Bioethics and law symposium: deconstructing traditional paradigms in bioethics: race, gender, class, and culture. Foreword: bioethics -- from mirror to window.
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Bioethics↗
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On the possibility of a pragmatic discourse bioethics: Putnam, Habermas, and the normative logic of bioethical inquiry.
Pragmatic bioethics represents a novel approach to the discipline of bioethics, yet has met with criticisms which have beset the discipline of bioethics in the past. In particular, pragmatic bioethics has been criticized for its excessively fuzzy approach to fundamental questions of normativity, which are crucial to a field like bioethics. Normative questions need answers, and consensus is not always enough. The approach here is to apply elements of the discourse ethics of Habermas and Putnam to the sphere of bioethics, in order to develop a normative structure out of the framework of bioethical inquiry as it stands. The idea here is that the process of inquiry contains its own normative structure as it aims to discover norms. Such an approach, which fuses pragmatic bioethics with discourse ethics (which equally draws on pragmatism), may rightly be called a "Pragmatic Discourse Bioethics."
Bioethics↗
Christian bioethics, secular bioethics, and the claim to cultural authority.
Though the papers in this volume for the most part address the question, "What is Christian about Christian Bioethics", this paper addresses instead a closely related question, "How would a Christian approach to bioethics differ from the kind of secular academic bioethics that has emerged as such an important field in the contemporary university?" While it is generally assumed that a secular bioethics rooted in moral philosophy will be more culturally authoritative than an approach to bioethics grounded in the contingent particularities of a religious tradition, I will give reasons for rejecting this assumption. By examining the history of the recent revival of academic bioethics as well as the state of the contemporary moral philosophy on which it is based I will suggest that secular bioethics suffers from many of the same liabilities as a carefully articulated Christian bioethics. At the end of the paper I will turn briefly to examine the question of how, in light of this discussion, a Christian bioethics might best be pursued.
Bioethics↗
The bioethics discussion forum--an implementation of an Internet-based bioethics information analysis resource.
Ethical analysis is crucial to decision making in biomedicine and health care, necessitating both rapid access to diffusely disseminated sources of information pertinent to bioethics and promotion of analysis in the field of bioethics through a resource for information analysis. We developed the Bioethics Discussion Forum, an Internet-based information analysis resource, in order to supplement the Bioethics Online Service with an interactive information medium to meet the demand for such an interactive resource. The Bioethics Discussion Forum has shown promise for information analysis, providing an arena for the review and discussion of complex bioethical information, establishing a connection nationally and internationally among individuals with high levels of expertise in bioethics, and providing a template for future interactive informatics services.
Bioethics↗
Multiple roles and successes in public bioethics: a response to the public forum critique of bioethics commissions.
National bioethics commissions have been critiqued for a variety of structural, procedural, and political aspects of their work. A more recent critique published by Dzur and Levin uses political philosophy to constructively critique the work of national bioethics commissions as public deliberative forums. However, this public forum critique of bioethics commissions ignores empirical research in political science and normative claims that suggest that advisory commissions can and should have diverse of functions beyond that of being public forums. The present paper argues that the public forum critique too narrowly considers the roles that bioethics commissions can play in public bioethics and ignores the moral obligation of commissions to fulfill their mandates. Evaluations of commissions must consider that these institutions can serve in capacities other than those of a public deliberative forum and use additional measures to evaluate the multiple roles and successes of bioethics commissions in public policy.
Advisory Committees↗
Look who's talking: the interdisciplinarity of bioethics and the implications for bioethics education.
There are competing accounts of the birth of bioethics. Despite the differences among them, these accounts share the claim that bioethics was not born in a single disciplinary home or in a single social space, but in numerous, including hospitals, doctors' offices, research laboratories, courtrooms, medical schools, churches and synagogues, and philosophy classrooms. This essay considers the interdisciplinarity of bioethics and the contribution of new disciplines to bioethics. It also explores the implications of interdisciplinarity for bioethics education. As bioethics develops, it will be helpful to identify essential elements in the education of bioethicists and to distinguish between members of other disciplines who make important contributions to bioethics and bioethicists.
Bioethics↗
Urban bioethics: adapting bioethics to the urban context.
Urban bioethics is an area of inquiry within the discipline of bioethics that focuses on ethical issues, problems, and conflicts relating to medicine, science, health care, and the environment that typically arise in urban settings. Urban bioethics challenges traditional bioethics (1) to examine value concerns in a multicultural context, including issues related to equity and disparity, and public health concerns that may highlight conflict between individual rights and the public good, and (2) to broaden its primary focus on individual self-determination and respect for autonomy to include examination of the interests of family, community, and society. Three features associated with urban life-density, diversity, and disparity-affect the health of urban populations and provide the substrate for identifying ethical concerns and value conflicts and creating interventions to affect population health outcomes. The field of urban bioethics can be helpful in creating ethical foundations and principles for public health practice, developing strategies to respect diversity in health policy in a pluralistic society, and fostering collaborative work among educators, social scientists, and others to eliminate bias among health professionals and health care institutions to enhance patients' satisfaction with their care and ultimately affect health outcomes. Educational programs at all levels and encompassing all health professions are needed as a first step to address the perplexing and important problem of eliminating health disparities. Urban bioethics is both contributing to the social science literature in this area and helping educators to craft interventions to affect professional attitudes and behaviors.
