Integrative bioethics is a brand of bioethics conceived and propagated by a group of Croatian philosophers and other scholars. This article discusses and shows that the approach encounters several serious difficulties. In criticizing certain standard views on bioethics and in presenting their own, the advocates of integrative bioethics fall into various conceptual confusions and inconsistencies. Although presented as a project that promises to deal with moral dilemmas created by modern science and technology, integrative bioethics does (...) not contain the slightest normativity or action-guiding capacity. Portrayed as a scientific and interdisciplinary enterprise, integrative bioethics displays a large number of pseudoscientific features that throw into doubt its overall credibility. (shrink)
Since the 1980s, Islamic scholars and medical experts have used the tools of Islamic law to formulate ethico-legal opinions on brain death. These assessments have varied in their determinations and remain controversial. Some juridical councils such as the Organization of Islamic Conferences' Islamic Fiqh Academy (OIC-IFA) equate brain death with cardiopulmonary death, while others such as the Islamic Organization of Medical Sciences (IOMS) analogize brain death to an intermediate state between life and death. Still other councils have repudiated the notion (...) entirely. Similarly, the ethico-legal assessments are not uniform in their acceptance of brain-stem or whole-brain criteria for death, and consequently their conceptualizations of, brain death. Within the medical literature, and in the statements of Muslim medical professional societies, brain death has been viewed as sanctioned by Islamic law with experts citing the aforementioned rulings. Furthermore, health policies around organ transplantation and end-of-life care within the Muslim world have been crafted with consideration of these representative religious determinations made by transnational, legally-inclusive, and multidisciplinary councils. The determinations of these councils also have bearing upon Muslim clinicians and patients who encounter the challenges of brain death at the bedside. For those searching for ‘Islamically-sanctioned’ responses that can inform their practice, both the OIC-IFA and IOMS verdicts have palpable gaps in their assessments and remain clinically ambiguous. In this paper we analyze these verdicts from the perspective of applied Islamic bioethics and raise several questions that, if answered by future juridical councils, will better meet the needs of clinicians and bioethicists. (shrink)
This article details the relationship between history and bioethics. I argue that historians' reluctance to engage with bioethics rests on a misreading of the field as solely reducible to applied ethics, and overlooks previous enthusiasm for historical perspectives. I claim that seeing bioethics as its practitioners see it – as an interdisciplinary meeting ground – should encourage historians to collaborate in greater numbers. I conclude by outlining how bioethics might benefit from new histories of the field, (...) and how historians can lend a fresh perspective to bioethical debates. (shrink)
Before asking what U.S. bioethics might learn from a more comprehensive and more nuanced understanding of Islamic religion, history, and culture, a prior question is, how should bioethics think about religion? Two sets of commonly held assumptions impede further progress and insight. The first involves what “religion” means and how one should study it. The second is a prominent philosophical view of the role of religion in a diverse, democratic society. To move beyond these assumptions, it helps to (...) view religion as lived experience as well as a body of doctrine and to see that religious differences and controversies should be welcomed in the public square of a diverse democratic society rather than merely tolerated. (shrink)
Carson Strong has recently argued that wide reflective equilibrium (WRE) is an unacceptable method of justification in bioethics. In its place, Strong recommends a methodology in which certain foundational moral judgments play a central role in the justification of moral beliefs, and coherence plays a limited justificatory role in that the rest of our judgments are made to cohere with these foundational judgments. In this paper, I argue that Strong’s chief criticisms of WRE are unsuccessful and that his proposed (...) alternative is in fact just another version of WRE. In the course of doing so, I specify which theses are central to WRE and which are not, and thus, provide a response to an additional objection, advanced by Peter Singer, that WRE is vacuous. I conclude by arguing that there may be better prospects for advancing the debate regarding methodology in bioethics if we focus on restricted epistemic and methodological theses rather than broad approaches, such as WRE, that come in many different varieties. (shrink)
A rich literature in public health has demonstrated that health is strongly influenced by a host of environmental factors that can vary according to social, economic, geographic, cultural or physical contexts. Bioethicists should, we argue, recognize this and – where appropriate – work to integrate environmental concerns into their field of study and their ethical deliberations. In this article, we present an argument grounded in scientific research at the molecular level that will be familiar to – and so hopefully more (...) persuasive for – the biomedically-inclined in the bioethics community. Specifically, we argue that the relatively new field of molecular epigenetics provides novel information that should serve as additional justification for expanding the scope of bioethics to include environmental and public health concerns. We begin by presenting two distinct visions of bioethics: the individualistic and rights-oriented and the communitarian and responsibility-oriented. We follow with a description of biochemical characteristics distinguishing epigenetics from genetics, in order to emphasize the very close relationship that exists between the environment and gene expression. This then leads to a discussion of the importance of the environment in determining individual and population health, which, we argue, should shift bioethics towards a Potterian view that promotes a communitarian-based sense of responsibility for the environment, in order to fully account for justice considerations and improve public health. (shrink)
In recent years there has been a wealth of literature arguing the need for empirical and interdisciplinary approaches to bioethics, based on the premise that an empirically informed ethical analysis is more grounded, contextually sensitive and therefore more relevant to clinical practice than an ‘abstract’ philosophical analysis. Bioethics has (arguably) always been an interdisciplinary field, and the rise of ‘empirical’ (bio)ethics need not be seen as an attempt to give a new name to the longstanding practice of interdisciplinary (...) collaboration, but can perhaps best be understood as a substantive attempt to engage with the nature of that interdisciplinarity and to articulate the relationship between the many different disciplines (some of them empirical) that contribute to the field. It can also be described as an endeavour to explain how different disciplinary approaches can be integrated to effectively answer normative questions in bioethics, and fundamental to that endeavour is the need to think about how a robust methodology can be articulated that successfully marries apparently divergent epistemological and metaethical perspectives with method. This paper proposes ‘Reflexive Bioethics’ (RB) as a methodology for interdisciplinary and empirical bioethics, which utilizes a method of ‘Reflexive Balancing’ (RBL). RBL has been developed in response to criticisms of various forms of reflective equilibrium, and is built upon a pragmatic characterization of Bioethics and a ‘quasi-moral foundationalism’, which allows RBL to avoid some of the difficulties associated with RE and yet retain the flexible egalitarianism that makes it intuitively appealing to many. (shrink)
Who are the gatekeepers in bioethics? Does editorial bias or institutional racism exist in leading bioethics journals? We analyzed the composition of the editorial boards of 14 leading bioethics journals by country. Categorizing these countries according to their Human Development Index (HDI), we discovered that approximately 95 percent of editorial board members are based in (very) high-HDI countries, less than 4 percent are from medium-HDI countries, and fewer than 1.5 percent are from low-HDI countries. Eight out of (...) 14 leading bioethics journals have no editorial board members from a medium- or low-HDI country. Eleven bioethics journals have no board members from low-HDI countries. This severe underrepresentation of bioethics scholars from developing countries on editorial boards suggests that bioethics may be affected by institutional racism, raising significant questions about the ethics of bioethics in a global context. (shrink)
Informed consent is a central topic in contemporary biomedical ethics. Yet attempts to set defensible and feasible standards for consenting have led to persistent difficulties. In Rethinking Informed Consent in Bioethics Neil Manson and Onora O'Neill set debates about informed consent in medicine and research in a fresh light. They show why informed consent cannot be fully specific or fully explicit, and why more specific consent is not always ethically better. They argue that consent needs distinctive communicative transactions, by (...) which other obligations, prohibitions, and rights can be waived or set aside in controlled and specific ways. Their book offers a coherent, wide-ranging and practical account of the role of consent in biomedicine which will be valuable to readers working in a range of areas in bioethics, medicine and law. (shrink)
This is the table of contents of and introduction to a textbook entitled Bioethics in Canada. It will be published by Oxford University Press in March of 2013. It is designed mainly for use in Canada. Of the 51 articles that it contains, 26 are written by Canadians. -/- For further information, see http://www.oupcanada.com/catalog/9780195440157.html and http://www.amazon.ca/Bioethics-Canada-Charles-Weijer/dp/0195440153/ref=sr_1_1?s=books&ie=UTF8&qid=1359542985&sr=1-1.
