Bioethics: Definition and Principles

Introduction

Bioethics is becoming commonplace among medical schools; from 1990 there has been a 182 percent increase in bioethics training programs (2001 statistics; ASBH). It has been reported that advanced degrees and certificates give students the opportunity to understand critical ethical issues in the clinical and community settings, as well as the tools for teaching future students, patients, and the community about these issues.

Main Item

Medical Definition of Bioethics

"The discipline dealing with the ethical implications of biological research and applications especially in medicine. Bioethics includes the study of what is right and wrong in new discoveries and techniques in biology, such as genetic engineering and the transplantation of organs."

The term Bioethics (Greek bios, life; ethos, behavior) was coined in 1926 by Fritz Jahr, who anticipated many of the arguments and discussions now current in biological research involving animals. Many religious communities have their own histories of inquiry into bio-ethical issues and have developed rules and guidelines on how to deal with these issues from within the viewpoint of their respective faiths.

Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy. It also includes the study of the more commonplace questions of values ("the ethics of the ordinary") which arise in primary care and other branches of medicine.

Advances in life sciences are giving humans new capacities:

New medicines, biomedical procedures, and ways of altering plants and animals are bringing benefits to millions of people. However, these same innovations also have the potential to bring harms or to raise other kinds of ethical questions about their appropriate use.

Bioethics looks at "what should be done" when dealing with or taking care of people and other living creatures. Bioethics looks at questions about values and what matters in medicine, biological research, care of people who cannot speak up for themselves (the severely mentally ill, small children, prisoners) and similar topics. The word is made up of two parts: "bio" (from the Greek word for "life") and "ethics", so it is the study of ethics as it relates to living things.

Bioethics is an activity; it is a shared, reflective examination of ethical issues in health care, health science, and health policy. These fields have always had ethical standards, of course, handed down within each profession, and often without question. About forty years ago, however, it became obvious that we needed a more public, and more critical, discussion of these standards.

Bioethics takes place in the media, in the academy, in classrooms, and in labs, offices, and hospital wards. It involves not just doctors, but patients, not just scientists and politicians but the general public. Traditional ethical standards have been articulated, reflected on, challenged, and sometimes revised; standards for new issues have been created - then challenged and revised. The conversation is often sparked by new developments, like the possibility of cloning. But bioethics also raises new questions about old issues, like the use of placebos and the treatment of pain.

Bioethics is also concerned with questions about basic human values such as the rights to life and health, and the rightness or wrongness of certain developments in healthcare institutions, life technology, medicine, the health professions and about society's responsibility for the life and health of its members.

Decisions involving bio-ethical issues are made every day in diverse situations such as the relationship between patients and their physicians, the treatment of human subjects in biomedical experimentation, allocation of scarce medical resources, complex questions that surround the beginning and end of a human life and the conduct of clinical medicine and life sciences research.

Bioethics Principles

Early founders of bioethics put forth four principles which form the framework for moral reasoning:

• Nonmaleficence

  One should avoid causing harm. The healthcare professional should not harm the patient. All treatment involves some harm, even if minimal, but the harm should not be disproportionate to the benefits of treatment.

• Justice

  Benefits and risks should be fairly distributed. The notion that patients in similar positions should be treated in a similar manner.

• Beneficence

  One should take positive steps to help others. Considers the balancing of benefits of treatment against the risks and costs; the healthcare professional should act in a way that benefits the patient

• Autonomy

  One should respect the right of individuals to make their own decisions by respecting the decision making capacities of autonomous persons; enabling individuals to make reasoned informed choices.

These 'Four Principles' have been one of the most widely discussed issues in Biomedical Ethics with arguments for and against them. The authors' claim has been tested by research conducted in different cultures and societies. One commentator has been quoted as saying,

"...the four principles should...be thought of as the four moral nucleotides that constitute moral DNA - capable, alone or in combination, of explaining and justifying all the substantive and universal moral norms of health care ethics..."

Fundamental Values at Stake

• Human life
• Authenticity
• Responsibility
• Intrinsic value
• Bodily integrity
• Fair and just healthcare
• Dignity of the frail and elderly
• Ability to make reasonable decisions