Kimberli D.

Denaya Bachelor of Science in Nursing 2-A

What is bioethics?
Bioethics is the discipline dealing with the ethical implications of both biological research and the applications of that research, especially in medicine. It is a newer, broader field of study that has arisen during the past twenty or thirty years. It will become increasingly more important to the future as the biological revolution opens up new powers, new choices, and new dilemmas. For example, cancer and AIDS have brought about fundamental changes in the accepted ethics principles with the rise of autonomy as a cardinal principle. Perhaps the most striking development in the study of ethics during the second half of the 20th century has been the growing interest among philosophers in applied ethics - i.e., the application of normative theories to practical moral problems. Such moral issues as racial and sexual equality, human rights, and justice have become prominent, as have questions about the value of human life raised by controversies over abortion and euthanasia. Related to the latter are the ethical implications of various developments in regard to reproduction as, for example, in vitro fertilisation, sperm banks, gene manipulation, and cloning. This field of applied ethics, known as bioethics, frequently involves the cooperative efforts of philosophers, physicians, scientists, lawyers, and theologians. y Bioethics has been used in the last twenty years to describe the investigation and a study of ways in which decisions in medicine and science touch upon our health and lives and upon our society and environment. Bioethics is concerned with questions about basic human values such as the rights to life and health, and the rightness or wrongness of certain developments in healthcare institutions, life technology, medicine, the health professions and about societys responsibility for the life and health of its members. Bioethics involves issues relating to the beginning and end of human life, all the way from issues relating to in vitro fertilisation and abortion to euthanasia and palliative care. Bioethics has an impact on every level of human community from the local nursing home to the huge international conferences on issues like the Human Genome. Bioethics is a branch of applied ethics and requires the expertise of people working in a wide range disciplines including: law, philosophy, theology, medicine, the life sciences, nursing and social science. Bioethics is full of difficult ethical questions for everybody: families, hospitals, governments and civilisation. Fundamental values are at stake: human life, the dignity of the frail and elderly, just health care, bodily integrity and the ability to make reasonable decisions.

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SOURCES: http://ep.llnl.gov/bep/english/10/sEth.html http://www.uib.no/People/mblpp/bioethics/Bioethics.html

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. 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. Lolas, F. (2008). Bioethics and animal research: A personal perspective and a note on the contribution of Fritz Jahr. Fritz Jahr's 1927 concept of bioethics. Kennedy Inst Ethics J, 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.

Source : http://en.wikipedia.org/wiki/Bioethics

BIOETHICS CONCEPT

On Bioethics, Potter (1971) says that Bioethics thus emerges as an attempt to build a bridge between experimental science and humanities Bioethics is the morality of life are standards that are based on ethical principles that normalize the individual and social behavior of the person. This follows from the definition of bioethics at the Encyclopaedia Of. Bioethics : According to Reich, (1978) says that the systematic study of human behavior in the field of sciences of life and health, considered in the light values and moral principles. Bioethics is the ethics that want to deliver the guiding principles of human behavior in the biomedical field. This preparation should be demanding and continuous and must meet both theoretical aspects (ethics, anthropology, history of technological development, philosophy of science) and practical (thinking critically, acquire the habit of honesty and intellectual capacity for communication and dialogue including the learning of a language and familiarity with computerized virtual communication). But bioethics is not limited to medical field, but includes all the moral problems having to do with life in general, thus extending its scope to issues related to the environment. Other literatures define bioethics as the systematic study of human behavior in the field of life sciences and healthcare, as wing behavior is examined in light of the values and moral principles. It now includes not only the traditional aspects of medical ethics, but include environmental ethics, with discussions on the rights of future generations, sustainable development, etc..

