INTRODUCTION IN

MEDICAL BIOETHICS

LECTURER, PH.D., PSIH. COSMIN POPA

 Qui prodest?
 What are the courses of this subject?
 Why should this subject be studied?
 How does the knowledge gained in this matter help in
medical practice?
 What are the aims and objectives of this subject?
 What is the structure of this course?
 How is the exam going to be?
 It is a compulsory or optional subject?
 How many credits are given for this course?
 Medical ethics and deontology
 Professional ethics can be defined as the science that deals
with the totality of behaviors, attitudes and moral habits
exhibited by a person in a gainful activity (Duţescu, 1980)
 A major contribution in medical ethics had the ancient healers
of ancient Greece.
 The contribution of Hippocrates in medical ethics today is also
reflected in the standards of medical ethics or profession.
 Medicine practiced by Hippocrates was founded on evidence
so that doctors at the time were interested in diagnosis,
syndromes or diseases, trying to gather as much adjacent
evidence such as the geographical area where the patient
lived, climate, age, sex, behavior and type of food, all in a way
reminiscent of how medicine is practiced today (Kleisiaris,
Sfakianakis, Papathanasiou, 2014).
 Medical Bioethics
 Medical Bioethics is the science that explores certain
questions or dilemmas related to life sciences and
medical issues from the ethical point of view.
 The analysis conducted by medical bioethics is
considered as defining, when people want to make
decisions about their behavior in a matter of medical
bioethics.
 Also, when desired disseminated new innovations and
biomedical knowledge to the entire population,
governments, organizations and communities use
bioethics to take the best decision in terms of ethics
(E.D.C., 2009)
 Medical Ethics vs. Medical
Bioethics
 Medical ethics and bioethics interfere as science, and are closely
related, but not identical.
 If ethics refers to the practice of medicine and the problems
associated with this practice, medical bioethics is a much broader
science that relates to moral issues arising from biological sciences
practice.
 Another major difference occurs in the conceptual traditions,
bioethics not including the acceptance of traditional values (World
Medical Association, 2009).
 The history of medical bioethics (1)
 Bioethics therefore appear to be a drastic revision of the
concepts of professional medical ethics, which was for
centuries the basis of the relationship between doctors
and patients.
 The emergence of medical bioethics is related to criticism
of a medical ethical code which no longer met the
absolutely outstanding medical discoveries, after the
Second World War.
 Medical Bioethics is the result of a team work, doctors
searching with philosophers, theologians, lawyers and
social scholars, answers to the new challenges of
medicine such as the definition of death, organ transplant,
reproduction and use of support systems life.
 Medical Bioethics history (2)
 The period between 1947 and 1987 can be considered a
defining period in establishing bioethics care, because in this
period begins the discussins on the origin and evolution of the
human experiments, aspects related to genetic engineering,
organ transplant, discontinuation of life support and new
reproductive technologies (Jonsen, 2003).
 In Romania and in general in Central and Eastern Europe,
bioethics started to be known only after 1989.
 Before 1989, medicine was dominated by paternalistic attitude
that the doctor frequently manifested in the relationship with the
patient. In other words, the doctor was the one who decided
what is best for the patient and this in virtue of the fact that he
was the one who knew best.
 In parallel, a radical approach called Scientism developed,
based on a theory of the English philosopher Francis Bacon
(1561-1626), who postulated that human happiness can only be
achieved if there are policies based on science (Bauzon, 2009).
 Medical Bioethics and Human
Rights
 Philosophy, especially the modern one, links the concept of
dignity to the human rights. The man, looked at from this
perspective has inherent inviolable rights, a fundamental
right which is to respect and be respected.
 Immanuel Kant shows that a person should be treated as an
end and not a means, it is the basic principle underlying the
human rights.
 Under Article no. 1 of the Universal Declaration of Human
Rights (1948) and the Council of Europe and its position in
the Oviedo Convention (1997), in Article 12 of the Universal
Declaration on Bioethics and Human Rights, stated that
cultural diversity can not be relied upon in any way to violate
human dignity (UNESCO, 2011).
 Medical Bioethics in psychiatry (1)
 Since ancient times both in Greek philosophy and in the
Roman faith there is concern as well that use philosophy
can be an effective treatment of mental illnesses.
 Madness in the popular sense, is present in literary epic,
tragic, comic, poetic or historical antiquity, but scholars
realize that the verbalization of suffering is a starting point
for healing, or if not at least for relief (Simon, 2008) .
 In this way physical or mental suffering is streamlined and
the patient is seen as a person.
 Hippocratic oath represents a first starting point that ethics
is used in the doctor patient relationship.
 Thus they began to set the basis for psychiatric medical
ethics.
 Medical Bioethics in psychiatry (2)
 In psychiatry, perhaps more than any other medical
specialty bioethical problems are present and require rapid
solutions.
 Medical psychiatric bioethics seeks to answer through
committee (task force's) questions like: what are the
diagnostic criteria and how they are established, how
appropriate is a type of therapy that are steps, material and
method research in psychiatry ethically, ş.am.d. (Lolas,
2002).
 In the US the ability of a patient to decide on refusing
medical treatment is evaluated by a panel of psychiatrists.
 Ethical dilemma

