In 1970 Van Rensselaer Potter was the first to use the term "bioethics" in a publication to advocate the development of a new discipline to address the basic problems of human flourishing. This article analyzes Potter's notion of bioethics in order to understand its origins, sources, and substance. In early publications, Potter conceptualized bioethics as a bridge: between present and future, nature and culture, science and values, and finally between humankind and nature. In later publications, disappointed by a predominant focus (...) on individual and medical issues, and with a wish to underscore the need for a broader perspective, Potter introduced the new term "global bioethics," meant to transcend ethics specialties and integrate them into a new interdisciplinary endeavor to address global problems. A growing interest in global bioethics today means that Potter's original insights are more timely than ever. (shrink)

The Global Ethics Observatory, launched by the United Nations Educational, Scientific, and Cultural Organization in December 2005, is a system of databases in the ethics of science and technology. It presents data on experts in ethics, on institutions and on teaching programmes in ethics. It has a global coverage and will be available in six major languages. Its aim is to facilitate the establishment of ethical infrastructures and international cooperation all around the world.

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illnesses of contemporary medical ethics (...) focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us. (shrink)

UNESCO is an intergovernmental organization with 193 Member States. It is concerned with a broad range of issues regarding education, science and culture. It is the only UN organisation with a mandate in science. Since 1993 it is addressing ethics of science and technology, with special emphasis on bioethics. One major objective of the ethics programme is the development of international normative standards. This is particularly important since many Member States only have a limited infrastructure in bioethics, lacking expertise, (...) educational programs, bioethics committees and legal frameworks. UNESCO has recently adopted the Universal Declaration on Bioethics and Human Rights. The focus of current activities is now on implementation of this Declaration. Three activities are discussed that aim at improving and reinforcing the ethics infrastructure in relation to science and technology: the Global Ethics Observatory, the Ethics Education Programme and the Assisting Bioethics Committees project. (shrink)

Unesco initiated the Ethics Education Programme in 2004 at the request of member states to reinforce and increase the capacities in the area of ethics teaching. The programme is focused on providing detailed information about existing teaching programmes. It also develops and promotes teaching through proposals for core curricula, through a training course for ethics teachers and by distributing educational resources to support programmes.

War has major health consequences and poses significant ethical dilemmas for health professionals. In caring for victims of armed conflicts, health providers are obliged to put medical ethics before military aims. While the normative framework of warfare is clear and accepted by almost all countries, in practice, restrictions on violence are continuously broken, and the safety and independence of health professionals are not ensured. In bioethics, the issue of war has not been treated as a major concern. The field can (...) do more to articulate the responsibilities of health practitioners and scientists, arguing that Red Cross founder Henri Dunant's principle of humanity and the principles of professional and global ethics reject the idea of military necessity. Bioethics should focus on strategies to prevent war, encouraging the collective action of health professionals. Bioethics should also stress—as, so far, one national medical association has—that war is a man‐made public health problem. (shrink)

The number of national bioethics commissions has burgeoned since the establishment of the first one in 1983. They provide an arena in which stakeholders with widely differing moral views can discuss, interact and negotiate about controversial matters. The establishment of the Brazilian committee is used as an example of how such bodies can be introduced. If such councils are to be implemented effectively and regarded as legitimate, the society as a whole should be included in the construction of the proposal (...) and represented on the council, the council should have the benefit of specialist advice when that is needed, and the council should be linked to the elected government in an official advisory capacity. The article describes long process of planning and consultation to establish Brazil's National Bioethics Council and of eventually defining its task as advising the president on matters relating to bioethics. (shrink)

This contribution is a report of a two months' participant observation in a Dutch hospice. The goal of the observation was to gain an overview of moral decisions in a hospice in which euthanasia, a tolerated practice in the Netherlands, is not accepted as an option. In an introduction, the development of palliative care in the Netherlands will be briefly presented. Subsequently, various moral decisions that were taken during the participant observation are presented and analysed by means of case reports. (...) Attention is especially drawn to decisions that directly or indirectly relate to euthanasia. These moral decisions will be clarified in the light of the philosophy behind the concept of palliative care as it has evolved since the foundation of St Christopher's Hospice, London in 1967. (shrink)

