Download - Bioethics 2
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Mr. JOHN MICHAEL O. LORENA, RN MAN
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Objectives:
1. Define the domains of ethics2. Explain basic ethical principles3. Formulate ideas and stand on
various bioethical issues
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Course Description
• Deals with the ethics and moral decision making in relation to advances in the life and health sciences.
• It includes issues and principles on death, animal welfare, beneficence, maleficence, respect for persons, resource allocation and biotechnology
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Basics of BIOETHICS
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Course OutlineDates Chapters Topics
April 12-16 1-2 EthicsHippocratic Oath
April 19-23 3-4 Death, Abortion and Animal Welfare
Benefitting and Avoiding Harm
April 26-April 30 5-6 Respect for PersonsAvoiding Killing
May3-7 7-8 Death & DyingSocial Ethics
May 10-14 9-10 Human Control of LifeResolving Conflicts among Principles
May 17-21 11 Virtues in BioethicsFinal Exam
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1. Basics of Bioethics by Veatch, 2nd Edition
2. Other books (Ethics)
Required Book:
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Classroom Management1. No opening of book during lecture sessions
1. Must have notebook (Major requirement)2. Punctuality
1. Locking of doors2. Readmission slips/ Medical certificate
3. Examination1. Quizzes
1. No Make-up quizzes2. Graded Recitation3. Examination booklet
1. Blue ink2. Crossing out scheme
4. No using of cellular phone during lecture hours1. Penalty
5. Grading System
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Basics of BIOETHICS
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What is…………….
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Phencyclidine
Case 1
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Personal reflection…….
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ETHICS
• Greek word “ethicos or ethos” (custom or character)
• Philosophical science that deals with the morality of human conduct
• Philosophical discipline that provides the principles on the morality of human acts
• Provides theories and principles of right or wrong and good or bad actions
• The ‘should’ of human behavior • The study of morals
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Types of ethics
1. Bioethics or Clinical ethics 1. Ethics applied to human life or health
1. Abortion or euthanasia2. Nursing ethics
1. Refers to ethical issues that occur in the nursing practice
1. Patient confidentiality; being patient advocate
3. Management or business ethics
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Morality• Latin word “mos or moris”• Means custom• Actualizes the theories and principles
(provided by Ethics)• Relates to people’s behavior• Other term is “Applied ethics”• Function:
– Apply these theories and principles
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1. I do not talk with my seatmates during fire drill because that is one of the rules.
2. I do not say bad words because if I do, mommy will get mad at me.
3. I pay taxes because it is the right thing to do.
4. For a cookie, I will pick up my toys. 5. I do not eat in class because my
teacher does not like it. 6. I pay taxes because it is the law.
What specific stages of Moral Development are the following examples?
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Moral Development Stages
PRECONVENTIONAL / PREMORAL LEVEL (Egocentric focus)Stage 1 (Punishment Avoidance - Obedience) right
and wrong is determined by what is punishedStage 2 (Instrumental-Relativist) right and wrong is
determined by what is rewarded; own needs a priorityCONVENTIONAL LEVEL (Societal focus)
Stage 3 (Good Boy/Girl) right and wrong is determined by close others’ approval or disapproval; pleases others
Stage 4 (Law and Order Orientation) right and wrong is determined by society’s rules and laws, which should be obeyed rigidly; rules as inflexible, unchangeable
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POSTCONVENTIONAL LEVEL (universal focus)• Stage 5 ( Social Contract Legalistic
Orientation ) – – right and wrong is determined not only by
social rules but also higher moral principles like equality, justice or due process
• Stage 6 (Universal-Ethical Principle Orientation) – – right and wrong is determined by abstract
ethical principles that emphasize justice and equity; decisions are based on conscience rather than social laws
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BIOETHICS
• Daniel Callahan together with Willard Gaylin, 1969 (Hastings Center)
• Van Rensselaer Potter, 1970 (popularized)– Oncologist
• Bio (life)• Ethos (ethics/custom)
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"Biology combined with diverse humanistic knowledge forging a science that sets a
system of medical and environmental priorities for
acceptable survival.“Global Bioethics (1988)
Bioethics
-------- 1911 - 2001 --------
Van Rensselaer Potter
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BIOETHICS• Discipline that deals with morality of human
conduct• Multidisciplinary (law, philosophy, religion,
medicine)• Branch of ethics
– that deals with the life sciences and their impact in society
– Analyzes moral values in the context of biomedical sciences
• Deals with the life sciences, namely, medicine, health care, genetics, biology and research
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Bioethical Issues and Concerns
1. Ends and purposes of life sciences, quality of life, death and pain sufferings
2. Reproduction: genetic engineering, cloning, in-vitro fertilization, sperm banking
3. Organ harvesting and transplantation4. Advanced biomedical technology
1. Stem cell2. Gene therapy
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Individual Homework….
