PRINCIPLES OF BIOMEDICAL ETHICS
Section snippets
WHAT IS BIOETHICS?
Ethics is the application of values and moral rules to human activities. Bioethics is a subsection of ethics, actually a part of applied ethics, that uses ethical principles and decision making to solve actual or anticipated dilemmas in medicine and biology. Ethics seeks to find reasoned, consistent, and defensible solutions to moral problems. (Strictly speaking, when one speaks of ethics in this context, one mean normative ethics, as distinct from metaethics, descriptive ethics, professional
RELATIONSHIP BETWEEN LAW AND BIOETHICS
How does bioethics differ from law? Both give rules of conduct to follow. Laws stem from legislative statutes, administrative agency rules, or court decisions, and they often vary in different locales and are enforceable only in those jurisdictions where they prevail. Ethics incorporates the broad values and beliefs of correct conduct. Although bioethical principles do not change because of geography (at least not within one culture), interpretation of the principles may evolve as societies
RELATIONSHIP BETWEEN RELIGION AND BIOETHICS
In homogenous societies, religions have long been the arbiters of ethical norms. Western societies, however, are multicultural, with no single religion holding sway over the entire populace. There, a patient value–based approach to ethical issues is necessary. Religion still influences bioethics, however. Modern bioethics uses many decision-making methods, arguments, and ideals that originated from religion. In addition, clinicians' personal spirituality may allow them to relate better to
ETHICAL THEORIES
Ethical theories represent the grand ideas on which guiding principles are based. They attempt to be coherent and systematic, striving to answer the fundamental practical ethical questions: What ought I do? How ought I live? Generally ethical principles stem from ethical theories, and when defending a particular action, ethicists normally appeal to these principles, not the underlying theory. Ethical traditions stretch back to earliest recorded history. Separate bodies of ethics, often not
Where Learned?
Values are the standards by which we judge human behavior. They are, in other words, moral rules, promoting those things thought of as good and minimizing or avoiding those things thought of as bad. We usually learn these values at an early age, from observing behavior and through secular (including professional) and religious education. Although many of these learned values overlap, each source often claims moral superiority over the others, whether the values stem from generic and cultural,
Definition and Basis
Individual freedom is the basis for the modern concept of bioethics. This freedom, usually spoken of as autonomy, is the principle that a person should be free to make his or her own decisions. It is the counterweight to the medical profession's long-practiced paternalism (or parentalism), wherein the practitioner acted on what he or she thought was “good” for the patient, whether or not the patient agreed. This principle does not stand alone but is derived from an ancient foundation for all
OTHER BIOETHICAL PRINCIPLES
In addition to autonomy, there are other bioethical principles that guide the actions of emergency clinicians. The following are short descriptions of some of these principles:
ETHICAL OATHS AND CODES
Since ancient times, medical practitioners have formulated and established professional rules of behavior. Through the years, the medical profession has codified its ethics more rigorously than any other professional group.1 Many of the standard bioethics principles have been incorporated into the profession's ethical codes and oaths. The standard for the medical profession for countless generations was the existing part of the Hippocratic Oath (Table 3). Its precepts now clash with modern
APPLYING BIOETHICS
To apply bioethical principles to a clinical situation, one first must recognize that a bioethical problem exists. To do this, one must read and discuss the issues and specific situations both to be able to recognize bioethical issues within clinical cases and to formulate plans to handle with them.
Although physicians like to reduce all clinical situations to “medical problems,” the ever-more complex medical environment often produces problems that are inexorably intertwined with fundamental
CONCLUSION
Emergency clinicians must be able to recognize bioethical dilemmas, have action plans based on their readings and discussions, and have a method by which to apply ethical principles in clinical settings. The actions and decisions they face with bioethical dilemmas must be as well thought out as any others they prepare for in the emergency setting. Their best course is to have a plan using case-based reasoning through which to apply bioethical theories. Even in the absence of a more elaborate
ACKNOWLEDGMENT
I am grateful to Mary Lou Sherk and Jennifer Gilbert for their assistance in editing this article.
References (35)
A simplified prehospital advance directive law: Arizona's approach
Ann Emerg Med
(1993)Code of Ethics for Emergency Physicians
(1997)- Arizona Revised Statutes Living wills and health care...
- et al.
Ethics and Policy in Scientific Publication
(1990) - et al.
Do residents also feel “abused”? Perceived mistreatment during internship
Acad Med
(1997) - et al.
Residents' and medical students' reports of sexual harassment and discrimination
Acad Med
(1996) - et al.
Black's Law Dictionary
(1979)The question of competence
Natural Law
Contemporary deontology
Competency to give an informed consent
JAMA
J Feinberg Social philosophy
Moral Relativism
Cited by (25)
End of life/palliative care/ethics
2014, Emergency Medicine Clinics of North AmericaCitation Excerpt :Medical technology that can prolong life (or death), immense overcrowding, and increasing utilization of EDs have essentially changed the practice of emergency medicine. The emergency physician should have a basic understanding of the ethical framework that informs his or her practice, particularly for patients at the EOL.68–70 Code of ethics documents specific to the specialty of emergency medicine exist and should be reviewed for more information on the topic.71,72
End-of-Life Issues
2008, Pediatric Emergency MedicineEnd-of-Life Issues
2007, Pediatric Emergency MedicineEnd-of-life issues in the pediatric emergency department
2003, Clinical Pediatric Emergency MedicineConcept of operations for triage of mechanical ventilation in an epidemic
2006, Academic Emergency MedicineCitation Excerpt :Development of triage criteria must reflect basic medical ethics principles. However, in a resource-poor environment, the traditional bioethical focus on patient autonomy (which assumes respect for the individuals' freedom to make decisions) shifts to a utilitarian or “distributive justice” model that attempts to do the “greatest good for the greatest number” with the resources available.24–26 We attempted to develop a tiered, scalable framework for restricting mechanical ventilation.
Patient Opinions and Attitudes toward Medical Student Procedures in the Emergency Department
2003, Academic Emergency Medicine
Address reprint requests to Kenneth V. Iserson, MD, MBA, FACEP, Arizona Bioethics Program, Box 245057, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 85724