bioetika universal declaration_ benefit & harm

8/3/2019 BIOETIKA Universal Declaration_ Benefit & Harm

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BIO

ETH

ICS

Benefit and Harm

Universal Declaration on

Bioethics and Human Rights

Drs. Uki Dwiputranto, Grad. Dip. Sc., M.Sc


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Aims: Human Rights

Relationship betweenrights and responsibilities

Compare individual and

Collective Rights Implementation on Ethical

Issues


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WorldWar II

(e.g. genocidal horror)

Universal Declaration

of Human Rights

1948

Free and equal in dignity and

rights irrespective of race,

religion,politics

Rights to life, liberty,

security.., adequatestandard of living, health

care.

Freedom of thought,

expression, .. and access to

information from independent

media.

Enable people to

support their familys

basic needs, good

quality of life and

wellbeing (food,

health, education,

security, etc)


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HumanRights

HumanResponsibilities

To ensure the rights and

general welfare of others.

Rights confer new powers

and freedom. So, it must beexercised responsibly

with due respect for issues

of ethics and justice.


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The typical emphasis in

WESTERN NATIONS has been

on rights and freedom for the

individual (=individualism)

In many EASTERN NATIONS

there has been excessive

emphasis on duties and

responsibilities to society and

state (=collectivism)

Each value system can learn and benefit from the

other, to reach a common middle ground which

doesnt sideline either individual human rights orcollective human

responsibilities


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Human responsibilities at the global level include

concepts of SOCIAL JUSTICE (economic issue),

and ECOLOGICAL STEWARDSHIP(environmental issue).

Science

Technology

Dilemma

Foundation forhumanitys response

to the ever increasing

dilemmas and

controversies related

with science and

technologyapplication.

Universal Declaration on Bioethics and

Human Rights (03 October 2005)


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Implementation

on Ethical Issues..?


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1. Introduction of Bioethics

2. Ethics & Culture

3. Bioethicsin Medical Education

Four Basic Moral

Principles

4. Doctor-Patient Relationship

BHL-1

Beneficence

Non-maleficence

Autonomy

Justice


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Public and institutional policies are also

developed from reasoned choices aboutappropriate benefits relative to costs and risks

(Benefit vs Harm).

Judgment about the

most suitable medical

treatment.

Judgment about ethicalacceptibility of research

involving human

subjects.


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Example: in submitting a research

protocol involving human subjects to an

institutional review board (IRB)for approval.

An investigator is expected to array the

riskto subject andprobable benefits to

both subjects and society, and to

explain why the probable benefits

outweigh the risk.

IRB then offer a

reasoned

assessment

If approved

The investigator is expected to

describe the risk and probable

benefits to potential subjects

Informed

decision on

research

participation


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Variousinformal strategies have evolved to

helpmake decisions about benefits andcosts/ risks (benefits vs harm).

Expert judgments based on the most

reliable data that can be assembledand analogical reasoning based onprecedents.

To establish new policies on thebasis of policies that have already

proved their value.


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Analysis Tool


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It was six men of Indostan,To learning much inclined,Who went to see the Elephant

(Though all of them were blind),That each by observationMight satisfy his mind.

The Firstapproach'd the Elephant,And happening to fallAgainst his broad and sturdy side,At once began to bawl:"God bless me! but the Elephant

Is very like a wall!"

The Second, feeling of the tusk,Cried, -"Ho! what have we hereSo very round and smooth and sharp?To me 'tis mighty clear,This wonder of an ElephantIs very like a spear!"

The Thirdapproach'd the animal,And happening to takeThe squirming trunk within his hands,Thus boldly up and spake:"I see," -quoth he- "the ElephantIs very like a snake!"

The Fourth reached out an eager hand,And felt about the knee:"What most this wondrous beast is likeIs mighty plain," -quoth he,-

"'Tis clear enough the ElephantIs very like a tree!"

The Fifth, who chanced to touch the ear,Said- "E'en the blindest manCan tell what this resembles most;Deny the fact who can,This marvel of an ElephantIs very like a fan!"

The Sixth no sooner had begunAbout the beast to grope,Then, seizing on the swinging tailThat fell within his scope,

"I see," -quoth he,- "the ElephantIs very like a rope!"

And so these men of IndostanDisputed loud and long,Each in his own opinionExceeding stiff and strong,Though each was partly in the right,And all were in the wrong!

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The Ethical Matrix is a versatile tool for analysing ethical

issues. It is intended to help people make ethical decisions,

particularly about new technologies.

It is an aid to rational thought and democratic

deliberation, not a substitute for them.

The three principles of respect for wellbeing, autonomy

and justice form the columns of the matrix.

The rows consist of the interest groups caught up with

the issue in question.

These might include different groups of people, such asconsumers and food producers, and also non-humans,

such as farm animals or the environment.

