History of Bioethics

Dr. K.L. Ward

Assistant Professor
School of Chemistry, Environmental and Life Sciences
The College of The Bahamas
Introduction
History of Bioethics
International code of ethics
Role of science in society
Models of ethical analysis
Ethics is often defined as moral philosophy and deals with the proper cause of action for a being
(significant role in daily choices).
Moral philosophy
concerns about what is right (e.g. right and wrong behaviour)
decreases random, aimless actions
involves systematizing, defense and recommendations
Ethical theories are catogorised into the general areas
1. Metaethics
where are ethical principles derived and why
what types of beings have rights
emphasis is placed on universal truths (e.g. the will of God)
2. Normative ethics
involves practical moral standards for regulations (e.g. regulating behaviour practicing
right from wrong)
3. Applied ethics
zooms in and examines specific controversial issues (e.g. euthanasia)
Being ethical does not simply mean following the laws that govern a country or doing what society accepts
(e.g. abortion, homosexuality)
Bioethics (formerly referred to as medical ethics)
bio=life and ethos=behaviour (Greek term)
legitimate field of academic study; is applied ethics
resulted from medical and public discourse on crucial moral dilemmas in medicine/healthcare and
research (e.g. Tuskegee experiment)
became an academic study during the early 1960s (major contributors being scholars from the
religion and/or philosophy schools of universities)
creation of academic bioethics (1970)
involves the study of controversial questions/topics
controversial topics surround the disciplines of medicine, theology, politics, life sciences, law and
moral philosophy
actual emergence of bioethics was due to the outcome of infamous, historical developments (social
and technological), setting of laws/ precedents, medical scandals, life and death issues (incl.
abortion)

bioethics is centered around case studies that involve the application of moral, philosophical
theoretical reasoning e.g. fertility treatment and the famous octomom

History of bioethics
term coined by Fritz Jahr (1927), a protestant pastor, philosopher and educator
Bioethics first mentioned in an article bioethical imperative that mentioned the scientific use of
animals and plants
field of bioethics was formed in 1960s following public outcry against Russian Nazi experiments
during WWII of POWs
experiments involved the unethical use (without consent) of prisoners in concentration camps
experiments included immunological experiments for prevention and treatment of malaria and
diseases like tuberculosis, mustard gas in an attempt to find an antidote, cheap, effective
sterilization of Jews and other genetically misfit individuals
public outcry led to the Nuremberg Trials (1945-1949)
as a result the Nuremberg Code of medical ethics was established
code provides regulations/guideline for human experimentation
eventually an International code of Ethics was designed
International code of ethics
generalized guidance
designed to promote moral theory during decision making
emphasis placed on understanding of right and wrong
such understanding then applied in decision making process
universal application
aims to set standards, role expectations and responsibilities for members of a specific profession
Three levels of the ethical code exist:
1. Code of business (corporate) ethics
2. Code of conduct for employees
3. Code of professional practice (conduct)
1. Code of business ethics
general principles/guidelines set by organizations relating to social issues e.g. quality
includes cause for improper conduct or violation
efficacy is dependent upon the organizations enforcement
code of employee conduct is often generated from a well-defined and enforced code of business
ethics
2. Code of employee conduct
highly specific
describes the dos and donts for employees e.g. Anna Nicole and the gift of a Rolex watch
efficacy is dependent upon an organizations enforcement - in many instances violation results in
termination
3. Code of professional practice (conduct)
Adopted by a particular profession, governmental or non-governmental organization to regulate a
particular profession
sets guidelines to aid in decision making for cases within a particular profession

Moral theories
ethical theories and principles is the basis of ethical analysis
provides guidance on decision making
theories emphasize different points in an attempt to make an ethically correct decision
Deontological ethics (aka Kantian deontology: Immanuel Kant)
Greek term: deon=duty and logos= study or science
emphasis is placed on obligations and what is right
actions are morally correct and with good intentions e.g. wearing seat belts, stopping when traffic
light is red, keeping promises
Kantian deontology states that individuals are to act in ways that are logical and rational despite
ones feelings or emotions
W.D. Ross and deontological ethical theory
actions are right not based on consequences but rather these are acts that fulfill duties
Prima facie (on the face of) duties
three types of duties:
1. Reparation (e.g. borrowing money and paying off the debt)
2. Gratitude
3. Keeping faith
Kant states that reason can identify right from wrong hence the Categorical Imperative
Categorical imperative
considered the law of reason that commands (imperative) unconditionally, necessarily, and
universally (categorical)
two formulas exist:
1. Formula of universal law
- act in such a way that the maxim (reason) of your action could be willed to be a
universal law
- act in a manner that we will be willing to allow others to act the same
- based on principle of universalizability e.g. if you can lie then morally you should
permit others to lie
2. Formula of Humanity
- act in such a way that you treat persons as ends in themselves and not merely as
means
- actions are considered moral only when it recognizes the dignity, intrinsic value and
autonomy of an individual (respect for others)
- persons are not things but we use them as means in a particular situation e.g. nurses
caring for patients
Pitfalls of deontology
sometimes it is difficult to determine if the rules are contrary to reason
takes rules and actions seriously/literally
can have unrealistic expectations
can possibly ignore emotions and relationships

