History/ Theory of bioethics, medical ethics Flashcards
Misconduct
The violation of bioethical standards
The term ‘bioethics’
1970 Van Rensselaer Potter
Applying biological knowledge and the ‘cybernetic approach’ to ‘human value systems’ with the goal of improving human ‘wisdom’
5th century BC
Hippocratic oath
introduced principles of beneficence and non-maleficence
1750 BC - history
Hammurabi code
The code of Hammurabi mentioned penalties for medical malpractice, an early example of medical ethics
1803 - history
Thomas Percival, Medical ethics
1842 - history
Code of ethics of the AMA
1903 - history
First medical code by italian medical association
1939 - history
Hitler, T4
1947 - history
Nuremberg Code (voluntary consent)
1964 - history
Helsinki Declaration (informed consent, IRB (institutional review boards))
1970 - history
Term Bioethics, van Rensselear Potter
John Gregory, Lectures upon the duties and qualification of a physician (sympathy)
Treaty of non-proliferation of nuclear weapons
1978 - 79 - history
Belmont report (autonomy, beneficence and justice), after Tuskegee syphilis study (infected men not treated to monitor progress)
1968 - history
definition of brain death (harvard)
1972 - history
First recombinant DNA (Stanford, science)
1973 - history
First animal gene clone (frog with e. coli)
1975 - history
Asilomar Conference: request on a moratorium on recombinant DNA molecules
1975 - 77 - history
DNA sequencing
1976 - history
first genetic engineering company produced a human protein in e. coli (Genentech)
Karen Quinlan, a PVS patient, new jersey supreme court allowed disconnecting the feeding tube and respirator
1971 - history
Joseph and Rose Kennedy center for study of human reproduction and bioethics institute
1st wave
Naturalism in Bioethics, 1970
2nd wave
Anti-naturalism, 1990
1927 - history
Fritz Jahr coined german term ‘Bio-ethik’
3rd wave
Pragmatic; end of 1990s
4th wave
Neuroethics, etc; 2002
Naturalism
all beings in the universe are natural (ontological) and all knowledge in the universe can be explained by natural causes (epistemological)
- Emphasize importance of establishing bridges between humanities and biological sciences
- Some social and moral phenomenon can be explained by the biological sciences
- Maintain that ethical norms have a biological basis
Thomas Percival
1803, writes a book on medical ethics that inspired the first code of ethics of the American medical association (1842)
Main themes in literature on medicine and morality
- Character of the physician ( virtue ethics)
- Duties (deontological)
- Social responsibility (consequences)
Eugenics
Thesis that the human race might be improved by deliberately multiplying desirable human qualities and eliminating undesirable ones through selective breeding
- 1883 in inquiries into human faculty, GALTON coined the term eugenics
- Positive: Deliberate selection of desirable traits through reproductive choices
- Negative: Preventing reproduction, either voluntary or not (e.g. marriage prohibition)
- Nazi ‘euthanasia’: killing of people who were not fitting into the stereotype
-Anglo-american (end of 1800): in UK targeted the proletariat, in US the targets are immigrants
Latin: racial Laws and racist language
Nuremberg trial
by the US in Nuremberg, germany after WW2
2nd trial (1946-1947); 9 sentences to long prison terms, 7 with hanging
Right not to know
Expression of autonomy, when patient indicates they do not wish to be informed
Right to be forgotten
Autonomy
e.g. delete patient from database upon request
Privacy
Autonomy and Justice
More general, protection of the whole person’s life
freedom from interference or intrusion, the right “to be let alone,”
Confidentiality
Autonomy and Justice
the obligation of an individual or organization to safeguard entrusted information
Risk-benefit analysis
non-maleficence/ beneficence
a comparison between the potential risks of a situation and its potential benefits
non discrimination
requires the equal treatment of an individual or group irrespective of their particular characteristics
1899 - history
Establishment of the international council of nurses, emphasizing ethical practices in nursing
1950s - history
introduction of respirators and life-extending technology led to debates on brain death and organ donation
The Belmont report
1979
3 core principles
- Respect for persons: Acknowledging autonomy and informed consent
- Beneficence: Promoting well-being and minimizing harm
- Justice: Fair distribution of resources and benefits
Hedonic
Pleasure is the only good
Eudaimonic
moral aspects are good (happiness, flourishing life)
Principle-based
Based on deontological principles
Case-based
based on case-by-case determination
Types of euthanasia
Active:
When a medical professional deliberately do something that causes the patient to die
Passive:
Letting a patient die by withholding artificial life support means
Assisted:
Intervention made by the patient themselves, with the help of the professional
Deductivism in ethics
Moral judgements are justified by pre-existing theoretical structure of norms and principles (linked to deontology)
Principlism
Prescribes moral obligation in terms of principles
components of autonomy
Self-Governance and independence
1) intentionality
decisions/actions cant be accidental; agent has to intend that way
2) understanding
agent must have a sufficient grasp of relevant facts in order to make decision
3) Non-control
agent must be free from external/internal controls (coercion, manipulation etc.)
