Bioethics: Issues and Concerns Prof. Monique Frize, ELG5123/94.526

1
Bioethics Issues and ConcernsProf. Monique
Frize, ELG5123/94.526

• Definitions Morality and ethics
• Codes and oaths
• Some current dilemmas
• Problems in measuring a living system
• Human experimentation and consent
• Universality in research and health services?

2
Definition

• Morality What people believe to be right and
  good, and the reasons for it
• Ethics Study of right and wrong of good and
  evil (in human conduct)
• Greek ethos custom
• Latin mos/mores morals

3
Ethical principles

• From ethical theories
• From codes of ethics (nurses, engineers,
  physicians, etc)
• Code for physicians (Hypocratic oath)
• Helsinki Declaration
• Tri-Council principles for research on
  humans
• Hypocratic Oath

4
Some realities today...

• Assisted suicide is now legal in Oregon
• A sheep has been cloned. (A human?)
• Many people try alternative medicines and
  therapies
• We need to learn ethical decision-making.

5
Examples of difficult questions

• Should badly deformed infants be kept alive?
• When should a particular pregnancy be terminated?
• Should treatment cease to allow a terminally ill
  (and suffering) patient to die?
• How do you define death?
• Organ transplants human and animal
  experimentation
• How decisions are made is the ethical problem-
  solving

6
What is involved...

• Quality of life
• Heroic efforts
• Acts of mercy
• Patients (guardians) will
• Future? ...

7
Definition of death

• Absence of breathing (earliest)
• absence of the beating of the heart (later) no
  reflexes
• absence of a vital functioning brain (now, add
  EEG)
• Repeat after 24 hours--no change
• (Valid in absence of hypothermia or barbiturates)

8
Major issues in measuring living systems (human
experimentation)

• 1. Inaccessibility of variables to measure
• 2. Variability of data
• 3. Lack of knowledge about inter-relationships
• 4. Inter-action among physiological systems
• 5. Effect of the transducer on the measurement

9
Some of the basic principles

• Must have research protocol approved by an Ethics
  Review Committee
• Conform to generally accepted scientific
  principles and based on solid previous evidence
  (lab, animal,)
• Must have the safety of the subjects in mind at
  all times (may need a physician present)
• Importance of the objective is in proportion to
  inherent risk to subjects
• Inform subject thoroughly and have a consent form
  signed
• Preserve confidentiality and privacy of subjects

10
Elements of informed consent

• Autononous choice, competence
• Information disclosure
• Understanding
• Voluntariness

11
Material for decision-making

• Purpose of experiment
• Benefits expected
• Diagnostic or therapeutic?
• Elective or essential?
• Known consequences?
• Probable and possible risks
• Alternative treatments and risks
• Possible consequences of refusing

12
Gender equality? Not yet...

• Many research experiments carried out on men only
  (iron loading, coffee and heart, etc..)
• More angiograms and other expensive tests done on
  men than on women for equal risk
• Higher proportion of women die after heart attack
  than men
• Research dollars controlled by male-dominated
  committees and COUNCILS

13
Sources

• http//www.apnet.com/ethics/etharts.htm
• http//wwwgeorgetown.edu/research/nrcbl/
• http//www.learner.org/exhibits/medicalethics/
• http//www.uwc.edu/fonddulac/faculty/rrigteri/biom
  ed.htm
• http//www.onlineethics.com/text/reseth/helsinki.h
  tml
• http//summit.whitaker.org/white/ethics1.html