Subject: Bioethics

Topic: 1.01 Intro to Bioethics

Lecturer: Dr. Sombilon
Date: November 10, 2014

I. ETHICS o Medical ethics (more correct term)

 A branch of philosophy o Business ethics
 Practical science of MORALITY of human acts (Human act not the o Sexual ethics
same as the act of man as it is willful and voluntary.) o Social ethics
 Teaches us how to judge accurately the moral GOODNESS or o Environmental policy and ethics
BADNESS of any human action, which is, learned since childhood at
home, school. It is a set of values/ training that you grew up with. IV. MEDICAL ETHICS
 A “subset” of bioethics – a clinical or case-based approach
II. BASIC PRINCIPLES IN BIOETHICS  Used interchangeably: “bioethics”, “medical ethics” and
A. Beneficence “biomedical ethics”
 ONE OUGHT TO DO GOOD  Encompasses (but not limited to):
 Seek the patient’s well-being (Patient’s well-being is the #1 o Abortion
priority) o Euthanasia
 Provide standards of due care and risk/benefit assessment (Be o Confidentiality
competent. You cannot be ethical if you’re not competent because o Truth telling
you can’t provide adequate care. Always tell the risk of the o Fair distribution of resources
procedure/treatment!) o Informed consent
o Research involving human subjects
B. Non-Maleficence o HIV/AIDS issues
o Organ transplantation
 DO NO HARM
o Genetic engineering
 Latin: “Primum Non Nocere” = First Do No Harm
o Human cloning
 Avoid unnecessary expense, consult, procedures and medications
o Stem cell research
 Mirror image of Beneficence o Reproductive rights and assisted reproductive techniques
 The application of the GENERAL PRINCIPLES of ethics to the moral
C. Informed Consent problems of the medical profession
 In any procedure, provide the patient with a COMPLETE,  CORE: based on TRUST; ethics of a physician- patient relationship
ADEQUATE DISCLOSURE of his illness and OPTIONS in a language o As a physician, you have to follow certain specific RULES OF
he understands for the patient to be able to make a rational and CONDUCT (you can’t just act whatever you want to do) – it is
free decision mandated and looked-after by Philippine Medical Association
o What the physician PROVIDES for the patient: you should be
D. Autonomy competent, you should care for your patient, you should have
 RESPECT FOR PERSONS empathy and compassion
 Respect the patient’s rational decision as long as he is aware of the o What the physician’s DUTIES are to the patient and VICE-
consequences VERSA – the patients have to be truthful, and forward in their
 The patient has a right to refuse (if he is competent or in his right dealings with you
mind) o Further proofreading of the trans
 Especially important in terminally ill patients when they refuse o correction of minor details such as
extraordinary means of treatment  chemical synapse is faster than electrical synapse ->
 This premise serves as basis why Jehovah’s witnesses do not electrical synapse is faster
accept blood transfusion, and women do abortion  fertilized egg goes through respiratory tract ->
reproductive tract
E. Justice  Addition of information from the book should there be a
 Allocating scarce resources fairly and according to medical needs need
 Improvement of explanation should there be a need
MNEMONIC- Principles in Bioethics  Ensure that the trans was properly formatted by following
A- Autonomy the Trans Template
B- Beneficence  Please note. They are to ensure that it is properly
C- Consent (Informed Consent) formatted. They are not to format it for you.
D- Do no harm (Non-maleficence)  Ensure that a hard copy is left in Alva so it may be
E- Equality (Justice) photocopied by those who prefer to have a hard copy

TUSKEGEE EXPERIMENT (1930s)

III. BIOETHICS
 “Life ethics” – philosophical and broad
 More encompassing than medical ethics, includes additional issues
not necessarily a part of medical ethics
o Done by the US Government
o 400 Black American farmers with Syphilis were signed up to
observe the course of the disease
o 1949 – discovery of a cure Penicillin
o Treatment was deliberately withheld from the subjects in order

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 to observe the progress of the disease and its complications Bioethics (1995-2001)
until death o Bioethics Institutes
o Patients were told they s imply had “bad blood” and lived with  Consists of physicians (not just one), layman, lawyer, and
the disease until their death, some in the 1970s theologians to help resolve medico-moral problems, NOT
o US Gov’t reparations and recognition of these men did little to just doctors!
regain the trust of the public in human experimentation o Ethics Review Board (ERB)
o Only in the last term of President Clinton (recent) was a  No paper can be started without going through the ERB
FORMAL APOLOGY to the families of the Tuskegee victims o The Future of Bioethics
given  Brain mapping and highly precise image technology –
neuroethical issues to determine personality traits and
MODERN DAY BIOETHICS CASE CANDIDATES dis ease and behavior predisposition: assessing a
o 1962 – Shana Alexander on Seattle Artificial Kidney Program person’s memories for legal or forensic purposes
 First dialysis machine
 “God’s Squad” – decides who gets to live or die since
organ transplant was very limited
o 1967 – Dr. Christian Barnard on first successful heart transplant
o 1973 – Roe vs. Wade: US Supreme Court decision on abortion
 Declared the principle of autonomy
 Basis for legalization of abortion
o 1974 – Exposure of Tuskegee Syphilis study
 The National Commission for the Protection of Human
o Subjects in Biomedical and Behavioral Research
o 1976 – Quinlan Case: US Supreme Court decision on end of life
 Case of Karen Quinlan who was then in her 20s (First
Case of PVS)
 She took drugs, went to a party and consumed alcohol.
 She was in a coma for years and was hooked on artificial
respirator
 She was in PVS (Persistent Vegetative State)
 Decision was in favor of parent’s plea to remove life
support
o 1978 – Drs. Patrick Steptoe and Robert Edwards
 First test tube baby (In Vitro Fertilization or IVF) and
embryo trans plant baby Louise Brown
o 1980s-Present – HIV/AIDS
 Ethical issues: Discrimination and absence of beneficence
for the African population who were first tested and
studied for the diseases
o 1991 – The Patient Self-determination Act
 Emphasis on need for advanced directives, living will and
ethics committees
 Example is the case of Nancy Cruzan who was in PVS
o 1983 – Case of Nancy Cruzan (right-to-die, 2nd case of PVS)
 You may access her story at:
http://www.che.org/members/ethics/docs/2146/The%2
0case%20of%20Nancy%20Cruzan%20AC%20Module%20
12.pdf
o 1996 – Dolly the first cloned sheep and Stem Cell Technology
o 2002 – Legalization of Euthanasia in Netherlands
 Emergence of Right to Die advocates and movement
 Oregon Death with Dignity Act
o 2007 – Terri Schiavo
 End of life case involving termination of feeding (Third
Case of PVS)

BIOETHICS AS A FIELD MORE DEFINED

o Bioethics Institutes
 1969 Hastings Center
 1971 – Kennedy Institute for Ethics (Georgetown Univ.)
o Tom Beauchamp and James Childress (1977) - The Principles of
Biomedical Ethics (bible of bioethics)
o National Bioethics Advisory Committee, President’s Council on

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