Bioethics is now part of ethics that studies the correctness and incorrectness of the actions that are carried out in the field of nursing. His main area of study is medical ethics, as the nursing. Usually involves the technical intervention on the human body, and any intervention on the man is marked by its value maximum, this maximum value determines the purposes and actions to be pursued and made to act upon it. Thus bioethics, is interpreted as the art of achieving a social consensus about what can and can not do in health care. In the end, that agreement, the result of social discussion ends up being often the imposition of the pecking order, in sharp contrast with the obligation of physicians to respond in a more attentive to the weakest. This requirement must always be a limit to the performance and decisions of the nurses in the interaction with the user and this limit implies respect the free decision of the patient, the expression of his personality in all its aspects as well as human and spiritual. You have the right to accept or refuse any treatment he suggests, and the nurse only obligation to explain and justify the need for the procedure to practice and if the case requires notice of the risks of rejecting the procedure. But even there, the patient is the sole owner of his life and decisions. As nurses it is our duty to study, investigate and report on issues and ways of biomedicine, bioethics, policy and rights pertaining to the promotion and defense of human dignity, always monitor compliance with ethical principles. Thus the practice of medicine and nursing become a contact between two systems of values: one medical values and secondly the values of the user.

Source: http://nationalnursingreview.com/2009/10/nursing-ethics-and-bioethics/

Objectives 1. Identify concepts of human valuing essential for ethical decision making. 2. Identify selected ethical theories and principles basic to ethical decision making. 3. Identify current and future ethical issues related to nursing practice. 4. Analysis relationships between ANA Code of Ethics and personal morality/values in relationship to nursing practice. 5. Apply ethical decision making process to specific issues encountered in nursing practice. 6. Identify community resources available to patients facing difficult choices. 7. Develop a curiosity in the study of ethics by researching resources identified in SIMON. 8. Utilize NIC, NOC, and NANDA with Nursing Care Plans.

BACKGROUND AND OBJECTIVES Since the beginning of the 1980s, nursing ethics has developed to such a degree that it is now considered a fixture within applied ethics. The specific positions occupied within health care by nurses, their expertise and their responsibilities all result in them being confronted by ethically sensitive issues. The objective of the course is to foster exchanges on foundational and methodological approaches as well as on contemporary and educational issues in nursing ethics. More specifically, the aims of this course are: (1) To analyse fundamental notions that are being discussed in the field of nursing ethics, namely various notions of care, moral practice, the human person, vulnerability, dignity, and trust. As such, extensive understanding will be provided into the ethical and philosophical foundations of the practice of nursing. (2) To educate participants on a range of ethical topics that are predominant in the contemporary debate in nursing ethics, namely, nursing ethics perspectives on end-of-life care and on elderly care. These topics will be explored from a philosophical-ethical perspective as well as from an empirical-ethical perspective. (3) To introduce participants into methodological and educational aspects of nursing ethics. (4) To establish exchange among national and international experts with respect to new developments in nursing ethics from an international perspective.

Bioethical Principles
Decision making in the field of bioethics has become increasingly complex. Faced with such complexity, it is generally accepted that many issues are far too important to be left to individual preference or 'whim'. If we want something more than a totally subjective approach to decision making, logic suggests we need some common ground from which to work - in much the same way we need a common language to communicate. An ethical system or theory is just that. It is a means by which we organise complex information and competing values and interests and formulate an answer to the question 'What should I do? [1] There are many different theories of moral reasoning competing for the attention of medical professionals, ethics committees, ethicists and others, but as yet no complete agreement exists as to which is the most complete or coherent. In view of this has developed the notion of utilising a set of primary principles that, while not comprising in themselves a complete moral theory, are compatible with most moral theories. Within the field of bioethics principle-based approaches have dominated as a useful means in assisting people to make good decisions. Four-Principles Approach to Bioethics The four-principles approach to bioethics developed by Beauchamp and Childress is arguably the most well known and influential example of principle-based approaches. This approach recognises four key principles arising from reflections on common morality and many centuries of medical tradition. Together they provide

