Bioethics
Bioethics is both a field of study and professional practice, interested in ethical issues related to health (primarily focused on the human, but also increasingly includes animal ethics), including those emerging from advances in biology, medicine, and technologies. It proposes the discussion about moral discernment in society (what decisions are "good" or "bad" and why) and it is often related to medical policy and practice, but also to broader questions as environment, well-being and public health. Bioethics is concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, theology and philosophy. It includes the study of values relating to primary care, other branches of medicine ("the ethics of the ordinary"), ethical education in science, animal, and environmental ethics, and public health.
This article is about the discipline. For the journal, see Bioethics (journal).Etymology[edit]
The term bioethics (Greek bios, "life"; ethos, "moral nature, behavior"[1]) was coined in 1927 by Fritz Jahr in an article about a "bioethical imperative" regarding the use of animals and plants in scientific research.[2] In 1970, the American biochemist, and oncologist Van Rensselaer Potter used the term to describe the relationship between the biosphere and a growing human population. Potter's work laid the foundation for global ethics, a discipline centered around the link between biology, ecology, medicine, and human values.[3][4] Sargent Shriver, the spouse of Eunice Kennedy Shriver, claimed that he had invented the term "bioethics" in the living room of his home in Bethesda, Maryland, in 1970. He stated that he thought of the word after returning from a discussion earlier that evening at Georgetown University, where he discussed with others a possible Kennedy family sponsorship of an institute focused around the "application of moral philosophy to concrete medical dilemmas".[5]
Purpose and scope[edit]
The discipline of bioethics has addressed a wide swathe of human inquiry; ranging from debates over the boundaries of lifestyles (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 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.[6] 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 increase the scope of moral assessment to encompass the morality of all moves that would possibly assist or damage organisms successful of feeling fear.
The scope of bioethics has evolved past mere biotechnology to include topics such as cloning, gene therapy, life extension, human genetic engineering, it can also include astroethics and life in space,[7][8] and manipulation of basic biology through altered DNA, XNA and proteins.[9] These (and other) developments may affect future evolution and 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.[10] Moving beyond the biological, issues raised in public health such as vaccination and resource allocation have also encouraged the development of novel ethics frameworks[11] to address such challenges. A study published in 2022 based on the corpus of full papers from eight main bioethics journals demonstrated the heterogeneity of this field by distinguishing 91 topics that have been discussed in these journals over the past half a century.[12]
Medical sociology[edit]
The practice of bioethics in clinical care have been studied by medical sociology.[22] Many scholars consider that bioethics arose in response to a perceived lack of accountability in medical care in the 1970s.[23]: 2 Studying the clinical practice of ethics in medical care, Hauschildt and Vries found that ethical questions were often reframed as clinical judgments to allow clinicians to make decisions. Ethicists most often put key decisions in the hands of physicians rather than patients.[23]: 14
Communication strategies suggested by ethicists act to decrease patient autonomy. Examples include, clinicians discussing treatment options with one another prior to talking to patients or their family to present a united front limited patient autonomy, hiding uncertainty amongst clinicians. Decisions about overarching goals of treatment were reframed as technical matters excluding patients and their families. Palliative care experts were used as intermediaries to guide patients towards less invasive end-of-live treatment.[23]: 11 In their study, Hauschild and Vries found that 76% of ethical consultants were trained as clinicians.[23]: 12
Studying informed consent, Corrigan found that some social processes resulted in limitations to patients choice, but also at times patients could find questions regarding consent to medical trials burdensome.[24]
The most prevalent subject is how social stratification (based on SES, gender, class, ethnicity, and age) affects patterns of behavior related to health and sickness, illness risk, disability, and other outcomes related to health care. The study of health care organization and provision, which encompasses the evolving organizational structures of health care organizations and the social psychology of health and health care, is another important approach. These latter research cover topics including connections between doctors and patients, coping mechanisms, and social support. The description of other important fields of medical sociology study emphasizes how theory and research have changed in the twenty-first century.[25]
Professional practice[edit]
Bioethics as a subject of expert exercise (although now not a formal profession) developed at the beginning in North America in the Nineteen Eighties and Nineteen Nineties, in the areas of clinical / medical ethics and research ethics. Slowly internationalizing as a field, since the 2000s professional bioethics has expanded to include other specialties, such as organizational ethics in health systems, public health ethics, and more recently Ethics of artificial intelligence. Professional ethicists may be called consultants, ethicists, coordinators, or even analysts; and they may work in healthcare organizations, government agencies, and in both the public and private sectors. They may also be full-time employees, unbiased consultants, or have cross-appointments with educational institutions, such as lookup centres or universities.[66]
Learned societies and professional associations[edit]
The field of bioethics has developed national and international learned societies and professional associations, such as the American Society for Bioethics and Humanities, the Canadian Bioethics Society,[67] the Canadian Association of Research Ethics Boards,[68] the Association of Bioethics Program Directors,[69] the Bangladesh Bioethics Society and the International Association of Bioethics.[70]
Education[edit]
Bioethics is taught in courses at the undergraduate and graduate level in different academic disciplines or programs, such as Philosophy, Medicine, Law, Social Sciences. It has become a requirement for professional accreditation in many health professional programs (Medicine, Nursing, Rehabilitation), to have obligatory training in ethics (e.g., professional ethics, medical ethics, clinical ethics, nursing ethics). Interest in the field and professional opportunities[71] have led to the development of dedicated programs with concentrations in Bioethics, largely in the United States,[72] Canada (List of Canadian bioethics programs) and Europe, offering undergraduate majors/minors, graduate certificates, and master's and doctoral degrees.
Training in bioethics (usually clinical, medical, or professional ethics) are part of core competency requirements for health professionals in fields such as nursing, medicine or rehabilitation. For example, every medical school in Canada teaches bioethics so that students can gain an understanding of biomedical ethics and use the knowledge gained in their future careers to provide better patient care. Canadian residency training programs are required to teach bioethics as it is one of the conditions of accreditation, and is a requirement by the College of Family Physicians of Canada and by the Royal College of Physicians and Surgeons of Canada.[73]
Criticism[edit]
As a field of study, bioethics has also drawn criticism. For instance, Paul Farmer noted 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.[74]: 196–212 Farmer characterizes the bioethics of handling morally difficult clinical situations, normally in hospitals in industrialized countries, as "quandary ethics".[74]: 205 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.
Additionally, bioethics has been condemned for its lack of diversity in thought, particularly concerning race. Even as the field has grown to include the areas of public opinion, policymaking, and medical decision-making, little to no academic writing has been authored concerning the intersection between race–especially the cultural values imbued in that construct–and bioethical literature. John Hoberman illustrates this in a 2016 critique, in which he points out that bioethicists have been traditionally resistant to expanding their discourse to include sociological and historically relevant applications.[75] Central to this is the notion of white normativity, which establishes the dominance of white hegemonic structures in bioethical academia[76] and tends to reinforce existing biases.
These points and critiques, along with the neglect of women's perspectives within bioethics, have also been discussed amongst feminist bioethical scholars.[28]
However, differing views on bioethics' lack of diversity of thought and social inclusivity have also been advanced. For example, one historian has argued that the diversity of thought and social inclusivity are the two essential cornerstones of bioethics, albeit they have not been fully realized.[77][78]
In order to practice critical bioethics, bioethicists must base their investigations in empirical research, refute ideas with facts, engage in self-reflection, and be skeptical of the assertions made by other bioethicists, scientists, and doctors. A thorough normative study of actual moral experience is what is intended.[79]