Why has autonomy been a leading idea in philosophical writing on bioethics, and why has trust been marginal? In this important book, Onora O'Neill suggests that the conceptions of individual autonomy so widely relied on in bioethics are philosophically and ethically inadequate, and that they undermine rather than support relations of trust. She shows how Kant's non-individualistic view of autonomy provides a stronger basis for an approach to medicine, science and biotechnology, and does not marginalize untrustworthiness, while also (...) explaining why trustworthy individuals and institutions are often undeservingly mistrusted. Her arguments are illustrated with issues raised by practices such as the use of genetic information by the police or insurers, research using human tissues, uses of new reproductive technologies, and media practices for reporting on medicine, science and technology. Autonomy and Trust in Bioethics will appeal to a wide range of readers in ethics, bioethics and related disciplines. (shrink)
The expanded and revised edition of Bioethics: An Anthology is a definitive one-volume collection of key primary texts for the study of bioethics. Brings together writings on a broad range of ethical issues relating such matters as reproduction, genetics, life and death, and animal experimentation. Now includes introductions to each of the sections. Features new coverage of the latest debates on hot topics such as genetic screening, the use of embryonic human stem cells, and resource allocation between patients. (...) The selections are independent of any particular approach to bioethics. Can be used as a source book to complement A Companion to Bioethics (1999). (shrink)
Issues in reproductive ethics, such as the capacity of parents to ‘choose children’, present challenges to philosophical ideas of freedom, responsibility and harm. This book responds to these challenges by proposing a new framework for thinking about the ethics of reproduction that emphasizes the ways that social norms affect decisions about who is born. The book provides clear and thorough discussions of some of the dominant problems in reproductive ethics - human enhancement and the notion of the normal, reproductive liberty (...) and procreative beneficence, the principle of harm and discrimination against disability - while also proposing new ways of addressing these. The author draws upon the work of Michel Foucault, especially his discussions of biopolitics and norms, and later work on ethics, alongside feminist theorists of embodiment to argue for a new bioethics that is responsive to social norms, human vulnerability and the relational context of freedom and responsibility. This is done through compelling discussions of new technologies and practices, including the debate on liberal eugenics and human enhancement, the deliberate selection of disabilities, PGD and obstetric ultrasound. (shrink)
When philosophers address personal identity, they usually explore numerical identity: what are the criteria for a person's continuing existence? When non-philosophers address personal identity, they often have in mind narrative identity: Which characteristics of a particular person are salient to her self-conception? This book develops accounts of both senses of identity, arguing that both are normatively important, and is unique in its exploration of a range of issues in bioethics through the lens of identity. Defending a biological view of (...) our numerical identity and a framework for understanding narrative identity, DeGrazia investigates various issues for which considerations of identity prove critical: the definition of death; the authority of advance directives in cases of severe dementia; the use of enhancement technologies; prenatal genetic interventions; and certain types of reproductive choices. He demonstrates the power of personal identity theory to illuminate issues in bioethics as they bring philosophical theory to life. (shrink)
The Elimination of Morality poses a fundamental challenge to the dominant conception of medical ethics. In this controversial and timely study, Anne Maclean addresses the question of what kind of contribution philosophers can make to the discussion of medico-moral issues and the work of health care professionals. She establishes the futility of bioethics by challenging the conception of reason in ethics which is integral to the utilitarian tradition. She argues that a philosophical training confers no special authority to make (...) pronouncements about moral issues, and proposes that pure utilitarianism eliminates the essential ingredients of moral thinking. Maclean also exposes the inadequacy of a utilitarian account of moral reasoning and moral life, dismissing the claim that reason demands the rejection of special obligations. She argues that the utilitarian drive to reduce rational moral judgment to a single form is ultimately destructive of moral judgment as such. This vital discussion of the nature of medical ethics and moral philosophy will be important reading for anyone interested in the fields of health care ethics and philosophy. (shrink)
This book is for those interested in an extensive review of the field of bioethics. It is for philosophers who wish to understand the core conceptual issues in health care ethics, and for bioethicists who wish to better understand classical problems in philosophy that have a bearing on health care ethics. The Handbook of Bioethics: Taking Stock of the Field from a Philosophical Perspective: -presents a comprehensive survey of bioethics in one volume; -has 27 of the most (...) prominent scholars in the field take stock of the issues they helped define; -contains essays that outline areas where future research is needed; -identifies potential areas for fruitful collaboration between traditional philosophers and bioethicists; -is an ideal text for graduate or upper level undergraduate courses. (shrink)
Many people working in bioethics take pride in the subject’s embrace of a wide range of disciplines. This invites questions of what in particular is added by each. In this paper, I focus on the role of philosophy within the field: what, if anything, is its unique contribution to bioethics? I sketch out a claim that philosophy is central to bioethics because of its particular analytic abilities, and defend its place within bioethics from a range of (...) sceptical attacks. (shrink)
All persons, while different from one another, have the same value: this is the author's relatively uncontroversial starting point. Her end point is not uncontroversial: an ideal of justice as human flourishing, based on each person's unique set of capabilities. Because the book's focus is women's health care, gender justice, a necessary component of justice, is central to examination of the issues. Classical pragmatists and feminist standpoint theorists are enlisted in support of a strategy by which gender justice is promoted. (...) Two features of the book are unique: (1) the topics presented cover the entire life span of women, not just those related to reproduction; (2) a range views about moral status are applied not only to fetuses but also to individuals already born. Attention to these features is intended to facilitate ethical consistency or moral integrity and respect for those who hold different moral views. While delineating and defending the book's perspective, the first section provides an overview of bioethics, critiques prevalent approaches to bioethics and models of the physician-patient relationship, and sketches distinguishing aspects of women's health care that are prevalently neglected. Positions about moral status are also presented. The second section identifies topics that are indirectly as well as directly related to women's health, such as domestic violence and caregiving. Brief cases illustrate variables relevant to each topic. Empirical and theoretical considerations follow each set of cases; these are intended to precipitate more expansive and critical examination of the issues raised. The last section is devoted to an egalitarian ideal that may be pursued through an ethic of virtue or supererogation rather than obligation. By embracing this ideal, according to the author, moral agents support a more demanding level of morality than guidelines or laws require. (shrink)
Critiquing many areas of medical practice and research whilst making constructive suggestions about medical education, this book extends the scope of medical ethics beyond sole concern with regulation. Illustrating some humanistic ways of understanding patients, this volume explores the connections between medical ethics, healthcare and subjects, such as philosophy, literature, creative writing and medical history and how they can affect the attitudes of doctors towards patients and the perceptions of medicine, health and disease which have become part of contemporary culture. (...) The authors examine a range of ideas in medical practice and research, including: the idea that patient status or the doctor/patient relationship can be understood via quantitative scales the illusion fostered by medical ethics that doctors, unlike those in other professions, are uniquely beneficent and indeed altruistic. An excellent text for undergraduate and postgraduate students of law, medical ethics and medical healthcare law, Bioethics and the Humanities shows the real ethical achievements, problems and half-truths of contemporary medicine. (shrink)
Stem cell research. Drug company influence. Abortion. Contraception. Long-term and end-of-life care. Human participants research. Informed consent. The list of ethical issues in science, medicine, and public health is long and continually growing. These complex issues pose a daunting task for professionals in the expanding field of bioethics. But what of the practice of bioethics itself? What issues do ethicists and bioethicists confront in their efforts to facilitate sound moral reasoning and judgment in a variety of venues? Are (...) those immersed in the field capable of making the right decisions? How and why do they face moral challenge -- and even compromise -- as ethicists? What values should guide them? In The Ethics of Bioethics, Lisa A. Eckenwiler and Felicia G. Cohn tackle these questions head on, bringing together notable medical ethicists and people outside the discipline to discuss common criticisms, the field's inherent tensions, and efforts to assign values and assess success. Through twenty-five lively essays examining the field's history and trends, shortcomings and strengths, and the political and policy interplay within the bioethical realm, this comprehensive book begins a much-needed critical and constructive discussion of the moral landscape of bioethics. (shrink)
What role should religion play in a religiously pluralistic liberal society? Public bioethics unavoidably raises this question in a particularly insistent fashion. As the 20 papers in this collection demonstrate, the issues are complex and multifaceted. The authors address specific and highly contested issues as assisted suicide, stem cell research, cloning, reproductive health, and alternative medicine as well as more general questions such as who legitimately speaks for religion in public bioethics, what religion can add to our understanding (...) of justice, and the value of faith-based contributions to healthcare. Christian (Catholic and Protestant), Jewish, Islamic, and Buddhist viewpoints are represented. The first book to focus on the interface of religion and bioethics, this collection fills a significant void in the literature. (shrink)
Medicine and health care generate many bioethical problems and dilemmas that are of great academic, professional and public interest. This comprehensive resource is designed as a succinct yet authoritative text and reference for clinicians, bioethicists, and advanced students seeking a better understanding of ethics problems in the clinical setting. Each chapter illustrates an ethical problem that might be encountered in everyday practice; defines the concepts at issue; examines their implications from the perspectives of ethics, law and policy; and then provides (...) a practical resolution. There are 10 key sections presenting the most vital topics and clinically relevant areas of modern bioethics. International, interdisciplinary authorship and cross-cultural orientation ensure suitability for a worldwide audience. This book will assist all clinicians in making well-reasoned and defensible decisions by developing their awareness of ethical considerations and teaching the analytical skills to deal with them effectively. (shrink)
