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PubMed2006

Between technocracy and democratic legitimation: a proposed compromise position for common morality public bioethics.

In this article I explore the underlying political philosophy of public bioethics by comparing it to technocratic authority, particularly the technocratic authority claimed by economists in Mexico in the 1980s and 1990s. I find that public bioethics--at least in the dominant forms--is implicitly designed for and tries to use technocratic authority. I examine how this type of bioethics emerged and has continued. I finish by arguing that, as claims to technocratic authority go, bioethics is in an incredibly weak position, which partly explains why it has never gained the degree of public legitimacy that other technocracies have gained. I conclude by arguing for a "technocracy-lite" orientation for public bioethics.

Ethicists↗

PubMed2006

Social science and bioethics: the way forward.

It is no surprise that bioethics and sociology developed an adversarial relationship: bioethicists value the clear descriptions of ethically charged situations provided by social scientists, but doubt the ability of those trained in social science to logically derive and discern 'the good'. For their part, social scientists - experts in observing and collecting data about the way the world is- find bioethicists ignorant of the ways elegantly crafted solutions to ethical problems get altered when incarnated in varied social and cultural settings. This discipline-centred self-affirmation can be a satisfying exercise, but it offers nothing to the project of promoting more moral medicine and health care. The articles collected in this volume demonstrate the value of collaboration between social scientists and bioethicists. Focusing on four themes found in recent sociological research in bioethics - ethics of research, the creation of moral boundaries, bioethics and social policy, and the bioethical imagination - this anthology offers practical models of co-operative work where the strengths of each discipline are brought together to advance our understanding of bioethical issues and to show the way toward just and effective social policy.

Bioethics↗

PubMed1998

Bioethics education in a clinical pastoral education program.

Notes that contemporary health care delivery and the interface of clinical professionals with patients and families are marked by complexity and pluralism and that within this modern matrix patients, families, professionals, and administrators frequently struggle with difficult ethical issues. Observes that these realities have significant implications for chaplains and for chaplains-in-training, a factor which has received the attention of the Bioethics Committee of the Professional Chaplains Association through its Bioethics Committee and resulting in a set of guidelines for the chaplain's appropriate roles in bioethical issues and for their role on bioethics committees. Describes the establishment of a bioetchics modulate at the Cleveland Clinic Foundation (CCF) in which chaplain residents are enabled to function as professional peers with other healthcare professionals and as competent chaplains with patients and families in bioethical decision making. Reports on the methods and the results of a pilot study based on the model described.

Chaplaincy Service, Hospital↗

PubMed1996

Educating nurses for their future role in bioethics.

The emerging new multidisciplinary and crosscultural field of bioethics will require sensitive, open-minded professionals to take the lead in hospital ethics, in genetic counselling, and in the teaching of bioethics to students in nursing, medicine and the basic sciences. Nurses with ward experience who return to university to gain an MA or PhD in bioethics are eminently suited for this leadership role, for they may be more likely than physicians to study for a liberal education to supplement their professional knowledge; their first-hand experience in nursing is an antidote to the pointless subtleties into which philosophical ethics so often degenerates. When teaching ethics to nurses one must remember that, while some will simply use this knowledge in their own clinical work, others will go on to be teachers and researchers in bioethics. Their training must therefore be broad and interdisciplinary, including real substantive philosophy (as opposed to philosophical ethics), as well as mystical bioethics, religious law, ethics of genetic counselling, clinical approaches to ethical pseudo problems, research skills, etc.

Cultural Diversity↗

PubMed2006

Identifying bioethics learning needs: a survey of Canadian emergency medicine residents.

OBJECTIVES: Emergency medicine (EM) postgraduate training programs must prepare residents for the ethical challenges of clinical practice. Bioethics curricula have been developed for EM residents, but they are based on expert opinion rather than resident learning needs. Educational interventions based on identified learning needs are more effective at changing practice than interventions that are not. The goal of this study was to identify the bioethics learning needs of Canadian EM residents. METHODS: A survey-based needs assessment of Canadian EM residents was performed between July 2000 and June 2001. Residents were asked to identify their learning needs by rating bioethics topics and by relating their clinical experiences. Physicians and nurses who work with residents were surveyed in a similar manner and also asked to identify the residents' bioethics learning needs. RESULTS: A total of 129 EM residents (77% of eligible residents), 94 physicians, and 87 nurses responded. Residents, physicians, and nurses all identified issues in end-of-life care as the greatest bioethics learning needs of the residents. Other areas identified as learning needs included negotiating consent, capacity assessment, truth telling, and breaking bad news. A learning need identified by nurses, but not residents, was the manner in which residents interact with patients and colleagues. CONCLUSIONS: This needs assessment provides valuable information about the ethical challenges EM residents encounter and the ethical issues they believe they have not been prepared to face. This information should be used to direct and shape ethics education interventions for EM residents.

