BIOETHICS

In fulfillment of the requirements on

Ethics & Accountability in Public Service

Submitted by:

Linda Mercedes A. Perez

MPA

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 TABLE OF CONTENTS

 Cover Page ----------------------------------------------------------------- 1

 Table of Contents --------------------------------------------------------- 2

 Introduction ---------------------------------------------------------------- 3

 History of Bioethics ------------------------------------------------------ 3

 Nature and Scope of Bioethics ------------------------------------------ 6

a. Definition ------------------------------------------------------------- 8

b. Development --------------------------------------------------------- 9

 Importance of Bioethics ------------------------------------------------- 10

 Issues in Bioethics ------------------------------------------------------- 11

a. Health Care Context ------------------------------------------------- 11

b. Social and Legal Issues --------------------------------------------- 12

 Bioethics Approaches --------------------------------------------------- 12

a. Traditional and contemporary ethical theories -------------------12

b. The Four-Principles Approach -------------------------------------14

 Conclusion/Summary ----------------------------------------------------16

 Bibliography --------------------------------------------------------------17

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INTRODUCTION

Bioethics as a field is relatively new, emerging only in the late 1960s, though many

of the questions it addresses are as old as medicine itself . When Hippocrates wrote his now

famous dictum Primum non nocere (First, do no harm), he was grappling with one of the

core issues still facing human medicine, namely, the role and duty of the physician . With the

advent of late-twentieth-century science, an academic field emerged to reflect not only on

the important and age-old issues raised by the practice of medicine, but also on the ethical

problems generated by rapid progress in technology and science. Forty years after the

emergence of this field, bioethics now reflects the profound changes in medicine and the life

sciences.

The first to introduce the term “Bioethics” in 1969 was Daniel Callahan when he,

together with Willard Gaylin, founded the Hastings Center. However, it was Van Rensselaer

Potter who popularized the term in 1970. Dr. Potter is an oncologist at the University o f

Wisconsin.

HISTORY OF BIOETHICS

Bioethics as a distinct field of academic study has existed only since the early 1960s,

and its history can be traced back to a cluster of scientific and cultural developments in the

United States during that decade. The catalysts for the creation of this interdisciplinary field

were the extraordinary advances in American medicine during this period coupled

simultaneously with radical cultural changes. Organ transplantation, kidney dialysis,

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respirators, and intensive care units (ICUs) made possible a level of medical care never

before attainable, but these breakthroughs also raised daunting ethical dilemmas the public

had never previously been forced to face, such as when to initiate admission to an ICU or

when treatments such as dialysis could be withdrawn. The advent of the contraceptive pill

and safe techniques for performing abortions added to the ethical quandaries of the "new

medicine." At the same time, cultural changes placed a new emphasis on individual

autonomy and rights, setting the stage for greater public involvement and control over

medical care and treatment. Public debates about abortion, contraceptive freedom, and

patient rights were gaining momentum. In response, academics began to write about these

thorny issues, and scholars were beginning to view these "applied ethics" questions as the

purview of philosophy and theology. "Bioethics"—or, at the time, "medical ethics"—had

become a legitimate area of scholarly attention.

In its early years, the study of bioethical questions was undertaken by a handful of

scholars whose academic home was traditional university departments of religion or

philosophy. These scholars wrote about the problems generated by the new medicine and

technologies of the time, but they were not part of a discourse community that could be called

an academic field or subject area. Individual scholars, working in isolation, began to

legitimize bioethical issues as questions deserving rigorous academic study. But bioethics

solidified itself as a field only when it became housed in institutions dedicated to the study

of these questions. Academic bioethics was born with the creation of the first "bioethics

center."