Components of justice
Distributive
concerns the socially allocation of goods, benefits, resources, opportunities, this allocation is ‘just’ when socially impartial and fair on the basis of norms of social cooperation
depends on theory
utilitarian theory of justice
Justice in maximizing utility socially (in different circumstances): e.g. rights and common goods
Libertarian theory of justice
Justice is distribution given by the laissez-faire market “to each person according to free-market exchanges”: e.g. liberty rights and private property (health insurances are fine): fair procedures, but unexpected outcomes
Communitarian theory of justice
Solidarity (rather than justice) is the responsibility of individuals toward the member of their group/community/tribe/society: decisions depends on shared group values (NO free market)
Egalitarian theory of justice
Justice is equal resource distribution (benefits and social commitments): “Justice is equality”
components of beneficence
Positive:
- providing benefits to others
Utility:
- balancing benefits with costs or side effects (cost benefit analysis (CBA), or risk-benefit analysis (RBA)
Moral obligation to help others in satisfying their own interests
Non-maleficence
Moral obligation to not inflict harm intentionally
Anglo-American bioethics
-Analytic philosophy: Logic as core discipline, postulates continuity between philosophy and science
-Empiricism
-Consequentialism
-Autonomy as negative liberty (absence of obstacles from others: “I am a slave to no man”)
-Maximal concept of autonomy
European bioethics
-Continental philosophy: History as core discipline; postulates distinction between philosophy vs. science.
- Rationalism
-Deontological
-Autonomy as positive liberty (Control over oneself: “I am my own master”)
-Minimal concept of autonomy
Northern-European: Ethics of duty (the duty, Protestant ethics)
Latin-model: Virtue ethics (sacral value of life, Catholic model)
Strong naturalism
First wave of bioethics 1970
The view that everything is determined by the laws of nature
1) no distinction ‘is’ vs. ‘ought’
2) Ethical predicated are natural
3) Ethical knowledge is empirical
4) Ethical norms are natural laws
5) Bioethics are a posteriori (experience)
6)Bioethics are heteronomous (moral laws/norms come from biological sciences)
7) Normative and meta ethics are empirical
Antinaturalism
Classical (bio)ethics
1) Yes ‘is’ vs. ‘ought’
2) irreducible to the natural
3) theoretical
4) not natural laws
5) a priori (theoretical reflection)
6) Bioethics as autonomous
7) are conceptual
Traditionally, both deontological and utilitarian approaches were anti-naturalist
believes in the existence of non-natural entities (ontological), or that non-scientific disciplines can explain reality (epistemological); radical: “ANTISCIENCE” rejects science and the scientific method
Ontological (reality)
all that exists is determined by the laws of nature (no spiritual entities exist)
Epistemological (knowledge)
everything is explained by the sciences (no other kind of explanations) (sometimes referred to as “SCIENTISM”)
Moderate naturalism (pragmatism)
1) Granted with qualification
2) fact-value continuum
3) ‘ought’ implies ‘can’
4) rules proper to human social life
5) interaction, e.g. reflexive equilibrium
6) interdisciplinary
7) normative ethics is normative
CASE-BASED APPROACH (PRAGMATISM)
EMPIRICAL ETHICS, SUCH AS NEUROETHICS (MODERATE NATURALISM)
Descriptive ethics
the empirical observation and study of human (and non-human) moral attitudes, behavior, dispositions, intuition, processes etc.
sometimes called empirical
Evolutionary ethics
how moral behavior evolved by natural selection and why
Neuroethics or neuroscience of morality, includes also moral psychology (and genetics of morality)
how our brains process moral choices, actions etc.
Genetics of morality
Genetic determinants to morality
Experimental ethics
testing people’s ethical intuitions
naturalistic fallacy
implying norms from facts (is = ought)
critiques of principlism
- accused of being overly vague and requiring too much reliance on intuition
-critics argue it simplifies complex moral situations by reducing then to abstract principles
core tenets of utilitarianism
- consequentialism: morality is determined by outcomes
-welfarism: relevant consequences are those that affect overall welfare - Aggregationism: Maximizing total welfare, regardless of its distribution
Critiques of utilitarianism
Impartiality vs. Distribution
- aggregationism is criticized for ignoring fairness in distribution
Moral intuitions:
- critics argue it leads to counterintuitive decisions, such as sacrificing one to benefit many
definition of utilitarianism
emphasizing the morality of actions based on their consequences
The right action is the one that would produce the greatest utility of the greatest number of people
definition of virtue ethics
Virtue ethics focuses on the moral character of the agent rather than rules (deontology) or outcomes (consequentialism). It emphasizes the development of virtuous traits and the role of practical wisdom in moral decision-making
core tenets of virtue ethics
Virtues as habits:
- Morally good actions arise from virtues such as honesty, courage, compassion, and justice
Practical Wisdom (phronesis):
- The ability to make good judgements in specific contexts by balancing virtues
Eudaimonia:
- Living a flourishing, meaningful life is the ultimate goal
Critiques of virtue ethics
Lacks clear guidance for resolving specific moral dilemmas
May lead to subjective interpretation of what constitutes virtuous behavior
Difficult to apply systematically in large-scale public policy decisions
definition of principlism
Principles, such as those outlined by Beauchamp and Childress, are general moral guidelines that inform specific rules and judgements.
