Bioethics is the study of the typically controversial ethical issues emerging from new situations and possibilities brought about by advances in biology and medicine. It is also moral discernment as it relates to medical policy and practice. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy. It also includes the study of the more commonplace questions of values ("the ethics of the ordinary") which arise in primary care and other branches of medicine.
The term Bioethics (Greek bios, life; ethos, behavior) was coined in 1926 by Fritz Jahr, who "anticipated many of the arguments and discussions now current in biological research involving animals" in an article about the "bioethical imperative," as he called it, regarding the scientific use of animals and plants. In 1970, the American biochemist Van Rensselaer Potter also used the term with a broader meaning including solidarity towards the biosphere, thus generating a "global ethics," a discipline representing a link between biology, ecology, medicine and human values in order to attain the survival of both human beings and other animal species.
Purpose and scope
The field of bioethics has addressed a broad swathe of human inquiry, ranging from debates over the boundaries of life (e.g. abortion, euthanasia), surrogacy, the allocation of scarce health care resources (e.g. organ donation, health care rationing) to the right to refuse medical care for religious or cultural reasons. Bioethicists often disagree among themselves over the precise limits of their discipline, debating whether the field should concern itself with the ethical evaluation of all questions involving biology and medicine, or only a subset of these questions. Some bioethicists would narrow ethical evaluation only to the morality of medical treatments or technological innovations, and the timing of medical treatment of humans. Others would broaden the scope of ethical evaluation to include the morality of all actions that might help or harm organisms capable of feeling fear.
The scope of bioethics can expand with biotechnology, including cloning, gene therapy, life extension, human genetic engineering, astroethics and life in space, and manipulation of basic biology through altered DNA, XNA and proteins. These developments will affect future evolution, and may require new principles that address life at its core, such as biotic ethics that values life itself at its basic biological processes and structures, and seeks their propagation.
One of the first areas addressed by modern bioethicists was that of human experimentation. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was initially established in 1974 to identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects. However, the fundamental principles announced in the Belmont Report (1979)—namely, autonomy, beneficence and justice—have influenced the thinking of bioethicists across a wide range of issues. Others have added non-maleficence, human dignity and the sanctity of life to this list of cardinal values.
Another important principle of bioethics is its placement of value on discussion and presentation. Numerous discussion based bioethics groups exist in universities across the United States to champion exactly such goals. Examples include the Ohio State Bioethics Society and the Bioethics Society of Cornell. Professional level versions of these organizations also exist.
Many bioethicists, especially medical scholars, accord the highest priority to autonomy. Each person, e.g. patient, should determine which course of action they consider most in line with their conception of the good. In other words the patient needs to choose the best treatment for them. In contrast, communitarians argue that autonomy should be balanced with considerations for the common good. For example, autonomy should be limited when one deals with high levels of pollution, smoking in public, and infectious diseases.
Medical ethics is the study of moral values and judgments as they apply to medicine. The four main moral commitments are respect for autonomy, beneficence, normaleficence, and justice. Using these four principles and thinking about what the physicians specific concern is for their scope of practice can help physicians make moral decisions. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.
Medical ethics tends to be understood narrowly as an applied professional ethics, whereas bioethics appears to have worked more expansive concerns, touching upon the philosophy of science and issues of biotechnology. Biotechnology generally focuses on molecular biology which, can help improve the health of humans as well as prolong the lifespan of humans Still, the two fields often overlap and the distinction is more a matter of style than professional consensus. Medical ethics shares many principles with other branches of healthcare ethics, such as nursing ethics. A bioethicist assists the health care and research community in examining moral issues involved in our understanding of life and death, and resolving ethical dilemmas in medicine and science. Examples of this would be the topic of equality in medicine. Some may believe everyone should have the same health care compared to people who believe healthcare should be distributed based off medical need.
