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PubMed1986

Methodological concerns in bioethics.

Methodological concerns are moving to the top of the bioethics agenda for the next decade. This paper examines some of those concerns: medical ethics as a subset of bioethics versus medical ethics as a subset of professional ethics; a more in-depth examination of some methodological problems in treating medical ethics as professional ethics; the senses in which bioethics constitutes an inquiry into secular undertakings in a pluralistic society; 'federal ethics', the emergence to prominence of public commissions and study groups; and the institutional impact of bioethics on the relationship between medical schools and the liberal arts core of their sponsoring universities.

Advisory Committees↗

PubMedDate not supplied

[Current trends in bioethics in Canada].

In Canada, interest in bioethics intensified during the 1980s when a number of public and private agencies published papers on the opportunities and consequences presented by biotechnology in the industrial, agricultural, and medical fields. Bioethics is now a common subject in the universities, especially in the philosophy and religion study programs. It is also growing in importance as part of the training of health professionals. Several important bioethics centers and the Canadian Bioethics Society constitute a dynamic focus for the promotion of research and academic studies in this field. As in other countries, debate has centered around research involving human subjects, reproductive technologies, abortion, the dying process, organ transplants, and AIDS. Various guidelines and legislative measures have been established to deal with these questions.

Acquired Immunodeficiency Syndrome↗

PubMed1987

Bioethics as a prescription for civic action: the Japanese interpretation.

This paper reports on recent developments in the rise of bioethics in Japan. Much of the recent interest in bioethics in Japan is seen as a response to various civic movements. The women's liberation movement, access to equal opportunity, and the recognition of patients' rights and the importance of informed consent are among some of the movements influencing the development of bioethics in Japan. The author argues that this movement is to be encouraged and fostered by health care professionals, public policy makers, as well as lay persons in Japan.

Bioethical Issues↗

PubMed1990

Method in bioethics: a troubled assessment.

This discussion is a critical assessment of the methods employed by some leading writers in the field of bioethics. The author agrees with those in the field who regard its primary or essential method as moral philosophy, but he nevertheless finds a prevalent tendency among bioethical writers merely to apply received moral principles to issues and to avoid penetrating theoretical analysis, even when such analysis is unavoidably required. He explains these deficiencies in terms of the exigencies of interdisciplinary work and the affinity of much early bioethics with policy- or legislatively-oriented "public ethics". The discussion ends with a call for increased theoretical sophistication in this field.

Bioethics↗

PubMedDate not supplied

[The moral significance of religion for bioethics].

Religion is concerned with problems of health, medicine, and disease. Conversely, concepts of health and disease reflect values that are often influenced by religious postulates. Thus, the complex ways in which religion refers to and describes health, medicine, and disease help to explain its many-sided relationship to bioethics. This article examines the manner in which religion, as a descriptive and empirical entity, and also a normative and conceptual one, has moral meaning for bioethics and can enrich it. An analysis is also made of how a particularly complex problem in bioethics--whether the medical technology available for prolonging life should be used--could be approached from the standpoint of different religious traditions.

Bioethics↗

PubMed1979

Bioethical decision making: an approach to improve the process.

Current problems with the decision-making process for bioethical dilemmas are described, with emphasis on the social roles taken in this process by medical experts and laypersons. An approach is presented to improve bioethical decision making. Two consecutive steps are required. First, branching logic is used to separate the bioethical dilemmas into a series of independent, sequential decision points along a decision-making tree. This allows complex dilemmas to be dealt with more easily by resolving the individual component issues in a logical, stepwise fashion. Secondly, explicit criteria are used to decide whether each individual component is ethical or technical in nature. Using these two steps increases the likelihood that the professional and the layperson will assume their appropriate social roles and improve the overall decision-making process. How this approach can be applied to policy-making decisions, in addition to case-by-case deciding, is discussed, as are some of the settings in which the approach might be particularly helpful.

Amniocentesis↗

PubMed1988

Bioethics in Thailand: the struggle for Buddhist solutions.

