Bioethics

Bioethics is the philosophical study of the ethical controversies brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy.

History

Terminology

The term Bioethics (Greek bios, life; ethos, behavior) was coined in 1927 by Fritz Jahr, who "anticipated many of the arguments and discussions now current in biological research involving animals" in an article about the "bioethical imperative," as he called it, regarding the scientific use of animals and plants.^[1][2] In 1970, the American biochemist Van Rensselaer Potter also used the term with a broader meaning including solidarity towards the biosphere, thus generating a "global ethics," a discipline representing a link between biology, ecology, medicine and human values in order to attain the survival of both human beings and other animal species.^[3][4]

Development of a discipline

Although bioethical issues have been debated since ancient times, and public attention briefly focused on the role of human subjects in biomedical experiments following the revelation of Nazi experiments conducted during World War II, the modern field of bioethics first emerged as an academic discipline in Anglophone societies in the 1960s. Technological advances in such diverse areas as organ transplantation and end-of-life care, including the development of kidney dialysis and respirators, posed novel questions regarding when and how care might be withdrawn. Furthermore, as philosophy in Britain and elsewhere moved away from the influences of logical positivism and emotivism, the development of theories of ethics and their application to practical problems gained in interest. These questions were often discussed by philosophers and religious scholars; in England, there were notable contributions from GEM Anscombe and RM Hare. By the 1970s, bioethical think tanks and academic bioethics programs had emerged. Among the earliest such institutions were the Hastings Center (originally known as The Institute of Society, Ethics and the Life Sciences), founded in 1969 by philosopher Daniel Callahan and psychiatrist Willard Gaylin, and the Kennedy Institute of Ethics, established at Georgetown University in 1971. The publication of Principles of Biomedical Ethics by James F. Childress and Tom Beauchamp—the first American textbook of bioethics—marked a transformative moment in the discipline.

During the subsequent three decades, bioethical issues gained widespread attention through the court cases surrounding the deaths of Karen Ann Quinlan, Nancy Cruzan and Terri Schiavo. The field developed its own cadre of widely-known advocates, such as Al Jonsen at the University of Washington, John Fletcher at the University of Virginia, Jacob M. Appel at Brown University, Ruth Faden at Johns Hopkins University, and Arthur Caplan at the Center for Bioethics at the University of Pennsylvania. In 1995, President Bill Clinton established the President's Council on Bioethics, a sign that the field had finally reached maturity and acceptance in the United States of America. President George W. Bush also relied upon a Council on Bioethics in rendering decisions in areas such as the public funding of embryonic stem-cell research.

Purpose and scope

The field of bioethics has addressed a broad swath of human inquiry, ranging from debates over the boundaries of life (e.g. abortion, euthanasia) to the allocation of scarce health care resources (e.g. organ donation, health care rationing) to the right to turn down medical care for religious or cultural reasons. Bioethicists often disagree among themselves over the precise limits of their discipline, debating whether the field should concern itself with the ethical evaluation of all questions involving biology and medicine, or only a subset of these questions. Some bioethicists would narrow ethical evaluation only to the morality of medical treatments or technological innovations, and the timing of medical treatment of humans. Others would broaden the scope of ethical evaluation to include the morality of all actions that might help or harm organisms capable of feeling fear and pain, and include within bioethics all such actions of a bear in relation to medicine and biology. However, most bioethicists share a commitment to discussing these complex issues in an honest, civil and intelligent way, using tools from the many different disciplines that "feed" the field to produce meaningful frameworks for analysis.

Principles

One of the first areas addressed by modern bioethicists was that of human experimentation. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was initially established in 1974 to identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects. However, the fundamental principles announced in the Belmont Report (1979)--namely, autonomy, beneficence and justice--have influenced the thinking of bioethicists across a wide range of issues. Others have added non-maleficence, human dignity and the sanctity of life to this list of cardinal values.

Medical ethics

Medical ethics is the study of moral values and judgments as they apply to medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.

Medical ethics tends to be understood narrowly as an applied professional ethics, whereas bioethics appears to have worked more expansive concerns, touching upon the philosophy of science and issues of biotechnology. Still, the two fields often overlap and the distinction is more a matter of style than professional consensus. Medical ethics shares many principles with other branches of healthcare ethics, such as nursing ethics.

Perspectives and methodology

Bioethicists come from a wide variety of backgrounds and have training in a diverse array of disciplines. The field contains individuals trained in philosophy such as Peter Singer of Princeton University, Daniel Callahan of the Hastings Center, and Daniel Brock of Harvard University, medically-trained clinician ethicists such as Mark Siegler of the University of Chicago and Joseph Fins of Cornell University, lawyers such as Jacob Appel and Wesley J. Smith, political economists like Francis Fukuyama, and theologians including James Childress. The field, once dominated by formally trained philosophers, has become increasingly interdisciplinary, with some critics even claiming that the methods of analytic philosophy have had a negative effect on the field's development. Leading journals in the field include The American Journal of Bioethics, Hastings Center Report, the Journal of Medical Ethics and the Cambridge Quarterly of Healthcare Ethics.

