Bioethics is both a field of study and professional practice, interested in ethical issues related to health (primarily focused on the human, but also increasingly includes animal ethics), including those emerging from advances in biology, medicine, and technologies. It proposes the discussion about moral discernment in society (what decisions are "good" or "bad" and why) and it is often related to medical policy and practice, but also to broader questions as environment, well-being and public health. Bioethics is concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, theology and philosophy. It includes the study of values relating to primary care, other branches of medicine ("the ethics of the ordinary"), ethical education in science, animal, and environmental ethics, and public health.
Etymology The term bioethics (Greek , "life"; , "moral nature, behavior") was coined in 1927 by Fritz Jahr in an article about a "bioethical imperative" regarding the use of animals and plants in scientific research. In 1970, the American biochemist and oncologist Van Rensselaer Potter used the term to describe the relationship between the biosphere and a growing human population. Potter's work laid the foundation for global ethics, a discipline centered around the link between biology, ecology, medicine, and human values. Sargent Shriver, the spouse of Eunice Kennedy Shriver, claimed that he had invented the term "bioethics" in the living room of his home in Bethesda, Maryland, in 1970. He stated that he thought of the word after returning from a discussion earlier that evening at Georgetown University, where he discussed with others a possible Kennedy family sponsorship of an institute focused around the "application of moral philosophy to concrete medical dilemmas".
Purpose and scope
The discipline of bioethics has addressed a wide swathe of human inquiry; ranging from debates over the boundaries of lifestyles (e.g. abortion, euthanasia), surrogacy, the allocation of scarce health care resources (e.g. organ donation, health care rationing), to the right to refuse medical care for religious or cultural reasons. Bioethicists disagree among themselves over the precise limits of their discipline, debating whether the field should concern itself with the ethical evaluation of all questions involving biology and medicine, or only a subset of these questions. Some bioethicists would narrow ethical evaluation only to the morality of medical treatments or technological innovations, and the timing of medical treatment of humans. Others would increase the scope of moral assessment to encompass the morality of all moves that would possibly assist or damage organisms successful of feeling fear.
The scope of bioethics has evolved past mere biotechnology to include topics such as cloning, gene therapy, life extension, human genetic engineering, astroethics and life in space, and manipulation of basic biology through altered DNA, XNA and proteins. These (and other) developments may affect future evolution and require new principles that address life at its core, such as biotic ethics that values life itself at its basic biological processes and structures, and seeks their propagation. Moving beyond the biological, issues raised in public health such as vaccination and resource allocation have also encouraged the development of novel ethics frameworks to address such challenges. A study published in 2022 based on the corpus of full papers from eight main bioethics journals demonstrated the heterogeneity of this field by distinguishing 91 topics that have been discussed in these journals over the past half a century.
Principles
One of the first areas addressed by modern bioethicists was human experimentation. According to the Declaration of Helsinki (1964) published by the World Medical Association, the essential principles in medical research involving human subjects are autonomy, beneficence, non-maleficence, and justice. The autonomy of individuals to make decisions while assuming responsibility for them and respecting the autonomy of others ought to be respected. For people unable to exercise their autonomy, special measures ought to be taken to protect their rights and interests.
In US, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was initially established in 1974 to identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects. However, the fundamental principles announced in the Belmont Report (1979)—namely, respect for persons, beneficence and justice—have influenced the thinking of bioethicists across a wide range of issues. Others have added non-maleficence, human dignity, and the sanctity of life to this list of cardinal values. Overall, the Belmont Report has guided research in a course centered on defending difficult topics as properly as pushing for transparency between the researcher and the subject. Research has flourished within the past 40 years and due to the advance in technology, it is thought that human subjects have outgrown the Belmont Report, and the need for revision is desired.
Another essential precept of bioethics is its placement of cost on dialogue and presentation. Numerous dialogue based bioethics organizations exist in universities throughout the United States to champion precisely such goals. Examples include the Ohio State Bioethics Society and the Bioethics Society of Cornell. Professional level versions of these organizations also exist.
Many bioethicists, in particular scientific scholars, accord the easiest precedence to autonomy. They trust that every affected person ought to decide which direction of motion they think about most in line with their beliefs. In other words, the patient should always have the freedom to choose their own treatment.
