Dr Howie_Introduction to BioEthics

1. Introduction to Bioethics
HowieLim,Ph.D.
SocialandPreventiveMedicine
FacultyofMedicine
UniversityofMalaya
17June2021

2. Acknowledgement
Professor Jeffrey Khan from the Johns Hopkins Berman Institute of Bioethics.

3. Ethics
What do you know about ethics?
Why is it more important to consider ethics in the pandemic?
https://youtu.be/VJ_s51QGbg8
https://youtu.be/4vWXpzlL7Mo
Meta- ethics
https://youtu.be/FOoffXFpAlU

4. COVID19 and ethics
https://youtu.be/nYrP14BhMXg
1) Is it OKAY to disclose information about an infected person?
2) Ethics about social distancing/movement restriction?
3) Are the medical professional ethically bound to work in an unsafe environment?
4) Allocation of resources: who should be tested? Who should be treated?

5. Who should mandate COVID
vaccination?

6. Ethics
A branch of philosophy that ask the practical questions on:
What should we live?
What choices should we make?
What makes our lives worth living?
Provides a framework for understanding and interpreting what’s
right and wrong in the society

7. Morality versus Ethics
•Morality refers to “traditional belief about right and wrong human conducts” and is a
social institution
•Ethics is the study of social morality and trying to understand morality through
approaches:
•Non-normative approaches
 Meta-ethics
-The study of terms and concepts central to ethics, e.g. rights, virtue, obligation,
responsibility
 Descriptive Ethics
• Normative approaches
 General normative ethics – Formulative and defending basic principles and
virtues
 Delineating practical action guides

8. Why act ethically?
Where do ethics come from?
Discuss (2 minutes)

9. Working in Moral Philosophy
•Facts and Values
•What is the case and what ought to be the case
• The so-called Is/Ought problem
• How to move from “is” to “ought”?
• Resolving moral disagreements
• Facts matter
• Definition matter
• Agreeing on a common set of moral guidelines (codes)
• Examples and counterexamples
• Analysis of arguments

10. Ethical Theories
Classic Theories
1) Virtue Theory
• Actions governed by good character
2) Deontological (Kantian)
• Actions governed by duties (“deon”)
• Kant’s categorical imperative
-universal duties
-including never treat another person as a mere means to the ends of another
-who counts as a person, and what are mere means
3) Consequentialism
• Action guided by outcomes (consequences)
• Utilitarianism (Mills and others)
• Acts are good (right) if they create the greatest utility
• Acts are good (right) if they serve the role of utility; the greatest good to the greatest number

11. Virtue Ethics
• Aristotle (384-322 B.C.)
• The highest aims of life are living well through virtue and the pursuit of
eudaimonia, that feeling of well being or happiness, or living one’s best
life, flourishing and thriving instead of mere existing.
• In Nicomachean Ethics, Aristotle discusses the cause of happiness. If it is
not god-sent, he says (and Aristotle did not believe that gods involve
themselves in human affairs),
“then it comes as a result of a goodness, along with a learning process,
and effort”
• “a person with excellent character just has an inclination to the right thing;
and not only does such person do the right thing, he also does it the right
time and in the right way”
• Character-based ethics

13. Deontological Theory
• Immanuel Kant (1724-1804)
• “Deon”, Greek word for duty
• Morality is based on duties and obligations – that as human
beings we are bound by some unwritten code or codified
system to do and say the objectively right thing.
• Rule-based ethics (“Rules Are Meant To Be Followed”)

15. Consequentialism
• ethical theory that judges an action’s moral correctness by its consequences.
• Utilitarianism (John Stuart Mill, 1806-1873)
• Hedonism
• Consequences may be unknown
• The end justifies the mean

18. JusticeTheory
Political theory by John Rawls
How do you cut the pizza?
https://youtu.be/H0CTHVCkm90

19. Overview of bioethics
Clinical ethics
Public Health Ethics
Research ethics
Animal ethics
Environmental ethics
Emerging science and technology

