[Bioethics theories, the protection of life and natural law]. / Teorías bioéticas, protección de la vida y ley natural.

Principlist Bioethics by Beauchamp and Childress has reached a prominent status in contemporary Bioethics. Nevertheless, it includes some important theoretical problems: some lacks when defining some concepts, a tendency to ethical relativism, etc. Among the ethical alternative approaches from which such problems can be solved, we think that the most appropiate is the Natural Law theory. It offers a reasoned reflection on the concept of good and on human basic goods and their relation with moral general principles. From such goods, this ethical theory supports the existence of actions that are always maleficent acts, that is, intrinsically and universally evil acts. The article applies the Natural Law theory to issues related to the protection of human life (abortion, euthanasia, self-defense and genetic manipulation)..

Controlled drugs and the principle of double effect: the role of the district nurse.

The role of district nurses in the effective management of pain in palliative care has been strengthened by the Misuse of Drugs (Amendment No.2) (England, Wales and Scotland) Regulations 2012 that allow district nurses who are independent or supplementary prescribers to prescribe and administer controlled drugs. However, prescribing controlled drugs brings increased responsibility and accountability for the safe management of these medicines. In this article Richard Griffith considers the principle of double effect that seeks to ensure that patients in intractable pain receive the analgesia they require to manage that pain while district nurses avoid liability and prosecution under the law of murder.

On genies and bottles: scientists' moral responsibility and dangerous technology R&D.

The age-old maxim of scientists whose work has resulted in deadly or dangerous technologies is: scientists are not to blame, but rather technologists and politicians must be morally culpable for the uses of science. As new technologies threaten not just populations but species and biospheres, scientists should reassess their moral culpability when researching fields whose impact may be catastrophic. Looking at real-world examples such as smallpox research and the Australian "mousepox trick", and considering fictional or future technologies like Kurt Vonnegut's "ice-nine" from Cat's Cradle, and the "grey goo" scenario in nanotechnology, this paper suggests how ethical principles developed in biomedicine can be adjusted for science in general. An "extended moral horizon" may require looking not just to the effects of research on individual human subjects, but also to effects on humanity as a whole. Moreover, a crude utilitarian calculus can help scientists make moral decisions about which technologies to pursue and disseminate when catastrophes may result. Finally, institutions should be devised to teach these moral principles to scientists, and require moral education for future funding.

Continuous deep sedation until death: palliation or physician-assisted death?

Published literature has not discerned end-of-life palliative versus life-shortening effects of pharmacologically maintaining continuous deep sedation until death (i.e., dying in deep sleep) compared with common sedation practices relieving distress in the final conscious phase of dying. Continuous deep sedation predictably suppresses brainstem vital centers and shortens life. Continuous deep sedation remains controversial as palliation for existential suffering and in elective death requests by discontinuation of chronic ventilation or circulatory support with mechanical devices. Continuous deep sedation contravenes the double-effect principle because: (1) it induces permanent coma (intent of action) for the contingency relief of suffering and for social isolation (desired outcomes) and (2) because of its predictable and proportional life-shortening effect. Continuous deep sedation should be distinguished from common sedation practices for palliation and characterized instead as physician-assisted death.

The potential dual use of online pharmacies.

The technological advances of the 20th century resulted in the creation of the Internet and its introduction into everyday life on a global scale. The Internet provides access to information and the sale and purchase of goods. Medications are also subject to trade. Their sale is conducted by online pharmacies and their global turnover amounts to hundreds of billions of dollars. Medications ordered over the Internet are sent by mail all over the world. Considering the events of recent years, we cannot exclude the risk of a terrorist attack through online pharmacies. Terrorists can establish such companies, legally or illegally, or acquire ones already existing. Parcels, which are highly trusted by the customers of online pharmacies, can, for example, be contaminated with dangerous materials. The sale of online medications in the international system is potentially dangerous and requires international regulation.

Why science cannot be value-free: understanding the rationality and responsibility of science.

