Bioethics
1) Principles of bioethics:
Non-maleficence:
Do no harm, or the principle of non-maleficence, states that a healthcare professional should operate in a way that prevents harm from occurring, even if the patient or client asks it. Due to its historical precedent, this principle was the first to be put forth. It is similar, though not exactly the same as, the renowned Hippocratic dictum of medical ethics, “primum nil nocere”—first of all, do no harm.
Degrees of harm are frequently “traded off” in public health policy and practise when there is a chance of greater harm or perhaps a positive benefit. For instance, prohibiting smoking in public places may harm some smokers individually, but it will likely prevent greater harms (and possibly produce benefits) by serving as a general disincentive to smoking among a larger population. The burden of proof changes to individuals engaging in potentially harmful behaviour when the non-maleficence principle is taken into account, at least.
Beneficence:
The duty to act in a patient’s or client’s best interest is closely related to the duty of non-maleficence. The other tenet of the Hippocratic tradition stands out due to its apparent self-evident significance: doctors should treat and assist their patients in accordance with their skills and judgement. The clear distinction between the principles of beneficence and non-maleficence is that the former entails active contribution to the wellbeing of others, whilst the latter generally – though not always – requires the omission of harmful conduct.
Health maximisation:
Both deontological and consequentialist perspectives can be used to understand beneficence and non-maleficence. However, as principles, they don’t seem to align with the essential concepts of public health. This is due, at least in part, to their propensity to be utilised in conjunction with and to analyse specific professional-client interactions. The population is not at all within the focus of these micro-encounters, therefore even when beneficence and non-maleficence are followed in these individual encounters, it does not necessarily indicate that population health is maximised. The improvement of the general people’s health is the major goal sought in the field of public health, and this is the primary metric used to assess progress. In actuality, the pursuit of beneficence and non-maleficence on the one hand, and the maximisation of population health on the other, may clash.
Therefore, understanding the moral need to produce benefit in a broader sense and speaking of the duty to “social beneficence” are two ways to conceptualise the moral impulse of beneficence in terms of public health. Here, we’re referring to the notion that public health professionals have a duty to promote health in the communities they are in charge of. In reality, we prefer to refer to this obligation’s guiding ethical premise as one of health maximisation. The reason for this is that, as implied by the concept of “social beneficence”, we need to be more precise than merely asserting that public health practitioners have a duty to produce benefit.
Benefits (at both the individual and, especially, the community level) are contested concepts that aren’t always believed to be synonymous with “health”. It seems absurd to suggest that public health professionals are primarily interested in benefits other than maximising health and opportunities for health. Accordingly, we contend that a specific maximisation of health principle should make up the third of the mid-level principles.
None of this, of course, negates the concept of health’s subjectivity or the likelihood of fundamental disagreement regarding the precise goal of our efforts to maximise health. Maximizing (population) health should take precedence over broader ideas of the “(common) good” (however that term is defined), which may well fall outside the purview of public health.
Efficiency:
There will always be greater healthcare needs than available resources to address those needs. Resources are an absolute necessity for all public health (and healthcare) systems globally. The moral obligation to make effective use of the limited health resources is encouraged by these two assertions. Effective utilisation will allow public health specialists to deliver more health benefits for a larger population, which is at least one of the reasons this duty exists. In order to decide what should be done and how to do it, a moral principle of efficiency would, for instance, require the use of the evidence base and the completion of cost-benefit evaluations.
However, there is an equal challenge here as there was with the issue of determining the precise nature of the “health” that we are supposed to be maximising in the prior principle. Efficiency is a complicated concept, as are its related ideas like “cost” and “benefit”. Are we, for instance, restricting our perspectives on these issues to the health sector alone or to the impact of the intervention on the larger social fabric and the management of public services when weighing the costs and benefits of carrying out (or not carrying out) a specific public health intervention?
Additionally, it is imaginable to think of limited or no activity in the realm of public health as constituting “efficiency” in the sense of negligible resource input returning small results but the cost-benefit ratio seeming appropriate in simply economic terms. Here, it is important to stress the moral relevance of the efficiency principle, which must be distinguished from other efficiency factors like economics. Efficiency and the concept of “effectiveness” are commonly related.
