What is Ethics

What Is Ethics?What Is bioethics?

Short and simple definition:

• Ethics is the study of what is ‘good’ (and what is ‘bad’)

What is good?

• Vegetables are good for you- They help improve digestion and excretion• Smoking marijuana is bad for you

- Could result in addiction and loss of control over decision-making• Surgery would not have done him good

- Would not have eliminated the cancer cells

Case Study

• “Here you come across situations where a poor man has 40,000 in his bank, he's got a house and if he dies he's going to leave behind three children and a wife who doesn't earn. • So is it worth it (good) that his family spends all of that on him and

then be out on the street after he dies?

What Is good?

Medically good

•Matters of fact/logic/ probability

•What is? What could be?

•Will bring about successful management of the patient's condition

Ethically good

•Matters of value

•What ought to be?

•Will bring about ‘good’

What is good?

Differences in degree:

• Acceptable• Excusible / Tolerable• Justifiable• Commendable

Not so short, not so simple definition:

• Ethics is concerned with what is right or wrong, good or bad, fair or unfair, responsible or irresponsible, obligatory or permissible, praiseworthy or blameworthy. • It is associated with guilt, shame, indignation, resentment, empathy,

compassion, and care. • It is interested in character as well as conduct. • It addresses matters of public policy as well as more personal

matters.

Utilitarian Approach

• Jeremy Bentham, John Stuart Mill

• The ultimate end . . . for the sake of which all other things are desirable . . . is an existence exempt as far as possible from pain, and as rich as possible in enjoyments• Actions are right in

proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness


• Whatever can be proved to be good, must be so by being shown to be a means to something “good in itself”. • The medical art is proved to be good by its conducing to health; but

how is it possible to prove that health is good?


• The art of music is good, for the reason, among others, that it produces pleasure; but what proof is it possible to give that pleasure is good? • The proof that something is visible lies in its being seen; that

something is audible in its being heard; therefore that something is desirable in its being desired• Happiness is desired by all and is the only thing desired for its own

sake


• Epicurus – Roman Philosopher 200-300 BC• Good and evil lie in sensation, pleasure being good and pain being evil;

deities dwell apart from humans and are not concerned with the state of human existence.

2 Basic Utilitarian Types

• Act – Utilitarianism – choose actions that will increase the overall good.• Rule – Utilitarianism – act according to rules that tend to maximize

happiness and diminish unhappiness

Deontological Approach

• Immanuel Kant, Kantian, Formalism

• “There is nothing in this world, no, nothing even out of this world, that can be considered good without exception, except a good will.”• The value of a good will

does not depend on the results it manages to produce as the consequences of human action


• The moral value of the action can only reside in a formal principle or "maxim," the general commitment to act in this way because it is one's duty. • "Duty is the necessity to act out of reverence for the law”• Right actions are those that practical reason would will as universal

law


• THE CATEGORICAL IMPERATIVE• "Act only according to that maxim whereby you can at the same time

will that it should become a universal law." • "Act in such a way that you treat humanity, whether in your own

person or in the person of another, always at the same time as an end and never simply as a means."

Virtue Ethics

• Character ethics, represents the idea that individual’s actions are based upon a certain degree of innate moral virtue.• Cardinal virtues can be found in writings of homer, plato, aristotle

and other early christian thinkers.• With the rise of western moralism these were considered as virtuous

characteristics: wisdom, courage, temperance, justice, generosity, faith, hope and charity

Virtue Ethics

• Modern and contemporary writers even added: honesty, compassion, caring, responsibility, integrity, discernment, trustworthiness and prudence.• It provides guidelines to action. (What ought to be done?)• Virtue is not a moral requirement. A moral virtue is a character trait

that is socially valued.

Virtue Ethics

• A person with moral virtue has both consistent moral action and desire• Aristotle – Ethika, refers to matters having to do with character.

• Goodness of character is to be produced by the practice of virtuous behaviour, rather than virtuous acts being the end result of good character.

• Phillipa Foot – added will as a requirement. “disposition of the heart” “that is wished for as well as what is sought”

Virtue Ethics

• Focal virtues according to Beauchamp and Childress.• Character comprised of a set of stable traits that affect a person’s

judgement and action• Compassion• Discernment• Trustworthiness• Integrity

Origins of Bioethics

• The word “bioethics” appeared for the first time in 1970. It was coined by Van Rensselaer Potter, an American biochemist and professor of oncology at the McArdle Laboratory for Cancer Research at the University of Wisconsin-Madison (U.S.A.) for more than 50 years.

