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7/28/2019 Bioethics 1 (3)
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Introduction to Bioethics
What is bioethics?
What were the influential historical events andsocial processes that defined its emergence?
Pter Kakuk, [email protected]
Institute of Behavioural Sciences, 451-486, 55406, 55510
Bioethics seminars
2006/2007 2nd semester
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The emergence of bioethics
I doubt whether it will ever be a discipline. It
has become a meeting ground for a number
of disciplines, discourses and organisations
concerned with ethical, legal and socialquestions raised by advances in medicine,
science and biotechnology.(Onora ONeill)
The term, bioethics was coinedin 1971, with
the foundation of an institute in WashingtonDC. >> The Kennedy Institute for the Study of
Human Reproduction and Bioethics
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I will neither give a deadly drug to anybody who asked for it, nor will I
make a suggestion to this effect. Similarly I will not give to a woman
an abortive remedy. In purity and holiness I will guard my life and my
art.
I will not use the knife, not even on sufferers from stone, but will
withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick,
remaining free of all intentional injustice, of all mischief and in
particular of sexual relations with both female and male persons, be
they free or slaves.
What I may see or hear in the course of the treatment or even
outside of the treatment in regard to the life of men, which on no
account one must spread abroad, I will keep to myself, holding such
things shameful to be spoken about.
If I fulfil this oath and do not violate it, may it be granted to me to
enjoy life and art, being honored with fame among all men for all
time to come; if I transgress it and swear falsely, may the opposite of
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Hippocratic OathModern VersionWritten in 1964 by Louis Lasagna, Academic Dean of the
School of Medicine at Tufts University
I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians inwhose steps I walk, and gladly share such knowledge as is mine withthose who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required,avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and
that warmth, sympathy, and understanding may outweigh thesurgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in mycolleagues when the skills of another are needed for a patient'srecovery.
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Hippocratic OathModern VersionWritten in 1964 by Louis Lasagna, Academic Dean of the
School of Medicine at Tufts University
I will respect the privacy of my patients, for their problems are not disclosed tome that the world may know. Most especially must I tread with care in matters oflife and death. If it is given me to save a life, all thanks. But it may also be withinmy power to take a life; this awesome responsibility must be faced with greathumbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sickhuman being, whose illness may affect the person's family and economicstability. My responsibility includes these related problems, if I am to careadequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all
my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live andremembered with affection thereafter. May I always act so as to preserve thefinest traditions of my calling and may I long experience the joy of healing thosewho seek my help.
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Social processes that influenced the
modern ethical approach
Medicalization
Radical changes in the structure of health care
in the 20th century Development of powerful medical technologies
Human rights and anti-paternalist movements
Emerging demand on the wider social control ofscience and research.
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Science and responsibility
From the idea ofscience and humanityto the experience ofdestruction
The ethical self-controlof scientific practice: Isit sufficient?
The importance of awider publicity and
social control.
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Historical events and the application of
biological knowledge
Medicine under the Nazis
National Socialism as applied biology: racial hygiene and
the theory of the nordic superior race
Eutanasia program of the Nazis Research on humans and the final solution
Eugenics Movement (USA, England, North European
Countries)
Compulsary sterilization laws
Debated biomedical research on human subjects
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Eugenics as a social movement
Mostly positive propaganda for
achieving healthy nation
Pedigree construction
Fitter Family Contest
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Negative Eugenics:compulsory
sterilization laws
Buck vs. Bell case (2May 1927) JudgeHolmes famous
statement: Threegenerations ofimbeciles are enough.
This decision gave agreen light to
compulsory sterilizationin more than 30 statesof the US.
Estimates say about
60.000 sterilization.
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Eugenics supporting the political
program of immigration restriction
In the first two decades of
the last century
600 000 - 1250 000newcomers arrived an a
daily basis.
The 1924 Immigration
Restriction Act was based on
the ideology of eugenics. They reduced the number of
immigrants by 80 %.