Bioethics↗

PubMed1999

Bioethical language and its dialects and idiolects.

In their search for answers to the relevant theoretical questions on importing knowledge in practical ethics, the authors take an instrumental approach to metaphor. This figure of language allows one to compare language and linguistic variants to bioethics and knowledge. As defined by the dictionary, an 'idiom' is the official language of a nation, a 'dialect' is a regional variant of an idiom, and an 'idiolect' is an individual variant of a dialect. The bioethical idiom is thus seen as a linguistic set constituting a 'bioethical nation'. Since it is situated above particular dialects, it exercises more than a regulatory role over the discipline. In this article, in order to focus on the process of transmission of knowledge in bioethics, the authors chose Diego Gracia's work as a paradigmatic reference to the question on the transculturation of dialects and the relations in bioethics which are considered 'peripheral' or 'central'. Although this researcher found the key question pointing to the core of the problem of importing dialects, he is still searching for a proper answer to the cultural/bioethical context/contradiction.

Bioethics↗

PubMed2003

Framework for bioethical assessment of an article on therapy.

OBJECT: Frameworks for scientific assessment of articles on therapy published in the medical literature have become available and will likely enhance the quality of medical research that is published in peer-reviewed journals. Comprehensive frameworks do not exist for the assessment of bioethical issues pertaining to research on human volunteers. METHODS: The authors have developed a framework consisting of ethical dimensions or questions that they suggest should be applied to assess the bioethical integrity of articles on therapy. Thirteen questions were developed and discussed in the context of current bioethical principles, and examples were applied where possible. CONCLUSIONS: The simple framework the authors have developed offers a method to assess key bioethical issues surrounding an article on therapy and probably defines the minimum standard to which such articles should be held. Many ethical questions cannot yet be answered based on available information or bioethical theories. The authors are not suggesting that their framework is comprehensive; refinements and individualization of it to fit specific studies are probably required by each clinician-researcher who designs a therapy trial and reports its results.

Bioethical Issues↗

PubMed1999

Bioethics committees--a health communication approach.

The modern health care system is being transformed as a consequence of scarce resources and better informed consumers. In this transformed health care system human communication has become a crucially important process. This essay examines the health communication functions performed by bioethics committees in health care delivery and makes recommendations for promoting the effective use of these groups within the modern health care system. The essay describes how bioethics committee can help establish a climate in which physicians and other committee members can share relevant health information, learn about patient and family concerns, promote health education and informed consent, and facilitate effective decision making about complex health care practice issues. It is argued that clear recognition and attention to the central role of effective communication within the bioethics committee is essential for the survival of the modern health care system since ethics committees depend on sharing relevant information to diagnose health problems, provide health care, promote health education, help in the formulation of new health care policies, and provide much-needed decision-making support to health care providers and consumers. The role that health communication expertise can perform in the effective operation and utilization of bioethics committees is described. We conclude that in order to provide needed support in addressing the many complexities of modern health care, bioethics committees must develop clear communication processes, norms, and roles.

Bioethics↗

PubMedDate not supplied

[Care at the patient's bedside. Non-invasive bioethics].

This paper aims at describing the circumstances of the birth of Bioethics. In the first section, the paper points out some historical data supporting the widely diffused opinion according to which Bioethics started in the USA at the beginning of the '70s. In the second section, one of the most important factors in the birth of Bioethics is discussed: namely, the changes in medical enterprise and health care ethics. In the third section the impact of Bioethics on clinical medicine at the bedside is discusses, and, in the last section, one of the most important practical application of bioethical reflection is presented: the creation of Hospital Ethics Committees.

Bioethics↗

PubMed2001

[Is bioethics the Circe of medicine?].

