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Bioethics intoduction
1. Bioethics examines ethical issues that emerge from advances in science and medicine. It addresses dilemmas that arise when different parties hold conflicting values regarding appropriate care for patients. 2. Major historical events that shaped the field include the Nuremberg trials, which established standards of informed consent after Nazi human experiments, and the development of key principles like autonomy, non-maleficence, and beneficence. 3. Resolving bioethical dilemmas requires a systematic approach, including clarifying the medical facts and stakeholders' preferences, analyzing which values are most relevant, and making recommendations through shared decision-making.
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Bioethics intoduction
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- 2. What is Bioethics? Now often known as medical ethics or clinical ethics – hospital based issues Philosophical study of ethical issues brought about by advances in scientific and medical technologies Bioethical dilemmas arise when different parties, albeit all well- meaning, hold divergent values that lead to opposing viewpoints on appropriate actions
- 3. Common Bioethical Issues Disagreements between family and clinicians regarding the patient/resident’s best interest Living at risk (eating, wandering, falling) Deciding appropriate forms of care Determining legitimate level of restraint Determining patient preferences without clear instructions (Terri Schiavo) Providing services that take up tremendous resource (e.g., multiple transplants)
- 4. History of Bioethics Started as concerns regarding research ethics Nuremberg Doctors’ Trial -- 23 German physicians who either participated in the Nazi program to euthanize persons deemed "unworthy of life“ or who conducted experiments on concentration camp prisoners without their consent were tried. The trial lasted 140 days. 85 witnesses testified and almost 1,500 documents were introduced. 16 of the doctors charged were found guilty. 7 were executed.
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- 6. The Nuremberg Code(1947) Voluntary consent Anticipate scientific benefits Benefits outweigh risks Animal experiments first Avoid suffering No intentional death or disability Protection from harm Subject free to stop / withdraw Qualified investigators Investigator will stop if harm occurs
- 7. History of Bioethics The distinct academic field began in the 1960s in the United States Philosophers and theologians were later joined by physician-ethicists and lawyers Scientific advances coupled with cultural changes New emphasis on individual autonomy and rights – suspicion of medical paternalism Focused on individual research participant and patient
- 8. What Were Founding BioethicistsStudying? Normative ethics – formulation and defense of basic principles, values, virtues, and ideals governing moral behaviour Descriptive ethics – factual descriptions of moral behaviour and belief systems Analytic approach – discerning meanings of life, concepts of rights/justice/fairness, etc. Balancing ethical principles Shift from the greatest good to individual rights
- 9. Major Principles inBioethics Tom Beauchamp and James Childress’s Principles of Biomedical Ethics: Non-maleficence and Beneficence Utilitarian – harm-benefit analysis do no harm best interest standard Autonomy respect for one’s rights and dignity informed and voluntary consent Justice fairness caring for the most vulnerable
- 10. As the StoryGoes... Suppose a trolley is running out of control down a track. In its path are 5 people who have been tied to the track. Fortunately, you can flip a switch, which will lead the trolley down a different track to safety. Unfortunately, there is a single person tied to that track. Should you flip the switch?
- 11. Another Story... Aphysician has five patients, each in need of a different organ and will die without that organ. Unfortunately, there are no organs available to perform any of these five transplant operations. A young man who just got hit by a trolley is brought into the ER. In the course of assessing his injuries, which are not life-threatening if treated immediately, the doctor discovers that his organs are compatible with all five of his dying patients. Would it be justified for the physician to let the patient die to harvest his organs to save the other five patients?
- 12. How Bioethics Have Evolved Feminist critique Social structure and power hierarchy Concerns of medicalization Significance of social relationships Multiculturalism and perceived homogeneity among bioethicists Care ethics -- justice reconfigured Relational autonomy
- 13. How Bioethics Have Evolved(Continued) Disability critique Vulnerability and dependency as human conditions Meanings of “normal” and a “good” life Medical vs social model Cure vs social acceptance Social contexts affect individual decisions Meaning of autonomy challenged
- 14. Current Focus inBioethics Branches – biomedical/clinical ethics, research ethics, organizational ethics Genetics Brain imaging technologies Multiculturalism End-of-life care Aging Health-care resource allocation
- 15. Systematic Approach inResolving Dilemmas Finding thoughtful and rational justification for our beliefs and decisions More than intuitive responses – ask why we may have certain intuitions, and how to manage conflicting intuitions Systematic approach can help to identify essential elements to ethical decision-making, ease pressure, and promote consistency in resolving dilemmas
- 16. Issues to Considerin Approaching Dilemmas Define and identify the ethical dilemma Clarify the facts and identify stakeholders – what’s known and what’s not? Medical indications Diagnosis, prognosis, treatments or medication history, other clinical options, etc. Patient/Resident/Family (PRF) preferences Advance directives, code status, goals of care, etc. Quality of life The PR’s subjective evaluation of his or her situation Contextual factors Social contexts, family situation, cultural/religious values, financial situation, etc.
- 17. Issues to Consider(Continued) Analyze and balance the values involved Various principles may help – autonomy, beneficence, non-maleficence, justice What do various available options and our prioritization of certain values/principles over others say about who we are? Make a recommendation Involve relevant stakeholders – shared decision making Follow up and evaluation ensures accountability, consistency, and transparency, thereby promoting trust and integrity
- 18. Case Discussion Asa result of an automobile explosion, 25 year-old Dax Cowart was badly burned over 65% of his body. Both eyes, both ears and both hands were damaged beyond repair. Large doses of narcotics were required for minimal pain relief. To control the many infected areas on his body, Cowart had to be submerged daily in a tank of highly chlorinated water to disinfect his wounds. The experience was excruciatingly painful, and Cowart protested and refused the “tankings.” He pleaded with his caregivers to be allowed to die, and stated several times that he wanted to kill himself. The physicians turned to his mother to obtain consent for all his treatments.
- 19. What Should theClinicians Do? Moral Considerations Factual Considerations Non-Maleficence Medical Indication Beneficence PF Preference Autonomy Quality of Life Justice Contextual Factors Care
Editor's Notes
- #19 Should we continue various procedures that may appear to prolong pain based on resident/patient preference?