Bioethics↗
[Bioethics in historical perspective. For a critical approach to bioethics and his relationship to the history of medicine].
What is the history of bioethics? What are the shortcomings of the bioethical approach? And what could the history of medicine do for a better understanding of bioethics as discipline and of bioethical problems themselves? These are the central questions which are stressed in this article. The main conclusion is that bioethics has to be seen as a cultural product which can only be understood if the social context in which this new discipline has emerged is taken into consideration. History of medicine has furthermore the chance to contextualize bioethical problems and in this function history of medicine could be a helpful discipline for a better understanding of current problems in medicine.
Bioethics↗
The breadth of bioethics: core areas of bioethics education for hospital ethics committees.
The multidisciplinary nature of bioethics can result in narrow "sub-specialists" within the field, whose work reflects the issues and concerns most relevant to their "home discipline." This can result in work which is insensitive to the important ways in which particular areas of bioethics are interrelated, and which (while viable in the context of the sub-specialty) is not viable in a broader context. The narrow focus of many healthcare ethics committees on issues directly related to clinical patient care can exacerbate this problem. Increasingly, issues in the clinical care of patients cannot be separated from issues in research, organizational ethics, and public policy. I argue that these problems call for a need to identify "core" areas for bioethics education. This is especially true for education of hospital ethics committees, which increasingly face complex cases involving concerns that fall outside traditional patient care issues. I then consider nine areas examined in detail in A Companion to Bioethics edited by Helga Kuhse and Peter Singer, as potential candidates for "core" areas of bioethics education. At the same time, I evaluate the range of issues examined in each area of the book, in the context of the book's ability to provide an introduction to each area.
Bioethical Issues↗
[Basis of bioethics--bioethics in Japan and the United States].
During the past ten years bioethics has gradually become an important subject for discussion in Japan. However these discussions are quite different from those in the United States where bioethics has been a major field of study for some time. The purpose of this paper is to show the differences between the Japanese and American ideas regarding bioethics by studying the social environment in the United States. When compared to Japan, there is a great difference in this environment and the American views on ethics. Japanese studying bioethical problems should study them by first comparing the points of differences stated in this paper and then applying their conclusions to the bioethical problems here in Japan.
Bioethics↗
Basic ethical principles in European bioethics and biolaw: autonomy, dignity, integrity and vulnerability--towards a foundation of bioethics and biolaw.
This article summarizes some of the results of the BIOMED II project "Basic Ethical Principles in European Bioethics and Biolaw" (1995-1998) connected to a research project of the Danish Research Councils "Bioethics and Law" (1993-1998). The BIOMED project was based on cooperation between 22 partners in most EU countries. The aim of the project was to identify the ethical principles of respect for autonomy, dignity, integrity and vulnerability as four important ideas or values for a European bioethics and biolaw. The research concluded that the basic ethical principles cannot be understood as universal everlasting ideas or transcendental truths but they rather function reflective guidelines and important values in European culture. The method of the research was conceptual, philosophical analysis of the cultural background of the four values or normative ideas that people use and find important in their existence. Moreover, this was combined with analysis of empirical legal material and policy documents. Also, a number of qualitative interviews with relevant experts were carried out. Another important result of the BIOMED project was the partner's Policy Proposals to the European Commission, the Barcelona Declaration, unique as a philosophical and political agreement between experts in bioethics and biolaw from many different countries. The Policy Proposals are reprinted here at the end of the article.
Bioethics↗
Philosophical challenges in teaching bioethics: the importance of professional medical ethics and its history for bioethics.
The papers in this number of the Journal originated in a session sponsored by the American Philosophical Association's Committee on Philosophy and Medicine in 1999. The four papers and two commentaries identify and address philosophical challenges of how we should understand and teach bioethics in the liberal arts and health professions settings. In the course of introducing the six papers, this article explores themes these papers raise, especially the relationship among professional medical ethics, the "long history" of medical ethics, and bioethics. The tendency of bioethics to deprofessionalize medical ethics is rejected, in favor of an historically informed professional medical ethics. It is suggested that bioethics should be critically reconsidered from the perspective of medical ethics as professional ethics.
Bioethics↗
Bioethics for clinicians: 21. Islamic bioethics.
Islamic bioethics derives from a combination of principles, duties and rights, and, to a certain extent, a call to virtue. In Islam, bioethical decision-making is carried out within a framework of values derived from revelation and tradition. It is intimately linked to the broad ethical teachings of the Qur'an and the tradition of the Prophet Muhammed, and thus to the interpretation of Islamic law. In this way, Islam has the flexibility to respond to new biomedical technologies. Islamic bioethics emphasizes prevention and teaches that the patient must be treated with respect and compassion and that the physical, mental and spiritual dimensions of the illness experience be taken into account. Because Islam shares many foundational values with Judaism and Christianity, the informed Canadian physician will find Islamic bioethics quite familiar. Canadian Muslims come from varied backgrounds and have varying degrees of religious observance. Physicians need to recognize this diversity and avoid a stereotypical approach to Muslim patients.
