COURSECODE: NCM-6308/NCM-5308 BIOETHICS/PRELIMS

INTRODUCTION TO BIOETHICS

AN INTRODUCTION

The terms bioethics and healthcare ethics oftentimes are used

synonymously. Bioethics is defined as a result of the fast expansion
of technical environment of the 1900s, in which it was characterized
as a specific domain of ethics that is focused on moral issues in the
field of health care.

In today’s world, there’s increasing attention given to bioethics

as we are now confronted with questions and dilemmas that are
unprecedented in human history. Furthermore, topics such as
xenotransplantation, synthetic and artificial life, as well as IVF and
animal research raise questions of ethics and morality that we never
had to confront before. Against this backdrop of controversy and
dilemmas, the field of bioethics comes into play- with solutions
derived from the considerations of philosophy, law and politics to the
questions at hand. Bioethics has to date addressed a multitude of
questions ranging from abortion and euthanasia to health care policy
and the individual right to refuse treatment. Furthermore, the exact
scope of the field is debated upon by bioethithemselves as different
individuals prescribe to different scopes ranging from the very limited
to those who examine the morality of actions that deal with any
organism that is capable of fear and pain. In addition, Bioethics
employs ethical theories in philosophy in order to address some of
the problems encountered in the field of clinical medicine. Also, there

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is an increasing number of philosophers see bioethics as the practical

application of philosophy in today’s world as it deals with questions
on the morality of actions in the clinical and research fields. In
addition to that, much of the bioethical discourse conducted in the
public and academic arenas approach bioethical questions with a
philosophical framework and structure, invoking ideas brought forth
by the great philosophers of yore, such as Immanuel Kant and
Jeremy Bentham, and utilizing them as a means to a viable solution
for the dilemmas encountered (R. Mohan).

As a matter of fact, Nursing and bioethics complements each

other because they have a lot of similarities such as they are both
dealing with matters concerning life and death, sickness and health,
the rights of every living organisms and communities, ethical patient
care, health care delivery, and public health. In addition to that,
Nurses and bioethicists give rise to ethical discipline, ethics
knowledge, and health legislations in many ways. Also, some nurses
have bioethics guidance or exposures, some bioethicists learn or
works closely with nurses, and some of us dynamically determined
as both bioethicists and as nurses. In spite of other shared and
interconnected objectives, bioethicists and nurses usually achieves
their goals in different ways, have various educational and training
tracks , have apparent roles and responsibilities, as well as deemed
to be different within health care institutions (Grady, 2016).

PRINCIPLES OF BIOETHICS:

Due to the need for standardization, Dan Harms from the then
United States Department of Health, Education and Welfare
published the Belmont Report which set out to lay guidelines for the
employment of human test subjects in experiments. Three
fundamental principles were recommended within such as:

1. Respect for persons 3. Justice

2. Beneficence

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IMPORTANCE OF BIOETHICS:

Healthcare ethics is concerned with ethical problems in health

care, medicine and science. Since ethical codes and its application
have long dated from ancient era, both advancement in medical field
and the challenges are increasing in same pace in this contemporary
time for healthcare providers to deal with ethical issues. Therefore,
this is where the role of bioethics comes in.

Bioethics in healthcare gives rise to understanding and

knowledge among healthcare professionals about medical practice.
In addition to that, focusing upon the ethical attributes of bioethics,
health allied professionals are competent of following ethical codes
while practicing especially when dealing with issues. As ethical
ordeals are interwoven with issues in medical care, by the application
of bioethics, the healthcare system of our country can be better
radically. Furthermore, Bioethics includes health care ethics and
learning about balance between benefits, harm and duties, that is
why It does have an influence both on patients and health
professionals. Also, the significance of bioethics begins from birth to
end of life.

Bioethics does not only establish a guideline to health allied

professionals about clinical decision-making as well as in
advancements in medical technologies, but also playing important
role in legislative changes and legislation in recent years. Bioethics is
a combination of scientific and humanistic constituent and does not
have need of the recognition of certain long-established standards
that are essential to health care ethics. Bioethics contributes to the
rights and responsibilities of patients as persons. Its relevance
replicates in various divisions e.g. medical care, researches and
overall community (Taj, Rizwan and Khan, Asima , 2018) .

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HISTORY OF BIOETHICS

The field of inquiry we recognize today as “bioethics” began four

decades ago as an educational ideal directed at what many then
perceived to be the dehumanization of medical care by overemphasis
on its technological and scientific progress. The initial hope was to
re-infuse “human values” into the education of physicians and
nurses by teaching some combination of ethics, the humanities,
and/or human values broadly conceived.

According to Warren T. Reich, bioethics is the methodical study

of human behaviour in the field of the life sciences as well as in the
health care, in as much as this behaviour is assessed in the context
of moral values and principles. Despite the fact that the generality of
such a definition may be adequately clear about the field of bioethics,
it also encompasses various point of views of pertinent authors in
this object of knowledge, combining them under one idea that, indeed,
hides disputes among them that are deep enough to make the object
and the scope of bioethics lose much of the stability that seemed to
be provided by the original definition.

