18-12-2012, 04:34 PM
Bioethics: Philosophical Aspects
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Introduction
Etymologically, the term `bioethics' derives from the
Greek words bios (life) and ethike (ethics), and literally
means the ethics of life. In practice, however, it denotes
a ®eld largely concerned with the ethical analysis of
normative problems in the biomedical sciences, medical
practices, and health care management. Re¯ecting
this focus, this article addresses the nature and history
of bioethics, the dominant ethical theories employed
in bioethical reasoning, and their in¯uence in the main
areas of bioethical research.
BioethicsÐScope and History
Bioethics, both as an academic discipline and as a
professional activity, has evolved from the domain of
medical ethics. It is a multidisciplinary ®eld that
extends far beyond the spheres of healthcare and
medical ethics. It encompasses a wide range of ethical
problems in the life sciences. These include issues
related to genetics, theories of human development,
behavioral psychology, and resource allocation in
healthcare management.
Bioethical expertise is sought by courts, parliaments,
research ethics committees, and is used in
clinical consultations to guide the behavior of medical
professionals. Despite its practical appeal, however,
disagreement exists about the nature and scope of
bioethics as a professional}theoretical discipline. Bioethicists
come from a diverse range of professional
backgrounds, including healthcare professions, philosophy,
jurisprudence, sociology, and theology. Debate
about the proper relations between the disciplines
contributing to bioethical analysis is continuing
(Carson and Burns 1997).
Expanding Issues in Medicine
The reasons for the progression of bioethics as a
multidisciplinary activity can perhaps best be understood
by considering the societal context in which it
began. The rapid developments with regard to both
the availability of biomedical technology and dramatically
advancing biomedical research required a
rethinking of traditional approaches to medical ethics.
The 1960s saw not only the ®rst successful organ
transplantations, the contraceptive pill, and the arrival
of prenatal diagnosis, but also a shift to the deployment
of highly technological medicine. Particular
people began to demand greater liberties, such as
equal rights for those who were non-Caucasian,
female, and gay. Medical paternalism, and the attitude
that the `doctor knows best' were no longer considered
sacrosanct.
Bioethics Teaching
Bioethics is currently taught in many diverse forms
throughout both the developed and developing world.
Bioethicists teach in medical faculties, medical humanities,
and philosophy programs, and in one of
several hundred research centers in postgraduate
degree programs. The socioeconomic and cultural
contexts of teaching in¯uence the topics that constitute
a given syllabus. For example, in developing countries,
issues such as exploitation in organ transplantation or
human experimentation feature more prominently
than in developed nations. Teachers try to instill
heightened sensitivity in their students to ethical issues
and values in medicine, as well as provide them with
skills in dealing with ethical problems arising in
healthcare practice. Courses are often taken as part of
obligatory continuing medical education requirements.
Theoretical Approaches to Bioethics
Philosophical ethics, the theoretical heart of bioethical
analyses, consists of a variety of competing ethical
theories. Utilitarians, deontologists, casuists, communitarians,
contractarians, virtue ethicists, and
ethicists of other persuasions appeal to differing modes
of ethical reasoning. This has consequences for bioethical
analyses since the type of ethical theory or
religious framework to which a given bioethicist
subscribes will be re¯ected in the practical advice
advocated.
Principle-based Bioethics
Principle-based bioethics typically refers to an approach
developed by Beauchamp and Childress
(1994). They propose a system of bioethics comprised
of four major principles: autonomy, bene®cence,
nonmale®cence, and justice. These prima facie principles
primarily concern respect for the choices people
make, the obligation to help, but not harm, other
parties, and the requirement to act in a fair and
equitable manner with regard to the distribution of
medical burdens and bene®ts.
Deontological Bioethics
Secular deontological approaches to bioethics tend to
be based on Kantian and neo-Kantian ethical theories,
and feature most prominently in the areas of resource
allocation and general social health policy. Daniels
(1985), for example, uses a neo-Kantian form of
contractarianism to support his in¯uential argument
for a universal right to healthcare. The Kantian moral
agent is quite different from the utilitarian agent who
acts in order to satisfy interests or desires.
Kant was concerned with the motivation of action,
and argued that duty alone should motivate morally
adequate action. An `action done from duty has its
moral worth not in the purpose to be attained by it,
but in the maxim in accordance with which it is
decided upon' (Kant 1976). These maxims are constructed
as absolute imperatives of the sort, `don't
kill,' `don't lie,' etc.
Feminist Bioethics
Feminist approaches to bioethics are uni®ed by a
common concern for women's oppression. Feminist
bioethics raises the question of unequal distribution of
social power, and the subsequent biases that manifest
in the life sciences, medical practices, and philosophical
ethics. There are numerous feminist approaches to
these ®elds. Feminist projects provide a critique of
traditional approaches to bioethics, focusing on the
effects that the historical exclusion of women and their
experiences have had on theory production. Some
feminists aim merely to provide a correctie to dominant
theories and practices, while others embark on
the more radical project of creating positive feminist
theories and practices which differ fundamentally from
those which are the objects of critique. Whether one
stops at critique, or progresses to creating novel
theories founded on new premises, depends largely on
how deep the level of masculine bias is held to be.
Bioethics provides fertile ground for feminist analysis,
since scienti®c claims have long been used as tools to
justify women's oppression as part of the natural order
of things.
Communitarian Bioethics
In the context of bioethics, communitarianism constitutes
a critical discourse that challenges dominant
approaches which are based on Enlightenment
philosophies. The idea of an isolated knowing subject,
who de®nes ethical truth in accordance with the
dictates of human reason, is rejected. Communitarians
privilege the interests and values of the community in
negotiating morally optimal courses of action. They
argue that any moral theory is determined by sociohistorical
context, including the traditions, religions,
and culture of a community. Within traditional moral
theories, these in¯uences are often seen as extraneous,
contaminating the goal of objective moral truth. For
communitarians, however, attempts to produce an
impartial, universal moral theory are not only futile,
but represent a mistaken concept of what moral
thought should involve. They emphasize that certain
decisions require a view of the good, of what is
worthwhile and valuable for a community.