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ADVANCEDBIOETHICS
EMMANUEL JAMES P. PATTAGUAN, M.S.,PH.D
Vice-President for Administration
Used and modified with permission
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Course Requirements
Attendance-5%
Midterm Examination-25%Final Examination-35%
Reaction Papers(1-4)-20%
Classroom Participation-5%Case Presentation-10%
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Course Content
I. Preliminaries
Review of the Basics of Ethics
II. Course proper
1. Definition of Bioethics
2. History ofBioethics
3.Scope and Purposes of Bioethics
4. Principles Governing Bioethics
5. Perspectives and Methodology inBioethics
III.Bioethical Issues
IV.Case Presentation
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An overview
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Review of the Basics
What is Ethics?
Ethics is defined as the art andscience that deals with the morality of
human acts.
Human act- act that proceedsfrom the deliberate free will of man.
Acts of man- acts proper to man
as man.
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IN RELATION TO REASON, our acts
can beGood if it is in harmony with the
dictates of right reason
Evil if it is in opposition to the dictatesof reason
Indifferentwhen it stand in no positive
relation to the dictates.
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The etymology
ethics and morality
ethos
mos
Ruth Benedict
..all values are rooted in customs and
habits of a culture because the wordsmoral and ethics themselves were
essentially created to describe these
topics.
Conveys meaning
describing
customs,habits
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Ruth Benedict is among a group called
the cultural relativists that believewhatever is normal and customary is
what is right, and whatever is abnormal
and deviant is wrong.
Cultural relativism stresses acceptance
because it is a de facto of humanreality
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Nursing ethics is a branch ofapplied ethics that concerns itself
with activities in the field of nursing.
Nursing ethics shares many
principles with medical ethics, suchas beneficence, non-maleficence and
respect for autonomy. It can be
distinguished by its emphasis on
relationships, maintaining dignity andcollaborative care.
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What is Bioethics?
1. Bioethics is the philosophical study ofthe ethical controversies brought about
by advances in biologyandmedicine.
Bioethicists are concerned with the
ethical questions that arise in the
relationships among life sciences,biotechnology, medicine, politics, law,
philosophy and theology
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2.Ethics or 'moral philosophy', is
concerned with questions of howpersons ought to act or if such
questions are answerable.
3. Ethics is also associated with the
idea of Morality.
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History of Bioethics
I. 1960-the modern field of bioethics first
emerged as an academic discipline.
Technological advances in such diverse
areas as organ transplantation and end-of-life care, including the development of
kidney dialysis and respirators, posed
novel questions regarding when and howcare might be withdrawn. These questions
often fell upon philosophers and religious
scholars.
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II. 1970- bioethical think tanks and academic
bioethics programs emerged. Among the earliest
such institutions were the HASTINGS CENTER
(originally known as The Institute of Society,
Ethics and the Life Sciences), founded in 1969 by
philosopher Daniel Callahan and psychiatrist
Willard Gaylin, and the Kennedy Institute of
Ethics, established at Goergetown University in
1971. The publication ofPrinciples of Biomedical
Ethics by James F. Childress and Tom
Beauchamp the first American textbook of
bioethicsmarked a transformative moment in
the discipline.
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III. During the subsequent three decades, bioethical
issues gained widespread attention. The field
developed its own cadre of widely-knownadvocates, such as Al Jonsen at the University of
Washington, John Fletcher at the University of
Virginia, Jacob M. Appel at Brown University, Ruth
Faden at John Hopkins University, and Arthur Caplan at the University of Pennsylvania. In 1995,
President Bill Clinton established the Presidents
Council on Bioethics, a sign that the field had
finally reached an unprecedented level of maturityand acceptance. President George W. Bush also
relied upon a Council on Bioethics in rendering
decisions in areas such as the public funding of
embryonic stem-cell research.
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Scope and Purpose of Bioethics
1. Bioethics addresses a broad range of
human inquiry, ranging from debates
over the boundaries of life (eg.abortion,euthanasia) to the allocation of
scarce health care resources (eg. Organ
donation, health care rationing) to theright to turn down medical care for
religious or cultural reasons.
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2. Bioethicists often disagree among
themselves over the precise limits of
their discipline, debating whether thefield should concern itself with the
ethical evaluation of all questions
involving biology and medicine, oronly a subset of these questions.
