The Connection and the Difference.
Bioethics is an area of Philosophy concerned with ethical issues arising from biomedical scientific technologies.  It is a field of applied, or practical ethics.  Although it is a relatively new field, it has developed swiftly over the last few decades, as new medical technologies and legal cases have thrown up ethical issues which benefit from, and are worthy of, philosophical analysis.
However, as I have already indicated, bioethics is not just a project for practical philosophers.  It is by its very nature multidisciplinary, and this is one of the most important and exciting features of the field.  Bioethicists learn from doctors and other scientists working in clinical and research areas of biomedicine, and the work of ethicists also sometimes  also influences the legal status of activities considered in the study of bioethics in turn.  The heterogeneous nature of the contributions to Bioethics enriches it as a disclipline and thereby improves its relevance and value.  It is improved by being clinically, legally, and philosophically informed.
Bioethics and Medical Ethics are closely related, it is possible to describe the latter as a field within, or branch of, the former.  However, the distinction between Bioethics and Medical Ethics should be clarified.  Bioethics is broader, and is still mainly the domain of philosophers as I have described.  However, in its development it has influenced Medical Ethics.  Bioethics is generally more to do with theoretical ethical issues and concepts surrounding all biomedical technologies, such as cloning, stem cell therapy, xenotransplantation and the use of animals in research.  Medical Ethics is more specific and focuses on the medical treatment of humans in particular.  However, this is not to say that only doctors can do Medical Ethics.  Not so, other health and social care professionals, philosophers, lawyers, and policy makers are all involved, to the benefit of the field as a whole but also particularly to doctors and patients alike.
Medical Ethics began with the Hippocratic Oath, and so has a longer history than Bioethics, which itself only really began after the Second World War, with the Nuremberg Code, and Declaration of Helsinki.  Medical Ethics, as the name suggests, was historically the preserve of Doctors alone.  Judges in medical law cases¹ have in the past been very deferential to doctor’s clinical judgment of good practice (although this is changing).  The law associated Medical Ethics with professional guidelines and codes of practice, such as those produced by organisations like the BMA and GMC, and suggested that Medical Ethics was defined by the medical profession (in a self-regulating manner).  The relationship between law and morality in this area is very rich and important and I will write more about this separately.  But Medical Ethics today is not only about professional conduct.
The ‘new’ Medical Ethics is the result of the influence of Bioethics.  At its core there are still issues arising from clinical practice and the development of new technologies in areas such as reproduction, end of life care and everything in between.  But these issues inevitably raise deeper, more philosophical considerations such as the value of life, moral status of embryos and the significance of personhood².  Hence the relevance of theoretical bioethics³ (including metabioethics as a part of metaethics, which concerns the methodology of bioethics), and the application of ethical theories such as consequentialism, deontology and virtue ethics to real, practical dilemmas as opposed to hypothetical or imaginary thought experiments.  Research Ethics has always been separate, as indicated by the independent function of Clinical Ethics Committees (CEC’s) and Research Ethics Committees (REC’s), but it is obviously related to good clinical practice as practising doctors have a duty to keep up to date with new developments and treatments within their specialty, plus all treatments are developed through research.  But Research Ethics is broadly concerned with ensuring that research (medical or otherwise) on human or non human animals is done in an ethical manner.  Both Clinical and Research Ethics concentrate on the importance of consent, so there are areas where the two overlap.  As Spike suggests, ‘each of the three fields of bioethics needs to have philosophers, doctors and lawyers in it…[and furthermore] none of these fields could exist alone‘³.
The study of Medical Ethics involves the analysis of concepts such as the doctor-patient relationship, competence, autonomy, beneficence, compassion, personhood, quality and sanctity of life, best interests and just resource allocation.  Ideas like these are, I think, unique to Medical Ethics.  At least, they are not considered by Bioethics or any other field in quite the same way.  The work of Medical Ethics builds on that of Bioethics and enables good medical practice.  It is not an activity purely for doctors, or philosophers, or others; but instead can gain from the insights of many different perspectives.  Medicine allows for the practical application of the valuable contribution of these other disciplines.


THE IMPORTANCE OF BIOETHICS
02/06/2017 MIREIA RAMOS MUNTADA 3 COMENTARIS
When we talk about genetics, inevitably we can have ethics doubts. Bioethics is essential in science. Genetic modified organisms (GMO), assisted reproduction techniques (ARTs), genetic counselling, rare diseases, euthanasia and palliative care, among other topics; they have importance in bioethics. However, we have to know what bioethics is before applying it.  

WHAT IS BIOETHICS?
Ethics involves the set of rules that society have agreed about living with other people for minimums, which are human rights.

Bioethics is a branch of ethics, which is the interdisciplinary study of problems created by biological and medical progress (micro and macrosocial level), and its impact in society and value system, both for now and for the future.

Bioethics concerns for ethical questions involve in human understanding of life. It born by necessity of a critic reflection about ethical conflicts, which are caused by progressing in life science and medicine. Technological and medical tools have an important role in society and it has to manage.