• Biological sciences had been increasing their knowledge and technical power continuously, but reflection about the values at stake has not progressed in the same proportion.

Origins of Bioethics

•Bíos, life, representing the facts of life and life sciences, and éthos, morals, referring to values and duties.• The only profession dealing with life during centuries and

millennia, especially with human life, has been medicine. But today there are many sciences and professions working in this field. •Bioethics should not be confused with medical ethics,

which is only one of its branches. The field of bioethics is very wide and its study is divided in many branches, each one with its specificity: Ecological or environmental bioethics, Medical bioethics, Clinical bioethics.

Bioethics in History

•Avicenna (AD 981–1037) laid great emphasis on teaching and practicing medical ethics. • In The Paradise of Wisdom (Ferdous al Hekmat), Abu

al-Hasan Ali ibn-e Raban Tabari (AD 807–861) described the Islamic codes of ethics as: ‘personal characters of the physician, his obligation towards patients, his obligation towards the community, his obligations towards his colleagues, and his obligations towards his assistants.’• Zakariya Rhazes (AD 865–925) His work entitled

Spiritual Medicine (Teb-e Rohani) focused on ethics

Bioethics in History – Code of Hammurabi 1800 BC

• If the wife was barren, the husband was allowed to take a handmaid (slave) from his wife's court and bear a child for his house. The woman would consequently become free which was not the case if she came from the husband's harem. • This concubine was not held in equal status with the wife

but inferior to her. If the concubine became a rival, the wife could reduce her to slavery again, sell her or dismiss her from her household. • This is the apparent rule which Abraham and Sarah

followed in the discarding of Hagar from their household.

Evolutionary Phases in Bioethical Studies

• Stages in the Development of Bioethics• Humans are social beings. Even the most primitive tribes have some

code or set of unwritten precepts by which they act and behave in relation to each other. This situation brings certain rights and obligations by which a group or community are supposed to act or behave. This is what we refer to as group morality or ethics.


• Morality grows out of human relationships for the sake of survival. This is the same as with physician-patient relationship, teacher-student, employer-employee, labor-management, etc.


• Medical Ethics• Oldest phase of bioethical exploration; a formulation of ethical norms for the

conduct of health care professionals in the treatment of patients.

•As early as 3rd century BC; Hippocratic Oath (Hippocrates (460-357 BC)• Oath – theocentric pledge made by the physician to both Apollo and Asclepius, the

father-and-son gods of medicine in greek mythology.


• Medical Ethics•As early as 3rd century BC; Hippocratic Oath

(Hippocrates (460-357 BC)• Underscores the physician’s all-out concern for the patient to be kept from harm and

injustice; Moral significance of confidentiality, medical secrecy.


• Medical Ethics•Other landmark documents that followed:

• Percival’s Medical Ethics (England, 1803)• AMA’s Code of Ethics (1847)

•Followed by other groups of professionals; these contributed to the srticulation of ethical issues and the formalization of rules of conduct governing other human relations


• Medical Ethics• Research Ethics•Second phase, biomedical research, use of

humans as experimental specimens• Third Reich (1933 – 1945), Adolf Hitler, tremendously influenced by Friedrich Nietzsche’s

philosophy of will to power (concept of superman); progress could be attained not by the emancipation of the masses from poverty but by the cultivation of the superior race of humans. “super offspring”; “human experimentation on prisoners of concentration camps”


• Medical Ethics• Research Ethics•Nuremburg Code (Bavaria, West Germany 1947)

attempted to humanize the cruel and barbaric nature of experiments. It takes into account the experimental subjects consent, “informed consent”


• Medical Ethics• Research Ethics• Public Policy

• Third stage in the development of bioethical inquiry; refers to the people’s efforts or involvement in formulating public guidelines for both clinical cases and biomedical research.



• Done through surveys, meetings, consultations, conferences, convocation about their opinions and views on particular bioethical issues.• Experts from other disciplines are asked to give their suggestions and

recommendations; public discussion is encouraged and conducted to give everyone an opportunity to participate in the consultative process



• After public discussions and consultative meetings, official enactment of public policies or through legislation is made. In turn, these are subjected to ethical analysis and evaluation by experts on a particular subject at issue, so that final amendments and modifications will be made in conjunction with the needs of the times and situations. (legal procedure in determining the legitimacy of moral decisions on several biomedical issues.

Documents

What is Ethics