BLOCK 3 , UNIT – 2

BIO-ETHICS:

INTRODUCTION:

Bio-ethics, as a part of ethics discusses ethical questions related to life-sciences. Bio-ethical analysis helps people in deciding that what they should do and make the decisions regarding policies.

            The word ‘bio-ethics’ signifies both ethics and life-sciences.  Ethical issues regarding the investigations of biology, scientific technology create a new domain called ‘bio-ethics’. Van Rensselaer Potter coined the word ‘bio-ethics’ for this multidisciplinary science and defined it as ‘biology combined with diverse humanistic knowledge forging a science that sets a system of medical and environmental priorities for acceptable survival.’ Bio-ethics promotes critical thinking of life sciences from the point of view of ethics.  By broadening the connectivity it increases the accessibility of the content.  It tries to lessen the risk involved in the process of real-life situations. Bio-ethics gives life-sciences an integral approach.  Technological developments in modern medicine have brought forth new ethical challenges and bio-ethics tries to find out ways to meet these challenges so that people of societies can work without hassles. Bio-ethics is closely related with social philosophy because of the social construction of the concepts of health care.  At the same time bio-ethics deals with the questions concerning the allocation of resources, which are from the field of social philosophy and ethics.  After historical analysis of the medical field, Thomas Kuhn has given his views. Philosophers have transformed the world of medicine.  And they can further contribute in this field by taking into consideration the history of medical sciences, in which their ideas worked.

            Bio-ethics is a multidisciplinary field and different from ‘medical ethics’, the realm of which included only the conduct of physicians.  Bio-ethics deals with the ethical Issus in medical practice, research and policy. Taking into consideration the role of non-physicians in the field of medicine, the emergence of bio-ethics was inevitable.  Globalized and privatized industries can now discuss the issues like health care resources and patient care, according to the principles of bio-ethics.  The social aspect of medicine and health can be discussed now, due to the introduction of bio-ethics.

            Bio-ethics was sorely needed to curb the immorality and cruelties in the field of health care and bio-medical research.  Due to increasing malpractices and abuses of rights, bio-ethics was very important. Callahan declared it as ‘less wayward and more establishmentarian and suggested four developments which were important for it.  Firstly, it was necessary to open up once-closed professions to public scrutiny. Secondly, he proposed liberal individualism. Thirdly, technological development in the field biomedicine, to save lives, was needed.  Fourthly, survival of philosophical and theological aspects of normative ethics was crucial for the end of positivism and cultural relativism that was responsible for the elimination of ethics.

CORE AND OTHER ETHICAL CONSIDERATIONS RESPECT FOR PERSONS:

Quest: What are the major ethical issues in bio-medical and bio-technical fields? Discuss. (Dec. 2011, 500 words)

Ans. Respect for persons is one of the main ethical issues in the realm of bio-medical.  It means that nobody should be treated as means to an end or goal. It also includes this factor that nobody should interfere with a person’s ability to make or carry out decisions.  To force someone to support one’s decisions or to enforce someone to make a certain type of decision is also a kind of disrespect for the person.  Mere listening is not sufficient to respect someone but try to understand whatever one says is also necessary. It also includes not to neglect or ridicule the thoughts and feelings of other people.

            Further, positive consequences can be promoted by balancing harms and benefits.  It can be done by giving priority to those actions which provide benefit and avoiding those that would lead to harm. This approach will lead to apply the ethical norms of utilitarianism. The word utilitarianism has been derived from the word ‘utility’ which means positive uses or benefits of something.  By giving priority to one path and rejecting another one can come to this consequence.  

            There are various types of harms and benefits like, physical, emotional, economic and social etc.  As far as utilitarians are concerned, they consider every type of harms and benefits in their ethical considerations. ‘First of all do no harm’ is the suo motto of practicing medicine.  Therefore, physicians should try their best to avoid the harms caused by their prescription.  Non–maleficence is the other term for the ideal ‘do no harm’. And, beneficence (‘Do good’) gives stress on acting on the best interest of others and being of benefit to them.

