UNIT 1- Introducing Medical Ethics

(Bioethics: History, Scope, Object)

A.F. Cascais

1. Definition of Bioethics (Warren T. Reich):

○ Bioethics is the study of human behavior in life sciences and healthcare,
examined through moral values.
○ Though this definition unites many perspectives, it hides disagreements
about the field’s true focus and boundaries.
2. Historical Context and Emergence of Bioethics:
○ Bioethics emerged due to major conflicts between technology and human
values, especially with advancements in biomedical technologies (e.g.,
euthanasia, genetic interventions, reproductive technology).
○ These issues have raised new moral dilemmas concerning life, death,
privacy, and environmental health.
3. Key Reasons for Bioethics’ Growth (Warren T. Reich):
○ Technological Conflicts: Advances in biomedical technology sparked new
ethical questions about prolonging life, experimentation, and resource
allocation.
○ Intellectual and Moral Challenges: Bioethics offers a stimulating challenge
as old moral tools face scrutiny in a rapidly evolving world.
○ Multidisciplinary Interest: Scholars from diverse fields have contributed to
bioethics due to its relevance to both personal and societal behavior.
4. Factors Influencing Bioethics (H. Tristram Engelhardt):
○ Technological Changes: Innovations (e.g., organ transplants) forced a
rethinking of traditional medical practices.
○ Rising Healthcare Costs: Increasing expenses raised ethical questions
about how resources should be allocated.
○ Pluralistic Healthcare: Diverse patient populations mean healthcare
workers no longer share common values with patients, requiring new
ethical frameworks.
○ Rights of Self-Determination: There’s been a growing recognition of
individuals' rights to make their own health decisions.
5. Beyond Medical Ethics:
○ Bioethics has moved beyond just medical ethics to address wider
concerns like ecology, genetic engineering, reproductive medicine, and
environmental health.
 ○ It also reflects social movements questioning medical practices and the
need for new ethics suited to the technological age.
6. Challenges in Bioethics:
○ Issues like abuses in medical experimentation, new technologies, and
shifts in medical care call for a broader ethical perspective.
○ However, finding a universal ethical foundation for bioethics in a rapidly
changing world remains a challenge

Gestation Period of Bioethics:

1. Abuses in Human Experimentation:After WWII, the atrocities in Nazi

concentration camps and asylums, including unethical experiments on people
without consent, were exposed. The Nuremberg Trials (1946) revealed these
abuses, leading to the creation of the Nuremberg Code (1947), which outlined the
ethical conditions for medical experiments, emphasizing voluntary consent.The
Declaration of Helsinki (1964) expanded on this, focusing on patient autonomy
and informed consent. However, conflicts arose between prioritizing individual
well-being and advancing scientific knowledge.Despite these ethical codes,
unethical experiments like the Tuskegee Syphilis Study (1932–1972) and others
continued, highlighting the need for further judicial oversight and public
awareness.
2. Advances in Biomedical Technology: New medical technologies, such as organ
transplants and prenatal diagnosis, brought significant changes to healthcare
and sparked ethical debates. These innovations reshaped concepts of life, death,
and personal identity. Technologies like dialysis and life-support raised questions
about medical priorities, resource allocation, euthanasia, and the definition of
"quality of life. While medical progress was celebrated, it also generated fears
due to unforeseen risks, like the harmful effects of thalidomide (a drug causing
birth defects). High-profile cases like Karen Ann Quinlan's (1975–76), concerning
life-sustaining treatment, underscored the ethical challenges tied to medical
advancements.
3. Challenging Medical Paradigms: Medicine has shifted from a paternalistic
approach (where doctors made decisions for patients) to one where patients'
autonomy is emphasized. In the past, doctors were seen as the sole authority, but
now patients play an active role in their treatment decisions. This change has
been influenced by advancements in medical technology and ethical movements,
especially after World War II. However, some doctors feel they've lost control over
 the healing process due to these shifts, the rise of medical specializations, and
the increasing influence of non-medical professionals.
4. Criticism of Traditional Medicine: By the 1960s and 70s, there was growing
criticism of the traditional, aggressive biomedical model, which focused heavily
on interventions and treatments. Alternative approaches like homeopathy and
holistic medicine gained attention, with critics like Ivan Illich challenging the
political and economic influences on medicine. These critiques helped shape the
development of bioethics, questioning the direction and purpose of modern
medical practice.
5. Technoscientific Developments and Medicine: Advances in science and
technology have raised new ethical concerns. For example, the effects of
environmental pollution and radiation from Hiroshima highlighted the connection
between human actions and health. Issues like population growth, food
shortages, and uneven access to healthcare became global concerns.
Biotechnology, such as genetic engineering, brought hopes for medical
improvements but also fears about controlling nature and life itself. As science
progressed, the need for ethical responsibility in research became clear.
6. The Role of Social Movements in Medicine: After World War II, various social
movements, like the feminist and gay rights movements, challenged traditional
medical practices and ideas. These movements often critiqued medicine as a
tool of social control but also embraced new medical technologies, particularly in
reproductive health, to promote autonomy and self-determination. For example,
women's movements supported the separation of sexuality from reproduction
through technologies like birth control. Additionally, changes like the removal of
homosexuality from the list of mental illnesses showed the influence of these
movements in reshaping medical thinking and reducing medical paternalism.
This period also saw growing criticism of psychiatric practices and the rise of
patient advocacy.
7. Ethics in the Technological Age:The rapid advancement of science and
technology created new ethical challenges, which were recognized more broadly
after World War II. Philosophers and scientists began to explore how to deal with
the responsibilities that come with technological power. However, establishing a
solid ethical foundation became increasingly difficult in a secular world where
traditional sources of moral guidance, like religion, were losing influence. Radical
critics of technology, such as certain religious or countercultural groups, argued
that technoscience was dangerous and called for a return to simpler, pre-modern
ways of life. On the other hand, technocratic thinkers believed in continuous
progress through science. The debate centers around balancing the risks of
technology with its potential to improve human life, and bioethics emerged as a
 field where doctors and philosophers worked together to address these issues.
This led to the creation of important bioethics research centers like The Hastings
Center and the Kennedy Institute of Ethics.

