Bioethics is the study of controversial ethics brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy. It also includes the study of the more commonplace questions of values ("the ethics of the ordinary") which arise in primary care and other branches of medicine.

  History

  Terminology

The term Bioethics (Greek bios, life; ethos, behavior) was coined in 1927 by Fritz Jahr, who "anticipated many of the arguments and discussions now current in biological research involving animals" in an article about the "bioethical imperative," as he called it, regarding the scientific use of animals and plants.^[1] In 1970, the American biochemist Van Rensselaer Potter also used the term with a broader meaning including solidarity towards the biosphere, thus generating a "global ethics," a discipline representing a link between biology, ecology, medicine and human values in order to attain the survival of both human beings and other animal species.^[2][3]

  Development of an interdisciplinary field

Although bioethical issues have been debated since ancient times, and public attention briefly focused on the role of human subjects in biomedical experiments following the revelation of Nazi experiments conducted during World War II, the contemporary field of bioethics first emerged as an academic interdisciplinary field in Anglophone societies in the 1960s. Technological advances in such diverse areas as organ transplantation and end-of-life care, including the development of kidney dialysis and respirators, posed novel questions regarding when and how care might be withdrawn. Furthermore, as philosophy in Britain and elsewhere moved away from the influences of logical positivism and emotivism, the development of theories of ethics and their application to practical problems gained in interest. These questions were often discussed by philosophers and religious scholars; in England, there were notable contributions from GEM Anscombe and RM Hare. By the 1970s, bioethical think tanks and academic bioethics programs had emerged. Among the earliest such institutions were the Hastings Center (originally known as The Institute of Society, Ethics and the Life Sciences), founded in 1969 by philosopher Daniel Callahan and psychiatrist Willard Gaylin, and the Kennedy Institute of Ethics, established at Georgetown University in 1971. The publication of Principles of Biomedical Ethics by James F. Childress and Tom Beauchamp—the first American textbook of bioethics—marked a transformative moment in the discipline. The Asilomar Conference on Recombinant DNA, held in 1975, was the first self-regulatory discussion proposed by scientists, in order to discuss the different aspects involved in DNA recombinant research. In Brazil, the first university that teach Bioethics was Pontificia Universidade Católica do Rio Grande do Sul, by Prof. Joaquim Clotet, in 1988.

During the subsequent three decades, bioethical issues gained widespread attention through the court cases surrounding the deaths of Karen Ann Quinlan, Nancy Cruzan and Terri Schiavo. The field developed its own cadre of widely known advocates, such as Al Jonsen at the University of Washington, John C Fletcher at the University of Virginia, Ruth Faden at Johns Hopkins University, and Arthur Caplan at the Center for Bioethics at the University of Pennsylvania. US Presidents have focused attention on bioethics for several decades, for instance by forming the President's Commission on the Study of Ethical Problems in Medicine and Biomedicine and Behavioral Research, which produced the landmark report, "Defining Death" in 1981.^[4] President George W. Bush also relied upon a Council on Bioethics in rendering decisions in areas such as the public funding of embryonic stem-cell research.

  Purpose and scope

The field of bioethics has addressed a broad swath of human inquiry, ranging from debates over the boundaries of life (e.g. abortion, euthanasia), surrogacy to 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 often 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 broaden the scope of ethical evaluation to include the morality of all actions that might help or harm organisms capable of feeling fear.

  Principles

One of the first areas addressed by modern bioethicists was that of human experimentation. 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, autonomy, 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.

Another important principle of bioethics is its placement of value on discussion and presentation. Numerous discussion based bioethics groups exist in universities across the United States to champion exactly such goals. Examples include The Ohio State Bioethics Society and the Bioethics Society of Cornell. Professional level versions of these organizations also exist.

  Medical ethics

Medical ethics is the study of moral values and judgments as they apply to medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.

Medical ethics tends to be understood narrowly as an applied professional ethics, whereas bioethics appears to have worked more expansive concerns, touching upon the philosophy of science and issues of biotechnology. Still, the two fields often overlap and the distinction is more 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.