Issues concerning patients' rights are at the center of bioethics, but the political basis for these rights has rarely been examined. In Bioethics in a Liberal Society: The Political Framework of Bioethics Decision Making , Thomas May offers a compelling analysis of how the political context of liberal constitutional democracy shapes the rights and obligations of both patients and health care professionals. May focuses on how a key feature of liberal society -- namely, an individual's right to (...) make independent decisions -- has an impact on the most important relational facets of health care, such as patients' autonomy and professionals' rights of conscience. Although a liberal political framework protects individual judgments, May asserts that this right is based on the assumption of an individual's competency to make sound decisions. May uses case studies to examine society's approach to medical decision making when, for reasons ranging from age to severe mental disorder, a person lacks sufficient competency to make independent and fully informed choices. To protect the autonomy of these vulnerable patients, May emphasizes the need for health care ethics committees and ethics consultants to help guide the decision-making process in clinical settings. Bioethics in a Liberal Society is essential reading for all those interested in understanding how bioethics is practiced within our society. (shrink)
This collection of papers explores one of the central debates in the field of bioethics in the new century. It evaluates the controversy between the claim that there is a common morality accepted by all and the opposing view that there are different moral visions and moral rationalities, within which complex bioethical issues demand a solution. Contributions within this volume offer different approaches and perspectives on the pursuit of global ethics in the new century. They are organized under five (...) major themes. The first theme explores the different plausible understandings of the foundations of bioethics and contemporary reflections on the nature and role of moral theory. The second theme analyses the impact of moral loss and moral diversity on the character of bioethics and the search for alternative perspectives in post-traditional and post-modern societies. The third theme examines a number of theoretical issues raised by concrete examples of bioethnological applications, which bear importantly on contemporary debates between the possibility and impossibility of global bioethics. The fourth theme discusses examples of moral conflicts and dilemmas in everyday health care practice regarding the permissible treatment of humans by humans under different ethical perspectives and cultural traditions. The fifth theme explores alternative suggestions for opening up new modes of self-understanding and new strategies for bioethical exploration in the new century. The volume is an important work of reference for philosophers, moral theologians, ethicists, counsellors, doctors, nurses, sociologists, journalists, health care professionals, public policy makers and everyone who is interested in the profound ethical issues arising from modern technological advancements which are not only transforming our lives but are also demanding urgent ethical decision-making and `pragmatic' solutions from a cross-cultural perspective. (shrink)
The coming of bioethics -- The coming of bioethicists -- "Choices on our conscience": the inauguration of the Kennedy Institute of Education -- "Hello, Dolly": bioethics in the media -- Celebrating bioethics and bioethicists -- Thinking socially and culturally in bioethics -- Reminiscences of observing participants -- Bioethics circles the globe -- Bioethics in France -- The development of bioethics in the Islamic Republic of Pakistan -- The coming of the culture wars to (...) American bioethics. (shrink)
In this book, developed by a group of collaborating scholars in bioethics from different European countries, an overview is given of the most salient themes in present-day bioethics. The themes are discussed in order to enable the reader to have an in-depth overview of the state of the art in bioethics. Introductory chapters will guide the reader through the relevant dimensions of a particular area, while subsequent case discussions will help the reader to apply the ethical theories (...) to specific clinical problems and health policy queries. The book focuses on perspectives typical for the European context. This highlights not only particular bioethical themes such as social justice, choices in health care, and health policy (e.g., in post-communist countries), it also emphasizes specific approaches in ethical theory, in relation to Continental philosophies such as phenomenology and hermeneutics. Because of its articulation of what is typical for the European health care setting as well as for bioethical debate, this book is unique in comparison to existing textbooks in bioethics. The book is an introductory textbook acquainting the reader with the major issues in present-day health care as well as the various theoretical and practical approaches to clarify these issues. (shrink)
Bioethics as politics -- Bioethics and the politics of expectations -- Engendering consent : bioethics and biobanks -- Missing the big picture : bioethics and stem cell research -- Testing times : bioethics and "do-it-yourself" genetics -- Governing uncertainty : the politics of nanoethics -- Beyond bioethics.
Bioethics represents a dramatic revision of the centuries-old professional ethics that governed the behavior of physicians and their relationships with patients. This venerable ethics code was challenged in the years after World War II by the remarkable advances in the biomedical sciences and medicine that raised questions about the definition of death, the use of life-support systems, organ transplantation, and reproductive interventions. In response, philosophers and theologians, lawyers and social scientists joined together with physicians and scientists to rethink and (...) revise the old standards. Governments established commissions to recommend policies. Courts heard arguments and legislatures passed laws. This book is the first broad history of the growing field of bioethics. Covering the period 1947-1987, it examines the origin and evolution of the debates over human experimentation, genetic engineering, organ transplantation, termination of life-sustaining treatment, and new reproductive technologies. It assesses the contributions of philosophy, theology, law and the social sciences to the expanding discourse of bioethics. Written by one of the field's founders, The Birth of Bioethics is based on extensive archival research into sources that are difficult to obtain and on interviews with many of the leading figures in the moral debates in medicine. A very readable and comprehensive account of the evolution of bioethics, this book stresses the history of ideas but does not neglect the social and cultural context and the people involved. It will serve the information needs of philosophers, ethicists, social historians, and everyone interested in the origins of some of today's most hotly debated issues. (shrink)
Bioethics and the stages on life's way -- Bioethical challenges in the new millennium -- The covenantal aspect of Christian marriage -- The use and abuse of human embryos -- The sacredness of newborn life -- On addictions and family systems -- The hope of glory : from a physical to a spiritual body -- Care in the final stage of life.
A dictionary definition of Bioethics is, 'the ethics, or moral principles and rules of conduct, of medical and biological research'. This book is an introductory text of just biological and not medical bioethics. It covers the ethics of experimentation, including genetic manipulation, in plants and animals; ethics and biodiversity, ethics and the environment. There is increasing interest in bioethics - both in academia and by the media and the general public. Awareness of bioethics is incorporated into (...) Biological / Environmental Science courses, plus the first dedicated modular courses on bioethics are starting up. Includes case studies Has questions for students Chapters include environmental, animal, agricultural and reproductive ethics as well as a wide range of issues regarding genetic manipulation. (shrink)
The Edge of Life: Human Dignity and Contemporary Bioethics resituates bioethics in fundamental outlook by challenging both the dominant Kantian and utilitarian approaches to evaluating how new technologies apply to human life. Drawing on an analysis of the dignity of the human person, both as an agent and as the recipient of action, The Edge of Life presents a "theoretical" approach to the problems of contemporary bioethics and applies this approach to various disputed questions. Should conjoined twins (...) be split, if the division will end the life of the weaker twin? Was Bush's stem cell research decision morally acceptable? Are the 'quality of life' and 'sanctity of life' ethics irreconcilably incompatible? Accessible to both scholars and students, The Edge of Life focuses particularly on the controversial issues surrounding the beginning and ending of human life, tackling some of the toughest practical questions of bioethics including new reproductive technologies (artificial wombs), stem cell research, abortion and physician assisted suicide, as well as many of its vexing theoretical disputes. (shrink)
In hospital rooms across the country, doctors, nurses, patients, and their families grapple with questions of life and death. Recently, they have been joined at the bedside by a new group of professional experts, bioethicists, whose presence raises a host of urgent questions. How has bioethics evolved into a legitimate specialty? When is such expertise necessary? How do bioethicists make their decisions? And whose interests do they serve? Renowned sociologist Charles L. Bosk has been observing medical care for thirty-five (...) years. In What Would You Do? he brings his extensive experience to bear on these questions while reflecting on the ethical dilemmas that his own ethnographic research among surgeons and genetic counselors has provoked. Bosk considers whether the consent given to ethnographers by their subjects can ever be fully voluntary and informed. He questions whether promises of confidentiality and anonymity can or should be made. And he wonders if social scientists overestimate the benefits of their work while downplaying the risks. Vital for practitioners of both the newly prominent field of bioethics and the long-established craft of ethnography, What Would You Do? will also engross anyone concerned with how our society addresses difficult health care issues. (shrink)
Thomas Aquinas is one of the foremost thinkers in Western philosophy and Christian scholarship, recognized as a significant voice in both theological discussions and secular philosophical debates. Alongside a revival of interest in Thomism in philosophy, scholars have realized its relevance when addressing certain contemporary issues in bioethics. This book offers a rigorous interpretation of Aquinas's metaphysics and ethical thought, and highlights its significance to questions in bioethics. Jason T. Eberl applies Aquinas's views on the seminal topics of (...) human nature and morality to key questions in bioethics at the margins of human life - questions which are currently contested in the academia, politics and the media such as: · When does a human person's life begin? How should we define and clinically determine a person's death? · Is abortion ever morally permissible? How should we resolve the conflict between the potential benefits of embryonic stem cell research and the lives of human embryos? · Does cloning involve a misuse of human ingenuity and technology? · What forms of treatment are appropriate for irreversibly comatose patients? How should we care for patients who experience unbearable suffering as they approach the end of life? · What ethical mandates and concerns underlie the practice of organ donation? Thomistic Principles and Bioethics presents a significant philosophical viewpoint which should motivate further dialogue amongst religious and secular arenas of inquiry concerning such complex issues of both individual and public concern. It will be illuminating reading for scholars, postgraduate and research students of philosophy, metaphysics, ethics, bioethics and moral theology. (shrink)
This volume explores Confucian views regarding the human body, health, virtue, suffering, suicide, euthanasia, `human drugs,' human experimentation, and justice in health care distribution. These views are rooted in Confucian metaphysical, cosmological, and moral convictions, which stand in contrast to modern Western liberal perspectives in a number of important ways. In the contemporary world, a wide variety of different moral traditions flourish; there is real moral diversity. Given this circumstance, difficult and even painful ethical conflicts often occur between the East (...) and the West with regard to the issues of life, birth, reproduction, and death. The essays in this volume analyze the ways in which Confucian bioethics can clarify important moral concepts, provide arguments, and offer ethical guidance. The volume should be of interest to both general readers coming afresh to the study of bioethics, ethics, and Confucianism, as well as for philosophers, ethicists, and other scholars already familiar with the subject. (shrink)
Death, Posthumous Harm, and Bioethics offers a highly distinctive and original approach to the metaphysics of death and applies this approach to contemporary debates in bioethics that address end-of-life and post-mortem issues.