Respect for Autonomy:
The emphasis on respecting the autonomy of the patient whom the healthcare practitioner is trying to assist severely tempers the paternalistic kindness contained in the concepts of non-maleficence and beneficence. But the value of respecting one’s autonomy goes beyond the realm of personal healthcare; it is critical in the context of public health. Concern for individual welfare may be neglected due to the public health’s frequent emphasis on population benefits.
Every person has a high worth – qua her or his autonomy – and cannot only be considered as a means to others’ good, which is why respect for autonomy must be firmly ingrained in public health ethics teaching and learning. Despite this, the conflict between individual liberties and
more general notions of the public good has a significant impact on the practise of public health.
We claim that in situations where autonomy restriction is being considered for broader public health goals (such as legislation banning smoking in public places or limiting movement during periods of contagion), the burden of proof for doing so must always lie with those advocating restriction. This tension and the relative command that such broad conceptions of benefit frequently seem to possess, prompt us to make this claim.
Justice:
Equally plausible is the idea that the fundamental value of individual autonomy serves as the foundation for the justice principle, which is also referred to as “social justice”. We all have equal moral worth since, as humans, we all have (or ought to have) autonomy. Therefore, the burden of proof is once more required for recommendations for uneven treatment of people. On the other hand, justice requires equal opportunity. This also involves a fair distribution of health outcomes among cultures, or what is commonly referred to as “health equality” in terms of public health.
Daniels views health equity as a question of justice and fairness in his widely-used idea of justice in the context of health. If the socially controllable elements that influence health are not distributed so that everyone’s health is safeguarded or restored to the greatest extent feasible, then health disparities are unfair and unjust, and thus at odds with health equality.
We owe each other equal access to health resources and protective factors for health because of the crucial role that health plays in the formation and development of every part of our equally valuable human lives. The concept of justice also encompasses the normative elements that are frequently articulated in terms of reciprocity and solidarity. Justice accomplishes this by providing a response to the query of what we owe to one another. We solely concentrate on justice in order to have a succinct set of principles.
Proportionality:
Proportionality is unquestionably a normative principle. It necessitates that considerations be given in a proportionate manner when weighing and balancing individual freedom against larger social goods.
In order to demonstrate that the anticipated public health advantages outweigh the general moral considerations that were violated, proportionality must be demonstrated, claims Childress et al. The policy might, for instance, violate someone’s autonomy or privacy and have negative effects. All benefits and advantages must be weighed against disadvantages and drawbacks.
Proportionality is a methodological principle, nevertheless. It serves as the foundation for casuistic reasoning in connection to issues of individual welfare vs collective benefit in public health, in a manner distinct from the principles we have thus far explored. For instance, Singer et al. contend that the discovery of Chinese ancestry in the Canadian SARS outbreak shows the fundamental necessity for careful assessment prior to the dissemination of private information in cases of pandemic disease.
Beyond this, discussing how to allocate resources, where to place individual responsibility, and fundamental rights in the area of health and health care are just a few of the major ethical issues in public health policy and practise that can be discussed by balancing private interests against public ones. This definition of the principle as somewhat methodological is influenced by the idea of arguing the proportionality of actions and the aid it offers in developing understanding of situations. Although it is a methodological concept, it’s mentioned because it is normative and, like the other principles so far covered, it provides public health practitioners with crucial moral direction at the very least.
2) Fritz Jahr and Bioethics:
The word “Bioethics” was first used in 1975 by American oncologist Van Rensselaer Potter to describe the “science of survival”. In this way, he laid the groundwork for a brand-new field of study whose mission was to safeguard all living things, including humans, from the risks posed by the advancements and uses of new medical sciences and technology.
Potter’s goal in creating bioethical science was to extend a barrier from humans to all other living things, or to all of nature, against the hazards and perils that might result from the rapid advancement and applications of physical sciences to the living world. Therefore, his concern was not purely anthropological. Instead, it was broader since it covered all living things, including nature itself, including both plants and animals equally. From this vantage point, his concern was environmental in modern terms.