Abortion, Induced↗
Bioethics for clinicians: 28. Protestant bioethics.
"Protestant" is a term applied to many different Christian denominations, with a wide range of beliefs, who trace their common origin to the Reformation of the 16th century. Protestant ideas have profoundly influenced modern bioethics, and most Protestants would see mainstream bioethics as compatible with their personal beliefs. This makes it difficult to define a uniquely Protestant approach to bioethics. In this article we provide an overview of common Protestant beliefs and highlight concepts that have emerged from Protestant denominations that are particularly relevant to bioethics. These include the sovereignty of God, the value of autonomy and the idea of medicine as a calling as well as a profession. Most Canadian physicians will find that they share certain values and beliefs with the majority of their Protestant patients. Physicians should be particularly sensitive to their Protestant patients' beliefs when dealing with end-of-life issues, concerns about consent and refusal of care, and beginning-of-life issues such as abortion, genetic testing and the use of assisted reproductive technologies. Physicians should also recognize that members of certain Protestant groups and denominations may have unique wishes concerning treatment. Understanding how to elicit these wishes and respond appropriately will allow physicians to enhance patient care and minimize conflict.
Bioethics↗
The community bioethics committee: a unique pathway out of bioethical dilemmas.
We believe that most bioethics committees as well as individual ethics consultants have major shortcomings in that they are unlikely to be open to serving the widest number of citizens who may need their services when facing bioethical dilemmas. The HDCC serves as a community resource, is open to all citizens, is free standing, and provides a wide variety of perspectives which can assist patients, their families, and healthcare providers to explore a range of values and options. The HDCC serves as a model for communities that seek to establish a bioethics resource. Further, the HDCC model permits the further exploration of ways in which important healthcare issues can be faced. AHD believes, in keeping with its mission, that the creation of the HDCC can increase the public's awareness of and involvement in healthcare issues. As B. Jennings reminds us, The mission of community health decisions projects is to stimulate a well-informed conversation where many voices are heard and all reasonable perspectives given due consideration. They not only inform, but also enable responsible civic participation and thoughtful health care decisionmaking. The HDCC model can serve to bring discussions on bioethical dilemmas out of secrecy into safer, yet more open, community fora.
Arizona↗
Cultural assessment in bioethical advocacy--toward cultural competency in bioethical practice.
The continued diversification of the U.S. population poses increasing challenges for bioethical advocates (e.g., ethicists, physicians, nurses, social workers, psychologists, surrogates, researchers, and lawyers), especially those serving rapidly expanding and culturally varied populations. The issue from the bioethics perspective is that the members of ethnically diverse groups often bring different normative expectations and their own preferred decision-making formats to the bioethics table. For example, some advocates will encounter a "collectivity," or the family-as-a-whole rather than the individual, as a decision maker. In other instances, they may encounter cultural groups whose members (or some of whose members) will value the principle of beneficence more than personal autonomy. Moreover, such value-based challenges are likely to continue since forecasters predict that diversification will actually quicken in the United States throughout the next five decades. In the face of these changes in the bioethical climate, advocates must be prepared to strengthen their cultural assessment skills. Taking a multidimensional approach to the problem yields a four-point cultural assessment model to help advocates handle the great diversity of outlook and orientation among their culturally diverse clientele.
Beneficence↗
Bioethical blind spots: four flaws in the field of view of traditional bioethics.
In this paper it is argued that bioethics has tended to emphasise: 'high tech' areas of medicine at the expense of 'low tech' areas such as psychiatry; problems arising in treatment at the expense of those associated with diagnosis; questions of fact at the expense of questions of value; and applied ethics at the expense of philosophical theory. The common factor linking these four 'bioethical blind spots' is a failure to recognise the full extent to which medicine is an ethical as well as scientific discipline. Once this is acknowledged it leads to a full-field bioethics in which the different areas are mutually complementary. In particular, it paves the way for a fruitful two-way exchange between the more abstract aspects of philosophical theory and the contingencies of day-to-day clinical work. The arguments of the paper are illustrated with recent work on the abuse of psychiatry.
Bioethical Issues↗
Constructing empirical bioethics: Foucauldian reflections on the empirical turn in bioethics research.
The empirical turn in bioethics has been widely discussed by philosophical medical ethicists and social scientists. The focus of this discussion has been almost exclusively on methodological issues in research, on the admissibility of empirical evidence in rational argument, and on the possible superiority of empirical methods for permitting democratic lay involvement in decision-making. In this paper I consider how the collection of qualitative and quantitative social research evidence plays its part in the construction of social order, and how this creates certain paradoxes for the normative ideal of a public bioethics. The analysis in this paper is based on Foucauldian ideas, and on recent work in the history of the human sciences. The paper closes with some open questions for theoretical work in the sociology and philosophy of bioethics.
Bioethics↗