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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 therelationships among life sciences,biotechnology, medicine,politics, law,philosophy, and

theology.

1. Respect forautonomy of the Persons2. Beneficence3. Justice

Later principle of non-maleficence has been added to this list. To apply the general principles

to the conduct of research involving humans, the Belmont Report suggested that the

following requirements be considered: informed consent, risk/benefit assessment, and the just

and fair selection of subjects of research. The Belmont Report remains a touchstone for manybioethicists.

Today, the field of bioethics struggles with its proper scope. Should it concern itself with the

ethical evaluation of all questions involving biology and medicine? Some bioethicists would

narrow ethical evaluation only to the morality of medical treatments or technological

innovations, and the timing of medical treatment of humans. Others would broaden the scope

of ethical evaluation to include the morality of all actions that might help or harm organisms

capable of feeling fear and pain, and include within bioethics all such actions if they bear a

relation to medicine and biology.

The purpose of bioethics

The issues raised by bioethics as a distinct area of academic inquiry are largely answered by

the needs of institutions. Bioethicists today are not hired or engaged in conversation (and thus

"named") because of their opinions or because they have special skills of reasoning, but

because they know and can put to work the enormous body of research and history of

discussions about bioethics in a fair, honest and intelligent way, using tools from the different

disciplines that "feed" the field. Training programs in bioethics differ in skill sets of faculty

and size of program, but across the US, and increasingly globally, they do seem to share a

commitment to that goal with few exceptions.

As a result, bioethics has been distinctively created, by institutions, specifically the multi-

million dollar commitment of major and minor medical centers to the study of medical ethics

as part of the development of curriculum and research efforts. Today it is all but impossible

to create a major medical research effort without ethicists to assist. First in the regulatory

review of research, the responsibility of the IRB, which can be staffed by persons not trained

in ethics in any rigorous way, or trained specifically in the ethical and regulatory aspects of

research with human subjects, rather than more comprehensively in bioethics. The second

form of assistance is by those who can think in advance of the onset of research about its

social, ethical and economic implications.
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Medical Ethics

Medical ethics is primarily a field ofapplied ethics, the study ofmoral values and judgments

as they apply to medicine. As a scholarly discipline, medical ethics encompasses its practicalapplication in clinical settings as well as work on its history, philosophy, theology, and

sociology.

Medical ethics tends to be understood narrowly as an applied professional ethics, whereas

bioethics appears to have worked more expansive concerns, touching upon the philosophy of

science and the critique of biotechnology. Still, the two fields often overlap and the

distinction is more a matter of style than professional consensus.

Medical ethics shares many principles with other branches of healthcare ethics, such as

nursing ethics

.

Values in medical ethics

Six of the values that commonly apply to medical ethics discussions are:

Beneficence - a practitioner should act in the best interest of the patient. (Salusaegroti suprema lex.)

Non-maleficence - "first, do no harm" (primum non nocere). Autonomy - the patient has the right to refuse or choose their treatment. (Voluntas

aegroti suprema lex.)

Justice - concerns the distribution of scarce health resources, and the decision of whogets what treatment (fairness and equality).

Dignity - the patient (and the person treating the patient) have the right to dignity. Truthfulness and honesty - the concept of informed consent has increased in

importance since the historical events of the Doctors' Trial of the Nuremberg trials

and Tuskegee Syphilis Study.

Values such as these do not give answers as to how to handle a particular situation, but

provide a useful framework for understanding conflicts.

When moral values are in conflict, the result may be an ethical dilemma or crisis. Writers

about medical ethics have suggested many methods to help resolve conflicts involving

medical ethics. Sometimes, no good solution to a dilemma in medical ethics exists, and

occasionally, the values of the medical community (i.e., the hospital and its staff) conflict

with the values of the individual patient, family, or larger non-medical community. Conflicts

can also arise between health care providers, or among family members. For example, the

principles of autonomy and beneficence clash when patients refuse life-saving blood

transfusion, and truth-telling was not emphasized to a large extent before the HIV era.

