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Dr David Chan

Dr David Chan






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    Dr David Chan Dr David Chan Presentation Transcript

    • SMA Seminar in Bioethics and Health Law 2001 INTRODUCTION TO BIOETHICS Dr David K. Chan Department of Philosophy National University of Singapore
    • What is Bioethics? Study of ethical issues arising from biological and medical sciences
    • Varieties of Bioethics
      • Medical ethics
      • Physician-centered
      • Health care ethics
      • Includes nurses & other healthcare professionals
      • Clinical ethics
      • Hospital care decisions with aid of committees and consultants
      • Bioethics in general
      • Includes issues in genetics, reproductive technologies, experimentation, and distribution of life-saving resources
    • Origins of Bioethics
      • Emerged in early 1960s in the U.S.
      • Arose out of public concerns
      • E.g., issue of selecting patients for chronic haemodialysis in Seattle in 1962
      • Represented the view that ethical problems in medicine and biological sciences can be solved by applying moral principles
      • (Source: Albert R. Jonsen, Journal of Medicine and Philosophy (1991), pp. 113-30)
    • Why is Bioethics Important?
      • Changing doctor-patient relationship
      • Recognition of patient autonomy in decision-making
      • New technologies
      • E.g., assisted reproduction, gene therapy, support and prolonging of life
      • Changing economics of medicine
      • Managed care, health insurance, commercialization of medicine (profit motive)
    • Who Should Do Bioethics?
      • Lawyers and Doctors
      • Historically, issue is for doctors to avoid or to deal with charges of negligence.
      • Philosophers
      • Ethical dilemmas go beyond issues of legality. Philosophers can help doctors to make sound ethical decisions and to justify them to their patients and the public.
      • “ If you need an analysis, send the urine to the biochemist, and the ethics to the philosopher.”
    • Philosophy and Bioethics
    • What is Moral Philosophy?
      • Distinguish morality from law
      • Distinguish moral philosophy from religious ethics and codes
    • What Moral Philosophers Do
      • Use reason and arguments
      • Apply general moral principles
      • Provide conceptual and analytical tools
      • Justify or question moral practices
    • Normative Ethics Developing principles that tell us which actions are right, and what we are morally required to do.
    • Normative Theories
      • Deontological theories
      • Associated with German philosopher Immanuel Kant.
      • Consequentialist theories
      • Most well-known theory is utilitarianism.
      • Utilitarians seek to maximize general human happiness or well-being.
      • Famous utilitarian philosophers include John Stuart Mill and Jeremy Bentham.
    • Deontological Theories
      • A type of action is right or wrong no matter what its consequences are.
      • Moral agents have duties which oblige them to do certain types of action.
      • Duties can be specified in the form of rules that must be universally applicable.
      • Persons and their autonomy should be respected at all times.
    • Consequentialist Theories
      • What makes an action right or wrong are its consequences.
      • The consequences of an action can always be measured by a common standard: what it contributes to the good of all who are affected by the action
      • The right action is one that has the maximum beneficial results .
      • The same unit of benefit to any person should be given equal weight.
    • What is Applied Ethics? Use of general moral principles to test the morality of particular actions.
    • Problem for Applied Ethics
      • Presence of competing moral principles
      • Does this make applied ethics subjective?
      • Room for reasoning, argument and justification
      • Ethics is not a matter of taste.
      • Ethical dilemmas are real dilemmas
      • There are no easy answers.
      • Important to learn why people disagree
    • Ethical Theory and Bioethics
      • Straightforward application of principles
      • Four-principles approach (Childress & Beauchamp)
      • Case-study approach
      • Methodology of casuistry (Jonsen & Toulmin)
      • Interplay between theory and case-study
      • Bioethics contributes to ethical theory as well as benefiting from it
    • Problems for application of principles
      • Choice of ethical theory cannot be justified
      • Real life is too messy and detailed
      • Priority of principles cannot be resolved
      • E.g., principles of autonomy and beneficence can be in conflict.
    • Problems for case-study approach
      • Problem of bias
      • Intuitions need to be critically examined.
      • Too many mid-level principles in evaluating cases
      • Theoretical issues cannot be avoided
      • E.g., euthanasia raises questions about the value of human life; allocation of resources raises questions of distributive justice.
    • Bioethics and the Doctor
      • Philosophers can help doctors to identify goals in medicine and to develop practical principles.
      • Moral philosophy will impact on clinical practice by improving understanding and affecting the way in which ethical problems in medicine are described.
    • Useful References
      • Tom Beauchamp & James Childress, Principles of Biomedical Ethics (Oxford University Press, 1994)
      • Nancy Jecker, Albert Jonsen & Robert Pearlman (editors), Bioethics: An Introduction to the History, Methods, and Practice (Jones & Bartlett, 1997)
      • Robert Veatch (editor), Medical Ethics (Jones & Bartlett, 1997)