Typically, Bioethical Issues are addressed from many different disciplines. People contribute to the bioethics discussion drawing on expertise and methods from the sciences, social sciences, and the humanities. Professionals working in the field of bioethics include philosophers, scientists, health administrators, lawyers, theologians, anthropologists, disability advocates, and social workers. People may teach, do research, and treat patients in the clinical setting or work to change laws or public policy. The issues of bioethics are at the intersection between medicine, law, public policy, religion, and science. Each field contributes important insights, resources, and methodologies, and efforts to think about or make changes to practices and policies that raise ethical concerns are often strongest when they draw on resources across disciplines. The Showcase submission formats include some commonly used formats to present bioethics-related proposals or findings.
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. Sargent Shriver, the spouse of Eunice Kennedy Shriver, claimed that he had invented the word “bioethics” in the living room of his home in Bethesda, Maryland in 1970. He stated that he thought of the word after returning from a discussion earlier that evening at Georgetown University, where he discussed with others a possible Kennedy family sponsorship of an institute focused around the “application of moral philosophy to concrete medical dilemmas.”
Bioethics is commonly understood to refer to the ethical implications and applications of the health-related life sciences. These implications can run the entire length of the bench-to-bedside “translational pipeline.” Dilemmas can arise for the basic scientist who wants to develop synthetic embryos to better study embryonic and fetal development but is not sure just how real the embryos can be without running into moral limits on their later destruction.
Once treatments or drugs are in clinical trials involving human subjects, a new set of challenges arise, from ensuring informed consent, to protecting vulnerable research participants to guarantee their participation is voluntary and informed. Eventually, some of these new approaches exit the pipeline and are put into practice, where providers, patients, and families struggle with how to best align the risks and benefits of treatment with the patient’s best interest and goals. The added costs of new therapies inevitably strain available resources, forcing hard choices about how to fairly serve the needs of all, especially those already underserved by the health care system.
Examples of topic areas that have been the focus of bioethics for a long time are organ donation and transplantation, genetic research, death and dying, and environmental concerns. New developments in science and technology have focused attention on topics such as assisted reproductive technologies, neuroethics (ethical issues around brain imaging and testing), and nanotechnologies (using small particles to deliver medicine or other medical treatments).
Social and legal issues –
Many of these philosophical questions, however, they are answered, have significant social and legal dimensions. For example, advances in medical technology have the potential to create disproportionate disadvantages for some social groups, either by being applied in ways that harm members of the groups directly or by encouraging the adoption of social policies that discriminate unfairly against them. Accordingly, questions of discrimination in bioethics have arisen in a number of areas. In one such area, reproductive medicine, recently developed techniques have enabled parents to choose the sex of their child. Should this new power be considered liberating or oppressive? Would it be viewed positively if the vast majority of the parents who use it choose to have a boy rather than a girl? Similar concerns have been raised about the increasing use of abortion as a method of birth control in overpopulated countries such as India and China, where there is considerable social and legal pressure to limit family size and where male children are valued more highly than female children.
In the field of genetics, the use of relatively simple tests for determining a patient’s susceptibility to certain genetically transmitted diseases has led to concerns in the United States and other countries that the results of such tests, if not properly safeguarded, could be used in unfair ways by health-insurance companies, employers, and government agencies. In addition, the advent of so-called “genetic counseling” in which prospective parents receive advice about the chances that their offspring will inherit a certain genetic disease or disorder has allowed couples to make more informed decisions about reproduction but also has contributed, in the view of some bioethicists, to a social atmosphere considerably less tolerant of disability than it ought to be. The same criticism has been leveled against the practice of diagnosing, and in some cases treating, congenital defects in unborn children.
Research on the genetic bases of behavior, though still in its infancy, is controversial, and it has even been criticized as scientifically invalid. Whatever its scientific merits, however, it has the potential, according to some bioethicists, to encourage the adoption of crude models of genetic determinism in the development of social policies, especially in the areas of education and crime prevention. Such policies, it is claimed, could result in unfair discrimination against large numbers of people judged to be genetically disposed to “undesirable” forms of behavior, such as aggression or violence.