What are the resources and needs, the strengths and the vulnerabilities of patients, of society, or of nature? How do we evaluate the societal potential of scientific discovery? It is fairly well assured that we are influencing the terms of existence of many inhabitants of this planet, from flora to fauna to humans. Moreover, history has shown that while technologies can be used neutrally, they can be (and have been) used to the great benefit – or the great detriment – (...) of human life and the fate of the world as a whole. How various types of knowledge and technological ability will be deployed is up to us, individually and collectively. How such information and ability should be deployed, and for what reasons, are questions at the core of bioethical inquiry. These are the "expanding horizons in bioethics" to which this volume refers. This volume is comprised of fourteen essays. It is a rare gathering of scholarly opinion, featuring well-known experts from a diversity of disciplines. The topics addressed are of immediate concern to the public. The essays ask questions about human nature, genetic technologies, reproductive rights, human subjects research, and environmental issues – all in provocative and challenging new ways. Yet the themes that emerge throughout the volume are of enduring interest to anyone concerned about the interactions of scientific development, ethics, and society. This volume is of interest to students and teachers of bioethics and related topics, as well as to professionals working in these disciplines. (shrink)
Much has been written in the last decade about how we should understand the value of the sociology of bioethics. Increasingly the value of the sociology of bioethics is interpreted by its advocates directly in terms of its relationship to bioethics. It is claimed that the sociology of bioethics (and related disciplinary approaches) should be seen as an important component of work in bioethics. In this paper we wish to examine whether, and how, the sociology (...) of bioethics can be defended as a valid and justified research activity, in the context of debates about the nature of bioethics. We begin by presenting and arguing for an account of bioethics that does justice to the content of the field, the range of questions that belong within this field, and the justificatory standards (and methodological orientations) that can provide convincing answers to these questions. We then consider the role of sociology in bioethics and show how and under what conditions it can contribute to answering questions within bioethics. In the final section, we return to the sociology of bioethics to show that it can make only a limited contribution to the field. (shrink)
Machine generated contents note: Introduction; Part I. Backgrounds: 2. Some background: self and reason; 3. Some background: approaches to ethics; 4. Some background: our good; 5. Elusive lines, slippery slopes, and moral principles; Part II. Life, Death, and Bioethics: 6. Being alive; 7. Being healthy; 8. Health and virtue; 9. Death and life; 10. Drawing lines with death; 11. Double effect: euthanasia, and proportionality; 12. Abortion; 13. The gene I: the mystique; 14. The gene II: manipulation; 15. Ethics and (...) biomedical research; 16. Bioethics seen in an eastern light; 17. Toward a wider view. (shrink)
Preface -- How brave a new world? : God, technology, and medicine -- A theological reflection on reproductive medicine -- Are our genes our fate? : genomics and Christian theology -- Persons, neighbors, and embryos : some ethical reflections on human cloning and stem cell research -- Extending human life : to what end? -- What is Christian about Christian bioethics? -- Revitalizing medicine : empowering natality vs. fearing mortality -- The future of the human species -- Creation, creatures, (...) and creativity : the Word and the final Word. (shrink)
Machine generated contents note: 1. Introduction - when criminal law encounters bioethics: a case of tensions and incompatibilities or an apt forum for resolving ethical conflict? Amel Alghrani, Rebecca Bennett and Suzanne Ost; Part I. Death, Dying, and the Criminal Law: 2. Euthanasia and assisted suicide should, when properly performed by a doctor in an appropriate case, be decriminalised John Griffiths; 3. Five flawed arguments for decriminalising euthanasia John Keown; 4. Euthanasia excused: between prohibition and permission Richard Huxtable; Part (...) II. Freedom and Autonomy: When Consent Is Not Enough: 5. Body integrity identity disorder - a problem of perception? Robert Smith; 6. Risky sex and 'manly diversions': the contours of consent in criminal law - transmission and rough horseplay cases David Gurnham; 7. 'Consensual' sexual activity between doctors and patients: a matter for the criminal law? Suzanne Ost and Hazel Biggs; Part III. Criminalising Biomedical Science: 8. 'Scientists in the dock': regulating science Amel Alghrani and Sarah Chan; 9. Bioethical conflict and developing biotechnologies: is protecting individual and public health from the risks of xenotransplantation a matter for the (criminal) law? Sara Fovargue; 10. The criminal law and enhancement - none of the law's business? Nishat Hyder and John Harris; 11. Dignity as a socially constructed value Stephen Smith; Part IV. Bioethics and Criminal Law in the Dock: 12. Can English law accommodate moral controversy in medicine? The case of abortion Margaret Brazier; 13. The case for decriminalising abortion in Northern Ireland Marie Fox; 14. The impact of the loss of deference towards the medical profession Jose; Miola; 15. Criminalising medical negligence David Archard; 16. All to the good? Criminality, politics, and public health John Coggon; 17. Moral controversy, human rights and the common law judge Brenda Hale. (shrink)
Machine generated contents note: 1. Introduction - when criminal law encounters bioethics: a case of tensions and incompatibilities or an apt forum for resolving ethical conflict? Amel Alghrani, Rebecca Bennett and Suzanne Ost; Part I. Death, Dying, and the Criminal Law: 2. Euthanasia and assisted suicide should, when properly performed by a doctor in an appropriate case, be decriminalised John Griffiths; 3. Five flawed arguments for decriminalising euthanasia John Keown; 4. Euthanasia excused: between prohibition and permission Richard Huxtable; Part (...) II. Freedom and Autonomy: When Consent Is Not Enough: 5. Body integrity identity disorder - a problem of perception? Robert Smith; 6. Risky sex and 'manly diversions': the contours of consent in HIV transmission and rough horseplay cases David Gurnham; 7. 'Consensual' sexual activity between doctors and patients: a matter for the criminal law? Suzanne Ost and Hazel Biggs; Part III. Criminalising Biomedical Science: 8. 'Scientists in the dock': regulating science Amel Alghrani and Sarah Chan; 9. Bioethical conflict and developing biotechnologies: is protecting individual and public health from the risks of xenotransplantation a matter for the (criminal) law? Sara Fovargue; 10. The criminal law and enhancement - none of the law's business? Nishat Hyder and John Harris; 11. Dignity as a socially constructed value Stephen Smith; Part IV. Bioethics and Criminal Law in the Dock: 12. Can English law accommodate moral controversy in medicine? Lessons from abortion Margaret Brazier; 13. The case for decriminalising abortion in Northern Ireland Marie Fox; 14. The impact of the loss of deference towards the medical profession Jose; Miola; 15. Criminalising medical negligence David Archard; 16. All to the good? Criminality, politics, and public health John Coggon; 17. Moral controversy, human rights and the common law judge Brenda Hale. (shrink)
Bioethics' interdisciplinary base -- Patient-centered care -- Evidence-based medicine and pay-for-performance -- Community dialogue -- Overview : bioethics, power, and learning to see -- Cross-cultural concerns -- Race and health disparities -- Disabilities -- Environmental and global issues -- New technologies -- Conclusion.
