This article explores the implications of what it means to moralize about future technological innovations. Specifically, I have been invited to comment on three papers that attempt to think about what seems to be an impending social reality: the availability of life-like sex robots. In response, I explore what it means to moralize about future technological innovations from a secular perspective, i.e., a perspective grounded in an immanent, socio-historically contingent view. I review the arguments of Nancy Jecker, Mark Howard and (...) Robert Sparrow, and Wang Jue and respond to their arguments concerning the permissible limits of human-robot sexual interaction. I argue that we are in a poor epistemic position regarding what the actual future human response will be towards sex robots and how it affects society generally. Given this poor epistemic position, I argue that moralizing about future trends like human-robot sex is difficult because we do not have the relevant facts to work with. Furthermore, I remain skeptical as to policy recommendations based on socio-historically contingent moral viewpoints both because they do not carry in principle moral authority to say what future others may or may not do with their property and they may not even appeal to future secular others, insofar as secular morality is plural and consistently develops anew. (shrink)

In her excellent essay, Blumenthal-Barby (2024) argues that it is “time for bioethics to end talk of personhood.” She is concerned, more specifically, with “the philosophical concept of personhood,...

De moderne filosofie lijdt aan muziekvergetelheid. Opvallend is echter dat filosofen, wanneer ze toch aandacht schenken aan muziek, hun aandacht bij voorkeur op één bepaald genre richten, namelijk de opera. Filosofen zoals Søren Kierkegaard en Friedrich Nietzsche lieten hun gedachten over Don Giovanni, Parsifal en Carmen gaan, terwijl omgekeerd de filosofie van Arthur Schopenhauer de opera heeft beïnvloed via Wagner. Diens werk lijkt zich op het snijpunt van het grensverkeer tussen moderne filosofie en moderne muziek te bevinden. Het was zijn (...) ambitie de menselijke existentie en de menselijke geschiedenis in één panoramisch oeuvre te vatten, vanaf het primordiale begin tot en met de dramatische finale die ophanden leek: een catastrofale apotheose die een geheel nieuwe toekomst mogelijk zou maken. Dat is althans de verhaallijn van zijn meesterwerk Der Ring des Nibelungen. Aan het slot van Götterdämmerung lijkt zich een algehele verwoesting te hebben voltrokken: ‘Everything is destroyed and there is an enigmatic kind of hovering over the scene of destruction’ (Badiou 2010, p. 106), een ambivalente stemming van hoop en destructie zette Wagner op muziek. Voor Wagner is dan ook een hoofdrol in deze studie weggelegd: voor zijn muziektheoretische geschriften (waarin hij over een ‘muziek van de toekomst’ filosofeerde), maar meer nog voor de muzikale totaalkunstwerken die hij daadwerkelijk componeerde. (shrink)

As climate change risks intensify, I welcome Ray and Cooper’s call for bioethicists to engage with environmental injustice, though I am pessimistic it is another false dawn for bioethics engagement...

Professor Jecker (2008) argues that a broader conception of justice in allocating health care resources would focus moral attention on how the determinants of socioeconomic marginalization unfairly...

Emphasizing the importance of language is a key characteristic of philosophical reflection in general and of bioethics in particular. Rather than trying to eliminate the historicity and ambiguity of language, a continental approach to bioethics will make conscious use of it, for instance by closely studying the history of the key terms we employ in bioethical debates. Continental bioethics entails a focus on the historical vicissitudes of the key signifiers of the bioethical vocabulary, urging us to study the history of (...) terms such as “bioethics,” “autonomy,” “privacy,” and “consensus.” Instead of trying to define such terms as clearly and unequivocally as possible, a continental approach rather requires us to take a step backwards, tracing the historical backdrop of the words currently in vogue. By comparing the original meanings of terms with their current meanings, and by considering important moments of transition in their history, obfuscated dimensions of meaning can be retrieved. Thus, notwithstanding a number of methodological challenges involved in etymological exercises, they may foster moral articulacy and enhance our ability to come to terms with moral dilemmas we are facing. (shrink)

