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Bio-Ethics Lecture Notes

The document discusses various approaches to bioethical decision making including inherent jurisdiction, religious bioethics, secular bioethics using theories like utilitarianism and Kantianism, virtue ethics, and principlism. It also covers concepts like casuistry, feminism, disability rights, and relevant statutes.

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miah16
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29 views5 pages

Bio-Ethics Lecture Notes

The document discusses various approaches to bioethical decision making including inherent jurisdiction, religious bioethics, secular bioethics using theories like utilitarianism and Kantianism, virtue ethics, and principlism. It also covers concepts like casuistry, feminism, disability rights, and relevant statutes.

Uploaded by

miah16
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Bio-Ethics

1. Why do we need to consider making ethical decisions?

Inherent Jurisdiction - a doctrine of the English common law that a


superior court has the jurisdiction to hear any matter that comes before it
unless a statute or rule limits that authority or grants exclusive jurisdiction
to some other court or tribunal.
- Civil case of Re PS (incapacitated/ vulnerable adult) [2007] 2 FLR
1083, para 16 – “it is in my judgement quite clear… ensure that he
remains there”
- Re X (a child) [2016] EWHC 2271 (Fam), para 37 – “the exercise of
prerogative – and the inherent jurisdiction is an exercise of the
prerogative albeit the prerogative vested in the judges rather than
ministers – is pro tanto ousted by any relevant statutory scheme.”
Pro tanto – ‘to that extent’
- Re Z (Recognition of Foreign Order) [2016] EWHC 784 (Fam), para
16 – “it is well established that the High Court may, in appropriate
circumstances, use its inherent jurisdiction to supplement a statutory
scheme.”
- Re F (mental patient: sterilisation) [1990] 2 AC 1, para 30 – “the
common law is the great safety net… It is not a legislative function
or process.” – Example: (vulnerable) individuals who could not cope
with a child

2. What approaches to decision-making can we consider?


Reugnance
- Human cloning, the gut reaction to human cloning is perhaps unsure and
uneasy. ‘revulsion is not an argument’, it is a reaction.
LR Kass believes this can produce some human wisdom – ‘The Wisdom of
Repugnance’
George Orwell – ‘Moral Nose’ - Many authors consider the so-called “moral
nose” a valid epistemological tool in the field of morality. The expression
was used by George Orwell, following in Friedrich Nietzsche’s footsteps,
and was very clearly described by Leo Tolstoy. It has also been employed
by authors such as Elisabeth Anscombe, Bernard Williams, Noam
Chomsky, Stuart Hampshire, Mary Warnock, and Leon Kass. This article
examines John Harris’ detailed criticism of what he ironically calls the
“olfactory school of moral philosophy.” Harris’ criticism is contrasted with
Jonathan Glover’s defense of the moral nose. Glover draws some useful
distinctions between the various meanings that the notion of moral nose
can assume. Finally, the notion of moral nose is compared with classic
notions such as Aristotelian phronesis, Heideggerian aletheia, and the
concept of “sentiment” proposed by the philosopher Thomas Reid. The
conclusion reached is that morality cannot be based only on reason, or—as
David Hume would have it—only on feelings.
‘Moral Nose’ was discredited by J Harris in ‘ Enhancing Evolution: The
ethical case for making people better.’

Religious Bio-Ethics
- Acknowledges the right and wrong of an action without consideration of
pragmatic or consequential arguments.
- Religious bioethics shares to principles across all religion:
1. Love thy neighbour
2. Sense of awe and respect for ‘God’s Creation’ and the Sanctity of Life.

Example of Abortion:
Roman Catholic Bio-Ethics – Life exists at conception; a body is owned by God
and no person owns their own body. However, no baptism for stillbirths
Anglican Bio-Ethics – no consensus on when life begins, abortion is a matter of
each individual’s conscience.
Islamic – some differences in opinion; however, whether an abortion is allowed is
dependent (i) the threat of harm to the mother, (ii) the status of pregnancy
before or after ensoulment (on the 120th day of gestation), and (iii) the
presence of foetal anomalies that are incompatible with life.
Jewish – foetal life does not have the same status as a pregnant woman, so the
morality of abortion is dependent on whether there is cause to justify it.
Buddhism/Jainism – the sanctity of life extends beyond humans to all living
creatures.
Confucianism – the decision is that of the family as much is it is that of the
pregnant woman.