MORAL PLURALISM:

Traditional medical ethics was confined to physician’s ethics and theological ethics. Ethics and medicine has been influenced by theology in many religious traditions.  The field of medicine was mainly monitored by ethics in the past.  So, the question arises about the need of bioethics. Why traditional medical ethics was not sufficient?

            The reason behind the introduction of bio-ethics is this that traditional medical ethics was ‘physician ethics’. But besides physicians there are other people who are involved in medical decision making.  From the point of view of society, medicine and healthcare was needed to be defined. ‘Moral pluralism’ was reason behind this change. According to moral pluralism people have different moral views on various topics like: abortion, foeticide, euthnasia etc.  They use different moral framework and different methodology to analyse these problems. Now, due to the advancement of scientific medicine patents have various options regarding the courses of treatment to be accepted or refused.  Being on

the same ground on the level of moral values will help both patient and physician to solve this problem. But when patient and physician hold different views, in that case traditional medical ethics will be insufficient to resolve the issue.  To solve the problems arising from such situations, bio-ethics was needed. May be so that the physician’s view is medically accurate but is not suited to the patient. So, patient’s views must be included in the prescription to be pursued.   

            Also, moral standards are decided by different religious views, in secular societies.  Now, both clinical and research ethics have taken recourse to informed consent. Thus, people can exercise their judgement as per their interest.

SOCIAL DIMENSIONS:

The development of medical knowledge and technology are the two reasons, due to which bio-ethics came into existence.

            It is the impact of moral pluralism and multi-

culturalism in the societies that there are different moral voices and views.  Being a part of society medical care couldn’t remain unaffected by this diversity and there was a different view on appropriate medical care.

            Bio-ethics came into existence to help people from different moral views. One can have a view of social and cultural settings of medical practices and through it a better understanding of the society.  On the other hand, it provides the society or culture better way of examining basic questions of health, disease, sickness and death. It can also change the perspective of the society about moral authority and its exercise. Also, bio-ethics could be considered and a form of social philosophy and its development as a research field.

            Medical science is not value free. It is embedded in the values of the society.  The scientific norms of medicine are not unaffected by the social and moral values.  Thus, if medicine is monitored by social norms then bioethics may be considered as social philosophy which guides the social norm.  So, medicine is considered as a ‘social construction’.

            But, philosopher Ian Hacking has some objection regarding the use of this word. He says that the term has been over used and is incoherent. It may be so that the term doesn’t specify the exact meaning of medicine but it does indicate that the construction of medicine is influenced by the norms and values of the society.  The medical concepts like ‘health disease’ and ‘standard of care’ are not unaffected by the trends and ideals of the society.  Though, it cannot be denied there are universal elements in ‘health and healing’ but influence of local elements is also a matter of fact.

            The term ’social construction’ has been used to indicate this influence. Surely, the nature and knowledge of medicine will decide the practice and understanding of medicine.

            In fact, medicine is being considered as applied science and philosophy of medicine, as the principle of deciding ideals. But before considering medicine as a science one needs to analyse the concept of science and its various uses.  Being based on statistical data,

empirically verifiable and generalized, medical knowledge may be considered as a form of science.

            But since medical knowledge is not confined to the scientific datas only but includes also social factors.  First of all we need to examine that how the concepts of medicine like, disease, health are being defined in a given society.  Then only the relationship between the values of society and its medical practices can be discerned.

Traditional medical ethics was confined to physician’s ethics and theological ethics. Ethics and medicine has been influenced by theology in many religious traditions.  The field of medicine was mainly monitored by ethics in the past.  So, the question arises about the need of bioethics. Why traditional medical ethics was not sufficient?

