Self or small-group interest versus community
or large-group interest
Short-term interest versus long-term interest
Loyalty versus truth
Mercy versus justice
In the highly regulated environment of the phar-
maceutical industry, ‘ethical’ approaches often
seem to be predetermined by local legislation and
regulation (or ‘fiat’). Additionally, we are guided
by voluntary national guidelines, as well as inter-
national codes of practice (see below). Nonethe-
less, merely relying on these alone is dangerous. A
decision may be within the letter of the law and be
covered by all such voluntary codes and yet still
may arguably be unethical. Shannan Muskopf has
written^6 :
Science asks ‘Canwe’?
Law asks ‘Maywe’?
Ethics asks ‘Shouldwe’?
Thus, while regulations help ensureminimumethi-
cal standards, they do not necessarily ensure the
highestethical standards. Increasingly, therefore,
the medical and pharmaceutical research and prac-
tice environments face a growing need for a formal
approach to ethics, and particularly to bioethics.
45.2 Basic tools of bioethics
The process of analyzing and solving ethical pro-
blems involves
recognition of the relevant ethical issues;
analysis of the subcomponents of these ethical
issues;
finding appropriate tools to help solve these
issues and their subcomponents;applying those tools;checking that the selected tools have indeed met
the recognized bioethical need.The two fundamental types of bioethical tools are
deductive and inductive reasoning. There are, how-
ever, complexities and adaptations for both of
them. Let us first consider the two fundamental
systems and then examine their complexities.Deductive reasoning
Deductive reasoning is the process ofconcluding
that something must be true because it is a special
case of a general principle that is known to be true.
It relies on the establishment of laws or rules that
are generally applicable. It can be summed up as
top-downreasoning: one moves from thegeneral to
the specific(s). Much of medicine uses deductive
reasoning: a general law, such as a fractured tibia
heals best when immobilized in the correct posi-
tion, is applied frequently to individual patients in
the Emergency and Accident departments.
Emmanuel Kant (1724–1804) can probably be
credited with enunciating best the classic approach
to deductive reasoning. Kant believed that the
moral worth of an action was basednoton the
ultimate outcome of the action, but rather on the
motive behind that action. Kant described morality
as being governed by universal laws that he termed
categorical imperatives– these are duties that are
inescapable. Perhaps the most famous of his cate-
gorical imperatives is that one has a duty always to
tell the truth. Kant took the hypothetical example
of a would-be murderer seeking to kill one’s friend.
If the friend is hiding in one’s house, then when the
murderer knocks on the door one has an absolute
duty to answer truthfully his inquiry whether the
friend is inside. This truthfulness, according to
Kant, might not, however, preclude shouting the
answer loudly, thus giving the friend the chance to
escape. There was no such thing as a ‘white lie’ for
Kant.(^6) Modified from http://www.biologycorner.com/quests/
bioethics. html.
588 CH45 INTRODUCTION TO BIOETHICS FOR PHARMACEUTICAL PROFESSIONALS