Perspectives and methodology
Bioethicists come from a wide variety of backgrounds and have training in a diverse array of disciplines. The field contains individuals trained in philosophy such as H. Tristram Engelhardt, Jr. of Rice University, Baruch Brody of Rice University, Peter Singer of Princeton University, Daniel Callahan of the Hastings Center, 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 Nancy Dubler of Albert Einstein College of Medicine or Jerry Menikoff of the federal Office of Human Research Protections, political scientists like Francis Fukuyama, religious studies scholars including James Childress, public intellectuals like Amitai Etzioni of The George Washington University, and theologians like Lisa Sowle Cahill and Stanley Hauerwas. 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 Journal of Medicine and Philosophy, The Hastings Center Report, the American Journal of Bioethics, the Journal of Medical Ethics and the Cambridge Quarterly of Healthcare Ethics. Bioethics has also benefited from the process philosophy developed by Alfred North Whitehead.
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 and Muslim 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 lively discussion 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 a leading bioethicist speaking from the Hindu tradition. In Africa, and partly also in Latin America, the debate on bioethics frequently focuses on its practical relevance in the context of underdevelopment and geopolitical power relations. Masahiro Morioka argues that in Japan the bioethics movement was first launched by disability activists and feminists in the early 1970s, while academic bioethics began in the mid-1980s. During this period, unique philosophical discussions on brain death and disability appeared both in the academy and journalism.
Bioethics has also had its critics. Paul Farmer has pointed out that bioethics tends to focus its attention on problems that arise from "too much care," for patients in industrialized nations, while giving little or no attention to the ethical problem of too little care for the poor. Farmer characterizes the bioethics of handling difficult clinical situations, normally in hospitals in industrialized countries, as "quandary ethics." And he refers to bioethicists as "endlessly rehashing the perils of too much care." He does not regard quandary ethics and clinical bioethics as unimportant; he argues, rather, that bioethics must be balanced and give due weight to the poor.
Areas of health sciences that are the subject of published, peer-reviewed bioethical analysis include:
- Alternative Medicine
- Animal rights
- Applied ethics
- Artificial insemination
- Artificial life
- Artificial womb
- Assisted suicide
- Biological agent
- Biological patent
- Biotic ethics
- Blood transfusion
- Body modification
- Brain-computer interface
- Confidentiality (medical records)
- Contraception (birth control)
- Euthanasia (human, non-human animal)
- Faith Healing
- Feeding tube
- Gene theft
- Gene therapy
- Genetically modified food
- Genetically modified organism
- Great Ape Project
- Human cloning
- Human enhancement
- Human experimentation in the United States
- Human genetic engineering
- Infertility treatments
- Life extension
- Life support
- Medical malpractice
- Medical research
- Medical torture
- Mitochondrial donation
- Moral obligation
- Moral status of animals
- Nazi human experimentation
- Ordinary and extraordinary care
- Organ donation
- Organ transplant
- Pain management
- Patients' Bill of Rights
- Political abuse of psychiatry
- Population control
- Prescription drug prices in the United States
- Procreative beneficence
- Professional ethics
- Quality of Life (Healthcare)
- Quaternary prevention
- Recreational drug use
- Reproductive rights
- Reproductive technology
- Sex reassignment therapy
- Sperm and egg donation
- Spiritual drug use
- Stem cell research
- Transplant trade
- Vaccination controversy
- Bioethics (journal)
- Biotechnology risk
- Cytoplasmic transfer
- Feminist Approaches to Bioethics
- Hastings Center Report (journal)
- Johns Hopkins Berman Institute of Bioethics
- Kennedy Institute of Ethics Journal
- Medical law
- Preimplantation genetic diagnosis
- Resources for clinical ethics consultation
- The Convention on Human Rights and Biomedicine
- Yeshiva University Medical Ethics Society
- Rinčić, I., Muzur, A.: Fritz Jahr i rađanje europske bioetike (Fritz Jahr and the Birth of European Bioethics). Zagreb: Pergamena, 2012., page 141 (Croatian)
- Lolas, Fernando (2008). "Bioethics and animal research: A personal perspective and a note on the contribution of Fritz Jahr". Biological Research (Santiago). 41 (1): 119–123. doi:10.4067/S0716-97602008000100013. Retrieved 15 January 2010.
