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Jehovah's Witnesses' (JWs) refusal of blood transfusions has recently gained support in the medical community because of the growing popularity of "no-blood" treatment. Many physicians, particularly so-called "sympathetic doctors", are establishing a close relationship with this religious organization. On the other hand, it is little known that this blood doctrine is being strongly criticized by reform-minded current and former JWs who have expressed conscientious dissent from the organization. Their arguments reveal religious practices that conflict with many physicians' moral standards. They also suggest that a certain segment of "regular" or orthodox JWs may have different attitudes towards the blood doctrine. The author considers these viewpoints and argues that there are ethical flaws in the blood doctrine, and that the medical community should reconsider its supportive position. The usual physician assumption that JWs are acting autonomously and uniformly in refusing blood is seriously questioned.
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1. Introduction. 2. History of Bioethics in Japan. 3. First international bioethics seminar in Fukui on human dignity and medicine (1987). 4. Second international bioethics seminar in Fukui--international association of human biologists--japan society of human genetics joint symposium on medical genetics and society (1990). 5. Third international bioethics seminar in Fukui on human genome research and society (1992). 6. Fourth international bioethics seminar in Fukui on intractable neurological disorders, human genome research and society (1993). 7. Fifth international bioethics seminar in Fukui on the MURS japan/IBC UNESCO joint seminar on the protection of the human genome and scientific responsibility (1995). 8. Sixth international bioethics seminar in Fukui--UNESCO Asian bioethics conference- and who assisted satellite symposium on medical genetics services and bioethics, in Kobe and Fukui (1997). 9. Coming seventh international bioethics seminar in Fukui on pharmaco-genomics and DNA polymorphism (2000). 10. Conclusion.
Urban bioethics has two goals. First, it aims to focus attention on neglected bioethical problems that have particular salience in urban settings. Three problems are highlighted: socioeconomic inequality as a major determinant of health inequality, the foundations of an ethic for public health, and the impact of social context on the therapeutic alliance between patients and physicians. Second, urban bioethics serves as a vehicle for raising deep theoretical and methodological questions about the dominant assumptions and approaches of contemporary bioethics. Demands for cultural sensitivity, so pronounced in the urban context, compel us to reexamine the central commitment in bioethics to personal autonomy. The multiculturalism of urban life also argues for a dialogic approach to bioethical problem solving rather than the monologic approach that characterizes most bioethical thinking. Although my brief for redirecting bioethics will resonate with many critics who do not consider themselves urban bioethicists, I argue that there are special advantages in using urban bioethics to expose the limitations of contemporary bioethical paradigms.
This paper illustrates a role that bioethics should play in developing and criticizing protocols for breast cancer genetic screening. It demonstrates how a critical bioethics, using approaches and reflecting concerns of contemporary philosophy of science and science studies, may critically interrogate the normative and conceptual schemes within which ethical considerations about such screening protocols are framed. By exploring various factors that influence the development of such protocols, including politics, cultural norms, and conceptions of disease, this paper and the critical bioethics' approach it endorses illuminate and critically assess some of the competing worldviews informing protocol development. One of the frequently neglected worldviews in traditional bioethics' treatment of protocols concerning breast care is constituted by women's own views of their breasts and breast cancer, both within the technologically-oriented social practice of American medicine and in light of the social construction of their breasted experience in American society. This paper attempts to redress and critically assess this neglect on the part of traditional bioethics. Finally, in contrast to traditional bioethics, critical bioethics critically interrogates its own normative and conceptual commitments. In this final capacity, a critical bioethics' approach makes a valuable contribution to the evolution of bioethics.
