BIOS 384 - Bioethical Problems in Biology and Medicine
Five Quarter Hours

I. PREREQUISITES
9 hours in BIOS or MICR or PBIO.

II. COURSE DESCRIPTION
Bioethical (medical ethics) issues are becoming more and more noticed among the general public. Recently a local newspaper carried a year-end story dealing with events of a bioethical nature. The ten events follow: universal health care (in view of the enormous costs of health care), unequal and uneven health care for persons, testing for HIV of health-care workers and patients, notifying patients of their rights, euthanasia and/or doctor-assisted suicide, deaths due to epidemics and destruction from war, babies born to be “parts” donors, a surrogate grandmother who bore her daughter’s twins, the federal rule forbidding doctors in family planning clinics to mention abortions as an option for pregnant women, the use or misuse of Norplant (a long-term implanted contraceptive).

As you can see from the list, it is not exhaustive, but nevertheless raises some important ethical issues. One of the bright spots is that these issues are becoming more familiar to the general population and as a result, discussion is becoming more and more open among many people.

III. TEXTBOOK AND SUPPLIES
ISBN 0534504760 Beauchamp, Tom L. and Leroy Walters, Contemporary Issues in Bioethics, 5th ed., Wadsworth Publishing Co., 1999

...available from EdMap's distance-learning online bookstore.

IV. NATURE OF THE EXAMINATION
The examination consists of multiple-choice and short-essay questions; you will have some choice of essay questions.
You will have two hours for the examination. You must bring two #2 pencils to the examination site, all other materials will be provided. You are not permitted to use books, notes, or supplementary aids.

V. GRADING CRITERIA
The course grade is determined by your test score, according to the scale below:

100 - 85% = A
84 - 75% = B
74 - 65% = C
64 - 50% = D
Below 50% = F

This curve is somewhat more liberal than used in the classroom setting because the personal face-to-face contact is lacking.

Best wishes to you in the successful completion of this class. Congratulations on your selection of Ohio University for the continuation of your independent study program.

VI. BACKGROUND FOR BIOETHICS
In 1859 Charles Darwin published his famous work, The Origin of the Species. As expected, the work generated an extreme amount of discussion and controversy not only in the scientific world but in the theological and philosophical world as well. Darwin, with his thoughts on evolution, caused a major stir in the world of biology which is still in evidence today. Biology in the time of Darwin introduced the concept of change and evolution. The term evolution is derived from the Latin, evoleré, which means to unroll or unfold. This evolutionary theme is now the dominant theme of many biology courses, especially at the university level. The naming and classifying function has been delegated to a separate branch of biology, taxonomy and systematics. This shift in emphasis in the later years did not finally lay to rest the controversy in the biological sciences. With the continuing progress and technological advances in this field, many new and previously unthought-of problems came to light.

We could classify one of the later emerging problem areas as bioethics. As you can readily see bioethics is a combination of two terms, bio; (life) and ethics; (moral).

New and rapid advancements in the biological and medical fields (medicine is applied biology) have triggered many unanswered problems and questions. The emerging problems have outdistanced the legal systems which, in the opinion of many, have put us in a legal limbo or legal purgatory depending upon your point of view. The legal never-never land has caused an enormous amount of unrest and concern among health-care professionals, lawmakers, family members, and attorneys. (Your course author is married to an attorney who is a prosecutor.)

It is this legal limbo which has given a major emphasis or push to the field of bioethics. It is also this field which has forced the health-care professionals, the philosophers, the legal establishment and other interested persons to talk with each other to try to iron out some of the problems which have arisen as a result of the modern technology. As you progress through the reading, you will probably become aware of the fact and experience a sense of frustration from the lack of concrete and absolute answers. It is reasonable to expect this attitude to be quite common to persons trained in the sciences who are used to dealing with facts and figures. It is this shift from the concrete to the abstract which is the cause of much frustration and consternation for bioethics students who come from the biological science orientation (such as your author).

Major Ethical Theories
Many people have a tendency to think of bioethics as a newly emergent field of study which, in a way, it is. However, if they look, historically, at some of the early philosophers, they were primarily called "natural scientists." Plato and Aristotle, for example, were pretty fair scientists in their own right even though they were mainly known as philosophers. This is probably a good place to consider a definition of ethics. Ethics, according to Frankena, "is a brand of philosophy; it is moral philosophy or philosophical thinking about morality, moral problems, and moral judgement." Ethics is becoming an increasingly important consideration in many fields of study, not only in the biological sciences but in business, the environment, population, law, etc. Hopefully this increase in interest in ethics will persist, and the field will become an important part of the lives of all people.