Furthermore, Warren T. Reich pointed to three remarkable

reasons for the rise of bioethics: 1) the fact that the issues of bioethics
have captured the contemporary mind because they represent major
conflicts in the area of technology and basic human values, those
dealing with life, death, and health, mainly due to the fact that the
introduction of modern biomedical technologies, especially since the
1950s, has intensified some age-old questions and has given rise to
perplexing new problems -the prolongation of life, euthanasia,
prenatal diagnosis and abortion, human experimentation, genetic
interventions and reproductive technologies, behaviour control and
psychosurgery, the definition of death, the right to privacy, allocation
of scarce resources, and dilemmas in the maintenance of
environmental health. 2) there would be an intense and widespread
interest in bioethics because it offers a stimulating intellectual and
moral challenge, in a time when it's the very tools long since used to

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deal with moral dilemmas that are now subject to controversy and in
which ethical principles and priorities are under systematic scrutiny.
3) The rapid growth of the field of bioethics has been facilitated by
the openness to multidisciplinary work that characterizes many
scholars and academic institutions today, especially in matters
dealing with personal and social aspects of human behaviour.

Similarly, H. Tristram Engelhardt highlights four historical

elements underneath the emergence of bioethics: 1) major and rapid
technological changes that have created pressures to re-examine the
underlying assumptions of established practices (e.g., the advent of
transplantation contributed to interests in a brain-oriented definition
of death); 2) rising health care costs, which have occasioned
questions about the allocation of resources; 3) the frankly pluralistic
context in which health care is now delivered (e. g., physicians and
nurses can no longer presuppose that they share a view in common
with their patients, or with each other, or that the conduct of their
practice will be framed within acknowledged Judeo-Christian
assumptions); and 4) the expansion of publicly recognized rights of
self-determination. (Cascais,1997)

Bioethics has therefore been a “revitalized” study of applied

medical ethics, its freshness coming not from technology or from the
novelty of problems, but rather from the method with which such
themes had to be tackled, because of both the diversity of disciplines
involved and the pluralistic context of modern society.

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EARLY EVENTS IN BIOETHICS:

August 19, 1947: The Nuremberg trials of Nazi doctors who conducted heinous medical experiments
during World War II began.

April 25, 1953: Watson and Crick published a one-page paper about DNA.

December 23, 1954: The first renal transplant was performed.

March 9, 1960: Chronic hemodialysis was first used.

December 3, 1967: The first heart transplant was done by Dr. Christiaan Barnard.

August 5, 1968: The definition of brain death was developed by an ad hoc committee at Harvard
Medical School.

July 26, 1972: Revelations appeared about the unethical Tuskegee syphilis research.

January 22, 1973: The landmark Roe v. Wade case was decided.

April 14, 1975: A comatose Karen Ann Quinlan was brought to Newton Memorial Hospital; she
became the basis of a landmark legal case about the removal of life support.

July 25, 1978: Baby Louise Brown was born. She was the first test-tube baby.

Spring 1982: Baby Doe became the basis of a landmark case that resulted in legal and ethical
directives about the treatment of impaired neonates.

December 1982: The first artificial heart was implanted into the body of Barney Clark, who lived 112
days after the implant.

April 11, 1983: Newsweek published a story that a mysterious disease called AIDS was at epidemic
levels.

Source: Jonsen, A. R. (2000). A short history of medical ethics. New York, NY: Oxford University
Press, pp. 99–114.

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RECENT EVENTS IN BIOETHICS:

• 2001: Appointment of Bush President’s Council on Bioethics

• 2005: Universal Declaration on Bioethics and Human Rights (UNESCO; United Nations
Educational, Scientific, and Cultural Organisation)

• 2009: Dismissal of Bush PBC

• 2009: Bioethics skirmishes in healthcare reform debate

• 2009: A new genome editing tool called CRISPR (Clustered Regularly Interspaced Short
Palindromic Repeats) invented in 2009, has made it easier than ever to edit DNA.

• 2010: Appointment of Obama Bioethics commission

• 2015: Scientists successfully used somatic gene therapy when a one-year old in the United
Kingdom named Layla received a gene editing treatment to help her fight leukemia, a type of
cancer. These scientists did not use CRISPR to treat Layla, and instead used another genome
editing technology called TALENs (Transcription activator-like effector nuclease).
• 2018: the forensic use of Direct-To-Consumer (DTC) genealogy databases or simple called
biobanks to catch criminals. Interest in this topic burgeoned following the arrest of the Golden
State Killer in California in 2018.

SELF ASSESSMENT TASK:

1. Find a Recent Bioethics Case or News. Analyze the Case or News and
write a reflection paper of no more than 500 words.

REFERENCES:
1. John A. Bryant, Linda Baggott la Velle (2018), Introduction to
Bioethics John Wiley & Sons.
2. Christine Grady, “Cultivating Synergy in Nursing, Bioethics, and
Policy,” Nurses at the Table: Nursing, Ethics, and Health Policy,

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special report, Hastings Center Report 46, no. 5 (2016): S5-S8.

DOI: 10.1002/hast.623
3. Taj, Rizwan and Khan, Asima (2018) "Importance of bioethics in
healthcare," Pakistan Journal of Neurological Sciences (PJNS): Vol.
13 : Iss. 1 , Article 2
4. https://samples.jbpub.com/9781284059502/Chapter_2_Sample
.pdf
5. https://www.asiabiotech.com/15/1505/0034_0035.pdf
6. https://www.bioedge.org/bioethics/should-biobanks-be-used-in-
criminal-investigations/13481
7. https://www.genome.gov/
8. A.F. Cascais (1997) Bioethics: History, Scope, Object, Global
Bioethics, 10:1-4, 9-
24, DOI: 10.1080/11287462.1997.10800712

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