Ethical and bioethical issues - PowerPoint PPT Presentation


PPT – Ethical and bioethical issues PowerPoint presentation | free to download - id: 5dc44c-NjllY


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation

Ethical and bioethical issues


Title: PowerPoint Presentation Last modified by: Eric Created Date: 1/1/1601 12:00:00 AM Document presentation format: (4:3) Other titles – PowerPoint PPT presentation

Number of Views:423
Avg rating:3.0/5.0
Slides: 54
Provided by: intranetT2


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Ethical and bioethical issues

Ethical and bioethical issues
Bioethics - what is it
  • Bioethics is a specific discipline that probes
    the reasoning behind our moral life within the
    context of the life sciences how we decide what
    is morally right or wrong bioscience
  • Ethics is different from morals. Ethics tries to
    probe the reasoning behind our moral life, by
    examining and analyzing the thinking used to
    justify our moral choices and actions in
    particular situations

Bioethics what is it
  • Bioethics is normative ethics applied to the
    practice of science and medicine. It falls under
    the general group of applied and professional
  • It is predicated on an assumption that some
    solutions to the ethical problems that arise in
    science and medicine are more moral than others
    and that these solutions can be arrived at by
    moral reasoning and reflections

Bioethics what is it
  • It is a branch of knowledge like mathematics, and
    thinking in this field is not wholly different
    from thinking in those other fields, however it
    cannot be reduced to them.
  • Bioethical conclusions cannot be unambiguously
    proved like mathematical theorems
  • Research ethics or more specifically health
    research ethics is the branch of bioethics that
    deals with issues relating to the ethical conduct
    of research

History of bioethics
  • There was little broad interest in research
    ethics before the Second World War
  • Smidovichs The Confessions of a Physician (1901)
  • Public concern about Walter Reeds yellow fever
    research in the United States
  • The Nuremberg trial that followed the evil that
    was Nazi war experiments which were marked by
    unprecedented cruelty and inferior science,
    focused attention on the need for a code of
    research ethics
  • Prosecutors argued that the experiments violated
    fundamental ethical standards of civilized society

History of bioethics
  • The Nazi war experiments were more bizarre given
    that in 1931, Germany had enacted strict
    Richtlinien to control human experimentation
    and the use of innovative therapies in medicine
  • Two of the 14 provisions of these guidelines
    concerned consent requirements
  • Questions about nature of appropriate
    information, bona fide consent, careful research
    design, special protections for vulnerable
    subjects were all carefully outlined
  • Experimentation on dying patients was completely

History of bioethics
  • No other nation had such legally and morally
    advanced regulations at this time
  • These regulations were in force and binding
    throughout Germany from before and through the
    duration of the Second World War
  • They were no less comprehensive and adequate than
    the more popular Nuremberg Code
  • Yet, the Nazi experiments comprehensively ignored
    and violated every one of the regulations
  • The defendants argued that voluntary
    participation by human subjects in medical
    experimentation was not the norm at that time

Nuremberg code 1948
  • The main components of the code are
  • Requirement for voluntary participation
  • Informed consent
  • Favorable risk/benefit analysis
  • Right to withdraw without penalty
  • Criticized for being legalistic
  • Largely ignored by medicine
  • No mention of independent review or fair
    selection of participants

1950s Wichita Jury Study
  • Social science researchers from the University of
    Chicago conducted a study involving secret audio
    taping of jury deliberations in order to better
    understand decision making process of jurors in
    criminal trials
  • Their hypothesis was that showmanship on the part
    of trial attorneys was affecting the outcome of
  • When the results were presented in respectable
    academic forums, public reaction was markedly

1950s Wichita Jury Study
  • People objected to deception for research
    purposes in a setting where privacy and
    confidentiality were critically important
  • This prompted the U.S. Congress to pass a law
    prohibiting recording of jury deliberations,
    marking the first time that actions of well
    meaning researchers will result in action to
    protect people from exploitation
  • Case highlighted the fact that some research
    questions cannot be answered without compromising
    the integrity of significant and cherished social