Ethical issues in health care, medicine and biotechnology are often discussed in the abstract, without reference to the social or political context from which they arise. We live in a liberal, democratic, multicultural society where ideally the values of personal liberty and autonomy are paramount. In such a society the state, through the law, should live their lives. In spite of this, many of the ethical stances taken in liberal societies are paternalistic and authoritarian. This readable and balanced book is (...) an original discussion of contemporary issues in bioethics. Max Charlesworth argues that as there can be no public consensus on a set of core values - liberal societies accept a variety of religious, non-religious, political and moral stances - there should be a plurality of ethical stances as well. On this basis he discusses issues such as: the ending of human life: suicide, the 'right to die', euthanasia; new reproductive technologies such as in vitro fertilisation and alternative ways of reproduction such as surrogacy; and ethical questions concerned with the distribution of limited health-care resources, particularly hospital care. This discussion of crucial bioethical issues will be read by people in all areas where medical ethics are considered - nursing, medicine, health administration, sociology, philosophy and religious studies - as well as by general readers interested in some of the most compelling ethical questions of our time. (shrink)
A collection celebrating some of the best essays from the Blackwell journals, Bioethics and Developing World Bioethics. Contributors include Helga Kuhse, Michael Selgelid and Baroness Mary Warnock, former Chair of the British Government’s Committee of Inquiry into Human Fertilization and Embryology’s. Traces some of the most important concerns of the 1980s, such as the ethics of euthanasia, reproductive technologies, the allocation of scarce medical resources, surrogate motherhood, through to a range of new issues debated today, particularly in the (...) field of genetics. Includes contributions that are still as hotly debated today as they were 20 years ago and serves as a salutary reminder that free and open discussion is vital to the health of the discipline itself. Includes eight sections comprising some of the journals' best publications in methodological issues, the health care professional-patient relationship, public health ethics, research ethics, genetics, as well as beginning- and end-of-life issues. Will serve the academic bioethicists as well as students of bioethics as an excellent source book. (shrink)
Machine generated contents note: Abbreviations; Preface; Introduction; Part I. How are we to do Bioethics?: Section 1. Context: Challenges and Resources of a New Millennium: 1. Sex and life in post-modernity; 2. Catholic engagement with the culture of modernity; 3. Promising developments; 4. Conclusion; Section 2. Conscience: The Crisis of Authority: 5. The voice of conscience; 6. The voice of the magisterium; 7. Conscience in post-modernity; 8. Where to from here?; Section 3. Cooperation: Should we ever Collaborate with Wrongdoing?: (...) 9. Traditional example; 10. Five modern examples; 11. Some fundamental issues raised by these examples; 12. Why it matters so much; 13. Conclusion; Part II. Beginning-of-Life: Section 4. Beginnings: When do People Begin?: 14. Method, thesis and implications; 15. A closer look at Ford's science; 16. A closer look at Ford's philosophy; 17. Individuality criteria; 18. Conclusions; Section 5. Stem Cells: What's all the Fuss About?: 19. Scientific potential and concerns about stem cells; 20. Ethical concerns about embryonic stem cells; 21. Social concerns about embryonic stem cells; Section 6. Abortion - and the New Eugenics: 22. The perennial debate about abortion; 23. Pre-natal screening: a search and destroy mission?; 24. The new abortion debate; Part III. Later Life: Section 7. Transplants: Bodies, Relationships and Ethics: 25. Love beyond death; 26. Conceptions of the body and relationships in organ transplantation; 27. Fashionable bioethical approaches to organ procurement; 28. Better bioethical approaches to organ procurement; 29. Ethical issues in organ reception; 30. Conclusion; Section 8. Artificial Nutrition: Why do Unresponsive Patients Matter?: 31. Civilisation after Schiavo?; 32. Why the unresponsive still matter: a philosophical account; 33. Why the unresponsive still matter: a theological account; 34. Some final questions; Section 9. Endings: Suicide and Euthanasia in the Bible: 35. The problem of suicide and euthanasia in the Bible; 36. Suicides and euthanasias in the Bible; 37. The Scriptural basis of Judeo-Christian opposition to suicide and euthanasia; Part IV. Protecting Life: Section 10. Identity: What Role for a Catholic Hospital?: 38. A tale of two hospitals; 39. Current challenges for Catholic hospitals; 40. Catholic hospitals as diakonia; 41. Catholic hospitals as martyria; 42. Catholic hospitals as leitourgia; 43. Conclusion: six tasks for a new century; Section 11. Regulation: What Kinds of Laws and Social Policies?: 44. A tale of three politicians; 45. Catholic principles for politicians; 46. Reasonable stances for a pro-life politician; 47. Some virtues of a pro-life politician. (shrink)
Is there only one bioethics? Is a global bioethics possible? Or, instead, does one encounter a plurality of bioethical approaches shaped by local cultural and national traditions? Some thirty years ago a field of applied ethics emerged under the rubric `bioethics'. Little thought was given at the time to the possibility that this field bore the imprint of a particular American set of moral commitments. This volume explores the plurality of moral perspectives shaping bioethics. It is (...) inspired by Kazumasa Hoshino's critical reflections on the differences in moral perspectives separating Japanese and American bioethics. The essays include contributions from Hong Kong, China, Japan, Texas, the United States, Germany, Switzerland, and Italy. The volume offers a rich perspective of the range of approaches to bioethics. It brings into question whether there is unambiguously one ethics for bioethics to apply. (shrink)
Bioethics claimed to offer a set of generally applicable, universally accepted guidelines that would simplify complex situations. In Thieves of Virtue, Tom Koch argues that bioethics has failed to deliver on its promises.
This book aims to redress the imbalance in moral philosophy created by the dominance of consequentialism and utilitarianism, the view that criterion of morality is the maximisation of good effects over bad without regard to intrinsic rightness or wrongness. This approach has become the orthodoxy over the last few decades particularly in bioethics, where moral theory is applied to bioethics. Human Lives critically examines the assumptions and arguments of consequentialism reviviing in the process such concepts as rights, justice, (...) innocence, natural integrity, flourishing, the virtues and the fundamental value of human life. (shrink)
Modern scientific and medical advances bring new complexity and urgency to ethical issues in health care and biomedical research. This book applies the American philosophical theory of pragmatism to such bioethics. Critics of pragmatism argue that it lacks a universal moral foundation. Yet it is this very lack of a metaphysical dividing line between facts and values that makes pragmatism such a rigorous and appropriate method for solving problems in bioethics. For pragmatism, ethics is a way of satisfying (...) the complex demands of multiple individuals and groups in a contingent and changing world. Pragmatism also demands careful attention to the ways in which scientific advances change our values and ethics.The essays in this book present different approaches to pragmatism and different ways of applying pragmatism to scientific and medical matters. They use pragmatism to guide thinking about such timely topics as stem cell research, human cloning, genetic testing, human enhancement, and care for the poor and aging. This new edition contains three new chapters, on difficulties with applying pragmatism to law and bioethics, on helping people to die, and on embryonic stem cell research. (shrink)
Bioethical issues remain front-page news, with debate continuing to rage over issues including genetic modification, animal cloning, and "designer babies." With public opinion often driven by media speculation, how can we ensure that informed decisions regarding key bioethical issues are made in a reasoned, objective way? Ideal for students new to the subject, Bioethics: An Introduction for the Biosciences offers a balanced, objective introduction to the field. With a focus on developing powers of reasoning and judgment, the book presents (...) different perspectives on common themes in an impartial way, thereby fostering debate and discussion. The opening section, "The Ethical Groundwork," introduces students to the nature of bioethics and ethical theory. The book goes on to cover a broad range of bioethical issues relating to people, animals, and food, before concluding with an overview of bioethics in practice. Features: * The broadest, most balanced textbook on bioethics available, offering students just the right mix of science and philosophy as well as a clear, objective introduction to the subject * Presents different perspectives on common themes in order to encourage students to question, evaluate, and form their own opinions * Incorporates many useful pedagogical tools including self-assessment questions, topics for discussion, and exercises * Includes references for further reading and useful web sites * A companion website offers resources for both students and instructors. (shrink)
Western society today is less unified by a set of core values than ever before. Undoubtedly, the concept of moral consensus is a difficult one in a liberal, democratic and pluralistic society. But it is imperative to avoid a rigid majoritarianism where sensitive personal values are at stake, as in bioethics. Bioethics has become an influential part of public and professional discussions of health care. It has helped frame issues of moral values and medicine as part of a (...) more general effort to find consensus about some of the most perplexing questions of our time. But why is it thought that a moral consensus is important or that it deserves respect? How does moral consensus acquire legitimacy in a society that includes diverse value systems? How is moral consensus possible and how do small groups help create or distort consensus processes? Written by a medical school professor trained in philosophy, this timely work tackles these questions from philosophical, historical, and social scientific standpoints. It begins by describing the traditional ambivalence about consensus in Western culture as well as the uncertain relationship in modernity between consensus and expertise. After outlining the current bioethical consensus, the book gives philosophical and political analyses of the idea of consensus, then assesses the role of consensus in national ethics commissions and in the ethics committee movement. Moreno constructs an original, naturalistic philosophy of moral consensus, referred to as "bioethical naturalism", and then applies sociology and social psychology to actual consensus processes. The book concludes with an account of bioethics as a consensus-oriented social reform movement. This insightful volume will be essential reading for bioethicists, philosophers, physicians, members of ethics committees, and all those concerned with ethical and social issues in health care. (shrink)
This is a series of essays critical of the utilitarian bioethics now dominating contemporary discussion. Analysing questions of moral theory as well as applied ethics this book aims to supply essays on matters as diverse as beginning and end-of-life issues as well as animal rights, the act-omission distinction and the principle of double effect in caring in medical ethics.
