BIOETHICS

Bioethics, also known as biomedical ethics, is one branch of applied, or practical, ethics. It refers to moral dilemmas and issues prevalent in today’s society as a result of advances in medicine and medical research. The term bio, meaning life, combined with ethics relates to the moral conduct of right and wrong in life and death issues. Ethical problems of the biological sciences, including research on animals, all fall under the domain of bioethics. Some of the bioethical issues discussed in this text include the allocation of scarce resources such as transplant organs, beginning-of-life issues, cloning, harvesting embryos, concerns surrounding death and dying, experimentation and the use of human subjects, who owns the right to body cells, and dilemmas in the treatment of catastrophic disease.

Bioethics uses a form of moral analysis to assist in determining the obligations and responsibilities of unique issues relating to modern healthcare. Today’s modern medical care requires that decision-makers carefully examine facts, identify the moral challenges, and then look carefully at all alternatives. There are basically four principles that can serve as guidelines when confronting bioethical dilemmas. These include the principles of autonomy, beneficence, nonmalfeasance, and justice.

The principle of autonomy means that people have the right to make decisions about their own life. The concept of “informed consent” is included in this principle. It means that patients must be informed and understand what they are told before they can provide consent for the treatment. They must be told what the treatment involves, the risks involved, the chance for success, and the alternatives.

The principle of beneficence , or the principle of doing good, means that we must not harm patients while we are trying to help them. This principle recognizes that medical science must do what is best for each individual patient. If there are risks involved, then the principle of autonomy must be invoked so that decisions are made in conjunction with patient’s wishes.

The principle of nonmalfeasance is taken from the Latin maxim Primum non nocere, which means “First, do no harm.” This is a warning to all members of the healthcare profession. Nonmalfeasance completes the principle of beneficence because we are now asking the medical profession to not only do good for the patient, but also to do no harm in the process. In some cases the risks of a treatment may outweigh the benefits. For example, when a surgeon removes a pregnant woman’s cancerous uterus to save her life, her unborn child will not live. The principle of nonmalfeasance causes the medical profession to stop and think before acting.

Finally, the principle of justice warns us that equals must be treated equally. The same treatments must be given to all patients whether they are rich, poor, educated, uneducated, able-bodied, or disabled.

These four bioethical principles are guidelines for physicians and healthcare professionals to use when patients are unable to provide their personal wishes. For example, there have been cases of “wrongful life” in which a fetus is delivered too soon before development is complete. These infants, if they survive, may have severe disabilities. Physicians may be requested by parents to “do nothing” to resuscitate or save their undeveloped child. Issues such as these weigh heavily upon the shoulders of all medical professionals. Having a set of guidelines, such as the above four principles, to follow has helped in some of the decision-making.

Bioethicists , specialists in the field of bioethics, give thought to ethical concerns that often examine the more abstract dimensions of ethical issues and dilemmas. For example, they might ask, “What are the social implications of surrogate motherhood?” Bioethicists are often authors, teachers, and researchers. This branch of ethics poses difficult, if not impossible, questions for the medical practitioner. Examples of some of the difficult ethical and bioethical situations that face the healthcare professional are listed under “Points to Ponder” at the end of this chapter.