Q.

"Explore and delineate the central themes and concepts in the Philosophical approaches to
Bioethics."

Kuhse and Singer in ‘What is Bioethics? A historical introduction’ provides us with a comprehensive
guide to the field of bioethics, delving into its historical roots, core concepts and the contemporary
relevance of bioethics. It prods us to engage with the ethical dimensions of healthcare and biomedical
advancements. Since the 1960s, there has been a growing awareness of ethical challenges in healthcare
and the biomedical sciences, largely due to significant advancements in these fields. Medical
breakthroughs like dialysis machines, artificial ventilators, and organ transplants have expanded our
ability to prolong life, raising profound questions about when and how to do so ethically. Similarly,
reproductive technologies like in vitro fertilization have reshaped traditional notions of parenthood,
while modern contraceptives, prenatal testing, and safe abortions have provided individuals and
couples with unprecedented control over their reproductive choices. Moreover, the emergence of
genetic advancements and the potential for genetic enhancement have added layers of complexity to
these ethical considerations.

However, the surge in ethical discourse is not solely a consequence of technological progress; there is
also a growing apprehension regarding the authority held by medical professionals and scientists. This
concern has sparked conversations about ‘patients' rights’ and the importance of community
involvement in decision-making processes. The ethical implications of decisions such as the dilemma
surrounding life-support for patients in a persistent vegetative state highlight the need for a broader
dialogue that considers diverse perspectives.

In response to these evolving ethical dilemmas, the field of ‘bioethics’ has emerged. Initially coined by
Van Rensselaer Potter to denote a "science of survival" aimed at preserving the biosphere, the term
gradually evolved to encompass the ethical considerations arising from healthcare and the biomedical
sciences. While the term "bioethics" is recent and fueled by advancements in biomedicine, it can be
viewed as a more modern and critical extension of the older field of medical ethics. Bioethics
encompasses medical ethics, but with a distinct approach. Traditionally, medical ethics focused on the
‘doctor-patient’ relationship and the virtues of a "good doctor." It also addressed relationships within
the medical profession, sometimes leading to the perception that doctors protect themselves over
patients. Bioethics, takes a more critical and questioning stance. It goes beyond doctor-patient and
doctor-doctor relationships by:

1. Bioethics aims to achieve a deeper understanding of ethical issues, rather than simply enforcing
a set of rules.
2. Bioethics delves into philosophical questions about what makes ethical conduct, ethical, the
value of life, and the meaning of being human and ‘what is to be a person’.
3. Bioethics expands to consider public policy issues surrounding healthcare and the direction of
scientific advancements.

These characteristics establish bioethics as a novel and distinct field of inquiry. However, its journey
begins by acknowledging its foundation in the history of medical ethics.

MEDICAL ETHICS

According to Reich medical ethics had a very long and diverse history. Often thought to date back to
Hippocrates in ancient Greece, it is in fact much more older. Even before written records, tribal
societies had established values guiding healthcare practices, with shamans and healers adhering to
established principles. The Code of Hammurabi written in Babylon around 1750 BC, for instance,
prescribed severe consequences for medical errors. Similarly, religious traditions like those in ancient
Greece emphasized the compassionate care of all, regardless of social status. The Hippocratic Oath,
often considered the cornerstone of Western medical ethics, emerged from the Hippocratic School,
though its exact origins remain uncertain. It highlights principles like beneficence (acting in the
patient's best interest) and nonmaleficence (avoiding harm), underlining doctors' obligations to benefit
patients and avoid harm. Additionally, it addresses ethical issues such as abortion and euthanasia,
reflecting prevailing views on the sanctity of human life.

According to Jones, Christianity introduced significant moral considerations to medical ethics,

emphasizing compassion and charity in caring for the ill. Medieval Christian teachings stressed the
importance of treating patients regardless of their wealth or status, condemning practices like excessive
fees and euthanasia. Reich in view of abortion, expresses that Christian perspectives evolved over time,
with varying views on the moral status of the fetus. While the Roman Catholic Church has been
influential in shaping medical ethics, other religious traditions like Judaism and Islam also offer
distinct perspectives.

Beyond religious influences, medical practitioners themselves reflected on the qualities of a virtuous
doctor, particularly in their relationship with patients. The 18th century saw figures like John Gregory
advocating for empathy and sympathy in doctors, echoing the importance of care and compassion in
the doctor-patient dynamic.

NURSING ETHICS

While medical ethics has a long history, professional nursing emerged in the 19th century with
Florence Nightingale establishing the first school of nursing and laying down some of the ethical
standards that would shape the practice of nursing. Initially, emphasis was placed on a nurse's
character, with the ideal being a "good woman”. Ethical discussions within nursing began around
1890s, leading to the creation of professional organizations and publications on nursing ethics.

Historically, nursing was predominantly a female profession, while medicine was dominated by men.
This social dynamic between doctors and nurses often reflected societal gender roles, with nurses
traditionally viewed as subservient to physicians and the expectation of absolute obedience from
nurses towards doctors. A 1917 quote exemplifies this view, with a nurse leader describing her role as
"simply an intelligent machine" following doctors' orders. This dynamic persisted until the 1960s. The
revival of feminism and the growing self-awareness of nurses challenged this traditional hierarchy. The
1973 International Council of Nurses' Code reflected this shift, changing the "primary responsibility"
of nurses from doctors to "those people who require nursing care."

Parallel to these developments, feminist philosophers challenged the traditional, male-dominated view
of ethics based on abstract principles. Instead, they proposed an ‘ethics of care’ grounded in personal
relationships and responsibility. Building on this perspective, nursing scholars like Jean Watson
advocated for a nursing ethics of care, emphasizing the importance of human connection and
compassion in healthcare.