Before Potter’s time, in 1926, the German protestant theologian Fritz Jahr (1895–1953) used the term “Bioethics” for the first time in a considerably broader sense. According to Jahr’s essay “Life sciences and the teaching of Ethics” from 1926, the term “bioethics” is used to refer to the branch of human science whose goal is to safeguard all living things as well as the natural world against needless harm and destruction. He certainly has an environmental viewpoint in addition to an anthropological one.
He claims that in addition to biology, which covers both zoology and botany, there is also anthropology, the study of man. He goes on to say that modern psychology, in a similar vein, compares the human soul to that of animals rather than focusing solely on man. In addition, he discovers the beginnings of a plant psychology in some German writers, which prompts him to adopt the name “Bio-Psychics” in accordance with R. Eisler’s suggestion. He comes to the conclusion that there is a very little transition from biology to bio-psychics, and then from there to bio-ethics. According to Jahr, bioethics suggests that we have moral obligations to all living things, not only to humans.
Fritz Jahr foresees everything that Van Rensselaer Potter and the other environmental philosophers will do in the late 20th century from this perspective, with one exception. While Fritz Jahr does not share Potter’s desire to save humans and all other living things from the potential threat posed by the tremendous advancement of medical and genetic technologies, it is the case with Potter. When Jahr wrote his essays in the first half of the 20th century, the medical and genetic sciences had not made as much progress.
As a result, Jahr was more concerned with preventing the needless destruction of all living things than with safeguarding living things from the risks and harms that genetic technologies may cause. Therefore, he proposes the field of bioethics, which analyses the moral duties we
have to all living things in order to keep them safe from any threat, as opposed to the specific dangers and risks associated with the use of genetic and medical technologies.
When he coined the term “Bioethics” in the 1970s, Potter had this latter idea of protection in mind. In light of this, Jahr and Potter both introduce the term “bioethics” with the intention of protecting all living things. However, Jahr refers to this protection as being against all threats, whereas Potter refers to it as being against the harms specifically caused by the use of medical and genetic technologies.
It becomes clear that there is a complex relationship between Jahr’s Bioethical Imperative and Kant’s Categorical Imperative, regardless of the phrasing. As a result, the two have a lot in common despite their stark contrasts. Starting with the commonalities, Kant decides to define our duties toward every human being as a requirement set forth by moral law, or more specifically, by practical reason.
In a same vein, Jahr views our responsibilities to all living things as an imperative. We may therefore claim that Jahr and Kant both think of our duties toward one another and other living things in terms of an imperative that forbids us from failing to carry them out. However, this is where the similarities between the two types of imperatives end and the distinctions between them start.
Kant’s Categorical Imperative is essentially formal and is based on practical reason. On the other side, Jahr’s Bioethical Imperative is based on love and compassion, some truths about human psychology, and it is empirical. This distinction has the logical effect that although Jahr’s Bioethical Imperative is conditional and can accept exceptions, Kant’s Categorical Imperative is essential but does not allow for exceptions and cannot be delayed.
It is true that Kant’s main contention is that only sentient, reason-bearing living things—both human and nonhuman—possess moral agency. This should not be interpreted to mean that he disrespects or undervalues non-human living things or other forms of nature, both organic and inorganic. We have obligations toward other objects that we owe to ourselves, he explains in The Metaphysics of Morals. Kant believed that a tendency to destroy inanimate nature, for example, contradicts our responsibility to ourselves.
This undermines our feelings, which, while not moral, serve as the foundation for morality. Similarly, being harsh to animals goes against the obligations we have to ourselves. Because such aggressive behaviour affects the innate desire we all have to empathise and understand the pain of all creatures, these innate tendencies are progressively uprooted and destroyed, which has a significant negative impact on the development of our moral behaviour toward other people.
In other words, Kant holds that through showing respect for non-humans and inanimate objects, humans might gradually develop the instincts that will lead them to act morally in their interactions with other people. He also mentions honouring what is imaginable via the use of practical reason and exist outside the realm of experience. He refers to it as “a duty of religion” not “a duty to God” because that would be unthinkable. He implies that we have a responsibility to ourselves in terms of religion, which is to foster the natural emotions and tendencies appropriate to religion since they support moral law and morality in our conduct toward other people.