OBJECTIVES: Cognitive and sensory difficulties frequently jeopardize informed consent of frail elderly patients This study is the first to test whether preliminary research experience could enhance geriatric patients' capacity to consent. DESIGN/SETTING: A step-wise consent procedure was introduced in a study on fluid balance in geriatric patients. Eligible patients providing verbal consent participated in a try-out of a week, during which bioelectrical impedance and weight measurements were performed daily. Afterwards, written informed consent was requested. Comprehension, risk and inconvenience scores (ranges: (...) 0-10) were obtained before and after the try-out by asking ten questions about the study's essentials and by asking for a risk and inconvenience assessment on a ten-points rating scale. SUBJECTS AND RESULTS: Seventy of the 78 eligible subjects started the try-out and 53 (68%) provided written consent. The comprehension score increased from 5.0 (+/- 2.3) to 7.0 (+/- 1.9) following the try-out (P < 0.001). The number of subjects capable of weighing risks and inconveniences increased from 32 to 48 (P < 0.001). CONCLUSIONS: Research experience improved the capacity to consent, still enabling an acceptable participation rate. Therefore, experienced consent seems a promising tool to optimize informed consent in frail elderly subjects. (shrink)

This reply to Giles Scofield's critique of the authors' article in the June 2008 issue of the Kennedy Institute of Ethics Journal highlights two main topics. First, contrary to what Scofield suggests, using the terms "ethics" and "morality" interchangeably constitutes an oversimplification that blurs important distinctions. Second, in a representative democracy, ethical expertise and consultation need not generate a "tragic choice" of the kind Scofield has in mind.

Solidarity belongs to the basic principles of Catholic Social Teaching (CST) and is part of the ethical repertoire of European moral traditions and European healthcare systems. This paper discusses how leaders of Catholic healthcare organizations (HCOs) can understand their institutional moral responsibility with regard to the preservation of solidarity. In dealing with this question, we make use of Taylor's philosophy of modern culture. We first argue that, just as all HCOs, Catholic ones also can embody and strengthen solidarity by just (...) doing their quintessential job, that is, to care for people with ill health. Second, we focus on the Catholic identity of these organizations and argue that this characteristic can empower a radical commitment to solidarity. Finally, we argue that CST provides a critical ethical framework for approaching solidarity from the perspective of the common good. (shrink)

Many have argued that certain statues or monuments are objectionable, and thus ought to be removed. Even if their arguments are compelling, a major obstacle is the apparent historical value of those commemorations. Preservation in some form seems to be the best way to respect the value of commemorations as connections to the past or opportunities to learn important historical lessons. Against this, I argue that we have exaggerated the historical value of objectionable commemorations. Sometimes commemorations connect to (...) biased or distorted versions of history, if not mere myths. We can also learn historical lessons through what I call repudiatory honouring: the honouring of certain victims or resistors that can only make sense if the oppressor(s) or target(s) of resistance are deemed unjust, where no part of the original objectionable commemorations is preserved. This type of commemorative practice can even help to overcome some of the obstacles objectionable commemorations pose against properly connecting to the past. (shrink)

I think Tongdong Bai's Confucian Meritocracy requires a lot of idealisation. Feasibility aside, should we realise the conditions for Confucian Meritocracy to work, we would have created the ideal situation for democracy to function properly. This challenges the purported advantages Confucian Meritocracy enjoys over democracy.

John Stuart Mill's essay On Liberty, published in 1859, has had a powerful impact on philosophical and political debates ever since its first appearance. This volume of essays covers the whole range of problems raised in and by the essay, including the concept of liberty, the toleration of diversity, freedom of expression, the value of allowing 'experiments in living', the basis of individual liberty, multiculturalism and the claims of minority cultural groups. Mill's views have been fiercely contested, and they (...) are at the centre of many contemporary debates. The essays are by leading scholars, who systematically and eloquently explore Mill's views from various perspectives. The volume will appeal to a wide range of readers including those interested in political philosophy and the history of ideas. (shrink)

