Bioethics Reviewer PDF

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BIOETHICS (ETHICS OF CARE) WHAT IS BIOETHICS concerns the moral, legal, political, and social issues raised by medicine, biomedical research, and life sciences technologies. The notion of bioethics is commonly understood as a generic term for three main sub-disciplines: medical ethics, animal ethic...

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BIOETHICS (ETHICS OF CARE)  WHAT IS BIOETHICS - concerns the moral, legal, political, and social issues raised by medicine, biomedical research, and life sciences technologies. - The notion of bioethics is commonly understood as a generic term for three main sub-disciplines: 1. medical ethics, 2. animal ethics, and 3. environmental ethics.  THREE SPHERES OF BIOETHICS 1. THE ACADEMIC BIOETHICS - a sphere primarily focused on how theoretical and practical aspects of medicine affect considerations such as special obligations or responsibilities of clinicians, what is valuable, good, right, etc. in the biomedical context and how one might go about providing systematic accounts of such considerations. 2. PUBLIC POLICY AND LAW BIOETHICS - where concerns lies in how legal and extra-legal institutions can and should be involved in the regulation of clinical and research practices. 3. CLINICAL ETHICS - its focus is directly related to how the incorporation of bioethics into clinical practice can help to improve patient care.  DIFFERENT BIOETHICAL METHODOLOGIES 1. PRACTICAL OR APPLIED ETHICS, or even an applied philosophy of medicine. - This approach addresses ethical issues that arise in practice through the application of aspects of particular ethical theories, or specific notions/concepts to concrete clinical or research cases. - E.g. double effect, treatment versus enhancement distinction, etc. - focus not on providing a decision procedure but to provide theoretical framework concerning - E.g., what considerations would make an action good or a policy right. 2. PRINCIPLISM - This approach seeks to provide ethical guidance in clinical practice through a specified number of moral principles. - Most common are: the principles of autonomy, beneficence, nonmalfeasance, and justice

- Criticized for being too insensitive to the complexities and tensions inherent in morality 3. CASUISTRY - This case-based approach addresses ethical problems by guiding clinicians through specific issues via paradigm cases that have come up in clinical education or practice - analogous to the use of case-based reasoning in the process of differential diagnosis. - It provides a bottom-up approach – use of case- based reasoning to identify the morally relevant features of a situation and relate it to the specific circumstances of a previous case and its resolution 4. COMBINATION OF TECHNIQUES for identifying and resolving ethical conflicts & related problems. - treats the ethical issues in clinical practice as those similar to inter-personal issues alleviated through techniques such as conflict resolution, mediation, negotiation, and arbitration.  KNOWLEDGE, PRACTICE, AND ETHOS OF ANCIENT GREEK PHYSICIAN-HEALERS  THE HIPPOCRATICS AND OTHER HEALERS - HIPPOCRATES GREEK MEDICAL >> ETHICS >> BIOETHICS - HIPPOCRATES he was born around 460 B.C. from Cos. A contemporary of Socrates, was famous in his time, and likely taught apprentices for a fee. - The HIPPOCRATIC CORPUS is a collection of about sixty anonymous writings assembled in the third century B.C.  GREEK HEALERS - Seers, fortune-tellers or forecasters - Decipher omens (flights of birds); read signs like the patterns of livers obtained from sacrificial animals (hepatoscopy). - Calchas, son of Thestor - Knew about the sickness even before asking the patient - Machaon and Podalirius – cared for the soldiers during the Trojan war; went with soldiers in battle - Illness could be sent by an angry god or goddess  HIPPOCRATIC IATROS - The Hippocratics applied the ancient art of prognostics. - These IATROS practiced telling the past, present and future of the sick. - The Hippocratic iatros examined signs on the surfaces of the human body, scrutinized material coming from inside the body, and studied the environment surrounding the body in order to make their prognosis.

They were also influenced by a humoral understanding of health and illness.  INTEGRATING EPISTEME, TECHNE, ETHOS, AND RHETORIC IN THE IATROS’ CRAFT ▪ EPISTEME involved reading the body in prognosis ▪ ETHOS involved personal interaction between the physician and the sick, including the household members. TRUST and REPUTATION are necessary in the craft, and developed through this interaction. ▪ The WORK OF CRAFTSMEN as model for their healing activity. The Iatros is like working on the material to produce the outcome. ▪ Use of RHETORIC was also resorted to in order to convince the patient to follow prescription, and to encourage him to be forthright.  HIPPOCRATIC OATH - It was important for the iatros to establish a good and trusting relationship not only with the sick person but also with other members of the household. - Interaction with household members were clearly necessary to a healing practice focused on the body of the sick person and often carried on in the dwelling of the sick. - Hippocratic Oath developed out of a pattern of healing practices - I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong- doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein. - Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.  A GLOBAL ETHICAL FRAMEWORK FOR BIOETHICS - It is claimed that morality is universal; but it allows for variations due to cultural differences. - A global bioethics should be thought of as an application of the common moral system to medicine and medical

