Intro Bioethics

8/18/2019 Intro Bioethics

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INTRODUCTION TOBIOETHICS

DR. M BILALAPPNA Institute of Public Health

Jinnah Sindh Medical University



Ethics (moral philosophy

Addresses!"#hat is the best #ay forpeople to live$" and %#hat actions areri&ht or #ron& in particular

circumstances$" 'ersions

)* +he science of moral duty

,* a set of concepts and principles that&uide us in determinin& #hat behaviorhelps or harms sentient creatures



Ethics (contd*

Areas of studyin& ethics

)* Meta!ethics

,* Normative ethics

-* Applied ethics



.hat is /ioethics$

/ioethics is the study of controversial ethics brou&htabout by advances in biolo&y and medicine*

/ioethics also needs to address emer&in&biotechnolo&ies that a1ect basic biolo&y and future

humans* No# often 2no#n as medical ethics or clinical ethics

3 hospital based issues

Advancements

/ioethical dilemmas arise #hen di1erent parties4albeit all #ell!meanin&4 hold diver&ent values thatlead to opposin& vie#points on appropriate actions



5ommon /ioethical Issues

Abortion

Arti6cial life

5ontraception

Euthanasia Human clonin&

Infertility treatments

Suicide

(Terri Schiavo)



History of /ioethics

+erm coined by 7rit8 Jahr in )9,:*!Animals 'an ;anssellaer Potter used more broader term in

)9<=> “Global Ehic!" (involvin& other disciplinesfor survival of human and others*

+he distinct academic 6eld be&an in the )9:=s inthe United States

Philosophers and theolo&ians #ere later ?oined byphysician!ethicists and la#yers

Scienti6c advances coupled #ith cultural chan&es Ne# emphasis on individual autonomy and ri&hts 3

suspicion of medical paternalism #oc$!e% o& i&%ivi%$al re!earch 'arici'a&

a&% 'aie&



History of /ioethics

Started as concerns re&ardin& research ethics

N$reber Docor!* Trial !! ,- @ermanphysicians #ho either participated in the Na8i

pro&ram to euthani8e persons deemedun#orthy of life% or #ho conductedeBperiments on concentration camp prisoners#ithout their consent #ere tried* +he trial

lasted )C= days* D #itnesses testi6ed andalmost )4== documents #ere introduced* ):of the doctors char&ed #ere found &uilty* <#ere eBecuted*



E+a'le! o, U&ehicalE+'erie&!



Na8i EBperiments





Foctors +rial



Ehical 'ri&ci'le!



+he Nurember& 5ode()9C<)* 'oluntary consent is a must

,* Anticipate scienti6c bene6ts

-* /ene6ts out#ei&h ris2s

C* Animal eBperiments 6rst* Avoid su1erin& to individual

:* No intentional death or disability

<* Protection from harmD* Sub?ect free to stop G #ithdra#

9* uali6ed investi&ators

)=* Investi&ator #ill stop if harm occurs



Feclaration of Helsin2i )9:C

Set of ethical principles for h$a&e+'erie&aio&

5ornerstone document in Human

research ;elaBation on 5onsent!S$rroae

co&!e&



/elmont ;eport )9<D

+hefty ;eport on Ethical considerations

+hree core principles ;espect for others>/ene6cence> Justice*

Important Pre!reuisite for any research

i informed consent4 ii ris2s bene6t

assessment4 and iiiselection of sub?ectsof research*



Ma?or Principles in /ioethics

+om /eauchamp and James 5hildresssPrinciples of Biomedical Ethics in )9D No&-alece&ce a&% Be&ece&ce

Utilitarian 3 harm!bene6t analysis

do no harm

best interest standard

A$o&o/

respect for ones ri&hts and di&nity informed and voluntary consent

0$!ice

fairness

carin& for the most vulnerable



ScenarioK**

Suppose a trolley is runnin& out of controldo#n a trac2* In its path are people #hohave been tied to the trac2* 7ortunately4

you can Lip a s#itch4 #hich #ill lead thetrolley do#n a di1erent trac2 to safety*Unfortunately4 there is a sin&le person tiedto that trac2*

Should you Lip the s#itch$



As the story &oesK**

A physician has 6ve patients4 each in need of adi1erent or&an and #ill die #ithout that or&an*Unfortunately4 there are no or&ans available toperform any of these 6ve transplant operations*

A youn& man #ho ?ust &ot hit by a trolley isbrou&ht into the E;* In the course of assessin&his in?uries4 #hich are not life!threatenin& iftreated immediately4 the doctor discovers that

his or&ans are compatible #ith all 6ve of hisdyin& patients*

.ould it be ?usti6ed for the physician to let thepatient die to harvest his or&ans to save the

other 6ve patients$

S i h i l i



Systematic Approach in ;esolvin&Filemmas

7indin& thou&htful and rational ?usti6cationfor our beliefs and decisions

More than intuitive responses 3 as2 #hy #e

may have certain intuitions4 and ho# tomana&e conLictin& intuitions

Systematic approach can help to identifyessential elements to ethical decision!

ma2in&4 ease pressure4 and promoteconsistency in resolvin& dilemmas

I 5 id i A hi



Issues to 5onsider in Approachin&Filemmas

Fe6ne and identify the ethical dilemma 5larify the facts and identify sta2eholders 3

#hats 2no#n and #hats not$ Medical indications

Fia&nosis4 pro&nosis4 treatments or medicationhistory4 other clinical options4 etc*

PatientG;esidentG7amily (P;7 preferences Advance directives4 code status4 &oals of care4 etc*

uality of life +he P;s subjective evaluation of his or her

situation 5onteBtual factors

Social conteBts4 family situation4 culturalGreli&iousvalues4 6nancial situation4 etc*



Issues to 5onsider(5ontinued

Analy8e and balance the values involved 'arious principles may help 3 autonomy4 bene6cence4

non!male6cence4 ?ustice

.hat do various available options and our prioriti8ationof certain valuesGprinciples over others say about #ho#e are$

Ma2e a recommendation Involve relevant sta2eholders 3 shared decision

ma2in&

7ollo# up and evaluation ensures accountability4 consistency4 and transparency4

thereby promotin& trust and inte&rity



5ase Fiscussion

As a result of an automobile eBplosion4 , year!oldFaB 5o#art #as badly burned over : of his body*/oth eyes4 both ears and both hands #eredama&ed beyond repair* ar&e doses of narcotics

#ere reuired for minimal pain relief* +o control themany infected areas on his body4 5o#art had to besubmer&ed daily in a tan2 of hi&hly chlorinated#ater to disinfect his #ounds* +he eBperience #aseBcruciatin&ly painful4 and 5o#art protested andrefused the %tan2in&s*" He pleaded #ith hiscare&ivers to be allo#ed to die4 and stated severaltimes that he #anted to 2ill himself* +he physiciansturned to his mother to obtain consent for all his

treatments*

Documents

Intro Bioethics