 If the capacity of discernment there and this was proven

by a court order issued following another psychiatric
expert, is a conflict between the patient's decision of not
taking medication (despite a severe depression or mental
anorexia), while maintaining discernment.
 Ethical dilemma: the patient may be required in this case
to take medication? And if so under what conditions?
 Answer
 When a hospitalized patient refuses medical treatment,
the doctor's task is to ensure that the patient who refuses
treatment is truly informed and aware of all the risks and
benefits of such a decision.
 Akin to what is called informed consent process is to
ensure that informed refusal patient's right to self-
determination (Schneider Bramstedt, 2006).
 Lawrence Kohlberg's moral
dilemmas
 The psychologist Lawrence Kohlberg issued a so-called psychological
theory of moral dilemmas. Next we will try to debate such a psychological
moral dilemma:
 Heinz lives in Alaska in a very isolated area. He goes with his wife to a
medical examination, following which his doctor detected a strong
infection which is likely to turn into sepsis, the infection being in its early
stages. The doctor prescribes an extremely strong antibiotic to Heinz's
wife, costing it $ 100. As it was evening, Heinz hurries to the pharmacy but
notes that the pharmacist wants to leave as closing time approached.
Glad he found it still open and notify the pharmacist recipe, and then when
he wants to pay for the antibiotic, notes with amazement that he is short of
$ 10 to pay. He asks the pharmacist to allow him to take the cheaper
medicine, but he politely refuses. After the pharmacist leaves the
pharmacy, Heinz robs it, and steals the antibiotic giving the medicine to
his wife. Moral and ethical question: is Heinz’s behavior right or wrong?
 Bioethics and Medical Ethics
 Medical ethics can be regarded as a professional duty, thereby
interfering with the professional ethics to establish rules,
responsibilities - sometimes medical, sometimes legal - all
carrying them essential medical profession.
 In fact the concept of medical ethics and deontology establish the
ethical-moral coordinates of the medical profession.
 The doctor will take all necessary measures not to affect by his
actions the health of the patient.
 The doctor is obliged to bear the entire medical act privately, any
professional secret may be revealed only at the lawful request
and in law enforcement.
 The doctor is obliged to continually improve professional
knowledge by participating in conferences, seminars, or by
studying articles, journals, books, presenting the latest news in
their specialty.
 Questions verification
 What are the similarities and differences between medical ethics and
medical bioethics?
 What were the needs and context in which it arose medical
bioethics?
 What is the link between medical bioethics and human rights?
 What is the conceptual difference between man and man intended as
a means?
 What is medical ethics?
 What should we rely on when we want to resolve ethical dilemmas /
moral?
 Bibliography
 Christos F. Kleisiaris et al., (2014), Health care practices in ancient
Greece: The Hippocratic ideal, J Med Ethics Hist Med,, 7:6.
 Bauzon, S., (2009), The rise of Bioethics in East-Central Europe from
1989 to nowadays, Romanian Journal of Bioethics, Vol. 7, No. 3. p.
6-10.
 Duţescu, B., (1980), Etica profesiunii medicale, Bucureşti: Editura
Didactică şi Pedagogică.
 Education Development Center, (2009), Exploring Bioethics, Newton:
Education Development Center, Inc.
 Jonsen, A.R., (2003), The Birth of Bioethics, Oxford University Press.
 Lolas, F., (2002), Bioethics and psychiatry: a challenging future,
World Psychiatry, 1(2): 123–124.
 UNESCO, (2011). Casebook on Human Dignity and Human Rights,
Bioethics Core Curriculum, Casebook Series, No. 1, UNESCO: Paris,
144 pp.
 Schneider, P.L., Bramstedt, K.A., (2006), When psychiatry and
bioethics disagree about patient decision making capacity (DMC), J
Med Ethics;32:90–93.