1960s Thalidomide Study
  • Thalidomide was introduced for the treatment of
    hyperemesis gravidarum in Europe and while still
    undergoing review in the U.S., an influential
    group of East Coast practitioners started using
    it before it became clear that it was causing a
    large number of birth defects
  • Public outrage led to legislation that required
    investigators to obtain informed consent before
    administering investigational medications

1964 World Medical Council Declaration of Helsinki
  • This basically builds on the Nuremberg code and
    adds two additional points
  • That the interests of the subject should always
    be given a higher priority than those of society
  • That every subject in clinical research should
    get the best known treatment

Other seminal events
  • Henry Beechers 1959 Experimentation in Mans
  • 1960 1963 The Law-Medicine Research Institute
    of Boston Universitys survey of researhers
    attitudes and the anthology Clinical
    Investigation in Medicine
  • Henry Beechers article in NEJM in 1966
    discussing 22 out 50 collected cases of unethical
    research in Americas leading universities
  • 1966 - Henry Beechers editorial in the Journal
    of the American Medical Association and argument
    for virtue ethics
  • 1967 - M.H. Papworth Human Guinea Pigs
    collected more than 500 papers describing
    unethical experiments

Other seminal events
  • 1972 Jay Katz, Alex Capron and Eleanor Glass
    Experimentation with Human Beings
  • 1973 Congressional hearings on quality of health
    care and human experimentation
  • Main catalyst for this was the Tuskegee Study
    (1932 1972), but there were others, like
  • 1950 Willowbrook Hepatitis Study
  • 1960 Jewish Chronic Diseases Hospital Studies
  • 1960 Milgram study of obedience
  • 1970 San Antonio study of contraceptive pills
  • 1970 Humphreys Tearoom Trade Study
  • 1970 Zimbardos Mock Prison Research

1974 U. S. National Research Act
  • This act established the modern research ethics
    system. The act created U.S. federal regulations
    that required ethical approval before most kinds
    of research involving human subjects can be
    conducted, defined policy and procedures that EC
    must follow when reviewing research, and
    established the criteria that an EC must use to
    approve research conduct
  • It also established the National Commission for
    the Protection of Human Subjects of Biomedical
    and Behavioral Research. The function of the
    Commission is to issue recommendations when what
    to do is not clear to researchers.
  • In 1978, the Commission issued the Belmont Report

Other influences on development of bioethics
  • The 60s and 70s civil rights movement in the
    United States with distrust of authority,
    emphasis on individual rights and autonomy
  • The pace and variety of development of new health
    care technology
  • The Cold War and fear of any type of socialism
  • The allocation, by the NHGRI, of substantial
    funds to bioethics in 1989 leading to
    codification of the currently predominant
    academic mode of discourse for bioethicists
    research concerning ethical issues as they are
    encountered and resolved in society, culminating
    in data that is subject to the same rigors of
    peer review as other social science.

How bioethical dilemmas are resolved
  • Ethical dilemmas continue to arise in research
  • Should we select some people and expose them to
    an unproven but potentially beneficial treatment
    so that we can know if the rest of the population
    can benefit
  • How should we select such people
  • Who should we select
  • Why
  • Should such research participants be compensated
  • How should they be compensated

How ethical dilemmas are resolved
  • If the questions are clear cut, there is no
  • Many times they are not and that is where the
    ethical dilemma arises. To resolve this, we look
    for guidance
  • Guidance are based on
  • The arguments are conducted within an established
    ethical framework
  • Arguments that lead to the particular conclusions
    are supported by reason
  • A reasonable consensus exists about validity of
    the conclusions, arising from a process of
    genuine debate