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3. Some bioethicists would narrow
ethical evaluation only to the morality of
medical treatments or technological
innovations, and the timing of medical
treatment of humans
4. Others would broaden the scope of ethical
evaluation to include the morality of all
actions that might help or harm organismscapable of feeling fear and pain, and include
within bioethics all such actions if they bear
a relation to medicine and biology.
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5. However, most bioethicists share a
commitment to discussing thesecomplex issues in an honest, civil and
intelligent way, using tools from the
many different disciplines that "feed"
the field to produce meaningful
frameworks for analysis.
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Principles of Bioethics
1. Autonomy (Ancient Greek: autonomos, Modern Greek:
autonomia, from auto "self" + nomos, "law": one who gives
oneself his/her own law) is a concept found in moral,
political, and bioethical philosophy. Within these contexts, it
refers to the capacity of a rational individual to make aninformed, un-coerced decision. In moral and political
philosophy, autonomy is often used as the basis for
determining moral respectibility for one's actions. One of the
best known philosophical theories of autonomy was
developed by Kant. In Medicine, respect for the autonomy ofpatients is an important goal, though it can conflict with a
competing ethical principle, namely beneficence. Politically,
it is also used to refer to the self-governing of a people.
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2. Beneficence
James Childress and Tom Beauchamp in
Principle of Biomedical Ethics (1978) identify
beneficence as one of the core values of healthcare ethics. Some scholars, such as Edmund
Pellegrino, argue that beneficence is the only
fundamental principle of medical ethics. They
argue that healing should be the solepurpose of medicine, and that endeavors
like cosmetic surgery, contraception and
euthanasia fall beyond its purview.
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3. Justice is the concept of moral
rightness based on ethics, rationality,law,fairness or equity.
4. Others have added non-
maleficence, human dignity and
the sanctity of life to this list ofcardinal values.
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Non-malefecence
In practice, however, many treatments
carry some risk of harm. In somecircumstances, e.g. in desperate situations
where the outcome without treatment will
be grave, risky treatments that stand ahigh chance of harming the patient will be
justified, as the risk of not treating is also
very likely to do harm. So the principle ofnon-maleficence is not absolute, and must
be balanced against the principle of
beneficence (doing good).
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Pope Pius defines Human Dignity-as something that is inherently a
persons God-given inalienable rights
that deserves to be protected byGovernment and promoted by the
community.
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inviolability orsanctity of life is a
principle of implied protection regarding
aspects of life which are said to be holy,
saintly,sanctified, or otherwise of such
value that they are not to be violated. In
western religions, the concept is based
on the belief that all human beings have
souls or are created in God's image.
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Perspectives and methodology
Bioethicists come from a wide variety of backgrounds
and have training in a diverse array of disciplines. Thefield contains individuals trained in philosophy such as
Peter Singer of Princeton University and Daniel Brock of
Harvard University, medically-trained clinician ethicists
such as Mark Siegler of the University of Chicago and
Joseph Fins of Cornell University, lawyers such as Jacob
Appel and Wesley J. Smith, political economists like
Francis Fukuyama, and theologians including James
Childress. The field, once dominated by formally trained
philosophers, has become increasingly interdisciplinary,with some critics even claiming that the methods of
analytic philosophy have had a negative effect on the
field's development. Leading journals in the field include
the Hastings Center report, the Journal of Medical Ethics
and the Cambridge Quarterly of Healthcare Ethics.
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Many religious communities have their own histories of inquiry
into bioethical issues and have developed rules and
guidelines on how to deal with these issues from within the
viewpoint of their respective faiths. The Jewish, Christian andMuslim faiths have each developed a considerable body of
literature on these matters. In the case of many non-Western
cultures, a strict separation of religion from philosophy does
not exist. In many Asian cultures, for example, there is a livelydiscussion on bioethical issues. Buddhist bioethics, in general,
is characterised by a naturalistic outlook that leads to a
rationalistic, pragmatic approach. Buddhist bioethicists include
Damien Keown. In India, Vandana Shiva is the leading
bioethicist speaking from the Hindu tradition. In Africa, andpartly also in Latin America, the debate on bioethics frequently
focusses on its practical relevance in the context of
underdevelopment and geopolitical power relations.
