Bioethics

This article is about the discipline. For the journal, see Bioethics (journal).

Bioethics is both a field of study and professional practice, interested in ethical issues related to health (primarily focused on the human, but also increasingly includes animal ethics), including those emerging from advances in biology, medicine, and technologies. It proposes the discussion about moral discernment in society (what decisions are "good" or "bad" and why) and it is often related to medical policy and practice, but also to broader questions as environment, well-being and public health. Bioethics is concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, theology and philosophy. It includes the study of values relating to primary care, other branches of medicine ("the ethics of the ordinary"), ethical education in science, animal, and environmental ethics, and public health.

Etymology

The term bioethics (Greek bios, "life"; ethos, "moral nature, behavior"<ref>"Definition of ETHOS". merriam-webster.com. Retrieved 25 December 2022.</ref>) was coined in 1927 by Fritz Jahr in an article about a "bioethical imperative" regarding the use of animals and plants in scientific research.<ref>Sass HM (2007). "Fritz Jahr's 1927 concept of bioethics". Kennedy Institute of Ethics Journal. 17 (4): 279–295. doi:10.1353/ken.2008.0006. PMID 18363267. S2CID 21957991.</ref> In 1970, the American biochemist, and oncologist Van Rensselaer Potter used the term to describe the relationship between the biosphere and a growing human population. Potter's work laid the foundation for global ethics, a discipline centered around the link between biology, ecology, medicine, and human values.<ref>Lolas F (2008). "Bioethics and animal research: a personal perspective and a note on the contribution of Fritz Jahr". Biological Research. 41 (1): 119–123. doi:10.4067/S0716-97602008000100013. PMC 2997650. PMID 18769769.</ref><ref name="pmid19684372">Goldim JR (2009). "Revisiting the beginning of bioethics: the contribution of Fritz Jahr (1927)". Perspectives in Biology and Medicine. 52 (3): 377–380. doi:10.1353/pbm.0.0094. PMID 19684372. S2CID 41451993.</ref> Sargent Shriver, the spouse of Eunice Kennedy Shriver, claimed that he had invented the term "bioethics" in the living room of his home in Bethesda, Maryland, in 1970. He stated that he thought of the word after returning from a discussion earlier that evening at Georgetown University, where he discussed with others a possible Kennedy family sponsorship of an institute focused around the "application of moral philosophy to concrete medical dilemmas".<ref>Martensen R (April 2001). "The history of bioethics: an essay review". Journal of the History of Medicine and Allied Sciences. 56 (2): 168–175. doi:10.1093/jhmas/56.2.168. PMID 11392084.</ref>

Purpose and scope

The discipline of bioethics has addressed a wide swathe of human inquiry; ranging from debates over the boundaries of lifestyles (e.g. abortion, euthanasia), surrogacy, the allocation of scarce health care resources (e.g. organ donation, health care rationing), to the right to refuse medical care for religious or cultural reasons. Bioethicists disagree among themselves over the precise limits of their discipline, debating whether the field should concern itself with the ethical evaluation of all questions involving biology and medicine, or only a subset of these questions.<ref>Bracanovic, T (June 2012). "From integrative bioethics to pseudoscience". Developing World Bioethics. 12 (3): 148–156. doi:10.1111/j.1471-8847.2012.00330.x. PMID 22708689.</ref> 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 increase the scope of moral assessment to encompass the morality of all moves that would possibly assist or damage organisms successful of feeling fear.

The scope of bioethics has evolved past mere biotechnology to include topics such as cloning, gene therapy, life extension, human genetic engineering, it can also include astroethics and life in space,<ref>"Astroethics". Legacy Books. 2004. Archived from the original on 23 October 2013. Retrieved 21 December 2005.</ref><ref>Kaçar B (20 November 2020). "If we're alone in the Universe, should we do anything about it?". Aeon. Retrieved 11 December 2020.</ref> and manipulation of basic biology through altered DNA, XNA and proteins.<ref>Freemont PF, Kitney RI (2012). Synthetic Biology. New Jersey: World Scientific. ISBN 978-1-84816-862-6.</ref> These (and other) developments may affect future evolution and require new principles that address life at its core, such as biotic ethics that values life itself at its basic biological processes and structures, and seeks their propagation.<ref name="Bioethics">Mautner MN (October 2009). "Life-centered ethics, and the human future in space" (PDF). Bioethics. 23 (8): 433–440. doi:10.1111/j.1467-8519.2008.00688.x. PMID 19077128. S2CID 25203457. Archived (PDF) from the original on 2 November 2012.</ref> Moving beyond the biological, issues raised in public health such as vaccination and resource allocation have also encouraged the development of novel ethics frameworks<ref>"Repertoire – Ethics Frameworks for Public Health". NCCPPH. 2022. Retrieved 22 October 2022.</ref> to address such challenges. A study published in 2022 based on the corpus of full papers from eight main bioethics journals demonstrated the heterogeneity of this field by distinguishing 91 topics that have been discussed in these journals over the past half a century.<ref>Bystranowski, Piotr; Dranseika, Vilius; Żuradzki, Tomasz (2022). "Half a century of bioethics and philosophy of medicine: A topic‐modeling study". Bioethics. 36 (9): 902–925. doi:10.1111/bioe.13087. ISSN 0269-9702. PMC 9827984. PMID 36170119.</ref>

Principles

Hippocrates Refusing the Gifts of Artaxerxes by Anne-Louis Girodet-Trioson

One of the first areas addressed by modern bioethicists was human experimentation. According to Declaration of Helsinki published by the World Medical Association, the essential principles in medical research involving human subjects are autonomy, beneficence, non-maleficence, and justice. The autonomy of individuals to make decisions while assuming responsibility for them and respecting the autonomy of others ought to be respected. For people unable to exercise their autonomy, special measures ought to be taken to protect their rights and interests.

