INTRODUCTION TO

BIOETHICS

DR. M BILAL
APPNA Institute of Public Health
Jinnah Sindh Medical University

Ethics (moral philosophy)

Addresses-what is the best way for
people to live? and what actions are
right
or
wrong
in
particular
circumstances?
Versions:
1. The science of moral duty
2. a set of concepts and principles that
guide us in determining what behavior
helps or harms sentient creatures

Ethics (contd).
Areas of studying ethics:
1. Meta-ethics
2. Normative ethics
3. Applied ethics

What is Bioethics?

Bioethics is the study of controversial ethics brought

about by advances inbiologyandmedicine.
Bioethics also needs to address emerging
biotechnologies that affect basic biology and future
humans.
Now often known as medical ethics or clinical ethics
hospital based issues
Advancements
Bioethical dilemmas arise when different parties,
albeit all well-meaning, hold divergent values that
lead to opposing viewpoints on appropriate actions

Common Bioethical Issues

Abortion
Artificial life
Contraception
Euthanasia
Human cloning
Infertility treatments
Suicide
(Terri Schiavo)

History of Bioethics

Term coined by Fritz Jahr in 1926.-Animals

Van Ranssellaer Potter used more broader term in
1970; Global Ethics (involving other disciplines
for survival of human and others).
The distinct academic field began in the 1960s in
the United States
Philosophers and theologians were later joined by
physician-ethicists and lawyers
Scientific advances coupled with cultural changes
New emphasis on individual autonomy and rights
suspicion of medical paternalism
Focused on individual research participant
and patient

History of Bioethics

Started as concerns regarding research ethics

Nuremberg Doctors Trial -- 23 German
physicians who either participated in the Nazi
program to euthanize persons deemed
"unworthy of life or who conducted
experiments on concentration camp prisoners
without their consent were tried. The trial
lasted 140 days. 85 witnesses testified and
almost 1,500 documents were introduced. 16
of the doctors charged were found guilty. 7
were executed.

Examples of Unethical
Experiments

Nazi Experiments

Doctors Trial

Ethical principles

The Nuremberg Code

(1947)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Voluntary consent is a must

Anticipate scientific benefits
Benefits outweigh risks
Animal experiments first
Avoid suffering to individual
No intentional death or disability
Protection from harm
Subject free to stop / withdraw
Qualified investigators
Investigator will stop if harm occurs

Declaration of Helsinki 1964

Set of ethical principles for human

experimentation
Cornerstone document in Human
research
Relaxation on Consent-Surrogate
consent

Belmont Report 1978

Thefty Report on Ethical considerations

Three core principles: Respect for others;
Beneficence; Justice.
Important Pre-requisite for any research:
i) informed consent, ii) risks benefit
assessment, and iii)selection of subjects
of research.

Major Principles in Bioethics

Tom Beauchamp and James Childresss

Principles of Biomedical Ethics in 1985:

Non-maleficence and Beneficence

Utilitarian harm-benefit analysis
do no harm
best interest standard
Autonomy
respect for ones rights and dignity
informed and voluntary consent
Justice
fairness
caring for the most vulnerable

Scenario..

Suppose a trolley is running out of control

down a track. In its path are 5 people who
have been tied to the track. Fortunately,
you can flip a switch, which will lead the
trolley down a different track to safety.
Unfortunately, there is a single person tied
to that track.
Should you flip the switch?

As the story goes..

A physician has five patients, each in need of a

different organ and will die without that organ.
Unfortunately, there are no organs available to
perform any of these five transplant operations.
A young man who just got hit by a trolley is
brought into the ER. In the course of assessing
his injuries, which are not life-threatening if
treated immediately, the doctor discovers that
his organs are compatible with all five of his
dying patients.
Would it be justified for the physician to let the
patient die to harvest his organs to save the
other five patients?

Systematic Approach in Resolving

Dilemmas

Finding thoughtful and rational justification

for our beliefs and decisions
More than intuitive responses ask why we
may have certain intuitions, and how to
manage conflicting intuitions
Systematic approach can help to identify
essential elements to ethical decisionmaking, ease pressure, and promote
consistency in resolving dilemmas

Issues to Consider in Approaching

Dilemmas

Define and identify the ethical dilemma

Clarify the facts and identify stakeholders
whats known and whats not?

Medical indications
Diagnosis, prognosis, treatments or medication
history, other clinical options, etc.
Patient/Resident/Family (PRF) preferences
Advance directives, code status, goals of care, etc.
Quality of life
The PRs subjective evaluation of his or her
situation
Contextual factors
Social contexts, family situation, cultural/religious
values, financial situation, etc.

Issues to Consider
(Continued)

Analyze and balance the values involved

Make a recommendation

Various principles may help autonomy, beneficence,

non-maleficence, justice
What do various available options and our prioritization
of certain values/principles over others say about who
we are?

Involve relevant stakeholders shared decision

making

Follow up and evaluation

ensures accountability, consistency, and transparency,

thereby promoting trust and integrity

Case Discussion

As a result of an automobile explosion, 25 year-old

Dax Cowart was badly burned over 65% of his body.
Both eyes, both ears and both hands were
damaged beyond repair. Large doses of narcotics
were required for minimal pain relief. To control the
many infected areas on his body, Cowart had to be
submerged daily in a tank of highly chlorinated
water to disinfect his wounds. The experience was
excruciatingly painful, and Cowart protested and
refused the tankings. He pleaded with his
caregivers to be allowed to die, and stated several
times that he wanted to kill himself. The physicians
turned to his mother to obtain consent for all his
treatments.