            The reason behind the introduction of bio-ethics is this that traditional medical ethics was ‘physician ethics’. But besides physicians there are other people who are

 involved in medical decision making.  From the point of view of society, medicine and healthcare was needed to be defined. ‘Moral pluralism’ was reason behind this change. According to moral pluralism people have different moral views on various topics like: abortion, foeticide, euthnasia etc.  They use different moral framework and different methodology to analyse these problems. Now, due to the advancement of scientific medicine patents have various options regarding the courses of treatment to be accepted or refused.  Being on the same ground on the level of moral values will help both patient and physician to solve this problem. But when patient and physician hold different views, in that case traditional medical ethics will be insufficient to resolve the issue.  To solve the problems arising from such situations, bio-ethics was needed. May be so that the physician’s view is medically accurate but is not suited to the patient. So, patient’s views must be included in the prescription to be pursued.   

            Also, moral standards are decided by different religious views, in secular societies.  Now, both clinical

and research ethics have taken recourse to informed consent. Thus, people can exercise their judgement as per their interest.

MINIMIZING HARMS WHILE MAXIMIZING BENEFITS:

Further, positive consequences can be promoted by balancing harms and benefits.  It can be done by giving priority to those actions which provide benefit and avoiding

 those that would lead to harm. This approach will lead to apply the ethical norms of utilitarianism. The word utilitarianism has been derived from the word ‘utility’ which means positive uses or benefits of something.  By giving priority to one path and rejecting another one can come to this consequence.  

            There are various types of harms and benefits like, physical, emotional, economic and social etc.  As far as utilitarians are concerned, they consider every type of harms and benefits in their ethical considerations. ‘First of all do no harm’ is the suo motto of practicing medicine.  Therefore, physicians should try their best to avoid the harms caused by their prescription.  Non–maleficence is the other term for the ideal ‘do no harm’. And, beneficence (‘Do good’) gives stress on acting on the best interest of others and being of benefit to them.

Q4. Explain the term ‘social construction’.

Ans. SOCIAL DIMENSIONS:

Quest: What are the social dimensions of Bio-ethics? (June-2014, 250 words)

Ans. The development of medical knowledge and technology are the two reasons, due to which bio-ethics came into existence.

            It is the impact of moral pluralism and multi-culturalism in the societies that there are different moral voices and views.  Being a part of society medical care couldn’t remain unaffected by this diversity and there was a different view on appropriate medical care.

            Bio-ethics came into existence to help people from different moral views. One can have a view of social and cultural settings of medical practices and through it a better understanding of the society.  On the other hand, it provides the society or culture better way of examining basic questions of health, disease, sickness and death. It can also change the perspective of the society about moral authority and its exercise. Also, bio-ethics could be considered and a form of social philosophy and its development as a research field.

            Medical science is not value free. It is embedded in the values of the society.  The scientific norms of medicine are not unaffected by the social and moral values.  Thus, if medicine is monitored by social norms then bioethics may be considered as social philosophy which guides the social norm.  So, medicine is considered as a ‘social construction’.

            But, philosopher Ian Hacking has some objection regarding the use of this word. He says that the term has been over used and is incoherent . It may be so that the term doesn’t specify the exact meaning of medicine but it does indicate that the construction of medicine is influenced by the norms and values of the society.  The medical concepts like ‘health disease’ and ‘standard of care’ are not unaffected by the trends and ideals of the society.  Though, it cannot be denied there are universal elements in ‘health and healing’ but influence of local elements is also a matter of fact.

            The term ’social construction’ has been used to indicate this influence. Surely, the nature and knowledge of medicine will decide the practice and understanding of medicine.

            In fact, medicine is being considered as applied science and philosophy of medicine, as the principle of deciding ideals. But before considering medicine as a science one needs to analyse the concept of science and its various uses.  Being based on statistical data, empirically verifiable and generalized, medical knowledge may be considered as a form of science.

            But since medical knowledge is not confined to the scientific datas only but includes also social factors.  First of all we need to examine that how the concepts of medicine like, disease, health are being defined in a given society.  Then only the relationship between the values of society and its medical practices can be discerned.