Post on 06-Jul-2018
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INTRODUCTION TOBIOETHICS
DR. M BILALAPPNA Institute of Public Health
Jinnah Sindh Medical University
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Ethics (moral philosophy
Addresses!"#hat is the best #ay forpeople to live$" and %#hat actions areri&ht or #ron& in particular
circumstances$" 'ersions
)* +he science of moral duty
,* a set of concepts and principles that&uide us in determinin& #hat behaviorhelps or harms sentient creatures
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Ethics (contd*
Areas of studyin& ethics
)* Meta!ethics
,* Normative ethics
-* Applied ethics
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.hat is /ioethics$
/ioethics is the study of controversial ethics brou&htabout by advances in biolo&y and medicine*
/ioethics also needs to address emer&in&biotechnolo&ies that a1ect basic biolo&y and future
humans* No# often 2no#n as medical ethics or clinical ethics
3 hospital based issues
Advancements
/ioethical dilemmas arise #hen di1erent parties4albeit all #ell!meanin&4 hold diver&ent values thatlead to opposin& vie#points on appropriate actions
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5ommon /ioethical Issues
Abortion
Arti6cial life
5ontraception
Euthanasia Human clonin&
Infertility treatments
Suicide
(Terri Schiavo)
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History of /ioethics
+erm coined by 7rit8 Jahr in )9,:*!Animals 'an ;anssellaer Potter used more broader term in
)9<=> “Global Ehic!" (involvin& other disciplinesfor survival of human and others*
+he distinct academic 6eld be&an in the )9:=s inthe United States
Philosophers and theolo&ians #ere later ?oined byphysician!ethicists and la#yers
Scienti6c advances coupled #ith cultural chan&es Ne# emphasis on individual autonomy and ri&hts 3
suspicion of medical paternalism #oc$!e% o& i&%ivi%$al re!earch 'arici'a&
a&% 'aie&
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History of /ioethics
Started as concerns re&ardin& research ethics
N$reber Docor!* Trial !! ,- @ermanphysicians #ho either participated in the Na8i
pro&ram to euthani8e persons deemedun#orthy of life% or #ho conductedeBperiments on concentration camp prisoners#ithout their consent #ere tried* +he trial
lasted )C= days* D #itnesses testi6ed andalmost )4== documents #ere introduced* ):of the doctors char&ed #ere found &uilty* <#ere eBecuted*
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E+a'le! o, U&ehicalE+'erie&!
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+he Nurember& 5ode()9C<)* 'oluntary consent is a must
,* Anticipate scienti6c bene6ts
-* /ene6ts out#ei&h ris2s
C* Animal eBperiments 6rst* Avoid su1erin& to individual
:* No intentional death or disability
<* Protection from harmD* Sub?ect free to stop G #ithdra#
9* uali6ed investi&ators
)=* Investi&ator #ill stop if harm occurs
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Feclaration of Helsin2i )9:C
Set of ethical principles for h$a&e+'erie&aio&
5ornerstone document in Human
research ;elaBation on 5onsent!S$rroae
co&!e&
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/elmont ;eport )9<D
+hefty ;eport on Ethical considerations
+hree core principles ;espect for others>/ene6cence> Justice*
Important Pre!reuisite for any research
i informed consent4 ii ris2s bene6t
assessment4 and iiiselection of sub?ectsof research*
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Ma?or Principles in /ioethics
+om /eauchamp and James 5hildresssPrinciples of Biomedical Ethics in )9D No&-alece&ce a&% Be&ece&ce
Utilitarian 3 harm!bene6t analysis
do no harm
best interest standard
A$o&o/
respect for ones ri&hts and di&nity informed and voluntary consent
0$!ice
fairness
carin& for the most vulnerable
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ScenarioK**
Suppose a trolley is runnin& out of controldo#n a trac2* In its path are people #hohave been tied to the trac2* 7ortunately4
you can Lip a s#itch4 #hich #ill lead thetrolley do#n a di1erent trac2 to safety*Unfortunately4 there is a sin&le person tiedto that trac2*
Should you Lip the s#itch$
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As the story &oesK**
A physician has 6ve patients4 each in need of adi1erent or&an and #ill die #ithout that or&an*Unfortunately4 there are no or&ans available toperform any of these 6ve transplant operations*
A youn& man #ho ?ust &ot hit by a trolley isbrou&ht into the E;* In the course of assessin&his in?uries4 #hich are not life!threatenin& iftreated immediately4 the doctor discovers that
his or&ans are compatible #ith all 6ve of hisdyin& patients*
.ould it be ?usti6ed for the physician to let thepatient die to harvest his or&ans to save the
other 6ve patients$
S i h i l i
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Systematic Approach in ;esolvin&Filemmas
7indin& thou&htful and rational ?usti6cationfor our beliefs and decisions
More than intuitive responses 3 as2 #hy #e
may have certain intuitions4 and ho# tomana&e conLictin& intuitions
Systematic approach can help to identifyessential elements to ethical decision!
ma2in&4 ease pressure4 and promoteconsistency in resolvin& dilemmas
I 5 id i A hi
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Issues to 5onsider in Approachin&Filemmas
Fe6ne and identify the ethical dilemma 5larify the facts and identify sta2eholders 3
#hats 2no#n and #hats not$ Medical indications
Fia&nosis4 pro&nosis4 treatments or medicationhistory4 other clinical options4 etc*
PatientG;esidentG7amily (P;7 preferences Advance directives4 code status4 &oals of care4 etc*
uality of life +he P;s subjective evaluation of his or her
situation 5onteBtual factors
Social conteBts4 family situation4 culturalGreli&iousvalues4 6nancial situation4 etc*
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Issues to 5onsider(5ontinued
Analy8e and balance the values involved 'arious principles may help 3 autonomy4 bene6cence4
non!male6cence4 ?ustice
.hat do various available options and our prioriti8ationof certain valuesGprinciples over others say about #ho#e are$
Ma2e a recommendation Involve relevant sta2eholders 3 shared decision
ma2in&
7ollo# up and evaluation ensures accountability4 consistency4 and transparency4
thereby promotin& trust and inte&rity
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5ase Fiscussion
As a result of an automobile eBplosion4 , year!oldFaB 5o#art #as badly burned over : of his body*/oth eyes4 both ears and both hands #eredama&ed beyond repair* ar&e doses of narcotics
#ere reuired for minimal pain relief* +o control themany infected areas on his body4 5o#art had to besubmer&ed daily in a tan2 of hi&hly chlorinated#ater to disinfect his #ounds* +he eBperience #aseBcruciatin&ly painful4 and 5o#art protested andrefused the %tan2in&s*" He pleaded #ith hiscare&ivers to be allo#ed to die4 and stated severaltimes that he #anted to 2ill himself* +he physiciansturned to his mother to obtain consent for all his
treatments*