Bioethics

Bioethics is the ethics of biological science and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, philosophy, and theology.

Scope
Scientific research has produced substantial social benefits. It has also posed some troubling ethical questions. Public attention was drawn to these questions by abuses of human subjects in biomedical experiments, especially during the Second World War. During the Nuremberg War Crime Trials, the Nuremberg code was drafted as a set of standards for judging physicians and scientists who had conducted biomedical experiments on concentration camp prisoners. This code is often credited with jump starting the interdisciplinary field now called bioethics.

On July 12, 1974, the National Research Act (Pub. L. 93-348) was signed into law in the United States, thereby creating the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. One of the commission's charges was to identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects, as well as to develop guidelines. After nearly five years of discussion and collaboration, these guidelines were published. In 1979, a statement of basic ethical principles and guidelines to assist decision-makers in resolving the ethical problems that surround the conduct of research with human subjects appeared in the Federal Register. This became known as the Belmont Report. The report centered around the following three important principles, or general prescriptive judgments:

1. Respect for Persons 2. Beneficence 3. Justice

To apply the general principles to the conduct of research involving humans, the Belmont Report suggested that the following requirements be considered: informed consent, risk/benefit assessment, and the just and fair selection of subjects of research. The Belmont Report remains a touchstone for many bioethicists.

With new challenges in public health and health policy, and with advances in bio-technology, today bioethics is a fast-growing academic and professional area of inquiry. Since the early 1980s, the field has generated at least a dozen English-language journals. In addition, many academic medical centers and some schools of law, engineering and the liberal arts offer degree programs with a specialization in bioethics. Such programs train physicians and nurses, attorneys, philosophers, theologians, health services researchers and even bench scientists.

As a field of inquiry, bioethics received another boost when President Clinton created an Advisory Committee on Human Radiation Experiments, chaired by Ruth Faden of the Johns Hopkins Berman Institute of Bioethics. The committee sought to analyze the following questions:

''What is the federal government's responsibility for wrongs and harms to human subjects as a result of experiments with ionizing radiation? What remedies are appropriate for those wronged or harmed? And what lessons learned from studying research standards and practices in the past and present can be applied to the future?''

President Clinton directed the Advisory Committee to uncover the U.S. history of human radiation experiments during the period 1944 through 1974. It was in 1944 that the first known human radiation experiment of interest was planned, and in 1974 that the U.S. Department of Health, Education and Welfare adopted regulations governing the conduct of human research, a watershed event in the history of federal protections for human subjects. In addition, the Advisory Committee examined cases in which the government had intentionally released radiation into the environment for research purposes. The Advisory Committee also identified ethical and scientific standards for evaluating these events, and made recommendations to help ensure that wrongdoing could not be repeated.

Today, the field of bioethics struggles with its proper scope. Should it concern itself with the ethical evaluation of all questions involving biology and medicine? Some bioethicists would narrow ethical evaluation only to the morality of medical treatments or technological innovations, and the timing of medical treatment of humans. Others would broaden the scope of ethical evaluation to include the morality of all actions that might help or harm organisms capable of feeling fear and pain, and include within bioethics all such actions if they bear a relation to medicine and biology. The 1989 funding of the U.S. Human Genome Project, today known as the NHGRI, is credited with helping to create a more rigorous social science approach to the field.

Why bioethics?
The issues raised by bioethics as a distinct area of academic inquiry (why must it exist apart from philosophy? isn't everyone an 'ethicist'?) are largely answered by the needs of institutions. Bioethicists today are not hired or engaged in conversation (and thus "named") because of their opinions or because they have special skills of reasoning, but because they know and can put to work the enormous body of research and history of discussions about bioethics in a fair, honest and intelligent way, using tools from the different disciplines that "feed" the field. Training programs in bioethics differ in skill sets of faculty and size of program, but across the US, and increasingly globally, they do seem to share a commitment to that goal with few exceptions.

