What Is Bioethics And Why Is It Important In Public Health?

Morality has always been intertwined with medicine. Between 440 and 360 BC, Hippocrates (the Father of Medicine) wrote several bodies of medical literature and provided the foundation for the Hippocratic Oath as it exists today. Later, in the late 1700s, German philosopher Immanuel Kant made his contribution to the healthcare field. Kant played a big role in the ethics revolving around organ transplant, donation, and autonomy. Although things have changed a lot in the last 1.600 years, ethics remain important. Today, the origins of bioethics even extend to cryopreservation and its application as a potential life-saving technology. Here, we’ll discuss the essential topic of bioethics and why it’s important in public health. 

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What Is Bioethics? 

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The field of bioethics emerged in the early 1960s as the study of health and life sciences began to flourish. Bioethics is the branch of ethics that involves the social, legal, and philosophical issues that are present in medicine, healthcare, and life sciences [1]. Its primary focus revolves around the quality of human life and overall well-being. Sometimes, bioethics extends to nonhuman, biological environments. Bioethics is similar to medical ethics, but it focuses on everything that affects well-being rather than strictly medicinal aspects. In short, bioethics is an all-encompassing study of the ethics that surround healthcare professions and society, meaning that it extends far past medicine alone. 

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While health care ethics has been used as a more inclusive term, bioethics remains to be the most broad, far-reaching category of ethics in relation to human life. It covers topics such as medical testing, cloning, stem cell research, gene therapy, human longevity, cryonics, and cryopreservation. Bioethics aims to address issues involved in the doctor-patient relationship, patient autonomy, and overall well being. 

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Different Subsets of Bioethics

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Bioethics is a wide-reaching discipline, but it includes some extremely important facets of health-related sciences and wellness research. The primary subsets of bioethics include the following [2]: 

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• Clinical Ethics - this is a subset of bioethics that involves how to analyze and resolve issues of conflict between various parties when there is a disagreement on the ethically best course of action. Clinical ethics is also used to help “improve institutional responses to ethical dilemmas through education and policy formation” [2]. 

• Health Policy - this involves the degree to which government agencies should manage health care as a public good. 

• Genetics - bioethics in relation to genetics covers what is ethically acceptable or appropriate when working with individuals who have a serious, potentially untreatable genetic disorder. A good example of this is, do individuals within a family need to inform their relatives who may be at future risk? Or can they maintain their right to privacy? [2]

• Neuroethics - the more we realize we can measure human brain functioning, the finer the line of ethical behavior becomes. Neuroethics involves understanding the potential implications of emerging tools, neuroenhancement drugs, and other uses of neurotechnologies on morality.

• Precision Medicine - this subset primarily focuses on cancer medications, their price, and their readiness to respond to certain biomarkers more effectively than others. It begs the question, should individuals who don’t have the biomarkers be denied the drug and given to those who do? [2]

• Reproductive Ethics - reproductive ethics is controversial, as it can impact the life of future children. This subset of bioethics revolves around “issues related to assisting fertility (assisted reproduction, surrogacy, genetic manipulation of offspring), restricting fertility (contraception and sterilization), terminating a pregnancy (abortion), minors and access, and concerns that are more general over maternal and fetal best interest” [2].

• Research Ethics - while scientific studies can help answer a lot of questions, results need to be achieved ethically. This includes distinguishing between identifiable and non-identifiable data to determine whether informed consent is necessary, anonymity, and more. 

• Shared Decision-Making - this subset of bioethics focuses on communication between the patient and the healthcare professional to ensure that an informed decision can be made. 

• Social Determinants of Health - this aims to examine how an individual’s physical and social environment impacts their overall care including prevention, treatment, and recovery in terms of illness or disease. 

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While each of these subsets may vary based on location, uniformity around the world is becoming increasingly common. 