• Submit a picture/clipping of a recent bioethical issue that has a relevance on your life as a student nurse and make a reaction (30 sentences).
• Submission is tomorrow• Short bond paper
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• Given that case 1, the people involved are faced with some difficult and controversial ethical choices….
• Thus, we need to study the map of ETHICAL TERRAIN (overview of the ethical issues at stake)
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Levels of Moral Discourse
METAETHICS
Normative Ethics
Rules and Rights (Codes of Ethics)
Cases (Casuistry)
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Casuistry
• Rely on paradigms cases (similar)• Similar cases should be treated
similarly• New case is similar in all relevant
respects– May consult a colleague or refer to a
hospital ethics committee
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Rules & Rights• Tell us what is legal and ethical
– If considered ethical –Seen as grounded in our moral systemGroups of rules or rights-claims are called CODE of ETHICS
Therefore, can consult the Codes of Ethics a particular discipline
Rule-like maxim (Nurse)Right-claims (Patient)
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Rules & Rights• When organization gather together collection of
rules or right-claims • – they produce a CODE of ETHICS
• Can also be in a form of OATHS or Directives• When made up of rights-claims
– Bill of Rights• Physicians may consult the Code of Ethics of the their
Medical Association• Controversies
1. Legalism (no exceptions)2. Antinomianism (every case is unique)3. Situationalism (must be evaluated)4. Rules of practice
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Rules & Rights continuum
Antinomianism Situationalism Rules of Practice Legalism
No Rules apply Rules apply rigidly
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Normative ethics1. Norms of behavior/character are discussed2. Norms of good moral character are
articulated1. It involves (3) questions
1. What principles make actions morally right? (ACTION)
2. What kinds of consequences are good or valuable? (VALUE)
3. What kinds of character traits are morally praiseworthy? (VIRTUE)
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Normative ethicsA. Action Theory (Questions of ethical
principle)A. Principles of Beneficence and
NonmaleficenceB. Value Theory (Intrinsic goods)
A. ValueA. Money (Instrumental)B. Happiness, beauty, knowledge and health
(Valuable)
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Normative EthicsC. Virtue Theory (Good character)
A. Morally praiseworthy character traits (VIRTUE)
A. Compassion (Professional VIRTUE)A. Hippocratic Oath
B. Benevolence (Willingness to do good) = (Secular VIRTUE)A. Japanese, Greek
C. Faithfulness (Religious VIRTUE)A. Christian, Muslim, etc.
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Metaethics• Deals with the most basic questions
of ethics– What is the meaning?– How it can be justified?– Which one is correct?
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Metaethics• Source?
– Religious• Approved by God
– Secular• Natural law or Contract (hypothetical)
– Relativists• Culture or personal preference
• Is it ethical?– Divine Law or church tradition– Secular
• Empirical experience by Kant• Experience of sympathy by Hume
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Hippocratic Oath
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Hippocrates
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Hippocrates
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I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that, according to my ability and judgment, I will keep this Oath and this contract: To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures, and every other mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others.I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them.I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.In purity and according to divine law will I carry out my life and my art.I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate.
Hippocratic Oath
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I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation. TO RECKON all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient. I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life. WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient. WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret. WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse by my lot.
Hippocratic Oath (Modern)
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Why Bioethics?
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Current Bioethical Issues1. Check the local news paper2. Stem cells (state, national,
international)3. Genetically Engineered Organisms4. Knowing your genes5. In vetro fertilization – choosing your
child's genes and characteristics6. Global warming7. Chemicals exposures – human health8. Environmental health
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"A thing is right when it tends to preserve the integrity, stability, and beauty of the biotic community. It is wrong when it tends otherwise." -
Aldo Leopold, 1949, A Sand County Almanac
The First Bioethicist
---------- 1887 - 1948 ----------
Aldo Leopold
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“An ethic, ecologically, is a limitation on freedom of action in the struggle for
existence”Aldo Leopold
Limits on Freedom
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“The Commons”
The Tragedy of the CommonsBy Garrett Hardin, Science, 1968
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Technical Solutions
“It is our considered professional judgment that
this dilemma has no technical solution.”
The Tragedy of the CommonsBy Garrett Hardin, Science, 1968
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Problems – Solutions?
