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    ADVANCEDBIOETHICS

    EMMANUEL JAMES P. PATTAGUAN, M.S.,PH.D

    Vice-President for Administration

    Used and modified with permission

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    Course Requirements

    Attendance-5%

    Midterm Examination-25%Final Examination-35%

    Reaction Papers(1-4)-20%

    Classroom Participation-5%Case Presentation-10%

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    Course Content

    I. Preliminaries

    Review of the Basics of Ethics

    II. Course proper

    1. Definition of Bioethics

    2. History ofBioethics

    3.Scope and Purposes of Bioethics

    4. Principles Governing Bioethics

    5. Perspectives and Methodology inBioethics

    III.Bioethical Issues

    IV.Case Presentation

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    An overview

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    Review of the Basics

    What is Ethics?

    Ethics is defined as the art andscience that deals with the morality of

    human acts.

    Human act- act that proceedsfrom the deliberate free will of man.

    Acts of man- acts proper to man

    as man.

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    IN RELATION TO REASON, our acts

    can beGood if it is in harmony with the

    dictates of right reason

    Evil if it is in opposition to the dictatesof reason

    Indifferentwhen it stand in no positive

    relation to the dictates.

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    The etymology

    ethics and morality

    ethos

    mos

    Ruth Benedict

    ..all values are rooted in customs and

    habits of a culture because the wordsmoral and ethics themselves were

    essentially created to describe these

    topics.

    Conveys meaning

    describing

    customs,habits

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    Ruth Benedict is among a group called

    the cultural relativists that believewhatever is normal and customary is

    what is right, and whatever is abnormal

    and deviant is wrong.

    Cultural relativism stresses acceptance

    because it is a de facto of humanreality

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    Nursing ethics is a branch ofapplied ethics that concerns itself

    with activities in the field of nursing.

    Nursing ethics shares many

    principles with medical ethics, suchas beneficence, non-maleficence and

    respect for autonomy. It can be

    distinguished by its emphasis on

    relationships, maintaining dignity andcollaborative care.

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    What is Bioethics?

    1. Bioethics is the philosophical study ofthe ethical controversies brought about

    by advances in biologyandmedicine.

    Bioethicists are concerned with the

    ethical questions that arise in the

    relationships among life sciences,biotechnology, medicine, politics, law,

    philosophy and theology

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    2.Ethics or 'moral philosophy', is

    concerned with questions of howpersons ought to act or if such

    questions are answerable.

    3. Ethics is also associated with the

    idea of Morality.

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    History of Bioethics

    I. 1960-the modern field of bioethics first

    emerged as an academic discipline.

    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 howcare might be withdrawn. These questions

    often fell upon philosophers and religious

    scholars.

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    II. 1970- bioethical think tanks and academic

    bioethics programs 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 Goergetown University in

    1971. The publication ofPrinciples of Biomedical

    Ethics by James F. Childress and Tom

    Beauchamp the first American textbook of

    bioethicsmarked a transformative moment in

    the discipline.

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    III. During the subsequent three decades, bioethical

    issues gained widespread attention. The field

    developed its own cadre of widely-knownadvocates, such as Al Jonsen at the University of

    Washington, John Fletcher at the University of

    Virginia, Jacob M. Appel at Brown University, Ruth

    Faden at John Hopkins University, and Arthur Caplan at the University of Pennsylvania. In 1995,

    President Bill Clinton established the Presidents

    Council on Bioethics, a sign that the field had

    finally reached an unprecedented level of maturityand acceptance. 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.

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    Scope and Purpose of Bioethics

    1. Bioethics addresses a broad range of

    human inquiry, ranging from debates

    over the boundaries of life (eg.abortion,euthanasia) to the allocation of

    scarce health care resources (eg. Organ

    donation, health care rationing) to theright to turn down medical care for

    religious or cultural reasons.

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    2. Bioethicists often disagree among

    themselves over the precise limits of

    their discipline, debating whether thefield should concern itself with the

    ethical evaluation of all questions

    involving biology and medicine, oronly a subset of these questions.

