NCM 108 Bioethics

Ethics
is the branch of philosophy which deals with moral aspects of human behavior.

Medical ethics
is that the physician has a moral (and at times legal) obligation to act for the
patient’s good, using the most up-to-date information. The question is how to
establish that “good,” who defines it,
Chiefly to the rules of etiquette adopted by the medical profession to regulate
professional conduct with each other, but also towards their individual patients
and towards society, and includes considerations of the motives behind that
conduct.
Moral
Nursing as an ethical practice requires courage to be moral, taking tough stands
for what is right, and living by one's moral values. Nurses need moral courage in
all areas and at all levels of nursing.

Bioethics
Bioethics, as defined by “a discipline dealing with the ethical implications of
biological research and applications especially in medicine.” It comprises the basic
principles that govern nurses and is helpful in guiding how to approach and
engage patients, especially when difficult decisions about life, death and
interventional treatment are being made. Morals are slightly different and
represent your personal belief system of what is right and wrong.

Professional ethics
is concerned with the standards and moral conduct that govern the profession
and its members. More specifically, professional ethics examines issues,
problems, and the social responsibility of the profession itself and individual
practitioners in the light of philosophical and, in some contexts, religious
principles among which are duty and obligation.

Moral vs Immorality:
Being moral is when an individual is concerned with the principles of right and
wrong behavior. Being immoral is when the individual is not concerned with the
principles of right and wrong behavior.

Nursing Ethics
are defined as the moral principles that determine how a person or group of
people will act or behave in specific situations. Strong ethics are vital to nursing,
as moral dilemmas can frequently arise while attending to patients. Nurses and
other healthcare professionals must recognize these ethical problems when they
occur and apply the profession’s ethics and core values in their judgment and
decision-making.

Nuremberg Code/Kodex is a set of ethical research principles for human

experimentation created by the court in U.S. v Brandt, one of the Subsequent
Nuremberg trials that were held after the Second World War.

U.S. v Brandt "Doctor's Trial"

The doctors' trial (officially United States of America v. Karl Brandt, et al.) was the
first of 12 trials for war crimes of high-ranking German officials and industrialists
that the United States authorities held in their occupation zone in Nuremberg,
Germany, after the end of World War II.

Twenty of the twenty-three defendants were medical doctors and were accused
of having been involved in Nazi human experimentation and mass murder under
the guise of euthanasia. Of the 23 defendants, seven were acquitted and seven
received death sentences; the remainder received prison sentences ranging from
10 years to life imprisonment.

The accused faced four charges, including:

1. Conspiracy to commit war crimes and crimes against humanity.
2. War crimes: performing medical experiments, without the subjects' consent,
on prisoners of war and civilians of occupied countries, in the course of which
experiments the defendants committed murders, brutalities, cruelties, tortures,
atrocities, and other inhuman acts. Also planning and performing the mass
murder of prisoners of war and civilians of occupied countries, stigmatized as
aged, insane, incurably ill, deformed, and so on, by gas, lethal injections, and
diverse other means in nursing homes, hospitals, and asylums during the
Euthanasia Program and participating in the mass murder of concentration camp
inmates.
3. Crimes against humanity: committing crimes also on German nationals.
Sterilization Law
4. Membership in a criminal organization, the SS
(The Schutzstaffel was a major paramilitary organization under Adolf Hitler and
the Nazi Party in Nazi Germany, and later throughout German-occupied Europe
during World War II.

10 points for legitimate medical research

revised the original six points of the Memorandum to ten points. The ten points
became known as the Code, which includes such principles as informed consent
and absence of coercion; properly formulated scientific experimentation; and
beneficence towards experiment participants. It is thought to have been mainly
based on the Hippocratic Oath, which was interpreted as endorsing the
experimental approach to medicine while protecting the patient.
1. The voluntary consent of the human subject is absolutely essential.
2. The experiment should be such as to yield fruitful results for the good of
society, unprocurable by other methods or means of study, and not random and
unnecessary in nature.
3. The experiment should be so designed and based on the results of animal
experimentation and a knowledge of the natural history of the disease or other
problem under study that the anticipated results will justify the performance of
the experiment.
4. The experiment should be so conducted as to avoid all unnecessary physical
and mental suffering and injury.
5. No experiment should be conducted where there is an a priori reason to
believe that death or disabling injury will occur; except, perhaps, in those
experiments where the experimental physicians also serve as subjects.
6. The degree of risk to be taken should never exceed that determined by the
humanitarian importance of the problem to be solved by the experiment.
7. Proper preparations should be made, and adequate facilities provided to
protect the experimental subject against even remote possibilities of injury,
disability, or death.
8. The experiment should be conducted only by scientifically qualified persons.
The highest degree of skill and care should be required through all stages of the
experiment of those who conduct or engage in the experiment.
9. During the course of the experiment the human subject should be at liberty to
bring the experiment to an end if he has reached the physical or mental state
where continuation of the experiment seems to him to be impossible.
10. During the course of the experiment the scientist in charge must be prepared
to terminate the experiment at any stage, if he has probable cause to believe, in
the exercise of the good faith, superior skill and careful judgment required of him
that a continuation of the experiment is likely to result in injury, disability, or
death to the experimental subject.
The Code has not been officially accepted as law by any nation or as official ethics
guidelines by any association. In fact, the Code's reference to Hippocratic duty to
the individual patient and the need to provide information was not initially
favored by the American Medical Association
The lack of clarity, the brutality of the unethical medical experiments, and the
uncompromising language of the Code created an image that it was designed for
singularly egregious transgressions.

However, the Code is considered by some to be the most important document in

the history of clinical research ethics, because of its massive influence on global
human rights.

