Bioethics is the study of the ethical issues emerging from advances in biology and medicine. It is also moral discernment as it relates to medical policy and practice. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy. It includes the study of values ("the ethics of the ordinary") relating to primary care and other branches of medicine.
The term Bioethics (Greek bios, life; ethos, behavior) was coined in 1926 by Fritz Jahr in an article about a "bioethical imperative" regarding the use of animals and plants in scientific research. In 1970, the American biochemist Van Rensselaer Potter used the term to describe the relationship between the biosphere and a growing human population. Potter's work laid the foundation for global ethics, a discipline centered around the link between biology, ecology, medicine, and human values.
Purpose and scope
The field of bioethics has addressed a broad swathe of human inquiry, ranging from debates over the boundaries of life (e.g. abortion, euthanasia), surrogacy, 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.
The scope of bioethics can expand with biotechnology, including cloning, gene therapy, life extension, human genetic engineering, astroethics and life in space, and manipulation of basic biology through altered DNA, XNA and proteins. These developments will affect future evolution, and may require new principles that address life at its core, such as biotic ethics that values life itself at its basic biological processes and structures, and seeks their propagation.
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, respect for persons, 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. Overall, the Belmont Report (1979) has guided research in a direction focused on protecting vulnerable subjects as well as pushing for transparency between the researcher and the subject. Research has flourished within the past 40 years and due to the advance in technology, it is thought that human subjects have outgrown the Belmont Report (1979) and the need for revision is desired.
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.
Many bioethicists, especially medical scholars, accord the highest priority to autonomy. They believe that each patient should determine which course of action they consider most in line with their beliefs. In other words, the patient should always have the freedom to choose their own treatment .
Medical ethics is the study of moral values and judgments as they apply to medicine. The four main moral commitments are respect for autonomy, beneficence, nonmaleficence, and justice. Using these four principles and thinking about what the physicians’ specific concern is for their scope of practice can help physicians make moral decisions. 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 has a more expansive application, touching upon the philosophy of science and issues of biotechnology. 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, resolving ethical dilemmas in medicine and science. Examples of this would be the topic of equality in medicine, the intersection of cultural practices and medical care, and issues of bioterrorism.
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; public intellectuals like Amitai Etzioni of The George Washington University; 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, Bioethics, the Kennedy Institute of Ethics Journal and the Cambridge Quarterly of Healthcare Ethics. Bioethics has also benefited from the process philosophy developed by Alfred North Whitehead.
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 a 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. Masahiro Morioka argues that in Japan the bioethics movement was first launched by disability activists and feminists in the early 1970s, while academic bioethics began in the mid-1980s. During this period, unique philosophical discussions on brain death and disability appeared both in the academy and journalism.
Bioethics is taught in courses at the undergraduate and graduate level in different academic disciplines or programs, such as Philosophy, Medicine, Law, Social Sciences. It has become a requirement for professional accreditation in many health professional programs (Medicine, Nursing, Rehabilitation), to have obligatory training in ethics (e.g., professional ethics, medical ethics, clinical ethics, nursing ethics). Interest in the field and professional opportunities have led to the development of dedicated programs with concentrations in Bioethics, largely in the United States and Europe, offering undergraduate majors/minors, graduate certificates, and Masters and Doctorate degrees.
As a study, bioethics has also drawn criticism. For instance, Paul Farmer noted that bioethics tends to focus its attention on problems that arise from "too much care" for patients in industrialized nations, while giving little or no attention to the ethical problem of too little care for the poor. Farmer characterizes the bioethics of handling morally difficult clinical situations, normally in hospitals in industrialized countries, as "quandary ethics". He does not regard quandary ethics and clinical bioethics as unimportant; he argues, rather, that bioethics must be balanced and give due weight to the poor.
Additionally, bioethics has been condemned for its lack of diversity in thought, particularly with regards to race. Even as the field has grown to include the areas of public opinion, policymaking, and medical decisions, little to no academic writing has been authored concerning the intersection between race- especially the cultural values imbued in that construct- and bioethical literature. John Hoberman illustrates this in a 2016 critique, in which he points out that bioethicists have been traditionally resistant to expanding their discourse to include sociological and historically relevant applications. Central to this is the notion of white normativity, which establishes the dominance of white hegemonic structures in bioethical academia and tends to reinforce existing biases.
Some criticisms have been made about the experience of disability. Some people in the disabled community feel that mainstream bioethics embraces ableist premises about medical care and resources. Thinkers such as Princeton's Peter Singer, who has argued that parents have the right to choose healthy children over disabled ones, have upset people with disabilities, who feel threatened by his position.