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 characterised by a naturalistic outlook that leads to a rationalistic, pragmatic approach. Buddhist bioethicists include Damien Keown. In India, Vandana Shiva is the leading bioethicist speaking from the Hindu tradition. In Africa, and partly also in Latin America, the debate on bioethics frequently focusses on its practical relevance in the context of underdevelopment and geopolitical power relations.

See also

• Bioethics (journal)
• Johns Hopkins Berman Institute of Bioethics
• Linacre Quarterly
• Medical law
• Resources for clinical ethics consultation

Issues

Areas of health sciences that are the subject of published, peer-reviewed bioethical analysis include:

References

Further reading

General bioethics

• Andre, Judith (2002), Bioethics as Practice, Chapel Hill and London: University of North Carolina Press, ISBN 0-8078-2733-9 
• Appel, Jacob (2009), A Supreme Court for Bioethics 
• Aulisio, Mark; Arnold, Robert; Younger, Stuart (2003), Ethics Consultation; from theory to practice, Baltimore, London: Johns Hopkins University Press, ISBN 0-8018-7165-4 
• Faden, Ruth (2004), Bioethics: A field in transition, Journal of Law, Medicine & Ethics 
• Caplan, Arthur Smart Mice Not So Smart People Rowman Littlefield 2006
• Glad, John (2008). Future Human Evolution: Eugenics in the Twenty-First Century. Hermitage Press. ISBN 1-55779-154-6. 
• Emanuel, Ezekiel; Crouch, Robert; Arras, John; Moreno, Jonathan; Grady, Christine (2003), Ethical and Regulatory Aspects of Clinical Research, Baltimore, London: Johns Hopkins University Press, ISBN 0-8018-7813-6 
• Crowley, Mary (ed) (2008), From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book, Garrison, New York: The Hastings Center 
• Beauchamp, Tom; Childress, James (2001), Principles of Biomedical Ethics, Oxford, New York: Oxford University Press, ISBN 0-19-514332-9 
• Jonsen, Albert; Veatch, Robert; Walters, leRoy (1998), SourceBook in Bioethics, Washington: Georgetown University Press, ISBN 0-87840-685-9 
• Jonathan, Baron (2006). Against Bioethics. The MIT Press. ISBN 978-0-262-02596-6. 
• McGee, Glenn (2003), Pragmatic Bioethics, Cambridge: Massachusetts Institute of Technology Press, ISBN 0-2626-3272-1 
• Khushf, Tom (ed) (2004), Handbook of Bioethics: taking stock of the field from a philosophical perspective, Dordrecht, Boston, London: Kluwer Academic Publishers, ISBN 1-4020-1893-2 
• Korthals, Michiel; Robert J. Bogers (eds.) (2004). Ethics for Life Scientists. Springer. ISBN 978-1-4020-3178-6. 
• Kuczewski, Mark G.; Ronald Polansky (eds.) (2002). Bioethics: Ancient Themes in Contemporary Issues. The MIT Press. ISBN 978-0-262-61177-0. 
• Murphy, Timothy (2004). Case Studies in Biomedical Research Ethics. The MIT Press. ISBN 978-0-262-13437-8. 
• Ravitsky, Vardit; Fiester, Autumn; Caplan, Arthur (eds.) (2009), The Penn Center Guide to Bioethics, New York: Springer, ISBN 978-0826115225 
• Singer, Peter A.; Viens, A.M. (2008), Cambridge Textbook of Bioethics, Cambridge: Cambridge University Press, ISBN 978-0-521-69443-8 
• Sugarman, Jeremy; Sulmasy, Daniel (1999), Confessions of a Medicine Man, Cambridge: MIT Press, ISBN 0-262-70072-7 
• Tauber, Alfred I (2005), Patient Autonomy and the Ethics of Responsibility, Cambridge: MIT Press, ISBN 0-262-70112-x 