Hippocratic Oath: Modern Version

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I
walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding
those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth,
sympathy, and understanding may outweigh the surgeon's knife or the chemist's
drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues
when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to
me that the world may know. Most especially must I tread with care in matters of
life and death. If it is given me to save a life, all thanks. But it may also be within
my power to take a life; this awesome responsibility must be faced with great
humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick
human being, whose illness may affect the person's family and economic stability.
My responsibility includes these related problems, if I am to care adequately for
the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all
my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and
remembered with affection thereafter. May I always act so as to preserve the
finest traditions of my calling, and may I long experience the joy of healing those
who seek my help.

1. Deontology
is an ethical theory that says actions are good or bad according to a clear set of
rules. Its name comes from the Greek word deon, meaning duty. Actions that
align with these rules are ethical, while actions that don't aren't.

A. Natural law theory

  natural law, in philosophy, system of right or justice held to be common to
all humans and derived from nature rather than from the rules of society,
or positive law.
 In philosophy, politics, and civil law, natural law theories provide an ethical
framework that describes and defines human behavior as it relates to two
basic principles: legality and morality.
It refers to a type of moral theory, as well as to a type of legal theory, but the core
claims of the two kinds of theory are logically independent. It does not refer to
the laws of nature, the laws that science aims to describe. According to natural
law moral theory, the moral standards that govern human behavior are, in some
sense, objectively derived from the nature of human beings and the nature of the
world.
Aristotle held that what was “just by nature” was not always the same as what
was “just by law,” that there was a natural justice valid everywhere with the same
force and “not existing by people’s thinking this or that,” and that appeal could be
made to it from positive law.
Unlike laws enacted by governments to address specific needs or behaviors,
natural law is universal, applying to everyone, everywhere, in the same way. For
example, natural law assumes that everyone believes killing another person is
wrong and that punishment for killing another person is right.
Humans have a natural drive to eat, drink, sleep and procreate. These actions are
in accord with a natural law for species to survive and procreate. Thus, activities
in conformity with such a law are morally good. Activities that work against that
law are morally wrong. As an example, consider that to eat too much or too little
and place life in jeopardy is morally wrong.

B. Kantianism
Kantianism is the philosophy of Immanuel Kant, a German philosopher born in
Königsberg, Russia.
Kantianism is defined as a branch of philosophy that follows the works of
Immanuel Kant who believed that rational beings have dignity and should be
respected.

Kant's ethics are organized around the notion of a “categorical imperative,”

which is a universal ethical principle stating that one should always respect the
humanity in others, and that one should only act in accordance with rules that
could hold for everyone.
For example, if you hide an innocent person from violent criminals in order to
protect his life, and the criminals come to your door asking if the person is
with you, what should you do? Kantianism would have you tell the truth, even
if it results in harm coming to the innocent person.

C. Ross Theory
Sir William David Ross was a Scottish philosopher, known for work in ethics
and for his work on Aristotle. In Foundations of Ethics, Ross suggests that the
duties of beneficence, self-improvement, and justice could be subsumed under
a single duty to promote intrinsic values (that is, things that are intrinsically
good). Doing this would reduce the number of prima facie duties from seven
to five.

Ross vs Kant
Ross basically accepts Kant’s claim and agrees that it is not enough merely to
do the right thing. For an act to be morally good, we must perform it because
it is the right thing. For example, if I repay a loan simply to avoid a heavy fine
or some form of legal penalty, I will have done the right thing but my action
will have no genuine moral significance. Only if I repay the loan out of a sincere
sense of personal obligation and a willing adherence to principle will my right
action also be morally good.
Ross's (incomplete) list of prima facie duties:

Duties stemming from one's own previous actions:

1. fidelity - duty to fulfill (explicit and implicit) promises/agreements into
which one has entered
2. reparation - duty to make up for wrongful acts previously done to
others
Duties stemming from the previous actions of others:
3. gratitude - duty to repay others for past favors done for oneself
Duties stemming from the (possibility of) a mismatch between persons'
pleasure or happiness and their "merit":
4. justice - duty to prevent or correct such a mismatch
Duties stemming from the possibility of improving the conditions of others
with respect to virtue, intelligence, or pleasure:
5. beneficence - duty to improve the conditions of others in these respects
Duties stemming from the possibility of improving one's own condition with
respect to virtue or intelligence:
6. self-improvement - duty to improve one's own condition in these
respects
Special duty to be distinguished from the duty of beneficence:
7. nonmaleficence - duty not to injure others
2. Teleological
relating to or involving the explanation of phenomena in terms of the purpose
they serve rather than of the cause by which they arise.
Teleology or finality is a reason or an explanation for something which serves as a
function of its end, its purpose, or its goal, as opposed to something which serves
as a function of its cause. A purpose that is imposed by a human use, such as the
purpose of a fork to hold food,
For instance, if we ask ourselves, “Why did John switch the TV on?” And we
respond, “To watch his favorite program,” we are giving a teleological
explanation.

3. Utilitarianism
is an ethical theory that determines right from wrong by focusing on outcomes. It
is a form of consequentialism. Utilitarianism holds that the most ethical choice is
the one that will produce the greatest good for the greatest number.

Jeremy Bentham
In the Fragment Bentham stated the “fundamental axiom” that “it is the greatest
happiness of the greatest number that is the measure of right and wrong”, and
“the obligation to minister to general happiness, was an obligation paramount to
and inclusive of every other”

"the greatest amount of good for the greatest number of people."

Utilitarianism would say that an action is right if it results in the happiness of the
greatest number of people in a society or a group.