When we talk about genetics, inevitably we can have ethics doubts. Bioethics is essential in science. Genetic modified organisms (GMO), assisted reproduction techniques (ARTs), genetic counselling, rare diseases, euthanasia and palliative care, among other topics; they have importance in bioethics. However, we have to know what bioethics is before applying it.
WHAT IS BIOETHICS?
Ethics involves the set of rules that society have agreed about living with other people for minimums, which are human rights.
Bioethics is a branch of ethics, which is the interdisciplinary study of problems created by biological and medical progress (micro and macrosocial level), and its impact in society and value system, both for now and for the future.
Bioethics concerns for ethical questions involve in human understanding of life. It born by necessity of a critic reflection about ethical conflicts, which are caused by progressing in life science and medicine. Technological and medical tools have an important role in society and it has to manage.
It is important know that bioethics does not defend a particular moral attitude nor offer determinant and definitive answers, but it searches a grounded, critic and argued reflection centred in the singularity of a concrete situation.
In bioethics we find several grounded ethical theories. Two of these are deontological ethics and utilitarian ethics.
Deontological ethics was proposed by Immanuel Kant and it consists in that reason identifies actions like good or bad, independent of their consequences.
Utilitarian ethics was proposed by Jeremy Bentham and John Stuart-Mill and it says that actions are good or bad depend on their consequences. The balance between purposes that give benefits or damage is produced by utilitarian ethics.
BASIC PRINCIPLES IN BIOETHICS
In bioethics they are four basic principles and they were proposed by Beaucham and Childress (1979):
- No maleficence
These principles can be grouped in two levels:
- Minimum levels: obligations that generate universal duties and these involve negative transitive duties (facts that you cannot do other people). Here, there are principles of no maleficence and justice.
- Maximum levels: they are related with the choice of the vital project that every person choose to depend on their scale of values. They generate imperfect obligations: facts that I can auto impose, but I cannot call for other people (neither other people to me). Here, there are principles of autonomy and beneficence.
PRINCIPLE OF AUTONOMY
Actions are only autonomous when it exists:
- Knowledge (it is essential)
- Not external control (there are not pressures)
- Authenticity (coherence with system of values and usual attitudes of the person)
An autonomous person is who has capacity to act and judge consequences of their acts and be responsible. This person has to be able to communicate his decision clear and reiterated.
PRINCIPLE OF BENEFICENCE
It has to act in benefit of person, but it can cause collateral effects.
It is important to know that you cannot do good against the other person’s will.
PRINCIPLE OF NO MALEFICENCY
You cannot harm unnecessary other people. Damage can be avoided not acting, with a passive attitude. However, good has done with active attitude.
If someone asks you, you cannot do damage.
PRINCIPLE OF JUSTICE
It involves to tract on the same way equal to equal and unequal to unequal. Vulnerable population have to receive an immediate benefit.
This principles, with principle of autonomy and beneficence (principle of no maleficence rises after), were necessary to regulate clinical trials with humans, due to Tuskegee case (Figure 1).
In the 60s, researchers did a clinical trial about syphilis. They wanted to see the evolution of the disease and find an alternative to painful treatments. So, they injected syphilis viruses without information of study and its consequences.
OTHER IMPORTANT PRINCIPLES
There are other important principles in bioethics.
- Fidelity: protection of people, based on caution, proportionality, no discrimination and respect for people’s dignity. It includes privacy’s protection and confidentiality, keeping the promises and commitment.
- Transparency: gives law and access to information. All information has to communicate clearly, comprehensively, honest and real.
- Caution: based on analysis of risks. All investigations that could put at risk people’s health and future generations has to avoid.
- Principle of proportionality: it is related to the principle of beneficence and looks at the relationship between the benefit obtained and the “costs” of means, human and monetary resources, risks and what the negative effects are.
- Principle of non-discrimination: all persons who must be treated equally.
- Principle of respect for dignity: no one has to be subjected to humiliation, must receive help in situations of need, have a minimum quality of life without suffering and freedom of action and decision, and not be used as the purpose of others.
- Principle of respect for privacy and confidentiality: not unnecessarily reveal and/or interested personal and sensitive data concerning the subject. It is not an absolute principle and in front of a crime is not fulfilled.
- Principle of respect for the right to information: all those involved in the process must know all the information (before, during and after the investigation).
- Principle of free participation and donation: participation and donation are free and altruistic since if we are not talking about sale or exchange.
- Comitè de Bioètica de Catalunya
- Comité de Bioética de España
- Asociación de Bioética de la Comunidad de Madrid
- NIH: The Department of Bioethics
- Main picture: Definición ABC