In US, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was initially established in 1974 to identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects. However, the fundamental principles announced in the Belmont Report (1979)—namely, respect for persons, beneficence and justice—have influenced the thinking of bioethicists across a wide range of issues. Others have added non-maleficence, human dignity, and the sanctity of life to this list of cardinal values. Overall, the Belmont Report has guided lookup in a course centered on defending prone topics as properly as pushing for transparency between the researcher and the subject. Research has flourished within the past 40 years and due to the advance in technology, it is thought that human subjects have outgrown the Belmont Report, and the need for revision is desired.<ref>Friesen P, Kearns L, Redman B, Caplan AL (July 2017). "Rethinking the Belmont Report?". The American Journal of Bioethics. 17 (7): 15–21. doi:10.1080/15265161.2017.1329482. PMID 28661753. S2CID 5659722.</ref>

Another essential precept of bioethics is its placement of cost on dialogue and presentation. Numerous dialogue based totally bioethics corporations exist in universities throughout the United States to champion precisely such goals. Examples include the Ohio State Bioethics Society<ref>"The Bioethics Society of Ohio State". Thebioethicssociety.org.ohio-state.edu. Archived from the original on 13 June 2013. Retrieved 17 September 2013.</ref> and the Bioethics Society of Cornell.<ref>"Bioethics Society of Cornell". Cornell University. Archived from the original on 17 June 2012.</ref> Professional level versions of these organizations also exist.

Many bioethicists, in particular scientific scholars, accord the easiest precedence to autonomy. They trust that every affected person ought to decide which direction of motion they think about most in line with their beliefs. In other words, the patient should always have the freedom to choose their own treatment.<ref>Entwistle VA, Carter SM, Cribb A, McCaffery K (July 2010). "Supporting patient autonomy: the importance of clinician-patient relationships" (PDF). Journal of General Internal Medicine. 25 (7): 741–745. doi:10.1007/s11606-010-1292-2. PMC 2881979. PMID 20213206.</ref>

Medical ethics

Medical ethics is a utilized department of ethics that analyzes the exercise of clinical medicinal drug and associated scientific research. Medical ethics is based totally on a set of values that gurus can refer to in the case of any confusion or conflict. These values consist of the appreciation for autonomy, beneficence, and justice.

Main article: Medical ethics

Ethics affects medical decisions made by healthcare providers and patients.<ref name=":1"/> Medical ethics is the study of moral values and judgments as they apply to medicine. The four main moral commitments are respect for autonomy, beneficence, nonmaleficence, and justice. Using these four principles and thinking about what the physicians' specific concern is for their scope of practice can help physicians make moral decisions.<ref>Gillon R (July 1994). "Medical ethics: four principles plus attention to scope". BMJ. 309 (6948): 184–188. doi:10.1136/bmj.309.6948.184. PMC 2540719. PMID 8044100.</ref> As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.

Medical ethics tends to be understood narrowly as applied professional ethics; whereas bioethics has a more expansive application, touching upon the philosophy of science and issues of biotechnology. The two fields often overlap, and the distinction is more so a matter of style than professional consensus. Medical ethics shares many principles with other branches of healthcare ethics, such as nursing ethics. A bioethicist assists the health care and research community in examining moral issues involved in our understanding of life and death, and resolving ethical dilemmas in medicine and science. Examples of this would be the topic of equality in medicine, the intersection of cultural practices and medical care, ethical distribution of healthcare resources in pandemics,<ref>Bioethics committees and public engagement.</ref> and issues of bioterrorism.<ref>Horne LC (October 2016). "Medical Need, Equality, and Uncertainty". Bioethics. 30 (8): 588–96. doi:10.1111/bioe.12257. PMID 27196999. S2CID 23682804.</ref>

Medical ethical concerns frequently touch on matters of life and death. Patient rights, informed consent, confidentiality, competency, advance directives, carelessness, and many other topics are highlighted as serious health concerns.

The proper actions to take in light of all the circumstances are what ethics is all about. It discusses the difference between what is proper and wrong at a certain moment and a particular society. Medical ethics is concerned with the duties that doctors, hospitals, and other healthcare providers have to patients, society, and other health professionals.

The health profession has a set of ethical standards that are relevant to various organizations of health workers and medical facilities. Ethics are never stagnant and always relevant. What is seen as acceptable ethics now may not be so one hundred years ago. The hospital administrator is required to have a thorough awareness of their moral and legal obligations.<ref>Markose, Aji; Krishnan, Ramesh; Ramesh, Maya (October 2016). "Medical ethics". Journal of Pharmacy & Bioallied Sciences. 8 (Suppl 1): S1–S4. doi:10.4103/0975-7406.191934. ISSN 0976-4879. PMC 5074007. PMID 27829735.</ref>

Medical sociology

The practice of bioethics in clinical care have been studied by medical sociology.<ref>Orfali K, de Vries R (2021). "Bioethics". The Wiley Blackwell Companion to Medical Sociology. John Wiley & Sons, Ltd. pp. 82–101. doi:10.1002/9781119633808.ch5. ISBN 978-1119633808. S2CID 241369995.</ref> Many scholars consider that bioethics arose in response to a perceived lack of accountability in medical care in the 1970s.<ref name=":4">Hauschildt K, De Vries R (February 2020). "Reinforcing medical authority: clinical ethics consultation and the resolution of conflicts in treatment decisions". Sociology of Health & Illness. 42 (2): 307–326. doi:10.1111/1467-9566.13003. PMC 7012693. PMID 31565808.</ref> Studying the clinical practice of ethics in medical care, Hauschildt and Vries found that ethical questions were often reframed as clinical judgments to allow clinicians to make decisions. Ethicists most often put key decisions in the hands of physicians rather than patients.<ref name=":4" />

Communication strategies suggested by ethicists act to decrease patient autonomy. Examples include, clinicians discussing treatment options with one another prior to talking to patients or their family to present a united front limited patient autonomy, hiding uncertainty amongst clinicians. Decisions about overarching goals of treatment were reframed as technical matters excluding patients and their families. Palliative care experts were used as intermediaries to guide patients towards less invasive end-of-live treatment.<ref name=":4" /> In their study, Hauschild and Vries found that 76% of ethical consultants were trained as clinicians.<ref name=":4" />