In order to grasp “the close conversation” that has been taking place between Jahr and Kant, Sass argues that it is not enough to see Jahr’s Bioethical Imperative as an extension of Kant’s formal Categorical Imperative, which includes a content-based principle. Furthermore, we must recognise that, in contrast to Jahr’s 1927 Bioethical Imperative, which had “the sanctity of life as its foundation”, Kant’s Categorical Imperative had its foundation in “the sanctity of moral law”. Kant declares that “the moral law is holy (inviolable)”. Although there are clear distinctions between the two, there are more commonalities than one may think.
As a result, Jahr develops Kant’s logical morality and transforms it into a form of theology. By expanding it to include all living things, he applies Kant’s Categorical Imperative. Jahr, like other theologians, is a strong realist, though. His theology would undoubtedly be applicable in the Garden of Eden. Every living thing would be revered and nurtured as if it were its own goal. However, the average person does not reside in the Garden of Eden; rather, they reside in the actual world, where it is not always simple to see every living thing as a means to an end. This is a reality that Jahr is aware of.
This is the reason he qualifies and makes a conditional statement out of his first, Categorical Bioethical Imperative, which is to “Treat every living being, if possible, as an end in itself”. This does not imply that he rejects or undercuts the categorical imperative’s necessary nature. Instead, it demonstrates that he puts out a bioethical imperative that can take into account the unforeseen events and conflicts that arise in actual life.
The “struggle for survival” is one of these conflicts, which Jahr addresses frequently in his articles. Jahr hopes to illustrate one of those life’s conflicts by the use of this concept, forcing us to use his Bioethical Principle in its conditional version.
In other words, we will not be able to treat every living thing as an end in itself, and we will have to prioritise some living things above others from a moral standpoint. However, using Jahr’s Bioethical Imperative in this situation does not refute the conditional nature of the principle. Instead, it demonstrates that it is a situation-sensitive necessity and, as such, has significant relevance to the problems that occur in real life.
3) Our ethical relation with animals and plants:
History shows that people have had mixed feelings about wildlife and the wilderness. Cave paintings demonstrate that hunter-gatherer societies viewed wild animals as objects of adoration in addition to using them as a source of food and fur. Additionally, other Christian traditions, such as St. Francis’ celebration of animals as “brothers and sisters”, interpret the value of animals very differently from the dominant Judaeo-Christian tradition, which views them only as human resources. The concept of wilderness has also been complicated and ambivalent; it has been seen as both a place of utter beauty and spiritual purity as well as one that is unsullied, chaotic, and frightening.
The sensible use of nature and the preservation of nature are the two basic approaches to managing wildlife and nature in general. Both of these strategies criticise the mindless marginalisation or extinction of nature. However, the two strategies diverge when it comes to the practical management of wildlife and nature. The smart use strategy seeks to accept humanity’s ongoing exploitation of natural environment as a source of food, raw materials, recreation, and lumber. The concept of prudent use is in line with our personal interests as well as the interests of future generations of humanity (this approach is often called
“sustainable use”). Management’s objective is to maintain and increase nature’s production as a valuable resource for humans.
On the other side, for a preservationist, the objective is to preserve untainted nature, and not to use it in any way. Projects to restore nature to a state that is similar to what it was in before human interference (such as pollution) may be allowed. However, outside of legitimate restoration situations, wild areas should be let to evolve naturally with the least amount of human intrusion, according to preservationists. Here, what is prized is the “otherness” or “naturalness” of the non-human world. Protected areas should only be used by humans for recreation, and only if that recreation leaves no trace behind.
An influential school of ethical perspectives known as contractarianism holds that morality developed — or should have developed — as a result of agreements or contracts that people made with one another. These agreements may guarantee people’s safety, enable them to benefit from cooperation, and through defending and advancing people’s interests, they can also help build a good society. Animals, however, cannot sign contracts.
