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WELCOME TO PGDBEME 2017 BATCH

This session provides an overview of bioethics, its relative positioning, and how it compares to medical ethics. It explores moral judgment, ethics, and the importance of relearning bioethics in today's changing healthcare landscape.

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WELCOME TO PGDBEME 2017 BATCH

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Presentation Transcript

  1. WELCOME TO PGDBEME 2017 BATCH CFE YU

  2. Introduction to bioethics Ravi Vaswani MD PGDBEME PGDHPE Professor, Department of Internal Medicine Yenepoya Medical College, Mangalore

  3. Objectives • By the end of this session you will • Understand what is bioethics • Know the relative positioning of bioethics • Compare and contrast medical ethics from bioethics CFE YU

  4. What are morals? • The use of a system of values that tell us what is good or bad; right or wrong; good or evil • Strong roots in religion • Ethics can be considered the fruit of the tree of morality, that has fallen away and has lost its weak connection with the religion CFE YU

  5. What is bioethics? • Application of ethical reasoning using ethical theories & principles in any field involving living beings • People feel the need to justify their behaviour • To explain why their behaviour is (un)acceptable CFE YU

  6. Morality of right or wrong • A 24 yr old poor lady sold her 4th daughter to a rich man for Rs 50,000 • Right or wrong? CFE YU

  7. What yardstick? • Intuition • Precedence • Justification CFE YU

  8. Moral judgments based on.. • Consequences • Underlying intention • Beliefs • What if the girl grows up to be a famous actress, & mother now wants to reclaim her • All four daughters are dying of starvation • Rich men are evil and the girl will be abused and then sold CFE YU

  9. Moral judgments • Most moral judgments revolve around value or duty • Values predate ethics • They represent religion, tradition, history. • Important function of ethics is intellectual analysis of value conflicts CFE YU

  10. What do you think is ethics? CFE YU

  11. Ethics • Ethics is the formal, systematic study of • who we ought to be • what counts as a virtuous life and • how we should judge right from wrong action • Ethics provide reasons for choosing one course of action over others CFE YU

  12. What is bioethics? • Bioethics - how scientists and health professionals ought to behave in the biomedical sciences • Bioethics can be seen as an attempt to understand and justify the link between values (fundamental principles) and actions • Bioethics goes beyond medical ethics and relates man in harmony with nature CFE YU

  13. Bioethics • The term “bioethics” was coined by Fritz Jahr, a philosopher in Germany in 1926, but largely unread by the scientific community • In 1970 Van Rensselaer Potter re-introduced it as a term for ensuring the preservation of the biosphere. • It was later used to refer a study of the ethical issues arising from health care, biological and medical sciences. • It is a major area in applied ethic CFE YU

  14. What’s the difference? Medical Ethics Bioethics Newer concept Broader scope (clinical, research, etc) Includes medical ethics Freedom from the law • Older concept • Restricted to medical treatment • Restricted to Doctor-Patient relationship • Codified ethics • More leaning towards the law - negligence CFE YU

  15. Relative positioning of bioethics Law Morality Moral values Moral reasoning Consciousness Bioethics Medical ethics CFE YU

  16. CFE YU

  17. Ethical versus legal CFE YU

  18. Ethical versus legal CFE YU

  19. What’s wrong with our good old method of medical ethics? • Codified (do’s and don’ts) • Does not link actions to values • Very less time allocated in the medical curriculum • Taught by non-clinicians • No real-life comparisons for students • No summative or formative exam • Not taken seriously (therefore ethics is not important) CFE YU

  20. What ails ethics education today? • If the horse was good for my father; it is good for me • Thinning moral fibre in all arenas of society • ‘Chaltahai’ attitude (adjust to everything and dilute standards) • Commercialization of medical education • Students have few (or no?) role models CFE YU

  21. Remedies • No quick fix • Ethics as a subject to be brought into mainstream • Structured; comprehensive • From the beginning of the medical curriculum CFE YU

  22. Why is it important to relearn it? • What do you think has changed in health care over the last 20 - 30 years? • Explosion of knowledge • Increase in technology • Explosion of internet access • Increasing shades of grey CFE YU

  23. Case scenario • Tom and Bob are recently married (same sex marriage). They want to have a “custom made baby”. They approach you, the top geneticist in the country and ask for a baby that will grow to a height of 6 feet, have blue eyes and have the speed and stamina of Usain Bolt • They are willing to pay Usain Bolt lots of money to get his DNA sample • Can you? Will you? Should you? • They also want a gene for homosexuality inserted • Can you? Will you? Should you? CFE YU

  24. Case scenario • Santhosh, a 24-year old techie was hit by a lorry while driving home in Bengaluru • Santhosh has had serious brain damage and is unconscious for the last 2 years • His respiration is maintained on a ventilator • His heart is maintained on drugs that keep it beating • The family want you to remove the ventilator • Can you? Will you? Should you? • The family want you to remove the ventilator two days from today, as there is a marriage function tomorrow • Should you accede to their wishes? CFE YU

  25. Issues • Technological advances in such diverse areas as Healthcare, Biological sciences and biotechnology • organ transplantation • end-of-life care, • Genetic testing • development of kidney dialysis & respirators • Critical care • Palliative and end of life care • Novel questions regarding when and how care might be withdrawn CFE YU

  26. Until 50 years ago… • Death was a short event, unalterable • At times early, sudden or unexpected • Usually holistic CFE YU

  27. Medicalization of Death: The process of dying can be prolonged CFE YU

  28. The Bio-social revolution • Life saving interventions have redefined the meaning of health care • Separated biology from biography • Biology: a set of functions operating within fixed ranges • Biography: takes into account the quality and meaning of life; a complex interplay of consciousness, memory, emotions and relationships CFE YU

  29. Biology- Biography • Without meaning to life, life support systems become agony prolonging machines CFE YU

  30. Frozen Embryos • How long can they be preserved • How often they can be utilized • Do they have the same status of embryo • Can consent be withdrawn after freezing the embryos? CFE YU

  31. How old is too old to become mother • Patricia Rashbrook at the age of 63 becomes a mother thro IVF CFE YU

  32. What the medical profession has lost over the years • Attitude of caring • Empathetic presence • Responsiveness and respect • Centrality of trust • Confidentiality • Non-judgmental regard • Truth-telling and • Informed consent CFE YU

  33. How can we win it back? • Through increasing our knowledge, attitude and practice of ethics in not only our profession but in every walk of our life CFE YU

  34. Do unto others what you would them do unto you CFE YU

  35. Thank YU CFE YU

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