As a result, bioethics has been distinctively created, by institutions, specifically the multi-million dollar commitment of major and minor medical centers to the study of medical ethics as part of the development of curriculum and research efforts. Today it is all but impossible to create a major medical research effort without ethicists to assist. First in the regulatory review of research, the responsibility of the IRB, which can be staffed by persons not trained in ethics in any rigorous way, or trained specifically in the ethical and regulatory aspects of research with human subjects, rather than more comprehensively in bioethics. The second form of assistance is by those who can think in advance of the onset of research about its social, ethical and economic implications. A shrinking number of those who would say that they "work in bioethics" are actually employed in other academic disciplines, because so many such disciplines reject as credible or important the work of bioethics in journals that are outside the methods of the traditional discipline within which such a person would work. A publication in JAMA would be meaningless to a tenure committee in most philosophy departments. A publication in the Journal of Philosophy would be meaningless to the same committee in a medical school. Seven articles would be sufficient for promotion in many philosophy departments, where 37 might be closer to the typical number of peer-reviewed publications for bioethicists, but of much shorter length, and philosophers would contest the possibility of rigor at that level of productivity. A book is a primary credential in the liberal arts and law. A book is virtually meaningless in medicine. So, as institutions employing bioethics change, the jobs change, and thus the training changes.

Nonetheless, many claim to work in bioethics, and indeed can feel free to do so, in just the same way that self-help book authors claim to work in philosophy. However, those not working in and trained in bioethics in the now fairly well established range of ways typical of bioethicists, demonstrated by, e.g., publishing in AJOB, Hastings Center Report, Journal of Medical Ethics, etc., will be perceived as amateurs by those in the field per se, again for the same reason that while Einstein did fabulous work as a patent clerk, he would not have been properly considered a physicist (and was not) until he joined the academic community, because without such standards universities and their growth in terms of new disciplines would spiral out of control.

Ideology and methodology
Bioethicists often focus on using philosophy to help analyze issues, and philosophical ethicists such as Peter Singer tend to treat the field as a branch of moral or ethical philosophy. However, this approach is sometimes challenged, and bioethics is becoming increasingly interdisciplinary. Many bioethicists come from backgrounds outside of academic philosophy, and some even claim that the methods of analytic philosophy have had a negative effect on the field's development. The percentage of bioethicists with professional backgrounds in health care, especially physicians, has been steadily increasing over time. In fact, the last two Presidents of the primary academic society for bioethicists in the U.S. (the American Society for Bioethics and Humanities) have been physicians. Some bioethicists, especially those who perform ethics consultation in clinical settings, emphasize the practical aspects of bioethics, and view the field as more closely related to clinical practice or public health than philosophy.

Religious bioethicists have developed rules and guidelines on how to deal with these issues from within the viewpoint of their respective faiths. Many religious bioethicists are Jewish, and Christian scholars. Since the Indian traditions of Hinduism, Buddhism, and Jainism considers the sanctity of all life, there is much literature related to the philosophy and ethics related to life in each of these traditions. A growing number of religious scholars from Islam have also become involved in this field. There has been some criticism by liberal Muslims that only the more religiously conservative voices in Islam are being heard on this issue.

Although there are a number of eminently qualified philosophers who approach bioethics from a religious perspective, some Western secular bioethicists are critical of the fact that religious bioethicists are often religious scholars without an academic degree or training in disciplines that pertain to the issues, such as philosophy (wherein the formal study of ethics is usually found), biology or medicine. From the standpoint of bioethicists whose work is secular, the central cause for caution as regards religious bioethics work is that tools and methods should be brought to bear on problems, rather than starting with conclusions, and then looking for justifications. Of course, this criticism does not apply solely, of even to all, forms of religious bioethical work.