  Perspectives and methodology

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 H. Tristram Engelhardt, Jr. of Rice University, Baruch Brody of Rice University, Peter Singer of Princeton University, Daniel Callahan of the Hastings Center, and Daniel Brock of Harvard University, medically trained clinician ethicists such as Mark Siegler of the University of Chicago and Joseph Fins of Cornell University, lawyers such as Nancy Dubler of Albert Einstein College of Medicine or Jerry Menikoff of the federal Office of 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, once dominated by formally trained philosophers, has become increasingly interdisciplinary, with some critics even claiming that the methods of analytic philosophy have had a negative effect on 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 and the Cambridge Quarterly of Healthcare Ethics.

Many religious communities have their own histories of inquiry into bioethical issues and have developed rules and guidelines on how to deal with these issues from within the viewpoint of their respective faiths. The Jewish, Christian and Muslim faiths have each developed a considerable body of literature on these matters. In the case of many non-Western cultures, a strict separation of religion from philosophy does not exist. In many Asian cultures, for example, there is a lively discussion on bioethical issues. Buddhist bioethics, in general, is characterised by a naturalistic outlook that leads to a rationalistic, pragmatic approach. Buddhist bioethicists include Damien Keown. In India, Vandana Shiva is the leading bioethicist speaking from the Hindu tradition. In Africa, and partly also in Latin America, the debate on bioethics frequently focuses on its practical relevance in the context of underdevelopment and geopolitical power relations.

  Issues

Areas of health sciences that are the subject of published, peer-reviewed bioethical analysis include:

  See also

• Bioethics (journal)
• Hastings Center Report (journal)
• Johns Hopkins Berman Institute of Bioethics
• Kennedy Institute of Ethics Journal
• Medical law
• Neuroethics
• Resources for clinical ethics consultation
• The Convention on Human Rights and Biomedicine

  References

  Further reading

  General bioethics

• Andre, Judith (2002), Bioethics as Practice, Chapel Hill and London: University of North Carolina Press, ISBN 0-8078-2733-9 
• Appel, Jacob (August 9, 2009), "A Supreme Court for Bioethics", Huffington Post, http://www.huffingtonpost.com/jacob-m-appel/a-supreme-court-for-bioet_b_228967.html 
• Aulisio, Mark; Arnold, Robert; Younger, Stuart (2003), Ethics Consultation; from theory to practice, Baltimore, London: Johns Hopkins University Press, ISBN 0-8018-7165-4 
• Faden, Ruth (2004), Bioethics: A field in transition, Journal of Law, Medicine & Ethics 
• Caplan, Arthur Smart Mice Not So Smart People Rowman Littlefield 2006
• Glad, John (2008), Future Human Evolution: Eugenics in the Twenty-First Century, Hermitage Press, ISBN 1-55779-154-6, http://www.whatwemaybe.org/txt/txt0000/Glad.John.2008.FHE.Meisenberg-abridgement.en.pdf 
• Emanuel, Ezekiel; Crouch, Robert; Arras, John; Moreno, Jonathan; Grady, Christine (2003), Ethical and Regulatory Aspects of Clinical Research, Baltimore, London: Johns Hopkins University Press, ISBN 0-8018-7813-6 
• Crowley, Mary (ed) (2008), From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book, Garrison, New York: The Hastings Center, http://www.thehastingscenter.org/Publications/BriefingBook/Default.aspx 
• Beauchamp, Tom; Childress, James (2001), Principles of Biomedical Ethics, Oxford, New York: Oxford University Press, ISBN 0-19-514332-9 
• Häyry, Matti; Tuija Takala; Peter Herissone-Kelly; Gardar Árnason (Eds.) (2010). Arguments and Analysis in Bioethics. Amsterdam/New York: Rodopi. ISBN 978-90-420-2802-9
• Jonsen, Albert; Veatch, Robert; Walters, leRoy (1998), SourceBook in Bioethics, Washington: Georgetown University Press, ISBN 0-87840-685-9 
• Jonathan, Baron (2006), Against Bioethics, The MIT Press, ISBN 978-0-262-02596-6 
• McGee, Glenn (2003), Pragmatic Bioethics, Cambridge: Massachusetts Institute of Technology Press, ISBN 0-262-63272-1 
• Khushf, Tom (ed) (2004), Handbook of Bioethics: taking stock of the field from a philosophical perspective, Dordrecht, Boston, London: Kluwer Academic Publishers, ISBN 1-4020-1893-2 
• Luna, Florencia, (2006) Bioethics and Vulnerability: A Latin American View. Edited by Peter Herissone-Kelly. Translated from Spanish by Laura Pakter. Amsterdam/New York: Rodopi. ISBN 978-90-420-2073-3
• McGee, Glenn (2003), Pragmatic Bioethics (2nd Edition), Cambridge: The MIT Press, ISBN 978-0-262-63272-0 
• Korthals, Michiel; Robert J. Bogers (eds.) (2004), Ethics for Life Scientists, Springer, ISBN 978-1-4020-3178-6, http://library.wur.nl/frontis/ethics/toc.html 
• Kuczewski, Mark G.; Ronald Polansky (eds.) (2002), Bioethics: Ancient Themes in Contemporary Issues, The MIT Press, ISBN 978-0-262-61177-0 
• Murphy, Timothy (2004), Case Studies in Biomedical Research Ethics, The MIT Press, ISBN 978-0-262-13437-8 
• Ravitsky, Vardit; Fiester, Autumn; Caplan, Arthur (eds.) (2009), The Penn Center Guide to Bioethics, New York: Springer, ISBN 978-0-8261-1522-5, http://www.springerpub.com/product/9780826115225 
• Singer, Peter A.; Viens, A.M. (2008), Cambridge Textbook of Bioethics, Cambridge: Cambridge University Press, ISBN 978-0-521-69443-8, http://www.cambridge.org/catalogue/catalogue.asp?isbn=9780521694438 
• Sugarman, Jeremy; Sulmasy, Daniel (2001), Methods in Medical Ethics, Washington: Georgetown University Press, ISBN 0-262-70072-7 
• Tauber, Alfred I (2005), Patient Autonomy and the Ethics of Responsibility, Cambridge: MIT Press, ISBN 0-262-70112-X 