Studying informed consent, Corrigan found that some social processes resulted in limitations to patients choice, but also at times patients could find questions regarding consent to medical trials burdensome.<ref>Corrigan O (2003). "Empty ethics: the problem with informed consent". Sociology of Health & Illness. 25 (7): 768–792. doi:10.1046/j.1467-9566.2003.00369.x. PMID 19780205.</ref>

The most prevalent subject is how social stratification (based on SES, gender, class, ethnicity, and age) affects patterns of behavior related to health and sickness, illness risk, disability, and other outcomes related to health care. The study of health care organization and provision, which encompasses the evolving organizational structures of health care organizations and the social psychology of health and health care, is another important approach. These latter research cover topics including connections between doctors and patients, coping mechanisms, and social support. The description of other important fields of medical sociology study emphasizes how theory and research have changed in the twenty-first century.<ref>International encyclopedia of the social & behavioral sciences. Neil J. Smelser, Paul B. Baltes (1st ed.). Amsterdam: Elsevier. 2001. ISBN 0-08-043076-7. OCLC 47869490.{{cite book}}: CS1 maint: others (link)</ref>

Perspectives and methodology

Bioethicists come from a wide variety of backgrounds and have training in a diverse array of disciplines. The field contains individuals trained in philosophy such as Baruch Brody of Rice University, Julian Savulescu of the University of Oxford, Arthur Caplan of NYU, Peter Singer of Princeton University, Frances Kamm of Rutgers University, Daniel Callahan of the Hastings Center, and Daniel Brock of Harvard University; medically trained clinician ethicists such as Mark Siegler of the University of Chicago and Joseph Fins of Cornell University; lawyers such as Nancy Dubler of Albert Einstein College of Medicine or Jerry Menikoff of the federal Office for Human Research Protections; political scientists like Francis Fukuyama; religious studies scholars including James Childress; and theologians like Lisa Sowle Cahill and Stanley Hauerwas.

The field, formerly dominated by formally trained philosophers, has become increasingly interdisciplinary, with some critics even claiming that the methods of analytic philosophy have harmed the field's development. Leading journals in the field include The Journal of Medicine and Philosophy, the Hastings Center Report, the American Journal of Bioethics, the Journal of Medical Ethics, Bioethics, the Kennedy Institute of Ethics Journal, Public Health Ethics, and the Cambridge Quarterly of Healthcare Ethics. Bioethics has also benefited from the process philosophy developed by Alfred North Whitehead.<ref>Weber M, Desmond W, eds. (2008). Handbook of Whiteheadian process thought. Frankfurt: Ontos Verlag. ISBN 978-3938793923.</ref><ref>Desmet R, Weber M, eds. (July 2010). Whitehead-The Algebra of Metaphysics (Les éditions Chromatika ed.). Archived from the original on 27 July 2017.</ref>

Another discipline that discusses bioethics is the field of feminism; the International Journal of Feminist Approaches to Bioethics has played an important role in organizing and legitimizing feminist work in bioethics.<ref name=":3" />

Many religious communities have their histories of inquiry into bioethical issues and have developed rules and guidelines on how to deal with these issues from within the viewpoint of their respective faiths. The Jewish, Christian and Muslim faiths have each developed a considerable body of literature on these matters.<ref>As regards the Christian Orthodox perspective see e.g. Constantine B. Scouteris, Bioethics in the light of orthodox anthropology, Polytechnic School of Crete (ed), First International Conference: Christian Anthropology and Biotechnological Progress (Financially Supported by CTNS, U.S.A.), Orthodox Academy of Crete, 26–29 September 2002, pp. 75–81.</ref> In the case of many non-Western cultures, a strict separation of religion from philosophy does not exist. In many Asian cultures, for example, there is a lively discussion on bioethical issues. Buddhist bioethics, in general, is characterized by a naturalistic outlook that leads to a rationalistic, pragmatic approach. Buddhist bioethicists include Damien Keown. In India, Vandana Shiva is a leading bioethicist speaking from the Hindu tradition.

In Africa, and partly also in Latin America, the debate on bioethics frequently focuses on its practical relevance in the context of underdevelopment and geopolitical power relations.<ref>Bobyrov VM, Vazhnicha OM, Devyatkina TO (2012). Basics of Bioethics and Safety. Nova Knyha. ISBN 978-9663824079.</ref> In Africa, their bioethical approach is influenced by and similar to Western bioethics due to the colonization of many African countries.<ref name=":2" /> Some African bioethicists are calling for a shift in bioethics that utilizes indigenous African philosophy rather than western philosophy. Some African bioethicists also believe that Africans will be more likely to accept a bioethical approach grounded in their own culture, as well as empower African people.<ref name=":2">Behrens KG (2013). "Towards an Indigenous African Bioethics". South African Journal of Bioethics and Law. 6: 30. doi:10.7196/sajbl.255.</ref>

Masahiro Morioka argues that in Japan the bioethics movement was first launched by disability activists and feminists in the early 1970s, while academic bioethics began in the mid-1980s. During this period, unique philosophical discussions on brain death and disability appeared both in the academy and journalism.<ref>Morioka M (July 2015). "Feminism, Disability, and Brain Death: Alternative Voices from Japanese Bioethics". Journal of Philosophy of Life. 5 (1): 19–41.</ref> In Chinese culture and bioethics, there is not as much of an emphasis on autonomy as opposed to the heavy emphasis placed on autonomy in Western bioethics. Community, social values, and family are all heavily valued in Chinese culture, and contribute to the lack of emphasis on autonomy in Chinese bioethics. The Chinese believe that the family, community, and individual are all interdependent of each other, so it is common for the family unit to collectively make decisions regarding healthcare and medical decisions for a loved one, instead of an individual making an independent decision for his or her self.<ref>Bowman KW, Hui EC (November 2000). "Bioethics for clinicians: 20. Chinese bioethics". CMAJ. 163 (11): 1481–1485. PMC 80420. PMID 11192658.</ref>