BACKGROUND: Recent development in the biomedical fields have led to considerable moral perplexity, about the rights and duties of health professionals, patients and research subjects. Since about 1970 bioethics have become involved in an ongoing discussion of the complex ethical issues raised by these developments. OBJECTIVE: To review the precise relationship between Nietzsche's ontology and an eventual bioethics. METHOD: The author intends to give a picture of how ontological factors have influenced the beginnings of bioethics. RESULTS: Ethics for Nietzsche symbolizes Circe, the enchantress in Homer's Odyssey. Nietzsche's task is to proclaim the emptiness (devaluation) of all traditional values, thus soliciting a rejection of them. But bioethics must not be content with merely replacing the old values by new ones. v.g. by filling the place left by the supreme values. CONCLUSIONS: Despite the efforts to overcome technic, bioethics remains locked in the subject-ism of which technic is but a consequence. Nietzsche's special insight is to perceive that the interpretation of beings currently prevalent is valueless for it is an interpretation that has returned to values that are precisely without an value at all.

Bioethics↗

PubMedDate not supplied

[The bioethics as a new paradigm].

The word "bioethics" is a key to understand the nature and the origins of this new discipline. Made up of bios and ethiké (life and ethics), that it conjugates biology and moral in paradigmatic synthesis of science and it makes aware, facts and values, to be and duty to be. If there is "two cultures" that seem unable to speak one to the other one, science and humanities, and if this is part of the reason for which the future is shown so uncertain, then we should spread a "bridge toward the future" building the discipline of the bioethics like a bridge among the two cultures. To what bios and to what ethos does the the bioethics refer? By definition, it is biology or biomedicine and of ethics applied to the human behavior. The bioethics, bridge toward the future and among the two cultures, he or she responds to the challenge of the crisis bioethics of the technological era, crisis at the same time vital and normative in whose warp stands out the ecological catastrophe, the new biology and the medicalization of the life.

Bioethics↗

PubMedDate not supplied

[Dynamics of the dialogue on bioethics in a Spain in transition].

The bioethics dialogue began in Spain in 1975 in private institutions and developed in a society in transition toward democracy. Nostalgia for a nationalist Catholicism by some and the fervor of others to demonstrate that a break with the past had taken place have been important factors in bioethics legislation. Imitation of legislation considered progressive prevailed in the debate taking place in the country's bioethics centers, although in the case of assisted reproduction a commission of experts was set up to advise the government. The public has not participated in the debates, despite their coverage by the communications media. The medical schools have attempted to reform the deontological codes as a basis for formulating, promoting, and protecting the values of a pluralistic society. Results have been minimal, but the work of the bioethics centers is gradually being recognized and evaluated, and it is hoped that this ongoing bioethical dialogue will gradually mature.

Bioethics↗

PubMed1993

The European Convention on Bioethics.

For nearly 20 years, the Council of Europe, the organization for intergovernmental cooperation of the great Europe (26 countries are members of the council) has worked in the different fields of what is now called bioethics (reproductive technologies, organ transplants, human experimentation, etc). The council mainly proposes recommendations to member states in order to implement harmonized legislation. During the past ten years, this activity has been concentrated in a unique and multidisciplinary committee of experts; the CAHBI (ad hoc Committee of Experts on Bioethics). The recent development of national and very diverse legislation related to bioethical issues emphasized the necessity of adopting common binding principles at the European level. It was then decided at the end of 1991 by the Committee of Ministers of the council that the CAHBI would prepare a European Convention on Bioethics. This text, which is now being drafted, will in fact be composed of three documents. The Convention itself will list a set of general principles such as respect for human dignity, respect for the integrity of the person, the prohibition of any commercial arrangement on the human body and the principle of nondiscrimination. Two protocols will specifically deal with two important bioethical issues: organ transplants and human experimentation, but other topics could be covered in the future. All these texts will create obligations for member states and others that would like to ratify them to implement national regulations. An independent committee will have the duty to control how these obligations will be respected.

Bioethics↗

PubMed1995

[Introduction to bioethics in contemporary medicine].

