To browse other articles on a range of HSL topics, see the A-Z index.
Bioethics is an interdisciplinary field that concerns a broad range of "ethical issues relating to human life and health, biology, and the environment" (Canadian Bioethics Society, 2012). Bioethics comprises four principles relevant to the practice of clinical medicine: beneficence (duty to do your best for patients), nonmaleficence (duty to do no harm), respect for autonomy of patients (and, their caregivers) and justice (duty to uphold the rights of others, including patients). Some bioethicists add the virtues of empathy, compassion, fidelity and integrity to their view of this topic. In many debates involving bioethics, there is considerable ferment about the context for making decisions in modern health care, and the importance of doing no harm.
Bioethics in the 21st century deals with a number of human issues, and layers of complexity. For example, upholding the sanctity of human life is a principle that leads debate about abortion and euthanasia. Due to advances in modern medicine, prolonging life in the face of death is also upheld, but not in all cases. Many bioethicists approve of the use of human stem cells to combat disease although some groups oppose it on moral and religious grounds. Bioethicists deal with philosophical issues regularly, as do lawyers and judges who apply the law in order to guide their opinions. Bioethics can be said to come fully into play whenever difficult decisions have to be made about patients, providing care for the sick, or in conducting biomedical research and clinical trials. There are numerous contexts to consider: legal, religious, social/cultural and ethical.
The pharmaceutical and medical technology industries are very innovative fields. In society, there is some consternation, however, about the intrusion of medical devices and pharmaceuticals into our lives. The intrusion has more than one ethical angle, and the awareness of this intrusion follows from interactions with the health care system, and concerns about patient confidentiality. For example, many patients are concerned about digitizing their health records, and oppose attempts to do so. Given medicine's ability to prolong life, the question is whether all the medical care available is worth pursuing, and at what cost? A major flash point in bioethics is the issue of using animals in experimentation, and testing new drugs on human beings.
What is ethical conduct?
The Canadian Oxford dictionary defines ethics as the "...science of morals in human conduct; or moral principles and rules of conduct...". Some related philosophical areas include information ethics, computer ethics and privacy and security in the digital age. However, others place ethics within a context of their own philosophical and religious beliefs which suggests ways of being, acting and interacting with others. In cases where professional ethics are severely tested (such as end-of-life issues, abortion and information provision), issues of morality (i.e. moral imperatives) will undoubtedly be introduced into the equation. In legal terms, ethical conduct in providing patient care is often connected to the notion of what any prudent person would do and does not extend to performing unproven procedures or those thought to be experimental.
Bioethics is context-dependent
Although bioethics is a topic of universal concern in countries around the world, bioethical standards are not universal. For example, the use of medical treatments is highly dependent on the social and cultural circumstances prevalent in a given society. Bioethics in Canada and the US have similarities but often differ in important ways. Patients from different cultural and religious backgrounds in both countries have different expectations with respect to bioethics, and those needs must be met through close consideration of their personal circumstances. What might be an appropriate approach to providing care for a Chinese Christian woman in Vancouver may not be appropriate for a First Nations male in Nunavut (CMAJ, 2000).
The future of bioethics should include more empirical work on health care practices, and combine the medical evidence with good qualitative studies in nurturing patient-physician-family relationships. Through further debate among experts and with patients seeking medical care, bioethics can adapt accordingly to emerging issues and needs in contemporary society.
Clinical ethics refers to a range of ethical and moral issues that apply to clinical practice, research and policy in hospitals and other health organizations. Typically, clinical ethics involves health professionals such as physicians and surgeons in the clinic but also nurses, social workers, psychologists, medical technicians, chaplains, and others responsible for patients in hospitals. There are several principles that must be considered in following clinical ethics but often they recall Hippocrates' axiom, "do no harm", and the importance of informed consent, confidentiality and patient rights. Clinical cases that require clear ethical guidelines may involve end-of-life care, the care of minors and substitute decision-making when and if patients cannot decide treatment for themselves.
Four topics method
Using the method laid out by Jonsen, Siegler, and Winslade (2010) clinical cases are analyzed using:
Consulting an ethicist
In some cases, health practitioners may need to consult an ethicist. Accredited Canadian hospitals must have an ethics framework in place; some hospitals have ethics committees while others employ bioethicists.
Clinical trials and other studies also require ethical consideration. Because they carry the most direct risk to participants, "clinical trials are, perhaps, the most regulated type of research" (TCPS 2, 2011). Provincial, federal, and international standards apply, as well as ethical guidelines from the Interagency Advisory Panel on Research Ethics.
Ethical considerations for clinical trials are not limited to balancing the risk and potential benefit of the research. Choosing participants also presents dilemmas. Historically, medical research has been conducted at the expense of individuals from vulnerable populations. Participants should be selected for qualities directly relevant to the study, not for their vulnerability; "research should not unduly involve persons from groups unlikely to be among the beneficiaries of subsequent applications of the research" (Belmont Report, 1979). Groups shouldn't be excluded from research either. For many years clinical trials were more likely to include men than women. As a result, clinical guidelines may not adequately reflect how conditions like heart disease affect female patients.