The identity of indiscernibles is false. Robert Adams and others have argued that if the identity of indiscernibles is false, then primitive thisness must be admitted as a fundamental feature of the world (i.e. haecceitism is true). Moreover, it has been suggested that if haecceitism is true, then essentialism is false - that accounting for individuation by means of haecceities precludes a thing's having essential qualitative properties. I will argue that this suggestion is misguided. In so doing, I will (...) be defending what Adams has labeled 'moderate haecceitism'.After working through some preliminary issues, I will attempt (in section I) to motivate haecceitism. I will begin by reviewing Adams' arguments against the doctrine of the identity of indiscernibles. Next, I will examine altemative accounts of individuation which concede the falsity of that doctrine. I will reject these accounts and conclude that primitive thisness has an essential role to play in any satisfying account of individuation. In section II, I will surface the alleged tension between haecceitism and essentialism. In section III, I will suggest that Adams' moderate haecceitism avoids the tension surfaced in section II. Finally, in section IV, I will raise a difficulty for Adams' view and suggest a different understanding of the nature of haecceities. I will argue that the alleged tension between haecceitism and essentialism rests on a conflation of the metaphysical problem of individuation either with the epistemological problem which goes by the same name or with problems involving the unity of a thing. I will conclude with a few brief comments about the significance of moderate haecceitism for modal epistemology. (shrink)

I want now to argue that just as no intentional representations of retinal images intervene between physical objects and the seeing of those objects, no representations of speaker intentions in speaking need intervene between world affairs spoken of by speakers and hearers' understandings of those words.1 When conventional signs are true or satisfied and when this has come about in the normal way, conventional signs are locally recurrent natural signs. True, tokens of the same conventional sign may have diverse (...) etiologies, through different people's perceptual systems and cognitive systems. They differ from more ordinary recurrent natural signs in that there will usually be numerous different kinds of causal paths to their production, depending on the ways that different speakers have managed to translate diverse prior natural signs into a uniform medium of thought and expression. But there are reasons why the same linguistic form continues to coincide with the same kind of represented affair over a certain domain --it is no accident-- and we have decided to take that as the primary criterion for a locally recurrent sign. Assuming that this step in the production of a conventional sign has been accomplished through normal mechanisms --the speaker is not confused, does not lie, and so forth-- then reading a conventional sign is mainly a matter of tracking its natural domain, that is, determining what reproducing family it has been copied from. Compare tracking the. (shrink)

Sher's notion of deserved punishment has unacceptable implications. It does not justify punishing some serious wrongdoers, who are unwilling to commit lesser wrongs, more severely than minor offenders. It requires victim-inflicted punishments which repeat the wrongdoings, with the roles reversed. But if Sher moves away from such victim-inflicted punishments, then his theory should treat wrongdoers like tort-feasors who have to pay monetary compensations to their victims.

This paper takes issue with what seem to be standard practices of at least some organizations that use models in their ad campaigns. These organizations know that many of their models have had drug problems but refuse either to tolerate this or to help them. Some organizations have, allegedly in the name of a responsibility for the health of their customers, rather opted for a firm condemnation of the practices in which models such as Kate Moss apparently engage. (...) This raises questions about hypocrisy. The paper uses Levinas's concept of the face critically to describe what might be going on in the conflict between Moss and some of the companies she worked for. Moss is arguably understood by these companies as a role model who should not engage with drugs or street life. Against these more or less patronizing tendencies, the paper claims that it is not so much the face but processes of defacement that should trouble us from a moral perspective. The face, it is maintained, is not only ethical but also has a materiality. In opposition to what is maintained by at least some scholars of Levinas, art, literature and history have alerted us over and over again that the face is anything but indelible. Some examples from art show us the versatility and vulnerability of the face. The gossip and hype about what came to be known as the Kate Moss affair stands, it is argued, in a long misogynic tradition of defacement. (shrink)

This paper takes issue with what seem to be standard practices of at least some organizations that use models in their ad campaigns. These organizations know that many of their models have had drug problems but refuse either to tolerate this or to help them. Some organizations have, allegedly in the name of a responsibility for the health of their customers, rather opted for a firm condemnation of the practices in which models such as Kate Moss apparently engage. (...) This raises questions about hypocrisy. The paper uses Levinas's concept of the face critically to describe what might be going on in the conflict between Moss and some of the companies she worked for. Moss is arguably understood by these companies as a role model who should not engage with drugs or street life. Against these more or less patronizing tendencies, the paper claims that it is not so much the face but processes of defacement that should trouble us from a moral perspective. The face, it is maintained, is not only ethical but also has a materiality. In opposition to what is maintained by at least some scholars of Levinas, art, literature and history have alerted us over and over again that the face is anything but indelible. Some examples from art show us the versatility and vulnerability of the face. The gossip and hype about what came to be known as the Kate Moss affair stands, it is argued, in a long misogynic tradition of defacement. (shrink)