Some argue that spirituality and understanding one another as spiritual beings and moral agents is an important aspect of bioethics and that spirituality and bioethics are heavily intertwined with one another. As a healthcare provider, it is important to know and understand varying world views and religious beliefs. Having this knowledge and understanding can empower healthcare providers with the ability to better treat and serve their patients. Developing a connection and understanding of a patient's moral agent helps enhance the care provided to the patient. Without this connection or understanding, patients can be at risk of becoming "faceless units of work" and being looked at as a "set of medical conditions" as opposed to the storied and spiritual beings that they are.<ref name="pmid11660133">Muldoon M, King N (1995). "Spirituality, health care, and bioethics". Journal of Religion and Health. 34 (4): 329–349. doi:10.1007/BF02248742. PMID 11660133. S2CID 2483306.</ref>

Islamic bioethics

Bioethics in the realm of Islam differs from Western bioethics, but they share some similar perspectives viewpoints as well. Western bioethics is focused on rights, especially individual rights. Islamic bioethics focuses more on religious duties and obligations, such as seeking treatment and preserving life.<ref>Chamsi-Pasha H, Albar MA (January 2013). "Western and Islamic bioethics: How close is the gap?". Avicenna Journal of Medicine. 3 (1): 8–14. doi:10.4103/2231-0770.112788. PMC 3752859. PMID 23984261.</ref> Islamic bioethics is heavily influenced and connected to the teachings of the Qur'an as well as the teachings of Prophet Muhammad. These influences essentially make it an extension of Shariah or Islamic Law. In Islamic bioethics, passages from the Qur'an are often used to validate various medical practices. For example, a passage from the Qur'an states "whosoever killeth a human being ... it shall be as if he had killed all humankind, and whosoever saveth the life of one, it shall be as if he saved the life of all humankind." This excerpt can be used to encourage using medicine and medical practices to save lives, but can also be looked at as a protest against euthanasia and assisted suicide. A high value and worth are placed on human life in Islam, and in turn, human life is deeply valued in the practice of Islamic bioethics as well. Muslims believe all human life, even one of poor quality, needs to be given appreciation and must be cared for and conserved.<ref>Shomali MA (2008). "Islamic bioethics: a general scheme". Journal of Medical Ethics and History of Medicine. 1: 1. PMC 3713653. PMID 23908711.</ref>

The Islamic education on sensible problems associated to existence in normal and human lifestyles in unique can be sought in Islamic bioethics. As we will see later, due to the fact of interconnectedness of the Islamic regulation and the Islamic ethics, the Islamic bioethics has to reflect onconsideration on necessities of the Islamic regulation (Shari‘ah) in addition to ethical considerations.

To react to new technological and medical advancements, informed Islamic jurists regularly will hold conferences to discuss new bioethical issues and come to an agreement on where they stand on the issue from an Islamic perspective. This allows Islamic bioethics to stay pliable and responsive to new advancements in medicine.<ref name="pmid11202669">Daar AS, al Khitamy AB (January 2001). "Bioethics for clinicians: 21. Islamic bioethics". CMAJ. 164 (1): 60–63. PMC 80636. PMID 11202669. Whosoever killeth a human being … it shall be as if he had killed all humankind, and whosoever saveth the life of one, it shall be as if he saved the life of all humankind.</ref> The standpoints taken by Islamic jurists on bioethical issues are not always unanimous decisions and at times may differ. There is much diversity among Muslims varying from country to country, and the different degrees to which they adhere by Shariah.<ref>Bagheri A (December 2014). "Priority Setting in Islamic Bioethics: Top 10 Bioethical Challenges in Islamic Countries". Asian Bioethics Review. 6 (4): 391–401. doi:10.1353/asb.2014.0031. S2CID 144977787.</ref> Differences and disagreements in regards to jurisprudence, theology, and ethics between the two main branches of Islam, Sunni, and Shia, lead to differences in the methods and ways in which Islamic bioethics is practiced throughout the Islamic world.<ref>Aramesh K (December 2009). "Iran's Experience on Religious Bioethics: An Overview". Asian Bioethics Review. 1: 318–328.</ref> An area where there is a lack of consensus is brain death. The Organization of Islamic Conferences Islamic Fiqh Academy (OIC-IFA) holds the view that brain death is equivalent to cardiopulmonary death, and acknowledges brain death in an individual as the individual being deceased. On the contrary, the Islamic Organization of Medical Sciences (IOMS) states that brain death is an "intermediate state between life and death" and does not acknowledge a brain dead individual as being deceased.<ref name=":0">Padela AI, Arozullah A, Moosa E (March 2013). "Brain death in Islamic ethico-legal deliberation: challenges for applied Islamic bioethics". Bioethics. 27 (3): 132–139. doi:10.1111/j.1467-8519.2011.01935.x. PMID 22150919. S2CID 15869323.</ref>

Islamic bioethicists look to the Qur'an and religious leaders regarding their outlook on reproduction and abortion. It is firmly believed that the reproduction of a human child can only be proper and legitimate via marriage. This does not mean that a child can only be reproduced via sexual intercourse between a married couple, but that the only proper and legitimate way to have a child is when it is an act between husband and wife. It is okay for a married couple to have a child artificially and from techniques using modern biotechnology as opposed to sexual intercourse, but to do this out of the context of marriage would be deemed immoral.

Islamic bioethics is strongly against abortion and strictly prohibits it. The IOMS states that "from the moment a zygote settles inside a woman's body, it deserves a unanimously recognized degree of respect." Abortion may only be permitted in unique situations where it is considered to be the "lesser evil".<ref name=":0" />

Islamic bioethics may be used to find advice on practical matters relating to life in general and human life in particular. As we will see later, Islamic bioethics must take into account both moral concerns and the requirements of the Islamic law (Shari'ah) due to the interdependence of Islamic law and Islamic ethics. In order to avoid making a mistake, everything must be thoroughly examined, first against moral criteria and then against legal ones. It appears that many writers on Islamic bioethics have failed to distinguish between the two.

