Bioethics

WHAT IS BIOETHICS?

Today the word bioethics is commonplace. Several newsmagazines, television shows, and Web sites have devoted special editions to topics such as stem cell technology, cloning, organ transplantation, in vitro fertilization, and gene therapy. Almost daily, media attention focuses on some particular problem, application, or breakthrough in science that inevitably raises as many problems as it solves.

We have become so used to these discussions and events that we forget that it was only forty years ago that the institute of Society, Ethics and the Life Sciences-as the Hastings Center was known then- was founded.’ In 1965, few knew of the institute, and fewer still understood what its members were talking about. But the role and value of this institute, and others that were to follow in its footsteps, were soon discovered as the major questions of abortion, population control, the allocation of resources, genetic engineering, behavior modification, and all the problems associated with dying began to press in upon us. Discoveries and applications began to outpace our ability to reflect on them, and everyone was reeling from the biological revolution.

We have seen several presidential commissions and advisory boards, an encyclopedia and its revised editions/ numerous journals3 and books,’ several societies, associations, and centers,’ and innumerable conferences all devoted to various problems in bioethics. Courses have spread throughout undergraduate and graduate schools; even graduate programs in bioethics now exist. Bioethicists have appeared as experts in court trials, and journalists frequently cite them in media reports about various dilemmas in health care and the life sciences. Institutional review boards, which examine the ethical dimensions of human research, are present almost everywhere.’ Many hospitals now have in-house ethicists and/or ethics committees to help evaluate a variety of ethical dilemmas that occur in the routine provision of health care.’

Few would have thought that such events could have happened when the first few tentative steps in the ethical examination of issues in health care were being taken in the 1960s. From these early days, commentators generated a wealth of scholarship; and although many problems seem as intractable as they did when first considered, the field has advanced considerably, and we are the beneficiaries of such scholarship.

A number of names have come into use to describe different areas of study in this field. One is

medical ethics. This looks primarily to the study of ethics within the discipline of medicine and the medical profession. Another term is health care ethics, which examines all the various issues in health care, including medical and nursing ethics, as well as public policy and institutional issues. The term organizational ethics sometimes designates ethical discourse concerning institutional issues. When considering the ethics of caring for patients at the bedside, the terms clinical ethics or clinical bioethics are used. We will use the term bioethics, which is a more inclusive term.

Since bioethics examines the ethical issues at both the heart and the cutting edge of technology in health care and the life sciences, the area covered is necessarily broad. This is what makes bioethics as a field of study complex but also exciting. There is a need for many specialties and disciplines because no one field can claim the territory of life. In addition to the potential benefits and harms, we have learned that medical technologies have economic consequences, which raise questions of allocation. Reality-which is itself interdisciplinary-has taught us to be interdisciplinary in our thinking. Similarly, bioethics is teaching us the necessity of genuine interdisciplinary thinking and working. Traditional disciplines that participated in one way or another in the field of bioethics include, for example, theology, philosophy, medicine, law, and biology. One might say that bioethics is a multidisciplinary field carried out through interdisciplinary discourse.

BIOETHICS

When we focus on the first part of the word bioethics- are thrust into the exciting, complex, and often troublesome world of medicine and the life sciences, which includes neuroscience, genetics, and molecular biology. The prefix biocomes from the Greek word for life (bios). Several questions emerge when one thinks about applications of both biotechnology and nanotechnology. This aspect of our topic requires that we study these fields to understand the biological revolution that is occurring around us. While we need be neither experts nor even competent amateurs, we do need to be informed citizens if for no other reason than the developments in these fields have a profound impact on our lives and our society. Thus paying attention to developments in these fields is a critical first step in examining ethical dilemmas in bioethics.

BIOETHICS

The other part of the word-“ethics”-is equally important, for the developments we discuss raise serious and profound dilemmas that challenge our value system as well as the culture supporting those values. The root ethics comes from the Greek word ethike meaning the science of morals or the study of habits.

Ethics, of course, has a problematic reputation. Many regard ethics as the great naysayer and dismiss it out of hand. Others reduce ethical arguments to opinion or taste and refuse to face arguments and conflicts. Still others use carefully developed principles and/or methodologies to consider various values and to tease out hidden conflicts and complex relationships.

Let us present an overview of two methods of ethical decision making that are frequently used in bioethics. The first is a kind of ethics known as deontological ethics. The Greek word deon means duty, obligation, or principle. Deontological ethics is a method of decision making that begins by asking, “What are my duties?” or “What are my obligations?” The correct ethical course is to follow

one’s duties-regardless of where they lead one. One may refer to this as the “Damn the torpedoes, full steam ahead” school of ethics. For once duties or obligations are established, the appropriate actions are clear and must be undertaken regardless of circumstances or outcomes.

A very common example of deontological ethics is the Ten Commandments of the Judeo-Christian religious tradition. The Ten Commandments are basically a set of moral duties that tell what to do or not to do. Biblical writers present them as clear and certain moral guides that mean what they say and say what they mean. They are, after all, the Ten Commandments, not the Ten Suggestions.

The second is a kind of ethics known as teleological ethics. The Greek word telos means end or goal. Thus, in teleological ethics, one’s moral obligations are established, not by an evaluation of obligations, but by an examination of consequences or outcomes of various actions. Thus one name for this kind of ethical theory is consequentialism. This method attempts to predict what will happen if one acts in various ways and to compare these various outcomes against one another. This outcomes-based evaluative process determines what is moral or the right act.

Situation ethics is probably one of the better known of the many variants of consequentialism. Popularized in the mid1960s by Joseph Fletcher, situation ethics requires that we attend seriously to the implications of actualizing our ethical beliefs. Thus situation ethics would argue that it is not enough to do good; one must also know which of the many possible goods is better. Therefore, the basis for right action is found in the particular characteristics of the situation.