Medical ethics
Ethics affects medical decisions made by healthcare providers and patients. Medical ethics is the study of moral values and judgments as they apply to medicine. The four main moral commitments are respect for autonomy, beneficence, nonmaleficence, and justice. Using these four principles and thinking about what the physicians' specific concern is for their scope of practice can help physicians make moral decisions. As a scholarly discipline, medical ethics includes its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. It is concerned with the duties that doctors, hospitals, and other healthcare providers have to patients, society, and other health professionals.
Medical ethics tends to be understood narrowly as applied professional ethics; whereas bioethics has a more expansive application, touching upon the philosophy of science and issues of biotechnology. The two fields often overlap, and the distinction is more so a matter of style than professional consensus. Medical ethics shares many principles with other branches of healthcare ethics, such as nursing ethics. A bioethicist assists the health care and research community in examining moral issues involved in our understanding of life and death, and resolving ethical dilemmas in medicine and science. Examples of this would be the topic of equality in medicine, the intersection of cultural practices and medical care, ethical distribution of healthcare resources in pandemics, and issues of bioterrorism.
Medical sociology The practice of bioethics in clinical care have been studied by medical sociology. Many scholars consider that bioethics arose in response to a perceived lack of accountability in medical care in the 1970s. Studying the clinical practice of ethics in medical care, Hauschildt and Vries found that ethical questions were often reframed as clinical judgments to allow clinicians to make decisions. Ethicists most often put key decisions in the hands of physicians rather than patients.
Communication strategies suggested by ethicists act to decrease patient autonomy. Examples include, clinicians discussing treatment options with one another prior to talking to patients or their family to present a united front limited patient autonomy, hiding uncertainty amongst clinicians. Decisions about overarching goals of treatment were reframed as technical matters excluding patients and their families. Palliative care experts were used as intermediaries to guide patients towards less invasive end-of-live treatment. In their study, Hauschild and Vries found that 76% of ethical consultants were trained as clinicians.
Studying informed consent, Corrigan found that some social processes resulted in limitations to patients choice, but also at times patients could find questions regarding consent to medical trials burdensome.
The most prevalent subject is how social stratification (based on SES, gender, class, ethnicity, and age) affects patterns of behavior related to health and sickness, illness risk, disability, and other outcomes related to health care. The study of health care organization and provision, which encompasses the evolving organizational structures of health care organizations and the social psychology of health and health care, is another important approach. These latter research cover topics including connections between doctors and patients, coping mechanisms, and social support. The description of other important fields of medical sociology study emphasizes how theory and research have changed in the twenty-first century.
Value pluralism
Bioethicists come from a wide variety of backgrounds and have training in a diverse array of disciplines. The field contains individuals trained in philosophy such as Deryck Beyleveld of Durham University, Daniel Brock of Harvard University, Baruch Brody of Rice University, Arthur Caplan of NYU, Joseph Fins of Cornell University, Frances Kamm of Rutgers University, Daniel Callahan of the Hastings Center, Peter Singer of Princeton University, and Julian Savulescu of the University of Oxford; medically trained clinician ethicists such as Mark Siegler of the University of Chicago; lawyers such as Nancy Dubler of Albert Einstein College of Medicine and Jerry Menikoff of the federal Office for Human Research Protections; political scientists like Francis Fukuyama; religious studies scholars including James Childress; and theologians like Lisa Sowle Cahill and Stanley Hauerwas.
The field, formerly dominated by formally trained philosophers, has become increasingly interdisciplinary, with some critics even claiming that the methods of analytic philosophy have harmed the field's development. Leading journals in the field include The Journal of Medicine and Philosophy, the Hastings Center Report, the American Journal of Bioethics, the Journal of Medical Ethics, Bioethics, the Kennedy Institute of Ethics Journal, Public Health Ethics, and the Cambridge Quarterly of Healthcare Ethics. Bioethics has also benefited from the process philosophy developed by Alfred North Whitehead.
Another discipline that discusses bioethics is the field of feminism; the International Journal of Feminist Approaches to Bioethics has played a role in organizing and legitimizing feminist work in bioethics.