Despite the fact that Islamic law and morality are completely in agreement with one another, they may have distinct prescriptions because of their diverse ends and objectives. One distinction, for instance, is that Islamic ethics seeks to teach those with higher desires how to become more perfect and closer to God, but Islamic law seeks to decrease criteria for perfection or pleasure in both realms that are doable for the average or even lower than average.

So whatever is deemed essential or required by Islamic law is undoubtedly viewed the same way by Islamic ethics. However, there may be situations where something is not against Islamic law but is nonetheless condemned by Islamic ethics. Or there can be circumstances that, while not required by Islamic law, are essential from an ethical standpoint. For instance, while idle conversation is not strictly forbidden by Islamic law, it is morally unacceptable since it wastes time and is detrimental to one's spiritual growth. The night prayers are another illustration (which should be performed after midnight and before dawn).

Islamic bioethics's first influences Islamic bioethics is founded on the Qur'an, the Sunnah, and reason (al-'aql), much like any other inquiry into Islam. Sunni Muslims may use terms like ijmaa' (consensus) and qiyas in place of reason (analogy). Ijmaa' and qiyas as such are not recognized by Shi'a since they are insufficient proofs on their own.<ref>Shomali, Mohamamd Ali (2008). "Islamic bioethics: a general scheme". Journal of Medical Ethics and History of Medicine. 1: 1. ISSN 2008-0387. PMC 3713653. PMID 23908711.</ref>

Christian bioethics

In Christian bioethics it is noted that the Bible, especially the New Testament, teaches about healing by faith. Healing in the Bible is often associated with the ministry of specific individuals including Elijah, Jesus and Paul.<ref>Village, Andrew (1 June 2005). "Dimensions of belief about miraculous healing". Mental Health, Religion & Culture. 8 (2): 97–107. doi:10.1080/1367467042000240374. ISSN 1367-4676. S2CID 15727398.</ref> The largest group of miracles mentioned in the New Testament involves cures, the Gospels give varying amounts of detail for each episode, sometimes Jesus cures simply by saying a few words, at other times, he employs material such as spit and mud.<ref>Twelftree (1999) p. 263</ref><ref>H. Van der Loos, 1965 The Miracles of Jesus, E.J. Brill Press, Netherlands.</ref>

Christian physician Reginald B. Cherry views faith healing as a pathway of healing in which God uses both the natural and the supernatural to heal.<ref name="Cherry">Cherry, Reginald B. (1999) [1998]. The Bible Cure (reprint ed.). HarperOne. ISBN 9780062516152. Citing: John 9:1–7 and Mark 10:46–52.</ref> Being healed has been described as a privilege of accepting Christ's redemption on the cross.<ref name="FOOTNOTEBosworth200132">Bosworth 2001, p. 32.</ref> Pentecostal writer Wilfred Graves Jr. views the healing of the body as a physical expression of salvation.<ref>Graves, Wilfred Jr. (2011). In Pursuit of Wholeness: Experiencing God's Salvation for the Total Person. Shippensburg, PA: Destiny Image. p. 52. ISBN 9780768437942.</ref> Matthew 8:17, after describing Jesus exorcising at sunset and healing all of the sick who were brought to him, quotes these miracles as a fulfillment of the prophecy in Isaiah 53:5: "He took up our infirmities and carried our diseases".

Jesus endorsed the use of the medical assistance of the time (medicines of oil and wine) when he told the parable of the Good Samaritan (Luke 10:25–37), who "bound up [an injured man's] wounds, pouring on oil and wine" (verse 34) as a physician would. Jesus then told the doubting teacher of the law (who had elicited this parable by his self-justifying question, "And who is my neighbor?" in verse 29) to "go, and do likewise" in loving others with whom he would never ordinarily associate (verse 37).<ref>Booth, Craig W. (16 December 2003). "Faith Healing – God's Compassion, God's Power, and God's Sovereignty: Is a Christian permitted to seek medical assistance and to use medicine?". thefaithfulword.org. Retrieved 1 May 2007.</ref>

The principle of the sacredness of human life is at the basis of Catholic bioethics.<ref name="faculty.cua.edu">"Abortion and Catholic Thought: The Little-Told History" Archived 18 February 2012 at the Wayback Machine</ref> On the subject of abortion, for example, Catholics and Orthodox are on very similar positions. Catholic bioethics insists on this concept,<ref name="faculty.cua.edu"/> without exception, while Anglicans, Waldensians and Lutherans have positions closer to secular ones, for example with regard to the end of life.<ref name="autogenerated3">When Children Became People: the birth of childhood in early Christianity by Odd Magne Bakke</ref><ref name="universityofcalifornia">Abortion and the Politics of Motherhood by Kristin Luker, University of California Press</ref>

In 1936, Ludwig Bieler argued that Jesus was stylized in the New Testament in the image of the "divine man" (Greek: theios aner), which was widespread in antiquity. It is said that many of the famous rulers and elders of the time had divine healing powers.<ref>ST. PATRICK, SAINT & SECUNDINUS (1 January 1953). The Works of St. Patrick. St. Secundus: Hymn on St. Patrick. Translated and Annotated by Ludwig Bieler. Newman Press.</ref>

Contemporary bioethical and health care policy issues, including abortion, the distribution of limited resources, the nature of appropriate hospital chaplaincy, fetal experimentation, the use of fetal tissue in treatment, genetic engineering, the use of critical care units, distinctions between ordinary and extraordinary treatment, euthanasia, free and informed consent, competency determinations, the meaning of life, are being examined within the framework of traditional Christian moral commitments.<ref>Kleppe, R. K.; Kleppe, K. (February 1976). "Preparations and properties of ribonucleic acid polymerase from Acinetobacter calcoaceticus". Journal of Bacteriology. 125 (2): 435–443. doi:10.1128/jb.125.2.435-443.1976. ISSN 0021-9193. PMC 236101. PMID 1380.</ref>