The Ethical Matrix

http://www.nottingham.ac.uk/bioethics/theory_pages/matrix.htm

http://www.foodethicscouncil.org/ourwork/tools/ethicalmatrix/uses


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This example involves a hormone called bovine somatotrophin (bST), which

increases milk yield when injected subcutaneous into dairy cattle.

The hormone, which is produced by recombinant DNA technology (genetic

engineering) in cultures of the bacterium E. coli, was the first GM product to be

used (in the USA) in animal agriculture.

By injecting cows every two weeks with bST, farmers can expect an average

increase in yields of 12-15%; and, although slight changes in nutrient contentmay result, the overall concentrations of nutrients in bulked milk are probably

unaffected.

However, because higher metabolic demands may lead to increased rates of

illness, there is a risk that the welfare of injected cattle will be diminished.

The treatment also leads to an increase in the milk concentration of insulin-like

growth factor 1 (IGF-1), which is a potent mitogen (i.e. it stimulates celldivision).

If the increased milk concentration of IGF-1 was physiologically significant and

if it were to remain biologically active at the level of the gut mucosa (a claim

which is contested by some scientists), it might pose a public health threat to

people consuming the milk or dairy products.


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Farmers can expect

an average

increase in yields of12-15%

The cows are

injected every two

weeks with bST


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Figure 2 shows how the use of an ethical matrix can help to summarise

the ethical issues raised by this technology in a systematic way that is

based on the principles that comprise the common morality. The Ethical

analysis of bsT

use in dairy cattle (Mepham, 2005)


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2 (two) situations : 1. Current situation (the status quo)

2. Expected result from theintroduction of a new technology

Content of the cells:

Facts.

Values (more important than facts). Possible asymmetrics b/w + and scores.


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A more detail description of ways in which the different principles are

specified for each of the four identified interest groups.

Dairy farmersWellbeing: satisfactory incomes and working conditions for farmers and farmworkers: ('satisfactory' is obviously debatable, but it is a better word than

'adequate', which might imply 'just enough to meet bare necessities')

Autonomy: allowing farmers to use their skills and judgement in making

managerial decisions, e.g. in choosing a farming system

Fairness: farmers and farm workers receiving a fair price for their work andproduce, and being treated fairly by trade laws and practices

ConsumersWellbeing: protection from food poisoning (and harmful agents e.g. residues of

veterinary drugs); this also refers to the quality of life citizens enjoy as a

consequence of a productive and profitable farming industryAutonomy: a good choice of foods, which are appropriately labelled, together with

adequate knowledge to make wise food choices; this principle also encompasses

the citizen's democratic choice of how agriculture should be practised

Fairness: an adequate supply of affordable food for all, ensuring that no one goes

hungry of poverty


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Dairy cowsWellbeing: prevention of animal suffering; improving animal health; avoiding risks

to animal welfare

Autonomy: ability to express normal patterns of instinctive behaviour, e.g. grazing

and mating

Fairness: treated with respect for their intrinsic value as sentient beings rather

than just as useful possessions (instrumentally)

The BiotaWellbeing: protection of wildlife from harm (e.g. bypollution), with remedial

measures taken when harm has been caused

Autonomy: protection of biodiversity and preservation of threatened species (and

rare breeds)Fairness: ensuring sustainability of life-supporting systems (e.g. soil and water) by

responsible use of non-renewable (e.g. fossil fuels) and renewable (e.g. wood)

resources; cutting greenhouse gas emissions


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Summary: the ethical acceptability of bST use for those who have licensed

it (e.g. the USA) would probably cite

the need to respect farmers' freedom to innovate;

and the economic benefits to the manufacturers of bST, the

economies of countries producing it, the farmers using it,

and, were prices to fall, consumers of dairy products.

Moreover, if its use led to reduced cow numbers it might result in

marginally reduced emissions of methane.

This case also rests on perceptions that the welfare of treated

cows is not affected significantly (or that increased disease can

be effectively treated) and that there are no risks to humansafety, so that labelling is unnecessary.

Job losses in the dairy industry would not be seen as an ethical

issue, being merely a feature of market economies, in which

competition guarantees efficient production;


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the ethical case of those who have banned bST use (e.g. the

EU) would probably focus on respects in which it appears toinfringe commonly accepted ethical principles.

They would point to authoritative reports suggesting that bST

use substantially increases the risk of pain and disease in dairy

cows, and that it might present a risk to human safety through

ingestion of increased IGF-1 in milk. Moreover, they might consider that bST use would

reduce farmers' autonomy; undermine consumer choice if

milk products from treated cattle were not labelled;

jeopardise public health if rejection of dairy products

followed the licensing of bST (because milk is a valuablesource of dietary nutrients);

and increase local pollution through the intensification of

dairying.


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Life is something we are all in

together in harmony

bioetika universal declaration_ benefit & harm

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