About one third of patients with epilepsy have seizures refractory to the medical treatment. Electrical stimulation mapping is the gold standard for the identification of “eloquent” areas prior to resection of epileptogenic tissue. However, it is time-consuming and may cause undesired side effects. Broadband gamma activity recorded with extraoperative electrocorticography during cognitive tasks may be an alternative to ESM but until now has not proven of definitive clinical value. Considering their role in cognition, the alpha and beta bands could (...) further improve the identification of eloquent cortex. We compared gamma, alpha and beta activity, and their combinations for the identification of eloquent cortical areas defined by ESM. Ten patients with intractable focal epilepsy participated in a delayed-match-to-sample task, where syllable sounds were compared to visually presented letters. We used a generalized linear model approach to find the optimal weighting of each band for predicting ESM-defined categories and estimated the diagnostic ability by calculating the area under the receiver operating characteristic curve. Gamma activity increased more in eloquent than in non-eloquent areas, whereas alpha and beta power decreased more in eloquent areas. Diagnostic ability of each band was close to 0.7 for all bands but depended on multiple factors including the time period of the cognitive task, the location of the electrodes and the patient’s degree of attention to the stimulus. We show that diagnostic ability can be increased by 3–5% by combining gamma and alpha and by 7.5–11% when gamma and beta were combined. We then show how ECoG power modulation from cognitive testing can be used to map the probability of eloquence in individual patients and how this probability map can be used in clinical settings to optimize ESM planning. We conclude that the combination of gamma and beta power modulation during cognitive testing can contribute to the identification of eloquent areas prior to ESM in patients with refractory focal epilepsy. (shrink)

Geneticization is a broad term referring to several related processes such as a spreading tendency to use a genetic model of disease explanation, a growing influence of genetics in medical practice, and the slow changing of individual and societal attitudes towards reproduction, prevention and control of disease. These processes can be demonstrated in medical literature on preventive genetic screening and counselling programs for β-thalassaemia in Cyprus, the United Kingdom and Canada. The preventive possibilities of the new genetic and diagnostic technologies (...) have been quickly understood and advocated by health professionals, and their educational strategies have created a web of social control, in marked contrast to the alleged voluntary decision-making process and free choice. Genetic diagnostic technologies have led to considerable changes in control and management of β-thalassaemia, and have generated a number of unresolved incongruities. (shrink)

The concept of ‘geneticization’ has been introduced in the scholarly literature to describe the various interlocking and imperceptible mechanisms of interaction between medicine, genetics, society and culture. It is argued that Western culture currently is deeply involved in a process of geneticization. This process implies a redefinition of individuals in terms of DNA codes, a new language to describe and interpret human life and behavior in a genomic vocabulary of codes, blueprints, traits, dispositions, genetic mapping, and a gentechnological approach to (...) disease, health and the body. This article analyses the thesis of ‘geneticization’. Explaining the implications of the thesis, and discussing the critical refutations, it is argued that ‘geneticization’ primarily is a heuristic tool that can help to re-focus the moral debate on the implications of new genetic knowledge towards interpersonal relations, the power of medicine, the cultural context and social constraints, rather than emphasizing issues as personal autonomy and individual rights. (shrink)

This Dictionary presents a broad range of topics relevant in present-day global bioethics. With more than 500 entries, this dictionary covers organizations working in the field of global bioethics, international documents concerning bioethics, personalities that have played a role in the development of global bioethics, as well as specific topics in the field.The book is not only useful for students and professionals in global health activities, but can also serve as a basic tool that explains relevant ethical notions and (...) terms. The dictionary furthers the ideals of cosmopolitanism: solidarity, equality, respect for difference and concern with what human beings- and specifically patients - have in common, regardless of their backgrounds, hometowns, religions, gender, etc. Global problems such as pandemic diseases, disasters, lack of care and medication, homelessness and displacement call for global responses.This book demonstrates that a moral vision of global health is necessary and it helps to quickly understand the basic ideas of global bioethics. (shrink)