  Christian bioethics

• Colson, Charles W. (ed.) (2004). Human Dignity in the Biotech Century: A Christian Vision for Public Policy. Downers Grove, Illinois: InterVarsity Press. ISBN 0-8308-2783-8
• Demy, Timothy J. and Gary P. Stewart. (1998). Suicide: A Christian Response: Crucial Considerations for Choosing Life. Grand Rapids: Kregel. ISBN 0-8254-2355-4
• Pope John Paul II. (1995). Evangelium Vitae: The Gospel of Life. New York: Random House. ISBN 0-8129-2671-4
• Kilner, John et al. (1995). Bioethics and the Future of Medicine: A Christian Appraisal. Grand Rapids, Michigan: Wm. B. Eerdmans Publishing Company. ISBN 0-8028-4081-7
• Kilner, John F., Arlene B. Miller, and Edmund D. Pellegrino (eds.). (1996). Dignity and Dying: A Christian Appraisal. Grand Rapids, MI: Eerdmans Publishing Co.; and Carlisle, United Kingdom: Paternoster Press. ISBN 0-8028-4232-1
• Meilaender, Gilbert (2004). Bioethics: A Primer For Christians. Grand Rapids, Michigan: Wm. B. Eerdmans Publishing Company. ISBN 0-8028-4234-8
• Loudovikos, Nikolaos, Protopresbyter (2002). The Individualization of Death and Euthanasia, Holy Synod of the Church of Greece, Committee of Bioethics, Scientific Conference on Euthanasia (Athens, May 17–18, 2002), retrieved on February 27, 2009. (Article in Greek).
• Pope Paul VI. (1968). Humanae Vitae: Human Life. Vatican City.
• Smith, Wesley J. (2004). Consumer's Guide to A Brave New World. San Francisco: Encounter Books. ISBN 1-893554-99-6
• Smith, Wesley J. (2000). Culture of Death: The Assault on Medical Ethics in America. San Francisco: Encounter Books. ISBN 1-893554-06-6
• Smith, Wesley J. (1997). Forced Exit: The Slippery Slope from Assisted Suicide to Murder. New York: Times Books. ISBN 0-8129-2790-7
• Stewart, Gary P. et al. (1998). Basic Questions on Suicide and Euthanasia: Are They Ever Right? BioBasics Series. Grand Rapids: Kregel. ISBN 0-8254-3072-0
• Stewart, Gary P. et al. (1998). Basic Questions on End of Life Decisions: How Do We Know What's Right? Grand Rapids: Kregel. ISBN 0-8254-3070-4
• Westphal, Euler Renato. O Oitavo dia – na era da seleção artificial (See The Eighth Day (book) Review) . 1. ed. São Bento do Sul: União Cristã, 2004. v. 01. 125 p. ISBN 85-87485-18-0