research that allows for significant variations in different cultures or societies.  MORALITY OR MORAL SYSTEM - Morality is a public system that is known by all moral agents. - A public system is a system that has the following two characteristics. 1. All persons to whom it applies know what behavior the system prohibits, requires, discourages, encourages, and allows; 2. It is not irrational for any of these persons to accept being guided and judged by that system. - Ex. Game, e.g., basketball, tennis - So if morality is a public system, then moral agents are subject to moral judgments simply by virtue of being rational persons who are responsible for their actions. - Moral system is analogous to grammatical system – - No competent speaker can explicitly describe the grammatical system that she uses, yet they know the grammar when speaking and interpreting the speech of others. - Like speaking a language, people simply feel that “causing pain to someone simply because one feels like doing it” is wrong, without consciously making judgment about it. - Bioethics is a field in which people often do consciously deliberate about what is the morally right thing to do, for example, whether to perform an abortion.  GLOBAL MORAL RULES 1. Do not kill. 2. Do not deceive. 3. Do not cause pain. 4. Keep your promises. 5. Do not disable.

6. Do not cheat. 7. Do not deprive of freedom. 8. Obey the law. 9. Do not deprive of pleasure. 10. Do your duty.

 WHAT DOES EACH ONE INCLUDE?  DECEIVING: withholding information, lying  KEEP YOUR PROMISES: keeping informal agreements as well as formal contracts  CAUSING PAIN: physical pain but also mental pain  CAUSING DISABILITIES: not only physical disabilities but also mental and volitional disabilities  DEPRIVING OF FREEDOM: depriving of opportunities and resources  DEPRIVING OF PLEASURE: depriving of future pleasure as well as present pleasure

 DO YOUR DUTY: everyday duty determined by your social role, job or profession, or by special circumstances.

 THESE RULES ARE UNDERSTOOD TO PROHIBIT: - not only actual violations but also attempts to violate them, even if the attempt is unsuccessful. - also to prohibit not only intentional violations but also violations done knowingly but not intentionally  DISAGREEMENTS BASED ON DIFFERENT INTERPRETATIONS OF A MORAL RULE - Ex. People may agree that withdrawing life-support is killing, but disagree about whether is it considered killing to discontinue food and fluids to the patient? - Some disagreements can be resolved by certain institutions by formulating specific rules for people governed by the institution. - E.g. Hospitals may adopt rules determining when it is allowed to discontinue life-sustaining treatments - Variations in the specific ways the universal rules are being followed are due to cultural, legal & societal variations.  JUSTIFYING VIOLATION OF SOME RULES - Morality requires impartiality – - i.e., same situation does not change simply because the identity of the persons involved in that situation changes. - However, impartiality does not require uniformity  TWO-STEP PROCEDURE FOR JUSTIFYING VIOLATIONS OF THE UNIVERSAL RULES 1. FIRST STEP: Describing a situation in terms of its morally relevant features.  List of 10 questions, the answers to which are morally relevant 1. What kind of act is it, that is, what moral rule is it a violation of? 2. What harms are caused, avoided (not caused), and prevented? 3. What are the relevant beliefs and desires of the person harmed? 4. What is the relationship between the parties? 5. What goods are being gained? 6. Is a violation of a moral rule being prevented? 7. Is a violation of a moral rule being punished? 8. Are there alternative actions that will not violate a moral rule or cause less harm?

9. Is the action being done intentionally, or only knowingly? 10. Is the situation an emergency? 2. SECOND STEP: Estimating the results of everyone knowing that they are allowed to violate the rule in these circumstances. - If one estimates that less harm would result from everyone knowing that they are allowed to violate the rule in these circumstances than from everyone knowing that they are not allowed to violate the rule in these circumstances, then one is acting impartially in violating that rule. - If everyone would make the same estimate, then the violation is strongly justified. - If everyone would estimate that more harm would result from everyone knowing that they are allowed to violate the rule in these circumstances than everyone knowing that they are not allowed to violate the rule in these circumstances, then the violation is unjustified....