Secular Bio-Ethics
A moral decision is not like a decision about taste:
- ‘I like chocolate’ need not be justified.
- ‘You should not have an abortion’ does as it infers a value system and
attempts to impose this on the receiver.
Moral Theories
Teleological theory
- Utilitarianism – Principle proponents – Jeremy Bentham – John Stuart Mill
- Utilitarianism is an ethical theory that determines right from wrong by
focusing on outcomes it is a form of consequentialism.
- ‘Act Utilitarianism’ is concerned with the consequences of an action,
regardless of whether it is right or wrong.
- We should weigh the good against the bad and decide our actions
accordingly - even if these involve breaking promises or changing plans.
- ‘Rule Utilitarianism’ is concerned with which general rules would, overall,
lead to the best outcome for the largest number of people.

Deontological theory
- Kantianism – Categorical Imperative (act as you would want all other
people to act towards all other people)
- 1. Act only on that maxim whereby you can at the same time will that it
should become a universal law
- 2. So act as to treat humanity, whether in your own person or in that of
any other, never solely as a means but always also as an end.
- Kant's moral philosophy is unique and counterintuitive. Kant believed
that for something to be good, it had to be universal—that is, it can't be
“right” to do something in one situation and “wrong” to do it in another. If
lying is wrong, it has to be wrong all the time. It has to be wrong when
everyone does it.

Virtue Ethics
- Aristotelianism
- Concerned with whether the act is the ‘right’ thing to do.
- Virtues are the character traits necessary for human flourishing.
- Consider the virtues of fairness and compassion.
- Is a doctor who withholds a diagnosis of terminal cancer from a patient
acting out of compassion, and even if they are, is it still wrong?
- One central feature of virtue ethics is that patient autonomy is not an
absolute or overriding virtue.
- If a patient wants to die, that does mean that death is a good thing for
the patient. Instead, causing a person’s death could be virtuous only if
their life lacks the most basic human goods.

Disclosure of patients’ information:


- Hunter v Mann [1974] QB 767 – ‘the doctor is under a duty not to
[voluntarily] disclose, without the consent of the patient information
which he, the doctor, has gained in his professional capacity.’

Preventing harm to others:


- Saha v General Medical Concil [2009] EWHC 1907 (Admin) – Doctor did
not disclose to the NHS that he had Hepatitis B. Hospital reported him
to the GMC and he was barred from practice as he could have caused
harm to patients.

Preventing or detecting a crime

Teaching, research, or audit purposes


- R v Department of Health, ex parte Source Information [2001] QB 424 –
Involves pharmacists, software installed in pharmacies to harvest
information n on prescribing habits etc. The patient’s name was not used.
GPs were aware but patients were not. Found that there was NO breach
of confidentiality.

Principlism
Referred to by Beauchamp and Childress as ‘the most general and basic norms
of the common morality’.
- 4 basic principles (according to B&C):
- Autonomy, non-maleficence, beneficence, and justice

However, Etzioni adds that the focus is on the individual doctor-patient


encounter and misses the wider implications that bioethical dilemmas have on
society. Etzioni also suggests adding ‘the common good’ to the list above.

Critiqued by Clouser and Gert.

Casuistry
Philosophers tend to discuss general abstract principles; clinicians tend to be
more interested in individual cases.
- In Casuistry, we begin by formulating a response to a case and then
reason by analogy (bottom-up reasoning)
- Like the judiciary, developing the common law.
- No ethical problem is novel, so it makes sense to consider how these have
been addressed in the past.

Feminism
Disability and Human Rights

Statutes requiring patient information disclosure:


- Criminal Appeal Act 1995
- Terrorism, Prevention and Investigation Measure Act 2011
- Public Health (Control of Disease Act 1984)
- Road Traffic Act 1988
- NHS Act 2016 in cases of NHS Fraud
- Medical Act 1083 – if GMC are carrying out a fitness to practice
investigation.

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