It is important know that bioethics does not defend a particular moral attitude nor offer determinant and definitive answers, but it searches a grounded, critic and argued reflection centred in the singularity of a concrete situation.

In bioethics we find several grounded ethical theories. Two of these are deontological ethics and utilitarian ethics.

Deontological ethics was proposed by Immanuel Kant and it consists in that reason identifies actions like good or bad, independent of their consequences.

Utilitarian ethics was proposed by Jeremy Bentham and John Stuart-Mill and it says that actions are good or bad depend on their consequences. The balance between purposes that give benefits or damage is produced by utilitarian ethics.

BASIC PRINCIPLES IN BIOETHICS
In bioethics they are four basic principles and they were proposed by Beaucham and Childress (1979):

Autonomy
Beneficence
No maleficence
Justice
These principles can be grouped in two levels:

Minimum levels: obligations that generate universal duties and these involve negative transitive duties (facts that you cannot do other people). Here, there are principles of no maleficence and justice.
Maximum levels: they are related with the choice of the vital project that every person choose to depend on their scale of values. They generate imperfect obligations: facts that I can auto impose, but I cannot call for other people (neither other people to me). Here, there are principles of autonomy and beneficence.
PRINCIPLE OF AUTONOMY
Actions are only autonomous when it exists:

Intentionality
Knowledge (it is essential)
Not external control (there are not pressures)
Authenticity (coherence with system of values and usual attitudes of the person)
An autonomous person is who has capacity to act and judge consequences of their acts and be responsible. This person has to be able to communicate his decision clear and reiterated.

PRINCIPLE OF BENEFICENCE
It has to act in benefit of person, but it can cause collateral effects.

It is important to know that you cannot do good against the other person’s will.

PRINCIPLE OF NO MALEFICENCY
You cannot harm unnecessary other people. Damage can be avoided not acting, with a passive attitude. However, good has done with active attitude.

If someone asks you, you cannot do damage.

PRINCIPLE OF JUSTICE
It involves to tract on the same way equal to equal and unequal to unequal. Vulnerable population have to receive an immediate benefit.

This principles, with principle of autonomy and beneficence (principle of no maleficence rises after), were necessary to regulate clinical trials with humans, due to Tuskegee case (Figure 1).

experimento-tuskegee
Figure 1. Researchers injecting the syphilis virus into African Americans (Source: Omicrono)
In the 60s, researchers did a clinical trial about syphilis. They wanted to see the evolution of the disease and find an alternative to painful treatments. So, they injected syphilis viruses without information of study and its consequences.

OTHER IMPORTANT PRINCIPLES
There are other important principles in bioethics.

Fidelity: protection of people, based on caution, proportionality, no discrimination and respect for people’s dignity. It includes privacy’s protection and confidentiality, keeping the promises and commitment.
Transparency: gives law and access to information. All information has to communicate clearly, comprehensively, honest and real.
Caution: based on analysis of risks. All investigations that could put at risk people’s health and future generations has to avoid.
Principle of proportionality: it is related to the principle of beneficence and looks at the relationship between the benefit obtained and the “costs” of means, human and monetary resources, risks and what the negative effects are.
Principle of non-discrimination: all persons who must be treated equally.
Principle of respect for dignity: no one has to be subjected to humiliation, must receive help in situations of need, have a minimum quality of life without suffering and freedom of action and decision, and not be used as the purpose of others.
Principle of respect for privacy and confidentiality: not unnecessarily reveal and/or interested personal and sensitive data concerning the subject. It is not an absolute principle and in front of a crime is not fulfilled.
Principle of respect for the right to information: all those involved in the process must know all the information (before, during and after the investigation).
Principle of free participation and donation: participation and donation are free and altruistic since if we are not talking about sale or exchange.


Bioethical Issues in Health Care ManagementPosted June 2, 2017 | By Tricia Hussung
Lab equiptment with title text overlay

As medical technology advances at a rapid pace, health care professionals are tasked with examining the resulting ethical dilemmas. This is where bioethics comes in. By applying the principles of ethics to the field of medicine, bioethics aims to investigate and study how health care decisions are made. It is a core component of ensuring that medical practices and procedures benefit society as a whole.

According to the Center for Practical Bioethics, those who are concerned with bioethics ask questions such as the following, within the context of modern medicine and health care:

What is the right thing to do?
What is worthwhile?
What are our obligations to one another?
Who is responsible, to whom and for what?
What is the fitting response to this moral dilemma, given the context?
On what moral grounds are such claims made?
Bioethics is a multidisciplinary field, combining philosophy, theology, history and law with medicine, nursing, health policy and the medical humanities. Because the health care system is so complex, it is important to consider relevant issues from multiple points of view.

The term “bioethics” was first introduced in 1971 to reference “the combination of biology and bioscience with humanistic knowledge,” the Center for Practical Bioethics explains. However, its application has become much broader today, including clinical decision-making, controversial new research, the implications of emerging technologies, global concerns, public policy and more. In fact, bioethics has played a central role in influencing policy changes and legislation in recent years. Its relevance for medical professionals is difficult to overstate, as the modern health care system continues to change at a rapid pace.

