BIOETHICS

DR HIRA JAHANGIR
LECTURE #2
BIOETHICS
A discipline dealing with the ethical and philosophical implications of biological advances and their
applications on living beings

HUMAN BIOMEDICAL
ETHICS HEALTH ETHICS
ETHICS
Ethics is a branch of philosophy that studies the difference between right and wrong also called
moral philosophy . The discipline concerned with what is morally good and bad, right and wrong.

It should also be defined as the study of morality questions.

 ETHICS
(SUBJECT
MATTER OF
ETHICS)
BRANCHES
OF ETHICS
NORMATIVE EHTICS:
It is concerned with establishing how things should or ought to
be, which things are good or bad, and which actions are right or
wrong.

Is the study of what is right and wrong.

Examples of normative ethical theories :

Consequentialism.

Deontology.

Virtue ethics.
META ETHICS:
It is concerned with the meaning of moral terms and judgements and seeks to understand the
nature of ethical statements , attitudes and judgements and how they can be defended.

Is the study of ethical concepts and theories.

DISCRIPTIVE ETHICS:
it is the study of people’s belief about morality and is not
designed to provide guidelines to people in making moral
decisions.

Is the value free approach to ethics.

Examines ethics from the perspectives of observations of actual

choices made by moral agents.

More likely to be investigated by social scientists.

e.g.; sociologists and anthropologists.
APPLIED ETHICS:

Applied ethics refers to the practical application of

moral considerations.

For example, the bioethics community is concerned

with identifying the correct approach to moral issues in
the life sciences, such as euthanasia, the allocation of
scarce health resources, or the use of human embryos in
research.
• Beauchamp and Childress (2008) in their book, Principles of
Biomedical Ethics assert that
the four principles represent fundamental
values that are equal in importance and therefore, ideally,
should always be honored.
AUTONOMY
The word autonomy means “self-rule.”

The principle of respect for patient autonomy means that

each individual patient has the right to determine which
medical interventions he or she will accept or refuse.

This principle reflects our belief that patients have a right to

make decisions about things that will affect their own lives.
BENEFICENCE
This principle refers to the duty of physicians to act in the best
interests of their patients, i.e., to act for the good of their
patients.

When making diagnosis, providing information, or

recommending or implementing treatment, the physician
should be guided by what he or
she believes is best for the patient.
EXAMPLE
◦ A patient with a medical history of kidney cancer, stage 1, seen to the office. he doesn’t want
any therapy for that neither chemo, nor radio therapy or surgery. he wants to die. patient is
judged to have full capacity in making decision. which of the following is the best response.

◦ A. I respect your decision but tell me how you arrived at this decision.
◦ B. I respect your decision but medically there is hope to treat this.
◦ C. I respect your decision, but this is my obligation to tell you that this is not the course of
action.
◦ D. We will not proceed with further treatment.
EXAMPLE
◦ A patient with a medical history of kidney cancer, stage 1, seen to the office. he doesn’t want
any therapy for that neither chemo, nor radio therapy or surgery. he wants to die. patient is
judged to have full capacity in making decision. which of the following is the best response.

◦ A. I respect your decision but tell me how you arrived at this decision.
◦ B. I respect your decision but medically there is hope to treat this.
◦ C. I respect your decision, but this is my obligation to tell you that this is not the course of
action.
◦ D. We will not proceed with further treatment.
NON-MALEFICENCE
Maleficence is harm or evil, so the principle of nonmaleficence refers to the
requirement to avoid harming
patients, as expressed in the famous Hippocratic aphorism: “First do no
harm.”

This principle applies to all persons, not only physicians, whereas the
principle of beneficence is not a requirement of all persons.

