A commentary on a special report, titled Narrative Ethics: The Role of Stories in Bioethics, that appeared with the January‐February 2014 issue.

When I heard that a laboratory in China had cloned two long‐tailed macaques, I thought of Mary Shelley's novel Frankenstein. When academics write about the novel, many point out that the reason the creature becomes a “monster” is not that he has any inherently evil qualities but that Victor Frankenstein, the creature's “mother,” immediately rejects him. All later problems can be traced to the fact that Frankenstein does not take responsibility for his creation. While I do not disagree with this, (...) we need to think beyond (or before) Frankenstein's rejection to the reason he rejects it. I would like to suggest that this reason reveals something about how bioethics judges new biological technologies. I suggest that what causes Frankenstein to feel revulsion toward his creation is its unsettling mix of the beautiful and the ugly. (shrink)

The authors of “A Conceptual Model for the Translation of Bioethics Research and Scholarship” argue that bioethics must respond to institutional pressures by demonstrating that it is having an impact in the world. Any impact, the authors observe, must be “informed” by the goals of the discipline of bioethics. The concept of bioethics as a discipline is central to their argument. They begin by citing an essay that Daniel Callahan wrote in the first issue of Hastings Center Studies. Callahan argued (...) in this 1973 piece that bioethics had yet to attain the status of a discipline, and he lauded the freedom of being able to define a new discipline. Callahan's essay shares with Mathews and colleague's a peculiarity: neither ever defines what it means to refer to something as a “discipline.” To define a discipline does mean attending to the intended end product of scholarly activity, so I concur with Mathews et al.’s focus on outcomes. But I am concerned that in their argument they confusingly entangle their understanding of an academic discipline's internal goals, its telos, with its potential to have an impact on the external world, its praxis. The confusion that this can bring exposes what I believe is a profound problem within bioethics, the discipline's peculiar and at times intellectually hazardous relationship with its institutional hosts. (shrink)

Can one publish a bioethics case ethically? I suspect that most in bioethics would feel comfortable publishing a case if the subject—the patient—gave explicit permission, the amount of biographical information revealed was under the control of the subject, and the subject fully understood the benefits and risks of publishing the case. Some might add that the subject should have a chance to approve the final representation. I think that the ethics of publishing cases needs to be rethought. And this rethinking (...) needs to be focused not on the way publishing a case might harm a patient (that is, nonmaleficence) but, rather, on how a case presentation does not convey the patient’s own voice in the narrative (that is, respect for autonomy). Bioethics needs a new model of case presentation: the polyphonic case, which demands that the subject be a part of the case’s construction. (shrink)

Contra those bioethicists who think that their cases are based on “real” events and thus not motivated by any particular ethical theory, Chambers explores how case narratives are constructed and thus the extent to which they are driven by particular theories.

It is pictures rather than propositions, metaphors rather than statements, which determine most of our philosophical convictions. Bioethics has been particularly attentive to the role of metaphors in the discourse on moral issues in medicine. In The Physician’s Covenant, William May discusses how the various metaphors of the physician influence the manner in which we analyze problems in clinical ethics. Meaghan O’Keefe and colleagues have argued that particular metaphors dominate and in turn mediate the representation of genetic modification to the (...) public’. Craig Klugman has analyzed the power of various metaphors used in the discussion of... (shrink)

A collection of essays written by arts and humanities scholars across disciplines, this book argues that higher education has been compromised by its uncritical acceptance of our culture's standards of productivity, busyness, and speed. Inspired by the Slow Movement, contributors explain how and why university culture has come to value productivity over contemplation and rapidity over slowness. Chapter authors argue that the arts and humanities offer a cogent critique of fast culture in higher education, and reframe the discussion of the (...) value of their fields by emphasizing the dialectic between speed and slowness. (shrink)