Against the ideal of value-free science I argue that science is not--and cannot be--value-free and that relevant values are both cognitive and moral. I develop an argument by indicating various aspects of the value-ladenness of science. The recognition of the value-ladenness of science requires rethinking our understanding of the rationality and responsibility of science. Its rationality cannot be seen as merely instrumental--as it was seen by the ideal of value-free science--for this would result in limiting the autonomy of science and reducing scientists to "minds to hire". The scientific rationality must be seen as practical rationality which takes into account the full horizon of values. The scientific responsibility must also be broaden in scope and type. On this basis I draw three practical conclusions concerning the organization of research and training of young scientists, appealing to Plato's claim that those most capable of healing are also those most capable of harming.

The social nature of engineering and its implications for risk taking.

Making decisions with an, often significant, element of risk seems to be an integral part of many of the projects of the diverse profession of engineering. Whether it be decisions about the design of products, manufacturing processes, public works, or developing technological solutions to environmental, social and global problems, risk taking seems inherent to the profession. Despite this, little attention has been paid to the topic and specifically to how our understanding of engineering as a distinctive profession might affect how we should make decisions under risk. This paper seeks to remedy this, firstly by offering a nuanced account of risk and then by considering how specific claims about our understanding of engineering as a social profession, with corresponding social values and obligations, should inform how we make decisions about risk in this context.

Managing dual use technology: it takes two to tango.

Like nuclear energy, most technologies could have dual use-for health and well being and disaster and terror. Some research publications have brought to the forefront the tragic consequences of the latter potential through their possible use. Monitoring life science research and development (R&D) to prevent possible misuse is a challenging task globally, more so in developing economies like India, which are emerging as major biotech hubs. As a signatory to the Biological and Toxin Weapons Convention, India has put in motion a process of evolving a series of measures to manage dual-use technology. The Indian Council of Medical Research (ICMR) has taken a lead in drafting model codes of conduct, ethics and practice for use by other S&T agencies to tailor them as per their requirements. Taking cue from the discussions held by the editors of the various medical and science journals in the developed world, the Indian Journal of Medical Research, the official publication of the ICMR, is working on policy and uniform practice of publication of dual-use research results. The Government of India too has promulgated legal provisions to minimize the risks of misuse of technology, like the Weapons of Mass Destruction Act. Clearly, no single agency would be able to manage the dual-use of technology effectively. Multiple agencies have to come together to work in tandem for effective implementation of various measure and also like Janus, ensure that they are neither too restrictive nor intrusive to discourage the development of science.

Philosophical aspects of dual use technologies.

The term dual use technologies refers to research and technology with the potential both to yield valuable scientific knowledge and to be used for nefarious purposes with serious consequences for public health or the environment. There are two main approaches to assessing dual use technologies: pragmatic and metaphysical. A pragmatic approach relies on ethical principles and norms to generate specific guidance and policy for dual use technologies. A metaphysical approach exhorts us to the deeper study of human nature, our intentions, goals, values ideals and social relations when considering dual use technology. Use of science and technology (S and T) is determined by two components of human nature: human intentions and choices. We have drawn a distinction between specific measures, goals and intentions with respect to technologies in order to show that moral judgment about technologies must precede their use. Understanding of our intentionality and values, and our moral ideals, as a measurable, tangible part of the real world is important for the prevention of any possible harm from S and T. In the context of dual use technologies, we stress the importance of three main understandings of human nature: vulnerability, responsibility and narrative identity. These can become a strong ontological "antidote" to technology's poisoning of modern man. Each new technology can be measured and compared with man's values, traditions and societal norms. This can be done bearing in mind the concept that human nature is not dualistic, but pluralistic. A system of ethical principles that includes the principles of good intentions, the correspondence of goals and means, the balancing of risks and benefits, simplicity, and contextuality, will help ensure that technologies are more humanistic and friendly to human beings.

Temporal indiscriminateness: the case of cluster bombs.

