

Norms= rules or customs

 Social norms are the accepted behaviors within a society or group.
 This sociological and social psychological term has been defined as "the rules that a group uses for appropriate and
inappropriate values, beliefs, attitudes and behaviors.
 These rules may be explicit or implicit. They have also been described as the "customary rules of behavior that coordinate our
interactions with others."
 Norms vary and evolve not only through time but also vary from between social classes and social groups. What is deemed to
be acceptable dress, speech or behavior in one social group may not be accepted in another.
 Essentially, social norms are rules that define the behavior that is expected, required, or acceptable in particular circumstances.
 They are learned through social interaction.
 Deference to social norms maintains one's acceptance and popularity within a particular group.
 Social norms can be enforced formally (e.g., through sanctions= consent form) or informally (e.g., through body language and
non-verbal communication cues). By ignoring social norms, one risks becoming unacceptable, unpopular or even an outcast.

As social beings, individuals learn when and where it is appropriate to say certain things, to use certain words, to discuss certain topics or
wear certain clothes, and when it is not. Thus, knowledge about cultural norms is important for impression management, which is an
individual's regulation of their nonverbal behavior. One also comes to know through experience what types of people he/she can and
cannot discuss certain topics with or wear certain types of dress around. Typically, this knowledge is derived through experience.

Belief
• Acceptance of truth of something: acceptance by the mind that something is true or real, often underpinned by an emotional or
spiritual sense of certainty

Biology
 Is the study of life
 A branch of the natural science which studies living organism and how they interact with each other and their environment
 The term was first used by the French naturalist Jean-Baptise Lamarck
 It examines the structure, function, growth, origin, evolution, and distribution of living things; also, it classifies and described organisms,
their functions, and how species come into non-existence.
 Is a natural science concerned with the study of life and living organisms, including their structure, function, growth, origin, evolution,
distribution, and taxonomy

Bioethics
 The study of the ethical and moral implications of new biological discoveries and advances, as in the field of genetic engineering and drug
research.
 the application of ethics to the field of medicine and healthcare.
 multidisciplinary. It blends philosophy, theology, history, and law with medicine, nursing, health policy, and the medical humanities.
 Insights from various disciplines are brought to bear on the complex interaction of human life, science, and technology.
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  The field of bioethics addresses ethical issues that arise from modern medicine. Unlike the nurses' code of ethics, bioethics are largely still
under discussion and are not determined by a nationally standardized document. Bioethical issues include such controversial topics as
stem cell research, physician-assisted suicide, abortion, cloning and genetic modification. As medicine advances, new ethical dilemmas
arise, and bioethics is the field of research and analysis addressing them

 the term “bioethics” was first coined in 1971 (some say by University of Wisconsin professor Van Rensselaer Potter; others, by fellows of
the Kennedy Institute in Washington, D.C.), it may have signified merely the combination of biology and bioscience with humanistic
knowledge.
 However, the field of bioethics now encompasses a full range of concerns, from difficult private decisions made in clinical settings, to
controversies surrounding stem cell research, to implications of reproductive technologies, to broader concerns such as international
human subject research, to public policy in healthcare, and to the allocation of scarce resources.

Ethicists and bioethicists ask relevant questions more than provide sure and certain answers

MEDICAL ETHICS
 Medical ethics is the study of moral values and judgments as they apply to medicine.
 The four main moral commitments are respect for autonomy, beneficence, nonmaleficence, and justice. Using these four principles and
thinking about what the physicians specific concern is for their scope of practice can help physicians make moral decisions
 medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.
 The two fields often overlap, and the distinction is more a matter of style than professional consensus. Medical ethics shares many
principles with other branches of healthcare ethics, such as nursing ethics. Examples of this would be the topic of equality in medicine,
the intersection of cultural practices and medical care, and issues of bioterrorism

HEALTH ETHICS
 This course deals with the study of concepts and principles of Health ethics and their implications to the individual, schools,
hospitals, community and society.
 It presents issues in the health care system that will require the practitioner a commitment to excellence in clinical practice and
commitment to a set of appropriate moral, ethical and social behavior.
 It aims to develop in students an understanding of these important concepts and principles as well as to provide guidelines in
dealing with ethical issues with emphasis on the role of the health care practitioner as a patient advocate.
Professional Ethics
 This concern one’s conduct of behavior and practice when carrying out professional work.
 Works: consulting researching, teaching, and writing.
 The institutionalization of Codes of Conduct and codes of Practice is common with many professional bodies for their members to
observe.
 Any code may be considered to be a formalization of experience into a set of rules.
 A code is adopted by a community because its members accept the adherence to these rules, including the restrictions that apply.
 It must be noted that there is distinction between a professional such as Information System and controlled professions such as medicine
and law, where the loss of membership may also imply the loss of the right to practice.
 Professional ethics encompass the personal, organizational, and corporate standards of behavior expected by professionals
 The term professionalism originally applied to vows of a religious order. By at least the year 1675, the term had seen secular application
and was applied to the three learned professions: Divinity, Law, and Medicine.
 The term professionalism was also used for the military profession around this same time.
 Professionals and those working in acknowledged professions exercise specialist knowledge and skill. How the use of this knowledge
should be governed when providing a service to the public can be considered a moral issue and is termed professional ethics
 Professionals are capable of making judgments, applying their skills, and reaching informed decisions in situations that the general public
cannot because they have not attained the necessary knowledge and skills
 One of the earliest examples of professional ethics is the Hippocratic oath to which medical doctors still adhere to this day

