Bioethics Essay

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Bioethics refers to an interdisciplinary approach used to address quandaries and moral dilemmas that arise from applied biology and medical science. It involves applying societal mores, philosophical principles, religious values, and human judgment to making decisions about human life and death, health and medical treatment, environmental issues, and the relationship of humans to other organisms on our planet. Principles of bioethics arose from secular and religious ethical principles. As medical science and biological technology developed and enabled humans to change their natural environment in dramatic ways, consideration of bioethics principles became more critical to guide applications of the technologies and human behavior.

History of Bioethics

Religious traditions served as the earliest sources to guide individuals and communities in decisions vis-avis medical practice, treatment of animals, and the environment. For instance, Judeo-Christian sources such as the Bible address bioethics issues, including injunctions to heal the sick and prohibitions regarding wanton destruction of property. The humane treatment of animals is also emphasized, as are mechanisms to provide reparations for personal harm. Healers and medical practitioners find guidelines in other ancient codes of law and thought as well, including those of Islam, Hinduism, Buddhism, Confucianism, and Taoism.

The Hippocratic tradition, developed in ancient Greece approximately 2,500 years ago, includes guidelines for doctors in their relationships with their patients. The sections of the oath most influential for modern medicine include the prohibition against giving patients deadly drugs, directives against euthanasia and abortion, and most important, the core principle of the oath, the pledge to improve the health of the patient.

Modern codes of medical ethics include Percival’s Code, developed by Thomas Percival of Great Britain in 1803, which also emphasized the physician’s duty to the patient. With the founding of the American Medical Association in the mid-19th century, that group developed a code of ethics that focused on doctors benefiting their patients, in addition to the physician’s role in benefiting society. After World War II, at the Nuremberg trials, the world learned of the unspeakable violations of human rights carried out by Nazi doctors in the name of science. Nazi medical practitioners performed grievous experiments on Jews, Gypsies, and homosexuals—innocent victims and unwilling subjects—imprisoned in concentration and death camps. The Nuremberg Code of 1946 was developed in response to the testimonies at the Nazi doctors’ trials. That code stipulated, for the first time, the principle of voluntary and informed consent. The medical community, represented by the World Medical Association, also reacted to Nazi violations of human rights by developing a code in response to Nazi atrocities. Their document, the Declaration of Geneva of 1948, states that the health of the patient is of paramount importance and should be the doctor’s first consideration.

Biotechnology and Bioethics

The advent of biotechnology and its myriad new applications in the 1970s and 1980s created a need for reconsideration of bioethics issues. In 1998, the Biotechnology Industry Organization developed a statement of principles to address some of the issues by reaffirming the basic principles of bioethics and declaring that biotechnology should be used in only beneficial ways. It emphasizes the importance of respect for animals, protection of the environment, and observance of the principle of informed consent for patients and the research subjects. The statement recommends that the power of biotechnology be applied to endeavors that lead to improvements in food production and the cleaning up of toxic wastes. The organization also emphasized its opposition to the use of the new technology to develop weapons. These noble concepts of the biotechnology industry clearly arose from general principles of bioethics and from previous codes guiding applied science and medicine.

The Roots of Bioethics

Bioethics rests on a foundation of ethics thousands of years in the making. Codes of law and other guidelines for human behavior have traditionally involved two major approaches: principle-based ethics and casuistry.

Principle-based approaches to ethics are top-down (“here are the rules, follow them”), whereas casuistry is a bottom-up type of ethical approach, which involves the application of case studies (“here are the situations, figure out the rules for yourself). Exclusive use of either approach limits flexibility and adaptability to new situations. Thus, many ethicists find combination approaches more acceptable. One such approach, reflective equilibrium, developed by John Rawls in 1971, combines theories, principles, rules, and judgments about specific cases. Many legal and ethical systems are based, at least in part, on casuistry. For instance, legal precedents play important roles in determining the decisions of U.S. courts. But legal and ethical systems also combine case-based reasoning with a clear set of rules. Bioethics likewise developed from both approaches—from a set of principles, and from analysis of cases.

Major Principles of Secular Bioethics

In 1979 Tom Beauchamp and James Childress proposed four principles of modern secular bioethics: respect for autonomy, nonmaleficence, beneficence, and justice. The principles, developed specifically to address issues in medical and environmental science, serve as cornerstones for the development of bioethical codes of behavior.