Wild animals are therefore seen as existing outside the realm of ethics and serving primarily as resources for humans from a contractarian point of view. According to this perspective, the primary ethical requirement for wildlife management is to ensure that wildlife is managed sensibly, for the benefit of humans, and in ways that humans can accept. From a contractarian perspective, there may be very solid reasons to favour legally binding international agreements on the protection of endangered animal species because efficient conservation of nature and wildlife frequently necessitates concerted action at a global scale. The long-term objective will always be to make it possible for humans to exploit wildlife.
The ethical theory of consequentialism, on which utilitarianism is based, holds that we should strive to achieve the optimal outcome overall while taking into account everyone affected by the decision. According to utilitarians, the major value is welfare, which may be described as either pleasure or the satisfaction of one’s preferences or wishes, while the primary devaluation is suffering or the unfulfilled desires of one’s wants. Therefore, we ought to strive to reduce overall suffering or frustration and increase overall pleasure or satisfaction of desire.
Since the creatures we’re thinking about here have the capacity for suffering, we should consider their welfare while making management decisions. The management of wildlife will be significantly impacted by this viewpoint. Take hunting as an illustration. When sport hunting is likely to cause animal suffering without providing advantages similar to those provided to humans, it may be morally wrong to a utilitarian. Other types of hunting, however, can be allowed or even needed. Imagine that a herd of deer has gotten so big that there isn’t enough food to feed them all, leading to their suffering and eventual starvation. In this situation, lessening animal suffering overall may be achieved by humanely killing some deer. The extent to which wildlife management lowers or raises the general level of animal and human welfare is what counts in this situation.
Animal rights advocates assert that there are important similarities between humans and some other animals (such as being able to feel pain and having desires about their future). One such advocate is the philosopher Tom Regan (1983). According to this perspective, the holding of moral rights is based on these common capacities. Additionally, there are some things we may never do to an animal if it has rights. We shouldn’t harm, confine, or otherwise interfere
with the lives of wild animals. We have neither the right nor the obligation to manage wild animals through culling or other means. We also cannot deprive wild creatures of the land and other resources they need to live their natural lifestyles. Since we are allowed to defend ourselves against other people, this does not imply that we are unable to defend ourselves against wild creatures in the event of an assault. Furthermore, ecosystems might be maintained as necessary, so long as animals were permitted to carry on living the lifestyles they had evolved to have. However, a wildlife policy based on the viewpoint of animal rights would generally instruct us to simply leave wild creatures alone.
“Respect for nature” actually refers to a broad spectrum of beliefs that are concerned with principles other than those held by particular sentient creatures. Some of these viewpoints place special emphasis on preserving the value of naturalness itself. Others concentrate on biodiversity, maintaining the “integrity” of species, or preserving entire species. Others contend that native ecological communities, or ecosystems, are morally significant and ought to be protected as such. In his posthumously released essay collection A Sand County Almanac (1949), Aldo Leopold, who became the first US professor of game management in 1933, widely advocated for this viewpoint. According to all of these “respect for nature” viewpoints, the moral significance of each given animal relies on the extent to which it supports or undermines the important environmental values in question. Members of keystone species will therefore be particularly vital to an ecosystem, whereas invasive species that pose a threat to native species or the health of an ecosystem should be eradicated or eliminated.
This is a collection of related viewpoints that place equal emphasis on the moral significance of interactions between humans and animals. According to this perspective, humans have moral obligations toward wild animals that are somewhat different from those toward domestic animals. Domestic animals depend on people for both their mere survival (unlike wild animals) and their natures (via selective breeding), which frequently makes the relevant animals vulnerable and dependent in ways that wild animals are not. Therefore, even if we may have obligations to help starving or distressed domestic animals, such particular duties to care for animals typically do not fall under the purview of wildlife management.
It’s challenging to “choose” one of the aforementioned strategies and consequently reject the others given the plausibility of many of the ideals at stake. A hybrid perspective tries to incorporate at least some of these ideals. “Ecological ethics” is a significant hybrid viewpoint. This point of view calls for the development of a thorough, pragmatic, and pluralistic ethical framework with a case study database that research scientists and managers of conservation efforts can refer to when faced with challenging moral dilemmas. Diverse theories of ethics, research ethics, and environmental and animal ethics should all be included in this pluralistic ethical framework.