Feminist bioethics

Feminist bioethics critiques the fields of bioethics and medicine for its lack of inclusion of women's and other marginalized group's perspectives.<ref name=":3">Donchin A (2008). "Remembering Fab's Past, Anticipating Our Future". International Journal of Feminist Approaches to Bioethics. 1 (1): 145–160. ISSN 1937-4585. JSTOR 40339216.</ref> This lack of perspective from women is thought to create power imbalances that favor men.<ref name=":02">Nelson HL (2000). "Feminist Bioethics: Where We've Been, Where We're Going". Metaphilosophy. 31 (5): 492–508. doi:10.1111/1467-9973.00165. ISSN 0026-1068. JSTOR 24439396.</ref> These power imbalances are theorized to be created from the androcentric nature of medicine.<ref name=":02" /> One example of a lack of consideration of women is in clinical drug trials that exclude women due to hormonal fluctuations and possible future birth defects.<ref name=":04">"History of Women's Participation in Clinical Research | Office of Research on Women's Health". orwh.od.nih.gov. Retrieved 12 November 2020.</ref> This has led to a gap in the research on how pharmaceuticals can affect women.<ref name=":04" /> Feminist bioethicists call for the necessity of feminist approaches to bioethics because the lack of diverse perspectives in bioethics and medicine can cause preventable harm to already vulnerable groups.<ref name=":3" />

This study first gained prevalence in the field of reproductive medicine as it was viewed as a "woman's issue".<ref name=":02" /> Since then, feminist approaches to bioethics has expanded to include bioethical topics in mental health, disability advocacy, healthcare accessibility, and pharmaceuticals.<ref name=":02" /> Lindemann notes the need for the future agenda of feminist approaches to bioethics to expand further to include healthcare organizational ethics, genetics, stem cell research, and more.<ref name=":02" />

Notable figures in feminist bioethics include Carol Gilligan, Susan Sherwin, and the creators of the International Journal of Feminist Approaches to Bioethics, Mary C. Rawlinson and Anne Donchin. Sherwin's book No Longer Patient: Feminist Ethics in Health Care (1992) is credited with being one of the first full-length books published on the topic of feminist bioethics and points out the shortcomings in then-current bioethical theories.<ref name=":3" /> Sherwin's viewpoint incorporates models of oppression within healthcare that intend to further marginalize women, people of color, immigrants, and people with disabilities.<ref>Taylor AT (1 July 1993). "No Longer Patient: Feminist Ethics and Health Care". American Journal of Health-System Pharmacy. 50 (7): 1510–1513. doi:10.1093/ajhp/50.7.1510a. ISSN 1079-2082.</ref> Since created in 1992, the International Journal of Feminist Approaches to Bioethics has done much work to legitimize feminist work and theory in bioethics.<ref name=":3" />

By pointing out the male marking of its purportedly generic human subject and the fact that the tradition does not see women's rights as human rights, feminist bioethics challenges bioethics. This article explores how the other gender becomes mute and invisible as a result of this unseen gendering of the universal. It demonstrates how the dehumanization of "man" is a root cause of illness on a social and personal level. Finally, it makes many recommendations for how representations of women's experience and bodies could help to constructively reconsider fundamental ethical principles.<ref>Rawlinson, M. C. (August 2001). "The concept of a feminist bioethics". The Journal of Medicine and Philosophy. 26 (4): 405–416. doi:10.1076/jmep.26.4.405.3010. ISSN 0360-5310. PMID 11484132.</ref>

Environmental bioethics

Bioethics, the ethics of the life sciences in general, expanded from the encounter between experts in medicine and the laity, to include organizational and social ethics, environmental ethics.<ref>Kaebnick, Gregory E. (September 2018). "At the Borders of Bioethics". Hastings Center Report. 48 (5): 2. doi:10.1002/hast.891. ISSN 0093-0334. PMID 30311201. S2CID 52966807.</ref> As of 2019 textbooks of green bioethics existed.<ref>Richie, Cristina (2019). Principles of green bioethics : sustainability in health care. East Lansing, Michigan. ISBN 978-1-60917-602-0. OCLC 1162014794.{{cite book}}: CS1 maint: location missing publisher (link)</ref>

Ethical issues in gene therapy

Gene therapy involves ethics, because scientists are making changes to genes, the building blocks of the human body.<ref name=":1">"Medical Ethics". medlineplus.gov. Retrieved 6 May 2019.</ref> Currently, therapeutic gene therapy is available to treat specific genetic disorders by editing cells in specific body parts. For example, gene therapy can treat hematopoietic disease.<ref>Kohn DB, Porteus MH, Scharenberg AM (May 2016). "Ethical and regulatory aspects of genome editing". Blood. 127 (21): 2553–2560. doi:10.1182/blood-2016-01-678136. PMID 27053531.</ref> There is also a controversial gene therapy called "germline gene therapy", in which genes in a sperm or egg can be edited to prevent genetic disorder in the future generation. It is unknown how this type of gene therapy affects long-term human development. In the United States, federal funding cannot be used to research germline gene therapy.<ref name=":1" />