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The Importance of Bioethics in Public Health and Safety

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Maintaining a degree of bioethics norms is essential for the safe, fair, and just functioning of society. It ensures that certain standards of care are met, that individuals’ rights are protected, and that various principles are upheld. The field of bioethics involves more than just the doctor-patient relationship. It also involves things like cloning, genetic engineering, abortion, assisted fertility technology, euthanasia, clinical drug trials, organ transplants, assisted suicide, and even cryopreservation. 

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These are all sensitive areas of practice, some of them containing vastly polarized opinions. Bioethics aims to uphold certain principles and values so they can be consistently applied to these types of issues. Some of the most important principles of bioethics include honesty, transparency, objectivity, integrity, accountability, rights to intellectual property, non-discrimination, competence, legality, social responsibility, and more. There are also differences between secular bioethics and Catholic bioethics. 

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• Honesty ensures that scientific communications, data, methods, and results are not fabricated or falsified [3]. 
• Transparency discloses information the public needs to evaluate the statement or results.
• Objectivity promotes a lack of bias amongst healthcare professionals and researchers to avoid skewed information. 
• The principle of integrity holds professionals to a higher standard, so that they act within their word. 
• Accountability ensures that individuals take responsibility for their actions and are able to justify them if need be. 
• Rights to intellectual property aims to honor patents or copyrights and give the proper party credit for their contributions to the research. 
• Bioethics also helps reduce the occurence of discrimination in the field. 
• Competence principles ensure that healthcare professionals undergo continual opportunities for education and growth throughout their careers. 
• The principle of legality aims to uphold institutional and/or governmental policies in place.
• Social responsibility encourages people to work towards a greater good. 

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There are several other principles involved in bioethics, and without them, the healthcare industry could become a scary place. This becomes apparent when we recall what happened with ethically questionable experiments such as Stanley Milgram’s Behavior Experiments—where one group of subjects willingly hurt other subjects using electrical shockwaves simply because they were told to do so—or the Memorial-Sloan Kettering experiment where non-cancer patients were injected with cancer cells without their consent. 

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Bioethics help promote the goals of research and reduce the chance of unnecessary error. They enhance collaboration between individuals with the goal of reducing conflict. Most importantly, bioethics holds healthcare professionals, researchers, and scientists accountable to the public and to the environment. Over time, bioethics can also have an impact on overall moral and social values. If they did not exist, human experimentation could take an ugly turn, medicine could be released before it was deemed safe, and healthcare professionals may not act in the best interest of the patient or public. 

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Notable Historic Moments in Bioethics

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Although ethics has been around for centuries, the term bioethics wasn’t introduced until 1970, by Van Rensselear Potter, an American biochemist and oncologist. However, since then, it’s had a huge impact on the study, research, and practice of medicine as a whole. Some of the most notable moments that influenced bioethics as we know today include the following.

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• Guatemala Syphilis Studies: this 1946, extremely controversial, study allowed researchers to intentionally infect individuals with syphilis, gonorrhea, and chancroid to test treatment efficacy. It’s an example of how, without bioethics, human trials can be dangerous and quite terrifying. 

• Nuremberg Code: the 1947 Nuremberg Code outlined 10 principles of permissible medical experiments. It’s historically known as one of the most important documents in the history of bioethics and ethics surrounding medical research. There have since been many amendments and revisions, including the Wilson Memorandum. 

• Declaration of Geneva: this was one of the first, notable instances when multiple nations met to discuss ethics following the Second World War (1947). The Declaration of Geneva modifies previous language of the Hippocratic Oath to include stipulations regarding the laws of humanity.

• Universal Declaration of Human Rights: this was established (1948) to “create rights to which all human beings are entitled and became a foundational document for international bioethics” [4].

• The World Health Organization: the WHO was also created in 1948 to help create unity across various health affairs within the United Nations. It has since grown to the entity it is today. 

• International Code of Medical Ethics: adopted in 1949, this was the “first effort at globalizing medical ethics and the responsibilities of doctors and patients” [4].

