HISTORY OF BIOETHICS

The term bioethics and medical ethics are sometimes used

interchangeably.
bioethics has a much broader scope than medical ethics.
Bioethics is a recently developed multidisciplinary field of learning
that encompasses issues in healthcare, research,biotechnology,
environment along with the traditional elements of medical ethics.
Bioethics emerged in the 1960s due to rapid medical advancements and a
growing awareness of patient rights. Unlike traditional medical ethics, which
focused on doctor-patient relationships and professional conduct, bioethics is a
broader, more critical field. It tackles ethical dilemmas arising from new
technologies, explores philosophical questions about life and personhood, and
addresses public policy related to medicine and science. Essentially, it's about
understanding the ethical implications of healthcare and biomedical research,
not just following established rules.
The World War II Nazi medical experiments in Europe - “Permissible
Medical Experiments” &“Nuremberg Code‘ (before these trials there
was no international law to
differentiate between legal and illegal human experimentation.)
Tuskegee research in the United States - 1932
Medical ethics
Medical ethics is regarding ethical and moral issues related to the practice of
medicine and health care.
1750 BCE, the code of Hammurabi in Babylonia is recorded as the oldest text
that states the professional expectations of the medical practitioners.
It stipulates that if a doctor uses a bronze lancet to perform a major operation on
a member of the nobility that results in death or leads to the loss of an eye, the
doctor’s hand will be cut off(Pritchard 1969).
In India, one may refer to Ayurveda that describes the attribute of a good doctor
in the Samhita of Athreya, Charaka and Sushruta around 300 BCE-500 CE.
Hippocrates
Hippocrates is called the father of medical ethics and the founder of
the famous “Hippocratic Oath”. The Oath is commonly assumed to
be of 5th century BC and is regarded as the foundation of western
medical ethics.
In the present times, most graduating medical school students swear
to the Hippocratic oath (modernised version)
· To have a parental like respect to the one who has taught the art and to
continue this regard, as his brother, to his offspring
· To do no harm.
· Whatever I see or hear in the lives of my patient, I will keep it secret.
The key controversial aspects of the Hippocratic Oath are its precepts against
Euthanasia,Abortion and surgery. All these have been abrogated in later versions.
 “do no harm” and “patient’s confidentiality” are still intact..
On the basis of Hippocratic Oath, four basic principles of biomedical
ethics were described by Tom Beauchamp and James Childress in
1979.
1. Principle of beneficence
2. Principle of non- maleficence
3. Principle of respect for autonomy
4. Principle of justice
What is Bioethics ?
The term ‘Bioethics’ was coined in 1927 by Fritz Jahr in the article
about “bioethical imperative” regarding the use of animals and plants
in scientific research.
Bioethics in its very inception remains an interdisciplinary field. Various
breakthrough researches in the field of medicine, nursing, biomedical
technology, and human sciences have shaped and framed its structure from time
to time.
Breakthrough developments in medicine and technology such as, organ
transplant, dialysis machine, artificial ventilators, in vitro fertilization, have led
to a sea change in the world outlook. All these have had a deep impact in the
ethical reflections of people around the world.
EUTHANASIA

In bioethics, the end of life issues often come under the issues of Euthanasia. It comes from
the Greek word, “eu”, meaning “good”, and “thanatos”, meaning “death”. It is sometimes
referred to as good death. It includes the issues of right to die, and physician assisted suicide.
In most of the cases, euthanasia involves a deliberate action carried by someone else, usually
a medical practitioner, to bring about the death of a person. In this form euthanasia is
understood as “mercy killing”. Oxford dictionary describes Euthanasia as “a gentle and easy
death especially in case of irrevocable and irreversible painful disease”.
1. Voluntary Euthanasia
It is a situation where the patient is conscious and is able to make a rational
decision, to end his/her life. In some cases, the patient may have his living will, as
a form of consent to terminate his/her life, if at all he/she is infected by an
irreversible disease. The request may be of the nature to withhold treatment that
would prolong one's suffering.
2. Involuntary Euthanasia
It is a situation where the patient has not given his or her consent and euthanasia is
administered against his/her will.
3. Non Voluntary Euthanasia
It is a term which is used when the patient is not in a position to
convey his wishes about ending his life. Here the patient’s wishes are
not known and thus it is usually a caretaker or a family member who
may be consulted to make the decision. These are the cases not really
against the will of the person, as his wishes are not known. In such
cases, a person may be in a coma, brain damaged or a neonate.
4. Active Euthanasia
It is sometimes referred to as ‘killing’. Here some steps are taken to
assist in one’s death, for instance, by injecting a lethal injection. The
point here is to make death painless as much as possible.
5. Passive Euthanasia
It is referred to as “letting die”. In this case, there is no action or
“negative” action undertaken consciously to let someone die. In other
words, the health care professional deliberately withholds the treatment,
to let the patient die through the natural course of the illness.
The debate on Euthanasia
Those who are against it, argue from the perspective of the “sanctity of
life” principle.
They fear that by allowing euthanasia may lead to devaluation of human
life.