Its application to medicine is important in situations where diagnostic tests or

therapeutic interventions carry significant risks of harming the patient, or a
small risk of causing serious harm, or when not intervening carries great risk.
EXAMPLES
◦ Do not kill.
◦ Do not cause pain and suffering to other.
◦ Do not cause offense to others.
◦ Stopping a medication that is harmful
◦ Refuse to provide a treatment that is not effective.
EXAMPLE
◦ A 56-year-old patient with increased LFT’S on routine examination. Recommended to
undergo a liver biopsy. During informed consent process all the information is given.
Explanation of risks vs benefits in this situation is carefully balancing which ethical principle.

◦ A. Non maleficence vs. autonomy.

◦ B. Non maleficence vs. beneficence.
◦ C. Non maleficence vs. justice.
◦ D. Non maleficence vs. beneficence and autonomy.
EXAMPLE
◦ A 56-year-old patient with increased LFT’S on routine examination. Recommended to
undergo a liver biopsy. During informed consent process all the information is given.
Explanation of risks vs benefits in this situation is carefully balancing which ethical principle.

◦ A. Non maleficence vs. autonomy.

◦ B. Non maleficence vs. beneficence.
◦ C. Non maleficence vs. justice.
◦ D. Non maleficence vs. beneficence and autonomy.
JUSTICE
The principle of justice is generally considered to have two
components: equitability and distributive justice.

EQUITABILITY
Equitability means that persons in like circumstances should be
treated similarly. In healthcare, this concept means that persons
with similar medical conditions should receive the same quality
of medical care regardless of nonmedical factors, such as
wealth or social standing.
DISTRIBUTIVE JUSTICE
Distributive justice means that, in view of the unavoidable reality
that we do, and will always, have limited resources to devote to
healthcare, we are morally obligated to distribute those resources
fairly among patients.

Of course, there is dispute about what constitutes fairness in this

context.
EXAMPLE
◦ Parents being fair between children.
◦ Having the optimal treatment for all children who present with meningitis in any hospital in
the community.
◦ All potential eligible participants should have equal access to participation, irrespective of
their socioeconomic status, racial and other demographic differences.
Match the following
◦ 1. Autonomy 1. duty to do good to others.

◦ 2. Justice 2. respect for individual’s right.

◦ 3. Non maleficence 3.equitable distribution of potential

benefits and tasks
determining an order in which clients
should be cared for.

◦ 4. Beneficence 4. the obligation to do no harm.

Practice question.
◦ Q1. Having freedom to make choices that affects one’s life is the principle of

◦ 1. beneficence.
◦ 2. autonomy.
◦ 3. non maleficence.
◦ 4. justice
◦ Ethical code attributed to the ancient Greek physician Hippocrates, adopted as a guide to
conduct by the medical profession throughout the ages and still used in the graduation
ceremonies of many medical schools.

◦ Although little is known of the life of Hippocrates—or, indeed, if he was the only practitioner
of the time using this name—a body of manuscripts, called the Hippocratic Collection (Corpus
Hippocratic), survived until modern times.

◦ In addition to containing information on medical matters, the collection embodied a code of

principles for the teachers of medicine and for their students.

◦ This code, or a fragment of it, has been handed down in various versions through generations
of physicians as the Hippocratic oath.
◦ The oath dictates the obligations of the physician to students of medicine and the duties of
pupil to teacher.

◦ In the oath, the physician pledges to prescribe only beneficial treatments, according to his
abilities and judgment; to refrain from causing harm or hurt; and to live an exemplary personal
and professional life.
ETHICAL THEORIES
ETHICAL THEORIES:

it is the process by which we justify a particular ethical

decision.

Main purpose is to provide

consistency
coherence in decision making.

THREE MAIN THEORIES TO RESOLVE ETHICAL

DELEMMAS ARE

1. DEONTOLOGY
2. CONSEQUENTIALISM
3. VIRTUE ETHICS
 GERMAN
PHILOSOPHER
(1724-1804)

IMMANUEL
DEONTOLOGICAL KANT
ETHICS

DUTY
DEONTOLOGY
It is sometimes called duty-based ethics.

One of the main German philosopher is Immanuel Kant.

Reason based ethics.

Emotions or religion has no role in ethical decisions.