Bioethics has applications ranging from birth to the end of life, and it directly affects both patients and care providers. “Bioethics has an impact on every level of human community from the local nursing home to the huge international conferences on issues like the Human Genome … [It] is full of difficult ethical questions for everybody: families, hospitals, governments and civilization,” the Adelaide Centre for Bioethics and Culture explains.

The following are some of the most relevant bioethical issues faced by the health care industry.

End-of-Life Care
Elderly individuals and their families face a variety of difficult decisions as they near the end of life. Whether legal, practical, spiritual or medical in nature, the American Psychological Association notes that health care professionals overseeing these decisions “should ideally [consider them] in terms of the relief of suffering and the values and beliefs of the dying individual and his or her family.”

Advancements in medical treatment may prolong life, but quality of life can decrease once an individual becomes too ill. Then it is time to consider the level of pain management offered, whether to deliver care at home or in a hospital setting, what kind of caregiver is needed and more.

Medical Resource Allocation
When medical resources are limited or scarce, it is difficult to meet all health care needs due to a limited supply. This is why, in some cases, there is some degree of rationing in the health care system. One good example of this is intensive care units (ICUs). Patients might need to be transferred out of the ICU when they could still derive a small amount of benefit from ongoing monitoring, according to “The Ethics and Reality of Rationing in Medicine.” Decisions like this might be made to accommodate the needs of more seriously ill patients who need access to limited space in the unit.

Resource allocation could also apply to something as simple as physician time. Leaders and other stakeholders must determine which patients should be seen first and how much time should be dedicated.

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Eugenics
With modern advances in technology, it is possible to improve genetic quality through selective reproduction, gene selection and gene manipulation. But just because more choice exists, does that mean we should take advantage of it? That’s the ethical question behind eugenics. Options like embryo selection can allow parents to choose the sex of their child, for example. “Such possibilities raise important ethical questions – questions about which of these choices, if any, are morally wrong – along with closely related questions about the extent to which law and regulation should restrict these areas of medicine,” according to Eugenics and the Ethics of Selective Reproduction.

Euthanasia
One of the most controversial topics in bioethics is euthanasia. According to the BBC, “Euthanasia is the termination of a very sick person’s life in order to relieve them of their suffering. A person who undergoes euthanasia usually has an incurable condition.” In some cases, it may be done at the patient’s request, but when a patient is incapacitated, the decision can be made by others, such as family members or medical professionals.

In the medical community, there are two categories of euthanasia. Active euthanasia occurs when a medical professional does something that allows the patient to die. Passive euthanasia occurs when “medical professionals either don’t do something necessary to keep the patient alive, or when they stop doing something that is keeping the patient alive,” according to the BBC. It is important to note that in both cases this is done at the patient or family member’s request. The American Medical Association Code of Ethics makes a distinction between “withdrawing life-sustaining treatment” and euthanasia, which indicates just how complex this issue is.

Organ Donation
The importance of organ transplantation in modern medicine can’t be overstated. It helps patients by prolonging their lives after the failure of vital organs. For organ transplantation to work, of course, it requires donation from deceased or living individuals. According to “Ethical Issues in Organ Transplantation,” “The increasing incidence of vital organ failure and the inadequate supply of organs … has created a wide gap between organ supply and organ demand.” This means that patients often have long wait times before they receive an organ — and this can result in death. The ethical questions surrounding this issue are complex, including whether organ donation should continue to be voluntary and whether minors should be allowed to donate organs.

Bioethics and Health Care Management
For leaders in the health care field, it is important to create an ethical environment in which to deal with the daily challenges that arise. According to the National Center for Ethics in Health Care (NCEHC), ethical leadership can be achieved when managers prioritize ethics, communicate clear expectations to their employees and practice ethical decision-making.

According to the NCEHC, ethical health care organizations create a culture where individuals:

Appreciate the importance of ethics
See ethics as part of quality
Recognize and discuss ethical concerns
Understand what is expected of them
Seek consultation on ethics cases when needed
Feel empowered to behave ethically
Work to resolve ethics issues on a systems level
View organizational decisions as ethical
When managers are able to foster a culture of ethics, employee behavior is more likely to follow suit. This is one of the many important responsibilities of professionals in health care management roles.

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From factory working conditions at the turn of the 20th century, to today’s emphasis on diversity training, the history of workplace ethics is the ongoing story of the relationship between employees and employers.

Ethical Issues in Business
According to the Global Business Ethics Survey of 2018, employees (40%) believe that their company has a weak leaning ethical culture, and that little progress has been made to mitigate wrongdoing. Here are some of the ethical issues in business and real-world cases of how these ethical issues have affected companies.

1.    Accounting
“Cooking the books” and otherwise conducting unethical accounting practices is a serious problem, especially in publicly traded companies. One of the most infamous examples is the 2001 scandal that enveloped American energy company Enron, which for years inaccurately reported its financial statements and its auditor, accounting firm Arthur Andersen, signed off on the statements despite them being incorrect. When the truth emerged, both companies went out of business, Enron’s shareholders lost $25 billion, and although the former “Big Five” accounting firm had a small portion of its employees working with Enron, the firm’s closure resulted in 85,000 jobs lost.