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VALUES

• A common framework used in the analysis of medical ethics is the "four principles" approach postulated by Tom
Beauchamp and James Childress in their textbook Principles of biomedical ethics.
• It recognizes four basic moral principles, which are to be judged and weighed against each other, with attention given to the scope of
their application.

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The four principles:

A. Respect for autonomy

• the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)

B. Beneficence

• a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
C. Non-maleficence
• to not be the cause of harm. Also, "Utility" - to promote more good than harm
D. Justice
 concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality). (Iustitia.)
Other values that are sometimes discussed include:

A. Respect for persons – the patient (and the person treating the patient) have the right to be treated with dignity.

B. Truthfulness and honesty – the concept of informed consent has increased in importance since the historical events of the Doctors'
Trial of the Nuremberg trials and Tuskegee syphilis experiment.

 Values such as these do not give answers as to how to handle a particular situation but provide a useful framework for understanding
conflicts.

 When moral values are in conflict, the result may be an ethical dilemma or crisis. Sometimes, no good solution to a dilemma in medical
ethics exists, and, on occasion, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the
individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family
members. Some argue for example, that the principles of autonomy and beneficence clash when patients refuse blood transfusions,
considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.

A. Autonomy
 The principle of autonomy views the rights of an individual to self-determination.
 This is rooted in society's respect for individuals' ability to make informed decisions about personal matters.
 Autonomy has become more important as social values have shifted to define medical quality in terms of outcomes that are important to
the patient rather than medical professionals.

 The increasing importance of autonomy can be seen as a social reaction to a "paternalistic" tradition within healthcare
 Some have questioned whether the backlash against historically excessive paternalism in favor of patient autonomy has inhibited the
proper use of soft paternalism to the detriment of outcomes for some patients

 Respect for autonomy is the basis for informed consent and advance directives.
Paternalism
• action limiting a person or group's liberty or autonomy which is intended to promote their own good.
• Paternalism can also imply that the behavior is against or regardless of the will of a person, or also that the behavior expresses an
attitude of superiority.

 The definition of Autonomy is the ability of an individual to make a rational, un-influenced decision. Therefore, it can be said that
autonomy is a general indicator of health. The progression of many terminal diseases are characterized by loss of autonomy, in various
manners. For example, dementia most always results in the loss of autonomy. Dementia is a chronic and progressive disease that attacks
the brain and effects the ability to make judgments, can induce memory loss, cause a decrease in rational thinking and effect
orientationThis makes autonomy an indicator for both personal well-being, and for the well-being of the profession. This has implications
for the consideration of medical ethics: "is the aim of health care to do good, and benefit from it?"; or "is the aim of health care to do

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 good to others, and have them, and society, benefit from this?". (Ethics – by definition – tries to find a beneficial balance between the
activities of the individual and its effects on a collective.) The right of patients to make decisions about their medical care without their
health care provider trying to influence the decision. By considering autonomy as a gauge parameter for (self) health care, the medical
and ethical perspective both benefit from the implied reference to health.
 Psychiatrists and clinical psychologists are often asked to evaluate a patient's capacity for making life-and-death decisions at the end of
life. Persons with a psychiatric condition such as delirium or clinical depression may lack capacity to make end-of-life decisions. For these
persons, a request to refuse treatment may be taken in the context of their condition. Unless there is a clear advance directive to the
contrary, persons lacking mental capacity are treated according to their best interests. This will involve an assessment involving people
who know the person best to what decisions the person would have made had they not lost capacity. Persons with the mental capacity to
make end-of-life decisions may refuse treatment with the understanding that it may shorten their life. Psychiatrists and psychologists may
be involved to support decision making

B. Beneficence
• The term beneficence refers to actions that promote the well being of others. In the medical context, this means taking actions
that serve the best interests of patients.
• However, uncertainty surrounds the precise definition of which practices do in fact help patients.
James Childress and Tom Beauchamp in Principle of Biomedical Ethics (1978)
• identify beneficence as one of the core values of healthcare ethics.
Edmund Pellegrino,
• argue that beneficence is the only fundamental principle of medical ethics.
• They argue that healing should be the sole purpose of medicine, and that endeavors like cosmetic surgery and euthanasia fall beyond its
purview.