In the United Kingdom, General Medical Councilprovides clear overall modern guidance inthe form of its 'Good Medical Practice' statement. Other organisations, such as the Medical
http://en.wikipedia.org/wiki/Applied_ethicshttp://en.wikipedia.org/wiki/Moral_valuehttp://en.wikipedia.org/wiki/Medicinehttp://en.wikipedia.org/wiki/Bioethicshttp://en.wikipedia.org/wiki/Philosophy_of_sciencehttp://en.wikipedia.org/wiki/Philosophy_of_sciencehttp://en.wikipedia.org/wiki/Biotechnologyhttp://en.wikipedia.org/wiki/Healthcarehttp://en.wikipedia.org/wiki/Nursing_ethicshttp://en.wikipedia.org/wiki/Beneficencehttp://en.wikipedia.org/wiki/Primum_non_nocerehttp://en.wiktionary.org/wiki/autonomyhttp://en.wikipedia.org/wiki/Justicehttp://en.wikipedia.org/wiki/Dignityhttp://en.wikipedia.org/wiki/Truthhttp://en.wikipedia.org/wiki/Honestyhttp://en.wikipedia.org/wiki/Informed_consenthttp://en.wikipedia.org/wiki/Doctors%27_Trialhttp://en.wikipedia.org/wiki/Tuskegee_Syphilis_Studyhttp://en.wikipedia.org/wiki/Dilemmahttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/General_Medical_Councilhttp://www.gmc-uk.org/guidance/good_medical_practice/index.asphttp://en.wikipedia.org/wiki/Medical_Protection_Societyhttp://en.wikipedia.org/wiki/Medical_Protection_Societyhttp://www.gmc-uk.org/guidance/good_medical_practice/index.asphttp://en.wikipedia.org/wiki/General_Medical_Councilhttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Dilemmahttp://en.wikipedia.org/wiki/Tuskegee_Syphilis_Studyhttp://en.wikipedia.org/wiki/Doctors%27_Trialhttp://en.wikipedia.org/wiki/Informed_consenthttp://en.wikipedia.org/wiki/Honestyhttp://en.wikipedia.org/wiki/Truthhttp://en.wikipedia.org/wiki/Dignityhttp://en.wikipedia.org/wiki/Justicehttp://en.wiktionary.org/wiki/autonomyhttp://en.wikipedia.org/wiki/Primum_non_nocerehttp://en.wikipedia.org/wiki/Beneficencehttp://en.wikipedia.org/wiki/Nursing_ethicshttp://en.wikipedia.org/wiki/Healthcarehttp://en.wikipedia.org/wiki/Biotechnologyhttp://en.wikipedia.org/wiki/Philosophy_of_sciencehttp://en.wikipedia.org/wiki/Philosophy_of_sciencehttp://en.wikipedia.org/wiki/Bioethicshttp://en.wikipedia.org/wiki/Medicinehttp://en.wikipedia.org/wiki/Moral_valuehttp://en.wikipedia.org/wiki/Applied_ethics


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Protection Society and a number of university departments, are often consulted by British

doctors regarding issues relating to ethics.

How does one ensure that appropriate ethical values are being applied within hospitals?

Effective hospital accreditation requires that ethical considerations are taken into account, for

example with respect to physician integrity, conflicts of interest, research ethics and organtransplantation ethics.

Informed consent

Informed Consent in ethics usually refers to the idea that an uninformed agent is at risk of

mistakenly making a choice not reflective of his or her values. It does not specifically mean

the process of obtaining consent, nor the specific legal requirements, which vary from place

to place, for decision-making capacity. Patients can elect to make their own medical

decisions, or can delegate decision-making authority to another party. If the patient isincapacitated, laws around the world designate different processes for obtaining informed

consent, typically by having the next-of-kin make decisions for the incapacitated patient.

The value of informed consent is closely related to the values of autonomy and truth telling.

The American legal system places a high value on these principles, finding justification in the

U.S. Constitution and Declaration of Independence.

Beneficence

The concept of doing good to humanity in general. This is the principle of taking actions that

benefit the patients, and that are in their best interest. It is not an absolute principle in that it

only applies to doctors interacting with patients, unlike the principle on non-maleficence.

Many health care practitioners are driven by altruistic intentions: wishing to do good to

others, or a desire to be helpful. This may be based on personal history, such as being born

into a family with madical, psychological or social problems, and thence having learned to

cope with this or having thereby become competent in helping others.

Sometimes this can be tainted by- often unconscious - selfish aspects: the "do-good'ers". In

the medical profession this is regarded with caution, as it may lead persons to want to helpothers in cases where help is not really needed, or self-help would produce more benefit in

the long term. There often exists a co-dependence relationship between such "do-good'ers"

and "health care shopers" (people who go from one practitioner to another; sometimes in a

quest to find real solace, but sometimes also because true help would elominate their disease

or symptoms, and the social benefits the sick person may derife from them).

Beneficence, in health care, invites the more general interest in Preventive Health Care,

where not disease, but health is the focus and modus operandi.
http://en.wikipedia.org/wiki/Medical_Protection_Societyhttp://en.wikipedia.org/wiki/Hospital_accreditationhttp://en.wikipedia.org/wiki/Organ_transplantationhttp://en.wikipedia.org/wiki/Organ_transplantationhttp://en.wikipedia.org/w/index.php?title=Decision-making_capacity&action=edit&redlink=1http://en.wikipedia.org/wiki/Next-of-kinhttp://en.wikipedia.org/wiki/Next-of-kinhttp://en.wikipedia.org/w/index.php?title=Decision-making_capacity&action=edit&redlink=1http://en.wikipedia.org/wiki/Organ_transplantationhttp://en.wikipedia.org/wiki/Organ_transplantationhttp://en.wikipedia.org/wiki/Hospital_accreditationhttp://en.wikipedia.org/wiki/Medical_Protection_Society


