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Bioethics

Resources for education and research on bioethics

Introduction/Definition


The modern field of bioethics emerged in the 1950's and 1960's and represents a radical transformation of the much older, and traditional domain of medical ethics. The Dalhousie Department of Bioethics defines bioethics as the "critical analysis of emerging moral issues in health". A good overview is presented in the section "Bioethics" in the Encyclopedia of Bioethics3rd ed. New York: Macmillan Reference USA, 2004. p278-287.

The term "bioethics" was first used by the biologist Van Rensselaer Potter (Potter, Van Rensselaer. Bioethics: bridge to the future. Englewood Cliffs, N.J.: Prentice-Hall, 1971. DALKIL QH 333 P66). Potter used the term to refer to a new field devoted to human survival and an improved quality of life. Gradually, the term "bioethics" came to refer to "the broad terrain of the moral problems of the life sciences, ordinarily taken to encompass medicine, biology, and some important aspects of the environmental, population and social sciences. The traditional domain of medical ethics would be included within this array, accompanied now by many other topics and problems." (Encyclopedia of Bioethics. 1995. p. 250)

Four general areas of inquiry can be identified:

  • Theoretical bioethics which deals with the intellectual foundations of the field.
  • Clinical ethics which refers to the day-to-day moral decisions confronted in caring for patients.
  • Regulatory and policy bioethics which seeks legal and policy solutions for moral problems concerning life and death. Examples of issues falling into this area would be use of fetal tissue in research, defining death, guidelines for do-not-resuscitate (DNR) orders in hospitals, euthanasia, cloning, rationing health care resources, and so on.
  • Cultural bioethics
  • which considers ethical questions in relation to the historical, ideological, cultural, and social contexts in which they are expressed.

The moral questions of bioethics can also be viewed within broader theories of ethics, such as utilitarianism. A utilitarian approach asks which consequences of a choice or action or a policy would promote the best outcome. In this view, the broader good might be deemed the greatest good. The utilitarian view would, in the context of health care rationing, for example, look for the collective social benefit rather than advantages to individuals.

A deontological perspective, on the other hand, would argue that "good consequences may have to be set aside to respect inalienable human rights". An example would be subjecting individuals to medical research that may do harm to that individual, while providing the potential to help others.

"Other moral theories, such as that of Aristotle, stress neither principles nor consequences but see a combination of virtuous character and seasoned practical reason as the most likely source of good moral judgement." (Ibid., p. 252)

The approach of casuistry is to carefully examine individual cases in the solving of practical moral problems, and to let principles emerge from these over time. This process is similar to case-based English common law.

Robert Veatch, in his 1981 book, A Theory of Medical Ethics (DALWKK W 50 V395t 1981), proposed a new social contract between medicine and society. This "contract comprises basic ethical principles for society as a whole, a contract between society and the medical profession about the latter's social role,and a contract between professionals and laypersons that spells out the rights and prerogatives of each". (Ibid., p. 253)

"Contemporary feminist approaches to bioethics reject... the top-down rationalistic and deductivist model of an ethic of principles." This approach puts much more emphasis on the context of moral decisions, on human relationships, and on the importance of feeling and emotion in making a moral decision. (Sherwin, Susan. No Longer Patient: Feminist Ethics and Health Care. Philadelphia: Temple University Press, 1992. DALWKK W 50 S554 1992)

Daniel Callahan suggests (Encycopedia of Bioethics, 1995, p. 254) that "the first task of bioethics...is to help clarify what should be argued about. A closely related task will be to suggest how these issues should be argued so that sensible, moral decisions can be made. Finally, there will be the more advanced, difficult business of finding and justifying the deepest theories and principles." He suggests that there will be contention in each of these stages, but perhaps over time broad agreement on many issues will/can be reached. He points to such concepts as "patient rights", "informed consent", and "brain death", all hotly debated at one time, have now achieved widespread acceptance.

Callahan identifies two kinds of fundamental questions that bioethics asks (Ibid., p. 255):

  1. "First, what kind of medicine and health care, what kind of stance toward nature and our environment, do we need for the kind of society we want?"
  2. "The second question reverses the first: What kind of a society ought we to want in order that the life sciences will be encouraged and helped to make their best contribution to human welfare?"