C. Non-maleficence
• The concept of non-maleficence is embodied by the phrase, "first, do no harm," or the Latin, primum non nocere.
• Many consider that should be the main or primary consideration (hence primum): that it is more important not to harm your patient, than
to do them good. This is partly because enthusiastic practitioners are prone to using treatments that they believe will do good, without
first having evaluated them adequately to ensure they do no (or only acceptable levels of) harm. Much harm has been done to patients as
a result, as in the saying, "The treatment was a success, but the patient died." It is not only more important to do no harm than to do
good; it is also important to know how likely it is that your treatment will harm a patient. So a physician should go further than not
prescribing medications they know to be harmful—he or she should not prescribe medications (or otherwise treat the patient) unless
s/he knows that the treatment is unlikely to be harmful; or at the very least, that patient understands the risks and benefits, and that the
likely benefits outweigh the likely risks.

 In practice, however, many treatments carry some risk of harm. In some circumstances, e.g. in desperate situations where the outcome
without treatment will be grave, risky treatments that stand a high chance of harming the patient will be justified, as the risk of not
treating is also very likely to do harm. So the principle of non-maleficence is not absolute, and balances against the principle
of beneficence (doing good), as the effects of the two principles together often give rise to a double effect (further described in next
section).

 Depending on the cultural consensus conditioning (expressed by its religious, political and legal social system) the legal definition of non-
maleficence differs. Violation of non-maleficence is the subject of medical malpractice litigation. Regulations therefore differ over time,
per nation.
Double effect
• Double effect refers to two types of consequences that may be produced by a single action and in medical ethics it is usually regarded as
the combined effect of beneficence and non-maleficence
• A commonly cited example of this phenomenon is the use of morphine or other analgesic in the dying patient. Such use of morphine can
have the beneficial effect of easing the pain and suffering of the patient while simultaneously having the maleficent effect of shortening
the life of the patient through suppression of the respiratory system

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 D. Respect for human rights
• The human rights era started with the formation of the United Nations in 1945, which was charged with the promotion of human rights.
• The Universal Declaration of Human Rights (1948) was the first major document to define human rights. Medical doctors have an ethical
duty to protect the human rights and human dignity of the patient so the advent of a document that defines human rights has had its
effect on medical ethics.
• Most codes of medical ethics now require respect for the human rights of the patient.
• . It provides special protection of physical integrity for those who are unable to consent, which includes children.
No organ or tissue removal may be carried out on a person who does not have the capacity to consent under Article 5.

The United Nations Educational, Scientific and Cultural Organization (UNESCO)

• promotes the protection of human rights and human dignity. According to UNESCO, "Declarations are another means of defining norms,
which are not subject to ratification. Like recommendations, they set forth universal principles to which the community of States wished
to attribute the greatest possible authority and to afford the broadest possible support." UNESCO adopted the Universal Declaration on
Human Rights and Biomedicine to advance the application of international human rights law in medical ethics. The Declaration provides
special protection of human rights for incompetent persons.

Prevalence of bioethical issues

 Bioethics" has been used in the last twenty years to describe the investigation and a study of ways in which decisions in medicine and
science touch upon our health and lives and upon our society and environment.
 Bioethics is concerned with questions about basic human values such as the rights to life and health, and the rightness or wrongness of
certain developments in healthcare institutions, life technology, medicine, the health professions and about society's responsibility for the
life and health of its members.
 Bioethics involves issues relating to the beginning and end of human life, all the way from issues relating to in-vitro fertilisation and
abortion to euthanasia and palliative care.
 Bioethics has an impact on every level of human community from the local nursing home to the huge international conferences on issues
like the Human Genome.
 Bioethics is a branch of "applied ethics" and requires the expertise of people working in a wide range disciplines including: law,
philosophy, theology, medicine, the life sciences, nursing and social science.
 Bioethics is full of difficult ethical questions for everybody: families, hospitals, governments and civilisation.

Fundamental values are at stake: human life, the dignity of the frail and elderly, just healthcare, bodily integrity and the ability to make reasonable
decisions.

Bioethical Issues:

 Bioethical issues exist in plenty, ranging from the use of birth control pills and misuse of medical information to mercy killing and suicide.
We have made a lot of progress in the field of life sciences, which has in turn helped improve the quality of life; there is absolutely no
doubt about that. But then, we also need to understand that such progress comes at a cost. Every step that we take forward, calls for an
evaluation of it implications on humans and the environment alike, and when we talk of implications, we don't just mean ethical
implications, but also take into consideration the legal and social implications of the same.