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Autonomy

The principle of autonomy recognizes the rights of individuals to self determination. This is

rooted in societys respect for individuals ability to make informed decisions about personalmatters. Autonomy has become more important as social values have shifted to define

medical quality in terms of outcomes that are important to the patient rather than medical

professionals. The increasing importance of autonomy can be seen as a social reaction to a

paternalistic tradition within healthcare.[citation needed] Some have questioned whether the

backlash against historically excessive paternalism in favor of patient autonomy has inhibited

the proper use ofsoft paternalism to the detriment of outcomes for some patients[4]. Respect

for autonomy is the basis for informed consent and advance directives. Autonomy can often

come into conflict with Beneficence when patients disagree with recommendations that

health care professionals believe are in the patients best interest. [citation needed] Individuals

capacity for informed decision making may come into question during resolution of conflicts

between Autonomy and Beneficence. The role of surrogate medical decision makers is anextension of the principle of autonomy.

Autonomy is a general indicator of health. Many diseaes are characterised by loss of

autonomy, in various manners. This makes autonomy an indicator for both personal well-

being, and for the well-being of the profession. This has implications for the consideration of

medical ethics: "is the aim of health care to do good, and benefit from it?"; or "is the aim of

health care to do good to others, and have them, and society, benefit from this?". (Ethics - by

definition - tries to find a beneficial balance between the activities of the individual and its

effects on a collective.)

By considering Autonomy as a gauge parameter for (self) health care, the medical and ethicalperspective both benefit from the implied reference to Health.

Non-Maleficence

The concept of non-maleficence is embodied by the phrase, "first, do no harm," or the Latin,

primum non nocere. Many consider that should be the main or primary consideration (hence

primum): that it is more important not to harm your patient, than to do them good. This is

partly because enthusiastic practitioners are prone to using treatments that they believe will

do good, without first having evaluated them adequately to ensure they do no (or onlyacceptable levels of) harm. Much harm has been done to patients as a result. It is not only

more important to do no harm than to do good; it is also important to know how likely it is

that your treatment will harm a patient. So a physician should go further than not prescribing

medications they know to be harmful - he or she should not prescribe medications (or

otherwise treat the patient) unless s/he knows that the treatment is unlikely to be harmful; or

at the very least, that patient understands the risks and benefits, and that the likely benefits

outweigh the likely risks.

In practice, however, many treatments carry some risk of harm. In some circumstances, e.g.

in desperate situations where the outcome without treatment will be grave, risky treatments

that stand a high chance of harming the patient will be justified, as the risk of not treating is
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also very likely to do harm. So the principle ofnon-maleficence is not absolute, and must be

balanced against the principle ofbeneficence(doing good).

American physicians interpret this principle to exclude the practice ofeuthanasia, though not

all concur. Probably the most extreme example in recent history of the violation of the non-

maleficence dictum was Dr. Jack Kevorkian, who was convicted of second-degree homicidein Michigan in 1998 after demonstrating active euthanasia on the TV news show, 60 Minutes.

In some countries euthanasia is accepted as standard medical practice. Legal regulations

assign this to the medical profession. In such nations, the aim is to alleviate the suffering of

patients from diseases known to be incurable by the methods known in that culture. In that

sense, the "Primum no Nocere" is based on the realisation that the inability of the medical

expert to offer help, creates a known great and ongoing suffering in the patient. "Not acting"

in those cases is believed to be more damaging than actively relieving the suffering of the

patient. Evidently the ability to offer help depends on the limitation of what the practitioner

can do. These limitations are characteristic for each different form of healing, and the legal

system of the specific culture. The aim to "not do harm" is still the same. It gives the medicalpractitioner a responsibility to help the patient, in the intentional and active relief of suffering,

in those cases where no cure can be offered.

"Non-maleficence" is defined by its cultural context. Every culture has its on cultural

collective definitions of 'good' and 'evil'. Their definitions depend on the degree to which the

culture sets its cultural values apart from nature. In some cultures the terms "good" and "evil"

are absent: for them these words lack meaning as their experience of nature does not set them

apart from nature. Other cultures place the humans in interaction with nature, some even

place humans in a position of dominance over nature. The religions are the main means of

expression of these considerations.

Depending on the cultural consensus conditioning (expressed by its religious, political and

legal social system) the legal definition of Non-maleficence differs. Violation of non-

maleficence is the subject ofmedical malpractice litigation. Regulations thereof differ, over

time, per nation.
http://en.wikipedia.org/wiki/Medical_ethics#Beneficencehttp://en.wikipedia.org/wiki/Medical_ethics#Beneficencehttp://en.wikipedia.org/wiki/Medical_ethics#Beneficencehttp://en.wikipedia.org/wiki/Euthanasiahttp://en.wikipedia.org/wiki/Jack_Kevorkianhttp://en.wikipedia.org/wiki/Medical_malpracticehttp://en.wikipedia.org/wiki/Medical_malpracticehttp://en.wikipedia.org/wiki/Jack_Kevorkianhttp://en.wikipedia.org/wiki/Euthanasiahttp://en.wikipedia.org/wiki/Medical_ethics#Beneficence

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