general guidelines. Individually they each highlight certain obligations. In instances where the principles come into conflict with each other they require balancing. There is no predetermined order of preference; each is essentially of equal importance. In different situations a particular principle may assume a greater or lesser priority. 1. Autonomy: Put most simply, autonomy affirms that we ought to be the authors of our own fate, the captain of our own ship. Autonomy emphasises the personal responsibility we have for our own lives; the right to choose who we wish to be, to make our own decisions and to control what is done to ourselves. Autonomy includes the capacity to deliberate about a proposed course of action as well as the ability to actualise or carry it out. 2. Nonmaleficence: Nonmaleficence derives from one of the most traditional of medical guidelines that goes back to the time of the Hippocratic oath: First of all, do no harm. The principle of nonmaleficence imposes the obligation not to harm someone intentionally or directly. Clearly there are many instances in the field of healthcare where individuals are exposed to risks of harm, such as radiation or chemotherapy treatment. The principle of nonmaleficence is not necessarily violated if a proper balance of benefits exists; that is, if the harm is not directly intended but is rather an unfortunate side effect of attempts to improve a person's health or, at the very least, to provide relief from the burden of pain. 3. Beneficence: Beneficence may be described as the positive expression of nonmaleficence. This principle highlights that we have a positive obligation to advance the healthcare interests and welfare of others, to assist others in their choices to live life to the fullest. Beauchamp and Childress have described beneficence as a way of ensuring reciprocity in our relationships; i.e. we have a responsibility to help others because we have ourselves received benefits. The risk of harm to oneself represents a legitimate limit to our obligation to be beneficent. 4. Justice: In relation to healthcare, justice may be described as the allocation of healthcare resources according to a just standard. There are two basic types of justice. Comparative justice involves balancing the competing claims of people for the same health care resources. It is only necessary because of the fact that health funding is not unlimited if there was plenty of everything, there would be no need to allocate or prioritise resources. In comparative justice what one receives is determined by one's particular condition and needs. Distributive justice, on the other hand, determines the distribution of health care resources by a standard that is independent of the claims of particular people. For this reason it may also be called 'noncomparative' justice. Distribution is determined according to principles rather than individual or group need. Obviously, the four moral principles described above do not spell out exactly what should or should not be done in particular cases. One of the criticisms of the four principles approach is that it is sometimes uncritically used as if it were a sort of 'mantra', or as a set of rules to be followed in a step by step manner as if ethical dilemmas could be resolved by a 'paint by numbers' approach. But, reality tells us that people's motives and underlying values clearly affect the way in which they approach ethical dilemmas, and also shape the way in which they balance and prioritise the respective principles when they are in conflict with each other - as so often happens in practice. Therefore, while it is generally accepted that the four principles approach is an extremely useful tool, most agree that there needs to be more. The fact that the principles work as well as they do across various cultural, moral, religious, and political divides is due in large part to their appeal to the abstract and objective and their ability to name what is universal. However, ethical reasoning also needs to be sensitive to the contextual aspects that are such an important part of the ethical analysis of bioethical cases. Examples of this include attention to cultural uniqueness and gender, while also taking some account of the character attributes or virtues of persons. (Virtue ethics emphasises the importance of character traits, and includes the notion that the rightness or wrongness of actions should include some appraisal of people's

motives.) It is generally accepted that the limitations associated with principle approaches are best resolved if they are integrated into some larger theoretical framework.

From a Catholic perspective, the four principles may be supplemented by a number of other key principles. Without being an exhaustive list, these include: Sacredness of life: Human life is sacred because from its beginning it involves the creative action of God and it remains for ever in a special relationship with the creator, who is its sole end. God alone is the Lord of life from its beginning until its end: no one can under any circumstance claim for himself or herself the right directly to destroy an innocent human being. [2] The Innate Dignity of Human Life: Human dignity is not dependent on the way others value us this would make it conditional. All people have inalienable rights that must be recognised and respected by civil society and those with political authority. These human rights depend neither on single individuals nor on parents; nor do they represent a concession made by society and the state; they belong to human nature and are inherent in the person by virtue of the creative act from which the person took their origin. [3] From this perspective human dignity is unconditional. Truth-telling: Truth telling is a form of respect for the self as well as for others. Unless a person has access to the truth, an act of consent cannot be described as informed and therefore cannot be an expression of autonomy. Thus, the commitment to truthfulness in the healthcare professional - patient relationship is closely allied to the principle of autonomy. Good relationships are based on trust, and this is undermined by a lack of truthful disclosure. Common Good: The good of each individual is related to the common good, that is the social well being and development of the societies and the world in which we live. This is so because we are interdependent beings our physical, social, emotional and mental needs are fulfilled in and through our relationships with others. It is therefore false to see individual rights as somehow opposed to the common good (radical individualism rejects the belief that the good of the community is a moral value), although at times the common good does call for arbitration between various competing interests. Due consideration of the common good includes a respect for human relationships within the whole of the created order. The commitment to the common good calls for the co-operative organisation of structures that enable access to what is needed to live a truly human life: food, clothing, health, work, education, culture, information, the right to have a family, and so on. Justice: A Catholic understanding of justice in healthcare begins with the idea that medical care is a fundamental right, and that essential services should be equally accessible to all. A health system is unjust if the best services are available for those with healthcare insurance, but people who lack wealth, status and power can only access an inferior service (whether in terms of promptness and/or expertise). With respect to healthcare research it is also a fundamental tenet of justice that the burden of risks be fairly distributed between various groupings. In line with this, a Catholic approach to Bioethics is opposed to the idea that distributions of health care services can be left up to the marketplace or according to the ability of people to pay. Therefore, what may be defined from a legal point of view as being 'just' may not always be fair. Justice should ensure that all persons, irrespective of wealth, power, status, religion or affiliation, are treated in ways that accord with basic health needs. Due care may, therefore, mean offering different types of services to different groups of people. The commitment of the New Zealand government to the Treaty principles of participation, partnership and protection of M ori people in the shaping and provision of health services for M ori, is a good example of the application of the principle of justice in healthcare delivery in New Zealand.