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 Ironically, academic bioethics came into existence through the creation of an

institution that was not part of the traditional academy. The first institution devoted to the

study of bioethical questions was a freestanding bioethics center, purposely removed from

the academy with its rigid demarcations of academic study. The institution was the Hastings

Center, originally called The Institute of Society, Ethics and the Life Sciences, which opened

its doors in September 1970. Its founder, Daniel Callahan, along with the psychiatrist Willard

Gaylin, M.D., created the center to be an interdisciplinary institute solely dedicated to the

serious study of bioethical questions. Callahan, a recently graduated Ph.D. in philosophy,

had been one of the isolated scholars working on an issue in applied ethics, and he had found

himself mired in complex questions that took him far afield from the traditional boundaries

of philosophy. His topic, abortion, required engagement with the disciplines of law,

medicine, and social science, which he felt himself unprepared to navigate. With academic

departments functioning as islands within a university, it seemed that truly interdisciplinary

work was impossible. The Hastings Center was founded to create an intellectual space for

the study of these important questions from multiple perspectives and academic areas.

The second institution that helped solidify the field of bioethics was the Kennedy Institute

of Ethics, which opened at Georgetown University in 1971. The founders had similar goals

to those of Hastings, though they placed their center inside the tradition al academy. While

housed outside of any particular academic departments, the Kennedy Institute came to look

more like a traditional department, offering degree programs and establishing faculty

appointments along a university model.

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 From these modest beginnings, the field of bioethics exploded, with dozens of

universities following suit, creating institutions whose sole function was the study of

bioethical issues. Its growth was fueled by the appearance both of new technologies such as

the artificial heart and in vitro fertilization and new challenges such as HIV. Bioethics was

now permanently on the academic map and central to public discourse.

NATURE AND SCOPE OF BIOETHICS

Against the backdrop of advances in the life sciences, the field of bioethics h as a

threefold mission: (1) to raise important questions about the general practice of medicine and

the institutions of health care in the United States and other economically advanced nations,

(2) to wrestle with the novel bioethical dilemmas constantly being generated by new

biomedical technologies, and (3) to challenge the presumptions of international and

population-based efforts in public health and the delivery of health care in economically

underdeveloped parts of the globe. While attention to the ethical dilemmas accompanying

the appearance of new technologies such as stem cell research or nanotechnology can

command much of the popular attention devoted to the field, the other missions are of equal

importance.

At the core of bioethics are questions about medical professionalism, such as: What are

the obligations of physicians to their patients? What are the virtues of the "good doctor"?

Bioethics explores critical issues in clinical and research medicine, including truth telling,

informed consent, confidentiality, end-of-life care, conflict of interest, non-abandonment,

euthanasia, substituted judgment, rationing of and access to health care, and the withdrawal

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and withholding of care. Only minimally affected by advances in technology and science,

these core bioethical concerns remain the so-called bread-and-butter issues of the field.

The second mission of bioethics is to enable ethical reflection to keep pace with scientific

and medical breakthroughs. With each new technology or medical breakthrough, the public

finds itself in uncharted ethical terrain it does not know how to navigate. In the twenty-first

century—what is very likely to be the "century of biology"—there will be a constant stream

of moral quandaries as scientific reach exceeds ethical grasp. As a response to these

monumental strides in science and technology, the scope of bioethics has expanded to include

the ethical questions raised by the Human Genome Project, stem cell research, artificial

reproductive technologies, the genetic engineering of plants and animals, the synthesis of

new life-forms, the possibility of successful reproductive cloning, preimplantation genetic

diagnosis, nanotechnology, and xenotransplantation—to name only some of the key

advances.

Bioethics has also begun to engage with the challenges posed by delivering care in

underdeveloped nations. Whose moral standards should govern the conduct of research to

find therapies or preventive vaccines useful against malaria, HIV, or Ebola—local standards

or Western principles? And to what extent is manipulation or even coercion justified in

pursuing such goals as the reduction of risks to health care in children or the advancement

of national security? This population-based focus raises new sorts of ethical challenges both

for health care providers who seek to improve overall health indicators in populations and

for researchers who are trying to conduct research against fatal diseases that are at epidemic

levels in some parts of the world.

