Bioethics

Bioethics

Bioethics is the study of controversial ethics brought about by advances in biology and medicine. 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.

History

Terminology

The term Bioethics (Greek bios, life; ethos, behavior) was coined in 1927 by Fritz Jahr, who "anticipated many of the arguments and discussions now current in biological research involving animals" in an article about the "bioethical imperative," as he called it, regarding the scientific use of animals and plants. In 1970, the American biochemist Van Rensselaer Potter also used the term with a broader meaning including solidarity towards the biosphere, thus generating a "global ethics," a discipline representing a link between biology, ecology, medicine and human values in order to attain the survival of both human beings and other animal species.

Development of a discipline

Although bioethical issues have been debated since ancient times, and public attention briefly focused on the role of human subjects in biomedical experiments following the revelation of Nazi experiments conducted during World War II, the modern field of bioethics first emerged as an academic discipline in Anglophone societies in the 1960s. Technological advances in such diverse areas as organ transplantation and end-of-life care, including the development of kidney dialysis and respirators, posed novel questions regarding when and how care might be withdrawn. Furthermore, as philosophy in Britain and elsewhere moved away from the influences of logical positivism and emotivism, the development of theories of ethics and their application to practical problems gained in interest. These questions were often discussed by philosophers and religious scholars; in England, there were notable contributions from GEM Anscombe and RM Hare. By the 1970s, bioethical think tanks and academic bioethics programs had emerged. Among the earliest such institutions were the Hastings Center (originally known as The Institute of Society, Ethics and the Life Sciences), founded in 1969 by philosopher Daniel Callahan and psychiatrist Willard Gaylin, and the Kennedy Institute of Ethics, established at Georgetown University in 1971. The publication of Principles of Biomedical Ethics by James F. Childress and Tom Beauchamp—the first American textbook of bioethics—marked a transformative moment in the discipline. The Asilomar Conference on Recombinant DNA was held in 1975.

During the subsequent three decades, bioethical issues gained widespread attention through the court cases surrounding the deaths of Karen Ann Quinlan, Nancy Cruzan and Terri Schiavo. The field developed its own cadre of widely-known advocates, such as Al Jonsen at the University of Washington, John C Fletcher at the University of Virginia, Ruth Faden at Johns Hopkins University, and Arthur Caplan at the Center for Bioethics at the University of Pennsylvania. US Presidents have focused attention on bioethics for several decades, for instance by forming the President's Commission on the Study of Ethical Problems in Medicine and Biomedicine and Behavioral Research, which produced the landmark report, "Defining Death" in 1981. President George W. Bush also relied upon a Council on Bioethics in rendering decisions in areas such as the public funding of embryonic stem-cell research.

Purpose and scope

The field of bioethics has addressed a broad swath of human inquiry, ranging from debates over the boundaries of life (e.g. abortion, euthanasia), surrogacy to the allocation of scarce health care resources (e.g. organ donation, health care rationing) to the right to refuse medical care for religious or cultural reasons. Bioethicists often disagree among themselves over the precise limits of their discipline, debating whether the field should concern itself with the ethical evaluation of all questions involving biology and medicine, or only a subset of these questions. 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.

Principles

One of the first areas addressed by modern bioethicists was that of human experimentation. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was initially established in 1974 to identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects. However, the fundamental principles announced in the Belmont Report (1979)--namely, autonomy, beneficence and justice--have influenced the thinking of bioethicists across a wide range of issues. Others have added non-maleficence, human dignity and the sanctity of life to this list of cardinal values.

Another important principle of bioethics is its placement of value on discussion and presentation. Numerous discussion based bioethics groups exist in universities across the United States to champion exactly such goals. Examples include The Ohio State Bioethics Society and the Bioethics Society of Cornell. Professional level versions of these organizations also exist.

Medical ethics

Medical ethics is the study of moral values and judgments as they apply to medicine. As a scholarly discipline, medical ethics encompasses its practical application 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 issues 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. A bioethicist assists the health care and research community in examining moral issues involved in our understanding of life and death, and resolving ethical dilemmas in medicine and science.

Perspectives and methodology

Bioethicists come from a wide variety of backgrounds and have training in a diverse array of disciplines. The field contains individuals trained in philosophy such as H. Tristram Engelhardt, Jr. of Rice University, Baruch Brody of Rice University, Peter Singer of Princeton University, Daniel Callahan of the Hastings Center, and Daniel Brock of Harvard University, medically-trained clinician ethicists such as Mark Siegler of the University of Chicago and Joseph Fins of Cornell University, lawyers such as Nancy Dubler of Albert Einstein College of Medicine or Jerry Menikoff of the federal Office of Human Research Protections, political scientists like Francis Fukuyama, religious studies scholars including James Childress, and theologians like Lisa Sowle Cahill and Stanley Hauerwas. The field, once dominated by formally trained philosophers, has become increasingly interdisciplinary, with some critics even claiming that the methods of analytic philosophy have had a negative effect on the field's development. Leading journals in the field include The "Journal of Medicine and Philosophy", The Hastings Center Report, the American Journal of Bioethics, the Journal of Medical Ethics and the Cambridge Quarterly of Healthcare Ethics.

Many religious communities have their own histories of inquiry into bioethical issues and have developed rules and guidelines on how to deal with these issues from within the viewpoint of their respective faiths. The Jewish, Christian and Muslim faiths have each developed a considerable body of literature on these matters. In the case of many non-Western cultures, a strict separation of religion from philosophy does not exist. In many Asian cultures, for example, there is a lively discussion on bioethical issues. Buddhist bioethics, in general, is characterised by a naturalistic outlook that leads to a rationalistic, pragmatic approach. Buddhist bioethicists include Damien Keown. In India, Vandana Shiva is the leading bioethicist speaking from the Hindu tradition. In Africa, and partly also in Latin America, the debate on bioethics frequently focuses on its practical relevance in the context of underdevelopment and geopolitical power relations.


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