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Eugenics propaganda; social reform
through biological knowledge
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Biological ideology
The obscurely and widely
defined concept of hereditary
diseases (low IQ, alcoholism,
criminality etc.)
The supposed close
relationship between
genetical impurity and the
numbers of offsprings
Endanger the nation and the
nordic race
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experiments
Mostly ordered by the
German army.
Victim of a medical experiment
immersed in freezing water at the
Dachau concentration camp. Dachau,
Germany, between August 1942 and
May 1943. YV
A prisoner in a compression chamber loses
consciousness (and later dies) during an
experiment to determine altitudes at which
aircraft crews could survive without oxygen.Dachau, Germany, 1942. NARA
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Nuremberg Medical Trial
and the Nuremberg Code
1947
Birth of the firstinternational codeconcerning the ethicalrequirements of humanexperiments
Stressing the importance ofinformed consent and theautonomy of researchparticipants
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NUREMBERG CODE, 1947
1. The voluntary consent of the human subject is absolutelyessential. This means that the person involved should have legal capacityto give consent; should be so situated as to be able to exercise free power ofchoice, without the intervention of any element of force, fraud, deceit,duress, over-reaching, or other ulterior form of constraint or coercion; andshould have sufficient knowledge and comprehension of the elements of
the subject matter involved as to enable him to make an understanding andenlightened decision. This latter element requires that before theacceptance of an affirmative decision by the experimental subject thereshould be made known to him the nature, duration, and purpose of theexperiment; the method and means by which it is to be conducted; allinconveniences and hazards reasonable to be expected; and the effects upon
his health or person which may possibly come from his participation in theexperiment.
The duty and responsibility for ascertaining the quality of the consent restsupon each individual who initiates, directs or engages in the experiment. Itis a personal duty and responsibility which may not be delegated to another
with impunity.
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2. The experiment should be such as to yield fruitful results for thegood of society, unprocurable by other methods or means of study, andnot random and unnecessary in nature.
3. The experiment should be so designed and based on the results ofanimal experimentation and a knowledge of the natural history of thedisease or other problem under study that the anticipated results will
justify the performance of the experiment.
4. The experiment should be so conducted as to avoid all unnecessary
physical and mental suffering and injury.
5. No experiment should be conducted where there is an a priorireason to believe that death or disabling injury will occur; except,perhaps, in those experiments where the experimental physicians alsoserve as subjects.
6. The degree of risk to be taken should never exceed that determinedby the humanitarian importance of the problem to be solved by theexperiment.
7. Proper preparations should be made and adequate facilitiesprovided to protect the experimental subject against even remote
possibilities of injury, disability, or death.
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Nuremberg Code
9. During the course of the experiment the human subjectshould be at liberty to bring the experiment to an end if he hasreached the physical or mental state where continuation of theexperiment seems to him to be impossible.
10. During the course of the experiment the scientist in chargemust be prepared to terminate the experiment at any stage, if hehas probable cause to believe, in the exercise of the good faith,superior skill and careful judgment required of him that acontinuation of the experiment is likely to result in injury,disability, or death to the experimental subject.
Reprinted from Trials of War Criminals before the Nuremberg MilitaryTribunals under Control Council Law No. 10, Vol. 2, pp. 181-182..Washington, D.C.: U.S. Government Printing Office, 1949.
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Bioethics in the USA, problematic research on
humans, the Tuskegee Syphilis study and genetic
engineering
Henry Beechers classic paper in the
New England Journal of Medicine:
Ethics and Clinical Research 74
(1966) 1354-60.
The deliberate failure to treat a group
of male Negroes in Macon County
(near Tuskegee), Alabama who had
syphilis begun in 1932 and ended, by
unfavorable publicity, in 1972.