Machine generated contents note: Preface; Using this book; Notes for instructors; Part I. Bioethics and Ethics: 1. Biotechnology and bioethics: what it's all about; 2. Ethics in general: ethics, action and freedom; 3. Ethics in the context of society: ethics, society and the law; 4. Ethical theories: virtue, duty and happiness; 5. Identifying and evaluating arguments: logic and morality; 6. General arguments: unnatural, disgusting, risky, only opinion; Part II. The Beginning and End of Life: Section 1. Cloning: 7. (...) Therapeutic cloning: the moral status of embryos; 8. Reproductive cloning: science and science fiction; Section 2. Reproduction: 9. Reproductive freedom: rights, responsibilities and choice; 10. The resources of reproduction: eggs, sperm and wombs for sale; 11. Screening and embryo selection: eliminating disorders or people?; Section 3. Ageing and Death: 12. Ageing and immortality: the search for longevity; 13. Death and killing: the quality and value of life; Part III. In The Midst of Life: Section 4. Our Duties to Ourselves: 14. Human enhancement: the more the better?; 15. Bio-information: databases, privacy and the fight against crime; 16. Security and defence: security sensitivity, publication and warfare; Section 5. Our Duties to Each Other: 17. Food and energy security: GM food, biofuel and the media; 18. Bio-ownership: who owns the stuff of life?; 19. Human justice: the developed and developing worlds; Section 6. Our Duties to Nature: 20. Non-human animals: consciousness, rationality and animal rights; 21. The living and non-living environment: spaceship Earth; Index. (shrink)
Introduction: The Christian confronts bioethics -- Foundations of bioethics -- Christianity and health care in a fallen world -- Theological doctrines -- Christian virtues -- The beginning of life -- Marriage, procreation, and contraception -- Assisted reproduction -- The human embryo -- The end of life -- Approaching death : dying as a way of life -- Suicide, euthanasia, and the distinction between killing and letting die -- Accepting and forgoing treatment.
Moral reasoning in bioethics -- Bioethics and moral theories -- Paternalism and patient autonomy -- Truth-telling and confidentiality -- Informed consent -- Human research -- Abortion -- Reproductive technology -- Genetic choices -- Euthanasia and physician assisted suicide -- Dividing up health care resources.
The concept of human dignity is increasingly invoked in bioethical debate and, indeed, in international instruments concerned with biotechnology and biomedicine. While some commentators consider appeals to human dignity to be little more than rhetoric and not worthy of serious consideration, the authors of this groundbreaking new study give such appeals distinct and defensible meaning through an application of the moral theory of Alan Gewirth.
This paper discusses the viability of a virtue-based approach to bioethics. Virtue ethics is clearly appropriate to addressing issues of professional character and conduct. But another major remit of bioethics is to evaluate the ethics of biomedical procedures in order to recommend regulatory policy. How appropriate is the virtue ethics approach to fulfilling this remit? The first part of this paper characterizes the methodology problem in bioethics in terms of diversity, and shows that virtue ethics does not (...) simply restate this problem in its own terms. However, fatal objections to the way the virtue ethics approach is typically taken in bioethics literature are presented in the second section of the paper. In the third part, a virtue-based approach to bioethics that avoids the shortcomings of the typical one is introduced and shown to be prima facie plausible. The upshot is an inviting new direction for research into bioethics' methodology. (shrink)
The concept of dignity is pervasive in bioethics. However, some bioethicists have argued that it is useless on three grounds: that it is indeterminate; that it is reactionary; and that it is redundant. In response, a number of defences of dignity have recently emerged. All of these defences claim that when dignity is suitably clarified, it can be of great use in helping us tackle bioethical controversies. This paper rejects such defences of dignity. It outlines the four most plausible (...) conceptions of dignity: dignity as virtuous behaviour; dignity as inherent moral worth; Kantian dignity; and dignity as species integrity. It argues that while each conception is coherent, each is also fundamentally flawed. As such, the paper argues for a bioethics without dignity: an 'undignified bioethics.'. (shrink)
Various theories have been put forward in an attempt to explain what makes moral judgments justifiable. One of the main theories currently advocated in bioethics is a form of coherentism known as wide reflective equilibrium. In this paper, I argue that wide reflective equilibrium is not a satisfactory approach for justifying moral beliefs and propositions. A long-standing theoretical problem for reflective equilibrium has not been adequately resolved, and, as a result, the main arguments for wide reflective equilibrium are unsuccessful. (...) Moreover, practical problems that arise in using the method of wide reflective equilibrium undermine the idea that it is a viable approach for justifying moral judgments about cases and policies. Given that wide reflective equilibrium is the most prominent version of coherentism, these considerations call into question the coherentist approach to justification in bioethics. (shrink)
Fast forward 50 years into the future. A look back at what occurred in the field of bioethics since 2010 reveals that a conference in 2050 commemorated the death of bioethics. In a steady progression over the years, the field became increasingly fragmented and bureaucratized. Disagreement and dissension were rife, and this once flourishing, multidisciplinary field began to splinter in multiple ways. Prominent journals folded, one by one, and were replaced with specialized publications dealing with genethics, reproethics, nanoethics, (...) and necroethics. Mainstream bioethics organizations also collapsed, giving way to new associations along disciplinary and sub-disciplinary lines. Physicians established their own journals, and specialty groups broke away from more general associations of medical ethics. Lawyers also split into three separate factions, and philosophers rejected all but the most rigorous, analytic articles into their newly established journal. Matters finally came to a head with global warming, the world-wide spread of malaria and dengue, and the cost of medical treatments out of reach for almost everyone. The result was the need to develop plans for strict rationing of medical care. At the same time, recognition emerged of the importance of the right to health and the need for global justice in health. By 2060, a spark of hope was ignited, opening the door to the resuscitation of bioethics and involvement of the global community. (shrink)
In this introduction to the special issue of Theoretical Medicine and Bioethics on the topic of personal identity and bioethics, I provide a background for the topic and then discuss the contributions in the special issue by Eric Olson, Marya Schechtman, Tim Campbell and Jeff McMahan, James Delaney and David Hershenov, and David DeGrazia.
