Exploring Bioethics - NIH Office of Science Education - National ...

quence of choosing one path over another. Harms andbenefits come in a variety of types, including physical,emotional, economic, and social, to name a few. Utilitariansconsider all types of harms and benefits in theirethical deliberations.“First of all, do no harm” is a familiar expression ofminimizing harms when practicing medicine. Even ifphysicians cannot help a patient directly, they shouldtry to avoid actions that cause harm. “Do no harm” issometimes referred to as nonmaleficence. A closely relatedconcept, beneficence (“Do good”), stresses acting in thebest interest of others and being of benefit to them.FairnessStudents bring an inherent understanding of the conceptof fairness to the classroom. Even very young childrencan be heard voicing their opinions on whether anaction is fair or not. Fairness is an important aspect ofjustice. The consideration of fairness asks us to ensurethat resources, risks, and costs be distributed equitably.The question of how to fairly allocate a benefit or aburden is a question of distributive justice. When suchquestions are applied within society at large, the questionis one of social justice.There are many acceptable ways to figure out what wouldbe fair. Sometimes what is fair is giving each person anequal amount of something. Other times, it is providingaccording to each person’s need or according to each person’smerit or contribution. Please note that fairness doesnot necessarily entail equal shares; it usually depends onother factors, too.Other Ethical ConsiderationsIn addition to the three common and very importantcore ethical considerations discussed in this supplement,many other considerations can be equallyimportant depending on the nature of the ethicalchoices. Examples addressed in Exploring Bioethicsinclude the concepts of authenticity in individualachievement, responsibilities of individuals to theircommunity and to the natural world, and the intrinsicvalue of animals.Weighing Ethical ConsiderationsStudents will discover that sometimes these ethicalconsiderations clearly point out how best to act, whileat other times they conflict and cannot all be satisfied.Sometimes it is not easy or even possible to act inaccordance with all the relevant considerations at thesame time.For example, you might want to show respect for yourgrandmother by allowing her to continue driving, evenwhen her eyesight is failing, but to minimize harm, youmight feel a responsibility to take her keys away. In a caselike that, it’s hard both to show respect for her desire tomove around freely and to protect her and others fromthe harm that might be caused by a car accident. Whichof these core ethical considerations should count more(respect for persons, which motivates you to allow herto keep driving, or minimizing harms, which motivatesyou to take her keys away)? How should you decide?When an ethical problem arises, each individual mayprioritize and choose which considerations should befavored in a different way. Often, there is no one rightanswer. In addition, people can emphasize different ethicalconsiderations in the process of ethical analysis butarrive at the same decision about what should be done.Sometimes it is not easy or even possible to actin accordance with all the relevant considerationsat the same time.Building and AssessingStrong JustificationsOnce bioethicists have clearly stated the ethical question,collected all the facts, anticipated the likely stakeholders,and thought about the options in terms of therelevant ethical considerations, they are ready to makea decision or recommendation. But this is only part ofthe process. Sound ethical reasoning requires that peopleexplain their recommendation: Why is your decisionthe best decision or the best recommendation? Thisis the part of ethical reasoning called justification. Animportant aspect of this curriculum supplement isassessing the strength of students’ justifications—asshown in Table 1 on pages 10 and 11—so they canbuild more effective arguments and counterarguments.(An argument includes both the student’s recommendationand the justification for that recommendation.)8 Exploring Bioethics