The author makes a historical revision of his 50 years experience in medical ethics as a student and physician. In 1944, medical ethics was traditional and resolved simple problems based on Hippocrates postulates and christian humanism. The present scientific and cultural revolution has impelled the rise of bioethics defined as "the systematic study of human behavior in life sciences, based on moral principles". The bioethical methods attempt to facilitate the application of universal ethical principles to the solution of complex cases, generated by the new medical technology. These ethical problems were posed in Chile in 1962 by the french professor Jean Cheymol, who reported the serious human rights abused derives from new scientific experiments. Later in 1973, Dr. Motulsky predicted the advent of "a brave new world" and the need to create a new biological ethic. These challenges were faced by the professors of the faculty of Medicine, who created ethics commissions in 1975 and edited medical ethics code texts. There are three players in the bioethic context. Physicians apply beneficence; patients defend their autonomy: the State and the society defends justice. A conflict of values lies in the bottom of bioethics. The author vindicates the coherence of traditional medical ethics. Philosophers, theologians and lawyers can only help physicians, but are not responsible. Bioethics must allow a frank dialogue between these professionals, respecting their roles and responsibilities.

Bioethics↗

PubMed2002

Theological discourse and the postmodern condition: the case of bioethics.

Bioethics reflects--like many other disciplines--the cultural fragmentation and the complexity of what has come to be known as the postmodern condition. The case of bioethics is particularly acute because of its epistemological indeterminacy and the moral pluralism characterizing postliberal societies. A provisional solution to this situation is the retrieval of a neo-Kantian version of ethical formalism in which concern for a consensus on rules replaces universal dialogue on moral content. The article analyzes the possible consequences of this solution with reference to theological ethics. In particular, the reduction of ethical rationality to a function of political regulation on the one hand, and the implicit legitimization of ethical relativism on the other, push any theological contribution to bioethics to the margins. The central methodological issue for the articulation of theological discourse in bioethics is how to avoid the pitfall of privatism while creating the conditions for ethical dialogue across different traditions.

Bioethical Issues↗

PubMed1999

Bioethics as several kinds of writing.

Three different models are described of the relationship of bioethics to the press. The first two are familiar: bioethicists often are interviewed by journalists seeking background and short quotes to insert in a story; alternately, bioethicists sometimes themselves act as journalists of a sort, writing op-eds, articles or even longer works designed for wide readership. These models share the notion that bioethicists can provide information and ideas that increase the quality of people's thinking on moral matters. They share also a common difficulty: do the constraints the media impose on bioethical discourse keep bioethicists from deepening public reflection, and if not, how can those constraints be most effectively kept from distorting what bioethicists wish to say? The third model reverses--in part--the presupposition that bioethics bestows moral sophistication on a public naive about ethical issues, holding rather that matters run both ways; bioethicists stand to learn a great deal from their interactions with various publics and the media that serve them. On this view, the constraints imposed by media conventions constitute opportunities for new and potentially important forms of bioethical writing. Various concerns generated by the first two models are surveyed. It is concluded that while none of the difficulties constitute knock-down arguments against these forms of collaborating with the press, the worries are problematic enough to provide some support for considering the less familiar third approach. Further reason for taking the third model seriously draws on moral theoretic considerations.

Bioethical Issues↗

PubMed2005

Christian bioethics and the Church's political worship.

Christian bioethics springs from the worship that is the response of the Church to the Gospel of Jesus Christ. Such worship is distinctively political in nature, in that it acknowledges Christ as Lord. Because it is a political worship, it can recognize no other lords and no other prior claims on its allegiance: these include the claims of an allegedly universal ethics and politics determined from outside the Church. However the Church is called not just to be a contrast society, but also to witness to the freeing of the world from salvific pretensions in order that it may embrace its proper temporality. The implications of this for the distinctiveness of Christian bioethics are brought out in three movements: first, the Church's itself learning how it is to conceive bioethics; second, the Church's role in unmasking the idols of secular bioethics; and third, the Church's witnessing to the freeing of medicine from idolatrous aspirations.

Bioethical Issues↗

PubMed2005

Lessons in conflict of interest: the construction of the martyrdom of David Healy and the dilemma of bioethics.

Bioethics journals have lagged behind medical and science journals in exploring the threat of conflict of interest (COI) to the integrity of publications. Some recent discussions of COI that have occurred in the bioethics literature are reviewed. Discussions of what has been termed the "Healy affair" unintentionally demonstrate that the direct and indirect influence of undisclosed COI may come from those who call for protection from the undue influence of industry. Paradoxically, the nature and tone of current discussions may serve to dull sensitivities to what is indeed a serious set of issues facing bioethics. Some proposals are presented to address COI and other challenges to the integrity of bioethics and its journals. COI is too important a topic to be left to ideologues, and there is no substitute for readers' caution and skepticism as tools in dealing with the full range of biases that exist in published papers.

Academies and Institutes↗