Why not rely on reason alone
  • Reason alone is insufficient as there is no
    single universally accepted reason-based
    framework within which ethical questions can be
  • Nor is one likely in the future
  • E.g., reason alone cannot decide between an
    ethical framework that looks only at consequences
    and one that considers intrinsic rightness or
    wrongness of actions regardless of the
  • The history of discrimination against women for
    example provides strong arguments against
    reliance on reason alone

The need for ethical frameworks
  • The insufficiency of reason justifies the need
    for established ethical frameworks
  • The most widely accepted ethical frameworks in
    most cultures arose within systems of religious
    belief but these have limitations such as
  • A significant number of people do not accept
    scripture as the source of moral thinking
  • Human plurality is associated with scriptural
  • Many modern biotechnological issues are not
    addressed in the scriptures

Ethical frameworks
  • Despite these limitations, it is still necessary
    to consider the ethical frameworks because
  • Lives are not lived in isolation. We all grow up
    within certain mores and traditions
  • None of us derives our ethical thinking from
    first principles
  • Alternative ethical traditions are already
    accumulating, for example about biotechnology

How then should we resolve bioethical dilemmas?
  • The simplest way to decide whether an action is
    right or wrong is to look at the consequences
  • No one can argue that we should ignore
    consequences of an action before deciding whether
    it is right or wrong
  • But we can consider the consequences of our
    response and that of alternative responses
  • How far can we or should we go in consideration
    of consequences of specific actions?

Bioethical dilemmas
  • Even when we are in complete agreement about a
    moral question, consequences still have to be
  • The deeper question is not whether to take
    consequences into account when making ethical
    decisions but whether that is all we need to do
  • Are certain actions morally required, regardless
    of their consequences?
  • It would appear that the answer to these
    questions are obvious, but this is not the case

  • Consequentialists believe that consequences alone
    are sufficient to determine a course of action.
    Example is utilitarianism
  • Utilitarianism begins with the assumption that
    most actions lead to pleasure or to happiness
  • Its earliest origins can be found in the work of
    Mo Tzu in 5th Century BC, but the most popular
    exponent is Epicurus (341 271 BC) who combined
    consequentialism with hedonistic theory of value

  • There are many versions of utilitarianism, for
    example preference utilitarians argue for a
    subjective understanding of pleasure in terms of
    an individuals own perception of his/her
  • Utilitarians have no moral absolutes beyond
    maximization of the pleasure principle
  • Rather they examine particular cases in detail to
    see whether it would lead to greatest net
    increase in pleasure

  • This system has 2 great strengths
  • It provides a single ethical framework for all
  • Pleasure and Happiness are taken seriously
  • Limitations
  • Not always practicable. Detailed examination of
    every action will soon bring all actions to a
  • How do we measure pleasure?

Intrinsic Ethical Principles
  • Considers intrinsic nature of the action,
    whether, it is right or wrong
  • There are a number of possible intrinsic ethical
    principles depending on the rights and
    obligations to which they are concerned
  • This approach to ethics is called deontological
    (rights discourse)

  • Deontology considers the intrinsic value of
    actions rather than their consequences
  • Immanuel Kant German philosopher held that an
    act is moral only if it springs from a good
    will not because it gives us pleasure or leads
    to good consequences
  • He constructed a formal Categorical Imperative
    as the ultimate test of morality I ought never
    to act except in such a way that I can also will
    that my maxim should become universal law

  • Kant said a moral rule is one that can serve as a
    guide for everyones conduct
  • It allows people to treat others as ends in
    themselves and not solely as a means to someone
    elses ends
  • It is a rule that one can impose on oneself by
    ones will and not by the imposition of another
  • It embodies the principles of autonomy
    (individual rights) and justice (fair
    distribution of resources and opportunities), and
    is the basis for social contract approach in

  • Justice is a broader concept
  • It is about fair treatment, fair distribution of
    resources or opportunities
  • But this is associated with considerable
  • For examples, a lot of people accept that unequal
    distribution of certain resources (e.g.
    educational opportunities) may be fair provided
    certain other criteria are satisfied (e.g.
    educational opportunities are purchased with
    money earned or inherited)
  • Others have argued that we should all be

