BioethicsThis article or section is written like a personal reflection or essayand may require cleanup.
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Bioethics is the philosophical study of the ethical controversies brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, philosophy, and theology.
- 1 Scope
- 2 The purpose of bioethics
- 3 Ideology and methodology
- 4 Issues
- 5 References
- 6 Further reading
- 7 External links
While scientific research has produced social benefits, it has also posed some troubling ethical questions. Public attention was drawn to these questions by abuses of human subjects in biomedical experiments, especially during the Second World War. During the Nuremberg War Crime Trials, the Nuremberg code was drafted as a set of standards for judging physicians and scientists who had conducted biomedical experiments on concentration camp prisoners. This code is often credited with jump starting the interdisciplinary field now called bioethics.
On July 12, 1974, the National Research Act (Pub. L. 93-348) was signed into law in the United States, thereby creating the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. One of the commission's charges was to identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects, as well as to develop guidelines. After nearly five years of discussion and collaboration, these guidelines were published. In 1979, a statement of basic ethical principles and guidelines to assist decision-makers in resolving the ethical problems that surround the conduct of research with human subjects appeared in the Federal Register. This became known as the Belmont Report. The report centered around the following three important principles, or general prescriptive judgments:
Later principle of non-maleficence has been added to this list. To apply the general principles to the conduct of research involving humans, the Belmont Report suggested that the following requirements be considered: informed consent, risk/benefit assessment, and the just and fair selection of subjects of research. The Belmont Report remains a touchstone for many bioethicists.
With new challenges in public health and health policy, and with advances in bio-technology, today bioethics is a fast-growing academic and professional area of inquiry. Since the early 1980s, the field has generated at least a dozen English-language journals. In addition, many academic medical centers and some schools of law, engineering and the liberal arts offer degree programs with a specialization in bioethics. Such programs train physicians and nurses, attorneys, philosophers, theologians, health services researchers and even bench scientists.
As a field of inquiry, bioethics received another boost when President Clinton created an Advisory Committee on Human Radiation Experiments, chaired by Ruth Faden of the Johns Hopkins Berman Institute of Bioethics. The committee sought to analyze the following questions:
What is the federal government's responsibility for wrongs and harms to human subjects as a result of experiments with ionizing radiation? What remedies are appropriate for those wronged or harmed? And what lessons learned from studying research standards and practices in the past and present can be applied to the future?
President Clinton directed the Advisory Committee to uncover the U.S. history of human radiation experiments during the period 1944 through 1974. It was in 1944 that the first known human radiation experiment of interest was planned, and in 1974 that the U.S. Department of Health, Education and Welfare adopted regulations governing the conduct of human research, a watershed event in the history of federal protections for human subjects. In addition, the Advisory Committee examined cases in which the government had intentionally released radiation into the environment for research purposes. The Advisory Committee also identified ethical and scientific standards for evaluating these events, and made recommendations to help ensure that wrongdoing could not be repeated.
Today, the field of bioethics struggles with its proper scope. Should it concern itself with the ethical evaluation of all questions involving biology and medicine? Some bioethicists would narrow ethical evaluation only to the morality of medical treatments or technological innovations, and the timing of medical treatment of humans. Others would broaden the scope of ethical evaluation to include the morality of all actions that might help or harm organisms capable of feeling fear and pain, and include within bioethics all such actions if they bear a relation to medicine and biology.
The purpose of bioethics
The issues raised by bioethics as a distinct area of academic inquiry are largely answered by the needs of institutions. Bioethicists today are not hired or engaged in conversation (and thus "named") because of their opinions or because they have special skills of reasoning, but because they know and can put to work the enormous body of research and history of discussions about bioethics in a fair, honest and intelligent way, using tools from the different disciplines that "feed" the field. Training programs in bioethics differ in skill sets of faculty and size of program, but across the US, and increasingly globally, they do seem to share a commitment to that goal with few exceptions.