At the end of the 1960s: New
techniques for the direct manipulation
of genes: genetic engineering. Tuskegee Syphilis study
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Consequences
The importance of individual autonomy (instead
of collectivisim)
The growing importance of human rights
The social need for the transparency of scientificactivities
Insufficiency of the Hippocratic Oath
Need for new medical norms and regulations
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Medical ethics
traditional and modern
Hippocratic tradition
List of professional
moral duties From the perspective of
the doctor
Paternalism
Argumentative
Interdisciplinary
Moral pluralism Patient perspective
Stressing the autonomy
of the patient
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Bioethics as part of applied ethics
Modern
medical ethics
Applied ethics
Bioethics
A quite frequent definition of
bioethics as apllied ethics.
Bioethics applies moral
philosophical reasoning tothe ethical problems arising
in the diverse field of the
lifesciences.
criticism towards
this idea that stresses moral
philosophy in understanding
these problems
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The four principles approach (4PA)
(Childress and Beauchamp, 1979)
The four principles emerge from a rational reconstruction
of common morality (the immediate moral
intuitions/judgements) of ordinary people.
Respect for autonomy
Non-maleficence
Beneficence
Justice
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Attractions and Critiques of 4PA
its simple structure
its apparent ability to make adeeper understanding of,and engagement with moral
theory unnecesserary its apparent congruence with
common features of moralthinking
the derivation of the 4principles from moral theoryis problematic
the degree to which commonmorality can be said to
support the 4 principles isquestionable
the content of the 4principles is determinedwithin a specific culture
the four principles do not
cover the whole moraldomain
the guidelines forspecification and balancingare vogue.
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The pluralism in bioethical approaches
Legal context of the problem
Empirical evidences in approaching an ethical
problem
Social sciences approaches
Religious approaches
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DECLARATION OF GENEVAAdopted by the 2nd General Assembly of the
World Medical Association, Geneva, Switzerland, September 1948
AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICALPROFESSION:I SOLEMNLY PLEDGE myself to consecrate my life to the service ofhumanity;
I WILL GIVE to my teachers the respect and gratitude which is their due;
I WILL PRACTICE my profession with conscience and dignity;
THE HEALTH OF MY PATIENT will be my first consideration;I WILL RESPECT the secrets which are confided in me, even after thepatient has died;
I WILL MAINTAIN by all the means in my power, the honor and the nobletraditions of the medical profession;
MY COLLEAGUES will be my sisters and brothers;
I WILL NOT PERMIT considerations of age, disease or disability, creed,ethnic origin, gender, nationality, political affiliation, race, sexual orientation,or social standing to intervene between my duty and my patient;
I WILL MAINTAIN the utmost respect for human life from its beginning evenunder threat and I will not use my medical knowledge contrary to the laws ofhumanity;
I MAKE THESE PROMISES solemnly, freely and upon my honor.
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Further reading, useful sources:
World Medical Association (WMA), www.wma.net
American Journal of Bioethics, www.bioethics.net
Eugenics Archive (USA), www.eugenicsarchive.org
Tom L. Beauchamp, James F. Childress: Principles of
Biomedical Ethics. New York: Oxford University Press
(fifth ed.), 2001.
David J. Rothman: Strangers at the Bedside
Ahistory of how law and bioethics transformed medical
decision making. New York: Basic Books, 1991.
http://www.wma.net/http://www.bioethics.net/http://www.eugenicsarchive.org/http://www.eugenicsarchive.org/http://www.bioethics.net/http://www.wma.net/7/28/2019 Bioethics 1 (3)
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At the end of this section you should be able
to answer these questions!
What principles are formulated concretely in the original versionof the Hippocratic Oath?
What social processes and changes have lead to theemergence of bioethics?
What is the difference between traditional and modern medical
ethics? What does moral pluralism mean?
When was the Nuremberg Code established? What is the mainpoint the document is stressing?
What are the main points of the Declaration of Geneva?
What are the four principles of medical ethics? Define themeaning of each!
What are the attractions and critiques of the four principles?
What is eugenics? What is racial hygiene?