An introduction to Bioethics

1. 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

2. 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 Ethics, Morality and Theory

3. What is “ethics”? Ethics: “the rules of conduct recognized in respect to a particular class of human actions or a particular group, culture”

4. What is “Bioethics”? Bioethics: “a field of study concerned with the ethics and philosophical implications of certain biological and medical procedures, technologies, and treatments, such as organ transplants, genetic engineering, and care of the terminally ill”

5. A classic bioethical decision One heart available  who should get it? • 70-year-old woman • 40-year-old school principal • 17-year old girl

6. A classic bioethical decision One heart available  who should get it? • 70-year-old woman • 40-year-old school principal • 17-year old girl

7. Basic Bioethics Principles RESPECT for people’s rights Autonomy Dignity BENEFICENCE: Benefits must be proportionate to risks Potential harm = potential good

8. Basic Bioethics Principles JUSTICE: The even distribution of benefits and risks throughout society NONMALEFICENCE: Do no harm Experiment must stop if causes harm.

9. 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.) Is ethics relative?

10. 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 Defining Theory

11. 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 EXAMPLES OF MORAL THEORY

12. Theory Principle Rule Action Ethical Theory…to Action

13. 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 Bioethics

14. 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 Bioethics

15. Clinical Ethics CPR (1954) James Elam experiment Right to Refuse Care Research Ethics Tuskegee Syphilis Experiment Willowbrook Experiment WHAT KINDS OF PROBLEMS ARE DEALT WITH?

16. Autonomy: • Greek: • autos “self” and • 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)

17. 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 Beneficence

18. 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 Nonmaleficence

19. 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 Justice

20. 16 year old male Car accident Requires surgery Parents will not allow blood products to be used Patient refuses blood products Case 1: Jehovah's witness

21. 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 Case 2: Volleyball Player

22. 86 year old man Pancreatic Cancer Hospice and Palliative Care Refuses all pain medication Staff and other patients are upset at “screams of agony” Case 3: Pain relief in Hospice

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