The Thai concern for bioethics has been stimulated by the departure of Thai medicine from its long tradition through the introduction of Western medical models. Bioethics is now being taught to Thai medical students emphasizing moral insights and principles found within Thai culture. These are to a large extent Buddhist themes. Veracity is always a duty for people in general and medical personnel in particular. Falsehoods and deception cannot be morally justified simply on the grounds that we think it is good for another. Buddhism also prohibits killing. The doctrine of kamma holds that joys and sorrows are the result of one's own past actions. Kamma must run its course or will be manifest in a future life. Mercy-killing also violates the Buddhist psychology. A physician who kills subconsciously transfers his aversion to suffering to the one who embodies the suffering. Buddhist justice is understood in terms of impartiality and equal treatment. Compassion goes beyond justice to self-giving and self-denial. It is central to the path to the attainment of highest human fulfillment.

Advisory Committees↗

PubMed1985

Politics and bioethical commissions: "muddling through" and the "slippery slope".

When they have addressed highly controversial subjects, the bioethical commissions of the last decade have tended to avoid explaining the ethical justifications for their recommendations. This omission is consistent with the typical preference of policymakers for "muddling through," because it is often possible to reach agreement on specific decisions even when disagreeing sharply on principles. In bioethical policy, this omission of reasons has some special consequences. It allows commission members to ignore "slippery slope" arguments, which are based on the claim that the logic of justification adopted to address the current problem will ultimately lead us to great harms. Case-by-case decision-making--along with the omission of reasons for decisions--will tend to highlight the benefits of innovation, and downplay possible long-term effects that might be ethically upsetting.

Advisory Committees↗

PubMed1990

Current bioethics trends in Canada.

Canadian bioethicists have long enjoyed access to bioethics programs in the United States and have collaborated with U.S. organizations working in this field. Nevertheless, special features of Canada's multicultural society and public health services are increasingly seen as raising distinctive issues requiring special attention. The purpose of this article is to provide an overview of current Canadian bioethics trends in various areas--including those of training, research on human subjects, human reproduction, termination of life, biotechnology, organ transplants, and AIDS. Comparison of this work with other articles in this issue will show that while some of the trends involved have paralleled similar ones in the United States, some trends (such as that regarding confidentiality and the reporting of HIV infection) have been quite different.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Dynamics of the bioethics dialogue in a Spain in transition.

Serious work on bioethics at private Spanish institutions began in 1975, when the Spanish Government was in transition toward democracy. Since then the country has developed significant centers of bioethics study and a wide-ranging community of experts in this field. Reasons relating partly to Spain's recent history and partly to the nature of its health system have kept the discipline from attracting the support and collaboration of much of the nation's medical fraternity. This could change, however, in response to a changing legal picture, creation of hospital ethics committees, and a growing need for stronger ties between bioethicists and the medical community at large.

Bioethical Issues↗

PubMed1990

The limited relevance of analytical ethics to the problems of bioethics.

Philosophical ethics comprises metaethics, normative ethics and applied ethics. These have characteristically received analytic treatment by twentieth-century Anglo-American philosophy. But there has been disagreement over their interrelationship to one another and the relationship of analytical ethics to substantive morality--the making of moral judgments. I contend that the expertise philosophers have in either theoretical or applied ethics does not equip them to make sounder moral judgments on the problems of bioethics than nonphilosophers. One cannot "apply" theories like Kantianism or consequentialism to get solutions to practical moral problems unless one knows which theory is correct, and that is a metaethical question over which there is no consensus. On the other hand, to presume to be able to reach solutions through neutral analysis of problems is unavoidably to beg controversial theoretical issues in the process. Thus, while analytical ethics can play an important clarificatory role in bioethics, it can neither provide, nor substitute for, moral wisdom.

Abortion, Legal↗

PubMed1991

American moralism and the origin of bioethics in the United States.

The theology of John Calvin has deeply affected the American mentality through two streams of thought, Puritanism and Jansenism. These traditions formulate moral problems in terms of absolute, clear principles and avoid casuistic analysis of moral problems. This approach is designated American moralism. This article suggests that the bioethics movement in the United States was stimulated by the moralistic mentality but that the work of the bioethics has departed from this viewpoint.

Advisory Committees↗

PubMed1991

The merger of bioethics and epidemiology.