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Peter Singer
Outside academic circles, Singer is best known for his book Animal
Liberation, widely regarded as the touchstone of the animal liberation
movement. Not all members of the animal liberation movement share thisview, and Singer himself has said the media overstates his status. His views
on that and other issues in bioethics have attracted attention and a degree
of controversy.
InAnimal Liberation, Singer argues against what he calls speciesm:
discrimination on the grounds that a being belongs to a certain species. He
holds the interests of all beings capable of suffering to be worthy of equal
consideration, and that giving lesser consideration to beings based on their
species is no more justified than discrimination based on skin color. He
argues that animals should have rights based on their ability to feel pain
more than their intelligence. In particular, he argues that while animals
show lower intelligence than the average human, many severely retarded
humans show equally diminished, if not lower, mental capacity, and that
some animals have displayed signs of intelligence (for example, primates
learning elements of American sign language and other symbolic
languages) sometimes on par with that of human children, and that
therefore intelligence does not provide a basis for providing nonhuman
animals any less consideration than such retarded humans.
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Key Issues in Jewish Faith
In its early years, Jewish medical ethics addresseda range of ethical dilemmas, as well as general
questions about the professional ethics for doctors.
Major issues have included abortion, artificial
insemination, brain death, cosmetic surgery,euthanasia, genetic screening, hazardous medical
operations, oral suction in circumcision (metzitzah
b'peh), organ donation , psychiatric care, and
smoking cigarettes. In recent years, Jewishbioethics has examined questions of medical
technology, the allocation of medical resources,
and the philosophy ofJewish ethics
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Ethics in the Muslim Faith
Islam is the religion that heavily focuses on character building and
doesnt grant the place in paradise by merely admitting into Islam. Infact, it teaches that sins can be washed not just by accepting
commands of Allah but by physically doing these commands in
Actions, and that bad deed can be washed away by doing good
deeds. The person who acts on Allahs commands and perform
good deed invariably attain good character.
There is strong relationship between Strong Iman (faith) and good
character. A person cannot attain full or perfect faith without
attaining good character. In fact, a person with bad character is
likely to find a place in hell then in paradise. Anas reportedMuhammad as saying: A person can reach a high status in the
hereafter by his good conduct though he may be weak in matters of
worship, and he can also go down to the lowest part of Hell by his
wicked character [Abu Dawood]
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The person with good character elevates himself to the status of
those who are pious in their prayers and worships. Aisha (ra)
reported Muhammad saying: A believer with his noble manners
achieves the rank of one who prays late night and fast during theday [Abu Dawood]
Similarly, Ibn Omar related that he heard Muhammad saying: A
Muslim who worships in moderation reaches by means of his good
manners and noble nature the rank of a person who fasts and recites
the holy Quran in the night prayers. [Imam Ahmed]
Islam has five main pillars, namely belief in the oneness of God
(tawheed), daily prayers (salah), charity (zakat), fasting (sawm), and
pilgrimage to Mecca (hajj). These are various acts of worship and
obedience to Allah. All of these pillars are attributes directly towardscharacter building and bestowing high morals and ethics into
Muslims
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Buddhism and Bioethics
The five precepts are training rules in order to live a better life in which one ishappy, without worries, and can meditate well:
1. To refrain from taking life (non-violence towards sensient life forms)
2. To refrain from taking that which is not given (not committing theft)
3. To refrain from sensual (including sexual) misconduct
4. To refrain from lying (speaking truth always)
5. To refrain from intoxicants which lead to loss of mindfulness (specifically, drugsand alcohol)
The precepts are not formulated as imperatives, but as training rules that
laypeople undertake voluntarily to facilitate practice.In Buddhist thought, the
cultivation of dana and ethical conduct will themselves refine consciousness to
such a level that rebirth in one of the lower heavens is likely, even if there is no
further Buddhist practice. There is nothing improper or un-Buddhist aboutlimiting one's aims to this level of attainment.
In the eight precepts, the third precept on sexual misconduct is made more strict,
and becomes a precept of celibacy. The three additional precepts are:
6. To refrain from eating at the wrong time (only eat from sunrise to noon)
7. To refrain from dancing and playing music, wearing jewelry and cosmetics,
attending shows and other performances