As a result, bioethics has been distinctively created, by institutions, specifically the multi-million dollar commitment of major and minor medical centers to the study of medical ethics as part of the development of curriculum and research efforts. Today it is all but impossible to create a major medical research effort without ethicists to assist. First in the regulatory review of research, the responsibility of the IRB, which can be staffed by persons not trained in ethics in any rigorous way, or trained specifically in the ethical and regulatory aspects of research with human subjects, rather than more comprehensively in bioethics. The second form of assistance is by those who can think in advance of the onset of research about its social, ethical and economic implications.
Ideology and methodology
Bioethicists often focus on using philosophy to help analyze issues, and philosophical ethicists such as Peter Singer tend to treat the field as a branch of moral or ethical philosophy. However, this approach is sometimes challenged, and bioethics is becoming increasingly interdisciplinary. Many bioethicists come from backgrounds outside of academic philosophy, and some even claim that the methods of analytic philosophy have had a negative effect on the field's development. The percentage of bioethicists with professional backgrounds in health care, especially physicians, has been steadily increasing over time. In fact, the last two Presidents of the primary academic society for bioethicists in the U.S. (the American Society for Bioethics and Humanities) have been physicians. Some bioethicists, especially those who perform ethics consultation in clinical settings, emphasize the practical aspects of bioethics, and view the field as more closely related to clinical practice or public health than philosophy.
Religious bioethicists have developed rules and guidelines on how to deal with these issues from within the viewpoint of their respective faiths. Many religious bioethicists are Jewish, and Christian scholars. Since the Indian traditions of Hinduism, Buddhism, and Jainism considers the sanctity of all life, there is much literature related to the philosophy and ethics related to life in each of these traditions. A growing number of religious scholars from Islam have also become involved in this field. There has been some criticism by liberal Muslims that only the more religiously conservative voices in Islam are being heard on this issue.
Although there are a number of eminently qualified philosophers who approach bioethics from a religious perspective, some Western secular bioethicists are critical of the fact that religious bioethicists are often religious scholars without an academic degree or training in disciplines that pertain to the issues, such as philosophy (wherein the formal study of ethics is usually found), biology or medicine. From the standpoint of bioethicists whose work is secular, the central cause for caution as regards religious bioethics work is that tools and methods should be brought to bear on problems, rather than starting with conclusions, and then looking for justifications. Of course, this criticism does not apply solely, of even to all, forms of religious bioethical work.
In the case of most non-Western cultures a strict separation of religion from philosophy does not exist. In many Asian cultures, there is a lively (and often less dogmatic, but more pragmatic) discussion on bioethical issues. The discussion often refers to common demographic policies which are criticised, as in the case of China. Buddhist bioethics, in general, is characterised by a naturalistic outlook that leads to a rationalistic, pragmatic approach. Buddhist bioethicists include Damien Keown. In India, Vandana Shiva is the leading bioethicist whose speaks from the Hindu tradition. In Africa, and partly also in Latin America, the debate on bioethics frequently focus on its practical relevance in the context of underdevelopment and (national or global) power relations.