Although the Federal Government responded to the Enron case and other corporate scandals by creating the Sarbanes-Oxley Act in 2002, which mandates new financial reporting requirements meant to protect consumers, the “Occupy Wall Street” movement of 2011 and other issues indicate that the public still distrusts corporate financial accountability.

2.    Social Media
The widespread nature of social media has made it a factor in employee conduct online and after hours. Is it ethical for companies to fire or otherwise punish employees for what they post about? Are social media posts counted as “free speech”? The line is complicated, but it is drawn when an employee’s online activities are considered disloyal to the employer, meaning that a Facebook post would go beyond complaining about work and instead do something to reduce business.

For example, a Yelp employee wrote an article on Medium, a popular blogging website, about what she perceived as awful working conditions at the influential online review company. Yelp fired her, and the author said she was let go because her post violated Yelp’s terms of conduct. Yelp’s CEO denied her claim. Was her blog post libelous, or disloyal conduct, and therefore a legitimate cause for termination? In order to avoid ambiguity, companies should create social media policies to elucidate what constitutes an infringement, especially as more states are passing off-duty conduct laws that prohibit an employer’s ability to punish an employee for online activities.

3.    Harassment and Discrimination
Racial discrimination, sexual harassment, wage inequality – these are all costly ethical issues that employers and employees encounter on a daily basis across the country. According to a news release from the Equal Employment Opportunity Commission (EEOC), the EEOCC secured $505 million for victims of discrimination in private sector and government workplaces in 2019. The EEOC states that there are several types of discrimination, including age, disability, equal pay, genetic information, harassment, national origin, race, religion, retaliation, pregnancy, sex and sexual harassment.

One type of discrimination, families responsibilities discrimination (FRD), has had an increase in cases of 269% over the last decade, even as other forms of employee discrimination cases have decreased. FRD is found in every industry and at every level within the company, according to a 2016 report by the Center for WorkLife Law at the UC Hastings College of Law. The report defines FRD as “when an employee suffers an adverse employment action based on unexamined biases about how workers with caregiving responsibilities will or should act, without regard to the workers’ actual performance or preferences.” FRD includes many types of family responsibilities and caregiving, including pregnancy and eldercare. For example, a father being fired for wanting to stay home to care for his sick child, or a pregnant employee not being allowed to take a break even though it was her doctor’s orders.

These cases are expected to continue to rise due to the growing number of family members who have disabilities, the increase in people 65 and older who need care, the increase of men who are becoming caregivers, and growing expectation for employees that they can work and provide family care. Employers will need to adjust to these employee perspectives and restructure how work can be accomplished to reduce FRD.

4.    Health and Safety
The International Labour Organization (ILO) states that 7,397 people die every day from occupational accidents or work-related diseases. This results in more than 2.7 million deaths per year. According to the Occupational Safety & Health Administration, the top 10 most frequently cited violations of 2018 were:

Fall Protection, e.g. unprotected sides and edges and leading edges
Hazard Communication, e.g. classifying harmful chemicals
Scaffolding, e.g. required resistance and maximum weight numbers
Respiratory Protection, e.g. emergency procedures and respiratory/filter equipment standards
Lockout/Tagout, e.g. controlling hazardous energy such as oil and gas
Powered Industrial Trucks, e.g. safety requirements for fire trucks
Ladders, e.g. standards for how much weight a ladder can sustain
Electrical, Wiring Methods, i.e. procedures for how to circuit to reduce electromagnetic interference
Machine Guarding, e.g. clarifying that guillotine cutters, shears, power presses and other machines require point of operation guarding
Electrical, General Requirements; i.e. not placing conductors or equipment in damp or wet locations
Physical harm isn’t the only safety issue to be aware of, though. In 2019, an ILO report focused on rise of “psychosocial risks” and work-related stress.  These risks, which include factors like job insecurity, high demands, effort-reward imbalance, and low autonomy, have been associated with health-related behavioral risks, including a sedentary lifestyle, heavy alcohol consumption, increased cigarette smoking, and eating disorders.

5.    Technology/Privacy
With developments in technological security capability, employers can now monitor their employees’ activity on their computers and other company-provided electronic devices. Electronic surveillance is supposed to ensure efficiency and productivity, but when does it cross the line and become spying? Companies can legally monitor your company email and internet browser history; in fact, 66% of companies monitor internet connections, according to 2019 data from the American Management Association. 45% of employers track content, keystrokes and time spent on the keyboard, and 43% store and review computer files as well as monitor email. Overall, companies aren’t keeping this a secret: 84% told employees that they are reviewing computer activity. Employees should review the privacy policy to see how they are being monitored and consider if it can indicate a record of their job performance.
Morals are formed out of a person's values. Values are the foundation of a person's ability to judge between right and wrong. Morals build on this to form specific, context-driven rules that govern a person's behavior. They're formed from a person's life experience and are subject to opinion.
For example, someone's morals might indicate they're opposed to murder. That's a pretty general rule of thumb. But what about something more mundane? While one person's morals might tell them not to gossip, another person's morals might be quite different. They might not consider gossip to be a bad thing. Consider the following examples of morals and see how many line up with your core values and beliefs.