Clinicians may increasingly find themselves practicing, by choice or necessity, in resource-poor or extreme environments. This often requires altering typical patterns of practice with a different set of medical and ethical considerations than are usually faced by clinicians practicing in hospitals in the United States and Europe. Practitioners may be required to alter their usual scope of practice or their standard ways of medically treating patients. Limited resources will also often place clinicians in the position of having to make decisions (...) about fairly allocating healthcare, which will alter the physician–patient relationship. This does not absolve physicians and other healthcare practitioners of providing the best quality of care that can be given under the circumstances. In addition, the lack of a well-developed healthcare infrastructure and limited resources will require working with established providers to determine the needs of the community, and what types of healthcare are feasible given these limitations. The essays in this issue of HEC Forum encourage readers to reflect on the unique ethical challenges faced in the extreme or austere environment. (shrink)

Traditional Chinese culture, Confucianism, in particular, has a non-individualist conception of what it is to be human. It conceives of people fundamentally as members of social groups—specifically, the family, the clan, the political community and the state—not as atomic individuals as perceived in modern society. The communist ideology since the middle of the last century also emphasizes the significance of ‘the common good’ of the state which describes a specific ‘good’ that is shared and beneficial for all (or most) members (...) of a given community. Nevertheless, marketization and decentralization in China today have significantly challenged the notion of a state-oriented community that directly impacts China's healthcare system, beginning with the dismantling of the rural collectives and state-owned enterprises as part of the reform and opening process. This article will address healthcare challenges in China today, examining the conceptual/ethical issues raised by public healthcare, and contending that public health concerns should go beyond the dichotomy between individualism and collectivism. The article will argue that the family-oriented model of Confucianism offers an alternative way to look at what constitute a community and common goods. The Confucian approach to ethics is relevant to healthcare today. For example, it will be much easier to find a shared idea of common good in terms of complicated issues like healthcare; it would make sense to give a larger role to families via family savings accounts, and not have everything determined by the government. (shrink)

This paper focuses on Confucian formulations of personhood and the implications they may have for bioethics and medical practice. We discuss how an appreciation of the Confucian concept of personhood can provide insights into the practice of informed consent and, in particular, the role of family members and physicians in medical decision-making in societies influenced by Confucian culture. We suggest that Western notions of informed consent appear ethically misguided when viewed from a Confucian perspective.

Are there some newborn infants whose short- and long-term care costs are so great that treatment should not be provided and they should be allowed to die? Public discourse and academic debate about the ethics of newborn intensive care has often shied away from this question. There has been enough ink spilt over whether or when for the infant's sake it might be better not to provide life-saving treatment. The further question of not saving infants because of inadequate resources has (...) seemed too difficult, too controversial, or perhaps too outrageous to even consider. However, Roman Catholic ethicist Charles Camosy has recently challenged this, arguing that costs should be a primary consideration in decision-making in neonatal intensive care. In the first part of this paper I will outline and critique Camosy's central argument, which he calls the ‘social quality of life (sQOL)’ model. Although there are some conceptual problems with the way the argument is presented, even those who do not share Camosy's Catholic background have good reason to accept his key point that resources should be considered in intensive care treatment decisions for all patients. In the second part of the paper, I explore the ways in which we might identify which infants are too expensive to treat. I argue that both traditional personal ‘quality of life’ and Camosy's ‘sQOL’ should factor into these decisions, and I outline two practical proposals. (shrink)

