CHAPTER 12:

INTRODUCTION
TO BIOETHICS
AND BIOETHICAL
ANOMALIES
WHAT IS BIOETHICS?
Bioethics is the study of morality as it concerns issues
dealing with the biological
issues and facts concerning ourselves, and our close
relatives, for examples, almost any
non-human animal that is sentient It is very prevalent in the
areas of medicine,
healthcare, and biomedical research. Each of these areas
requires respect for the lives of
others. It is considered by many to be human nature to want
to succeed in life and as
such, the value of another person's life may be diminished or
the effect of manipulations
on another person's life may not be taken into as much
consideration as it should be.
GOALS OF BIOETHICS
As a discipline of applied ethics and a particular way of ethical reasoning that
substantially depends on the findings of the life sciences, the goals of bioethics are
manifold and involve, at least, the following aspects:

1. Discipline: Bioethics provides a disciplinary framework for the whole array of moral
questions and issues surrounding the life sciences concerning human beings,
animals, and nature.

2. Inter-disciplinary Approach: Bioethics is a particular way of ethical reasoning

and
decision making that: (i) integrates empirical data from relevant natural sciences,
most notably medicine in the case of medical ethics, and (ii) considers other
disciplines of applied ethics such as research ethics, information ethics, social
ethics, feminist ethics, religious ethics, political ethics, and ethics of law in order to
solve the case in question.

3. Ethical Guidance: Bioethics offers ethical guidance in a particular field of human

conduct.
4. Clarification:
Bioethics points to many novel complex cases, for example, gene
technology, cloning, and human-animal chimeras and facilitates the
awareness of the particular problem in public discourse.

5. Structure:
Bioethics elaborates important arguments from a critical
examination of judgements and considerations in discussions and
debates.

6. Internal Auditing:
The combination of bioethics and new data that stem from the
natural sciences may influence−in some cases −the key concepts and
approaches of basic ethics by providing convincing evidence for
important specifications, for example, the generally accepted concept
of personhood might be incomplete, too narrow, or ethically
problematic in the context of people with disability and, hence, need to
be modified accordingly.
THE FOUR BASIC PRINCIPLES OF BIOETHICS
Bioethicists often refer to the four basic principles of health care
ethics when evaluating the merits and difficulties of medical
procedures. Ideally, for a medical practice to be considered "ethical",
it must respect all four of these principles: autonomy, non-
maleficence, beneficence, and justice
1. AUTONOMY
• Autonomy is the freedom and ability to act in a self-determined
manner. It represents the right of a rational person to express
personal decisions independent of outside interference and to have
these decisions honored. It can be argued that autonomy occupies
a central place in Western healthcare ethics because of the
popularity of the Enlightenment-era philosophy of Immanuel Kant.
• The principle of autonomy sometimes is described as respect for
autonomy (Beauchamp & Childress, 2013).
• Respecting autonomy also is important in less obvious situations,
such as allowing home care patients to choose a tub bath versus a
shower when it is safe to do so and allowing an elderly long-term
care resident to choose her favorite foods when they are medically
prescribed.
• Restrictions on an individual’s autonomy may occur in cases when
a person presents a potential threat for harming others, such as
exposing other people to communicable diseases or committing
acts of violence; people generally lose the right to exercise
autonomy or self-determination in such instances.
 INFORMED CONSENT
Informed consent in regard to a patient’s treatment is a legal, and ethical, issue of
autonomy. At the heart of informed consent is respecting a person’s autonomy to make
personal choices based on the appropriate appraisal of information about the actual or
potential circumstances of a situation Though all conceptions of informed consent must
contain the same basic elements, the description of these elements is presented differently by
different people. Beauchamp and Childress (2013) outlined informed consent according to
seven elements. Dempski (2009) presented three basic elements that are necessary for
informed consent to occur:
1. Receipt of information

This includes receiving a description of the procedure, information about the risks
and benefits of having or not having the treatment, reasonable alternatives to the
treatment, probabilities about outcomes, and “the credentials of the person who will
perform the treatment” (Dempski, 2009, p. 78). Because it is too demanding to inform
a patient of every possible risk or benefit involved with every treatment or procedure,
the obligation is to inform the person about the information a reasonable person
would want and need to know. Information should be tailored specifically to a person’s
personal circumstances, including providing information in the person’s spoken
language.

2. Consent for the treatment must be voluntary

A person should not be under any influence or be coerced to provide consent. This
means patients should not be asked to sign a consent form when they are under the
influence of mind-altering medications, such as narcotics. Depending on the
circumstances, consent may be verbalized, written, or implied by behavior. Silence does
not convey consent when a reasonable person would normally offer another sign of
agreement.

3. Persons must be competent

Persons must be able to communicate consent and to understand the information
provided to them. If a person’s condition warrants transferring decision-making
authority to a surrogate, informed consent obligations must be met with the surrogate.
 2. NONMALEFICENCE
• Nonmaleficence is the principle used to communicate the
obligation to do no harm. Emphasizing the importance of
this principle is as old as organized medical practice.
• Nonmaleficence is the maxim or norm that “one ought not
to inflict evil or harm” (Beauchamp & Childress, 2013),
whereas beneficence includes the following three norms:
“one ought to prevent evil or harm, one ought to remove
evil or harm, [and] one ought to do or promote good”. As
evidenced by these maxims, beneficence involves action to
help someone and nonmaleficence requires “intentional
avoidance of actions that cause harm”.
• Nonmaleficence has a wide scope of implications in health
care, including the need to avoid negligent care, the need
to avoid harm when deciding whether to provide treatment
or to withhold or withdraw it, and considerations about
rendering extraordinary or heroic treatment.
ISSUES AND CONCEPTS ASSOCIATED
WITH THE PRINCIPLE OF
NONMALEFICENCE
1. Upholding standards of due care means abiding by the standards that are
specific to one’s profession; the acceptable and expected care a reasonable
person in a profession would render.