This paper argues that the current stock of anti-personnel cluster bombs are temporally indiscriminate, and, therefore, unjust weapons. The paper introduces and explains the idea of temporal indiscriminateness. It argues that to honor non-combatant immunity-in addition to not targeting civilians-one must adequately target combatants. Due to their high dud rate, cluster submunitions fail to target combatants with sufficient temporal accuracy, and, thereby, result in avoidable serious harm to non-combatants. The paper concludes that non-combatant immunity and the principle of discrimination require a moratorium on the use of current cluster munitions.

The bioterrorism threat and dual-use biotechnological research: an Israeli perspective.

Israel has a long history of concern with chemical and biological threats, since several hostile states in the Middle East are likely to possess such weapons. The Twin-Tower terrorist attacks and Anthrax envelope scares of 2001 were a watershed for public perceptions of the threat of unconventional terror in general and of biological terror in particular. New advances in biotechnology will only increase the ability of terrorists to exploit the burgeoning availability of related information to develop ever-more destructive bioweapons. Many areas of modern biological research are unavoidably dual-use by nature. They thus have a great potential for both help and harm; and facilitating the former while preventing the latter remains a serious challenge to researchers and governments alike. This article addresses how Israel might best (1) prevent hostile elements from obtaining, from Israel's biological research system, materials, information and technologies that might facilitate their carrying out a biological attack, while (2) continuing to promote academic openness, excellence and other hallmarks of that system. This important and sensitive issue was assessed by a special national committee, and their recommendations are presented and discussed. One particularly innovative element is the restructuring and use of Israel's extensive biosafety system to also address biosecurity goals, with minimal disruption or delay.

A note on the definition of "dual use".

While there has been much interest in this topic, no generally accepted definition of dual use has been forthcoming. As a contribution to this issue, it is maintained that three related kinds of things comprise the category of dual use: research, technologies and artefacts. In regard to all three kinds, difficulties are identified in making clear distinctions between those that are and are not dual use. It is suggested that our classification should take account of actual capacities and willingness to make use of these objects for 'bad ends' and not the mere possibility that this could be done, and here three 'contextual factors' are identified. A (provisional) definition is proposed that takes account of threats and risks.

Acute ethics: risk assessment and the Doctrine of Double Effect in a referral to on-call urology.

The Doctrine of Double Effect has been described as often used in medicine and surgery but is seldom described outside the palliative medicine context. This paper presents a possible clinically focussed illustration of the doctrine of double effect used in an acute urological setting. The authors describe the case of an elderly patient with significant dementia and haematuria who required anticoagulation. Implicit double effect reasoning may have helped the surgical team reach their initial decision with regard to a treatment plan, reconciling a duty to beneficence with a duty not to cause harm. This short case is offered as a stimulus for further discussion over the role of duty-based ethical reasoning in the acute surgical setting. It also highlights a possible need for more detailed case-analysis in identifying areas of interest in surgical ethics.

The criminalization of treating end of life patients with risky pain medication and the role of the extreme emergency situation.

This Note examines the legality of physicians treating patients near the end of life with risky pain medication, specifically during an extreme emergency situation. The issues discussed include whether such treatment should be criminalized and, if criminalized, what standard should be used to determine culpability. This Note proposes that physicians should not be shielded from the criminal justice system, but that the standard of double effect intent should be expressly adopted in the adjudication of such cases.

Controlled drugs and the principle of double effect.

The role of district nurses in the effective management of pain in palliative care has been strengthened by recent amendments to the Misuse of Drugs (Amendment) Regulations 2005 that allow district nurses who are independent or supplementary prescribers to prescribe and administer controlled drugs. However, the right to prescribe controlled drugs also brings increased responsibility and accountability for the safe management of these medicines. In this article Richard Griffith outlines the changes to the law relating to controlled drugs and calls for a clarification of the principle of double effect, to ensure patients in intractable pain receive the analgesia they require to manage their pain and district nurses avoid liability and prosecution under the law of murder.