1. The Dark Side of Organ Transplant

• Organ transplant, for instance, has become one of the oft-highlighted bioethical issues in the field of medicine of late.
• The life-saving procedure has helped scores of people, but then, it also has a dark side in the form of illegal organ trade, that needs to be
dealt with.
• According to the World Health Organization (WHO) estimates, anywhere around 10,000 black market operations involving human organs
are carried out every year.
• While that can be categorized as an illegal activity, the legal procedure of organ donation is by no means squeaky clean. Organs
harvested from impoverished people for as little as $5000 are sold to the rich buyers for 5-10 times that price. How ethical is it that only
rich people get to 'buy' new lives for themselves and that too, at the cost of some poor people who are in need of money?

2. ABORTION
How would you respond in this situation?

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 o A preacher and his wife are very, very poor. They already have 14 kids. Now she finds out she’s pregnant with the 15th. They’re
living in tremendous poverty. Considering their poverty and the excessive world population, would you consider recommending
she get an abortion?

How would you respond in this situation?

o A teenage girl is pregnant. She’s not married. Her fiancé is not the father of the baby, and he’s upset. Would you recommend
abortion?

ABORTION
 The expulsion of a living fetus from the mother’s womb before it is viable.
 In medical parlance, it is defined as termination of pregnancy, spontaneously or by induction prior to viability.
VIABILITY
 Has to do with the child’s capability to live independently of its mother after it has left the womb.
 A child is considered to be viable at about 28 th week or toward the end of the 7th months.
FIVE TYPES OF ABORTION
 Natural abortion
 Direct or intentional abortion
 Therapeutic abortion
 Eugenic abortion
 Indirect abortion
NATURAL ABORTION
 Expulsion of the fetus through natural or accidental causes.
 Also known as Spontaneous or Accidental abortion.
 In layman’s term it is called a Miscarriage (nakunan).
 It is unintentional and involuntary and hence devoid of moral significance.
 It assumes a moral bearing if and when it is voluntary in cause.
DIRECT OR INTENTIONAL ABORTION
 The deliberately induced expulsion of a living fetus before it has become viable.
 The intention is voluntary.
THERAPEUTIC ABORTION
 Which is the deliberately induced expulsion of a living fetus in order to save the mother from the danger of death brought on by
pregnancy.
 Note that the health and life of the mother are considered paramount in this case.
EUGENIC ABORTION
 It is recommended in cases where certain defects are discovered in the developing fetus.
 The argument is that it is better for a child not to be born than for it to lead a miserable life, burdened with crippling disorders.
 Eugenic means to get rid of abnormal babies and thus prevent them from contaminating the human species.
 Likewise known as selective abortion or abortion on fetal indications.
 It is only recommended on case a case-to-case basis, depending on the gravity of fetal indications or abnormalities.
INDIRECT ABORTION
 The removal of the fetus occurs as a secondary effect of a legitimate or licit action, which is the direct and primary object of the intention.
 An instance of the double effect principle which applies to a situation where a good effect as well as an evil effect will result from a good
cause.
 According to this principle, not every evil effect must be avoided simply because it flows from a good cause.
 Some evil effects, voluntary in cause, may be permitted to occur provided certain conditions are fulfilled.
THE MORAL ISSUE
o What is the moral issue of abortion? The beginning of human life is the difficult question moralists wants to point out. When
does life begin? Is the fetus a person?
o Here lies the moral impact of the matter: If the phenomenon of ensoulment occurs from the moment of conception, then the
newly fertilized ovum is already a person; hence to expel or abort it is to commit murder, but if the ensoulment phenomenon
occurs not from conception but at a certain stage of fetal development, then eugenic abortion as well as abortion may be
morally licit.
ENSOULMENT
 The fusion of the spiritual soul into the embryo (also known as animation) occurs when the matter (body) is sufficiently organized to
sustain the intellectual principle or the so-called substantial form of man.
IMMEDIATE HOMINIZATION
o The theory of immediate hominization contends that a new human person exists immediately upon conception. Catholic
church, professes today that from the moment of conception, the spiritual soul of each individual person is “immediately
created by God”. This explains why the church forbids abortion, as the life of a young innocent person is at stake.
DELAYED ANIMATION
o When is the embryo sufficiently organized? This leads us to the various types or interpretations of delayed animation.
INTERPRETATIONS OF DELAYED ANIMATION
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  IMPLANTATION
- takes place 6 to 7 days after conception.
 UNITY AND UNIQUENESS
- happens between 2 and 4 weeks after conception.
 “LOOKS” HUMAN
- takes place during the 5th and 6th week of fetal development.
- early abortion, therefore, is permissible.
- nostrils appear from the 6th to the 7th week of fetal development.
 ELECTRICAL ACTIVITY
- impulses or activities are first detectable from the brain, around the 8 th week of pregnancy.
 QUICKENING
- when the mother can feel spontaneous movements during the 10 th to 12th week of pregnancy.
 VIABILITY
- when the fetus is considered viable during the 28th week or 7th months of pregnancy.
- fetus is capable of living independently.
 BIRTH
- the child has become biologically independent of his mother.
THREE GENERAL VIEWPOINTS OF ABORTION
 THE CONSERVATIVE
- declares that abortion is never permissible, or at most, is permissible if and only if it is required to save the pregnant woman’s
life: removal of a cancerous uterus or removal of fallopian tube.
 THE LIBERAL POSITION
o states that abortion is always permissible, whatever the state of fetal development may be.
 THE MODERATE POSITION
o holds that abortion is morally permissible up to certain stage of fetal development, or of some limited set of reasons sufficient
to justify the taking of life in this circumstances.
PRO-LIFE MOVEMENT
 The disapproving view of abortion.
 It is clear, is committed to respect an individual’s right to life even if that is uncertain or in doubt
EFFECTS OF ABORTION
 Psychological effect: guilt, suicidal tendencies, loss of sense of fulfillment, mourning, loss of confidence, lower self-esteem, hostility, self-
destructive behavior, anger, rage, helplessness, loss of interest in sex, inability to forgive oneself, nightmares and frustration.
 There are physical and psychological effects on the woman concerned.
 Physical effect: habitual miscarriages, ectopic pregnancies, menstrual disturbances, stillbirths, bleeding, shock, coma, perforated uterus,
fever, cold sweat, intense pain, loss of other organs, insomnia, loss of appetite, weight loss and frigidity.
PRO-CHOICE MOVEMENT
 The approving view of abortion.
 The justifications for the expulsion of the fetus may be classified into: personal or familial, social and fetal.