If one compares the development of modern medical ethics in Germany with those in the Netherlands, what stands out are the cultural and intellectual differences between the two countries. Dealing with the problems involved in limiting medical treatment, the authors show the differing and the common standards and values on which the discussion of this is based in both countries. Three examples, active termination of life, the do-not-resuscitate order and pain management, which are examined from an historical, legal, philosophical and (...) ethical perspective, put this in concrete terms. The authors belong to different generations as well as different political and philosophical camps. Vergleicht man die Entwicklung der modernen Medizinethik in Deutschland mit jener in den Niederlanden, fallen die kulturellen und intellektuellen Unterschiede zwischen beiden Landern deutlich auf. Anhand der Problematik der Begrenzung medizinischen Handelns zeigen die Autoren die verschiedenen bzw. gemeinsamen Normen und Werte, die der Diskussion daruber in beiden Landern zugrunde liegen. Drei Beispiele, die aktive Lebensbeendigung, die Nicht-Reanimierung und die Schmerzbekampfung, die aus historischem, juristischem, philosophischem und ethischem Blickwinkel betrachtet werden, konkretisieren die Darstellung. Die Autoren gehoren unterschiedlichen Generationen, politischen und lebensanschaulichen Lagern an. (shrink)

Vulnerability has become a popular though controversial topic in bioethics, notably since 2000. As a result, a common body of knowledge has emerged distinguishing between different types of vulnerability, criticizing the categorization of populations as vulnerable, and questioning the practical implications. It is argued that two perspectives on vulnerability, i.e., the philosophical and political, pose challenges to contemporary bioethics discourse: they re-examine the significance of human agency, the primacy of the individual person, and the negativity of vulnerability. As a phenomenon (...) of globalization, vulnerability can only be properly addressed in a global bioethics that takes the social dimension of human existence seriously. (shrink)

This paper explores the role of ‘community’ in the context of global bioethics. With the present globalization of bioethics, new and interesting references are made to this concept. Some are familiar, for example, community consent. This article argues that the principle of informed consent is too individual-oriented and that in other cultures, consent can be community-based. Other references to ‘community’ are related to the novel principle of benefit sharing in the context of bioprospecting. The application of this principle necessarily requires (...) the identification and construction of communities. On the global level there are also new uses of the concept of community as ‘global community.’ Three uses are distinguished: (1) a diachronic use, including past, present, and future generations, (2) a synchronic ecological use, including nonhuman species, and (3) a synchronic planetary use, including all human beings worldwide. Although there is a tension between the communitarian perspective and the idea of global community, this article argues that the third use can broaden communitarianism. The current development towards cosmopolitanism is creating a new global community that represents humanity as a whole, enabling identification of world citizens and evoking a sense of global solidarity and responsibility. The emergence of global bioethics today demonstrates this development. (shrink)

In the 1970s “bioethics” emerged as a new interdisciplinary discourse on medicine, health care, and medical technologies, primarily in Western, developed countries. The main focus was on how individual patients could be empowered to cope with the challenges of science and technology. Since the 1990s, the main source of bioethical problems is the process of globalization, particularly neo‐liberal market ideology. Faced with new challenges such as poverty, inequality, environmental degradation, hunger, pandemics, and organ trafficking the bioethical discourse of empowering individuals (...) is no longer sufficient. Global bioethics nowadays is concerned with applying and implementing a universal ethical framework. Islamic bioethics has contributed to creating such framework (exemplified in the UNESCO Universal Declaration on Bioethics and Human Rights) while at the same time it is continuously articulating and interpreting this framework in specific settings and contexts. (shrink)

Current bioethical debate is bizarre because it concentrates on exceptional cases while it does not pay attention to underlying value perspectives that determine the agenda of the debate.

The current model of technology assessment treats ethics itself as just another problem‐solving technology. Ethics should resist this model to play a more critical role in technology assessment by better understanding the complex relationship between society, medicine, and technology—and by recasting how problems are defined.

Telling the truth is one of the most respected virtues in medical history and one of the most emphasized in the code of medical ethics. Health care providers are frequently confronted with the dilemma as to whether or not to tell the truth. This dilemma deepens when both choices are critically vicious: The choice is no longer between “right and right” or “right and wrong,” it is between “wrong and wrong.” In the case presented and discussed in this paper, a (...) research team in Saudi Arabia unintentionally uncovered information regarding misattributed paternity. In such a situation and in the context of a tribal cultural system, what should the team do with this information? This case analysis demonstrates the joint application of ethical resources originating from within and outside the Saudi Arabian context. The article analyses the case based on the moral problems involved, relevant medical application, and the impact of such information in the Saudi tribal and Islamic domains. The most pertinent relevant values and secular debates on similar matters are discussed. Finally, the article aims to provide an Islamic dimension of family, fatherhood, and adultery. (shrink)