- Goldim, J. R. (2009). Revisiting the beginning of bioethics: The contributions of Fritz Jahr (1927). Perspect Biol Med, Sum, 377-380.
- Muzur, Amir (2014). "The nature of bioethics revisited: A comment on Tomislav Bracanović". Developing World Bioethics. 14: 109–110. doi:10.1111/dewb.12008. PMID 23279218.
- "Astroethics". Retrieved 21 December 2005.
- Freemont, P. F.; Kitney, R. I. (2012). Synthetic Biology. New Jersey: World Scientific. ISBN 978-1-84816-862-6.
- Mautner, Michael N. (2009). "Life-centered ethics, and the human future in space" (PDF). Bioethics. 23: 433–440. doi:10.1111/j.1467-8519.2008.00688.x. PMID 19077128.
- "The Bioethics Society of Ohio State". Thebioethicssociety.org.ohio-state.edu. Retrieved 2013-09-17.
- "Bioethics Society of Cornell". Cornell University. Archived from the original on 17 June 2012.
- Entwistle, Vikki A.; Carter, Stacy M.; Cribb, Alan; McCaffery, Kirsten (2016-10-28). "Supporting Patient Autonomy: The Importance of Clinician-patient Relationships". Journal of General Internal Medicine. 25 (7): 741–745. doi:10.1007/s11606-010-1292-2. ISSN 0884-8734. PMC 2881979. PMID 20213206.
- Amitai Etzioni. 1973. Genetic Fix. Macmillan Publishing: New York.
- Gillon, R. (1994-07-16). "Medical ethics: four principles plus attention to scope.". BMJ : British Medical Journal. 309 (6948): 184–188. ISSN 0959-8138. PMC 2540719. PMID 8044100.
- University, Santa Clara. "Thinking Ethically About Human Biotechnology - Resources - Bioethics - Focus Areas - Markkula Center for Applied Ethics - Santa Clara University". www.scu.edu. Retrieved 2016-11-07.
- Horne, L. Chad. "Medical Need, Equality, and Uncertainty". Bioethics. 30 (8): 588–596.
- Cf. Michel Weber and Will Desmond (eds.). Handbook of Whiteheadian Process Thought (Frankfurt / Lancaster, Ontos Verlag, Process Thought X1 & X2, 2008) and Ronny Desmet & Michel Weber (edited by), Whitehead. The Algebra of Metaphysics. Applied Process Metaphysics Summer Institute Memorandum, Louvain-la-Neuve, Les Éditions Chromatika, 2010.
- See Feminism, Disability, and Brain Death
- Farmer, Paul. Pathologies of Power. pp. 196–212.
- Farmer, Paul. Pathologies of Power. p. 205.
- Andre, Judith (2002), Bioethics as Practice, Chapel Hill and London: University of North Carolina Press, ISBN 0-8078-2733-9
- Appel, Jacob (August 9, 2009), "A Supreme Court for Bioethics", Huffington Post
- Aulisio, Mark; Arnold, Robert; Younger, Stuart (2003), Ethics Consultation; from theory to practice, Baltimore, London: Johns Hopkins University Press, ISBN 0-8018-7165-4
- Faden, Ruth (2004), Bioethics: A field in transition, Journal of Law, Medicine & Ethics
- Caplan, Arthur Smart Mice Not So Smart People Rowman Littlefield 2006
- Glad, John (2008), Future Human Evolution: Eugenics in the Twenty-First Century (PDF), Hermitage Press, ISBN 1-55779-154-6
- Emanuel, Ezekiel; Crouch, Robert; Arras, John; Moreno, Jonathan; Grady, Christine (2003), Ethical and Regulatory Aspects of Clinical Research, Baltimore, London: Johns Hopkins University Press, ISBN 0-8018-7813-6
- Crowley, Mary (ed) (2008), From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book, Garrison, New York: The Hastings Center
- Beauchamp, Tom; Childress, James (2001), Principles of Biomedical Ethics, Oxford, New York: Oxford University Press, ISBN 0-19-514332-9
- Häyry, Matti; Tuija Takala; Peter Herissone-Kelly; Gardar Árnason (Eds.) (2010). Arguments and Analysis in Bioethics. Amsterdam/New York: Rodopi. ISBN 978-90-420-2802-9
- Jonsen, Albert; Veatch, Robert; Walters, leRoy (1998), SourceBook in Bioethics, Washington: Georgetown University Press, ISBN 0-87840-685-9
- Jonathan, Baron (2006), Against Bioethics, The MIT Press, ISBN 978-0-262-02596-6
- Kaldis, Byron (2011). "Bioethics". Sage Encyclopedia of Green Technology. Thousand Oaks: CA, Sage.