Lead and kids Fetal alcohol syndrome Nuclear disarmament Bioterrorism Ocean Fisheries Persistent chemicals The Commons
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"Biology combined with diverse humanistic knowledge forging a
science that sets a system of medical and environmental
priorities for acceptable survival.“Global Bioethics (1988)
Bioethics
-------- 1911 - 2001 --------
Van Rensselaer Potter
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1860’s - Scientific method in medicine, Gregor Mendel1928 - Penicillin discovered – widely used WWII1920’s - Lead in gasoline, lead in paint1931 - 30 states had sterilization laws on books1932 - Tuskegee syphilis study initiated 1947 - Nuremberg - The Doctors Trial1952 - First open heart surgery & Chlorpromazine1953 - Structure of DNA – Watson & Crick
Ethics and Science
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60’s - Thalidomide, mercury, chronic hemodialysis, amniocentesis, informed consent, IRB’s
70’s - Hastings Center founded, bioethics defined, Tuskegee noticed, Belmont Report (3 principles), Genentech Inc. founded, awareness of FAS, sensitivity of developing CNS
80’s - Recombinant microorganism could be patented, lead is harmful to developing brain
90’s - molecular biology, sequencing of human genome (other species), Jurassic Park
00’s - US stem cell research restricted03 - Human cloned?
Ethics and Science
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Question??Who were the most influential people
of the past century?
James Watson (L) and Francis Crick (R), and the model they built of the structure of DNA (and Rosalind Franklin).
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ELSI
Ethical Legal / Regulatory Social Implications or Issues What is unsaid or missing? Science Values Politics
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Topics
Why this is topic important DNA to RNA to Proteins Stem Cells Cloning – Therapeutic and Human
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Stem Cell History1998 - Researchers first extract stem cells from human
embryos 1999 - First Successful human transplant of insulin-
making cells from cadavers2001 - President Bush restricts federal funding for
embryonic stem-cell research2002 - Juvenile Diabetes Research Foundation
International creates $20 million fund-raising effort to support stem-cell research
2003?? - California ok stem cell research 2004 - Harvard researchers grow stem cells from embryos
using private funding2004 - Ballot measure for $3 Billion bond for stem cells
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Importance Disease
• Diabetes, Spinal cord injury, Parkinson’s disease, heart disease
Genetic based Disease• Cystic fibrosis,
Huntington’s
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DNA – T-A C-G
Thymine (T) Adenine (A)Cytosine (C) Guanine (G)
Over 3 billion base pairs, 30,000 genesHumans are over 99.9% identical
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Central Dogma of Molecular Biology
DNA
RNA
Protein
Transcription
Translation
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RNA Transcription Protein Translation
DNA RNA Protein
Gene Expression
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Human Variability in DNA
• SNPs (single nucleotide polymorphisms)• Many examples directly cause disease
– Huntington’s, Cystic Fibrosis, Muscular Dystrophy, etc.
• The ‘environment’ also plays a big role
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...AUC AUC UUU GGU...
...Ile Ile Phe Gly...
...AUC AU- --U GGU...
...Ile Il e Gly...
Normal
CF
Common Cystic Fibrosis Mutation
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Parents to Children
Mother & Father both CarriersChildren?
1 – Not a carrier (25%)2 – Carrier (50%)1 – With CF (25%)
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Gene Environment Interactions
• PKU and consumption of phenylalanine• Malaria and Sickle Cell gene• HIV infection and CCR5 receptor variant• Alcohol intolerance and aldehyde
dehydrogenase• Beryllium disease (exposure to beryllium)
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Sexual Reproduction
The Association of Reproductive Health Professionals
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Stem Cell Differentiation
Princeton University
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Stem Cell Cultivation
University of Wisconsin-Madison
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Embryonic Stem Cells (ESCs)
August 9, 2001 - President Bush restricted federal funding of human embryonic stem cell research to 70 lines thought to be in existence
Only 11 now available and useable
Many researchers calling for change
Science and Politics of ESCs research
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Blastocyst Diagram
Princeton University
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Human Clones?
Are there human clones?Yes – Identical Twins
(Time 2.19.01)
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Cloning Defined
• What is cloning?• Asexual reproduction
• Examples?• Bacteria, fungus• Plants – cutting – potato• Farm animals
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Asexual Reproduction
The Association of Reproductive Health Professionals
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Cloning Dolly
1997 - 2003(Roslin Institute http://www.roslin.ac.uk/library/)
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Cloning A Sheep
(Roslin Institute http://www.roslin.ac.uk/library/)
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Human Stem Cell Production
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Removing Nucleus
Removing the maternal nucleus before nuclear transfer
(Roslin Institute http://www.roslin.ac.uk/library/)
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Nuclear transfer
Nuclear transfer embryo about to be activated
(Roslin Institute http://www.roslin.ac.uk/library/)
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Coning for use in Stem Cells
Cloning techniques for creating stem cells
Therapeutic cloning
Reproductive cloning
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IVF – In Vitro Fertilization
Available since 1986 About 100,000 IVF kids in U.S. Often creates extra embryos U.S. - About 400,000 frozen
embryos (unregulated) England – 52,000 (regulated by
government)
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End of Lecture/Discussion
Questions or Comments?