Ita ArmyantiFarmakologi / Bioethics PSPD FK UNTAN

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Brief history of ethics and bioethics Nuremberg military tribunal (Germany,

1939 – 1945) Tuskegee Syphilis study (USA, 1932) Willowbrook study (USA, 1966) The Medical Atrocities (Ethics Unit 731-

Japanese on Chinese)

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Ethics are not … Ethics is not the same as

feelings Ethics is not religion Ethics is not following the law Ethics is not following

culturally accepted norms Ethics is not science

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Ethics are … Moral Principles What is good and bad What is right and wrong Based on value system Ethical norms are not universal

– depends on the sub culture of the society

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ethics refers to standards of behavior that tell us how human beings ought to act in the many situations in which they find themselves, as friends, parents, children, citizens, businesspeople, teachers, professionals, and so on.

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What is “ethics”?Ethics: “the rules of

conduct recognized in respect to a particular class of human actions or a particular group, culture”

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What is “Bioethics”?Bioethics: “a field of study

concerned with the ethics and philosophical implications of certain biological and medical procedures, technologies, and treatments, such as organ transplants, genetic engineering, and care of the terminally ill”

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A classic bioethical decision One heart available who should get it?17-year old girl

40-year-old school principal

70-year-old woman

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A classic bioethical decision One heart available who should get it?17-year old girl

40-year-old school principal

70-year-old woman

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Historically medical ethics may be traced

to guidelines on the duty of physicians such as the Hippocratic oath

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a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to

self. These are not laws, but standards of conduct which

define the essentials of honorable behavior for the physician

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Principles Approach toBiomedical Ethics

Non-maleficence Beneficence Justice Autonomy (Beauchamp & Childress 1983)

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Basic Bioethics Principles RESPECT for people’s rights

Autonomy

BENEFICENCE: Benefits must be proportionate to risksPotential harm = potential good

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Basic Bioethics Principles JUSTICE: The even distribution of

benefits and risks throughout society

NONMALEFICENCE: Do no harmExperiment must stop if causes harm.

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Autonomy Patient has freedom of thought,

intention and action when making decisions regarding health care procedures

For a patient to make a fully informed decision, she/he must understand all risks and benefits of the procedure and the likelihood of success.

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Always respect the autonomy of the patient - then the particular patient is free to choose

Such respect is not simply a matter of attitude, but a way of acting so as to recognize and even promote the autonomous actions of the patient.

The autonomous person may freely choose loyalties or systems of religious belief that may adversely affect him

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The patient must be informed clearly the consequences of his action that may affect him adversely.

Desiring to "benefit" the patient, the physician may strongly want to intervene believing it to be a clear "medical benefit." The physician has a duty to respect the autonomous choice of the patient, as well as a duty to avoid harm and to provide a medical benefit.

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But the physician should give greater priority to the respect for patient autonomy than to the other duties.

However, at times this can be difficult because it can conflict with the paternalistic attitude of many health care professionals.

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In the case of a child, the principle of avoiding the harm of death, and the principle of providing a medical benefit that can restore the child to health and life, would be given precedence over the autonomy of the child's parents as surrogate decision makers.

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Conclusions (1) Respect needs :

Tell the truthRespect privacy of othersProtect confidential informationObtain consent for intervention with patientsWhen asked, help others make important

decisions

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Conclusions (2) Respect for autonomy will end up in

informed consent In order to get good and right informed

consent, need :VoluntarinessCompetence to make decisionsFree of coercionFree of persuasionFree of manipulationRight and complete infomations

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Justice The distribution of scarce health

resources, and the decision of who gets what treatment “fairness and equality”

The burdens and benefits of new or experimental treatments must be distributed equally among all groups in society

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Hippocrates focused on doctor-patient relationship but did not deal with the social dimension of health and health-care.

Justice or fairness calls for people whose needs are alike being treated equally.

An important expression of justice is equity, which acknowledges that people have differential needs and fairness calls for responding with care according to such differential needs.

Jack Bryant27/04/23 23EBP3KH/2014

The four main areas that Health care provider must consider when evaluating justice1. Fair distribution of scarce resources2. Competing needs3. Rights and obligations4. Potential conflicts with established legislations

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Justice Webster’s definition: the quality of being just,

impartial, or fair (the principle or ideal of just dealing or right action)

Various forms of justiceTo each according to need.

○ Who is most in need?To each according to fair share.

○ What constitutes fair share?To each according to meritTo each according to societal contributionTo each according individual effort

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Justice In western, democratic societies, the rights of the

individual is emphasized. Personal freedom and choice valued.The individual most likely to die is most in need.Each individual should have fair and equal claim.

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Terima kasih..

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