Christian bioethics

• Colson, Charles W. (ed.) (2004). Human Dignity in the Biotech Century: A Christian Vision for Public Policy. Downers Grove, Illinois: InterVarsity Press. ISBN 0830827838
• Demy, Timothy J. and Gary P. Stewart. (1998). Suicide: A Christian Response: Crucial Considerations for Choosing Life. Grand Rapids: Kregel. ISBN 0825423554
• Pope John Paul II. (1995). Evangelium Vitae: The Gospel of Life. New York: Random House. ISBN 0812926714
• Kilner, John et al. (1995). Bioethics and the Future of Medicine: A Christian Appraisal. Grand Rapids, Michigan: Wm. B. Eerdmans Publishing Company. ISBN 0802840817
• Kilner, John F., Arlene B. Miller, and Edmund D. Pellegrino (eds.). (1996). Dignity and Dying: A Christian Appraisal. Grand Rapids, MI: Eerdmans Publishing Co.; and Carlisle, United Kingdom: Paternoster Press. ISBN 0802842321
• Meilaender, Gilbert (2004). Bioethics: A Primer For Christians. Grand Rapids, Michigan: Wm. B. Eerdmans Publishing Company. ISBN 0802842348
• Loudovikos, Nikolaos, Protopresbyter (2002). The Individualization of Death and Euthanasia, Holy Synod of the Church of Greece, Committee of Bioethics, Scientific Conference on Euthanasia (Athens, May 17–18, 2002), retrieved on February 27, 2009. (Article in Greek).
• Pope Paul VI. (1968). Humanae Vitae: Human Life. Vatican City.
• Smith, Wesley J. (2004). Consumer's Guide to A Brave New World. San Francisco: Encounter Books. ISBN 1893554996
• Smith, Wesley J. (2000). Culture of Death: The Assault on Medical Ethics in America. San Francisco: Encounter Books. ISBN 1893554066
• Smith, Wesley J. (1997). Forced Exit: The Slippery Slope from Assisted Suicide to Murder. New York: Times Books. ISBN 0812927907
• Stewart, Gary P. et al. (1998). Basic Questions on Suicide and Euthanasia: Are They Ever Right? BioBasics Series. Grand Rapids: Kregel. ISBN 0825430720
• Stewart, Gary P. et al. (1998). Basic Questions on End of Life Decisions: How Do We Know What's Right? Grand Rapids: Kregel. ISBN 0825430704
• Westphal, Euler Renato. O Oitavo dia – na era da seleção artificial (See The Eighth Day (book) Review) . 1. ed. São Bento do Sul: União Cristã, 2004. v. 01. 125 p. ISBN 85-87485-18-0

Jewish bioethics

• Bleich, J. David. (1981). Judaism and Healing. New York: Ktav. ISBN 087068891X
• Dorff, Elliot N. (1998). Matters of Life and Death: A Jewish Approach to Modern Medical Ethics. Philadelphia: Jewish Publication Society. ISBN 0827606478
• Feldman DM. (1974). Marital relations, birth control, and abortion in Jewish law. New York: Schocken Books.
• Freedman B. (1999). Duty and healing: foundations of a Jewish bioethic. New York: Routledge. ISBN 0415921791
• Jakobovits I. (1959). Jewish Medical Ethics. New York: Bloch Publishing.
• Mackler, Aaron L. (ed.) (2000). Life & Death Responsibilities in Jewish Biomedical Ethics. New York: JTS. ISBN 0873340817.
• Maibaum M. "A 'progressive' Jewish medical ethics: notes for an agenda" in Journal of Reform Judaism 1986;33(3):27-33.
• Rosner, Fred. (1986). Modern medicine and Jewish ethics. New York: Yeshiva University Press. ISBN 0881250910
• Conservative Judaism Vol. 54(3), Spring 2002 (contains a set of six articles on bioethics)
• Zohar, Noam J. (1997). Alternatives in Jewish Bioethics. Albany: State University of New York Press. ISBN 0791432734

Muslim bioethics

• Al Khayat MH. "Health and Islamic behaviour" in: El Gindy AR, editor, Health policy, ethics and human values: Islamic perspective. Kuwait: Islamic Organization of Medical Sciences; 1995. p. 447-50.
• Ebrahim, Abul Fadl Mohsin. (1989). Abortion, Birth Control and Surrogate Parenting. An Islamic Perspective. Indianapolis. ISBN 0892590815
• Esposito, John. (ed.) (1995). "Surrogate Motherhood" in The Oxford Encyclopedia of the Modern Islamic World (vol. 4). New York: Oxford University Press. ISBN 0195096150
• Karic, Enes. "The Ethics of Cloning" in Islamica Magazine Fall/Winter 2004. Issue #11

Buddhist bioethics

• Florida, R. E. (1994) Buddhism and the Four Principles in Principles of Health Care Ethics, ed. R. Gillon and A. Lloyd, Chichester: John Wiley & Sons, 105-16.
• Keown, Damien. (1995) Buddhism & Bioethics. London and New York: Macmillan/St. Martins Press.

Hindu bioethics

• Coward, H. G., J. J. Lipner, and K. K. Young. (1989) Hindu Ethics: Purity, Abortion, and Euthanasia. Albany: State University of New York Press.
• Crawford, S. C. (2003) Hindu bioethics for the Twenty-first Century. Albany, NY: State University of New York Press.
• Crawford, S. C. (1995) Dilemmas of Life and Death, Hindu Ethics in A North American Context 1995. Albany, NY: State University of New York Press.
• Firth, S. (2005) End-of-life: a Hindu view. The Lancet. 366(9486): 682-686.
• Lakhan, Shaheen. (2008) Hinduism: life and death. Student BMJ. 16(18):310-311.