Areas of health sciences that are the subject of published, peer-reviewed bioethical analysis include:
- Alternative Medicine
- Animal rights
- Applied ethics
- Artificial insemination
- Artificial life
- Artificial womb
- Assisted suicide
- Biological agent
- Biological patent
- Biotic ethics
- Blood transfusion
- Body modification
- Brain-computer interface
- Confidentiality (medical records)
- Contraception (birth control)
- Euthanasia (human, non-human animal)
- Faith healing
- Feeding tube
- Gene theft
- Gene therapy
- Genetically modified food
- Genetically modified organism
- Great Ape Project
- HeLa cells
- Human cloning
- Human enhancement
- Human experimentation in the United States
- Human genetic engineering
- Infertility treatments
- Life extension
- Life support
- Medical malpractice
- Medical research
- Medical torture
- Mitochondrial donation
- Moral obligation
- Moral status of animals
- Nazi human experimentation
- Ordinary and extraordinary care
- Organ donation
- Organ transplant
- Pain management
- Patients' Bill of Rights
- Political abuse of psychiatry
- Population control
- Prescription drug prices in the United States
- Procreative beneficence
- Professional ethics
- Quality of Life (Healthcare)
- Quaternary prevention
- Recreational drug use
- Reproductive rights
- Reproductive technology
- Sex reassignment therapy
- Sperm and egg donation
- Spiritual drug use
- Stem cell research
- Sterilization (medicine)
- Transplant trade
- Tubal ligation
- Vaccination controversy
- List of bioethics journals
- List of Canadian bioethics programs
- Biotechnology risk
- Cytoplasmic transfer
- Feminist Approaches to Bioethics
- Jewish medical ethics
- Johns Hopkins Berman Institute of Bioethics
- Islamic bioethics
- Medical law
- Preimplantation genetic diagnosis
- Resources for clinical ethics consultation
- The Convention on Human Rights and Biomedicine
- Rinčić, I., Muzur, A.: Fritz Jahr i rađanje europske bioetike (Fritz Jahr and the Birth of European Bioethics). Zagreb: Pergamena, 2012., p. 141 (Croatian)
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- "Astroethics". Archived from the original on 23 October 2013. Retrieved 21 December 2005.
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- Friesen, Phoebe; Kearns, Lisa; Redman, Barbara; Caplan, Arthur L. (2017). "Rethinking the Belmont Report?". The American journal of bioethics: AJOB. 17 (7): 15–21. doi:10.1080/15265161.2017.1329482. ISSN 1536-0075. PMID 28661753.
- "The Bioethics Society of Ohio State". Thebioethicssociety.org.ohio-state.edu. Archived from the original on 2013-06-13. Retrieved 2013-09-17.
- "Bioethics Society of Cornell". Cornell University. Archived from the original on 17 June 2012.
- Entwistle, Vikki A.; Carter, Stacy M.; Cribb, Alan; McCaffery, Kirsten (2016-10-28). "Supporting Patient Autonomy: The Importance of Clinician-patient Relationships". Journal of General Internal Medicine. 25 (7): 741–45. doi:10.1007/s11606-010-1292-2. ISSN 0884-8734. PMC 2881979
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- Horne, L. Chad (2016). "Medical Need, Equality, and Uncertainty". Bioethics. 30 (8): 588–96. doi:10.1111/bioe.12257.
- Cf. Michel Weber and Will Desmond (eds.). Handbook of Whiteheadian Process Thought Archived 2015-11-12 at the Wayback Machine. (Frankfurt / Lancaster, Ontos Verlag, Process Thought X1 & X2, 2008) and Ronny Desmet & Michel Weber (edited by), Whitehead. The Algebra of Metaphysics. Applied Process Metaphysics Summer Institute Memorandum Archived 2017-07-27 at the Wayback Machine., Louvain-la-Neuve, Les Éditions Chromatika, 2010.
- As regards the Christian Orthodox perspective see e.g. Constantine B. Scouteris, Bioethics in the light of orthodox anthropology, Polytechnic School of Crete (ed), First International Conference: Christian Anthropology and Biotechnological Progress (Financially Supported by CTNS, U.S.A.), Orthodox Academy of Crete, 26-29 September 2002, pp. 75-81.
- See Feminism, Disability, and Brain Death Archived 2015-12-22 at the Wayback Machine.
- "Bioethics Grows, But Will Jobs Follow?". MD Magazine. Retrieved 2018-07-01.
- Lee, Katarina (2016). "An Overview of Graduate Educational Bioethics Programs in the United States" (PDF). BCM. Retrieved 2018-07-01.
- Farmer, Paul. Pathologies of Power. pp. 196–212.
- Farmer, Paul. Pathologies of Power. p. 205.
- Hoberman, J. (2016). "Why Bioethics Has a Race Problem". The Hastings Center Report. 46 (2): 12–18. doi:10.1002/hast.542.
- Karsjens, K.L. (2003). "White Normativity and Subsequent Critical Race Deconstruction of Bioethics". The American Journal of Bioethics. 3 (2): 22–23. doi:10.1162/152651603766436144.
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