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An Introduction. Reproductive Ethics Workshop. fbsekaleshfar@gmail.com. Definitions of Bioethics.
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An Introduction Reproductive Ethics Workshop fbsekaleshfar@gmail.com
Definitions of Bioethics A new discipline which combines biological knowledge with a knowledge of human value systems, which would build a bridge between the sciences and the humanities, help humanity to survive, and sustain and improve the civilized world (Van Rensselaer Potter)
Possible criticisms to Potter Hardly a new discipline Limited to biological knowledge Limited to human value systems Limited to the civilized world Limited to helping humanity
Onora O’Neil’s definition Bioethics is not a discipline...It has become a meeting ground for a number of disciplines, discourses and organizations concerned with ethical, legal and social questions raised by advances in medicine, science and biotechnology.
Possible criticisms made against O’Neil Too general Underlines no specific aims Need not be associated with advances alone
Oxford Companion to Philosophy’s definition The study of the moral and social implications resulting from advances in the biological sciences
Possible criticisms Denies the bioethicist to speculate or theorize on rights and wrongs Limited to the moral and social Limited to biological sciences
A suggested definition an ideology assigned to respond to management-care decision-making with respect to life/death-orientated issues of animals’ and Man’s cells, self, family, society, environment and future
Principles of Biomedical Ethics • Respect for Autonomy • Nonmaleficence • Beneficence • Justice
Respect for Autonomy • Specific Conditions • Acting intentionally • Acting with understanding • Acting without controlling influences that determine their action
(i) Acting Intentionally • Not a matter of degree • Acts are either intentional or non-intentional
(ii) & (iii): Acting with understanding, and without constraint • Broad continuum exists • From children to the elderly “For an action to be autonomous in this account, it needs only a substantial degree of understanding and freedom from constraint, not a full understanding or a complete absence of influence”
When is an action deemed substantial? • “The line between what is substantial and what is insubstantial often appears arbitrary. However, thresholds marking substantially autonomous decisions can be carefully fixed in light of specific objectives, such as meaningful decision-making. Patients and research subjects can achieve substantial autonomy in their decisions, just as substantially autonomous choice occurs in other areas of life, such as buying a house or choosing a university to attend. According, appropriate criteria of substantial autonomy are best addressed in a particular context”
Autonomy versus Authority Is there an inconsistency between these two? “...individuals can exercise their autonomy in choosing to accept an institution, tradition or community that they view as a legitimate source of direction”
‘Means’ and ‘Individuality’ • Hence if a patient’s understanding is poorly inhibited and/or a patient’s freedom to act is compromised, such a person’s autonomy has been impaired • Kant: they have been used as a ‘means’ rather than an ‘ends’ • Mill: their ‘individuality’ has been sacrificed
Harris’ Classification of Factors that Undermine or Diminish one’s Autonomy • Defects in the ability to control either one’s desires or one’s actions or both [mentally ill, drug addiction... ] • Defects in the person’s reasoning [smoking...] • Defects in the information available to the individual, upon which one bases one’s choices [doctor-patient settings...] • Defects in the stability of the person’s own desires
Nonmaleficence • Summarized by the maxim ‘above all do no harm’
Concept of harm • X harms Y X wronged Y or treated Y unjustly X impaired Y’s interests Harmful actions are prima facie wrong because they “thwart, defeat or set back another party’s interests” In some cases harming may be justified and in most cases not. Harm can encompass a wide spectrum; but “everyone agrees that significant bodily harms and other setbacks to significant interests are paradigm instances of harm”
Withholding vs Withdrawing • Not starting versus stopping treatment • Omission versus commission treatment • Is there a moral difference? • Does our responsibility differ either way?
Ordinary vs Extraordinary Treatments • With or without reasonable hope of benefit • Degree of burdens to patient and society
Doctrine/Rule of Double Effect • Intended effects versus merely foreseen effects
Beauchamp & Childress Model • Patient’s interests have to be analysed • Futility and pointlessness of treatment • Burdens of treatment outweigh benefits
Principle of Beneficence • In addition to treating patients as an ends in themselves and not harming them, we must also contribute to their welfare • Its more than just refraining
Two sub-principles of Beneficence • Positive beneficence: providing benefits • Utility: since providing benefits inevitably comes with a degree of harm, balancing these to get the overall good must be established
Arising Conflicts... • Where beneficence and autonomy conflict • Where beneficence and nonmaleficence conflict • Primacy of which? Why? • Primacy of another principle?
Principle of Justice • Right to a decent minimum of healthcare • Allocation of healthcare resources • Rationing and setting priorities • Screening potential patients
Personal Identity Equation • Person 2 today (t2) is one and the same person as P1 at some past time (t1) if and only if P2 and P1 behold the same x properties • X: that which constitutes what we essentially are: • Biological organisms • Brains • Psychology • Souls
Surgery. 1971 Jul;70(1):135-9. Cephalic exchange transplantation in the monkey. White RJ, Wolin LR, Massopust LC Jr, Taslitz N, Verdura J.
Shoemaker’s Thought Experiment My brain is removed from my body, kept alive, and then hooked up inside a new skull and body, exactly similar to my old skull and body. My old body is destroyed. The resulting person has my brain and a new body. Since my brain directly supports my mental life, the new person is psychologically continuous with me…
Summary Sex, gender and psychology are accidental and secondary to the ‘I’ Altering one’s gender is a surety in the future One’s ‘I’ need not be on a par with one’s psychology The ‘I’ follows the brain The ‘I’ does not equal the material brain Brain transplantation, whole-body donation or trans-chromosomal surgery will benefit Man provided that their required technologies are perfected
Hierarchical Order of Investigation 1. Transmitted texts: Quran and/or Traditions • Sunni: Quran and traditions of Prophet Muhammad alone • Shiah: Quran and traditions of Prophet Muhammad plus his 12 successors 2. Non-transmitted sources: • Sunni: consensus (ijma) analogical reasoning (qiyas) public interests (masalihmursalah) : equity (istihsan) slippery slope arguments (sadd al- thara’i) • Shiah: rationality(aql): horizontal to the transmitted sources • procedural principles: vertical to the Quran, traditions & reason
Human Cloning according to the Quran/traditions • No reference to human cloning due to the nature of the subject • The shi’ah convert their line of reasoning into a purely rational consequentialist methodology. From now on, all things are deemed legitimate until: • Either serious side-effects are believed to occur: physical, social, psychological... • Or, it contradicts any injunction ordained by the Quran or traditions • The sunni school deny rationality any role and employ analogical reasoning as their first route of action
Human Cloning according to Shi’ism Due to a lack of reference of transmitted texts, the principle of prevalence of liberty is executed. Both therapeutic and reproductive human cloning are lawful Assuming any serious side-effects are substantiated or rationally feared of, the permissibility to clone may be temporarily over-ruled
Who are the cloned child’s parents? • predominant view: parents = genetic (chromosomal) parents • a number of potential mothers exist, not all approved of by Islam • Breast-feeding mother • Gestational mother: Khui vs popular verdict • Stepmother • Mother by adoption (not permitted in Sunnism) • Children only inherit, canonically, from their genetic parents • Children that share genetic, gestational and breast-feeding mothers become related – half-brothers and half-sisters – and so intra-marriages between them are impermissible.
Natural fertilization ♀/♂