On the other side are those who believe that it should be the right of an
individual to decide when to end life. They argue for the inclusion of “right
to die” as an extension to “right to life”. The right to life with dignity is the
threshold of the entire debate. Merely by being alive in a vegetative state is
contrary to the very essence of “life with dignity”.
Abortion
An ethical proposition that surrounds this issue is to perceive life as sacred in
itself.
Alongside are various other markers that questions the ethical standing of this
act, such as-
1. Concern for the welfare of the child.
2. Concern for the life and autonomy of the mother.
3. Concern for the future of society.
Those who support abortion provide pro-choice arguments in favour of the
woman’s rights to choose. The emphasis is on the autonomy and personal rights
of the woman.
On the other end, those who believe that abortion is inherently immoral, and are
against its application at any stage of pregnancy are pro-life groups.
The main contesting issue is with regard to the
moral status of the unborn foetus, and to consider
whether the unborn foetus has a right to life
or not?
Cloning

Types of Cloning:
•Reproductive Cloning:
•This aims to create a complete, living copy of an existing
organism.
•It's the most ethically controversial, particularly in humans.

•Therapeutic Cloning:
•This focuses on creating cloned embryos for the purpose
of harvesting stem cells.
•These stem cells can then be used to grow tissues or
organs for transplantation.
Key Bioethical Concerns:
•Human Dignity and Autonomy:
•Concerns exist that cloning could undermine the uniqueness and individuality
of a person.
•Questions arise about the psychological and social impact on a cloned
individual.
•Safety and Risks:
•Cloning procedures, particularly reproductive cloning, carry significant risks of
birth defects and health problems.
•The long-term effects on cloned individuals are unknown.
•"Playing God" Argument:
•Some believe that cloning interferes with the natural order or divine creation.
•Potential for Abuse:
•There are fears that cloning could be used for eugenic purposes, creating "designer babies" or
exploiting cloned individuals.
•The possibility of the creation of human clones for organ harvesting is a grave concern.
•Social Implications:
•Cloning could disrupt traditional family structures and raise complex questions about parentage
and identity.
•It could also exacerbate social inequalities if access to cloning technology is limited.
•Moral Status of the Embryo:
•The use of embryos in therapeutic cloning raises ethical debates about when life begins and the
moral status of an embryo.
•Religious Views:
•Religous views on cloning vary greatly. Some religions have strong oppositions to any form of
human cloning, while others may have more nuanced views, especially concerning therapeutic
cloning.
Current Status:
•Reproductive human cloning is widely condemned and legally banned in many
countries.
•Therapeutic cloning is subject to varying regulations, with some countries permitting it
under strict guidelines.
•Animal cloning is more common, and is being used in agriculture, and for other
purposes.
How various ethical perspectives
approach bioethics ?
 Utilitarianism:

Resource Allocation: Utilitarianism can be used to justify allocating limited medical resources
to treatments that benefit the most people. For example, in a pandemic, prioritizing vaccination
distribution to high-risk groups.
•Public Health: Utilitarian principles often underlie public health policies, such as mandatory
vaccinations or quarantine measures, which aim to protect the health of the population as a
whole.
•Medical Research: Utilitarianism may support research that has the potential to yield
significant benefits, even if it involves some risk to individual participants.
•Criticisms:
•Utilitarianism can potentially disregard the rights or interests of individuals if doing so benefits
the majority.
•It may lead to scenarios where the rights of minorities are violated.
Deontology:

•Deontology emphasizes moral duties and rules. It

focuses on the inherent rightness or wrongness of
actions, regardless of their consequences.
•In bioethics, deontology might prioritize respecting
individual autonomy and informed consent, even if
doing so does not maximize overall well-being.
Virtue Ethics:

•Virtue ethics focuses on the character of the

moral agent. It emphasizes the importance of
cultivating virtues such as compassion, integrity,
and wisdom.
•In bioethics, virtue ethics might emphasize the
importance of healthcare professionals acting
with compassion and empathy.
Principlism:

•This approach uses four key ethical principles:

autonomy, beneficence, non-maleficence, and justice.
•It provides a framework for analyzing bioethical
dilemmas by balancing these principles. This is very
popular in modern medical ethics.