The merger of bioethics and epidemiology reflects the established idea that values are important for epidemiologic practice. It also reflects the more recent realization that standards of conduct are a timely addition to the profession. The thesis of this paper goes somewhat further and asserts that this merger represents an essential cornerstone in the foundation of a philosophy of epidemiology. Historical reflection reveals existing ontological and epistemological components to this same foundation. The union of bioethics and epidemiology suggests an important philosophical problem: selecting a method for unifying ethical and scientific reasoning. Solutions are proposed including: dialectic and critical rationalism.

Bioethics↗

PubMed1990

Introduction: medical bioethics.

The key concepts of modern medical bioethics can be traced back to ideas developed in the course of the history of medicine and to political concepts harkening back as far as Plato. This work reviews these historical developments and demonstrates their relevance to current bioethics.

Beneficence↗

PubMed1986

Teaching of bioethics within a residency program in obstetrics and gynecology.

A formal curriculum for the teaching of bioethics was instituted within an obstetric and gynecologic residency program. The curriculum included an introductory lecture series, an ongoing series of case presentations, and occasional grand rounds on particular issues. An emphasis was placed on physician responsibilities within contemporary bioethical parameters. A summary of the first year of such an effort is presented.

Adolescent↗

PubMed1992

Moving forward in bioethical theory: theories, cases, and specified principlism.

The field of bioethics has deployed different models of justification for particular moral judgments. The best known models are those of deductivism, casuistry, and principlism (under one, rather limited interpretation). Each of these models, however, has significant difficulties that are explored in this essay. An alternative model, suggested by the work of Henry Richardson, is presented. It is argued that specified principlism is the most promising model of justification in bioethics.

Casuistry↗

PubMed1992

[Bioethical issues and principles in cancer treatment].

Bioethics was established as a new area of interdisciplinary studies focusing on human conduct in the field of the life sciences and health care in the light of moral values and principles in the 1960's and the beginning of the 1970's. Physicians abiding by classical medical ethics based upon the Oath of Hippocrates became subject to criticism because they behaved paternalistically in relation to their patients and provided medical treatment dogmatically without adequate explanation concerning conditions and diagnoses of patients' diseases, what kinds of treatments they were to receive and the possible benefits and risks thereof, along with their prognoses. During the patients' rights' movement, law suits against paternalistic physicians increased in number and the courts tried to establish ethical and legal principles for judgments in law suits using the Ethical Code of Neurenberg (1947) as an excellent model. The legal principles established as "informed consent" include obligations of physicians to provide their patients with adequate explanation and truth-telling, and the rights of patients to autonomy, choice, self-determination, and to give consent to physicians. Besides these rights, patients also have the right to put their veto on their own rights. In such cases, truth-telling by physicians, who believe in truth-telling, such as the disclosure of the diagnosis of cancer to these patients, can legally result in infringement of the patient's rights. It is important for physicians to respect the wishes and opinions of patients based on their own values and not to insist on personal dogmatic opinions. The disclosure of cancer diagnosis to terminal patients is certainly one of the most difficult procedures in medical practice and requires profound medical experience and bioethical insight.

Bioethics↗

PubMed1992

The design and use of the bioethics consultation form.

The emergence of the ethics consultation as a means to resolve moral crises in clinical medicine has revealed the need for a worksheet that would facilitate intake and analysis. The author developed the "Bioethics Consultation Form" as an attempt to remedy this need. The form is arranged in an outline format and is a useful asset to ethics committee discussions and record keeping. The first section covers basic intake data concerning the patient's medical and personal information, advance directives, and values, as well as the values of the physician and family. After the intake section is completed with the above data, the ethics consultant then turns to the analysis section. This second section allows for (1) the discussion of conflicting values, (2) the identification of priorities, and (3) the elucidation of ethical norms relevant to the case. The Bioethics Consultation Form was adopted by the Patient Care Advisory committee of the Franklin Square Hospital Center in Baltimore, Maryland in 1986. The methodology in the use of the form will be discussed. Further, the potential spectrum of consultative cases that can be analyzed using the form will be highlighted.

Bioethics↗