The ethical challenges in gene therapy for rare childhood diseases underscore the complexity of initiating trials, determining dosage levels, and involving affected families. With over a third of gene therapies targeting rare, genetic, pediatric-onset, and life-limiting diseases, fair participant selection and transparent engagement with patient communities become crucial ethical considerations.<ref>Iyer, Alexander A.; Saade, Dimah; Bharucha-Goebel, Diana; Foley, A. Reghan; Averion, Gilberto ‘Mike’; Paredes, Eduardo; Gray, Steven; Bönnemann, Carsten G.; Grady, Christine; Hendriks, Saskia; Rid, Annette (2021). "Ethical challenges for a new generation of early-phase pediatric gene therapy trials". Genetics in Medicine. 23 (11): 2057–2066. doi:10.1038/s41436-021-01245-3.</ref> Another concern involves the use of virus-derived vectors for gene transfer, raising safety and hereditary implications. Additionally, the ethical dilemma in gene therapy explores the potential harms of human enhancement, particularly regarding the birth of disabled individuals.<ref>Serguera, C.; Bemelmans, A.-P. (2014). "Gene therapy of the central nervous system: General considerations on viral vectors for gene transfer into the brain". Revue Neurologique. 170 (12): 727–738. doi:10.1016/j.neurol.2014.09.004.</ref> Addressing these challenges is vital for responsible development, application, and equitable access to gene therapies. The experience with human growth hormone further illustrates the blurred lines between therapy and enhancement, emphasizing the importance of ethical considerations in balancing therapeutic benefits and potential enhancements, especially in the rapidly advancing field of genomic medicine.<ref>"Human Genome Editing". National Academies of Sciences, Engineering, and Medicine, National Academy of Medicine, National Academy of Sciences, & Committee on Human Gene Editing: Scientific, Medical, and Ethical Considerations. (2017). Human Genome Editing: Science, Ethics, and Governance. National Academies Press (US). 2017. doi:10.17226/24623.</ref> As gene therapies progress towards FDA approval, collaboration with clinical genetics providers becomes essential to navigate the ethical complexities of this new era in medicine. <ref>Beretich, L.A.; Beretich, K.N. (2022). "The ethical case for clinical genetics providers in the deployment of gene therapy". Ethics, Medicine and Public Health. 22: 100781. doi:10.1016/j.jemep.2022.100781.</ref> <ref>Jotterand, Fabrice; Ienca, Marcello (2024). "The Routledge Handbook of the Ethics of Human Enhancement". Jotterand, F., & Ienca, M. (2024). The Routledge Handbook of the Ethics of Human Enhancement. Routledge. doi:10.4324/9781003105596.</ref>

Professional practice

Bioethics as a subject of expert exercise (although now not a formal profession) developed at the beginning in North America in the Nineteen Eighties and Nineteen Nineties, in the areas of clinical / medical ethics and research ethics. Slowly internationalizing as a field, since the 2000s professional bioethics has expanded to include other specialties, such as organizational ethics in health systems, public health ethics, and more recently Ethics of artificial intelligence. Professional ethicists may be called consultants, ethicists, coordinators, or even analysts; and they may work in healthcare organizations, government agencies, and in both the public and private sectors. They may also be full-time employees, unbiased consultants, or have cross-appointments with educational institutions, such as lookup centres or universities.<ref name="Bioethics jbs">"Jobs". Bioethics Today. AJOB Bioethics Today. Retrieved 22 October 2022.</ref>

Learned societies and professional associations

The field of bioethics has developed national and international learned societies and professional associations, such as the American Society for Bioethics and Humanities, the Canadian Bioethics Society,<ref>"Canadian Bioethics Society". Canadian Bioethics Society. CBS. Retrieved 22 October 2022.</ref> the Canadian Association of Research Ethics Boards,<ref>"Canadian Association of Research Ethics Boards". Canadian Association of Research Ethics Boards. CAREB. Retrieved 22 October 2022.</ref> the Association of Bioethics Program Directors,<ref>"Association of Bioethics Program Directors". Association of Bioethics Program Directors. ABPD. Retrieved 22 October 2022.</ref> the Bangladesh Bioethics Society and the International Association of Bioethics.<ref>"International Association of Bioethics". International Association of Bioethics. IAB. Retrieved 22 October 2022.</ref>

Education

Bioethics is taught in courses at the undergraduate and graduate level in different academic disciplines or programs, such as Philosophy, Medicine, Law, Social Sciences. It has become a requirement for professional accreditation in many health professional programs (Medicine, Nursing, Rehabilitation), to have obligatory training in ethics (e.g., professional ethics, medical ethics, clinical ethics, nursing ethics). Interest in the field and professional opportunities<ref>"Bioethics Grows, But Will Jobs Follow?". MD Magazine. Retrieved 1 July 2018.</ref> have led to the development of dedicated programs with concentrations in Bioethics, largely in the United States,<ref>Lee K (2016). "An Overview of Graduate Educational Bioethics Programs in the United States" (PDF). BCM. Retrieved 1 July 2018.</ref> Canada (List of Canadian bioethics programs) and Europe, offering undergraduate majors/minors, graduate certificates, and master's and doctoral degrees.

Training in bioethics (usually clinical, medical, or professional ethics) are part of core competency requirements for health professionals in fields such as nursing, medicine or rehabilitation. For example, every medical school in Canada teaches bioethics so that students can gain an understanding of biomedical ethics and use the knowledge gained in their future careers to provide better patient care. Canadian residency training programs are required to teach bioethics as it is one of the conditions of accreditation, and is a requirement by the College of Family Physicians of Canada and by the Royal College of Physicians and Surgeons of Canada.<ref name="pmid11338804">McKneally MF, Singer PA (April 2001). "Bioethics for clinicians: 25. Teaching bioethics in the clinical setting". Canadian Medical Association Journal. 164 (8): 1163–1167. PMC 80975. PMID 11338804.</ref>

Criticism

As a field of study, bioethics has also drawn criticism. For instance, Paul Farmer noted that bioethics tends to focus its attention on problems that arise from "too much care" for patients in industrialized nations while giving little or no attention to the ethical problem of too little care for the poor.<ref name = "Farmer_2004">Farmer P (2004). Pathologies of Power. University of California Press. doi:10.1525/9780520931473. ISBN 978-0520931473. S2CID 242296634.</ref> Farmer characterizes the bioethics of handling morally difficult clinical situations, normally in hospitals in industrialized countries, as "quandary ethics".<ref name = "Farmer_2004" /> He does not regard quandary ethics and clinical bioethics as unimportant; he argues, rather, that bioethics must be balanced and give due weight to the poor.