The ethical problem or problems arise when we pass the stage bounded by traditional laws, rules, and regulations enacted by traditional legislative bodies. As a result of passing through this stage(s), we enter the area of internalized thinking or thinking for ourselves in critical and general terms, and, in this specific case, become autonomous moral agents.

Frankena lists three kinds of thinking which relate to morality in one way or another.

Professor Gordon Groby, recently retired from the Lancaster Campus of Ohio University, summed up some major ethical theories as follows:

Utility Theory (Utilitarianism)
Utility theory is probably the most long-lived and persuasive of all, despite its obvious difficulties. Its major tenet is that rightness or wrongness of an act or practice is wholly dependent on the consequences thereof. So it may be called a consequentialist theory. Morality depends on a realization of values moral or nonmoral. On the other hand, consequences are irrelevant to duty theories. If the supreme value is taken to be pleasure, then one has hedonistic utilitarianism. But if happiness is the test, then the theory is better called eudaemonistic. (Four possible views of happiness are the essentialist, for human good, the plan-of-life, and self-evaluative).

There are problems with utility theory. For one thing, there do seem to be moral absolutes (the Law, the Right). Again, how can we know actual or even probable consequences? And couldn't an act both have good consequences and still be wrong—or have bad consequences and still be right? In the third place, what is the right standard of values? What ought people to value?

The strength of utility is that we do seem to appeal ultimately to utility to resolve moral dilemmas (duty, obligations, laws) with respect to consequences.

Deontological Theory: Kant and Ross
Immanuel Kant gave us the most powerful statement of deontological ethical theory, sometimes called duty, moral obligation, or nonconsequential theory. For him, an act is morally right because it is of a certain kind, and only if it is done only from duty (not merely in accordance with it) so motive or "the good will" is all important. He summarizes his theory in various statements of the "categorical imperative," as opposed to the "hypothetical imperative," or pursuit of happiness the principle of utility. Key concepts elucidated by Kant are: universality, respect for law, "the kingdom of ends," and respect for person. His emphasis was on individual rights and human dignity as opposed to the common good (utility). A major shortcoming of Kant's theory is in its failure to provide any help in deciding between conflicting duties which, after all, is the point where moral problems develop.

In the twentieth century, Sir W. D. Ross has attempted to fill this gap. He speaks of a "hierarchy of duties," but does not get far in constructing such a scale, except to show that retrospective duties (like promising) are more demanding than prospective ones (the concern of utility). "Prima facie duties" is his most significant contribution. Basically, he relies on moral "intuition" for actual moral judgment a very shaky foundation.

Natural Law Theory
This is the official basis of Roman Catholic morality, shared by many non-Catholics. Its origins go back to Aristotle, transmitted through the Stoics and Thomas Aquinas. All doctrines about the universal brotherhood of man, and of human rights, have their origin in natural law. "Follow nature" is the basic precept, and the more sophisticated "Suum Cuique tribureri, nocere non laedere," which means "To each and everyone let it be granted not to harm nor to wound." The teleological bent is obvious: everything has a "natural purpose"; and of course, the usual formulations are as much theological as ethical. The principles of double effect and of totality are important in the practical application.

The theory gives clear judgments about abortion, euthanasia, human experimentation, contraception, and the like. But, if the universe is not teleological, but instead morally indifferent and the product of evolution (natural selection), then the theory loses its support.

John Rawls' Theory of Justice
Rawls may be the most important moral and political philosopher of the century. In A Theory of Justice (1971) he sought to strengthen the values of utility theory and the deontological viewpoints of Kant and Ross, while correcting their shortcomings. He defines justice as fairness, and tries to show how this concept can be developed from the "original position." He believes that a group of rational, self-interested persons, deliberating behind a "veil of ignorance," would choose his principle over that of utility. The "maximin" game also would rule out taking the chance on inequalities which might benefit oneself. Two principles evolve from the concept of justice: The "lexically prior" one of liberty, and the "difference principle" which makes some inequalities not unjust. Briefly, a practice is just if it benefits everyone, or makes the worst off better off. The criticisms most often brought against Rawls' theory are that he biases his case at the original position by denying the information a moral agent needs to make judgments; and that, in some hard cases, his outcomes are hardly distinguishable from those of utility theory. (Note that no later theory has yet solved Kant's problem of the ranking obligations.)

Beauchamp and Walters expand on these rather abbreviated definitions above in Part I of the text. If you are not the philosophical type student, you may find it beneficial to make a brief outline of Part I in the text (pp 1-29). Your text offers excellent suggestions for further reading(s) listed under the notes and suggested readings. It is, however, beyond the scope of this course (and the examination) to go beyond the readings in the text.

It may also be helpful to summarize what you have read after each major section, covering what you have read, what was the problem or ethical dilemma, what ethical or moral principles were involved and what, if any, resolution was there.

Best wishes with your studies in this field.
– D.M.