In this article we distinguish between philosophical bioethics (PB), descriptive policy orientated bioethics (DPOB) and normative policy oriented bioethics (NPOB). We argue that finding an appropriate methodology for combining empirical data and moral theory depends on what the aims of the research endeavour are, and that, for the most part, this combination is only required for NPOB. After briefly discussing the debate around the is/ought problem, and suggesting that both sides of this debate are misunderstanding one another (...) (i.e. one side treats it as a conceptual problem, whilst the other treats it as an empirical claim), we outline and defend a methodological approach to NPOB based on work we have carried out on a project exploring the normative foundations of paternal rights and responsibilities. We suggest that given the prominent role already played by moral intuition in moral theory, one appropriate way to integrate empirical data and philosophical bioethics is to utilize empirically gathered lay intuition as the foundation for ethical reasoning in NPOB. The method we propose involves a modification of a long-established tradition on non-intervention in qualitative data gathering, combined with a form of reflective equilibrium where the demands of theory and data are given equal weight and a pragmatic compromise reached. (shrink)
The report of the President's Council on Bioethics, Human Cloning and Human Dignity, addresses the central ethical, political, and policy issue in human embryonic stem cell research: the moral status of extracorporeal human embryos. The Council members were in sharp disagreement on this issue and essentially failed to adequately engage and respectfully acknowledge each others' deepest moral concerns, despite their stated commitment to do so. This essay provides a detailed critique of the two extreme views on the Council (i.e., (...) embryos have full moral status or they have none at all) and then gives theoretical grounding for our judgment about the intermediate moral status of embryos. It also supplies an account of how to address profound moral disagreements in the public arena, especially by way of constructing a middle ground that deliberately pays sincere respect to the views of those with whom it has deep disagreements. (shrink)
In this paper I argue that bioethics is in crisis and that it will not have a future unless it begins to embrace a more Socratic approach to its leading assumptions. The absence of a critical and sceptical spirit has resulted in little more than a dominant ideology. I focus on three key issues. First, that too often bioethics collapses into medical ethics. Second, that medical ethics itself is beset by a lack of self-reflection that I characterize here (...) as a commitment to three dogmas. Third, I offer a more positive perspective by suggesting how bioethics may benefit from looking towards public health ethics as a new source of inspiration and direction. (shrink)
What makes individuals, groups, or even entire countries vulnerable? And why is vulnerability a concern in bioethics? A simple answer to both questions is that vulnerable individuals and groups are subject to exploitation, and exploitation is morally wrong. This analysis is limited to two areas. First is the context of multinational research, in which vulnerable people can be exploited even if they are not harmed, and harmed even if they are not exploited. Second is the situation of women, who (...) are made vulnerable in cultural settings or in entire countries in which they are oppressed and powerless. (edited). (shrink)
Uncertainty as to how we should articulate empirical data and normative reasoning seems to underlie most difficulties regarding the ‘empirical turn’ in bioethics. This article examines three different ways in which we could understand ‘empirical turn’. Using real facts in normative reasoning is trivial and would not represent a ‘turn’. Becoming an empirical discipline through a shift to the social and neurosciences would be a turn away from normative thinking, which we should not take. Conducting empirical research to inform (...) normative reasoning is the usual meaning given to the term ‘empirical turn’. In this sense, however, the turn is incomplete. Bioethics has imported methodological tools from empirical disciplines, but too often it has not imported the standards to which researchers in these disciplines are held. Integrating empirical and normative approaches also represents true added difficulties. Addressing these issues from the standpoint of debates on the fact-value distinction can cloud very real methodological concerns by displacing the debate to a level of abstraction where they need not be apparent. Ideally, empirical research in bioethics should meet standards for empirical and normative validity similar to those used in the source disciplines for these methods, and articulate these aspects clearly and appropriately. More modestly, criteria to ensure that none of these standards are completely left aside would improve the quality of empirical bioethics research and partly clear the air of critiques addressing its theoretical justification, when its rigour in the particularly difficult context of interdisciplinarity is what should be at stake. (shrink)
In this commentary, I critically discuss the respective views of Gert and Beauchamp–Childress on the nature of so-called common morality and its promise for enriching ethical reflection within the field of bioethics. Although I endorse Beauchamp and Childress’ shift from an emphasis on ethical theory as the source of moral norms to an emphasis on common morality, I question whether rouging up common morality to make it look like some sort of ultimate and universal foundation for morality, untouched by (...) the dialectics of time and reflective equilibrium, was an equally good move. As for Gert’s magisterial conception of common morality, I conclude that certain elements of his system are controversial at best and woefully inadequate at worst. He has a tendency to find in common morality what he himself put there, and his highly restricted conception of duties of assistance strikes this reader as ad hoc, inadequately defended, and unworthy of a project whose goal is to lessen the amount of misery in the world. (shrink)
Race and religion are integral parts of bioethics. Harm and oppression, with the aim of social and political control, have been wrought in the name of religion against Blacks and people of color as embodied in the Ten Commandments, the Inquisition, and in the history of the Holy Crusades. Missionaries came armed with Judeo/Christian beliefs went to nations of people of color who had their own belief systems and forced change and caused untold harms because the indigenous belief systems (...) were incompatible with their own. The indigenous people were denounced as ungodly, pagan, uncivilized, and savage. Hence, laws were enacted because of their perceived need to structure a sense of morality and to create and build a culture for these indigenous people of color. To date bioethics continues to be informed by a Western worldview that is Judeo/Christian in belief and orientation. However, missing from bioethical discourse in America is the historical influence of the Black Church as a cultural repository, which continues to influence the culture of Africans and Blacks. Cultural aspects of peoples of color are still largely ignored today. In attempting to deal with issues of race while steering clear of the religious and cultural impact of the Black Church, bioethics finds itself in the middle of a distressing situation: it simply cannot figure out what to do with race. (shrink)
For ten years, 1971–1981, the Institute onHuman Values in Medicine (IHVM) played a keyrole in the development of Bioethics as afield. We have written this history andanalysis to bring to new generations ofBioethicists information about the developmentof their field within both the humanitiesdisciplines and the health professions. Thepioneers in medical humanities and ethics cametogether with medical professionals in thedecade of the 1960s. By the 1980s Bioethics wasa fully recognized discipline. We show the rolethat IHVM programs played in defining (...) thefield, training faculty and helping schools todevelop programs. We review the beginnings ofthe IHVM in the crucible of social andtechnological change that led to theestablishment of the IHVM's parentorganization, the Society for Health and HumanValues. We then turn to the IHVM programsthrough which Faculty members receivedfellowships to explore new crossovers betweenthe humanities and the health professions. Wehave not only described the Fellows Program asit existed in 1973–1980, but have completed asurvey of the fellows a quarter of a centuryafter they held their fellowships. We describeother IHVM programs designed to facilitate theinitiation and development of new humanitiesprograms, to explore conceptual issues betweenmedicine and five humanities fields, to conductissue driven or educational method conferencesand to advance humanities programs intograduate education through the Directors ofMedical Education. (shrink)
The President's Council on Bioethics has recently released a report supportive of the continued use of brain death as a criterion for human death. The Council's conclusions were based on a conception of life that stressed external work as the fundamental marker of organismic life. With respect to human life, it is spontaneous respiration in particular that indicates an ability to interact with the external environment, and so indicates the presence of life. Conversely, irreversible apnoea marks an inability to (...) carry out the necessary work of life, an inability which the Council considers an indicator of death. This conception has been conceived to circumvent criticisms of the previous model of loss of somatic integration, a model the Council admits that, in the presence of evidence of continuing functional integration in brain dead patients, was looking less than convincing. Nevertheless, by focusing on external work and ignoring the more essential work of integrative unity, the Council's conception of the nature of life is untenable, and of no assistance in supporting a relation of equivalence between the concepts of brain death and death. Consequently, the Council's conclusions do little to advance the definition of death debate, a potentially intractable debate that may necessitate the investigation of alternate ethical justifications for organ harvesting. (shrink)
Research ethics is the most developed aspect of bioethics in Africa. Most African countries have set up Institutional Review Boards (IRBs) to provide guidelines for research and to comply with international norms. However, bioethics has not been responsive to local needs and values in the rest of the continent. A new direction is needed in African bioethics. This new direction promotes the development of a locally-grounded bioethics, shaped by a dynamic understanding of local cultures and informed (...) by structural and institutional problems that impact the public's health, as well as cognisant of the salient contribution of social sciences and social epidemiology which can bring a lasting impact on African local communities. In today's post-Structural Adjustment Africa, where healthcare has been liberalized and its cost increased, a bioethics agenda that focuses essentially on disease management and clinical work remains blind in the face of a structural marginalization of the masses of poor. Instead, the multidimensional public health crisis, with which most African countries are confronted, calls for a bioethics agenda that focuses primarily, but not exclusively, on health promotion and advocacy. Such an approach to bioethics reckons with the macro-determinants of health and well-being and places clinical and research ethics in the broader context of population's health. The same approach underscores the need to become political, not only by addressing health policymaking processes and procedures, but also by becoming an advocacy forum that includes other constituencies equipped with the potentialities to impact the population's health. (shrink)
In a prior issue of Developing World Bioethics, Cheryl Macpherson and Ruth Macklin critically engaged with an article of mine, where I articulated a moral theory grounded on indigenous values salient in the sub-Saharan region, and then applied it to four major issues in bioethics, comparing and contrasting its implications with those of the dominant Western moral theories, utilitarianism and Kantianism. In response to my essay, Macpherson and Macklin have posed questions about: whether philosophical justifications are something with (...) which bioethicists ought to be concerned; why something counts as ‘African’; how medicine is a moral enterprise; whether an individual right to informed consent is consistent with sub-Saharan values; and when thought experiments help to establish firm conclusions about moral status. These are important issues for the field, and I use this reply to take discussion of them a step or two farther, defending my initial article from Macpherson's and Macklin's critical questions and objections. (shrink)
Germund Hesslow has argued that concepts of health and disease serve no important scientific, clinical, or ethical function. However, this conclusion depends upon the particular concept of disease he espouses; namely, on Boorse's functional notion. The fact/value split embodied in the functional notion of disease leads to a sharp split between the science of medicine and bioethics, making the philosophy of medicine irrelevant for both. By placing this disease concept in the broader context of medical history, I shall show (...) that it does capture an essential part of modern medical ideology. However, it is also a self-contradictory notion. By making explicit the value desiderata of medical nosologies, a reconfiguration of the relation between medicine, bioethics, and the philosophy of medicine is initiated. This, in turn, will involve a recovery of the caring dimensions of medicine, and thus a more humane practice. (shrink)
American healthcare -- Bioterror and bioart -- State of emergency -- Licensed to torture -- Hunger strikes -- War -- Cancer -- Drug dealing -- Toxic tinkering -- Abortion -- Culture of death -- Patient safety -- Global health -- Statue of security -- Pandemic fear -- Bioidentifiers -- Genetic genocide.