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 As no realm of academic or public life remains untouched by pressing bioethical issues,

the field of bioethics has broadened to include representation from scholars in disciplines as

diverse as philosophy, religion, medicine, law, social science, public policy, disability

studies, nursing, and literature.

a. Definitions

In the course of the birth of bioethics, experts have skillfully crafted various meanings of

bioethics. Some of these definitions are the following:

 Bioethics is a discipline that deals with the ethical implications of biological

research.

 Bioethics is the study of ethical issues that emanate from the changes and

developments in the life science technologies.

 It is a branch of ethics that analyzes moral values in the context of biomedical

sciences.

 It is a systematic study of human conduct in the areas of the life sciences and

health care.

 It belongs to the auspices of medical ethics and is loosely anchored in the avenues

of life sciences.

 It is the study of the moral problems in medicine and biological technology.

The word “bioethics” is derived from word bio, which means life, and ethos (ethics),

which is the philosophical discipline that deals with the morality of human conduct. But

despite its heavy adherence to life sciences, bioethics is multi-disciplinary. It is the result of

the collective efforts in philosophy, theology, law, and medicine as it confronts the complex

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crisscrossing and intertwining of science and technology in the ambit of human life. The

term "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.

b. Development

The range of issues considered to fall within the purview of bioethics varies depending

on how broadly the field is defined. In one common usage, bioethics is more or less

equivalent to medical ethics, or biomedical ethics. The term medical ethics itself has been

challenged, however, in light of the growing interest in issues dealing with health care

professions other than medicine, in particular nursing. The professionalization of nursing

and the perception of nurses as ethically accountable in their own right have led to the

development of a distinct field known as nursing ethics. Accordingly, health care ethics has

come into use as a more inclusive term. Bioethics, however, is broader than this, because

some of the issues it encompasses concern not so much the practice of health care as the

conduct and results of research in the life sciences, especially in areas such as cloning and

gene therapy, stem cell research, xenotransplantation (animal-to-human transplantation), and

human longevity.

Although bioethics—and indeed the whole field of applied ethics as currently

understood—is a fairly recent phenomenon, there have been discussions of moral issues in

medicine since ancient times. Examples include the corpus of the Greek physician

Hippocrates (460–377 bc), after whom the Hippocratic oath is named (though Hippocrates

himself was not its author); the Republic of Plato (428/27–348/47 bc), which advocates

selective human breeding in anticipation of later programs of eugenics; the Summa contra

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gentiles of St. Thomas Aquinas (1224/25–1274), which briefly discusses the permissibility

of abortion; and the Lectures on Ethics of the German Enlightenment philosopher Immanuel

Kant (1724-1804), which contains arguments against the sale of human body parts .

Bioethics emerged as a distinct field of study in the early 1960s. It was influenced not

only by advances in the life sciences, particularly medicine, but also by the significant

cultural and societal changes taking place at the time, primarily in the West. The perfection

of certain lifesaving procedures and technologies, such as organ transplantation and kidney

dialysis, required medical officials to make difficult decisions about which patients would

receive treatment and which would be allowed to die. At the same time, the increasing

importance placed on individual well-being contributed to changes in conventional attitudes

toward marriage and sexuality, reproduction and child rearing, and civil rights. The ultimate

result was widespread dissatisfaction with traditional medical paternalism and the gradual

recognition of a patient’s right to be fully informed about his condition and to retain some

measure of control over what happens to his body.

IMPORTANCE OF BIOETHICS

The importance of bioethics is reflected in different parts of our society such as

healthcare, research and our society in general. Bioethics in healthcare brought about

awareness to health workers of the medical practice as well as enriching the ability of health

workers to further understand the patient as a person. Highlighting the ethical side of

bioethics, health workers were now able to follow an ethical code when working with patients

which was once a problem. Ethical problems had a clear connection to problems in health

care, so by the emergence of bioethics, the healthcare of our country has been significantly

improved.

