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.

1. Introduction to Bioethics

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.

5. Nazi Experiments

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
Bioethicists Studying?
 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 in Bioethics
 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 Story Goes...
 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...
 A physician 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 in Bioethics
 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 in Resolving
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 Consider in 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
 As a 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 the Clinicians Do?
Moral Considerations Factual Considerations
Non-Maleficence Medical Indication
Beneficence PF Preference
Autonomy Quality of Life
Justice Contextual Factors
Care