Bioethics 101

What is "bioethics"? It may be defined broadly as the field of study and practice dedicated to discerning and doing what is right (morally acceptable) in circumstances affecting the life, health or well-being of persons, potential persons (such as frozen embryos), animals, and the living environment surrounding us on planet Earth.

Healthcare bioethics is concerned with the life, health and well-being of persons and potential persons. This field covers a wide range of topics and situations, including: in vitro fertilization, stem cell research, genetic testing, access to medical care, privacy of medical records, end-of-life treatment, and much more.

The basic principles of bioethics are the following:

• Nonmaleficence ("Do no harm") -- Medical practitioners must refrain from doing anything that could worsen a patient's condition.
• Beneficence ("Do good") -- Medical practitioners must take all actions necessary and reasonable to improve the patient's condition. This includes providing the patient with adequate relief from pain and suffering ("palliative care").
• Autonomy -- A patient is an autonomous individual, which means she has the right and authority to refuse medical treatment, or to choose from among treatment alternatives that have been fully explained to her. If a patient is not conscious or has lost the mental capacity to make decisions for herself, we can still adhere to this principle by acting upon any advance directive she has signed, or by looking to the person she has appointed as attorney-in-fact or healthcare proxy to decide for her.
• Justice -- This principle of bioethics is concerned with the fairness of the ways in which medical care is provided, and in which medical research is conducted. Should all peoples in society have equal access to equally good medical care? If we want everyone to have such access, how do we achieve that? If pharmaceutical companies are enrolling certain populations in research trials of new medications without fully informing them of the potential risks, how do we stop that practice and prevent it from reoccurring? These questions are among the multitude of questions the justice principle requires us to examine.

Clinical ethicists are often called upon for assistance in the hospital setting. Sometimes, members of a medical team may disagree about the appropriate treatment for a patient. An ethicist can help the team members explore all the options and the ethical ramifications of those options, and guide them toward reaching a resolution. At other times, a patient's family members may disagree about whether their loved one, now unconscious and connected to a respirator and feeding tube, would want to discontinue treatment. An ethicist can help the family re-examine discussions they had with the patient in the past and talk to them about the ethical principles relating to their situation, in order to help them come to an understanding of what the patient would likely decide for herself and to provide ethical support for the decision they must reach. An ethicist never makes the decision for others, but merely informs, guides and advises.