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 Bioethics matters because it affects everyone. In reality, bioethical issues concern us

all in one way or another, but most people don’t see bioethics as something that is relevant

to their lives. Sadly, the it-can’t-happen-to-me attitude is a prevalent reaction. But, it

CAN happen to you. In fact, chances are it already is affecting your life without you even

realizing it.

ISSUES IN BIOETHICS

a. Health Care Context

The issues studied in bioethics can be grouped into several categories. One category

concerns the relationship between doctor and patient, including issues that arise from

conflicts between a doctor’s duty to promote the health of his patient and the patient’s right

to self-determination or autonomy, a right that in the medical context is usually taken to

encompass a right to be fully informed about one’s condition and a right to be consulted

about the course of one’s treatment. Is a doctor obliged to tell a patient that he is terminally

ill if there is good reason to believe that doing so would hasten the patient’s death? If a

patient with a life-threatening illness refuses treatment, should his wishes be respected?

Should patients always be permitted to refuse the use of extraordinary life-support measures?

These questions become more complicated when the patient is incapable of making rational

decisions in his own interest, as in the case of infants and children, p atients suffering from

disabling psychiatric disorders such as schizophrenia or degenerative brain diseases such as

Alzheimer disease, and patients who are in a vegetative state.

b. Social and Legal Issues

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 Questions of discrimination in bioethics have arisen in a number of areas. In one such

area, reproductive medicine, recently developed techniques have enabled parents to choose

the sex of their child. Should this new power be considered liberating or oppressive? Would

it be viewed positively if the vast majority of the parents who use it choose to have a boy

rather than a girl? Similar concerns have been raised about the increasing use of abortion as

a method of birth control in overpopulated countries such as India and China, where there is

considerable social and legal pressure to limit family size and where male children are valued

more highly than female children.

On another note, many of the moral issues that have arisen in the health care context and

in the wake of advances in medical technology have been addressed, in whole or in part, in

legislation. It is important to realize, however, that the content of such legislation is seldom,

if ever, dictated by the positions one takes on particular moral issues. For example, the view

that voluntary euthanasia is morally permissible in certain circumstances does not by itself

settle the question of whether euthanasia should be legalized. The possibility of legalization

carries with it another set of issues, such as the potential for abuse. Some bioethicists have

expressed the concern that the legalization of euthanasia would create a perception among

some elderly patients that society expects them to request euthanasia, even if they do not

desire it, in order not to be a burden to others. Similarly, even those who believe that abortion

is morally permissible in certain circumstances may consistently object to proposals to relax

or eliminate laws against it.

BIOETHICS APPROACHES

a. Traditional and contemporary ethical theories

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 As a branch of applied ethics, bioethics is distinct from both metaethics, the study of

basic moral concepts such as ought and good, and normative ethics, the discipline that seeks

to establish criteria for determining what kinds of action are morally righ t or wrong. To say

that bioethics is “applied,” however, does not imply that it presupposes any particular ethical

theory. Contemporary bioethicists make use of a variety of different views, including

primarily utilitarianism and Kantianism but also more recently developed perspectives such

as virtue theory and perspectives drawn from philosophical feminism, particularly the school

of thought known as the ethics of care.

Utilitarianism is a normative-ethical theory that holds that the moral rightness or

wrongness of an action should be ascertained in terms of the action’s consequences.

According to one common formulation, an action is right if it would promote a greater

amount of happiness for a greater number of people than would any other action performabl e

in the same circumstances. The Kantian tradition, in contrast, eschews the notion of

consequences and urges instead that an action is right only if it is universalizable —i.e., only

if the moral rule it embodies could become a universal law applicable to all moral agents.

The Kantian approach emphasizes respect for the individual, autonomy, dignity, and human

rights.