A List of Bioethical Issues

Like we said earlier, bioethics is a broad concept, involving a wide range of medical and biological procedures that have been implemented in the
field of medicine. While some issues, like abortion and suicide, are widely criticized, others, such as human cloning, gene therapy, and
nanomedicine, seem to have left the world divided. (Note: This is a partial list intended to give you a rough idea of the concept and therefore, does
not include all the issues that come under the umbrella topic.)

Animal rights Acknowledging the fundamental rights of animals, like we acknowledge our own rights.
Artificial insemination Deliberate introduction of semen into the vagina, or oviduct to achieve pregnancy.
Assisted suicide Helping a terminally ill person to end his life.
Biopiracy The illegal theft and patenting of indigenous plants by companies or individuals.
Body modification Deliberate altering of the human body for non-medical reasons.
Brain-computer interface A concept which facilitates direct interaction between brain and external device.

While bioethicists argue that the fundamental values of humanity are at stake, there are others who feel that the issues enlisted here are a part of
the development process in the field of science. When it comes to ethics or morality, arguments and counterarguments will never cease. As such,
the need of the hour is to identify the severity of these issues and take steps to ensure that they don't affect the basic rights of various life forms on
the planet.

3. ETHICAL AND LEGAL ISSUES OF SUICIDE

Professional Ethics and Suicide
The conduct of clinicians is guided by ethics codes that provide nominal protection to suicidal clients. The codes draw on these principles:
 Autonomy - Respect for the individual self-determination
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  Beneficence - Doing the greatest good possible
 Non-maleficence - Minimizing or preventing harm
 Justice - Fairness and equal access to care.

Bioethics has developed responsibilities based on autonomy:

 Respect for person - The basis of client rights
 Telling the truth and giving all the facts - Disclosure
 Confidentiality - Maintaining client privacy
 Fidelity - Doing the job" and "being there" for the client.
 Beneficence is acting in the best interest of clients. Non-maleficence is minimizing harm. Justice is treating individuals fairly.
Autonomy and Suicide
This principle impacts the clinical response to all suicidal individuals. It calls for respect, dignity, and choice. The
last often takes precedence.

A. Respect for personal rights:

 This duty sanctifies choice. Suicide is the outcome of psychological debilitation. Extending autonomy to those so afflicted
facilitates suicide. Respect for the individual is better served by recognizing their vulnerability.
B. Telling the truth:
 Clients at risk deserve candor as to their exposure and means of intervention. Clinicians with strong views about suicide should
disclose them or refer the client elsewhere.
C. Confidentiality:
 This presents many dilemmas. Suicidality and secrecy are a fatal combination. In some states clinicians may breach
confidentiality if the client is a danger to themselves or others. Therapists must disclose if the client is a threat to others.
Disclosure of suicidality not mandated.
D. Fidelity:
 Clinicians are to be faithful to clients. The risk of suicide must be taken seriously and be acknowledged as the primary problem.
Fidelity also demands that clinicians update their views and skills. Outmoded views of suicide put clients at risk.
Beneficence and Suicide
 Clinicians must be proactive in working for the client's well-being. Beneficence should not be sacrificed to autonomy if the client is
suicidal.
 Beneficence is caring not just treatment. Every attempt at intervention is warranted.