- McGee, Glenn (2003), Pragmatic Bioethics, Cambridge: Massachusetts Institute of Technology Press, ISBN 0-262-63272-1
- Khushf, George (ed) (2004), Handbook of Bioethics: taking stock of the field from a philosophical perspective, Dordrecht, Boston, London: Kluwer Academic Publishers, ISBN 1-4020-1893-2
- Luna, Florencia, (2006) Bioethics and Vulnerability: A Latin American View. Edited by Peter Herissone-Kelly. Translated from Spanish by Laura Pakter. Amsterdam/New York: Rodopi. ISBN 978-90-420-2073-3
- McGee, Glenn (2003), Pragmatic Bioethics (2nd Edition), Cambridge: The MIT Press, ISBN 978-0-262-63272-0
- Korthals, Michiel; Robert J. Bogers (eds.) (2004), Ethics for Life Scientists, Springer, ISBN 978-1-4020-3178-6
- Kuczewski, Mark G.; Ronald Polansky (eds.) (2002), Bioethics: Ancient Themes in Contemporary Issues, The MIT Press, ISBN 978-0-262-61177-0
- Murphy, Timothy (2004), Case Studies in Biomedical Research Ethics, The MIT Press, ISBN 978-0-262-13437-8
- Ravitsky, Vardit; Fiester, Autumn; Caplan, Arthur (eds.) (2009), The Penn Center Guide to Bioethics, New York: Springer, ISBN 978-0-8261-1522-5
- Singer, Peter A.; Viens, A.M. (2008), Cambridge Textbook of Bioethics, Cambridge: Cambridge University Press, ISBN 978-0-521-69443-8
- Sugarman, Jeremy; Sulmasy, Daniel (2001), Methods in Medical Ethics (Confessions of a Medicine Man), Washington: Georgetown University Press, ISBN 0-262-70072-7
- Tauber, Alfred I (2005), Patient Autonomy and the Ethics of Responsibility, Cambridge: MIT Press, ISBN 0-262-70112-X
- Elahi, Dr.Mansoor (2011), Medical ethics:A practical guide to patient care related ethics, conventions and laws,(downloadable www.medical-ethics.org), Islamabad, Pakistan: medical testing and research organization publishing unit, mtro, ISBN 978-969-8186-02-9
- Bleich, J. David. (1981). Judaism and Healing. New York: Ktav. ISBN 0-87068-891-X
- Dorff, Elliot N. (1998). Matters of Life and Death: A Jewish Approach to Modern Medical Ethics. Philadelphia: Jewish Publication Society. ISBN 0-8276-0647-8
- Feldman DM. (1974). Marital relations, birth control, and abortion in Jewish law. New York: Schocken Books.
- Freedman B. (1999). Duty and healing: foundations of a Jewish bioethic. New York: Routledge. ISBN 0-415-92179-1
- Jakobovits I. (1959). Jewish Medical Ethics. New York: Bloch Publishing.