Morals in Society

Is there really a standard moral code in society these days? Yes, while most people follow society's laws, they also abide by certain social mores, which are governed by morals. While morals tend to be driven by personal beliefs and values, there are certainly some common morals that most people agree on, such as:
  • Always tell the truth
  • Do not destroy property
  • Have courage
  • Keep your promises
  • Do not cheat
  • Treat others as you want to be treated
  • Do not judge
  • Be dependable
  • Be forgiving
  • Have integrity
  • Take responsibility for your actions
  • Have patience
  • Be loyal
  • Have respect for yourself and others
  • Be tolerant of differences
  • Seek justice
  • Have humility
  • Be generous
For a deeper dive into the difference between values and morals, read What's the Difference Between Ethics, Morals, and Values?.

The Ten Commandments

The Ten Commandments are often considered the basis for societies founded on Judeo-Christian principles. You'll notice some overlap with the list above, as many of these principles are still embedded in general society.
  1. Do not have any gods before me
  2. Do not make for yourself a graven image
  3. Do not take the name of the Lord your God in vain
  4. Remember the Sabbath day to keep it holy
  5. Honor your father and mother
  6. Do not kill
  7. Do not commit adultery
  8. Do not steal
  9. Do not bear false witness against your neighbor
  10. Do not covet your neighbor's wife or possessions

Bioethics

TABLE OF CONTENTS
  • Introduction
  • Definition and development
  • Issues in bioethics
  • Approaches
  • The significance of public attitudes
  • Policy making
  • Global bioethics
Bioethics, branch of applied ethics that studies the philosophical, social, and legal issues arising in medicine and the life sciences. It is chiefly concerned with human life and well-being, though it sometimes also treats ethical questions relating to the nonhuman biological environment. (Such questions are studied primarily in the independent fields of environmental ethics [see environmentalism] and animal rights.)

Definition and development

The range of issues considered to fall within the purview of bioethics varies depending on how broadly the field is defined. In one common usage, bioethics is more or less equivalent to medical ethics, or biomedical ethics. The term medical ethics itself has been challenged, however, in light of the growing interest in issues dealing with health care professions other than medicine, in particular nursing. The professionalization of nursing and the perception of nurses as ethically accountable in their own right have led to the development of a distinct field known as nursing ethics. Accordingly, health care ethics has come into use as a more inclusive term. Bioethics, however, is broader than this, because some of the issues it encompasses concern not so much the practice of health care as the conduct and results of research in the life sciences, especially in areas such as cloning and gene therapy (see clone and genetic engineering), stem cell research, xenotransplantation (animal-to-human transplantation), and human longevity.
Although bioethics—and indeed the whole field of applied ethics as currently understood—is a fairly recent phenomenon, there have been discussions of moral issues in medicine since ancient times. Examples include the corpus of the Greek physician Hippocrates (460–377 BC), after whom the Hippocratic oath is named (though Hippocrates himself was not its author); the Republic of Plato (428/27–348/47 BC), which advocates selective human breeding in anticipation of later programs of eugenics; the Summa contra gentiles of St. Thomas Aquinas (1224/25–1274), which briefly discusses the permissibility of abortion; and the Lectures on Ethics of the German Enlightenmentphilosopher Immanuel Kant (1724-1804), which contains arguments against the sale of human body parts.
Hippocrates, Roman bust copied from a Greek original, c. 3rd century bc; in the collection of the Antichità di Ostia, Italy.
Hippocrates, Roman bust copied from a Greek original, c. 3rd centuryBC; in the collection of the Antichità di Ostia, Italy.Courtesy of the Soprintendenza alle Antichità di Ostia, Italy
Bioethics emerged as a distinct field of study in the early 1960s. It was influenced not only by advances in the life sciences, particularly medicine, but also by the significant cultural and societal changes taking place at the time, primarily in the West. The perfection of certain lifesaving procedures and technologies, such as organ transplantation and kidney dialysis, required medical officials to make difficult decisions about which patients would receive treatment and which would be allowed to die. At the same time, the increasing importance placed on individual well-being contributed to changes in conventional attitudes toward marriage and sexuality, reproduction and child rearing, and civil rights. The ultimate result was widespread dissatisfaction with traditional medical paternalism and the gradual recognition of a patient’s right to be fully informed about his condition and to retain some measure of control over what happens to his body.

Issues in bioethics

The health care context

The issues studied in bioethics can be grouped into several categories. One category concerns the relationship between doctor and patient, including issues that arise from conflicts between a doctor’s duty to promote the health of his patient and the patient’s right to self-determination or autonomy, a right that in the medical context is usually taken to encompass a right to be fully informed about one’s condition and a right to be consulted about the course of one’s treatment. Is a doctor obliged to tell a patient that he is terminally ill if there is good reason to believe that doing so would hasten the patient’s death? If a patient with a life-threatening illness refuses treatment, should his wishes be respected? Should patients always be permitted to refuse the use of extraordinary life-support measures? These questions become more complicated when the patient is incapable of making rational decisions in his own interest, as in the case of infants and children, patients suffering from disabling psychiatric disorders such as schizophrenia or degenerative brain diseases such as Alzheimer disease, and patients who are in a vegetative state (seecoma).