Non-maleficence and Suicide

 Clinicians must strive to protect clients from harm. Non-maleficence calls for whatever it takes to assure the client's life.
Justice and Suicide
 Clinicians must treat all consistently. Fairness cannot be assumed.

Suicide: An Ethical Typology

Three distinct forms of suicide may be identified based on the role that a clinician plays in the process:
1. Unassisted Suicide
2. Facilitated Suicide
3. Assisted Suicide
1. Unassisted Suicide
 This may take two forms.
A. The first applies where the victim completes suicide while not currently or recently in the care of a clinician.
B. The second applies where the victim was currently under care but not for a condition associated with suicidality. The clinician had no
basis to assume or suspect risk. The victim did not confide any ideation, plan, or threat or did not acknowledge such behavior if
queried by the clinician.

2. Facilitated Suicide
 This applies where the victim completes suicide while currently or recently in the care of a clinician and where these factors were present:
 A clinical or custodial relationship existed
 The clinician or provider had knowledge of the risk
 Means of prevention or intervention were available
 A suicide in this context suggests a breach of duty. This could include ignoring the danger, and/or not effectively using resources that may
have ameliorated the risk.
 In such cases, the suicide has, in effect, been facilitated. This is not to say that the clinician caused the suicide. The ethical failing was
doing nothing or acting passively or conservatively despite the client's mortal danger.
3. Assisted Suicide
 This applies where a clinician with knowledge of the individual's wishes and consent enables completion by providing the lethal means
and guidance as to use.

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  This mode assumes capacity and rationality. However, most victims of assisted suicide appear driven by extreme stress and/or chronic
intractable pain which impair capacity and rationality.
 Enabling the suicide of such individuals, statutes to the contrary, is unethical.

Volition and Suicide

 Assisted suicide is justified, by its advocates, as a personal right. Unassisted suicide is customarily characterized as a personal decision.
Where does that leave facilitated suicide? Consider the following:
a. Assisted Suicide = Voluntary Action
 Assisted suicide is voluntary when the individual is determined to be capable of independently making the decision.
b. Facilitated Suicide = Involuntary Action
 Facilitated suicide is involuntary because the individual made a "cry for help" to a clinician that went unheeded
c. Unassisted Suicide = Nonvoluntary Action
 Unassisted suicide is nonvoluntary in the same way that death as the result of any disease is so.

 The most obvious variety of a suicide act involves the suicide actively bringing harm to himself. However, suicide may also be achieved by
the direct action of another, by the omissions to act of either the suicide or another, and by the suicide's putting himself in the way of
events that he intends and expects to kill him.

4. STEM CELLS TECHNOLOGY

Stem cell technology
 a rapidly developing field that combines the efforts of cell biologists, geneticists, and clinicians and offers hope of effective treatment for
a variety of malignant and non-malignant diseases.
 Stem cells are defined as totipotent progenitor cells capable of self renewal and multilineage differentiation.
 Stem cells have potential for treatment of many malignant and non-malignant diseases

 The promise of new therapeutic avenues for the treatment of a range of conditions has led researchers to consider the use of stem cells.
 These cells have the capacity to become some or even all of the 206 different cell types found in the human body.
 It has even been suggested that one day stem cells may be able to form whole organs and hence contribute to organ transplantation
therapies.
 Stem cells come in a wide variety of types.
1. Adult stem cells have been found in nearly every tissue of the human body, where they carry out a role in
tissue regeneration.
2. Embryonic stem cells are located in the human embryo at the blastocyst stage (5 to 6 days of age). Embryos
at this age are often unwanted in reproductive technology treatment, and some parents have donated them
for research. Embryonic stem cells may eventually be grown in vitro to produce complex organs

3. Cord blood stem cells are derived from the umbilical cord which is often still routinely discarded at birth.
4. Peripheral blood stem cells are used routinely in autologous and allogeneic bone marrow transplantation
5. Gene transfer into haematopoetic stem cells may allow treatment of genetic or acquired diseases
6. Neuronal stem cells are being used for neurone replacement in neurogenerative disorders such as
Parkinson's and Huntingdon's diseases
 The key ethical issues concern the destruction of human embryos for stem cell derivation. On the grounds that the human embryo is a
human life with moral value justifying its protection, the extraction of embryonic stem cells is unethical. The use of adult stem cells and
umbilical cord blood stem cells have generally been considered to be free of any particular ethical issues. In fact they have been
applauded as ethically superior alternatives to the use of embryonic stem cells.
 One limitation to the possible use of embryonic stem cells in therapy is that they will likely be rejected by the recipient. In an attempt to
overcome this researchers are attempting to produce cloned human embryos to derive genetically near-identical stem cells for possible
treatment.

5. SURROGACY

 It is often a devastating and life changing experience for a woman to discover that for one reason or another she cannot become pregnant
and have children of her own.