These approaches aim to balance conflicting ethical considerations in real-world situations
emphasize four key principles
- autonomy
-beneficence
-non-maleficence
-justice
care ethics definition
an approach to morality that prioritizes relationships, empathy, and the responsibilities we have to each other
Care ethics emerged as a critique of traditional ethical theories like deontology and utilitarianism, which often emphasize impartial rules or consequences over relational and contextual considerations
Core tenets of care ethics
Relational Morality
- Care ethics views moral actions as rooted in relationships and the responsibilities they entail, rather than abstract principles or outcomes
Contextual Decision-making
- Ethical decisions are context-dependent and shaped by understanding the unique circumstances and needs of the individuals involved.
Focus on Emotion and Empathy
- Emotions like compassion and empathy are central to moral reasoning, challenging the traditional emphasis on rationality
Critiques of care ethics
Subjectivity and Partiality
- critics argue care ethics may struggle with impartiality, as prioritizing relationships could lead to favoritism
Systemic Limitations
- Care ethics focuses on personal relationships, making it less effective for addressing large-scale ethical challenges like public policy
Gendered stereotypes
- Some critique its association with ‘feminine’ traits, which may reinforce traditional gender roles
dates for care ethics
1982
Carol Gilligan’s ‘In a Different Voice’ introduces care ethics
1984
Nel Nodding’s ‘Caring’ establishes care ethics as a moral framework
Casuistry / Case based approach
emphasizes practical reasoning through analogical case comparisons rather than abstract principles
Core concepts of casuistry
Focus on particular cases
- Ethical reasoning begins with specific, concrete cases rather than general principles or theories
Analogical reasoning
-Morally challenging cases are resolved by drawing analogies to paradigmatic cases where the moral outcome is clear
Incremental consensus
-Over time, examining similar cases builds a consensus on moral norms and ethical judgements
critiques of Casuistry
Lack of universality
- Critics argue it provides no overarching framework to address systemic issues or novel dilemmas
Reliance on intuition
- moral judgements may become overly subjective or inconsistent without guiding principles
Potential for Bias
- Paradigm cases may reflect historical or cultural biases, limiting casuistry’s inclusivity.
Deontology
An ethical theory, primarily associated with Immanuel Kant, that focuses on the inherent morality of actions based on rules of duties, rather than their consequences
Practical wisdom
Understanding the right thing to do in every given situation, including to balance different aspects (it has to do with rational choice)
core tenets of Deontology
There are strong intuitions to the effect that certain actions are morally required or forbidden
Deontologists usually think that these intuitions are rational
identify fixed moral principles or rules
and that these principles are universal, and absolute
Not always, but often, these are the rules we have been taught
Kantian Maxims
- Act only according to that maxim by which you can also will that it would become a universal law
- 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 means, but always at the same time as an end
- Every rational being must so act as if he were through his maxim always a legislating member in a universal kingdom of ends
Deontology in bioethics
It is usually intended to coincide with the so-called principle-based approach or principialism
The doctrine of double effect
two expected effects, in which one intended or desired and the other unintended or undesired
The unintended bad effect (harm) is a consequence of a good one
the 3Rs
Replacement
- Accelerating the development of methods which avoid or replace the use of animals
Reduction
-Minimizing the number of animals per experiment
Refinement
- Minimizing animal suffering
Human challenge studies/ controlled human infection trial
a clinical trial for vaccine/ pharmaceutical involving the intentional exposure of the test subject to the condition tested
Formal autonomy
refers to the conditions under which a person’s desires, preferences, and decisions are though to the ‘her own’, such that she would be properly considered to be self-governing
Effective autonomy
refers to the match between a person’s formally autonomous desires, preferences, and decisions, and her actual decisions, choices, and behaviours
Traditional values
importance of religion,
parent-child ties, deference to authority and
traditional family values (reject divorce,
abortion, euthanasia and suicide, high levels of
national pride and a nationalistic outlook)
Secular-rational values
less emphasis on
religion, traditional family values and authority
(divorce, abortion, euthanasia and suicide are
seen as relatively acceptable)
Survival values
economic and physical security
Self-expression values
environmental
protection, tolerance of foreigners, gays and
lesbians and gender equality, rising demands
for participation in economic and political life
ethical naturalism
moral facts are natural facts
moral realism
there are objective, mind-independent moral facts
scientific naturalism in morality
objects of human and social sciences are products of our products of our natural structures like our genes and our brains
Compatibilism
Free will and determinism are not mutually exclusive and can co-exist
Eudaimonia
‘flourishing’ or ‘well-being’
the works of Aristotle
for Aristotle, eudaimonia is achieved through living in accordance with virtue - acting in ways that express excellence of character, such as courage, honesty, and wisdom.
Living a life where one’s potential is fully realized