Traditional philosophical questions

Another category of issues concerns a host of philosophical questions about the definition and significance of life and death, the nature of personhood and identity, and the extent of human freedom and individual responsibility. At what point should a fatally injured or terminally ill patient be considered dead? When his vital functions—e.g., heartbeat and breathing—have ceased? When the brain stem has ceased to function? Should the presence of deep coma be sufficient to establish death? These and similar questions were given new urgency in the 1960s, when the increased demand for human organs and tissues for use in transplant operations forced medical ethicists to establish guidelines for determining when it is permissible to remove organs from a potential donor.
At about the same time, the development of safer techniques of surgical abortion and the growing acceptability of abortion as a method of birth control prompted increasing debate about the moral status of the human fetus. In philosophical discussion, this debate was framed in terms of the notion of a “person,” understood as any being whose interests are deserving of special moral concern. The central issue was whether—and, if so, at what stage—the fetus is a person in the moral sense. In slightly different terms, the issue was whether the class of persons is coextensive with the class of human beings—whether all and only human beings are persons, or whether instead there can be human beings who are not persons or persons who are not human beings (the latter category, according to some, includes some of the higher animals and hypothetical creatures such as intelligent Martians). These questions were raised anew in later decades in response to the development of drugs, such as RU-486 (mifepristone), that induce abortion up to several weeks after conception and to the use of stem cells taken from human embryos in research on the treatment of conditions such as parkinsonism (Parkinson disease) and injuries of the central nervous system.
A closely related set of issues concerns the nature of personal identity. Recent advances in techniques of cloning, which enabled the successful cloning of animals such as sheep and rabbits, have renewed discussion of the traditional philosophical question of what, if anything, makes a particular human being the unique person he is. Is a person just the sum of the information encoded in his genes? If so, is the patient who has undergone gene therapy a different person from the one he was before—i.e., has he become someone else? If a human being were to be cloned, in what sense would he be a copy of his “parent”? Would he and his parent be the same person? If multiple human beings were cloned from the same parent, would they and their parent all be the same person?
Dolly the sheep, the first clone of an adult mammal, at the Roslin Institute, near Edinburgh.
Dolly the sheep, the first clone of an adult mammal, at the Roslin Institute, near Edinburgh.© John Chadwick—AP/REX/Shutterstock.com
The attempt to understand personal identity in terms of genetic information also raised anew the philosophical problems of free will and determinism. To what extent, if any, is human personality or character genetically rather than environmentally determined? Are there genetic bases for certain types of behaviour, as there seem to be for certain types of diseases (e.g., Tay-Sachs disease)? If so, what kinds of behaviour are so influenced, and to what extent are they also influenced by environmental factors? If behaviour is at least partly genetically determined, should individuals always be held fully responsible for what they do?
Finally, the possibility of developing technologies that would extend the human life span far beyond its current natural length, if not indefinitely, has led to speculation about the value of life, the significance of death, and the desirability of immortality. Is life intrinsically valuable? In cases in which one is not suffering physically or emotionally, is it always better to be alive than dead? If so, is it rational to desire immortality? What would be the significance of death in a world in which dying was not biologically inevitable?