In the case of most non-Western cultures a strict separation of religion from philosophy does not exist. In many Asian cultures, there is a lively (and often less dogmatic, but more pragmatic) discussion on bioethical issues. The discussion often refers to common demographic policies which are criticised, as in the case of China. Buddhist bioethics, in general, is characterised by a naturalistic outlook that leads to a rationalistic, pragmatic approach. Buddhist bioethicists include Damien Keown. In India, Vandana Shiva is the leading bioethicist whose speaks from the Hindu tradition. In Africa, and partly also in Latin America, the debate on bioethics frequently focus on its practical relevance in the context of underdevelopment and (national or global) power relations.

Issues
Areas of health sciences that are the subject of published, peer-reviewed bioethical analysis include:


 * Abortion
 * Animal rights
 * Artificial insemination
 * Artificial life
 * Artificial womb
 * Assisted suicide
 * Biopiracy
 * Blood/blood plasma (trade)
 * Body modification
 * Brain-computer interface
 * Chimeras
 * Circumcision
 * Cloning
 * Confidentiality (medical records)
 * Consent
 * Contraception
 * Cryonics
 * Eugenics
 * Euthanasia (human, non-human animal)
 * Feeding tube


 * Gene therapy
 * Genetically modified food
 * Genomics
 * Great Ape Project
 * Human cloning
 * Human enhancement
 * Human genetic engineering
 * Iatrogenesis
 * Infertility (treatments)
 * Life extension
 * Life support
 * Lobotomy
 * Medical malpractice
 * Medical research
 * Medical torture
 * Moral obligation
 * Nanomedicine
 * Organ donation (fair allocation, class and race biases)
 * Pain management


 * Parthenogenesis
 * Patients' Bill of Rights
 * Placebo
 * Population control
 * Prescription drugs (prices in the US)
 * Procreative beneficence
 * Procreative liberty
 * Professional ethics
 * Psychosurgery
 * Recreational drug use
 * Reproductive rights
 * Reprogenetics
 * Sperm and eggs (donation)
 * Spiritual drug use
 * Stem cell research
 * Suicide
 * Surrogacy
 * Transexuality
 * Transhumanism
 * Transplant trade

List of notable bioethicists

 * Jacob M. Appel
 * John D. Arras
 * Tom L. Beauchamp
 * J. David Bleich
 * sarah V. Brakman
 * Baruch Brody
 * Howard Brody
 * Arthur Caplan
 * Ronald A. Carson
 * Eric J. Cassell
 * R. Alto Charo
 * James F. Childress
 * Elliot Dorff
 * H. Tristram Engelhardt, Jr.
 * Ruth Faden
 * Joseph Fins
 * Joseph Fletcher
 * Norm Fost
 * Robert P. George
 * Walter Glannon
 * Mordechai Halperin


 * James Hughes
 * Immanuel Jakobovits
 * Albert R. Jonsen
 * Leon Kass
 * Sir Ian Kennedy
 * Ken Kirkwood
 * Mark Kuczewski
 * John Lantos
 * Robert Levine
 * Bernard Lo
 * Alex John London
 * William F. May
 * Van McCrary
 * Glenn McGee
 * Gilbert Meilaender
 * Jonathan Moreno
 * Thomas Murray
 * E. Haavi Morreim
 * Lawrence J. Nelson
 * Bernard Nathanson
 * Onora O'Neill
 * Edmund Pellegrino


 * Gregory E. Pence
 * Thomas Percival
 * Stephen G. Post
 * James Rachels
 * John A. Robertson
 * Fred Rosner
 * Judith Wilson Ross
 * Hans-Martin Sass
 * Julian Savulescu
 * Harold Shapiro
 * Mark Siegler
 * Daniel Sinclair
 * Peter Singer
 * Wesley J. Smith
 * Moshe David Tendler
 * Etienne Vermeersch
 * Eliezer Waldenberg
 * William J. Winslade
 * Matthew K. Wynia
 * Stuart J. Youngner
 * Laurie Zoloth