Additionally, bioethics has been condemned for its lack of diversity in thought, particularly concerning race. Even as the field has grown to include the areas of public opinion, policymaking, and medical decision-making, little to no academic writing has been authored concerning the intersection between race–especially the cultural values imbued in that construct–and bioethical literature. John Hoberman illustrates this in a 2016 critique, in which he points out that bioethicists have been traditionally resistant to expanding their discourse to include sociological and historically relevant applications.<ref>Hoberman J (2016). "Why Bioethics Has a Race Problem". The Hastings Center Report. 46 (2): 12–18. doi:10.1002/hast.542. PMID 27120279.</ref> Central to this is the notion of white normativity, which establishes the dominance of white hegemonic structures in bioethical academia<ref>Karsjens KL, Johnson JM (2003). "White normativity and subsequent critical race deconstruction of bioethics". The American Journal of Bioethics. 3 (2): 22–23. doi:10.1162/152651603766436144. PMID 12859809. S2CID 9386244.</ref> and tends to reinforce existing biases.

These points and critiques, along with the neglect of women's perspectives within bioethics, have also been discussed amongst feminist bioethical scholars.<ref name=":3" />

However, differing views on bioethics' lack of diversity of thought and social inclusivity have also been advanced. For example, one historian has argued that the diversity of thought and social inclusivity are the two essential cornerstones of bioethics, albeit they have not been fully realized.<ref>Saxén H (2017). A Cultural Giant: An interpretation of bioethics in light of its intellectual and cultural history (PDF). Tampere: Tampere University Press. ISBN 978-9520305239.</ref><ref>Saxén H, Saxén S (1 April 2021). "What is Organic Bioethics?". Harvard Medical School Bioethics Journal.</ref>

In order to practice critical bioethics, bioethicists must base their investigations in empirical research, refute ideas with facts, engage in self-reflection, and be skeptical of the assertions made by other bioethicists, scientists, and doctors. A thorough normative study of actual moral experience is what is intended.<ref>Hedgecoe, Adam M. (April 2004). "Critical bioethics: beyond the social science critique of applied ethics". Bioethics. 18 (2): 120–143. doi:10.1111/j.1467-8519.2004.00385.x. ISSN 0269-9702. PMID 15146853.</ref>

Issues

Research in bioethics is conducted by a broad and interdisciplinary community of scholars, and is not restricted only to those researchers who define themselves as "bioethicists": it includes researchers from the humanities, social sciences, health sciences and health professions, law, the fundamental sciences, etc. These researchers may be working in specialized bioethics centers and institutes associated with university bioethics training programs; but they may also be based in disciplinary departments without a specific bioethics focus. Notable examples of research centers include, amongst others, The Hastings Center, the Kennedy Institute of Ethics, the Yale Interdisciplinary Center for Bioethics, the Centre for Human Bioethics.

Areas of bioethics research that are the subject of published, peer-reviewed bioethical analysis include:

• Abortion
• Alternative Medicine
• Animal rights
• Applied ethics
• Artificial insemination
• Artificial life
• Artificial womb
• Assisted suicide
• Biocentrism
• Biological agent
• Biological patent
• Biopiracy
• Biorisk
• Biotic ethics
• Blood transfusion
• Body modification
• Brain–computer interface
• Chimeras
• Circumcision
• Cloning
• Cognitive liberty
• Confidentiality (medical records)
• Conflict of interest in the healthcare industry
• Consent
• Contraception (birth control)
• Cryonics
• Disability
• End-of-life care
• Eugenics
• Euthanasia (human, non-human animal)
• Exorcism
• Faith healing
• Feeding tube
• Gain-of-function research
• Gene theft
• Gene therapy
• Genetic testing
• Genetically modified food
• Genetically modified organism
• Genomics
• Great Ape Project
• HeLa cells
• Human cloning
• Human enhancement
• Human experimentation in the United States
• Human genetic engineering
• Iatrogenesis
• Infertility treatments
• Intersex
• Life extension
• Life support
• Lobotomy
• Medicalization
• Medical malpractice
• Medical research
• Medical torture
• Mediation
• Mitochondrial donation
• Moral obligation
• Moral status of animals
• Nanomedicine
• Neuroethics
• Neuroenhancement
• Nazi human experimentation
• Ordinary and extraordinary care
• Overtreatment
• Organ donation
• Organ transplant
• Pain management
• Parthenogenesis
• Patients' Bill of Rights
• Placebo
• Pharmacogenetics
• Political abuse of psychiatry
• Population control
• Prescription drug prices in the United States
• Procreative beneficence
• Professional ethics
• Psychosurgery
• Quality of life (healthcare)
• Quaternary prevention
• Recreational drug use
• Reproductive rights
• Reproductive technology
• Reprogenetics
• Research ethics
• Resource allocation
• Sex reassignment therapy
• Sperm and egg donation
• Spiritual drug use
• Stem cell research
• Sterilization (medicine)
• Suicide
• Surrogacy
• Transsexuality
• Transhumanism
• Transplant trade
• Triage
• Tubal ligation
• Vaccination controversy
• Xenotransfusion
• Xenotransplantation

See also

• List of bioethics journals
• List of Canadian bioethics programs
• Biotechnology risk
• Cytoplasmic transfer
• The Hastings Center
• Johns Hopkins Berman Institute of Bioethics
• Medical law
• Neuroethics
• Preimplantation genetic diagnosis
• Resources for clinical ethics consultation
• The Convention on Human Rights and Biomedicine

Further reading

• Bosworth, Fred (2001). Christ the Healer. Revell. ISBN 0-8007-5739-4.
• Fry-Revere, Sigrid (2008). "Bioethics". In Hamowy, Ronald (ed.). The Encyclopedia of Libertarianism. Thousand Oaks, CA: Sage; Cato Institute. pp. 33–35. doi:10.4135/9781412965811.n21. ISBN 978-1412965804. LCCN 2008009151. OCLC 750831024.

External links

• Bioethics entry in the Internet Encyclopedia of Philosophy.
• "Feminist Bioethics" at the Stanford Encyclopedia of Philosophy
• "MyBioethics" a free online resource (app) for learning bioethics through real cases.