The late nineteenth century and first half of the the twentieth century revelled in an aura of triumphal positivism. The predominant attitude was that science produced facts which were solid, authoritative and didn't need to be questioned. Ethics and values occupied a back room of intellectual pursuit, or fell into the domain of religion. Science and medicine in the past half century, however, in forging new frontiers have exposed questions relating to human experience that are soft, relativistic and personal. It is now generally agreed that facts cannot be considered separately from values. Rachel Carson in her book Silent Spring (1962) awoke society to the environmental hazards which have been posed by the human appetite for economic progress and the domination of nature. Today, in the medical and health fields health practitioners are frequently called on to make moral decisions as well as medical decisions. Indeed, it may be held that a good medical decision should be tantamount to a good moral decision. It is in this context that the field of bioethics has emerged as a vitally important field.

"What distinguishes ethics from science is not any special kind of knowledge but merely desire. The knowledge required in ethics is exactly like the knowledge elsewhere; what is peculiar is that certain ends are desired, and that right conduct is what conduces to them." (Russell, Bertrand. What I Believe. New York: Dutton, 1925, pp. 19-24)

* Much of the material in this introduction is taken from the section written by Daniel Callahan entitled "Bioethics" in the Encyclopedia of Bioethics. Rev. ed. Toronto : Macmillan : Simon & Schuster Macmillan ; Prentice Hall International, c1995. Kellogg Library call no.: REF W 50 E56


Select bibliography:

(DALWKK denotes Kellogg Health Sciences Library, Dalhousie University.)

Beauchamp, Tom L., and Childress, James F. 2001. Principles of Biomedical Ethics. 5th ed. New York: Oxford University Press. DALWKK W 50 B372p 2001

Brody, Baruch A. 1988. Life and Death Decision Making. New York: Oxford University Press. DALWKK W 50 B8648 1988

_______________. 1995. "Bioethics" In vol. 1 of Encyclopedia of Bioethics, pp. 247-256 Rev. ed. New York: Macmillan : Simon & Schuster Macmillan ; Prentice Hall International. DALWKK REF W 50 E56

Engelhardt, H Tristram, Jr. 1996. The Foundations of Bioethics. 2nd ed. New York: Oxford University Press. DALWKK W 50 E57f 1996

Fletcher, Joseph F. 1954. Morals and Medicine: The Moral Problems of: The Patient's Right to Know the Truth, Contraception, Artificial Insemination, Sterilization, Euthanasia. Boston: Beacon. DALLAW KB93 F61

The Hastings Center's Bibliography of Ethics, Biomedicine, and Professional Responsibility. 1984 Frederick, MD : University Publications of America in association with the Hastings Center. DALWKK REF ZW 50 B5822 1984

Howell, Joseph H., and Sale, William F. 2000. Life Choices : a Hastings Center Introduction to Bioethics. 2nd ed. Washington, DC : Georgetown University Press. DALLAW K 27.B6 L72

Jonsen, Albert R., and Toulmin, Stephen E. 1988. The Abuse of Casuistry: A History of Moral Reasoning. Berkeley: University of California Press. DALKIL BJ 1441 J66 1988

Pellegrino, Edmund D., and Thomasma, David C. 1981. A Philosophical Basis of Medical Practice: Toward a Philosophy and Ethic of the Healing Professions. New York: Oxford University Press.

Potter, Van Rensselaer. 1971. Bioethics: Bridge to the Future. Englewood Cliffs, N.J.: Prentice-Hall. DALKIL QH 333 P66

Sherwin, Susan. 1992. No Longer Patient: Feminist Ethics and Health Care. Philadelphia: Temple University Press. DALWKK W 50 S554 1992

Veatch, Robert M. 1988. A Theory of Medical Ethics. New York: Basic Books. DALWKK W 50 V395t 1981

Williams, John Reynolds. 2005 Medical Ethics Manual. Ferney-Voltaire, France: World Medical Association. DALWKK W 50 W724m 2005 [Online]

Zaner, Richard M. 1988. Ethics and the Clinical Encounter. Englewood Cliffs, N.J.: Prentice-Hall. DALWKK W 50 Z28e 1988