Innovative theories and policy proposals originating in the economics profession have diffused globally over the past several decades, but these models and policy programs transform as they spread. Existing models of change based on the concept of “paradigm shifts” capture the transformation of the economics profession at a high level of abstraction, but analysis of more concrete policy changes and associated ideas requires developing theory at a lower level of abstraction. I propose a field theoretic model of change based on (...) the concept of cycles of polarization and settlement. According to this model, settlements are characterized by multiple cross-cutting axes of competition and debate in a professional field. Moments of contention emerge when field entrepreneurs successfully build professional movements, resulting in polarization. However, contention is episodic and followed by the emergence of “centripetal forces” which lead a gradual return to the center. I develop this model by examining the case of monetary economics and policy in Latin America, a critical case for studies of the policy influence of economic ideas and experts. (shrink)

Information is a force multiplier. Knowledge of the enemy's capability and intentions may be of far more value to a military force than additional troops or firepower. Situation assessment is the ongoing process of inferring relevant information about the forces of concern in a military situation. Relevant information can include force types, firepower, location, and past, present and future course of action. Situation assessment involves the incorporation of uncertain evidence from diverse sources. These include photographs, radar scans, and other forms (...) of image intelligence, or IMINT; electronics intelligence, or ELINT, derived from characteristics (e.g., wavelength) of emissions generated by enemy equipment; communications intelligence, or COMINT, derived from the characteristics of messages sent by the enemy; and reports from human informants (HUMINT). These sources must be combined to form a model of the situation. The sheer volume of data, the ubiquity of uncertainty, the number and complexity of hypotheses to consider, the high-stakes environment, the compressed time frame, and deception and damage from hostile forces, combine to present a staggeringly complex problem. Even if one could formulate a decision problem in reasonable time, explicit determination of an optimal decision policy exceeds any reasonable computational resources. While it is tempting to drop any attempt at rational analysis and rely purely on simple heuristics, we argue that this can lead to catastrophic outcomes. We present an architecture for a ``complex decision machine'' that performs rational deliberation to make decisions in real time. We argue that resource limits require such an architecture to be grounded in simple heuristic reactive processes. We thus argue that both simple heuristics and complex decision machines are required for effective decision making in real time for complex problems. We describe an implementation of our architecture applied to the problem of military situation assessment. (shrink)

Tod Chambers suggests that literary theory is a crucial component in the complete understanding of bioethics. _The Fiction of Bioethics_ explores the medical case study and distills the idea that bioethicists study real-life cases, while philosophers contemplate fictional accounts.

This narrative symposium examines the relationship of bioethics practice to personal experiences of illness. A call for stories was developed by Tod Chambers, the symposium editor, and editorial staff and was sent to several commonly used bioethics listservs and posted on the Narrative Inquiry in Bioethics website. The call asked authors to relate a personal story of being ill or caring for a person who is ill, and to describe how this affected how they think about bioethical questions and (...) the practice of medicine. Eighteen individuals were invited to submit full stories based on review of their proposals. Twelve stories are published in this symposium, and six supplemental stories are published online only through Project MUSE. Authors explore themes of vulnerability, suffering, communication, voluntariness, cultural barriers, and flaws in local healthcare systems through stories about their own illnesses or about caring for children, partners, parents and grandparents. Commentary articles by Arthur Frank, Bradley Lewis, and Carol Taylor follow the collection of personal narratives. (shrink)

Recently, bioethics has become interested in engaging with narrative, but in this engagement, narrative is usually viewed as a mere helpmate to philosophy. In this precis to his book The Fiction of Bioethics, Tod Chambers argues that narrative theory should not be simply a helpful addition to medical ethics but instead should be thought of as being as vital and important to the discipline as moral theory itself. The reason we need to rethink the relationship of medical ethics to (...) narrative is that ethicists test their ideas by applying them to cases, and cases are a narrative genre. Recognizing the importance that cases have for the way medical ethicists do ethics is essential in order to appreciate the field as a form of applied philosophy. Like other forms of representation, narrative has distinct and defining features, which ethicists, in order to understand the data of their field, must learn to recognize and differentiate. Ethicists need to attend to the way decisions about the discourse of a narrative influences the kind of moral theories judged relevant to it. The author briefly examines six features of narrative discourse that rhetorically condition the way we understand medical ethics cases: filter, reportability, closure, characters, chronotope, and gender. (shrink)

On reading “Algorithms for Ethical Decision-Making in the Clinical: A Proof of Concept,” I imagined that for some the fundamental problem with the authors' approach is the very...