Areas of health sciences that are the subject of published, peer-reviewed bioethical analysis include:
- Animal rights
- Artificial insemination
- Artificial life
- Artificial womb
- Assisted suicide
- Blood/blood plasma (trade)
- Body modification
- Brain-computer interface
- Confidentiality (medical records)
- Contraception (birth control)
- Euthanasia (human, non-human animal)
- Feeding tube
- Gene therapy
- Genetically modified food
- Genetically modified organism
- Great Ape Project
- Human cloning
- Human enhancement
- Human genetic engineering
- Infertility (treatments)
- Life extension
- Life support
- Medical malpractice
- Medical research
- Medical torture
- Moral obligation
- Organ donation (fair allocation, class and race biases)
- Pain management
- Patients' Bill of Rights
- Population control
- Prescription drugs (prices in the US)
- Procreative beneficence
- Professional ethics
- Recreational drug use
- Reproductive rights
- Sperm and eggs (donation)
- Spiritual drug use
- Stem cell research
- Transplant trade
- Beauchamp, Tom & Childress, James (2001), Principles of Biomedical Ethics, Oxford, New York: Oxford University Press, ISBN 0-19-514332-9
- Jonsen, Albert; Veatch, Robert & Walters, leRoy (1998), SourceBook in Bioethics, Washington: Georgetown University Press, ISBN 0-87840-685-9
- Khushf, Tom (ed) (2004), Handbook of Bioethics: taking stock of the field from a philosophical perspective, Dordrecht, Boston, London: Kluwer Academic Publishers, ISBN 1-4020-1893-2
- McGee, Glenn (2003), Pragmatic Bioethics, Cambridge: Massachusetts Institute of Technology Press, ISBN 0-2626-3272-1
- Sugarman, Jeremy & Sulmasy, Daniel (2001), Methods in Medical Ethics, Washington: Georgetown University Press, ISBN 0-87840-873-8
- Andre, Judith (2002), Bioethics as Practice, Chapel Hill and London: University of North Carolina Press, ISBN 0-8078-2733-9
- Emanuel, Ezekiel; Crouch, Robert; Arras, John; Moreno, Jonathan & Grady, Christine (2003), Ethical and Regulatory Aspects of Clinical Research, Baltimore, London: Johns Hopkins University Press, ISBN 0-8018-7813-6
- Aulisio, Mark; Arnold, Robert & Younger, Stuart (2003), Ethics Consultation; from theory to practice, Baltimore, London: Johns Hopkins University Press, ISBN 0-8018-7165-4
- Singer, Peter A. & Viens, Adrian M. (2008), Cambridge Textbook of Bioethics, Cambridge: Cambridge University Press, ISBN 978-0-521-69443-8
- Al Khayat MH. "Health and Islamic behaviour" in: El Gindy AR, editor, Health policy, ethics and human values: Islamic perspective. Kuwait: Islamic Organization of Medical Sciences; 1995. p. 447-50.
- Ebrahim, Abul Fadl Mohsin. (1989). Abortion, Birth Control and Surrogate Parenting. An Islamic Perspective. Indianapolis. ISBN 0892590815
- Esposito, John. (ed.) (1995). "Surrogate Motherhood" in The Oxford Encyclopedia of the Modern Islamic World (vol. 4). New York: Oxford University Press. ISBN 0195096150
- Karic, Enes. "The Ethics of Cloning" in Islamica Magazine Fall/Winter 2004. Issue #11
- Bleich, J. David. (1981). Judaism and Healing. New York: Ktav. ISBN 087068891X
- Dorff, Elliot N. (1998). Matters of Life and Death: A Jewish Approach to Modern Medical Ethics. Philadelphia: Jewish Publication Society. ISBN 0827606478
- Feldman DM. (1974). Marital relations, birth control, and abortion in Jewish law. New York: Schocken Books.
- Freedman B. (1999). Duty and healing: foundations of a Jewish bioethic. New York: Routledge. ISBN 0415921791
- Jakobovits I. (1959). Jewish Medical Ethics. New York: Bloch Publishing.
- Mackler, Aaron L. (ed.) (2000). Life & Death Responsibilities in Jewish Biomedical Ethics. New York: JTS. ISBN 0873340817.
- Maibaum M. "A 'progressive' Jewish medical ethics: notes for an agenda" in Journal of Reform Judaism 1986;33(3):27-33.
