1. The birth of Bioethics

a. The coining of the word ‘bioethics’
b. Bioethics as bridge between facts and values
c. Bioethics versus medical ethics
d. The idea of Potter
e. Bioethics as global ethics

2. Health and disease as values

a. Health and disease are facts as well as values
b. The interrelation between facts and values
c. Health identified with wellbeing

3. Principles of Bioethics

a. Health care decisions include facts and values
b. The principles of the Universal Declaration on Bioethics and Human Rights
c. Many principles have not been respected throughout history
d. Paternalism and ‘informed consent’
e. Conflicts between bioethical principles. Limits to the autonomy of patients
f. Limits of justice and resource allocation g. Limits to paternalism

4. Ethics comitees

a. Previously, moral conflicts were scarce
b. Nowadays, many principles need to be respected and they are often in conflict
c. The occurrence of conflicts is not negative
d. The main goal of bioethics is to manage moral conflicts
e. To accomplish this goal, bioethics uses deliberation
f. ‘Bioethics committees’ are platforms for deliberation
g. Different types of committees
h. Ethics committees are not legal tribunals

FILM: 21 grams / (A. González Iñárritu, 2003)

21 grams is a disquieting story concerning the value of life and death. Paul Rivers suffers a serious heart condition and must have an urgent transplant. He is not expected to live long so he goes with his wife Mary to a fertility center in search of help to conceive a child despite the difficult circumstances. He finally receives the heart of a man who died, together with his two daughters, in a car accident. The widow, devastated by the tragedy, later receives the unexpected visit of Paul, the recipient of the organ donated by her dead husband, thus opening a complex web of passion, guilt and vengeance.

Mary y Paul Rivers have been married for a long time. They are trying to have a baby because Paul suffers from a heart condition and he doesn't have much time left. But Mary does not get pregnant and decides to visit a medical center specialized in reproduction and fertility. A doctor examines her and this scene takes place:

•  Script - English (fragment 1)

A few days later, the couple attends to the clinic in order to talk to the doctor and arrange the surgery that will allow Mary to become pregnant. At this moment, this scene takes place:

Ethical Issues
Abortion, Organ transplantation, Confidentiality, Sperm insemination

•  Problem outline & Discussion

•  Script - English (fragment 2)

Problem outline & Discussion 21 GRAMS

The sequence brings to the fore the subject of confidentiality in matters of assisted procreation. In a private interview with Mary, she speaks of an abortion carried out while she was separated from her husband. How should the doctor handle this information received from his patient?
The first important issue brought up in the fragment from 21 grams is that the physician does not ask himself what the consequences could be if this information were given out. He matter-of-factly reveals the information regarding the abortion in the interview –it does not seem to present him with an ethical dilemma.
Our first interest is to establish whether the doctor should have pondered over the matter. Ethics entails a process of thought – transforming the case in a dilemmatic situation which should result in questions and not certainties, so that the professional procedure is not the result of automatism but of reflexive decision.


Script - (fragment 1)

Doctor- All right. You can get dressed now.
Your Fallopian tubes are severely damaged. It, uh, looks like you had some kind of an infection... that, uh, wasn't taken care of properly.We can try surgery, but I have to tell you, I think, uh, the probabilities are pretty slim. Look.
Excuse me for asking this, but it's important that you tell me the truth.
Have you ever had an abortion?

Mary - Yes.

Doctor - Any reason?

Mary - I had already separated from my husband when I got pregnant, and I...

Doctor - No. I meant a medical reason.

Mary - My husband's dying.

Doctor - I'm sorry?

Mary - Paul, my husband, he's dying, and I want to have his baby. Doctor - We can operate then and hope you get pregnant within three or four months.


Script - (fragment 2)

Doctor - Okay, now, we can schedule the surgery. I could get you in as early as Monday. Yeah. 9:00 a.m.?

Paul - What's the percentage chance that Mary will get pregnant?

Doctor - Well, I can't offer you a real number on that. Um, you know, there's the damage from the abortion that wasn't handled properly... the blockage...

Paul - What abortion? What abortion, Mary?

Mary - I can explain.

Paul - Explain what?

Mary - There is an explanation.

Paul - All that drama about artificial insemination. Kids names. You got picturesof our friends' babies all over the place. Why? So you can flush it down the fucking toilet?
We've been a fraud for a long time, Mary.

Mary - Oh, yeah? Why didn't you tell me that when you were sick, huh? Or did you expect one of your girlfriends to come and take care of you?

Paul - You came back because you wanted to. Don't blame me for that.

Mary - I came back to take care of you because I love you.

Paul - Or because you were feeling lonely.
I'm sorry. I'm sorry. I can't keep going like this. The insemination, the child.
It's like we're trying to put a Band-Aid on something that's just been bled dry.
It's finished.

Mary - But it... it isn't finished if we give it a chance and have this baby.

Paul - When we could have, you didn't want to.

Mary - We were separated, goddamn it! It's different now!

Paul - Yes, it's different.

Mary - We gonna go? You only know how to think about yourself.