From the inception of the relatively short history of American bioethics in the mid-to-late 1960s, the place of religion in this field has been complex and controversial. It has also been a subject of more than casual interest and concern to bioethicists, and to an array of medical and non-medical groups in U.S. society for whom the activities and issues in which bioethics is engaged have ongoing import. The questions and the tensions linked to the status and influence of religion in the sphere of bioethics have ramifications that extend beyond bioethics and biomedicine into matters involving the relationship of religion to the institutional structure of American society--most particularly its political, legal foundations, and realm of public affairs--and to its cultural attributes and tradition. It is within this larger perspective that we will consider the association between American bioethics and religion. Our analysis includes two case studies: (1) how, in the early years of bioethics, a pioneering organization in the field dealt with the "redefinition of death" in its discussions and in a major medical journal publication; and (2) the way in which the most recently appointed federal bioethics commission, the National Bioethics Advisory Commission, involved religion in its work on cloning and stem cell research.
The aim of bioethics is to define a wise conduct for humans with regard to their environments, whether living or inanimate. However, owing to their diversity, bioethics can only deal with general problems such as biodiversity. Within the framework of bioethics as a whole, different sectorial bioethics must therefore exist to deal with problems specific to certain environments, for example the Oceans and Seas, the Forests. General bioethics and sectorial bioethics have an important contribution to make to medical sciences but official regulations should be proposed only after an attentive investigation has been made. For instance, the preservation of an apparently threatened biodiversity or the revival of a seriously damaged biodiversity must be the subject of a thorough preliminary scientific study and, if legislative decisions are taken, a very careful scientific control of their consequences must be carried out. One example is given: the decree on the protection of Larids and its impact, with regard to an abusive proliferation of certain gull populations having varied effects on public health. Sectorial bioethics can also have obvious consequences on medical sciences. Thus various harmful attacks on coral reefs (contrary to the concepts of thalassoethics) can lead to the death of corals and the appearance of ciguatera. Thalassoethics, by inciting pollution control, should help to improve the conditions of thalassotherapy. Forest ethics, particularly concerning management, can reduce the greenhouse effect and its consequences on health, as well as protecting plant and animal species inhabiting the ecosystem and bringing new chemical bodies to inspire original pharmacological research. Thus the links between general or sectorial bioethics and medical sciences must always be very close.
We have previously reported that a smaller percentage of the surgical literature than the medical literature is devoted to bioethics, and that this difference is statistically significant. In order to determine: 1) whether the medical subspecialty literature is more akin, in terms of its quantitative bioethics content, to the surgical or to the medical literature, and 2) whether differences exist between the "invasive" and the "noninvasive" medical subspecialties in terms of their quantitative bioethics content, we conducted a computerized search of the MEDLINE database. The journals searched were selected from the "Medicine", "Surgery", and "Cardiovascular System" sections of the "Brandon-Hill List", and the search was limited to the 1994 issues of these journals. From the 15 medical journals searched, 331 out of a total of 10,578 bibliographic records indexed dealt with bioethics, while from the 12 surgical journals searched only 14 out of a total of 3990 bibliographic records indexed dealt with bioethics. From the 26 medical subspecialty journals searched (14 "invasive" and 12 "noninvasive"), 38 (20 "invasive", 18 "noninvasive") out of a total of 12,733 bibliographic records indexed (5745 in the "invasive" literature, 6988 in the "non-invasive" literature) dealt with bioethics. We conclude that there is a statistically significant difference (p < 0.001) between the general medical literature and the medical subspecialty literature in terms of their quantitative bioethics content, that there is no such difference between the surgical literature and the medical subspecialty literature, and that no statistically significant difference exists between the "invasive" and the "noninvasive" medical subspecialties in terms of their quantitative bioethics content.
The ethical issues raised by the Human Genome Project (HGP) and by human genetics in general are not entirely novel. In fact, the ethical issues surrounding genetic research and the provision of genetic services fit into the evolution of bioethics, a field of inquiry which has its roots in concerns of the 1970s, concerns about the dignity and self-determination of individuals and about the development of medical technologies. Although bioethics has been largely occupied with patient-centered concerns, attention is currently shifting toward socially oriented issues, such as the justice of the existing health-care system. Genetic counseling has already incorporated many of the lessons of early bioethics and, as a profession, adheres to a consultand-centered ethic which reflects the values incorporated into the doctrine of informed consent, which is a cornerstone of bioethics. The mandate of the Ethical, Legal, and Social Implications Program of the HGP--to anticipate ethical problems arising from advances in genetics and to educate the public about genetics--reflects not only the nonpaternalistic approach of early bioethics but also bioethics' increasing attention to the ethical import of systemic and institutional factors, as well as an anticipatory and preventive approach to dealing with ethical concerns. Because bioethics has so much to contribute to current consideration of ethical issues in human genetics, it is important to provide training in ethics to those working in the field. Guidelines for using a case-oriented approach are suggested.