BIOETHICS

The roots of modern bioethics can be traced back to Joseph Fletcher's groundbreaking work, "Morals
and Medicine," published in 1954. Fletcher, an Episcopalian theologian, introduced controversial
‘situation ethics’ approach that challenged traditional Christian views on ethics, laying the foundation
for discussions on ethical issues in medicine. However, it wasn't until the 1960s that bioethics truly
began to take shape as a distinct field of study. This period was marked by significant cultural and
social changes, including the civil rights movement, which highlighted issues of justice and inequality.
The Cuban missile crisis and the Vietnam War sparked renewed debates on war and nuclear weapons.
Moreover, the resurgence of feminism, alongside advancements in reproductive technologies like safe
abortions and contraceptives, raised questions about women's reproductive rights. These societal shifts
also influenced the practice of philosophy, leading to a renewed interest in normative and applied
ethics. Moral philosophers began addressing practical ethical issues such as abortion, euthanasia,
allocation of medical resources, and animal rights. This philosophical movement played a crucial role
in establishing bioethics as a critical discipline, especially as it related to healthcare and the biological
sciences.

The development of new medical technologies presented unprecedented ethical challenges. For
instance, the introduction of dialysis machines for patients with kidney failure raised questions about
resource allocation and the criteria of ethical decision-making. Similarly, the first heart transplant
performed by Christiaan Barnard in 1967 brought attention to the ethical dilemmas associated with
organ transplantation and the use of life-extending technologies. The emergence of respirators in the
1950s, capable of prolonging life but often leaving patients in a vegetative state, prompted discussions
about defining ‘death’ and determining the limits of medical intervention. The Harvard Brain Death
Committee's definition of brain death as the new criterion for death emerged from this context and has
been widely adopted with modifications. Questions arose about the treatment of incompetent patients,
including seriously disabled or premature newborns. The ethical dilemma revolved around whether to
prolong life indefinitely, even in cases with poor prospects, when patients were unable to express their
wishes.

In the 1970s, a study by Duff and Campbell ignited debate about life support for severely ill newborns.
The study challenged the notion that all severely ill or disabled infants should receive life-prolonging
treatment. Out of 299 infants in the special-care nursery, 43 died due to decisions to withhold
treatment, sparking debates on the moral and legal validity of such decisions. Australian and British
doctors also contributed to discussions on selective non-treatment of infants with conditions like spina
bifida. This debate centered on the concept of "quality of life" versus "sanctity of life" in medical
practice. The landmark Quinlan case in 1976 provided a legal precedent. The Supreme court ruled that
doctors were not obligated to prolong life in all circumstances and could discontinue life support for a
patient in a vegetative state, upholding the family's wishes. This case addressed various issues,
including the role of families in end-of-life decisions, the relevance of patient’s prior expressed wishes
and the ethical distinction between ordinary and extraordinary means of treatment.

Ethical concerns were raised in regard to unethical experimentation and research work with cases such
as the Tuskegee syphilis study and the Willowbrook hepatitis inoculations. Public outrage led to the
establishment of the National Commission for the Protection of Human Subjects of Biomedical and
Behavioral Research in 1973, which formulated regulations to safeguard research participants' rights
and interests. The Commission's recommendations, articulated in the Belmont Report, emphasized
ethical principles like respect for persons, beneficence, and justice, which have since become
foundational in bioethics. These principles have been integrated into seminal texts like "Principles of
Biomedical Ethics" by Beauchamp and Childress, shaping ethical discourse and practice in biomedical
research and healthcare. Towards the end of the 1960s, the surge of ethical challenges in medicine and
research prompted the establishment of the first bioethics institutions in the United States, the Hastings
Center, was established in 1969. Bioethics quickly became an interdisciplinary field, drawing on not
just philosophy and religion, but also medicine, law, economics, and public policy.

Today, numerous bioethics research centers exist globally, with bioethicists frequently consulted by
governmental bodies, professional organizations, and law reform agencies. National bioethics
associations and international forums like the International Association of Bioethics (IAB) further
foster collaboration and discourse among bioethicists worldwide. However, despite its global reach,
bioethics faces a disparity in addressing ethical issues relevant to developing countries. The bulk of
bioethical research historically focused on concerns prevalent in affluent nations, neglecting issues
affecting the majority of the global population. This imbalance raises ethical questions about the
obligation of wealthy nations to address healthcare disparities and prioritize research on diseases
affecting poorer regions.

Efforts to rectify this discrepancy are underway, exemplified by initiatives like Developing World
Bioethics journal and the advocacy of the International Association of Bioethics (IAB) to promote
bioethical discourse in developing nations. While progress has been made in increasing attention to
global bioethical issues, the field still moves sluggishly in addressing challenges outside affluent
nations, highlighting the need for greater inclusivity and representation of diverse perspectives in
bioethics discourse.

CONCLUSION

In conclusion, the exploration of bioethics reveals a dynamic field shaped by historical, cultural, and
technological developments. Bioethics has deep roots in ancient ethical codes and religious traditions,
emphasizing principles like beneficence and compassion. However, its contemporary form emerged in
the mid-20th century, fueled by technological innovations and societal shifts. Medical advancements in
areas like organ transplants and life support raised complex ethical dilemmas. societal concerns about
medical authority and patients' rights have catalyzed conversations about ethical decision-making and
the importance of inclusive dialogue. Bioethics has evolved to address these challenges, drawing on
diverse philosophical traditions and legal frameworks to navigate complex ethical landscapes.

Overall, the evolution of bioethics underscores the ongoing need for ethical reflection and dialogue in
addressing the complex ethical challenges of healthcare and biomedicine. By embracing
interdisciplinary collaboration and global engagement, bioethics continues to play a critical role in
shaping ethical decision-making and promoting the well-being of individuals and communities
worldwide.