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    3. Some bioethicists would narrow

    ethical evaluation only to the morality of

    medical treatments or technological

    innovations, and the timing of medical

    treatment of humans

    4. Others would broaden the scope of ethical

    evaluation to include the morality of all

    actions that might help or harm organismscapable of feeling fear and pain, and include

    within bioethics all such actions if they bear

    a relation to medicine and biology.

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    5. However, most bioethicists share a

    commitment to discussing thesecomplex issues in an honest, civil and

    intelligent way, using tools from the

    many different disciplines that "feed"

    the field to produce meaningful

    frameworks for analysis.

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    Principles of Bioethics

    1. Autonomy (Ancient Greek: autonomos, Modern Greek:

    autonomia, from auto "self" + nomos, "law": one who gives

    oneself his/her own law) is a concept found in moral,

    political, and bioethical philosophy. Within these contexts, it

    refers to the capacity of a rational individual to make aninformed, un-coerced decision. In moral and political

    philosophy, autonomy is often used as the basis for

    determining moral respectibility for one's actions. One of the

    best known philosophical theories of autonomy was

    developed by Kant. In Medicine, respect for the autonomy ofpatients is an important goal, though it can conflict with a

    competing ethical principle, namely beneficence. Politically,

    it is also used to refer to the self-governing of a people.

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    2. Beneficence

    James Childress and Tom Beauchamp in

    Principle of Biomedical Ethics (1978) identify

    beneficence as one of the core values of healthcare ethics. Some scholars, such as Edmund

    Pellegrino, argue that beneficence is the only

    fundamental principle of medical ethics. They

    argue that healing should be the solepurpose of medicine, and that endeavors

    like cosmetic surgery, contraception and

    euthanasia fall beyond its purview.

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    3. Justice is the concept of moral

    rightness based on ethics, rationality,law,fairness or equity.

    4. Others have added non-

    maleficence, human dignity and

    the sanctity of life to this list ofcardinal values.

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    Non-malefecence

    In practice, however, many treatments

    carry some risk of harm. In somecircumstances, e.g. in desperate situations

    where the outcome without treatment will

    be grave, risky treatments that stand ahigh chance of harming the patient will be

    justified, as the risk of not treating is also

    very likely to do harm. So the principle ofnon-maleficence is not absolute, and must

    be balanced against the principle of

    beneficence (doing good).

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    Pope Pius defines Human Dignity-as something that is inherently a

    persons God-given inalienable rights

    that deserves to be protected byGovernment and promoted by the

    community.

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    inviolability orsanctity of life is a

    principle of implied protection regarding

    aspects of life which are said to be holy,

    saintly,sanctified, or otherwise of such

    value that they are not to be violated. In

    western religions, the concept is based

    on the belief that all human beings have

    souls or are created in God's image.

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    Perspectives and methodology

    Bioethicists come from a wide variety of backgrounds

    and have training in a diverse array of disciplines. Thefield contains individuals trained in philosophy such as

    Peter Singer of Princeton University 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 Jacob

    Appel and Wesley J. Smith, political economists like

    Francis Fukuyama, and theologians including James

    Childress. 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 Hastings Center report, the Journal of Medical Ethics

    and the Cambridge Quarterly of Healthcare Ethics.

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    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 andMuslim 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 livelydiscussion 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, andpartly also in Latin America, the debate on bioethics frequently

    focusses on its practical relevance in the context of

    underdevelopment and geopolitical power relations.

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    Peter Singer

    Outside academic circles, Singer is best known for his book Animal

    Liberation, widely regarded as the touchstone of the animal liberation

    movement. Not all members of the animal liberation movement share thisview, and Singer himself has said the media overstates his status. His views

    on that and other issues in bioethics have attracted attention and a degree

    of controversy.