Social and legal issues

Many of these philosophical questions, however they are answered, have significant social and legal dimensions. For example, advances in medical technology have the potential to create disproportionate disadvantages for some social groups, either by being applied in ways that harm members of the groups directly or by encouraging the adoption of social policies that discriminate unfairly against them. Accordingly, questions of discrimination in bioethics have arisen in a number of areas. In one such area, reproductive medicine, recently developed techniques have enabled parents to choose the sex of their child. Should this new power be considered liberating or oppressive? Would it be viewed positively if the vast majority of the parents who use it choose to have a boy rather than a girl? Similar concerns have been raised about the increasing use of abortion as a method of birth control in overpopulated countries such as India and China, where there is considerable social and legal pressure to limit family size and where male children are valued more highly than female children.
In the field of genetics, the use of relatively simple tests for determining a patient’s susceptibility to certain genetically transmitted diseases has led to concerns in the United States and other countries that the results of such tests, if not properly safeguarded, could be used in unfair ways by health-insurance companies, employers, and government agencies. In addition, the advent of so-called “genetic counseling”—in which prospective parents receive advice about the chances that their offspring will inherit a certain genetic disease or disorder—has allowed couples to make more-informed decisions about reproduction but also has contributed, in the view of some bioethicists, to a social atmosphere considerably less tolerant of disability than it ought to be. The same criticism has been leveled against the practice of diagnosing, and in some cases treating, congenital defects in unborn children.
Research on the genetic bases of behaviour, though still in its infancy, is controversial, and it has even been criticized as scientifically invalid. Whatever its scientific merits, however, it has the potential, according to some bioethicists, to encourage the adoption of crude models of genetic determinism in the development of social policies, especially in the areas of education and crime prevention. Such policies, it is claimed, could result in unfair discrimination against large numbers of people judged to be genetically disposed to “undesirable” forms of behaviour, such as aggression or violence.
This last point suggests a related set of issues concerning the moral status of scientific inquiry itself. The notion that there is a clear line between, on the one hand, the discovery and presentation of scientific facts and, on the other, the discussion of moral issues—the idea that moral issues arise only after scientific research is concluded—is now widely regarded as mistaken. Science is not value-neutral. Indeed, there have been ethical debates about whether certain kinds of research should be undertaken at all, irrespective of their possible applications. It has been argued, for example, that research on the possible genetic basis of homosexuality is immoral, because even the assumption that such a basis exists implicitly characterizes homosexuality as a kind of genetic abnormality. In any case, it is plausible to suggest that scientific research should always be informed by philosophy—in particular by ethics but also, arguably, by the philosophy of mind. Consideration of the moral issues related to one particular branch of medicine, namely psychiatry, makes it clear that such issues arise not only in areas of treatment but also in matters of diagnosis and classification, where the application of labels indicating illness or abnormality may create serious disadvantages for the individuals so designated.
Many of the moral issues that have arisen in the health care context and in the wake of advances in medical technology have been addressed, in whole or in part, in legislation. It is important to realize, however, that the content of such legislation is seldom, if ever, dictated by the positions one takes on particular moral issues. For example, the view that voluntary euthanasia is morally permissible in certain circumstances does not by itself settle the question of whether euthanasia should be legalized. The possibility of legalization carries with it another set of issues, such as the potential for abuse. Some bioethicists have expressed the concern that the legalization of euthanasia would create a perception among some elderly patients that society expects them to request euthanasia, even if they do not desire it, in order not to be a burden to others. Similarly, even those who believe that abortion is morally permissible in certain circumstances may consistently object to proposals to relax or eliminate laws against it.
A final class of social and legal questions concerns the allocation of health care resources. The issue of whether health care should be primarily an individual or a public responsibility remains deeply controversial. Although systems of health care allocation differ widely, they all face the problem that resources are scarce and consequently expensive. Debate has focused not only on the relative cost-effectiveness of different systems but also on the different conceptions of justice that underlie them. The global allocation of health care resources, including generic forms of drugs for life-threatening illnesses such as HIV/AIDS, is an important topic in the field of developing world bioethics.

Approaches

Traditional and contemporary ethical theories

As a branch of applied ethics, bioethics is distinct from both metaethics, the study of basic moral concepts such as ought and good, and normative ethics, the discipline that seeks to establish criteria for determining what kinds of action are morally right or wrong. To say that bioethics is “applied,” however, does not imply that it presupposes any particular ethical theory. Contemporary bioethicists make use of a variety of different views, including primarily utilitarianism and Kantianism but also more recently developed perspectives such as virtue theory and perspectives drawn from philosophical feminism, particularly the school of thought known as the ethics of care.
Utilitarianism is a normative-ethical theory that holds that the moral rightness or wrongness of an action should be ascertained in terms of the action’s consequences. According to one common formulation, an action is right if it would promote a greater amount of happiness for a greater number of people than would any other action performable in the same circumstances. The Kantian tradition, in contrast, eschews the notion of consequences and urges instead that an action is right only if it is universalizable—i.e., only if the moral rule it embodies could become a universal law applicable to all moral agents. The Kantian approach emphasizes respect for the individual, autonomy, dignity, and human rights.
Unlike these traditional approaches, both virtue ethics and the ethics of care focus on dimensions of moral theorizing other than determining the rightness or wrongness of particular actions. Virtue ethics is concerned with the nature of moral character and with the traits, capacities, or dispositions that moral agents ought to cultivate in themselves and others. Thus, the virtue ethicist may consider what character traits, such as compassion and courage, are desirable in a doctor, nurse, or biomedical researcher and how they would (or should) be manifested in various settings. The basic aim of the ethics of care is to replace—or at least augment—the supposedly “masculine” moral values of rationality, abstraction, impartiality, and independence with ostensibly more “feminine” values, such as emotion (particularly compassion and benevolence), particularity, partiality, and interdependence. From this perspective, reflection on abortion would begin not with abstract principles such as the right to autonomy or the right to life but with considerations of the needs of women who face the choice of whether to have an abortion and the particular ways in which their decisions may affect their lives and the lives of their families. This approach also would address social and legal aspects of the abortion debate, such as the fact that, though abortion affects the lives of women much more directly than it does the lives of men, women as a group are significantly underrepresented in the institutions that create abortion-related laws and regulations.