- Mackler, Aaron L. (ed.) (2000). Life & Death Responsibilities in Jewish Biomedical Ethics. New York: JTS. ISBN 0-87334-081-7.
- Maibaum M. "A 'progressive' Jewish medical ethics: notes for an agenda" in Journal of Reform Judaism 1986;33(3):27-33.
- Rosner, Fred. (1986). Modern medicine and Jewish ethics. New York: Yeshiva University Press. ISBN 0-88125-091-0
- Conservative Judaism Vol. 54(3), Spring 2002 (contains a set of six articles on bioethics)
- Zohar, Noam J. (1997). Alternatives in Jewish Bioethics. Albany: State University of New York Press. ISBN 0-7914-3273-4
- Colson, Charles W. (ed.) (2004). Human Dignity in the Biotech Century: A Christian Vision for Public Policy. Downers Grove, Illinois: InterVarsity Press. ISBN 0-8308-2783-8
- Demy, Timothy J. and Gary P. Stewart. (1998). Suicide: A Christian Response: Crucial Considerations for Choosing Life. Grand Rapids: Kregel. ISBN 0-8254-2355-4
- Pope John Paul II. (1995). Evangelium Vitae: The Gospel of Life. New York: Random House. ISBN 0-8129-2671-4
- Kilner, John et al. (1995). Bioethics and the Future of Medicine: A Christian Appraisal. Grand Rapids, Michigan: Wm. B. Eerdmans Publishing Company. ISBN 0-8028-4081-7
- Kilner, John F., Arlene B. Miller, and Edmund D. Pellegrino (eds.). (1996). Dignity and Dying: A Christian Appraisal. Grand Rapids, MI: Eerdmans Publishing Co.; and Carlisle, United Kingdom: Paternoster Press. ISBN 0-8028-4232-1
- Meilaender, Gilbert (2004). Bioethics: A Primer For Christians. Grand Rapids, Michigan: Wm. B. Eerdmans Publishing Company. ISBN 0-8028-4234-8
- Loudovikos, Nikolaos, Protopresbyter (2002). The Individualization of Death and Euthanasia, Holy Synod of the Church of Greece, Committee of Bioethics, Scientific Conference on Euthanasia (Athens, May 17–18, 2002), retrieved on February 27, 2009. (Article in Greek).
- Pope Paul VI. (1968). Humanae vitae: Human Life. Vatican City.
- Cardinal William Levada. (2008) Instruction 'Dignitas Personae' on certain Bioethical Questions.
- Smith, Wesley J. (2004). Consumer's Guide to A Brave New World. San Francisco: Encounter Books. ISBN 1-893554-99-6
- Smith, Wesley J. (2000). Culture of Death: The Assault on Medical Ethics in America. San Francisco: Encounter Books. ISBN 1-893554-06-6
- Smith, Wesley J. (1997). Forced Exit: The Slippery Slope from Assisted Suicide to Murder. New York: Times Books. ISBN 0-8129-2790-7
- Stewart, Gary P. et al. (1998). Basic Questions on Suicide and Euthanasia: Are They Ever Right? BioBasics Series. Grand Rapids: Kregel. ISBN 0-8254-3072-0
- Stewart, Gary P. et al. (1998). Basic Questions on End of Life Decisions: How Do We Know What's Right? Grand Rapids: Kregel. ISBN 0-8254-3070-4
- Westphal, Euler Renato. O Oitavo dia – na era da seleção artificial (See The Eighth Day (book) Review) . 1. ed. São Bento do Sul: União Cristã, 2004. v. 01. 125 p. ISBN 85-87485-18-0
- Archimandrite Adam (Vakhtang Akhaladze)A Human in Bioethical Space and Time. 2010
- Hamdy, Sherine. "Our Bodies Belong to God: Organ Transplantation, Islam, and the Struggle for Human Dignity in Egypt" (2012) Berkeley: University of California Press. ISBN 978-0-520-27176-0
- Al Khayat MH. "Health and Islamic behaviour" in: El Gindy AR, editor, Health policy, ethics and human values: Islamic perspective. Kuwait: Islamic Organization of Medical Sciences; 1995. p. 447-50.