This last point suggests a related set of issues concerning the moral status of scientific inquiry itself. The notion that there is a clear line between, on the one hand, the discovery and presentation of scientific facts and, on the other, the discussion of moral issues the idea that moral issues arise only after scientific research is concluded is now widely regarded as mistaken. Science is not value-neutral. Indeed, there have been ethical debates about whether certain kinds of research should be undertaken at all, irrespective of their possible applications. It has been argued, for example, that research on the possible genetic basis of homosexuality is immoral, because even the assumption that such a basis exists implicitly characterizes homosexuality as a kind of genetic abnormality. In any case, it is plausible to suggest that scientific research should always be informed by philosophy in particular by ethics but also, arguably, by the philosophy of mind. Consideration of the moral issues related to one particular branch of medicine, namely psychiatry, makes it clear that such issues arise not only in areas of treatment but also in matters of diagnosis and classification, where the application of labels indicating illness or abnormality may create serious disadvantages for the individuals so designated.
Many of the moral issues that have arisen in the health care context and in the wake of advances in medical technology have been addressed, in whole or in part, in legislation. It is important to realize, however, that the content of such legislation is seldom if ever, dictated by the positions one takes on particular moral issues. For example, the view that voluntary euthanasia is morally permissible in certain circumstances does not by itself settle the question of whether euthanasia should be legalized. The possibility of legalization carries with it another set of issues, such as the potential for abuse. Some bioethicists have expressed the concern that the legalization of euthanasia would create a perception among some elderly patients that society expects them to request euthanasia, even if they do not desire it, in order not to be a burden to others. Similarly, even those who believe that abortion is morally permissible in certain circumstances may consistently object to proposals to relax or eliminate laws against it.
A final class of social and legal questions concerns the allocation of health care resources. The issue of whether health care should be primarily an individual or public responsibility remains deeply controversial. Although systems of health care allocation differ widely, they all face the problem that resources are scarce and consequently expensive. The debate has focused not only on the relative cost-effectiveness of different systems but also on the different conceptions of justice that underlie them. The global allocation of health care resources, including generic forms of drugs for life-threatening illnesses such as HIV/AIDS, is an important topic in the field of developing world bioethics.
Bioethical Issues in Pandemics –
Influenza pandemics which occur with remarkable, if unpredictable, regularity raises important bioethical issues that need to be examined as part of countries’ pandemic planning, said Benjamin Berkman, a faculty member in the Department of Bioethics at the U.S. National Institutes of Health, during a brown bag talk on January 27 at the headquarters of the Pan American Health Organization/World Health Organization (PAHO/WHO).
Berkman, who has served as a consultant for WHO on the ethical and legal aspects of public health interventions for pandemic influenza, said pandemics raise special concerns, including questions about the allocation of limited supplies of vaccines and antivirals among different population groups, the obligation (or not) of health workers and other essential personnel to report for duty during pandemics, and whether or not wealthier nations have the responsibility to make vaccines and antivirals available to developing nations at a lower cost or despite limited supplies.
Berkman noted that absent a clear domestic or international consensus on many key bioethical issues related to pandemics, more discussion was needed before any new pandemic breaks out.
“The magnitude of the risk is such that it demands a discussion about global equity,” he said.
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 characterized by a naturalistic outlook that leads to a rationalistic, pragmatic approach.
In Africa, their bioethical approach is influenced by and similar to Western bioethics. Some are calling for a change, and feel that indigenous African philosophy should be applied. The belief is that Africans will be more likely to accept a bioethical approach grounded in their own culture and that it will empower African people and give them dignity. In Chinese culture and bioethics, there is not as much of an emphasis on autonomy as opposed to the heavy emphasis placed on autonomy in Western bioethics. Community, social values, and family are all heavily valued in Chinese culture, and contribute to the lack of emphasis on autonomy in Chinese bioethics. The Chinese believe that the family, community, and individual are all interdependent of each other, so it is common for the family unit to collectively make decisions regarding healthcare and medical decisions for a loved one, instead of an individual making an independent decision for his or her self.