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PubMed1995

Breast cancer genetic screening and critical bioethics' gaze.

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.

Biomedical Research↗

PubMed2001

The presence and influence of religion in American 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.

Attitude to Death↗

PubMed2004

Enhancing the African bioethics initiative.

BACKGROUND: Medical ethics has existed since the time of Hippocrates. However, formal training in bioethics did not become established until a few decades ago. Bioethics has gained a strong foothold in health sciences in the developed world, especially in Europe and North America. The situation is quite different in many developing countries. In most African countries, bioethics - as established and practiced today in the west- is either non-existent or is rudimentary. DISCUSSION: Though bioethics has come of age in the developed and some developing countries, it is still largely "foreign" to most African countries. In some parts of Africa, some bioethics conferences have been held in the past decade to create research ethics awareness and ensure conformity to international guidelines for research with human participants. This idea has arisen in recognition of the genuine need to develop capacity for reviewing the ethics of research in Africa. It is also a condition required by external sponsors of collaborative research in Africa. The awareness and interest that these conferences have aroused need to be further strengthened and extended beyond research ethics to clinical practice. By and large, bioethics education in schools that train doctors and other health care providers is the hook that anchors both research ethics and clinical ethics. SUMMARY: This communication reviews the current situation of bioethics in Africa as it applies to research ethics workshops and proposes that in spite of the present efforts to integrate ethics into biomedical research in Africa, much still needs to be done to accomplish this. A more comprehensive approach to bioethics with an all-inclusive benefit is to incorporate formal ethics education into health training institutions in Africa.

Africa↗

PubMed2005

The UNESCO Bioethics Declaration 'social responsibility' principle and cost-effectiveness price evaluations for essential medicines.

The United Nations Scientific, Education and Cultural Organisation (UNESCO) has commenced drafting a Universal Bioethics Declaration. Some in the relevant UNESCO drafting committee have previously desired to restrict its content to general principles concerning the application (but not necessarily the goals) of science and technology. As potentially a crucial agenda-setting statement of global bioethics, however, it is arguable important the Universal Bioethics Declaration transparently address major bioethical dilemmas in the field of public health, such as universal access to affordable, essential medicines. Article 13 (Social Responsibility) of the Preliminary Draft Universal Bioethics Declaration states: 'Any decision or practice shall ensure that progress in science and technology contributes, wherever possible, to the common good, including the achievement of goals such as: (i) access to quality health care and essential medicines, including for reproductive health and health of children.' Cost effectiveness pricing systems, such as that most notably used in Australia's Pharmaceutical Benefits Scheme (PBS), arguably represent one of the most scientifically effective mechanisms whereby public monies may be utilised to assist in the provision of medicines for the common good. They contain two essential elements: first, a process of scientific evaluation of objectively demonstrated therapeutic significance, and then, a fiscal lever (the government reimbursement price) attached to that evaluation. It is now well established that the US Pharmaceutical Research and Manufacturers Association (Pharma), through the assistance of the US Trade Representative (USTR), saw the Australia United States Free Trade Agreement (AUSFTA) as an opportunity to fulfill a legislative mandate to 'eliminate' the cost-effectiveness pricing system in Australia's PBS. One of the most remarkable features of the arguments raised against the PBS in this context was the fact that they made almost no reference to the normative discourse of bioethics or international human rights. Provisions such as Article 13 in UNESCO's Universal Bioethics Declaration, although they will create no immediate obligations under international law, may play an extremely valuable role in legitimising the use of bioethical and human rights concepts in access to medicines debates surrounding multilateral and bilateral international trade deals such as the AUSFTA.

Australia↗

PubMed1997

[Ethics, bioethics and medical sciences].

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.

Bioethics↗

PubMedDate not supplied

Bioethics in the medical subspecialty literature.

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.

Bibliometrics↗

PubMed2004

How can we help? From "sociology in" to "sociology of" bioethics.

Sociology and bioethics have an uneasy relationship. Bioethicists find sociology helpful for describing and analyzing ethical issues, but they are less enthusiastic when bioethics becomes the subject of sociological scrutiny. After review of different sociological approaches to bioethical topics -- descriptive, evaluative, and analytical -- I explain how bioethics will benefit by using the tools of sociology to answer its questions ("sociology in bioethics") and by allowing sociology to use bioethics to answer sociological questions ("sociology of bioethics").

