1. An introduction to Bioethics
A Modified presentation by
Nicole M. Deming, J.D., M.A.
Assistant Professor of Bioethics
Case Western Reserve University
School of Medicine *

2. ETHICS, MORALITY AND THEORY
Define Ethics
Philosophy addressing questions of morality, understanding, and examining moral life
Define Morality
Code of conduct put forward by society
Normative claims: how things should or ought to be *

3. What is “ethics”?
Ethics: “the rules of conduct recognized in respect to a particular class of human actions or a particular group, culture”

4. What is “Bioethics”?
Bioethics: “a field of study concerned with the ethics and philosophical implications of certain biological and medical procedures, technologies, and treatments, such as organ transplants, genetic engineering, and care of the terminally ill”

5. A classic bioethical decision
One heart available  who should get it?
70-year-old woman
40-year-old school principal
17-year old girl

6. A classic bioethical decision
One heart available  who should get it?
70-year-old woman
40-year-old school principal
17-year old girl

7. Basic Bioethics Principles
RESPECT for people’s rights
Autonomy
Dignity
BENEFICENCE: Benefits must be proportionate to risks
Potential harm = potential good

8. Basic Bioethics Principles
JUSTICE: The even distribution of benefits and risks throughout society
NONMALEFICENCE: Do no harm
Experiment must stop if causes harm.

9. IS ETHICS RELATIVE? Darius, King of Persia…
“Summons Greeks to his court and asked them what they would take to eat the dead bodies of their fathers. They replied that they would not do it for any money in the world.
Later, in the presence of the Greeks , and through an interpreter, so that they could understand what was said, he asked some Indians, of the tribe called Callatiae, who in fact eat their parents’ dead bodies, what they would take to burn them. They uttered a cry of horror and forbade him to mention such a dreadful thing.”
- Herodotus ( B.C.) *

10. DEFINING THEORY Abstract reflection and argument
A systematic justification of those principles
Not all theories are of equal value or rigor
Aspect of each theory can contribute to our knowledge and analysis of a particular case in bioethics *

11. EXAMPLES OF MORAL THEORY
Utilitarianism
Consequence-based theory (Ends justify the means)
Kantianism
Why you do something matters…can you make something a universal rule?
The Golden Rule
Liberal Individualism
Positive Rights (education) and Negative Rights (Bill of Rights)
Communitarianism
The good of the community (Hoban)
Ethics of Care
Relationships matter
Focus on relationships involving care, responsibility, and trust *

12. ETHICAL THEORY…TO ACTION
Principle
Rule
Action *

13. BIOETHICS
Bioethics is the 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.
Applied Ethics: applied to actual ethical problems *

14. BIOETHICS Clinical Ethics Research Ethics Animal Rights
Withdrawal and Withholding Life Support, Doctor-Patient Relationship
Research Ethics
Stem Cells, Gene Therapy
Animal Rights
Euthanasia, Chimeras, Xenotransplantation
Environmental Ethics
Genetically Modified Food, Air Pollution
Biotechnology
Brain-computer interface, Department of Defense, Bioterrorism
Public Health
Newborn Screen Blood Banks, Vaccinations, FDA *

15. WHAT KINDS OF PROBLEMS ARE DEALT WITH?
Clinical Ethics
CPR (1954) James Elam experiment
Right to Refuse Care
Research Ethics
Tuskegee Syphilis Experiment
Willowbrook Experiment

16. Autonomy:
Greek:
autos “self” and
nomos “rule,” governance,” or “law”
Self-rule that is free from both controlling interference by others and from certain limitations such as an inadequate understanding that prevents meaningful choice
(Beauchamp and Childress) *

17. BENEFICENCE Providing a benefit to another
Principle of beneficence: a moral obligation to act for the benefit of others
Protect and defend rights of others
Help persons with disabilities
Rescue persons in danger *

18. NONMALEFICENCE An obligation to not inflict harm on others
First do no harm
Distinct from Beneficence
Obligations not to harm (rob or kill)
Obligations to help others (rescue a drowning child)
Withholding and withdrawing life-sustaining treatment
Intended effects and merely foreseen effects *

19. JUSTICE
Fair and just distribution of social burdens, benefits, opportunities and allocation of positions
Justice and Distributive Justice: fair, equitable and appropriate distribution determined by social norms
Access to Health Care
Selection of Research subject population *

20. CASE 1: JEHOVAH'S WITNESS
16 year old male
Car accident
Requires surgery
Parents will not allow blood products to be used
Patient refuses blood products *

21. CASE 2: VOLLEYBALL PLAYER
Infection in her leg
60% Chance of recovery with antibiotics alone
80% Chance of recovery with antibiotics and amputation of the leg
Parents want doctors to amputate the leg, patient would like to only take antibiotics *

22. CASE 3: PAIN RELIEF IN HOSPICE
86 year old man
Pancreatic Cancer
Hospice and Palliative Care
Refuses all pain medication
Staff and other patients are upset at “screams of agony” *

23. CONCLUSION Bioethics What should we do? Why? Case specific
Depends on values of the individuals
Some universal principles *