Natural Law approach
  • First developed by Thomas Aquinas, it states that
    actions are morally right if they accord with our
    nature as human beings. The attribute that is
    distinctively human is our ability to reason and
    exercise intelligence. The theory thus argues
    that we can know what is morally right through
  • Theory of virtue stresses the disposition of
    individuals to act virtuously

Virtues of a researcher
  • Temperance in personal life
  • Justice
  • Honesty
  • Courage
  • Compassion
  • Professional competence
  • Practical judgment

  • Much heat and little motion when proponents of
    one theory or the other argue
  • It has been argued that a middle level of ethics
    discussion between the abstractions of ethical
    theories and specifics of moral judgments are
  • While ethicists are needed, there is a far
    greater need for scientists, sociologist,
    psychologist, policy makers and politicians in
    setting ethical policy and standards

Belmont principles
  • Respect for persons
  • Persons should be treated as autonomous agents
  • Individuals with diminished autonomy deserve
    special protection
  • Derived moral principles
  • Informed consent incorporating information,
    comprehension and voluntariness
  • Truth telling. In Kants The supposed right to
    tell lies from benevolent motives, he wrote that
    If then, we define a lie merely as an
    intentionally false declaration towards another
    man, we need not add that it must injure another
    for it always injures another if not another
    individual, yet mankind generally
  • Confidentiality
  • Privacy

Belmont principles
  • Beneficence
  • Most well known principle to physician from the
    oft quoted dictum Primum non nocere What
    Hippocrates actually said is I will keep
    (patients) from harm and injustice I will
    remain free from intentional injustice
  • Frankena arranged the components of this
    principle in the following hierarchical order
  • I ought not to do evil or inflict harm
  • I ought to prevent evil or harm (beneficence)
  • I ought to remove evil or harm (beneficence)
  • I ought to do or promote good (beneficence)
  • This ordering is not universally accepted

Belmont principles
  • Justice in the sense of what is fair and what
    is deserved
  • An injustice occurs when an entitlement is denied
    without good reason or burden imposed unduly
  • Another conception is that equals must be treated
  • This plays a role in resource allocation,
    ensuring that no particular group bears excessive
    burden on behalf of others
  • The emphasis on rights in bioethics is another
    derivative of this principle

When principles conflict
  • Conflict of principles creates a weighting or
    priority problem
  • Ross proposed finding the greatest duty in any
    circumstance of conflict by finding the greatest
    balance of right over wrong in that particular
  • He proposed a distinction between prima facie and
    actual duties
  • Prima facie duties are those that must always be
    acted upon except they conflict with equal or
    stronger duties in that particular occasion. They
    are always right and always binding

When principles conflict
  • So, though firm, they are conditional on not
    being overridden or outweighed by competing moral
  • Actual duty is therefore determined by a balance
    of the respective weights of the competing prima
    facie duties
  • Therefore duties and rights are not absolutes but
    rather strong prima facie moral demands that may
    validly be overiden in circumstances where
    stringent opposing demands are presented by a
    competing moral principle

When principle conflict
  • These ideas also apply where a single principle
    is leading us to two equally attractive
    alternatives, only one of which can be pursued
  • They also allow us to see that there is no basis
    for always reifying one principle particularly
    autonomy as is wont to be the case in many
    writings on research ethics
  • Justice and beneficence can override respect for
    autonomy under certain circumstances some of
    which are more common in developing countries
    such as issues relating rights during epidemics
    and disasters, community benefit, consent in
    certain diseases/research and sharing of

When principles conflict
  • This does not diminish the value of autonomy but
    let us ask with Daniel Callahan What would it be
    like to live in a community for which autonomy
    was the central value
  • The arguments about duties applies to rights too
  • Many philosophers no longer submit to a thesis of
    absolute right to life irrespective of competing
    claims or social conditions
  • It is now commonly agreed that we have an
    exercisable right not to have our life taken only
    if there is not a sufficient moral justification
    to override this right

