Nature of Biomedical Ethics & Ethical Theories

Ethics The General discipline of Ethics is defined as the philosophical study of morality. Descriptive ethics. It should be distinguished from Descriptive ethics.

Descriptive ethics: defined as the scientific study of morality. The main goal here is to attain empirical knowledge about morality. It attempts to provide an explanation for the moral views or actions that are already accepted. e.g. why more people are opposing abortion?

Ethics is divided into: 1. Normative ethics : The study of ethical action. philosophers are concerned of establishing what human action is morally right and what is morally wrong. 2. Metaethics: concerned with analysis and meaning of moral concepts (e.g. concept of duty or concept of right) and moral reasoning.

Normative ethics is divided into: a. General Normative ethics : It examines standards for the rightness and wrongness of actions. Philosophers are concerned with establishing an ethical theory that provide a general answer to the question: What is morally right and what is morally wrong? b. Applied Normative ethics : Is concerned with the provision of solutions for particular moral problems. e.g.: is abortion morally justifiable?

Biomedical Ethics: constitute a set of ethical issues (problem areas) associated with the practice of medicine or biomedical research. Task : clarification or resolving of such ethical issues using a reasoned analysis

Biomedical ethics is one branch of Applied Normative ethics established to resolve ethical problems associated with the practice of Medicine and/or biomedical research. Note: all the ethical issues under discussion are Normative in nature.

There are two sets of questions that are typically raised in biomedical ethics: A. Questions related to the ethical justifiability of certain issues encountered in medical practice/research. e.g. Is abortion morally acceptable? Is it morally justifiable to tell a terminally ill patient that he is dying? Is it morally justifiable to breach confidentiality? Is it morally justifiable to experiment on patients? B. Questions related to the ethical justifiability of laws. e.g. Is society justified to enact a law that ban abortion centers? Is society justified to allow others to commit an individual, against his will, to a mental institution?

Evolution of biomedical ethics is related to two cultural developments: 1.Rapid advance in biomedical research (new technology); created new ethical problems and added new dimensions (complexity) to old problems thus making the solving of these matters more urgent. E.g. In-vitro fertilization, euthenasia ( terminate ventilation ), genetic abortion. The value of systemic research on human subjects call for reexamination of ethical limitations. 2. Medical practice becomes more institutionalized and getting more complicated. One provider-patient vs. Group providers-patient. We also became more conscious of the issue of social justice; e.g. right for access to health care and the problems of allocation of resources. Is Refusing blood transfusion as life-saving a suicide? Research on children vs. development of therapeutic technique.

Ethical theories

Existing Ethical Theories: Some theories are briefly discussed since they exist in the literature: A) Utilitarinism: Based on that the rightness of the act is measured by the consequences: The principle is that a person (physician) aught to act so as to produce the greatest balance of good over evil, everyone considered. We should act to produce the most benefits to the patient and causing the least possible risk or harm. Outcomes has to be understood from the patient’s point of view within acceptable constraints (not to prescribe inappropriate medicine based on patient will.

B. Obligation-Based Kants) (deontology): “Act in such a way that you always treat humanity - whether in your own person or in the person of any other - never simply as a mean but always as an end”. There are no legitimate exceptions to a perfect duty. Stands on that the rightness of actions depends on the nature of the act, not on consequences, although effects of actions are considered. Some actions even considered obligatory regardless of the consequences (moral obligations or moral duty). It is motivated from recognition of what is morally required in accordance with and for the sake of obligation.

C. Virtue-Based (Character Ethics): Based on the principle of virtue, which is a character’s trait that might be socially valued or not, but is supported by a moral reasons, obligations, or ideals. Virtue is connected to the individual’s motives such as sympathy, honesty, fidelity, wisdom, & self-restraint. The virtue as an individual characteristic that leads to practicing the right moral principles is what makes a health care professional ethically correct.

D. Rights-Based (Liberal Individualism): The basis is the rights of all parties – the providers of health care and the recipients of it. Patients have rights of autonomy, privacy, confidentiality, information about risks, benefits, and alternatives of any kind of treatment or procedures. On the other hand, health care professional has rights that are stated in the ethical codes concerning the health care. The right is a justified claim validated by moral principles and rules.

E. Community-Based: Based on what community (including the family) values and relationships are present or absent. Community control might overrides individual preferences, thus there should be a balance for the sake of better health care.

F. Relationship-Based (Ethics of Care): Concentrates on the intimate personal relationships such compassion, love. This imply caring for, emotional commitment to, and willingness to act on behalf of persons with whom health professional has a significant relationship. It includes elements of trustworthiness, and the quality of care itself.

G. Case-Based (Casuistry or Reasoning): The proponents of this theory focus on practical treatment of each case. Proper judgment should occur when health professionals deal with each case individually with all details, and comparing the historical records of similar cases.