In 1979 Tom Beauchamp and James Childress proposed four principles of modern secular bioethics: respect for autonomy, nonmaleficence, beneficence, and justice. The principles, developed specifically to address issues in medical and environmental science, serve as cornerstones for the development of bioethical codes of behavior.

The principle of respect for autonomy includes the patient's or research subject's right to freely choose or reject treatment, and the liberty to act accordingly. Every patient's autonomy is of paramount importance. The right of informed consent represents one aspect of this principle. Accordingly, patients should be educated and allowed to participate in decisions regarding their fate; patients should retain authority to determine what their course of treatment is. However, even patient autonomy has limits; for instance, many would agree that patients must be prevented from harming themselves. Euthanasia on demand is not legal in the United States.

The principle of nonmaleficence means that the physician or scientist should do no harm. Patients should not be injured in the course of treatment. This could also be expanded to include the environment and be understood as a directive to protect our natural world.

The principle of beneficence directs medical practitioners and researchers to do good, promote patient welfare, devise ways to improve quality of life, and repair the world.

The fourth principle, the principle of justice, focuses on fairness in allocating resources. For instance, social benefits such as health care services, including pharmaceutical drugs, diagnostic tests, donated organs, and medical expertise, should be distributed in a just manner. Likewise, social burdens such as taxes should be assessed fairly.

Most bioethics issues fall into five major themes: beginning of life, end of life, rights of patients, animal rights, and environmental protection and preservation.

The beginning of life category includes traditional areas of controversy (such as contraception and termination of pregnancy) and issues that more recently arose as a result of biotechnological advances. The latter category includes cloning, embryonic stem cell research, fetal experimentation, fetal surgery, multifetal pregnancy reduction, artificial reproductive technologies, eugenics, genetic screening, and gene therapy.

End-of-life issues include the injunction to preserve human life, assisted suicide and euthanasia, futility of end-of-life care, and allocation of medical resources.

The rights of patients involve issues such as voluntary participation and informed consent for medical treatment, truth-telling (i.e., sharing all information with patients), doctor-patient confidentiality, autonomy of patients, research on human subjects, the rights of the insured and the uninsured, and the fair allocation of limited resources.

Animal rights issues include questions regarding the use of animals as research subjects, the respectful and humane treatment of laboratory animals, domesticated farm animals and pets, and proper treatment of animals in the wild.

Environmental protection and preservation focus on minimizing the destruction of natural resources and habitats, preserving species, recovering and cleaning up fouled habitats, and reintroducing endangered species. Biotechnological advances have also led to novel bioethical conundrums, such as whether to alter species by genetic engineering and how to safely utilize genetically modified plants and animals so as not to harm humans or the environment or wreak havoc with the natural process of evolution.

As new technologies evolve, humankind will continue to grapple with new ethical dilemmas that arise. Increased human life expectancies will further stretch limited medical resources. As neonatal medicine improves, fetuses will be viable outside the womb at earlier stages, making abortion issues even more challenging. Genetic screening and gene therapy will permit parents to choose or reject offspring with particular traits, permitting humankind to change the course of evolution. Thus, in bioethics, the breakthroughs of today become the daunting dilemmas of tomorrow.

Bibliography:

1) Annas, George J. and Michael A. Grodin. 1992. The Nazi Doctors and the Nuremberg Code: Human Rights in Human Experimentation. New York: Oxford University Press.

2) Beauchamp, Tom and James F. Childress. 2008. Principles of Biomedical Ethics. 6th ed. New York: Oxford University Press.

3) Beauchamp, Tom L., LeRoy Walters, Jeffrey P. Kahn and Anna C. Mastroianni. 2007. Contemporary Issues in Bioethics. 7th ed. Belmont, CA: Wadsworth.

4) Levine, Carol, ed. 2006. Taking Sides: Clashing Views on Controversial Bioethical Issues. 11th ed. Dubuque, IA: McGraw-Hill/Dushkin.

5) Mappes, Thomas A. and David DeGrazia. 2006. Biomedical Ethics. 6th ed. New York: McGraw-Hill.

6) Ridley, Aaron. 1998. Beginning Bioethics. Boston: Bedford/St. Martin's.

7) Veach, Robert M. 2003. The Basics of Bioethics. 2nd ed. Upper Saddle River, NJ: Prentice Hall.

8) Wahrman, Miryam Z. 2004. Brave New Judaism: When Science and Scripture Collide. Hanover, NH: Brandeis University Press.

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