ZusammenfassungDas ethische Prinzip des Respekts vor der Autonomie des Patienten/probanden hat in der modernen Medizin mittlerweile weltweit Bedeutung erlangt. Die Betonung der Autonomie des Patienten und Probanden in allen in der letzten Zeit verabschiedeten internationalen Deklarationen gibt dieser Tendenz unmissverständlich Ausdruck. Doch wenngleich diese Entwicklung unstrittig positiv ist, wirft sie dennoch eine Reihe von Fragen auf, die mit der Kodifizierung, Interpretation, Reichweite und Anwendung dieses universalen Prinzips verbunden sind. Die Antworten auf diese Fragen entscheiden darüber, ob Autonomie als hilfreiches, emanzipatorisches (...) oder als überforderndes, gar hegemoniales Prinzip begriffen wird. Diese normativen Probleme werden anhand von Beispielen aus der globalen Medizinethik verdeutlicht. Was in modernen Gesellschaften als Autonomie bezeichnet und für die Praxis fruchtbar gemacht wird, ist als ein soziales Konstrukt zu verstehen, nicht im Sinne einer Schimäre, sondern im Sinne einer soziokulturellen Leistung, die auf komplexen, historisch gewachsenen und kulturell geprägten Interaktionen von Gesellschaften, Institutionen und Individuen beruht. (shrink)

ZusammenfassungDas ethische Prinzip des Respekts vor der Autonomie des Patienten/probanden hat in der modernen Medizin mittlerweile weltweit Bedeutung erlangt. Die Betonung der Autonomie des Patienten und Probanden in allen in der letzten Zeit verabschiedeten internationalen Deklarationen gibt dieser Tendenz unmissverständlich Ausdruck. Doch wenngleich diese Entwicklung unstrittig positiv ist, wirft sie dennoch eine Reihe von Fragen auf, die mit der Kodifizierung, Interpretation, Reichweite und Anwendung dieses universalen Prinzips verbunden sind. Die Antworten auf diese Fragen entscheiden darüber, ob Autonomie als hilfreiches, emanzipatorisches (...) oder als überforderndes, gar hegemoniales Prinzip begriffen wird. Diese normativen Probleme werden anhand von Beispielen aus der globalen Medizinethik verdeutlicht. Was in modernen Gesellschaften als Autonomie bezeichnet und für die Praxis fruchtbar gemacht wird, ist als ein soziales Konstrukt zu verstehen, nicht im Sinne einer Schimäre, sondern im Sinne einer soziokulturellen Leistung, die auf komplexen, historisch gewachsenen und kulturell geprägten Interaktionen von Gesellschaften, Institutionen und Individuen beruht. (shrink)

Are mental disorders natural kinds or socially constructed categories? What is at stake if either of these views prove to be true? This paper offers a qualified defence for the view that there may be natural kinds of mental disorder, but also that the implications of this claim are generally overestimated. Especially concerns about over-inclusiveness of diagnostic categories and medicalisation of abnormal behaviour are not addressed by the debate. To arrive at these conclusions the paper opens with a discussion of (...) kind formation in science, followed by an analysis of natural kinds. Seven principled and empirically informed objections to the possibility of natural kinds of mental disorder are considered and rejected. The paper ends with a reflection on diagnostics of mental health problems that don’t fall into natural kinds. Despite the defence of the possibility of natural kinds of mental disorder, this is likely to be the majority of cases. (shrink)

In this article, I address two objections developed by Kingma against Boorse’s bio-statistical theory of health, the objections that choice of reference classes renders the theory both circular and problematically value-laden. These objections not only apply to the bio-statistical theory of health but also to other naturalistic theories, like the dispositional theory of health. I present three rejoinders. First, I argue that the circularity objection arises from excessive methodological demands. Second, I argue that naturalists can resist the normativist claim that (...) health and pathology are differentiated on the basis of personal or cultural values. Finally, I show that it is possible to justify choices between rival theories of health without the interference of evaluative commitments. With these rejoinders, I conclude that the bio-statistical theory, as well as other naturalistic theories of health utilizing reference classes, is not undermined by Kingma’s arguments. (shrink)

