Church & Society
Azusa Pacific University
Church & Society
February 4, 2002

I.   Definition: the study of ethical issues that arise in health care and the biomedical sciences
A.   Example: dying on life support - do you turn off the machine (what type of question is that)
B.   The goal is to understand issues and possible behavior from different perspectives
C.   Asks deep philosophical questions (ex. What is the meaning of life)
D.   Government/philosophers deal with these issues
E.   Medical Ethics
1.   Narrower field dealing with ethical doctor/patient relations and virtuous doctor behavior
2.   The goal of medical ethics is to establish rules for behavior and actions
3.   Asks practical questions (how do you treat y our neighbor)
4.   Doctors and hospital administrators deal with this issue
II.   History of Bioethics
A.   Medical ethics (1750 BC)
1.   Hippocratic oath
a.   No one knows when it developed
i.   Late as 5th century BC
ii.   Early as 1st century AD
b.   Balance between two concepts
i.   Principle of beneficence - doctor must act to best help the patient
ii.   Non malfeasance - doctor must seek to prevent harm (societal)
c.   Cannot charge excessive fees
2.   Christian origins
a.   Many strong evangelistic movements have origins in the common societal need of helping others
b.   Since the 1960s, Christianity has backed away from this ministry
c.   The upcoming years will have a huge ministry with geriatrics
B.   Nursing ethics (began late 1800s)
1.   First major nursing ethics took place in 1901
a.   Nurses primary responsibility was to the doctor
b.   Follow doctor's orders no matter what
2.   In the 1970s, nurses responsibility shifted from doctor to patients
C.   Bioethics (developed in the 1960s)
1.   1970s is when it really developed
2.   Philosophers starting taking on tough issue
a.   Issues of pulling Life Support (1962)
b.   Heart transplant (1967) - needed new criteria for death so we could use these organs (concept of brain dead arouse)
c.   Issues of abortion (legalized in early 1973)
d.   Non-treatment of severally injured infants (1973)
e.   Patients rights
f.   Human experimentation rights
i.   Prior to 1970, patients were injected with live cancerous cells with out their consent
ii.   Mentally retarded children were inoculated with the hepatitis virus
III.   Bioethics and ethical theory
A.   Relating the two
1.   Ethical theory is more interested in general ethical principles (theory)
2.   Interested in particular cases and situations in the real of medicine reflecting a broader scientific/medical concerns (application)
B.   Bioetics is much like theology
1.   Theology
a.   Traditional: theory to practice
b.   Practical: practice to theory to practice
2.   Bioethics
a.   Method one: ethical theory (theory) to bioethics (practice)
i.   Reasons it doesn't not work
a)   There are different theories (See III.B.2.c. - below)
b)   Moral questions are complicated - cannot have the same set of rules
b.   Method two: bioethics (practice) to ethical theory (theory) to bioethics (practice)
c.   Theories
i.   Consequentialist - this behavior is right is because it has a good result
a)   Egoism - it is right because it is good for me
b)   Utilitarianism - most benefit for most people
ii.   Non-consequentialist - the action is what is important not what the outcome is
C.   Case study approach
1.   Midlevel principles express common sense views of right and wrong
a.   It's always wrong to take a life to save a life
b.   It's always right to save as many people as possible
c.   Theories regarding higher level ethical questions
i.   Kantianism - if something is ethical right/wrong it is always right/wrong
ii.   Utilitarianism - something is right/wrong depending on what does the most good
2.   Physics/car mechanic model
a.   Cars work on the laws of physics
b.   Mechanics do not usually apply physics to fix cars
c.   Mechanics learn how the devices work
d.   Andy's problem with this theory: this theory works fine for working with what has already been developed (i.e. a carburetor), however, engineers who must "reinvent" or "improve" the car parts, they must return to theory before they can do anything - therefore this theory may work at lower level decisions but when it comes to higher level philosophical questions that deal with the corporate understanding of ethics, we must apply theory before practice
3.   Biology/surgeon model
a.   Surgery works in relation to biology
b.   Does a surgeon think of biological principle