    InAnimal Liberation, Singer argues against what he calls speciesm:

    discrimination on the grounds that a being belongs to a certain species. He

    holds the interests of all beings capable of suffering to be worthy of equal

    consideration, and that giving lesser consideration to beings based on their

    species is no more justified than discrimination based on skin color. He

    argues that animals should have rights based on their ability to feel pain

    more than their intelligence. In particular, he argues that while animals

    show lower intelligence than the average human, many severely retarded

    humans show equally diminished, if not lower, mental capacity, and that

    some animals have displayed signs of intelligence (for example, primates

    learning elements of American sign language and other symbolic

    languages) sometimes on par with that of human children, and that

    therefore intelligence does not provide a basis for providing nonhuman

    animals any less consideration than such retarded humans.

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    Key Issues in Jewish Faith

    In its early years, Jewish medical ethics addresseda range of ethical dilemmas, as well as general

    questions about the professional ethics for doctors.

    Major issues have included abortion, artificial

    insemination, brain death, cosmetic surgery,euthanasia, genetic screening, hazardous medical

    operations, oral suction in circumcision (metzitzah

    b'peh), organ donation , psychiatric care, and

    smoking cigarettes. In recent years, Jewishbioethics has examined questions of medical

    technology, the allocation of medical resources,

    and the philosophy ofJewish ethics

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    Ethics in the Muslim Faith

    Islam is the religion that heavily focuses on character building and

    doesnt grant the place in paradise by merely admitting into Islam. Infact, it teaches that sins can be washed not just by accepting

    commands of Allah but by physically doing these commands in

    Actions, and that bad deed can be washed away by doing good

    deeds. The person who acts on Allahs commands and perform

    good deed invariably attain good character.

    There is strong relationship between Strong Iman (faith) and good

    character. A person cannot attain full or perfect faith without

    attaining good character. In fact, a person with bad character is

    likely to find a place in hell then in paradise. Anas reportedMuhammad as saying: A person can reach a high status in the

    hereafter by his good conduct though he may be weak in matters of

    worship, and he can also go down to the lowest part of Hell by his

    wicked character [Abu Dawood]

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    The person with good character elevates himself to the status of

    those who are pious in their prayers and worships. Aisha (ra)

    reported Muhammad saying: A believer with his noble manners

    achieves the rank of one who prays late night and fast during theday [Abu Dawood]

    Similarly, Ibn Omar related that he heard Muhammad saying: A

    Muslim who worships in moderation reaches by means of his good

    manners and noble nature the rank of a person who fasts and recites

    the holy Quran in the night prayers. [Imam Ahmed]

    Islam has five main pillars, namely belief in the oneness of God

    (tawheed), daily prayers (salah), charity (zakat), fasting (sawm), and

    pilgrimage to Mecca (hajj). These are various acts of worship and

    obedience to Allah. All of these pillars are attributes directly towardscharacter building and bestowing high morals and ethics into

    Muslims

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    Buddhism and Bioethics

    The five precepts are training rules in order to live a better life in which one ishappy, without worries, and can meditate well:

    1. To refrain from taking life (non-violence towards sensient life forms)

    2. To refrain from taking that which is not given (not committing theft)

    3. To refrain from sensual (including sexual) misconduct

    4. To refrain from lying (speaking truth always)

    5. To refrain from intoxicants which lead to loss of mindfulness (specifically, drugsand alcohol)

    The precepts are not formulated as imperatives, but as training rules that

    laypeople undertake voluntarily to facilitate practice.In Buddhist thought, the

    cultivation of dana and ethical conduct will themselves refine consciousness to

    such a level that rebirth in one of the lower heavens is likely, even if there is no

    further Buddhist practice. There is nothing improper or un-Buddhist aboutlimiting one's aims to this level of attainment.

    In the eight precepts, the third precept on sexual misconduct is made more strict,

    and becomes a precept of celibacy. The three additional precepts are:

    6. To refrain from eating at the wrong time (only eat from sunrise to noon)

    7. To refrain from dancing and playing music, wearing jewelry and cosmetics,

    attending shows and other performances