• Papal Approval of Organ Transplantation: in 1953, Pope Pius XII endorsed organ transplants. This was the first time it was considered acceptable to “sacrifice” an organ from one human to ensure the survival of another. He later made another addressment on the use of ventilators, saying that “it is not obligatory to initiate or to continue artificial ventilation when a patient is expected to inevitably die” [4]. This also included a statement that said the church was not competent to determine the “criteria” for death.

• Animal Welfare Act: this act was signed into law to regulate how animals are treated during research, transportation, exhibition, etc. It has been continually amended as the understanding of animals has progressed. 

• Definition of Death: in 1968, the legal Definition of Death was defined as “irreversible coma, or brain death.” This has created a stronger understanding of when healthcare professionals can legally (and ethically) retrieve organs for transplantation. 

• Orders Not to Resuscitate: in 1976, the first medical opinions on “Do Not Resuscitate” orders were published. This would eventually lead to the DNRs that we have today. 

• Defining Death: Medical, Legal, and Ethical Issues in the Determination of Death: this report, published in 1981, addressed the “neurological criteria for death known as ‘brain death’” [4]. 

• Health Insurance Portability and Accountability Act of 1996 (HIPAA): HIPAA was enacted to help protect individuals and families from lapses in health coverage while establishing one of the first standards of protected health information (PHI). 

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Several foundations have also been established to maintain bioethics and improve regulation. Some of them include The Nuffield Council of Bioethics, the International Association of Bioethics (IAB), the International Network on Feminist Approaches to Bioethics (FAB), and the UNESCO International Bioethics Committee. 

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Bioethics and Cryonics

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Understandably, bioethics needs to be applied to the field of cryonics and the process of cryopreservation as well. While there are not currently any laws against nor in favor of this biostasis, there are parameters that must be met. For instance, the process of cryopreservation can not begin until the legal pronouncement of death. Since there is currently no technology available to revive a cryopreserved patient, beginning any earlier would be considered unethical and, legally speaking, murder. 

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Aside from this, there hasn’t been any concerns raised regarding the bioethics of the process. To allow for the legal process of cryopreservation, Tomorrow.Bio requires a contractual agreement during registration. When you sign, you agree to “donate” your body to scientific research after legal death. This ensures ethical handling and reduces the risk of ownership complications. 

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However, cryopreservation is a personal choice and bioethics involves safeguarding individual autonomy. Furthermore, cryopreservation is used to help advance the process of organ transplants, assisted reproduction, and cellular preservation. Will bioethics eventually change the way these processes are handled? It’s possible. As the cryopreservation community continues to grow, we may see updates regarding the bioethics of the process. Only time will tell.

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Conclusion

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Bioethics is an important part of public health and safety, but it can result in some controversial discussions like abortion and maybe someday, human cryopreservation. However, at Tomorrow Bio, we believe that everyone has a right to personal autonomy. Cryopreservation could potentially become an important life-saving technology and we believe that, for this reason, we have a duty to put our efforts into developing and improving this practice and the ethics surrounding it. The vast majority of religions even approve the medical technology that does what’s possible to save lives. However, in the future this may change. Who knows how technological advancements could revolutionize the process of cryopreservation or the industry as a whole. 

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For now, if we’ve sparked a little bit of interest in you, contact one of our team members to learn more about cryopreservation. If you’re already interested and haven’t yet signed up, stop procrastinating! Become a member of Tomorrow.Bio today. 

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References

[1] bioethics. (n.d.). Encyclopedia Britannica. https://www.britannica.com/topic/bioethics#ref251764 

[2] McDaniel, L. (n.d.). What is Bioethics? Michigan State University. https://bioethics.msu.edu/what-is-bioethics 

[3] Resnik, D. B. (2020, December 23). What Is Ethics in Research & Why Is It Important? - by David B. Resnik, J.D., Ph.D. National Institute of Environmental Health Sciences. https://www.niehs.nih.gov/research/resources/bioethics/whatis/index.cfm 

[4] The Hastings Center. (2022, June 28). Bioethics Timeline. https://www.thehastingscenter.org/bioethics-timeline/