Throughout human history, human rights have been violated on many occasions, there have been both negative and positive repercussions on scientific advances in biomedicine in human life, and the advancement of industrial society has been prioritized at the cost of the damage that could be generated in ecosystems. In response, by way of awareness, a new area was created a few decades ago within general ethics: bioethics .
As we shall see, defining bioethics is not a simple matter. There is a great number of guidelines that make up bioethics, which nourish it for the analysis and resolution of problems that have justified its appearance.
Definition of Bioethics
Bioethics is a branch of ethics, responsible for providing and examining the principles of conduct best suited to human beings in relation to life (human, animal and plant life). Among the many definitions of bioethics, we can say that it is the systematic study of human behavior in the field of life sciences and health care, examined in the light of values and moral principles.
We must clarify that unlike medical ethics, bioethics is not limited to the medical environment, but addresses multiple issues (e.g., environment and animal rights).
In short, it is a question of reflecting ethically on the moral problems of the contemporary plural society in which we are immersed. Above all, it focuses on the professions that are part of the health field, such as Clinical Psychology.
Some of the best known issues within applied bioethics are:
- Abortion and the state of the embryo
- Genetics and human cloning
- Research and clinical trials
- Environment and animals (within this area the author Peter Singer stands out)
- The doctor-patient relationship
- Organ donation
- Treatment of pain
Brief historical evolution
This is a relatively young discipline, as it has less than half a century of history . Furthermore, it has become an area of obligatory study within research and medicine, and over the last 30 years its body of knowledge has expanded, becoming one of the most up-to-date branches of ethics.
The origin of the term is somewhat controversial: some advocate the German theologian and philosopher Fritz Jahr (1927), who used the term Bio-Ethik in an article related to ethics for plants and animals. Other authors highlight the oncological biochemist Potter, who in 1970 used the term bio-ethics in an article, and a year later published a text entitled “Bioethics: bridge to the future”.
But if there is one thing we must highlight in the history of bioethics, it is the Belmont Report (1978). It was born out of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in the United States, after the ravages of the well-known Tuskegee experiment (on untreated syphilis in African Americans). This text sets out the principles or criteria to guide human research in biomedicine. Today the Belmont Report is still considered a reference text for researchers.
Major Principles of Bioethics
We will now explain the four major principles of bioethics, proposed by Beauchamp and Childress (1979):
Autonomy reflects a person’s ability to make decisions about himself without outside influence, to his privacy and self-determination. This principle may not be applied when situations arise in which the person cannot be 100% autonomous or has reduced autonomy (e.g., vegetative state).
The maximum expression of this principle would be the informed consent of the patient. It is a right of the patient and a duty of the professional who treats him/her. In this sense, the patient’s preferences and values must be recognized and respected. This principle is also applied in Psychology, and the informed consent of patients, whether adults or children (through their parents or legal guardians), should always be obtained.
It is the obligation and duty of the professional to act in the best interests of the patient or others. It is intended to promote the legitimate interests of the patient and to eliminate as far as possible any prejudices. It would be like “doing what is best for the patient”.
The problem that arises from this principle is that sometimes the benefit of the patient is promoted but his or her opinion is not taken into account (e.g. the doctor has training and knowledge that the patient does not have, so the doctor freely decides what is in the best interest of the person). In other words, in these cases, the patient’s opinion is ignored because of his or her lack of knowledge.
The principle of beneficence depends on that of autonomy , it would be like doing the good that the patient consents or requests.
This principle seeks equality and to reduce discrimination on ideological, social, cultural, economic, race, gender, sexual orientation, etcetera . It is recognized that all persons have the right to the benefits of medicine, or psychology, for example. The aim is to provide all patients with the same quality, care and services in all interventions.
In psychology, for example, no discrimination or prejudice of any kind is accepted.
This principle is applied in a qualitatively different way depending on the country. For example, in the United States, medical care is based on insurance contracted with private companies, so there could be discrimination on economic grounds. In Spain, health care is free and universal, based on a principle of necessity.
This principle is based on refraining from acts that are intentionally harmful to the person. In other words, not to harm the other unjustifiably or unnecessarily.
In some disciplines this principle can be interpreted with nuances, for example:
In medicine, sometimes medical actions cause harm to the patient but the aim is to obtain his or her well-being (e.g. a surgical intervention).
In Psychology, asking the patient to be systematically and gradually exposed to situations that generate anxiety, fear, anger, etc., may be harmful or painful for the patient, but the ultimate goal is his or her psychological well-being and the overcoming of the problems.
There are other considerations in this principle: the professional must commit to having a training based on solid and scientific knowledge , he must update his knowledge (based on evidence and not on pseudosciences) in a permanent way in order to practice at a professional level, and he must research on new treatments or therapies in order to improve and offer his patients the best care.
As the deontological code of psychologists says, “without prejudice to the legitimate diversity of theories, schools and methods, the psychologist will not use means or procedures that are not sufficiently contrasted, within the limits of current scientific knowledge. In the case of research to test new techniques or instruments that have not yet been tested, he/she will inform his/her clients before using them” (…) “It is part of his/her work to continuously update his/her professional competence” .