A hybrid approach is also developed by American philosopher Bryan Norton (Norton 2005), who makes a distinction between animals in wild, domesticated, and mixed environments (zoos, wildlife parks, and the like). According to Norton, we have an implied responsibility to meet the requirements of domesticated animals, thus we shouldn’t sacrifice the individual in favour of the welfare of animal populations or species. However, he contends that in the case of wild creatures, we should appreciate their fight to preserve their species as well as to preserve their own lives.
Respect for this conflict may allow us to forgo the needs of a single wild animal in favour of the welfare of the entire animal population. Norton’s approach is undoubtedly intuitively appealing, but from a utilitarian and a rights standpoint, it raises ethical concerns to sacrifice a single animal for the benefit of the population.
4) Its criticisms:
According to Robert Holmes, philosophical ethics cannot assist in resolving bioethical issues. He would at most grant that analytical ethics might contribute to some clarification. Philosophers disagree on how any one aspect of philosophical ethics relates to real morality. When there is disagreement over the best theory to use, it is impossible to “apply” a theory in a useful way.
Additionally, there is no method to settle disagreements among hypotheses. In actuality, a bioethicist just picks a preferred theory and, with the unintentional aid of fudge variables, comes up with a “solution” that he knew was already intuitively acceptable. Holmes claims that what is required is moral wisdom, and philosophy does not prepare one for that.
In the midst of offering a very constructive critique of bioethics, Baruch Brody gives a superb overview of the subject. He gives us a thorough overview of the main intellectual pursuits in bioethics and how they relate to one another. Then, in great detail, he demonstrates for us where each fails and what exactly would be considered high calibre work in that specific field of academia.
Ronald Green investigates the issue of method in bioethics thoroughly, and the results disturb him. He observes a lot of activity at the level of problem-solving but very little at the end of the spectrum associated with ethical philosophy. In terms of serious moral philosophy, bioethics would thus seem hyperactive but not sufficiently thoughtful. It is common to heavily rely on and be comfortable with merely “applying” predetermined moral principles. Professor Green makes an effort to explain why bioethics doesn’t pay enough attention to in-depth theoretical analysis.
An important term in bioethics, apply, is philosophically explored by Loretta Kopelman. That idea offers—or at least claims to offer—the connection between theory and actual morality. It permeates Holmes, Brody, and Green’s conversations. When arguing that what is “applied” in applied ethics is certain and cannot be modified by the act of application, Kopelman walks the reader through an investigation of that core notion and critically assesses those arguments (which arguably is the meaning of “apply”). This examination will determine whether bioethics (and any other “applied” fields of philosophy) are essentially derivative endeavours or whether they may represent potentially novel solutions to philosophical issues.
Focus is placed on what Clouser and Gert see as the inadequateness and misapplication of purported “principles” of bioethics. They contend that the “principles” aren’t really acting as action manuals at all. The best they can do is provide as a checklist of things to think about while considering bioethical issues. Additionally, there is no obvious connection between them; instead, they act as conflicting, unfinished ethical systems. These “principles” are not based on a single, overarching theory that explains how they are logically connected. Clouser and Gert continue by outlining how a comprehensive and appropriate moral framework would facilitate problem-solving and eliminate the need for “principles”.
The various articles all share a number of common themes. Each contributor supports the criticism made by the others while also presenting it from an intriguingly different angle. For instance, four of the papers (Holmes, Brody, Green, and Clouser and Gert) criticise the “principles” of bioethics in various ways, claiming that they are unreliable, contradictory, not grounded in a theory, hazy in their origin, etc.
But based on these findings, each author comes to a different conclusion, which can range from “give it up” to “try harder” to “develop a theory”. Even though it might be unusual for a reader to read a complete issue, in this case, they will be rewarded with a comprehensive critique of bioethics. Each article relates to the others in some way, supporting and completing some ideas while offering alternative viewpoints on others. Even if only due to an accidental succession of familial similarities, their arguments, themes, and criticisms make sense as a whole.