Unlike these traditional approaches, both virtue ethics and the ethics of care focus on

dimensions of moral theorizing other than determining the rightness or wrongness of

particular actions. Virtue ethics is concerned with the nature of moral character and with the

traits, capacities, or dispositions that moral agents ought to cultivate in themselves and

others. Thus, the virtue ethicist may consider what character traits, such as compassion and

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courage, are desirable in a doctor, nurse, or biomedical researcher and how they would (or

should) be manifested in various settings. The basic aim of the ethics of care is to replace —

or at least augment—the supposedly “masculine” moral values of rationality, abstraction,

impartiality, and independence with ostensibly more “feminine” values, such as emotion

(particularly compassion and benevolence), particularity, partiality, and interdependence.

From this perspective, reflection on abortion would begin not with abstract principles such

as the right to autonomy or the right to life but with considerations of the needs of women

who face the choice of whether to have an abortion and the particular ways in w hich their

decisions may affect their lives and the lives of their families. This approach also would

address social and legal aspects of the abortion debate, such as the fact that, though abortion

affects the lives of women much more directly than it does the lives of men, women as a

group are significantly underrepresented in the institutions that create aborti on-related laws

and regulations.

b. The four-principles approach

Whereas some approaches in bioethics proceed by applying principles derived from

independent ethical theories to individual cases (a “top-down” approach), others proceed by

examining individual cases in order to elucidate the principles that seem to guide most

people’s thinking about bioethical issues in actual practice (a “bottom-up” approach). One

very influential approach along these lines, known as the “four principles” of bioethics,

attempts to describe a set of minimum moral conditions on the behavior of health care

professionals. The first principle, autonomy, entails that health care professionals should

respect the autonomous decisions of competent adults. The second principle, beneficence,

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holds that they should aim to do good - i.e., to promote the interests of their patients. The

third principle, non-maleficence, requires that they should do no harm. Finally, the fourth

principle, justice, holds that they should act fairly when the interests of different individuals

or groups are in competition—e.g., by promoting the fair allocation of health care resources.

According to proponents of the four-principles approach, one of its advantages is that,

because the principles are independent of any particular ethical theory, they can be used by

theorists working in a variety of different traditions. Both the utilitarian and the Kantian, it

is argued, can support the principle of autonomy, though they would do so for different

reasons. Nevertheless, this adaptability may also be construed as a disadvantage. Critics have

contended that the principles are so general that whatever agreement on t hem there may be

is unlikely to be very meaningful. Thus, although the utilitarian and the Kantian may both

accept the principle of autonomy, the principle as it is formulated allows them to understand

the notion of autonomy in very different ways. Another criticism of the approach is that it

does not offer any clear way of prioritizing between the principles in cases where they

conflict—as they are often liable to do. The principle of autonomy, for example, might

conflict with the principle of beneficence in cases where a competent adult patient refuses to

accept life-saving treatment.

Despite these problems, the principles remain useful as a framework in which to think

about moral issues in medicine and the life sciences. This is not an inconsiderable

contribution, for, on at least one conception of the field, the main task of bioethics is not so

much to provide answers to moral problems as to identify where the problems lie.

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CONCLUSION/SUMMARY

In the modern world that we have today, Bioethics has brought about significant

changes in standards for the treatment of the sick and for the conduct of research. Every

health care professional now understands that patients have a right to know what is being

done to them, and to refuse. Every researcher now understands that participants in their

studies have the same rights, and review boards to evaluate proposed research on those

grounds are almost universal. Our understanding of what is ethical has grown, but it is never

complete as ethical advances open new questions every time.

Bioethics concerns for ethical questions involve in human understanding of life. It

born by necessity of a critic reflection about ethical conflicts, which are caused by

progressing in life science and medicine. Technological and medical tools have an important

role in society and it has to manage. It is important know that bioethics does not defend a

particular moral attitude nor offer determinant and definitive answers, but it searches a

grounded, critic and argued reflection centered in the singularity of a concrete situation.

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