- Rosner, Fred. (1986). Modern medicine and Jewish ethics. New York: Yeshiva University Press. ISBN 0881250910
- Conservative Judaism Vol. 54(3), Spring 2002 (contains a set of six articles on bioethics)
- Zohar, Noam J. (1997). Alternatives in Jewish Bioethics. Albany: State University of New York Press. ISBN 0791432734
- Colson, Charles W. (ed.) (2004). Human Dignity in the Biotech Century: A Christian Vision for Public Policy. Downers Grove, Illinois: InterVarsity Press. ISBN 0830827838
- Demy, Timothy J. and Gary P. Stewart. (1998). Suicide: A Christian Response: Crucial Considerations for Choosing Life. Grand Rapids: Kregel. ISBN 0825423554
- Pope John Paul II. (1995). Evangelium Vitae: The Gospel of Life. New York: Random House. ISBN 0812926714
- Kilner, John et al. (1995). Bioethics and the Future of Medicine: A Christian Appraisal. Grand Rapids, Michigan: Wm. B. Eerdmans Publishing Company. ISBN 0802840817
- Kilner, John F., Arlene B. Miller, and Edmund D. Pellegrino (eds.). (1996). Dignity and Dying: A Christian Appraisal. Grand Rapids, MI: Eerdmans Publishing Co.; and Carlisle, United Kingdom: Paternoster Press. ISBN 0802842321
- Meilaender, Gilbert (2004). Bioethics: A Primer For Christians. Grand Rapids, Michigan: Wm. B. Eerdmans Publishing Company. ISBN 0802842348
- Pope Paul VI. (1968). Humanae Vitae: Human Life. Vatican City.
- Smith, Wesley J. (2004). Consumer's Guide to A Brave New World. San Francisco: Encounter Books. ISBN 1893554996
- Smith, Wesley J. (2000). Culture of Death: The Assault on Medical Ethics in America. San Francisco: Encounter Books. ISBN 1893554066
- Smith, Wesley J. (1997). Forced Exit: The Slippery Slope from Assisted Suicide to Murder. New York: Times Books. ISBN 0812927907
- Stewart, Gary P. et al. (1998). Basic Questions on Suicide and Euthanasia: Are They Ever Right? BioBasics Series. Grand Rapids: Kregel. ISBN 0825430720
- Stewart, Gary P. et al. (1998). Basic Questions on End of Life Decisions: How Do We Know What's Right? Grand Rapids: Kregel. ISBN 0825430704
- Glad, John (2008). Future Human Evolution: Eugenics in the Twenty-First Century. Hermitage Press. ISBN 1-55779-154-6.
- Kuczewski, Mark G.; Ronald Polansky (eds.) (2002). Bioethics: Ancient Themes in Contemporary Issues. The MIT Press. ISBN 978-0-262-61177-0.
- Korthals, Michiel; Robert J. Bogers (eds.) (2004). Ethics for Life Scientists. ISBN 978-1-4020-3178-6.
- Murphy, Timothy (2004). Case Studies in Biomedical Research Ethics. The MIT Press. ISBN 978-0-262-13437-8.
- Caplan Arthur Smart Mice Not So Smart People Rowman Littlefield 2006
- Association of Law, Ethics and Science
- The Hastings Center
- Centre for Science, Society and Citizenship
- bioethics.net and The American Journal of Bioethics
- Johns Hopkins Berman Institute of Bioethics
- the Alden March Bioethics Institute
- International Association of Bioethics
- WHO Global bioethics calendar
- American National Reference Center for Bioethics Literature
- Bioethics for Latin America and Colombia
- EURETHICS (European database on ethics in medicine) and ENDEBIT (European database on ethics in non-medical technologies)
- German Reference Centre for Ethics in the Life Sciences (DRZE)
- BELIT: an extensive world-wide bibliographic directory of literature in the area of bioethics, containing references to monographs, grey literature, legal documents, journal articles, newspaper articles and book contributions
- BioEthicWorld: A bioethics information site
- BEKIS The Bioethics Communication and Information System
- Nutritional Genomics (NuGO) Bioethics Online Tool
- Bioethics at the Open Directory Project
- Universal Declaration on the Human Genome and Human Rights
- International Declaration on Human Genetic Data
- Universal Declaration on Bioethics and Human Rights
- The Bio-Medical Ethics Reference Server at Stanford University
- UNESCO Bioethics Section
- Tishchenko P. D. , Yudin B. G. Toward a Bioethics in Post-communist Russia
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