  Jewish bioethics

• Bleich, J. David. (1981). Judaism and Healing. New York: Ktav. ISBN 0-87068-891-X
• Dorff, Elliot N. (1998). Matters of Life and Death: A Jewish Approach to Modern Medical Ethics. Philadelphia: Jewish Publication Society. ISBN 0-8276-0647-8
• Feldman DM. (1974). Marital relations, birth control, and abortion in Jewish law. New York: Schocken Books.
• Freedman B. (1999). Duty and healing: foundations of a Jewish bioethic. New York: Routledge. ISBN 0-415-92179-1
• Jakobovits I. (1959). Jewish Medical Ethics. New York: Bloch Publishing.
• Mackler, Aaron L. (ed.) (2000). Life & Death Responsibilities in Jewish Biomedical Ethics. New York: JTS. ISBN 0-87334-081-7.
• Maibaum M. "A 'progressive' Jewish medical ethics: notes for an agenda" in Journal of Reform Judaism 1986;33(3):27-33.
• Rosner, Fred. (1986). Modern medicine and Jewish ethics. New York: Yeshiva University Press. ISBN 0-88125-091-0
• Conservative Judaism Vol. 54(3), Spring 2002 (contains a set of six articles on bioethics)
• Zohar, Noam J. (1997). Alternatives in Jewish Bioethics. Albany: State University of New York Press. ISBN 0-7914-3273-4

  Muslim bioethics

• Al Khayat MH. "Health and Islamic behaviour" in: El Gindy AR, editor, Health policy, ethics and human values: Islamic perspective. Kuwait: Islamic Organization of Medical Sciences; 1995. p. 447-50.
• Ebrahim, Abul Fadl Mohsin. (1989). Abortion, Birth Control and Surrogate Parenting. An Islamic Perspective. Indianapolis. ISBN 0-89259-081-5
• Esposito, John. (ed.) (1995). "Surrogate Motherhood" in The Oxford Encyclopedia of the Modern Islamic World (vol. 4). New York: Oxford University Press. ISBN 0-19-509615-0
• Karic, Enes. "The Ethics of Cloning" in Islamica Magazine Fall/Winter 2004. Issue #11
• Islamic Medical and Scientific Ethics (IMSE) Special Collection and Database at Georgetown University

  Buddhist bioethics

• Florida, R. E. (1994) Buddhism and the Four Principles in Principles of Health Care Ethics, ed. R. Gillon and A. Lloyd, Chichester: John Wiley & Sons, 105-16.
• Keown, Damien. (1995) Buddhism & Bioethics. London and New York: Macmillan/St. Martins Press.

  Hindu bioethics

• Coward, H. G., J. J. Lipner, and K. K. Young. (1989) Hindu Ethics: Purity, Abortion, and Euthanasia. Albany: State University of New York Press.
• Crawford, S. C. (2003) Hindu bioethics for the Twenty-first Century. Albany, NY: State University of New York Press.
• Crawford, S. C. (1995) Dilemmas of Life and Death, Hindu Ethics in A North American Context 1995. Albany, NY: State University of New York Press.
• Firth, S. (2005) End-of-life: a Hindu view. The Lancet. 366(9486): 682-686.
• Lakhan, Shaheen. (2008) Hinduism: life and death. Student BMJ. 16(18):310-311.

  External links

• The Hastings Center's Bioethics Forum blog
• VIDEOS from Bioethics Symposium, University of Wisconsin-Madison School of Medicine and Public Health (2011)
• The Bioethics Research Library, Georgetown University
• Southern Cross Bioethics Institute, South Australia, Australia