- Ebrahim, Abul Fadl Mohsin. (1989). Abortion, Birth Control and Surrogate Parenting. An Islamic Perspective. Indianapolis. ISBN 0-89259-081-5
- Esposito, John. (ed.) (1995). "Surrogate Motherhood" in The Oxford Encyclopedia of the Modern Islamic World (vol. 4). New York: Oxford University Press. ISBN 0-19-509615-0
- Karic, Enes. "The Ethics of Cloning" in Islamica Magazine Fall/Winter 2004. Issue #11
- Islamic Medical and Scientific Ethics (IMSE) Special Collection and Database at Georgetown University
One of the fundamental beliefs of buddhism is that you should not take the life of another person, even that of a fetus. Since buddhism is very much about the soul they believe that abortion and organ transplantation can have effects on karma as extreme as murdering someone As new medical technologies raise more questions about bioethics, buddhists turn to their ancient texts to search for enlightenment. Buddhist texts focus on specific issues such as sickness and death and gives some insight about how to prepare the mind for death. Buddhist bioethics seems to align with the principles of nonmaleficence and beneficence.
- Florida, R. E. (1994) Buddhism and the Four Principles in Principles of Health Care Ethics, ed. R. Gillon and A. Lloyd, Chichester: John Wiley & Sons, 105-16.
- Keown, Damien. (1995) Buddhism & Bioethics. London and New York: Macmillan/St. Martins Press.
- Coward, H. G., J. J. Lipner, and K. K. Young. (1989) Hindu Ethics: Purity, Abortion, and Euthanasia. Albany: State University of New York Press.
- Crawford, S. C. (2003) Hindu bioethics for the Twenty-first Century. Albany, NY: State University of New York Press.
- Crawford, S. C. (1995) Dilemmas of Life and Death, Hindu Ethics in A North American Context 1995. Albany, NY: State University of New York Press.
- Firth, S. (2005) End-of-life: a Hindu view. The Lancet. 366(9486): 682-686.
- Lakhan, Shaheen. (2008) Hinduism: life and death. Student BMJ. 16(18):310-311.
East Asian bioethics
- Renée C. Fox and Judith P. Swazey. (1984) Medical Morality Is Not Bioethics: Medical Ethics in China and the United States. Perspectives in Biology and Medicine 27(3):336-360. PDF
- Masahiro Morioka. (2015) Feminism, Disability, and Brain Death: Alternative Voices from Japanese Bioethics. Journal of Philosophy of Life 5(1):19-41. PDF
- Ole Döring. (2006) A Confucian Asian Ethos? Essentials of the Culture of East Asian Bioethics. East Asian Science, Technology, and Medicine 25 (2006):127-149. PDF
- Bioethics entry in the Internet Encyclopedia of Philosophy.
- The Royal Children's Hospital Children's Bioethics Centre, Melbourne, Australia
- The Program for Biomedical Ethics, Yale University
- The Hastings Center's Bioethics Forum Blog
- The Berman Institute Bioethics Bulletin Blog, Johns Hopkins Berman Institute of Bioethics
- VIDEOS from Bioethics Symposium, University of Wisconsin-Madison School of Medicine and Public Health (2011)
- The Bioethics Research Library, Georgetown University
- Southern Cross Bioethics Institute, South Australia, Australia
- Bioethique.com Bioethics France
- "Feminist Bioethics" at the Stanford Encyclopedia of Philosophy
- BioExplorer.Net Bioethics and related web resources
- Hughes, James (2007). "Buddhist Bioethics" (PDF). Principles of Health Care Ethics: 127–132.
- Tsomo, Karma Lekshe (2006). Into the Jaws of Yama, Lord of Death. US: SUNY Press. ISBN 9780791481455.