In a recent article, Alasdair Cochrane argues for the need to have an undignified bioethics. His is not, of course, a call to transform bioethics into an inelegant, pathetic discipline, or one failing to meet appropriate disciplinary standards. His is a call to simply eliminate the concept of human dignity from bioethical discourse. Here I argue that he fails to make his case. I first show that several of the flaws that Cochrane identifies are not flaws of the (...) conceptions of dignity he discusses but rather flaws of his, often problematic, understanding of such conceptions. Second, I argue that Cochrane's case against the concept of human dignity goes too far. I thus show that were one to agree that these are indeed flaws that require that we discard our ethical concepts, then following Cochrane's recommendations would commit us not only to an undignified bioethics, i.e. a bioethics without dignity, but to a bioethics without much ethics at all. (shrink)
This article discusses what 'global bioethics' means today and what features make bioethical research 'global'. The article provides a historical view of the development of the field of 'bioethics', from medical ethics to the wider study of bioethics in a global context. It critically examines the particular problems that 'global bioethics' research faces across cultural and political borders and suggests some solutions on how to move towards a more balanced and culturally less biased dialogue in the (...) issues of bioethics. The main thesis is that we need to bring global and local aspects closer together, when looking for international guidelines, by paying more attention to particular cultures and local economic and social circumstances in reaching a shared understanding of the main values and principles of bioethics, and in building 'biodemocracy'. (shrink)
Refusing to pursue recent and possible future developments in medical research is itself a morally momentous decision—and that inaction has consequences Cohen and other right-wing thinkers refuse to acknowledge. -/- .
I reflect on the past, present, and future of the field of bioethics. In so doing, I offer a very situated overview of where bioethics has been, where it now is, where it seems to be going, where I think we could do better, and where I dearly hope the field will be heading. I also propose three ways of re-orienting our theoretic tools to guide us in a new direction: (1) adopt an ethics of responsibility; (2) explore (...) the responsibilities of various kinds of actors and relationships among them; (3) expand the types of participants engaged in bioethics. (shrink)
Since its origin bioethics has been a specialized, academic discipline, focussing on moral issues, using a vast set of globalized principles and rational techniques to evaluate and guide healthcare practices. With the emergence of a plural society, the loss of faith in experts and authorities and the decline of overarching grand narratives and shared moralities, a new approach to bioethics is needed. This approach implies a shift from an external critique of practices towards embedded ethics and interactive practice (...) improvement, and from a legal defence of rights towards fostering interdependent practices of responsibility. This article describes these transitions within bioethics in relation to the broader societal and cultural dynamics within Western societies, and traces the implications for the methodologies and changing roles of the bioethicist. The bioethicist we foresee is not just a clever expert but also a relationally sensitive person who engages stakeholders in reciprocal dialogues about their practice of responsibility and helps to integrate various sorts of knowledge (embodied, experiential, visual, and cognitive-scientific). In order to illustrate this new approach, we present a case study. It concerns a project focusing on an innovation in elderly care, based on the participation of various stakeholders, especially older people themselves. (shrink)
This essay addresses a moral and cultural challenge facing health care in the People’s Republic of China: the need to create an understanding of medical professionalism that recognizes the new economic realities of China and that can maintain the integrity of the medical profession. It examines the rich Confucian resources for bioethics and health care policy by focusing on the Confucian tradition’s account of how virtue and human flourishing are compatible with the pursuit of profit. It offers the Confucian (...) account of the division of labor and the financial inequalities this produces with special attention to China’s socialist project of creating the profession of barefoot doctors as egalitarian peasant physicians and why this project failed. It then further develops the Confucian acknowledgement of the unequal value of different services and products and how this conflicts with the current system of payment to physicians which has led to the corruption of medical professionalism through illegal supplementary payments. It further gives an account the oblique intentionality of Confucian moral psychology that shows how virtuous persons can pursue benevolent actions while both foreseeing profit and avoiding defining their character by greed. This account of Confucian virtue offers the basis for a medical professionalism that can function morally within a robustly profit-oriented market economy. The paper concludes with a summary of the characteristics of Confucian medical professionalism and of how it places the profit motive within its account of virtue ethics. (shrink)
Bioethics has a founding story in which medical paternalism, the interference with the autonomy of patients for their own clinical benefit, was an accepted ethical norm in the history of Western medical ethics and was widespread in clinical practice until bioethics changed the ethical norms and practice of medicine. In this paper I show that the founding story of bioethics misreads major texts in the history of Western medical ethics. I also show that a major source for (...) empirical claims about the widespread practice of medical paternalism has been misread. I then show that that bioethics based on its founding story deprofessionalizes medical ethics. The result leaves the sick exposed to the predatory power of medical practitioners and healthcare organizations with only their autonomy-based rights to non-interference, expressed in contracts, to protect them. The sick are stripped of the protection afforded by a professional, fiduciary relationship of physicians to their patients. Bioethics based on its founding story reverts to the older model of a contractual relationship between the sick and medical practitioners not worthy of intellectual or moral trust (because such trust cannot be generated by what I call ‘deprofessionalizing bioethics’). On closer examination, bioethics based on its founding story, ironically, eliminates paternalism as a moral category in bioethics, thus causing bioethics to collapse on itself because it denies one of the necessary conditions for medical paternalism. Bioethics based on its founding story should be abandoned. (shrink)
On February 3, 2010, a “Letter of Concern from Bioethicists,” organized by fetaldex.org, was sent to report suspected violations of the ethics of human subjects research in the off-label use of dexamethasone during pregnancy by Dr. Maria New. Copies of this letter were submitted to the FDA Office of Pediatric Therapeutics, the Department of Health and Human Services (DHHS) Office for Human Research Protections, and three universities where Dr. New has held or holds appointments. We provide a critical appraisal of (...) the Letter of Concern and show that it makes false claims, misrepresents scientific publications and websites, fails to meet standards of evidence-based reasoning, makes undocumented claims, treats as settled matters what are, instead, ongoing controversies, offers “mere opinion” as a substitute for argument, and makes contradictory claims. The Letter of Concern is a case study in unethical transgressive bioethics. We call on fetaldex.org to withdraw the letter and for co-signatories to withdraw their approval of it. (shrink)
In this paper, I explore one way to bring bioethics and environmental ethics closer together. I focus on a question at the interface of health, sustainability, and justice: How well does a society promote health with the use of no more than a just share of environmental capacity? To address this question, I propose and discuss a mode of assessment that combines a measurement of population health, an estimate of environmental sustainability, and an assumption about what constitutes a fair (...) or just share. This mode of assessment provides an estimate of the just and sustainable life expectancy of a population. It could be used to monitor how well a particular society promotes health within just environmental limits. It could also serve as a source of information that stakeholders use when they deliberate about programs, policies, and technologies. The purpose of this work is to focus attention on an ethical task: the need to fashion institutions and forms of life that promote health in ways that recognize the claims of sustainability and justice. (shrink)
This paper represents the first installment of alarger project devoted to the relevance of pragmatism forbioethics. One self-consciously pragmatist move would be toreturn to the classical pragmatist canon of Peirce, James andDewey in search of substantive doctrines or methodologicalapproaches that might be applied to current bioethicalcontroversies. Another pragmatist (or neopragmatist) move wouldbe to subject the regnant principlist paradigm to Richard Rorty'ssubversive assaults on foundationalism in epistemology andethics. A third pragmatist method, dubbed ``freestandingpragmatism'' by its proponents, embraces a ``pragmatist'' approachto practical (...) reasoning without discernable moorings either to theclassical canon or to Rorty's neopragmatism. This thirdpragmatist approach to method in practical ethics is the subjectof this article. I begin with an examination of freestandingpragmatism in the theory of judicial decision making. I arguethat this version of legal pragmatism – so described on account ofits commitments to contextualism, instrumentalism, eclecticism,and freedom from grand theory – bears a striking resemblance tomuch self-described pragmatist work in bioethics today. Ifurther argue that if this is what we mean by ``pragmatism,'' thenin a certain sense ``we are all pragmatists now.''. (shrink)