BACKGROUND/PURPOSE: Although clinical bioethics teaching (CBT) is not a required component of the essential curriculum for pediatric surgery residency, ethical considerations often accompany surgical decision making for infants and children. This study was designed to quantitate CBT during pediatric surgery residency (PSR) and to determine preferences about formal bioethics instruction. METHODS: An 80-item questionnaire was mailed to 140 graduates of accredited PSR in the United States and Canada. Questions included demographic data, experience in CBT during and after PSR, preferred topics and teaching methods, and self-assessed and objective competency in bioethics. RESULTS: The response rate was 78% (n = 109); 72% completed PSR between 1990 and 1995 (mean, 1991). Formal CBT within the curriculum of PSR was reported by 9% of respondents; lecture and consultation with an ethicist were the most frequent teaching methods. Informal CBT was noted by 88% of pediatric surgeons; observation of patient cases with ethical dilemmas was the primary mode of instruction. Quality of life, withholding/withdrawal of care, informed consent, child abuse, and economics ranked highest for most important CBT topics, while euthanasia, clinical research trials, and cultural diversity were given low priority. The preferred teaching methods were case-based discussions and consultation with an ethicist. Although 97% favored additional CBT in all postgraduate training, respondents who completed advanced study in medical ethics (P < .05), were women (P < .05), or were members of a hospital ethics committee (P < .05) were more likely to advocate a standardized bioethics curriculum during PSR. A majority (86%) expressed competency in handling ethical problems in clinical practice, however, 47% gave incorrect responses or were unsure about routine bioethics questions. CONCLUSIONS: Formal instruction in clinical bioethics is not included in the curriculum of most residencies in pediatric surgery. Recent graduates of PSR favor case-based and practice-oriented teaching in clinical bioethics.
Bioethical decision-making depends on presuppositions about the function and goal of bioethics. The authors in this issue of The Journal of Medicine and Philosophy share the assumption that bioethics is about resolving cases, not about moral theory, and that the best method of bioethical decision-making is that which produces useful answers. Because we have no universally agreed upon background moral theory which can serve as the basis for bioethical decision-making, they try to move bioethics away from theory. For them, a good method of bioethical decision-making is one which resolves cases in ways that are justifiable to the parties involved, not necessarily in ways that bring us "close" to the right and the true. The authors consider how the move away from theory and toward actual cases is best accomplished. In particular, the debate in this issue is about specification, specified principlism, and casuistry.
PURPOSE: Medical students must have some exposure to bioethics, whether it be at the undergraduate or the postgraduate level. The authors sought to determine the range and ranking of topics taught in bioethics courses at U.S. osteopathic medical schools. METHOD: A qualitative study using a repeated-measures design was used to determine curricular offerings at all 19 U.S. osteopathic medical schools. Nominal groups were held to identify an initial topics list. A modified reactive Delphi technique was constructed and three survey iterations were administered. RESULTS: Bioethics is taught in all osteopathic medical schools, although the numbers of hours dedicated to the subject in the course of a four-year curriculum vary greatly (range 0-40). To further differentiate a curriculum in bioethics, the respondents were asked to rank bioethics topics as essential, foundational, or peripheral to the undergraduate medical curriculum. A total of 16 topics, including confidentiality, informed consent, truth-telling, death and dying, palliative care, and refusal of care, were identified as "essential" for a bioethics curriculum. CONCLUSIONS: Bioethics is taught at osteopathic medical schools, but further studies are needed to recommend guidelines to standardize the curriculum.