Bioethics Aasim Ahmad
Ethics and Ethical Issues Ethic is defined as set of morals Ethics is the science of morals in human conduct; moral principles or code Bioethics is the application of these principles to the science of medicine Research ethics is the application of the principles of bioethics to research
Bioethics Philosophical study of the ethical controversies brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, philosophy, and theology. Wikipedia
History 6th century B.C.: Meat and vegetable experiment on young Jewish prisoners in Book of Daniel. 5th century B.C: "Primum non nocere" ("First do no harm"), medical ethics standard attributed to Hippocrates. This Oath became obligatory for physicians prior to practicing medicine in the 4th century AD 1st century B.C. Cleopatra devised an experiment to test the accuracy of the theory that it takes 40 days to fashion a male fetus fully and 80 days to fashion a female fetus.
1900: Berlin Code of Ethics 1915: A doctor in Mississippi, working for the U.S. Public Health Office produces Pellagra in twelve Mississippi inmates 1927: Carrie Buck of Charlottesville is legally sterilized against her will 1931: Lubeck, Germany, 75 children die in experiments with tuberculosis vaccine : U.S. Public Health Service study in Tuskegee, observed for the natural course of untreated syphilis cont…d History
1943 Refrigeration experiment conducted on sixteen mentally disabled patients 1946: Patients in VA hospitals are used as guinea pigs for medical experiments 1947: Judgment at Nuremberg Doctors Trial sets forth “Permissible Medical Experiments” – i.e., the Nuremberg Code, which begins: "The voluntary consent of the human subject is absolutely essential." cont…d History
1964: World Medical Association adopts Helsinki Declaration, asserting "The interests of science and society should never take precedence over the well being of the subject." 1974: Tuskegee study 1979: National Commission issues Belmont Report setting forth three basic ethical principles: respect for persons, beneficence, and justice 1991: World Health Organization announces CIOMS Guidelines which set forth four ethical principles: respect for persons, beneficence, nonmaleficence and justice. cont…d History
Birth of Theories Kantianism Utilitarianism Liberal Individualism Communitarianism Ethics of Care
Birth of Principles Medical Ethics of Hippocrates Faced with rising problems of advances in the field of medicine, biotechnology and pharmaceutical industry a new field called ‘Bioethics’ emerged PRINCIPLES OF BIOETHICS: –These principles brought the ethics deliberations to a lower level and gave some answers, seemed workable as compared to some abstract theories of philosophy
Principles Approach to Biomedical Ethics Non-maleficence Beneficence Justice Autonomy (Beauchamp & Childress 1983)
Non-maleficence Do No Harm Hippocratic oath expresses this: “I will use treatment to help the sick according to my ability and judgment, but I will never use it to injure or harm them”
Beneficence Do Good This goes beyond avoiding harm and includes an obligation to benefit persons, population or community at large.
Justice Be Fair Hippocrates focused on doctor-patient relationship but did not deal with the social dimension of health and health-care. Justice or fairness calls for people whose needs are alike being treated equally. An important expression of justice is equity, which acknowledges that people have differential needs and fairness calls for responding with care according to such differential needs. Jack Bryant
Moral Rules Veracity –Tell the truth Fidelity –Keep promises Privacy –Respect privacy –Consider sensitivity Confidentiality
What are the characteristics of treating people as ends in themselves? Not denying them relevant information Allowing them freedom of choice
Belmont Report: Ethical guidelines Three principles for biomedical and behavioural research on humans (a) respect for persons (people either have autonomy, or protection if they don't); (b) beneficence (research should do no harm to participants, and should benefit participants and society) (c) justice (burden of participation should not be limited to certain groups, and benefits should be available to all).
Guiding Ethical Principles Respect for human dignity Respect for free and informed consent Respect for vulnerable persons Respect for privacy and confidentiality Respect for justice and inclusiveness Balancing harms and benefits Minimizing harm (non-maleficence) Maximizing benefit (beneficence)
Personal Autonomy Self-rule that is free from both controlling influence by others, and from limitations (inadequate understanding that prevents meaningful choice). Requires 2 essential conditions: a) Liberty – independence of controlling influence; b) Agency – capacity for intentional action. This applies to the act of decision-making in both health care practice and research.
Respect for Autonomy Involves respectful action, not merely attitude – acknowledging decision-making rights AND enabling autonomous action. Emanuel Kant: Unconditional worth of the individual, entailing respectful treatment as an end. John Stuart Mill: Don’t interfere with others and strengthen autonomous expression, except the obligation to seek to persuade someone with ill- considered or false views.