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  In some cases, such as those involving repeated unsuccessful attempts involving assisted reproductive technology (ART) or having a non-
functional uterus, the remaining option (besides that of adoption) for these women and their partners is surrogacy. However, a major
concern with surrogacy is the potential harm that may be inflicted upon the surrogate mother and the child.
 . The ideals and values we hold concerning liberty and autonomy, have to be weighed against other values such as informed consent,
welfare and exploitation.
 Surrogacy, when occuring in the context of ART, is also an issue that forces us to reassess many concepts such as parenthood, family
structure and best interests, which until the recent surge in the popularity of surrogacy, we took for granted.
 In its most basic sense, a surrogate mother is used for the purpose of carrying and giving birth to a child for another person or couple
when these individuals are unable to conceive and/or carry a child on their own in the natural manner.
 There are a number of both medical and legal issues that are associated with the concept of surrogacy. These tend to be complex on many
levels, with one key issue being the legality of the surrogacy process, which varies a great deal from one country to another.
 In addition to ensuring that the surrogacy process is being carried out in a safe and legal manner, there are also a number of different
ethical issues that are – or should be – considered by the biological parent or parents and the surrogate mother prior to initiating the
process.

The Ethical Issues that are Pertinent in the Surrogacy Process

 While there are many religious organizations that frown upon the process of surrogacy, this concept is oftentimes the only option for
some individuals to start a family. It is for this reason that some highly controversial and key ethical issues be addressed.
 Attachment with the Gestational Mother – In a surrogate situation, the gestational mother is the woman who carries the baby to term.
This can be a very taxing process both physically and emotionally – and unique in that after the surrogate mother physically carries the
baby throughout the pregnancy, she needs to physically and emotionally detach herself from the child once it is born.
 Involvement with the Gestational Mother – Because the gestational mother will not likely be the child's primary caretaker, there could be
legal questions that arise in terms of what – if any – involvement she will have with the child once born.
 Identity of the Child – There are also ethical considerations that are brought to mind in terms of informing the child of his or her surrogate
mother, as doing so may have an effect on the child's self-identity.
 In addition to the above issues, there is also the factor of surrogate mother compensation. It is typically expected that the intended
parents of the child will reimburse the surrogate mother for her medical and other related expenses. This can include a dollar amount for
her hospitalization as well as incidentals such as her maternity clothing, meals, and other similar costs that she may be out during her
time of pregnancy.

6. REPRODUCTIVE TECHNOLOGY

 Assisted reproductive technology (ART) is a medical intervention developed to improve an ‘infertile’ couple’s chance of pregnancy.
‘Infertility’ is clinically accepted as the inability to conceive after 12 months of actively trying to conceive. The means of ART involves
separating procreation from sexual intercourse - the importance of this association is addressed in bioethics.
 Some techniques used in clinical ART include: artificial insemination; in vitro fertilization (IVF); gamete intra-fallopian transfer (GIFT);
gestational surrogate mothering; gamete donation; sex selection and pre-implantation genetic diagnosis. Issues addressed in bioethics
are the appropriate use of these technologies and the techniques employed to carry out procedures for quality and ethical reviews.
 Assisted reproductive technology and its use directly impact the foundational unit of society – the family. ART enables children to be
conceived who have no genetic relationship to one or both of their parents. Children can also be conceived who will never have a social
relationship with one or both of their genetic parents, e.g. a child conceived using donor sperm. Non-infertile people in today’s society
including both male and female homosexual couples, single men and women, and post-menopausal women are seeking the assistance of
ART.
 Concerns in all situations include the child and his or her welfare, including the right to have one biological mother and father. The
fragmented family created by ART can disconnect genetic, gestational and social child-parent relationships which have typically been one
and the same in the traditional nuclear family.

7. EUTHANASIA

 Euthanasia is the intentional and painless taking of the life of another person, by act or omission, for compassionate motives. The
word euthanasia is derived from the Ancient Greek language and can be literally interpreted as ‘good death.’ Despite its etymology, the
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 question whether or not euthanasia is in fact a ‘good death’ is highly controversial. Correct terminology in debates about euthanasia is
crucial.
 Euthanasia may be performed by act or omission - either by administering a legal drug or by withdrawing basic health care which
normally sustains life (such as food, water or antibiotics). T
 the term euthanasia mostly refers to the taking of human life on request of that person – the euthanasia is voluntary. However,
euthanasia may also occur without the request of person who subsequently – euthanasia is non-voluntary.
 Involuntary euthanasia refers to the taking of a person’s life against that person’s expressed wish/direction.
 Central to discussion on euthanasia is the notion of intention. While death may be caused by an action or omission of medical staff during
treatment in hospital, euthanasia only occurs if death was intended. For example, if a doctor provides a dying patient extra morphine with
the intention of relieving pain but knowing that his actions may hasten death, he has not performed euthanasia unless his intention was
to cause death (Principle of Double Effect). Euthanasia may be distinguished from a practice called physician-assisted suicide, which occurs
when death is brought about by the persons own hand (by means provided to him or her by another person). All practices of euthanasia
and physician-assisted suicide are illegal in Australia.

