What Is Ethics?

What Is bioethics?

Short and simple definition:

Ethics is the study of what is good (and what is bad)

What is good?
Vegetables are good for you
- They help improve digestion and excretion
Smoking marijuana is bad for you
- Could result in addiction and loss of control over
decision-making
Surgery would not have done him good
- Would not have eliminated the cancer cells

Case Study
Here you come across situations where a poor man
has 40,000 in his bank, he's got a house and if he dies
he's going to leave behind three children and a wife
who doesn't earn.
So is it worth it (good) that his family spends all of that
on him and then be out on the street after he dies?

What Is good?
Medically good
Matters of fact/logic/
probability
What is? What could be?
Will bring about
successful management
of the patient's
condition

Ethically good
Matters of value
What ought to be?
Will bring about
good

What is good?
Differences in degree:
Acceptable
Excusible / Tolerable
Justifiable
Commendable

Not so short, not so simple

definition:
Ethics is concerned with what is right or wrong, good or
bad, fair or unfair, responsible or irresponsible,
obligatory or permissible, praiseworthy or blameworthy.
It is associated with guilt, shame, indignation,
resentment, empathy, compassion, and care.
It is interested in character as well as conduct.
It addresses matters of public policy as well as more
personal matters.

Utilitarian Approach

Jeremy Bentham, John Stuart Mill

The ultimate end . . . for

the sake of which all
other things are desirable
. . . is an existence
exempt as far as possible
from pain, and as rich as
possible in enjoyments
Actions are right in
proportion as they tend
to promote happiness,
wrong as they tend to
produce the reverse of
happiness

Utilitarian Approach
Whatever can be proved to be good, must be so by
being shown to be a means to something good in
itself.
The medical art is proved to be good by its conducing
to health; but how is it possible to prove that health is
good?

Utilitarian Approach
The art of music is good, for the reason, among others,
that it produces pleasure; but what proof is it possible
to give that pleasure is good?
The proof that something is visible lies in its being
seen; that something is audible in its being heard;
therefore that something is desirable in its being
desired
Happiness is desired by all and is the only thing desired
for its own sake

Utilitarian Approach
Epicurus Roman Philosopher 200-300 BC
Good and evil lie in sensation, pleasure being good and pain
being evil; deities dwell apart from humans and are not
concerned with the state of human existence.

2 Basic Utilitarian Types

Act Utilitarianism choose actions that will increase
the overall good.
Rule Utilitarianism act according to rules that tend
to maximize happiness and diminish unhappiness

Deontological Approach

Immanuel Kant, Kantian, Formalism

There is nothing in this

world, no, nothing even
out of this world, that
can be considered good
without exception,
except a good will.
The value of a good will
does not depend on the
results it manages to
produce as the
consequences of
human action

Deontological Approach
The moral value of the action can only reside in a
formal principle or "maxim," the general commitment
to act in this way because it is one's duty.
"Duty is the necessity to act out of reverence for the
law
Right actions are those that practical reason would will
as universal law

Deontological Approach
THE CATEGORICAL IMPERATIVE
"Act only according to that maxim whereby you can at
the same time will that it should become a universal
law."
"Act in such a way that you treat humanity, whether in
your own person or in the person of another, always at
the same time as an end and never simply as a
means."

Virtue Ethics
Character ethics, represents the idea that individuals
actions are based upon a certain degree of innate
moral virtue.
Cardinal virtues can be found in writings of homer,
plato, aristotle and other early christian thinkers.
With the rise of western moralism these were
considered as virtuous characteristics: wisdom,
courage, temperance, justice, generosity, faith, hope
and charity

Virtue Ethics
Modern and contemporary writers even added:
honesty, compassion, caring, responsibility, integrity,
discernment, trustworthiness and prudence.
It provides guidelines to action. (What ought to be
done?)
Virtue is not a moral requirement. A moral virtue is a
character trait that is socially valued.

Virtue Ethics
A person with moral virtue has both consistent moral
action and desire
Aristotle Ethika, refers to matters having to do with
character.
Goodness of character is to be produced by the practice of
virtuous behaviour, rather than virtuous acts being the end
result of good character.

Phillipa Foot added will as a requirement. disposition

of the heart that is wished for as well as what is
sought

Virtue Ethics
Focal virtues according to Beauchamp and Childress.
Character comprised of a set of stable traits that affect
a persons judgement and action

Compassion
Discernment
Trustworthiness
Integrity

Origins of Bioethics
The word bioethics appeared for the first time in
1970. It was coined by Van Rensselaer Potter, an
American biochemist and professor of oncology at the
McArdle Laboratory for Cancer Research at the
University of Wisconsin-Madison (U.S.A.) for more than
50 years.
Biological sciences had been increasing their
knowledge and technical power continuously, but
reflection about the values at stake has not progressed
in the same proportion.