2. Negligence is “the absence of due care” (Beauchamp & Childress, 2013) and
imposing a risk of harm; imposing an unintended careless risk of harm or
imposing an intentional reckless risk of harm.

3. Making distinctions of and rules governing nontreatment and end-of-life

decisions (Beauchamp & Childress, 2013)

a. Withholding and withdrawing life sustaining treatment

b. Extraordinary (or heroic) and ordinary treatment
c. Sustenance technologies and medical treatments d. Intended effects and
merely foreseen effects (rule of double effect)
e. Killing and letting die
3. BENEFICENCE
• The principle of beneficence consists of performing
deeds of “mercy, kindness, friendship, charity and the
like” (Beauchamp & Childress, 2013).
• Beneficence means people take actions to benefit and
promote the welfare of other people. Whereas people
are obligated to act in a non-maleficent manner toward
all people that is, not to harm anyone there are limits to
beneficence or to the benefits people are expected to
bestow on other people.
• The ordinary meaning of this principle is that health care
providers have a duty to be of a benefit to the patient, as
well as to take positive steps to prevent and to remove
harm from the patient.
• These duties are viewed as rational and self-evident and
are widely accepted as the proper goals of medicine.
 PATERNALISM
The deliberate overriding of a patient’s opportunity to exercise autonomy
because of a perceived obligation of beneficence
TYPES OF PATERNALISM
1) Soft paternalism:
The use of paternalism to protect persons from
their own nonvoluntary conduct. People justify its
acceptance when a person may be unable to make
reasonable, autonomous decisions. Examples of when
soft paternalism is used include situations involving
depression, substance abuse, and addiction.

2) Hard paternalism:
“Interventions intended to prevent or mitigate
harm to or to benefit a person, despite the fact that
the person’s risky choices and actions are informed,
voluntary, and autonomous” (Beauchamp &
Childress, 2013).
 According to Beauchamp and Childress (2013), the following is a
summary of justifiable reasons to practice hard paternalism (p. 222):

a) A patient is at risk of a significant, preventable harm.

b) The paternalistic action will probably prevent the harm.

c) The prevention of harm to the patient outweighs risks to the

patient of the action taken.

d) There is no morally better alternative to the limitation of

autonomy that occurs.

e) The least autonomy-restrictive alternative that will secure the

benefits is adopted (p. 222).
4. JUSTICE
• Justice, as a principle in healthcare ethics, refers to
fairness, treating people equally and without
prejudice, and the equitable distribution of benefits
and burdens, including assuring fairness in biomedical
research.
• This principle seeks to eliminate discrimination in
biological studies and healthcare. Healthcare and
research should not be based on sex, race, religious
beliefs, and sexual orientation if possible.
• The other interference with this is the value that is
placed on a person's life due to prejudices, biases, and
racism. Healthcare workers may feel that a person that
helps others deserves to get resources more than a
person who previously committed a crime.
 FAMILY PLANNING
Family planning refers to the various methods used to control the size of one’s family or to space births.
PROBLEMS OF CONSENT AND
FAMILY PLANNING
In legal terms, the age of consent is the age at which one is
capable of giving deliberate and voluntary agreement. This implies
physical and mental ability and the freedom to act and make
decisions. In the Philippines, the age of legal capacity is 18. The
Family Code requires that those aged 18 to 21 who wish to contract
marriage should seek parental consent. Until children reach the age
of consent, parents are required to give consent for the care of their
children. Implicit in this is the assumption that the parents have the
best interests of the child at heart and that they are better qualified
than the child to make decisions in the child’s best interest.
Generally speaking, the parents are responsible for the care
(including medical costs) and education of the minor. However,
today’s trends cloud the issue as we struggle with “rights.” Those
who are concerned about the high incidence of teenage pregnancies
and sexually transmitted diseases argue that the information must
be disseminated, regardless of who does it. Others believe that this
promotes erosion of the role of the family, and worry that the
indiscriminate dispensing of contraceptives encourages promiscuity
among teenagers. Concern about the spread of AIDS has done much
to alter thinking, particularly regarding the dispensing of condoms.
 ABORTION
Abortion is the termination of pregnancy before the viability of the fetus that
is, any time before the end of the 6th month of gestation. An abortion may occur
spontaneously as a result of natural causes (spontaneous abortion). A pregnancy
may be interrupted deliberately for medical reasons (therapeutic abortion), or for
personal reasons (elective abortion).
History
Make a timeline of the important historical events or list historical contributions made by people of
African heritage.

1st Event 2nd Event 3rd Event 4th Event 5th Event 6th Event

Date Date Date Date Date Date

Description Description Description Description Description Description

Key people
Choose three leaders for Black History Month using Bing.com and discuss their lives and
accomplishments. Here are some examples:

Bayard Rustin was a close advisor to
Martin Luther King and an American
leader of the civil rights movement. Rustin
organized and led several protests,
including the 1963 March on Washington.
Jesse Owens was an American track and
field athlete and four-time gold medalist
in the 1936 Olympic Games in Germany.
Owens specialized in the sprints and the
long jump.
Zora Neale Hurston was an American
author, anthropologist, and filmmaker. In
1937, she published her famous novel,
Their Eyes Were Watching God.
Arts and literature Click icon to add picture

Provide examples of art and literature that are

significant to Black History Month. Here are a
few examples:
• The writing of James Baldwin
• The music of Miles Davis
Click icon to add picture
• The artwork of Alma Thomas
 Conclusion
Provide a brief summary of your presentation.
Remind the audience what you covered in the previous slides.
Questions & answers
Invite questions from the audience