Preferential Option for the Poor: This principle calls for a commitment to the most vulnerable - those who are oppressed by poverty - as an integral part of being faithful to the Gospel of Jesus Christ. Such a commitment is inspired by the Gospel of the Beatitudes, the poverty of Jesus himself, and Jesus' concern for the poor. It extends not only to material poverty but also to the many forms of cultural and religious poverty. This principle is grounded in the notion of the universal destination of human goods the idea that the goods of this world are there for all to share. As St John Chrysostom wrote: Not to enable the poor to share in our goods is to steal from them and deprive them of life. The goods we possess are not ours but theirs. [4] As noted above, the call to justice requires that the burdens and benefits of living are shared equally. The preferential option for the poor is one way of describing the Church's practical commitment to bringing abut proper justice by making those who are deprived the object of a preferential commitment and protection. Conclusion: Rules and principles are essential 'tools' in the process of decision-making. The four principles approach provides a useful way of approaching dilemmas in bioethics. An awareness of the limitations of the four principles reminds us of the need to ground this approach within a broader framework that allows for consideration of the deeper values and attitudes which ultimately shape the way in which people make use of the four principles. A Catholic-Christian framework, among other things highlights the sacredness and innate dignity of human life, upholds the need for truth, recognises the importance of the common good, and highlights the need for justice in a way that challenges us to make a preferential commitment to the 'poor'. Bibliography Ashley, Benedict. & O'Rourke, Kevin. (1989) Healthcare Ethics. St. Louis: The Catholic Health Association of the United States. Beauchamp, T.L., Childress, J.F. (1994) Principles of Bioethics. Fourth Edition. New York: Oxford University Press Brody, H. Transparency: Informed Consent in Primary Care. Hastings Centre Report 1989; 19 (5): 5-9. Gormally, L (Ed.). (1999) Issues for a Catholic Bioethic. London: The Linacre Centre. May, William. (2000) Catholic Bioethics and the Gift of Life. Huntington IN: Our Sunday Visitor Publishing Division. Mitchell, K.R., Kerridge, I. H., Lovat, T. J. (1996) 2nd Ed. Bioethics and Clinical Ethics for Health Care Professionals. Wentworth Falls NSW: Social Science Press. New Zealand Catholic Bishops' Conference. (1997) A Consistent Ethic of Life Te Kahu-O-Te-Ora. Wellington: Catholic Communications. O'Rourke, Kevin D. & Boyle, Philip. (1993) Medical Ethics: Sources of Catholic Teachings. Washington, D.C.: Georgetown University Press. Shannon, Thomas. A. (!997) 3rd edition. An Introduction to Bioethics. New York: Paulist Press. The Holy See. (1994) Catechism of dhe Catholic Church. Washington: the United States Catholic Conference. United States Bishops' Conference. (1995) Faithful for Life. Washington DC: United States Catholic Conference, Inc. References [1] Shannon, Thomas. A. (!997) 3rd edition. An Introduction to Bioethics. New York: Paulist Press. [2] Catechism of the Catholic Church # 2258 [3] Catechism of the Catholic Church # 2273 [4] Catechism of the Catholic Church # 2446