domingo, 29 de noviembre de 2009

Principio éticos de la investigación biomédica

The primer to ethical analysis provides an introduction to ethical decision-making. The
ethical theories discussed serve only as a starting point for understanding the
foundations of moral philosophy. These foundations are being continually debated
and revised.
FOUR BASIC PRINCIPLES OF BIOMEDICAL ETHICS
A CHECKLIST FOR ETHICAL DECISION MAKING
RESPECT FOR AUTONOMY
Does my action impinge on an individual's personal autonomy?
Do all relevant parties consent to my action?
Do I acknowledge and respect that others may choose differently?
BENEFICENCE
Who benefits from my action and in what way?
NON-MALEFICENCE
Which parties may be harmed by my action?
What steps can I take to minimise this harm?
Have I communicated risks involved in a truthful and open manner?
In the event of a disaster, how can I avert the possible harm caused?
JUSTICE
Have I identified all vulnerable groups that may be affected by my action?
Is my proposed action equitable? How can I make it more equitable?
Source: Beauchamp, T. & Childress, J. (2001) Principles of Biomedical Ethics, 5th Ed, Oxford University Press, Oxford.
A sound ethical decision-making process may incorporate the following abilities;
1. The ability to identify all related issues pertaining to the incident/issue/dilemma.
2. The ability to sort morally relevant issues from morally irrelevant issues in any given situation.
3. The ability to unpack the elements of morally relevant information.
4. The ablity and willingness to research issues and reflect upon them.
5. The ability and willingness to seek advice.
6. The ability to form a well-reasoned, unbiased, and morally defensible conclusion in any given
situation.
7. The ability to justify this position and act upon it.
8. The ability to challenge one's own moral framework in light of recalcitrant experiences.
9. Being in possession of a consistent moral framework.
MAJOR ETHICAL THEORIES
Action-based Approaches to Ethics
Principlism is a widely applied ethical approach based on four
fundamental moral principles sometimes referred to as ‘the big four’.
Developed in the 1970s by the Americans Tom Beauchamp and James
Childress, the principlist approach applies the principle of respect for
autonomy, the principle of beneficence, the principle of non-maleficence
and the principle of justice to contemporary ethical dilemmas. Although this
approach is sometimes criticised for its lack of foundational theory and its
Western-dominated methodology, principlism is widely used as a starting
point for practical ethical decision-making in the clinical, technological and
epidemiological professions.
Further Reading: Beauchamp, T. and Childress, J. (2001) Principles of Biomedical Ethics, 5th
Edition, Oxford University Press, Oxford.
Consequentialism refers to a group of normative ethical theories which
maintain that the moral status of an action is determined by the goodness
or badness of its consequences. One common type of consequentialism is
utilitarianism where a decision is made regarding the best course of action
by simply applying a cost-benefit analysis to the situation. A commonly
accepted utilitarian calculus for determining an action’s moral acceptability
is; “the greatest happiness for the greatest number.” Thus, a
consequentialist would typically attempt to calculate the consequences or
outcome of a decision and if the benefits of the outcome are outweighed
by the risks of either not performing the action or performing some other
action, then the action is considered as morally desirable.
Critics of consequentialism often cite situations in which the application of
a consequentialist theory runs into trouble. For instance, consequentialism
would allow actions of slavery or torture if the benefits to the majority
outweighed the harms to those who were enslaved to tortured. More
specific versions of consequentialism have attempted to address this
problem with some success.
Further Reading: Singer, P. (1979) Practical Ethics, Cambridge University Press, Cambridge.
The term non-consequentialism is given to a group of ethical theories
that do not determine the moral status of an action solely by the goodness
or badness of its consequences. Rather than calculating the
consequences of an action and then deciding whether the benefits of
performing that action are outweighed by its risks, a non-consequentialist
will tend to take other considerations into account when deciding upon the
morally right course of action.
The most referred to non-consequentialist ethical theory is deontology. A
deontologist simply judges the moral acceptability of an action using a
rights-based or duty-based system of analysis. In other words, a person
who adopts a deontological system of ethical decision-making will typically
think in terms of ‘a person’s right to act in some way’ or ‘a right to possess
something.’ Decisions are also made using duty-based justifications such
as ‘a duty to act on a certain principle’ or a ‘duty not to hinder some course
of action.’
Deontologists are sometimes confronted with the problem of conflicting
duties or rights. Thus, a morally right course of action may reveal that
there are in fact two opposing rights applicable in any one situation.
Further Reading: McDonald, H. P. (2001) Toward a Deontological Environmental Ethic,
Environmental Ethics, 23 (4), 411-430.
Agent-based Approaches to Ethics
Virtue-based approaches to ethics place importance on the character of
the person performing the action rather than on the action itself. Virtue
ethics has its roots in Greek philosophy in the work of Aristotle and most
recently in the work of Phillipa Foot and Alasdair MacIntrye. Hierarchies of
virtues, like vices, have changed over time but generally include justice,
temperance, charity, mercy and wisdom to name a few. Generally, virtue
ethicists believe that traditional moral theories fail to acknowledge the
importance of the role of inner character traits in ethical decision-making.
Situation-based Approaches to Ethics
Casuistry is the name given to a newly revived school of ethical thought
originating in 16th Century Spain. Casuists argue that specific cases
inform moral principles, not vice versa. Thus, the best starting point for
ethical-decision-making is examining particular cases and the respective
decisions made about those cases. Casuistry is most easily applied to
dilemmas in medical ethics where case study provides for effective
teaching practices.
Further Reading: Jonsen, A. R. and Toulmin, S. E. (1988) The Abuse of Casuistry: A History of
Moral Reasoning, University of California Press, Berkley.
Relativism is the view that moral appraisals are essentially dependent
upon a moral code that is specific to a time, place and culture. There are
no absolute criteria with which moral actions may be appraised. A relativist
may cite geographical, historical or anthropological data in support of his or
her case. In short, moral relativism accepts what all human beings do as
appropriate in their contexts. There is no basis for ethical argument or
discussion.
Modern feminist approaches to ethical analysis developed in the
seventies as a response to criticisms that contemporary fundamental moral
principles generally failed to consider the importance of moral
relationships, the role of emotion and the subjective in moral reasoning
and generally failed to redress the repression of women in decisions
concerning themselves. This alternative turns attention from moral
judgements to focus on the importance of the moral impulse or moral
attitude. Sometimes called an ethic of care, this approach to ethics
concentrates on the “being” of ethics rather than on the “doing”, much like
a virtue ethics position. The central focus of an ethic of care is on loving,
caring, empathy and sensitivity.
Further Reading: Tong, R. (1997) Feminist Approaches to Bioethics: Theoretical Reflections and
Practical Applications, Westview Press, Boulder, Colorado.
Geocultural approaches to ethics vary considerably from region to region.
Generally, they are responses to traditional Westernized approaches to
ethical decision-making which are criticised as appealing to mostly
American cultural traditions. South America, Asia and Northern Europe are
regions where more culturally-specific approaches to ethics have been
developed where, perspectives on liberty, social justice and the value of life
differ significantly.
Further Reading: Wulff, H. (1994) Against the four principles: a Nordic view, In Principles of
Health Care Ethics, R. Gillon and A. Lloyd (Eds.), Wiley, New York.
Prepared by Lucy Carter
Office of Public Policy and Ethics
Institute for Molecular Bioscience
The University of Queensland, Australia
http://www.uq.edu.au/oppe
October 2002

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