PRINCIPLES OF BIOMEDICAL ETHICS

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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.

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    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

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