When principles conflict
  • The right to
  • Life
  • Make autonomous decisions
  • Give informed consent
  • Decide for a child
  • Is legitimately exercisable and created duties on
    others if and only if the right has an overriding
    status in the situation
  • Therefore rights compete in many situations,
    producing controversies and need for balance

When principles conflict
  • The burden of moral proof lies with those who
    seek to intervene in anothers choice, because as
    the need to protect persons from harm becomes
    more compelling, the weight of other principles
    rise and may validly override demands to respect
  • The challenge is to conceptually analyze the
    ethical dilemmas and establish the relationship
    between principles

  • Consensus?
  • Based on reason
  • Genuine debate
  • Takes ethical traditions into account
  • Open to criticism, refutation and the possibility
    of change
  • It is not majority opinion as it often needs to
    protect the minority
  • Takes time

Levels of ethical discussion
  • Should research be allowed?
  • Lesson of history
  • Certain things used to be banned but are now
    considered appropriate, for example, allowing
    women to vote
  • Alternatively certain things that were allowed
    are now banned e.g. slavery
  • Scientist right to autonomy of action
  • Research provides the information needed for
    decision making because there is a reasonable
    chance that research will lead to increase in
    public goods

Bioethical dilemmas
  • Should we select some people and expose them to
    an unproven but potentially beneficial treatment
    so that we can know if the rest of the population
    can benefit
  • Research must be conducted on humans at some
    point in their development cycle because their
    results are ultimately to be used by humans and
    humans differ from animals
  • They can be done only in a subset of the
    population for economic and ethical reasons

Bioethical dilemmas
  • How should we select such people
  • We must ensure that the people who bear the
    burden of research are drawn from those who most
    likely to benefit from it
  • We must ensure that participants are adequately
    informed about the risks of research
  • We must ensure that participants know that they
    can voluntarily withdraw and the procedure for
    such withdrawal is set out
  • We must ensure that participants know the
    benefits in research and how these will be shared

Bioethical dilemmas
  • Who should we select
  • Avoid individuals who cannot comprehend the
  • Justify and ensure adequate information where
    vulnerable participants are being recruited into
  • Ensure adequate community engagement
  • Respect real and potential participants in

Bioethical dilemmas
  • Why select these people
  • Research must be relevant to the health needs of
    the community
  • It must have social or scientific values
  • Should such research participants be compensated
  • Participation in research should be based on
  • Participation should be cost-free to participants
    (including opportunity costs)

Bioethical dilemmas
  • How should they be compensated

Bioethical dilemma
  • Avoid undue compensation that can compromise an
    individuals ability to make rational choice
  • Avoid coercion
  • Avoid deception
  • Avoid perpetuation of injustices
  • Avoid disadvantageous exploitation

Resolving ethical dilemmas
  • No single way exists for resolving ethical
  • However, we can arrive at valid ethical positions
  • Requires education and vigorous debate as this
    allows expression of opinions, clarification of
    thoughts and participation
  • All moral, legal, social and cultural approaches
    must be considered
  • Some issues require extensive debates that may
    take time

What we must not do
  • Use inappropriate tools to examine moral issues
  • Fail to recognize legitimate diversity
  • Disparage or reproach others who reach different
  • Assume that we can always judge the right of
    individuals, societies and governments to
    construct different requirements that comprise
    part of moral life
  • Become skeptical about morality and moral thinking

Caution about perceived ethical conflicts
  • Factual disagreements
  • Scope of disagreements about who should be
    protected by moral norms
  • Which norms are relevant in particular
  • Appropriate specification
  • Weight of relevant norms
  • Appropriate forms of balancing
  • Presence of genuine moral dilemma
  • Sufficiency of information or evidence