Origins of Bioethics
Bos, life, representing the facts of life and life
sciences, and thos, morals, referring to values and
duties.
The only profession dealing with life during
centuries and millennia, especially with human life,
has been medicine. But today there are many
sciences and professions working in this field.
Bioethics should not be confused with medical
ethics, which is only one of its branches. The field
of bioethics is very wide and its study is divided in
many branches, each one with its specificity:
Ecological or environmental bioethics, Medical
bioethics, Clinical bioethics.

Bioethics in History
Avicenna (AD 9811037) laid great emphasis on
teaching and practicing medical ethics.
In The Paradise of Wisdom (Ferdous al Hekmat),
Abu al-Hasan Ali ibn-e Raban Tabari (AD 807861)
described the Islamic codes of ethics as: personal
characters of the physician, his obligation towards
patients, his obligation towards the community,
his obligations towards his colleagues, and his
obligations towards his assistants.
Zakariya Rhazes (AD 865925) His work entitled
Spiritual Medicine (Teb-e Rohani) focused on
ethics

Bioethics in History Code of

Hammurabi 1800 BC
If the wife was barren, the husband was allowed to
take a handmaid (slave) from his wife's court and
bear a child for his house. The woman would
consequently become free which was not the case
if she came from the husband's harem.
This concubine was not held in equal status with
the wife but inferior to her. If the concubine became
a rival, the wife could reduce her to slavery again,
sell her or dismiss her from her household.
This is the apparent rule which Abraham and Sarah
followed in the discarding of Hagar from their
household.

Evolutionary Phases in Bioethical Studies

Stages in the Development of Bioethics
Humans are social beings. Even the most primitive
tribes have some code or set of unwritten precepts by
which they act and behave in relation to each other.
This situation brings certain rights and obligations by
which a group or community are supposed to act or
behave. This is what we refer to as group morality or
ethics.

Evolutionary Phases in Bioethical Studies

Morality grows out of human relationships for the sake
of survival. This is the same as with physician-patient
relationship, teacher-student, employer-employee,
labor-management, etc.

Evolutionary Phases in Bioethical

Studies
Medical Ethics
Oldest phase of bioethical exploration; a formulation of ethical
norms for the conduct of health care professionals in the
treatment of patients.

As early as 3rd century BC; Hippocratic

Oath (Hippocrates (460-357 BC)
Oath theocentric pledge made by the physician to both Apollo and
Asclepius, the father-and-son gods of medicine in greek mythology.

Evolutionary Phases in Bioethical

Studies
Medical Ethics

As early as 3rd century BC; Hippocratic

Oath (Hippocrates (460-357 BC)
Underscores the physicians all-out concern for the patient to be kept
from harm and injustice; Moral significance of confidentiality, medical
secrecy.

Evolutionary Phases in Bioethical

Studies
Medical Ethics

Other landmark documents that

followed:
Percivals Medical Ethics (England, 1803)
AMAs Code of Ethics (1847)

Followed by other groups of

professionals; these contributed to the
srticulation of ethical issues and the
formalization of rules of conduct
governing other human relations

Evolutionary Phases in Bioethical

Studies
Medical Ethics
Research Ethics

Second phase, biomedical research, use

of humans as experimental specimens
Third Reich (1933 1945), Adolf Hitler, tremendously influenced by
Friedrich Nietzsches philosophy of will to power (concept of
superman); progress could be attained not by the emancipation of the
masses from poverty but by the cultivation of the superior race of
humans. super offspring; human experimentation on prisoners of
concentration camps

Evolutionary Phases in Bioethical

Studies
Medical Ethics
Research Ethics

Nuremburg Code (Bavaria, West

Germany 1947) attempted to humanize
the cruel and barbaric nature of
experiments. It takes into account the
experimental subjects consent,
informed consent

Evolutionary Phases in Bioethical

Studies
Medical Ethics
Research Ethics
Public Policy
Third stage in the development of bioethical inquiry; refers to
the peoples efforts or involvement in formulating public
guidelines for both clinical cases and biomedical research.

Evolutionary Phases in Bioethical

Studies
Medical Ethics
Research Ethics
Public Policy
Done through surveys, meetings, consultations, conferences,
convocation about their opinions and views on particular
bioethical issues.
Experts from other disciplines are asked to give their
suggestions and recommendations; public discussion is
encouraged and conducted to give everyone an opportunity
to participate in the consultative process

Evolutionary Phases in Bioethical

Studies
Medical Ethics
Research Ethics
Public Policy
After public discussions and consultative meetings, official
enactment of public policies or through legislation is made. In
turn, these are subjected to ethical analysis and evaluation by
experts on a particular subject at issue, so that final
amendments and modifications will be made in conjunction
with the needs of the times and situations. (legal procedure in
determining the legitimacy of moral decisions on several
biomedical issues.