This theory says” that you will always follow a set of moral
rules or principles, no matter what the situation is and what
the outcome will be”.
The only good is goodwill .

The goodwill is to follow their duty in accordance with

moral law.

According to Kant, essential component of moral law is

categorical imperative.

Imperative means “must do”

Hypothetical imperative Is you must do something in order

to achieve something else.
E.G:
if you want to be on time, you must leave now.

If you want to stop your hunger you must eat food.

Categorical imperative is something you must always do no matter
what the situation is , what you want to achieve and what your desires
are.

Categorical imperatives are universal laws.

Three formulations.

KANT says, “Act only according to that maxim whereby you can
at the same time will that it should become a universal law.”

e.g.; lying is always wrong. you should never lie.

Treat humanity as an end not simply as a mean.

Kant urged all people to see themselves as a lawmaker or member

of kingdom events and their actions are approved by the
kingdom.
ADVANTAGES:

Actions are right because they are good.

Rigid structure means decision making isn't blurred by

emotion.

Creates a sense of duty in a secular world.

DISADVANTAGES:

Lack of concern for consequences can sometimes be

disastrous.

No flexibility; deontology leaves the individual with no

chance to consider the circumstances or consequences of an
action.
CONSEQUENTIALISM THEORY
Through Mill’s work, this theory is also known as utilitarianism.

For this theory, your intentions are irrelevant; all that counts is the outcome.

Greatest Good for the Greatest Number is often used as a summary of the theory.

Consequentialism Theory Has two main types

Classical or act utilitarianism.

Each act considered on its own

Rule utilitarianism.

Develop rules that net the greatest benefit

Rule utilitarianism is used to make health care policy.

Exceptions can be made under special circumstances.

Rule utilitarianism also allows for negative consequentialism or preventing the greatest harm for the greatest number.

Preference utilitarianism argues that good is honoring preferences and bad is frustrating preferences.

Preferences must be known, or a substituted judgment can be used.

.
Criticisms of utilitarianism include
The minority is not protected when the greatest good for the greatest number is the goal.

Some say this theory means that the ends justifies the means.

These criticisms are not valid because respect for autonomy and liberty is essential to the theory.
VIRTUE ETHICS:
Associated with ARISTOTLE, concerned with the inherent character of a person rather than the consequences of a specific action.

The system identifies those virtues that will allow a person to achieve EUDEMONIA ( the well being or good life)

The right action is that which leads to well being which can be achieved by a lifetime practicing of virtues in one’s daily activities , acquired through
practices.

Individual based theory.

virtue is a habit or quality that allows individual to succeed at their purpose.

Emphasizes on individual’s character.

Aristotle is the primary thinker

GOLDEN MEAN

PRUDENCE JUSTICEFORTITUDE , TEMPERANCE

PATIENCE AND SELF SACRIFICE.

WISDOM
LIBERTARIANISM:
17TH- 18TH century onwards.
Maj thinkers
john Locke, David Hume, Adam smith, Thomas Jefferson, Thomas Paine.

Focus on individualism.

Rights based life.

Limited role of government.

Values money and free market.

Peace.
PROBLEMS”

rich becomes rich.

Poor will always remain poor.

COMMUNITARIANISM

Ethical values are grounded in communal values.

Lessen the focus on individual rights and increase the focus on communal responsibilities.
◦ We live most of our lives in communities, like lions who live in social groups rather than
individualistic tigers who live alone most of the time.

◦ Those communities shape, and ought to shape, our moral and political judgments and we have
a strong obligation to support and nourish the communities that provide meaning for our lives,
without which we’d be disoriented, deeply lonely, and incapable of informed moral and
political judgment.
ASSIGNMENT NO 1.
◦ Q1. Define ethics , morals with one example.
◦ Q2. Difference between ethics and morals?
◦ Q3. What are the four principles of ethics?
◦ Q4. Difference between deontology and consequentialism?
◦ Q5. Define all ethical theories and give one example of each.