What is Bioethics? Theoretical bases and objectives

A subdiscipline of ethics that studies the way we do research with living beings.

Throughout the history of humanity, human rights have been violated on multiple occasions, there have been negative and positive repercussions of scientific advances in biomedicine on human life, and the advancement of industrial society has been prioritized at the expense of the damage that could be generated in ecosystems. In response, as a way of raising awareness, a new area of general ethics was created a few decades ago: bioethics..

As we shall see, defining bioethics is no simple matter. There are a large number of orientations that make up bioethics, which nourish it for the analysis and resolution of problems that have justified its emergence.

Definition of Bioethics

Bioethics is a branch of ethics, responsible for providing and examining the most appropriate principles of conduct for human beings in relation to life (human, animal and plant life). Among the many definitions of bioethics, we can state that it is the systematic study of human conduct in the field of life sciences and health care, examined in the light of values and moral principles.

It should be clarified that unlike medical ethics, bioethics is not limited to the medical environment, but addresses multiple issues (e.g., environment and animal rights).

In short, it is an ethical reflection on the moral problems of the contemporary pluralistic society in which we are immersed. It is particularly focused on the health professions, such as clinical psychology.

Some of the best known topics within applied bioethics are:

• Abortion and the status of the embryo
• Euthanasia
• Genetics and human cloning
• Research and clinical trials
• Environment and animals (in this area the author Peter Singer stands out).
• Physician-patient relationship
• Organ donation
• Pain treatment

Brief historical evolution

It is a relatively young discipline, with less than half a century of history.. Moreover, it has become an area of compulsory study within research and medicine, and over the last 30 years it has expanded its body of knowledge, becoming one of the most up-to-date branches of ethics.

The author of the origin of the term is somewhat controversial: some argue for the German theologian and philosopher Fritz Jahr (1927), who used the term Bio-Ethik in an article related to ethics for plants and animals. Other authors highlight the biochemical oncologist Potter, who in 1970 used the term bio-ethics in an article, and a year later published a text entitled "Bioethics: bridge to the future".

But if there is one thing that stands out in the history of bioethics, it is the Belmont Report (1978). This report was created as a result of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in the United States, after the ravages of the well-known Tuskegee experiment (on untreated syphilis in African-Americans). This text sets out the principles or criteria to guide research on human subjects in biomedicine. Today, the Belmont Report is still considered a reference text for researchers.

Major principles of bioethics

We will now explain the four main principles of bioethics, proposed by Beauchamp and Childress (1979):

1. Autonomy

Autonomy reflects the person's capacity to make decisions about oneself without external influence, privacy and self-determination. This principle may not be applied in situations where the person cannot be 100% autonomous or has reduced autonomy (e.g., vegetative state). (e.g., vegetative state).

The highest expression of this principle would be the patient's informed consent. It is a right of the patient and a duty of the attending professional. In this sense, the patient's preferences and values must be recognized and respected. In psychology this principle is also applied, and informed consent must always be obtained from patients, whether they are adults or children (through their parents or legal guardians).

Beneficence

It is the obligation and duty of the professional to act for the benefit of the patient or others. The aim is to promote the patient's legitimate interests and to suppress the patient's prejudices as much as possible. It would be like "doing what is best for the patient".

The problem that arises from this principle is that sometimes the patient's benefit is promoted but without taking the patient's opinion into account (e.g., the physician has training and knowledge that the patient does not have, so the physician freely decides what is best for the person). In other words, in these cases the patient's or patient's opinion is disregarded because of his or her lack of knowledge.

The principle of beneficence depends on the principle of autonomy.The principle of beneficence depends on the principle of autonomy, i.e. doing the good that the patient consents to or requests.

3. Justice

This principle seeks equality and to reduce discrimination on ideological, social, cultural, economic, racial, gender, sexual orientation, etc. grounds.. It recognizes that all people are entitled to the benefits of medicine, or psychology, for example. The aim is to provide all patients with the same quality, care and services in all interventions.

In psychology, for example, no discrimination or prejudice of any kind is accepted.

This principle is applied in qualitatively different ways in different countries. For example, in the United States, medical care is based on insurance contracted with private companies, so there may be discrimination on economic grounds. In Spain, health care is free and universal, based on the principle of necessity.

4. Non-maleficence

This principle is based on refraining from acts that are intentionally harmful to the person. In other words, not to unjustifiably or unnecessarily harm the other person. In some disciplines this principle can be interpreted with nuances, for example:

In medicine, sometimes medical actions generate harm to the patient but the aim is to obtain the patient's well-being (e.g., a surgical intervention). In psychology, asking the patient to be systematically and gradually exposed to situations that generate anxiety, fear, anger, etc., may involve harm or Pain for the patient, but the ultimate goal is the patient's psychological well-being and the overcoming of problems.

There are other considerations in this principle: the professional must be committed to a training based on solid and scientific knowledge, must update his or her knowledge (based on a solid and scientific knowledge), and must be able to provide the best possible care.They must update their knowledge (based on evidence and not on pseudoscience) on a permanent basis in order to practice at a professional level, and they must research new treatments or therapies in order to improve and offer their patients the best care.

As stated in the code of ethics for psychologists, "Without prejudice to the legitimate diversity of theories, schools and methods, the psychologist will not use means or procedures that are not sufficiently contrasted, within the limits of current scientific knowledge. In the case of investigations to test new techniques or instruments, not yet contrasted, he/she will inform his/her clients before their use" (...) "The continuous effort to update his/her professional competence is part of his/her work" (...)..