8. CONSENT

Obtaining consent from a patient prior to treatment or from a research subject is a relatively new concept.

 Even so, obtaining genuine informed consent in practice often falls short of displaying respect for the decision-making capacity of the
patient or research subject. This is the primary idea behind the requirement for informed consent, that is, the basic ethical principle that
persons are owed respect for making their own autonomous decisions.

 For informed consent to be adequately served the person must be provided with all of the relevant information in the appropriate
context. Not only can consent be tricky in clinical practice, but when it comes to research there may be ethically justifiable circumstances
in which consent may be waived. Furthermore, consent can take on even more complex characteristics when it is expressed in an
advanced form such as in a medical advance directive, or in organ donation after death.

9. HEALTHCARE

 There are major ethical issues involved in the delivery and provision of healthcare. How are funds allocated? Who gets what, and who
decides? How are outcomes measured? What is 'success'?
 What matters most: cost-efficiency? Population health or wellbeing? Health inequality, or absolute measures of health? Personal
preference, or a more objective understanding of best interests?
 To establish what ought to be the guiding principles of healthcare is not an easy task. There are many varying perspectives. The ethics of
'principlism' is common, wherein there are four guiding principles: justice, autonomy, beneficence and non-maleficence.
 It is also at odds with the reality of life for those with chronic and disabling conditions, or who are completely dependant on others for
their daily needs.
 It is important that the assumptions and values underlying financial and governance decisions be recognised and analysed.

10. DISABILITY

 There is a significant controversy over whether one ought to speak of "disability" as a deficit compared to the norm, or whether it is
simply a part of the natural diversity among people.
 Is disability a biological reality, or is it socially constructed. Is every biological 'abnormality' a disability, or does a disability necessarily
entail some kind of disadvantage in comparison to most other people? These two different ways of conceptualizing disability are known
as the medical model and the minority group model (on which disability rights movements are based).

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  Deciding between these perspectives has important implications for public policy debates, and social and medical approaches to
disability.
 Of utmost importance is the debate over the value of the life of a person with a disability. For a healthy person, a common response to
severe disability is "I wouldn't want to live like that."
 The perspective of the person with the disability, however, may be quite different, especially if that person's family, friends and
environment are supportive and accommodating. Yet it is often people without a disability who call for euthanasia or assisted suicide for
such people, or termination for fetuses who may have a disability.

11. Transgenics and Xenotransplantation

 Advances in technology have made it possible for human and animal biological material to be mixed in a permanent way.
Xenotransplantation
 refers to the transplantation of animal tissues and organs into human recipients, either without or with genetic modification of the animal
to minimize tissue rejection.

Transgenics
 refers to the mixing of human and animal genes. For example, human genes can be introduced into sheep so that certain valuable
human proteins will be expressed in the sheep’s milk. Another variant of human/animal mixing has recently occurred in the context of
stem cell research. Researchers have introduced the human nuclear genome into enucleated eggs of cows, pigs and rabbits to produce a
cloned human/animal hybrid, termed a cybrid.
 There is no intention to implant any of the embryos for further development. Human and animal cells can also be mixed in the early
embryo to produce a chimera.
 Important ethical questions arise about such mixing and some of the concerns centre on safety issues. Will the introduction of animal
tissues into humans lead to new viral outbreaks? Other complex ethical questions surround the question of human dignity and whether it
is an affront to human dignity for such intimate mixing of human and animal biological material to occur. And whether there are issues
with some techniques that do not apply to others?

12. SUBSTANCE ABUSE

 Humans have used a variety of substances for a variety of purposes for millennia.

 By far the majority have been used for medicinal purposes, but others have been used to induce altered

conscious states or for recreational purposes like tobacco smoking.

 Some substances can be used medicinally at one dose or to induce euphoria at a higher dose.

 For example, morphine is an effective painkiller at modest doses yet can induce euphoria at higher doses,

and heroin is closely chemically related to morphine.

Many, if not all of the substances that are used for non-medicinal purposes have the potential to become addictive.

 Addictive use of alcohol, tobacco, cannabis, heroin, cocaine, amphetamines,

and hallucinogens is well documented and causes enormous problems in the community.

 In addition, even one-off experimental use of many of these substances has the potential to cause serious harm, including death.

 The central ethical question is whether it is justified to use a substance to alter one’s consciousness in

the knowledge that life and limb may be put at serious risk.

Related questions include the meaning of addiction and the damage it causes to human freedom,

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as well as how best to treat someone who has become addicted.

Some of the longer-term effects of these substances are still the subject of much research,

the outcomes of which are likely to influence how people behave.

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