Consequentialism
morality here is dependent upon consequences of actions
basically an action is right if it produces good results compared to another action
problem of controversy exist
unclear as to what type of consequences are good
- e.g. fatal car accidents may mean the speed limits are too high by contrast people will always
die in fatal car accidents therefore it may not necessarily mean that speed limits are too high
but then too high speed limits kill versus too low speed limits cause traffic problems
- focusing on the number of deaths and decreasing the deaths may be seen as a good result in
this case
another example would be pulling the plug on a comatose patient (elderly) to save the lives of
seven other people waiting for organs
consequentialism may indicate that it is right but the act of pulling the plug is against a human
rights
consequentialism theory gives rise to utilitarianism (most influential form of utilitarianism)
Utilitarianism
Jeremy Bentham and animal cruelty
resulted from social reformers (incl. John Stuart Mill)
supported suffrage for women and abolition of slavery
proposed that prisoners be reformed and not simply punished
proposed with an intention to make sure that everyone was happy
happiness for all = greatest happiness
an act or rule is right if the consequences are good (i.e. results in happiness)
basically utilitarianism proposes that we are all to act in manner that maximizes happiness for all
(or the greatest number of people)
hedonistic calculus: mathematical calculation that focuses on pleasure and avoidance of pain
(work of Bentham and Mills)
Jeremy Bentham describes several ways of measuring the value of pain or pleasure
1. Intensity more intense pleasure is more than least felt pleasure
2. Duration a long lasting pleasure is worth more than a short term pleasure
3. Purity a pleasure free from pain is worth more than a painful pleasure
4. Extent (fecundity) pleasure likely to produce more pleasure; how many persons does pleasure
affect
Sum: Total good total bad = true happiness
pain is measured in a similar way
pain is greater therefore unhappiness is greater
while deontology focuses on individuals and duty; by contrast utilitarianism focuses on the
common good and best consequences
utilitarianism still presents with controversy
Rule Utilitarianism Vs Act Utilitarianism
In society, it is difficult to measure whether an action brings good or bad result to the majority.
It is common to do evil with good intentions or do good with bad intentions.
Hence, utilitarianism can be further divided into two schools --- Rule Utilitarianism and Act Utilitarianism.
Act utilitarianism
supports and maintains the fact that the greatest happiness must always be applied

morally assess individual cases independent to the rules

decision making places emphasis on happiness in first instance

Rule utilitarianism
states that the principle of happiness must be applied to rules
tend not to be sensitive to difference among cases
decision making involves adhering to the rules but still aims to induce happiness
Basically utilitarianism maintains that happiness is the true goal.
Justice theory (aka rights theory)
does not involve a single moral thinker
Aristotle and John Rawls are often praised for contributions as architects for this theory
similar to deontology and utilitarianism as it intends to provide a standard for right versus wrong
emphasis is placed on the principle/value of justice
justice is seen as getting what one deserves
also involves respecting ones rights and fair treatment
employs the concept of rights
moral controversy exist; are some rights more important than others e.g. abortion: mothers rights
versus foetus rights
right to healthcare serious injury; no insurance
such controversy may result in decision making being based on combined theories: justice theory +
utilitarianism
despite controversy, justice theory focuses on the rights of an individual
Virtues ethics
focus is on persons and not actions
concerned with people that act and not necessarily the actions they perform
emphasis is placed on good character or good nature persons can perform good/right acts but do
not possess a good/virtuous character
being coerced into performing a good action differs greatly from choosing to become a person of
honest values
virtuous individuals are more likely to act/perform acts that are consistently moral (e.g. generosity,
temperance, friendliness)
according to Aristotle, people become virtuous by practicing good actions
virtue is considered the mean between extremes (in the middle of doing too much or too little) e.g.
virtuous people are courageous courage is the mean between recklessness and cowardice
Reading assignment: Care ethics and natural law
The four principles approach
devised by Tom Beauchamp and James Childress
Beauchamp and Childress proposed that answers to bioethical issues can be effectively determined
by employing four principles that are the core to medicine and other careers.
1. Autonomy - self governance
2. Justice - fairness; treat all cases the same
3. Beneficence - always aim to do good
4. Non-malfeasance - aim to not do harm

Respect for autonomy

proposes that well able, rational, competent individuals make their own decisions
based on an individual knowing their own values, beliefs, desires and preferences
dismisses paternalism (rule by the father) that can be equated to parent stating what is best for
child or doctor determining what is best for patient (paternalistic medicine)
permits persons to give their free willed, informed consent
informed consent is a matter of legality but also indicates that persons are entitled to respect
decreases litigations
Justice
aim to treat all the same with fairness, justness and equality (i.e. provision and delivery of service)
important in cases involving allocation and rationing of resources (e.g. beds in a hospitals,
scholarships for students)
Beneficence
proposes that goodwill or the act of doing good is done in all cases
seen as moral only when practiced correctly
Non-malfeasance
aim not to do harm
may sometimes involve risk (e.g. lifesaving procedure or not offering treatment due to the serious
side effects)
Casuistry
historically employed by the Romans and the Greeks (Cicero and Aristotle)
commonly described as case based reasoning or rule based reasoning
seen by many as clever but unsound reasoning
can also be seen as misleading
involves the application of theoretical rules to certain cases
may involve extracting from or an extension of theoretical rules or principles e.g. lying is morally
wrong but a casuist may say that lying can save a life in a particular case
Communitarian bioethics
decision making that benefits an entire community
decision making is often debated in public spaces
decreases the focus on individual rights but increases attention on communal responsibilities
all individual are responsible for occurrences in their community