Bioethical Issues↗

PubMed1994

Bioethics for human geneticists: models for reasoning and methods for teaching.

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.

Bioethical Issues↗

PubMed2005

Constructing critical bioethics by deconstructing culture/nature dualism.

This paper seeks to respond to some of the recent criticisms directed toward bioethics by offering a contribution to a "critical bioethics". Here this concept is principally defined in terms of the three features of interdisciplinarity, self-reflexivity and the avoidance of uncritical complicity. In a partial reclamation of the ideas of V.R. Potter, it is argued that a critical bioethics requires a meaningful challenge to culture/nature dualism, expressed in bioethics as the distinction between medical ethics and ecological ethics. Such a contesting of the "bio" in bioethics arrests its ethical bracketing of environmental and animal ethics. Taken together, the triadic definition of a critical bioethics offered here provides a potential framework with which to fend off critiques of commercial capture or of being "too close to science" commonly directed toward bioethics.

Animals↗

PubMed1998

Analysis of clinical bioethics teaching in pediatric surgery residency.

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.

Adult↗

PubMed2000

Bioethics as methodological case resolution: specification, specified principlism and casuistry.

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.

Bioethics↗

PubMedDate not supplied

Is pragmatism well-suited to bioethics?

This paper attempts to defend pragmatic approaches to bioethics against detractors, showing how particular critics have failed or succeeded. The paper divides bioethics from a pragmatic point of view into three groups. The first group is called "bioethical pragmatism" that will be represented by two book-chapters from the anthology, Pragmatic Bioethics. The second group is called "clinical pragmatism" championed by Fins, Baccetta, and Miller. Finally, a third group, which has roots in the legal tradition, has been called "freestanding pragmatism" and is portrayed by Grey, Posner, and Wolf. Each group has been criticized in journal articles, and, in turn, this paper critiques some of the (mis)understandings put forth by Tollefsen, Jansen, and Arras about the capabilities and status of pragmatism in bioethical discussions. Finally, it concludes with cautionary notes about pragmatic bioethics in hopes that pragmatists will learn from their own insights about the human condition and the discipline of bioethics.

Bioethics↗

PubMed2002

Resources in bioethics at osteopathic medical schools.

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.

Adult↗

PubMed2005

The birth of the empirical turn in bioethics.

Since its origin, bioethics has attracted the collaboration of few social scientists, and social scientific methods of gathering empirical data have remained unfamiliar to ethicists. Recently, however, the clouded relations between the empirical and normative perspectives on bioethics appear to be changing. Three reasons explain why there was no easy and consistent input of empirical evidence in bioethics. Firstly, interdisciplinary dialogue runs the risk of communication problems and divergent objectives. Secondly, the social sciences were absent partners since the beginning of bioethics. Thirdly, the meta-ethical distinction between 'is' and 'ought' created a 'natural' border between the disciplines. Now, bioethics tends to accommodate more empirical research. Three hypotheses explain this emergence. Firstly, dissatisfaction with a foundationalist interpretation of applied ethics created a stimulus to incorporate empirical research in bioethics. Secondly, clinical ethicists became engaged in empirical research due to their strong integration in the medical setting. Thirdly, the rise of the evidence-based paradigm had an influence on the practice of bioethics. However, a problematic relationship cannot simply and easily evolve into a perfect interaction. A new and positive climate for empirical approaches has arisen, but the original difficulties have not disappeared.

Bioethics↗

PubMed2006

How do bioethics teachers in Japan cope with ethical disagreement among healthcare university students in the classroom? A survey on educators in charge.

