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An introduction to Bioethics

  • A Modified presentation by
  • Nicole M. Deming, J.D., M.A.
  • Assistant Professor of Bioethics
  • Case Western Reserve University
  • School of Medicine

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Ethics, Morality and Theory

  • Define Ethics
    • Philosophy addressing questions of morality, understanding, and examining moral life

  • Define Morality
    • Code of conduct put forward by society
    • Normative claims: how things should or ought to be

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Is ethics relative?

Darius, King of Persia…

“Summons Greeks to his court and asked them what they would take to eat the dead bodies of their fathers. They replied that they would not do it for any money in the world.

Later, in the presence of the Greeks , and through an interpreter, so that they could understand what was said, he asked some Indians, of the tribe called Callatiae, who in fact eat their parents’ dead bodies, what they would take to burn them. They uttered a cry of horror and forbade him to mention such a dreadful thing.”

- Herodotus (485-430 B.C.)

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Defining Theory�

    • Abstract reflection and argument

    • A systematic justification of those principles
      • Not all theories are of equal value or rigor
      • Aspect of each theory can contribute to our knowledge and analysis of a particular case in bioethics

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Examples of Moral Theory

Utilitarianism

    • Consequence-based theory (Ends justify the means)

Kantianism

    • Why you do something matters…can you make something a universal rule?
    • The Golden Rule

Liberal Individualism

    • Positive Rights (education) and Negative Rights (Bill of Rights)

Communitarianism

    • The good of the community (Hoban)

Ethics of Care

    • Relationships matter
    • Focus on relationships involving care, responsibility, and trust

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Ethical Theory…to Action

Theory

Principle

Rule

Action

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Bioethics

  • Bioethics is the philosophical study of the ethical controversies 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, philosophy, and theology.

  • Applied Ethics: applied to actual ethical problems

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Bioethics

  • Clinical Ethics
    • Withdrawal and Withholding Life Support, Doctor-Patient Relationship
  • Research Ethics
    • Stem Cells, Gene Therapy
  • Animal Rights
    • Euthanasia, Chimeras, Xenotransplantation
  • Environmental Ethics
    • Genetically Modified Food, Air Pollution
  • Biotechnology
    • Brain-computer interface, Department of Defense, Bioterrorism
  • Public Health
    • Newborn Screen Blood Banks, Vaccinations, FDA

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What problems do we deal with…

  • Clinical Ethics
    • CPR (1954) James Elam experiment
    • Right to Refuse Care

  • Research Ethics
    • Tuskegee Syphilis Experiment
    • Willowbrook Experiment

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Case 1: Jehovah's witness

  • 16 year old male
  • Car accident
  • Requires surgery
  • Parents will not allow blood products to be used
  • Patient refuses blood products

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Autonomy:

    • Greek:
      • autos “selfand
      • nomos “rule,” governance,” or “law”
    • Self-rule that is free from both controlling interference by others and from certain limitations such as an inadequate understanding that prevents meaningful choice

(Beauchamp and Childress)

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Beneficence

  • Providing a benefit to another
  • Principle of beneficence: a moral obligation to act for the benefit of others
    • Protect and defend rights of others
    • Help persons with disabilities
    • Rescue persons in danger

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Nonmaleficence

  • An obligation to not inflict harm on others
  • First do no harm
  • Distinct from Beneficence
    • Obligations not to harm (rob or kill)
    • Obligations to help others (rescue a drowning child)
      • Withholding and withdrawing life-sustaining treatment
      • Intended effects and merely foreseen effects

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Justice

  • Fair and just distribution of social burdens, benefits, opportunities and allocation of positions
  • Justice and Distributive Justice: fair, equitable and appropriate distribution determined by social norms
    • Access to Health Care
    • Selection of Research subject population

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Case 2: Volleyball Player

  • Infection in her leg
  • 60% Chance of recovery with antibiotics alone
  • 80% Chance of recovery with antibiotics and amputation of the leg
  • Parents want doctors to amputate the leg, patient would like to only take antibiotics

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Case 3: Pain relief in Hospice

  • 86 year old man
  • Pancreatic Cancer
  • Hospice and Palliative Care
  • Refuses all pain medication
  • Staff and other patients are upset at “screams of agony”

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Conclusion

  • Bioethics
    • What should we do?
    • Why?
    • Case specific
    • Depends on values of the individuals
    • Some universal principles