This paper reports a literature review on the topic of ethical issues in in-depth interviews. The review returned three types of article: general discussion, issues in particular studies, and studies of interview-based research ethics. Whilst many of the issues discussed in these articles are generic to research ethics, such as confidentiality, they often had particular manifestations in this type of research. For example, privacy was a significant problem as interviews sometimes probe unexpected areas. For similar reasons, it is difficult to (...) give full information of the nature of a particular interview at the outset, hence informed consent is problematic. Where a pair is interviewed (such as carer and cared-for) there are major difficulties in maintaining confidentiality and protecting privacy. The potential for interviews to harm participants emotionally is noted in some papers, although this is often set against potential therapeutic benefit. As well as these generic issues, there are some ethical issues fairly specific to in-depth interviews. The problem of dual role is noted in many papers. It can take many forms: an interviewer might be nurse and researcher, scientist and counsellor, or reporter and evangelist. There are other specific issues such as taking sides in an interview, and protecting vulnerable groups. Little specific study of the ethics of in-depth interviews has taken place. However, that which has shows some important findings. For example, one study shows participants are not averse to discussing painful issues provided they feel the study is worthwhile. Some papers make recommendations for researchers. One such is that they should consider using a model of continuous (or process) consent rather than viewing consent as occurring once, at signature, prior to the interview. However, there is a need for further study of this area, both philosophical and empirical. (shrink)

This narrative symposium examines the relationship of bioethics practice to personal experiences of illness. A call for stories was developed by Tod Chambers, the symposium editor, and editorial staff and was sent to several commonly used bioethics listservs and posted on the Narrative Inquiry in Bioethics website. The call asked authors to relate a personal story of being ill or caring for a person who is ill, and to describe how this affected how they think about bioethical questions and (...) the practice of medicine. Eighteen individuals were invited to submit full stories based on review of their proposals. Twelve stories are published in this symposium, and six supplemental stories are published online only through Project MUSE. Authors explore themes of vulnerability, suffering, communication, voluntariness, cultural barriers, and flaws in local healthcare systems through stories about their own illnesses or about caring for children, partners, parents and grandparents. Commentary articles by Arthur Frank, Bradley Lewis, and Carol Taylor follow the collection of personal narratives. (shrink)

Linguistic capital is what is at issue when we ask who can speak for a religion. But asking who has the linguistic capital to speak for a religious community in public policy forums is different from asking who has linguistic capital within the religious community. The first question forces us to examine the acquisition of linguistic capital in three separate — yet overlapping — fields of social discourse: academia, religion, and government. Each of these requires distinctive ways of earning the (...) necessary social capital to be authorized to speak. The issue of who has the status to speak for a religion in a political forum is essentially a question of what types of linguistic capital gained in one field are deemed legal tender within another field. (shrink)

Professors of philosophy do from time to time seek to wear the clothes of relevanceAlasdair MacIntyre (1984, 36)I recall one of the first bioethics conferences I ever attended. During the question–...

This article argues for the importance of theoreticalreflections that originate from patients' experiences.Traditionally academic philosophers have linked their ability totheorize about the moral basis of medical practice to their roleas outside observer. The author contends that recently a new typeof reflection has come from within particular patientpopulations. Drawing upon a distinction created by AntonioGramsci, it is argued that one can distinguish the theorygenerated by traditional bioethicists, who are academicallytrained, from that of ``organic'' bioethicists, who identifythemselves with a particular patient community. (...) Thecharacteristics of this new type of bioethicist that are exploredin this article include a close association of memoir andphilosophy, an interrelationship of theory and praxis, and anintimate connection between the individual and a particularpatient community. (shrink)

As many in the United States feel a need to take a side in the ongoing culture wars, the people who make up the field of bioethics have an obligation to directly engage with those who hold different political views. If bioethics is an academic field, it must also affirm the overall values of the academy to continually challenge central assumptions. If the field wishes to be a part of the development of public policy, it must be able to construct (...) such policies that in some fundamental manner honor the values of the opposition. (shrink)