OBJECTIVE: The purpose of this study was to demonstrate how educators involved in the teaching of bioethics to healthcare university students in Japan would cope with ethical disagreement in the classroom, and to identify factors influencing them. METHODS: A cross sectional survey was conducted using self administered questionnaires mailed to a sample of university faculty in charge of bioethics curriculum for university healthcare students. RESULTS: A total of 107 usable questionnaires were returned: a response rate of 61.5%. When facing ethical disagreement in the classroom, coping behaviour differed depending on the topic of discussion, was influenced by educators' individual clear ethical attitudes regarding the topic of discussion, and was independent of many respondents' individual and social backgrounds. Among educators, it was commonly recognised that the purpose of bioethics education was to raise the level of awareness of ethical problems, to provide information about and knowledge of those issues, to raise students' sensitivity to ethical problems, and to teach students methods of reasoning and logical argument. Yet, despite this, several respondents considered the purpose of bioethics education to be to influence students about normative ethical judgments. There was no clear relationship, however, between ways of coping with ethical disagreement and educators' sense of the purpose of bioethics education. CONCLUSIONS: This descriptive study suggests that educators involved in bioethics education for healthcare university students in Japan coped in various ways with ethical disagreement. Further research concerning ethical disagreement in educational settings is needed to provide better bioethics education for healthcare students.

Adaptation, Psychological↗

PubMedDate not supplied

The role of psychosomatic-medicine psychiatrists in bioethics: a survey study of members of the academy of psychosomatic medicine.

The Bioethics Subcommittee of The Academy of Psychosomatic Medicine developed a survey to assess the involvement of psychosomatic-medicine psychiatrists in bioethics and the extent of their participation on bioethics committees and in the teaching of bioethics. Of 599 Academy members surveyed, 122 (20.4%) responded. The majority of respondents reported that the management of bioethical dilemmas had a significant impact on their work in psychosomatic medicine. Many respondents were involved in teaching bioethics and in serving on ethics committees. The majority of respondents reported psychiatry-resident involvement on ethics committees. Bioethics work is an integral part of the fabric of psychosomatic medicine.

Academies and Institutes↗

PubMed2003

Research bioethics training in Bangladesh.

The Bangladesh Medical Research Council is implementing a training program on research bioethics under International Bioethics Education and Career Development Award of Fogarty International Center of National Institutes of Health (NIH), USA. The ultimate goal of the program is to improve ethical practice in implementation of health research through capacity strengthening of the professionals involved in health research in Bangladesh. The duration of the program is 4 years and it has started from the year 2002. The first year (2002-2003) was assigned for curriculum development. Several workshops, focus group discussions and consultative meetings were organized during 2002-2003 and curriculum was developed. Under this training program every year 2 Certificate Courses on Research Bioethics (CCRB) with a duration of 10 weeks will be conducted for 40 participants (20 participants in each batch). Each year one Advance Course on Research Bioethics (ACRB) will be organized for 10 participants with a duration of 6 days. The courses are to be conducted during 2nd, 3rd and 4th year. The Certificate Course on Research Bioethics is intended for multidisciplinary participants having previous experience in research methodology while the Advance Course on Research Bioethics will target for training the members of Ethics Review Committees of the country. Through this program one hundred fifty Bangladeshi professionals will get adequate training on research bioethics. The training program will be implemented by national experts with technical assistance from distinguished international scientists in the field.

Bangladesh↗

PubMed2000

Using web-based discussion as a teaching strategy: bioethics as an exemplar.

Using web-based discussion as a teaching strategy: bioethics as an exemplar Nurses are required to be competent in the area of bioethics based on several accreditation standards. Bioethics courses are one strategy to develop such a competency. Bioethics education itself has various goals including the need to engage in discussion and the ability to debate diverse issues. Providing an educational experience that meets both disciplinary and topic needs can be challenging. On-line conferencing through WebBoard 3.0, a web-based discussion software program, within a graduate level bioethics course successfully contributed to meeting these needs. A technical description of the WebBoard is provided in the following discussion along with a description of the integration of this device into a bioethics course. The WebBoard conferencing allowed all students to enter the class discussion and especially facilitated discussion for reticent speakers and distance learners. Evaluations of the bioethics course from both the faculty and students' perspectives were generally positive. Most students found the technique easy to use and liked the asynchronous format that allowed them to read and contribute at any hour of the day or night. Despite the labour intensive nature of this experience, the strategy ensured participation by every student, a major goal of the project. Developing an interdisciplinary situation would increase the value of such an experience.

Attitude of Health Personnel↗