The principle of respect for autonomy includes the patient’s or research subject’s right to freely choose or reject treatment, and the liberty to act accordingly. Every patient’s autonomy is of paramount importance. The right of informed consent represents one aspect of this principle. Accordingly, patients should be educated and allowed to participate in decisions regarding their fate; patients should retain authority to determine what their course of treatment is. However, even patient autonomy has limits; for instance, many would agree that patients must be prevented from harming themselves. Euthanasia on demand is not legal in the United States.

The principle of nonmaleficence means that the physician or scientist should do no harm. Patients should not be injured in the course of treatment. This could also be expanded to include the environment and be understood as a directive to protect our natural world.

The principle of beneficence directs medical practitioners and researchers to do good, promote patient welfare, devise ways to improve quality of life, and repair the world.

The fourth principle, the principle of justice, focuses on fairness in allocating resources. For instance, social benefits such as health care services, including pharmaceutical drugs, diagnostic tests, donated organs, and medical expertise, should be distributed in a just manner. Likewise, social burdens such as taxes should be assessed fairly.

Major Issues in Bioethics

Most bioethics issues fall into five major themes: beginning of life, end of life, rights of patients, animal rights, and environmental protection and preservation.

The beginning of life category includes traditional areas of controversy (such as contraception and termination of pregnancy) and issues that more recently arose as a result of biotechnological advances. The latter category includes cloning, embryonic stem cell research, fetal experimentation, fetal surgery, multifetal pregnancy reduction, artificial reproductive technologies, eugenics, genetic screening, and gene therapy.

End-of-life issues include the injunction to preserve human life, assisted suicide and euthanasia, futility of end-of-life care, and allocation of medical resources.

The rights of patients involve issues such as voluntary participation and informed consent for medical treatment, truth-telling (i.e., sharing all information with patients), doctor-patient confidentiality, autonomy of patients, research on human subjects, the rights of the insured and the uninsured, and the fair allocation of limited resources.

Animal rights issues include questions regarding the use of animals as research subjects, the respectful and humane treatment of laboratory animals, domesticated farm animals and pets, and proper treatment of animals in the wild.

Environmental protection and preservation focus on minimizing the destruction of natural resources and habitats, preserving species, recovering and cleaning up fouled habitats, and reintroducing endangered species. Biotechnological advances have also led to novel bioethical conundrums, such as whether to alter species by genetic engineering and how to safely utilize genetically modified plants and animals so as not to harm humans or the environment or wreak havoc with the natural process of evolution.

The Future of Bioethics

As new technologies evolve, humankind will continue to grapple with new ethical dilemmas that arise. Increased human life expectancies will further stretch limited medical resources. As neonatal medicine improves, fetuses will be viable outside the womb at earlier stages, making abortion issues even more challenging. Genetic screening and gene therapy will permit parents to choose or reject offspring with particular traits, permitting humankind to change the course of evolution. Thus, in bioethics, the breakthroughs of today become the daunting dilemmas of tomorrow.

Bibliography:

  1. Annas, George J. and Michael A. Grodin. 1992. The Nazi
  2. Doctors and the Nuremberg Code: Human Rights in Human Experimentation. New York: Oxford University Press.
  3. Beauchamp, Tom and James F. Childress. 2008. Principles of Biomedical Ethics. 6th ed. New York: Oxford University Press.
  4. Beauchamp, Tom L., LeRoy Walters, Jeffrey P. Kahn and Anna C. Mastroianni. 2007. Contemporary Issues in Bioethics. 7th ed. Belmont, CA: Wadsworth.
  5. Levine, Carol, ed. 2006. Taking Sides: Clashing Views on Controversial Bioethical Issues. 11th ed. Dubuque, IA: McGraw-Hill/Dushkin.
  6. Mappes, Thomas A. and David DeGrazia. 2006. Biomedical Ethics. 6th ed. New York: McGraw-Hill.
  7. Ridley, Aaron. 1998. Beginning Bioethics. Boston: Bedford/St. Martin’s.
  8. Veach, Robert M. 2003. The Basics of Bioethics. 2nd ed. Upper Saddle River, NJ: Prentice Hall.
  9. Wahrman, Miryam Z. 2004. Brave New Judaism: When Science and Scripture Collide. Hanover, NH: Brandeis University Press.

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