The four-principles approach

Whereas some approaches in bioethics proceed by applying principles derived from independent ethical theories to individual cases (a “top-down” approach), others proceed by examining individual cases in order to elucidate the principles that seem to guide most people’s thinking about bioethical issues in actual practice (a “bottom-up” approach). One very influential approach along these lines, known as the “four principles” of bioethics, attempts to describe a set of minimum moral conditions on the behaviour of health care professionals. The first principle, autonomy, entails that health care professionals should respect the autonomous decisions of competent adults. The second principle, beneficence, holds that they should aim to do good—i.e., to promote the interests of their patients. The third principle, nonmaleficence, requires that they should do no harm. Finally, the fourth principle, justice, holds that they should act fairly when the interests of different individuals or groups are in competition—e.g., by promoting the fair allocation of health care resources.
According to proponents of the four-principles approach, one of its advantages is that, because the principles are independent of any particular ethical theory, they can be used by theorists working in a variety of different traditions. Both the utilitarian and the Kantian, it is argued, can support the principle of autonomy, though they would do so for different reasons. Nevertheless, this adaptability may also be construed as a disadvantage. Critics have contended that the principles are so general that whatever agreement on them there may be is unlikely to be very meaningful. Thus, although the utilitarian and the Kantian may both accept the principle of autonomy, the principle as it is formulated allows them to understand the notion of autonomy in very different ways. Another criticism of the approach is that it does not offer any clear way of prioritizing between the principles in cases where they conflict—as they are often liable to do. The principle of autonomy, for example, might conflict with the principle of beneficence in cases where a competent adult patient refuses to accept life-saving treatment.
Despite these problems, the principles remain useful as a framework in which to think about moral issues in medicine and the life sciences. This is not an inconsiderable contribution, for, on at least one conception of the field, the main task of bioethics is not so much to provide answers to moral problems as to identify where the problems lie.

The significance of public attitudes

Since its inception the field of bioethics has been populated by specialists from a number of different disciplines, including primarily philosophers, lawyers, and theologians. In the last decade of the 20th century, however, the contributions of social scientists to bioethical research became particularly important. Work of this type involved surveys of public attitudes to advances in the life sciences, including xenotransplantation and genetic modification. Programs for facilitating public understanding of these advances were developed, leading to the establishment of “public understanding” and later “public engagement,” or “participation,” as distinct topics of study in bioethics and the social sciences.
These topics have been important from both a practical and a theoretical point of view. In order to formulate sound public policies on issues such as human cloning, for example, it is important to be able to predict how such technology, were it to become widely available, would affect the public’s decision making about reproduction. At the same time, research on public attitudes may reveal that some bioethical principles, such as the principle of autonomy, may not be suitable for some societies, particularly those with cultures that are not particularly individualistic. For these societies, something like a “principle of solidarity” may have greater relevance. Nevertheless, it would be a mistake to assume that one of these principles must apply to the exclusion of the other—it is possible for a society to value both autonomy and solidarity.

Policy making

The importance of the social and legal issues addressed in bioethics is reflected in the large number of national and international bodies established to advise governments on appropriate public policy. At the national level, several countries have set up bioethics councils or commissions, including the President’s Council on Bioethics in the United States, the Det Etiske Råd (Danish Council of Ethics) in Denmark, and the Comité Consultatif National d’Ethique (National Consultative Bioethics Committee) in France. Elsewhere, as in the United Kingdom, there are a variety of different bodies that consider bioethical issues. The Nuffield Council on Bioethics has taken on the role of a national bioethics committee to a certain extent, but there also are national bodies that deal with specific fields, such as the Human Genetics Commission.
Several international organizations also are involved in policy making on bioethical issues. The United Nations Educational, Scientific and Cultural Organization (UNESCO), for example, has an International Bioethics Committee; the Human Genome Organisation has an Ethics Committee; and the Council of Europe has issued the Convention on Human Rights and Biomedicine. The proliferation of such committees is evidence of the increasing political influence of the work performed by bioethicists. Indeed, acquaintance with developments in bioethics arguably is becoming an important aspect of national and global citizenship. At the same time, however, the role of bioethical experts on advisory or decision-making bodies has itself become a topic of study in bioethics.

Global bioethics

The field of bioethics has grown most rapidly in North America, Australia and New Zealand, and Europe. Cross-cultural discussion also has expanded and in 1992 led to the establishment of the International Association of Bioethics. A significant discussion under way at the start of the 21st century concerned the possibility of a “global” bioethics that would be capable of encompassing the values and cultural traditions of non-Western societies. Some bioethicists maintained that a global bioethics could be founded on the four-principles approach, in view of its apparent compatibility with widely differing ethical theories and worldviews. Others argued to the contrary that the four principles are not an appropriate basis for a global bioethics because at least some of them—in particular the principle of autonomy—reflect peculiarly Western values. Although the issue remains unresolved, the field as a whole continues to grow in sophistication. At the same time, the increasing pace of technological advances in medicine and the life sciences demands that bioethicists continually rethink the basic assumptions of their field and reflect carefully on their own methodologies.
Ruth Felicity Chadwick
CITATION INFORMATION
ARTICLE TITLE: Bioethics
WEBSITE NAME: Encyclopaedia Britannica
PUBLISHER: Encyclopaedia Britannica, Inc.
DATE PUBLISHED: 27 May 2019
ACCESS DATE: December 17, 2019