The Scope of Bioethics:

1. Introduction to Bioethics and Thinkers:

○ Bioethics has a diverse scope, shaped by thinkers like Van Rensselaer
Potter, Andre Hellegers, H. Tristram Engelhardt, Hans Jonas, and Gilbert
Hottois.
○ Their contributions reveal the field's complexity and the controversies
surrounding its definition.
2. Van Rensselaer Potter’s Vision (Holistic Bioethics):
○ Original Concept: Potter coined the term "bioethics" to create a discipline
combining biological knowledge and human values, aimed at bridging
science and humanities.
○ Focus on Human Survival: His vision was anthropocentric (focused on
human survival and adaptation to the environment), emphasizing global
health and survival in a sustainable society.
○ Global Bioethics: In 1988, Potter redefined his concept as “global
bioethics,” advocating for a new ethical system to ensure human survival
through interdisciplinary cooperation among science, religion, and ethics.
3. Andre Hellegers and the Georgetown Model (Medicalized Bioethics):
○ Hellegers, through the Kennedy Institute of Ethics at Georgetown,
advocated for a bioethics focused on medical dilemmas.
○ Professionalization of Bioethics: He emphasized combining medical
expertise with ethical principles, focusing on clinical bioethics and applied
ethics within healthcare.
○ This approach became dominant in mainstream bioethics, centering on
resolving concrete medical and ethical issues using established
principles.
4. Warren T. Reich's "Bilocated Birth" of Bioethics:
○ Two Parallel Tracks: Reich noted that bioethics developed along two
paths: Potter’s global, holistic vision and Hellegers’ medicalized, clinical
model.
 ○ Reich’s Perspective: He supported a return to a global bioethics
framework that goes beyond clinical ethics to include issues like
environmental health, public health, genetics, and more.
5. Hans Jonas and the Imperative of Responsibility:
○ Jonas argued that modern technology has extended human actions,
requiring new ethical frameworks.
○ Emphasis on Responsibility: He introduced the “imperative of
responsibility,” focusing on the preservation of humanity and the natural
world.
○ Ethical Demands of Technology: Jonas emphasized that technological
advances must be guided by responsibility toward future generations and
the planet, opposing unchecked technological progress.
6. H. Tristram Engelhardt’s Secular and Pluralistic Bioethics:
○ Engelhardt viewed bioethics as a product of secular rationality, influenced
by the Enlightenment.
○ Polytheistic Approach: He believed in a pluralistic ethical system that
allows for open discussions among diverse groups, rejecting a single
moral authority.
○ Autonomy and Freedom: Engelhardt emphasized personal autonomy and
individual freedom in ethical decision-making, viewing bioethics as a
lingua franca for global health discussions.
7. Gilbert Hottois’ Middle Path (Technoscience and Ethics):
○ Hottois focused on the role of modern technoscience, which has changed
the nature of human knowledge and ethical challenges.
○ Ethics of Technoscience: He proposed a reevaluation of ethics in the face
of technological power, advocating for a balance between human progress
and ethical responsibility.
○ Anthropocosmic Solidarity: His concept stresses human
interconnectedness with nature, calling for a pragmatic and responsible
approach to scientific and technological possibilities.
8. Broader Scope of Bioethics (Global Perspective):
○ Beyond Medicine: Bioethics extends beyond medical ethics to include
environmental health, population concerns, genetics, reproductive
technologies, and animal welfare.
○ Multidisciplinary Approach: Bioethics is seen as a secular,
interdisciplinary field involving science, religion, philosophy, and public
policy, aimed at addressing the complex ethical challenges posed by
advancements in the life sciences.
 ○ Global Ethical Framework: Reich and others argue for a global bioethics
that addresses the larger issues of human survival, quality of life, and
environmental concerns, preventing bioethics from becoming too narrowly
focused on medical issues.

In summary, bioethics is an evolving field that encompasses a broad range of ethical

concerns, from clinical medical ethics to global health and environmental issues. It
balances diverse perspectives on technological progress, personal autonomy, and
collective responsibility for the future of humanity and the planet.