20. Why do we need bioethics?

21. 4 Principles in medical ethics
1) Respect for patient autonomy
2) Beneficence: the promotion of what is best for the patient
3) Non-maleficence: avoiding harm
4) Justice
 Distributive justice
 just or fair distribution of health benefits within the society
 Patients in similar situations should normally have access to the
same health care,
 In determining the level of healthcare for one set of patients, we
must take into account the effect of such use on other patients
->we must try to distribute our limited resources (time, money, intensive care
beds) fairly

22. Clinical ethics
Concerned with ethical issues encountered in the care of patients
Involves asking the question “What ought we be doing here?”
Every patient encounter has a moral dimension
Every interaction involves duties, responsibilities and values (for both
clinicians and patients)

23. Clinical ethics
Concerned with ethical issues encountered in the care of patients
Involves asking the question “What ought we be doing here?”
Every patient encounter has a moral dimension
Every interaction involves duties, responsibilities and values (for both
clinicians and patients)

24. Conceptual approaches to clinical ethics
Principlism:
-Respect for persons/autonomy
-Beneficence/ Non-maleficence
-Justice
Casuitry (case-based ethics)
-stresses the importance of appreciating the particular feature of
specific cases
- pragmatic, more likely to solve a problem than appealing to abstract
principles

25. Clinical ethics
Virtue Theory
- stresses qualities or character that a healthcare professional should exhibit:
compassion, honesty, respect, humility, altruism, courage, tolerance, etc.
Feminism/Ethics of care
-Question basic sociocultural assumptions underlying the core principles
- For example, respect for autonomy emphasizes individualism and self-determination,
while feminist thinking emphasizes the relational aspect of being human
-Feminist approaches to bioethics also focus on freedom, caring, and justice, and
critiquing existing power structures as they relate to gender

26. What are the contemporary (thorny)
issues in bioethics?

27. •The value of life (what is life? What is death?)
•Killing versus letting die
•Organ transplantation
•Prenatal genetic intervention (embryonic genetic therapy), “designer baby”
•Genetic enhancement
•Human cloning
•Vaccine allocation and distribution

31. Legal status of abortion
Indonesia- Abortion on request- To save a woman’s life
Malaysia – Abortion on request- To preserve physical/mental
health

32. ISLAM PERSPECTIVE
• Majority schools of Muslim law accept that abortion is
permitted only if continuing the pregnancy would put the
mother’s life in real danger
• Not allowed after 4 months/120 days of gestation
• Believe spirit/ruh has been blown into fetus at this time
• Sinful as the act of taking life
• Permissible if there is medical reason for mother/baby
• Before 4 months: • Principle of Muslim jurists “the greater
evil (the woman’s death) should be warded off by the lesser
evil(abortion)”
• Physician is considered a better judge than the scholar to
determine
• Rape case: Scholars permit if the foetus is less than four
months old, or if it endangers the life of its mother.
Hashmi, Tariq Mahmood (13 October 2009). "Abortion". Al-Mawrid. Archived from the original on 27 February 2012. Retrieved
11 July 2012

33. Spain’s parliament vote
to legalize euthanasia

35. “Uncertainty continues to swirl around scientist He Jiankui’s
gene-editing experiment in China. Using CRISPR technology, He
modified a gene related to immune function in human embryos
and transferred the embryos to their mother’s womb, producing
twin girls.
Many questions about the ethical acceptability of the
experiment have focused on ethical oversight and informed
consent. These are important issues; compliance with
established standards of practice is crucial for public trust in
science.”

36. Ethical violations in research
Violation of an international consensus on editing of human embroys
He has not reported prior studies of CRISPR edits on embroys of mice, primates, and
humans’
Reporting of off-target side effects, and highlighting the risks of gene-editing
embroys was insufficient
Did not comply national guidelines in China
Failed to work within the ethical framework of his own university
Engaged in undue inducement of parents
Not providing an acceptable informed consent document