What is Christian about Christian bioethics? The short answer to this question is that the Incarnation should shape the form and content of Christian bioethics. In explicating this answer it is argued that contemporary medicine is unwittingly embracing and implementing the transhumanist dream of transforming humans into posthumans. Contemporary medicine does not admit that there are any limits in principle to the extent to which it should intervene to improve the quality of human life. This largely inarticulate, yet ambitious, agenda (...) is derived first in late modernity's failed, but nonetheless ongoing, attempt to transform necessity into goodness, and second the loss of any viable concept of eternity, thereby stripping temporal existence of any normative significance. In short, medicine has become the vanguard of a profane attempt to save humankind by extracting data from flesh. In response, it is contended that an alternative Christian bioethics must be shaped by the Incarnation, the Word made flesh. This assertion does not entitle Christians to oppose the posthuman trajectory of contemporary medicine on the basis of any natural or biological essentialism. Rather, it is an evangelical witness to the grace of Christ's redemption instead of the work of self-transformation. It is Christ alone who thereby makes the vulnerability and mortality of finitude a gift and blessing. Specifically, it is maintained that the chasm separating necessity and goodness cannot be filled but only bridged through the suffering entailed in Christ's cross, and through Christ's resurrection eternity becomes the standard against which the temporal lives of human creatures are properly formed and measured. Consequently, Christian bioethics should help us become conformed to Christ rather than enabling selftransformation. (shrink)

The widespread practices of data collection by third-party actors pose challenges to children’s and adolescents’ privacy when they navigate digital environments. Given that the informed-consent par...

In celebration of the fortieth anniversary of the publication of Beauchamp and Childress’s Principles of Biomedical Ethics, a review is undertaken to compare the lists of principles in various bioethical theories to determine the extent to which the various lists can be reconciled. Included are the single principle theories of utilitarianism, libertarianism, Hippocratism, and the theories of Pellegrino, Engelhardt, The Belmont Report, Beauchamp and Childress, Ross, Veatch, and Gert. We find theories all offering lists of principles numbering from one to (...) ten. Many of the differences can be reconciled, but some critical differences remain. (shrink)

As lifestyle diseases put a heavy burden on health care expenditures, voices are raised and win in sound to hold people responsible for their unhealthy lifestyle. Most of the arguments in favour of responsibility are backward-looking. In this article, we describe the distributional consequences of these backward-looking measures and show that they are very harsh on those who regret a past unhealthy lifestyle. We demonstrate that it is possible to take policy measures which respect individual responsibility but which are at (...) the same time able to grant fresh starts to individuals who regret their past unhealthy lifestyle (which is an application of Fleurbaey (2005)). This ‘forgiving’ policy is confronted with a moral hazard problem, however. In general the regulator does not observe whether individuals really regret their past choices or they just pretend to have changed preferences in order to enjoy the compensatory measures for regretful people. In this article, we argue that the health setting offers interesting opportunities to move beyond this moral hazard problem and offer a solution through the use of redistributive instruments that are conditional on lifestyle changes. (shrink)

The modern doctor-patient relationship displays a patient-centred, mutual-participation characteristic rather than the former active-passive or guidance-cooperation models in terms of medical decision making. Respecting the wishes of patients, amounting to more than mere concern for their welfare, has become the feature central to certain modern bioethics theories. A group of ethical principles such as respect for autonomy, beneficence, non-maleficence, and justice has been proposed by bioethicists and widely adopted by many medical societies as an ethical guide to how doctors, in (...) their daily practice, should treat their patients. However, seeing patients as persons who are rational, self-conscious beings capable of valuing their own lives, and who are consequently entitled to the liberty and rights to choose for themselves, is in general the backbone of Western bioethical principles.Since Confucian philosophy has long been a representative of the East-Asia cultural tradition and Confucian bioethics has recently been developed as a theory of applied ethics, examining Confucius's idea of “persons” may shed some light on the current bioethical debates. Confucius's concept of persons, which is best interpreted via his theories of “chun-tze”, encapsulating a two-dimensional approach, , provides a more comprehensive model regarding what a person is and how he/she should be treated. This two-dimensional approach sees a person not only as a rational, autonomous agent but also as a relational, altruistic identity whose self actualisation involves incessant participating in and promoting of the welfare of his fellow persons. Hence this may balance the current bioethical trend whereby “respect for autonomy” often triumphs. (shrink)

Public deliberation about health policy in the United States often hinges on two untenable basic assumptions about political legitimacy. The first assumption, common in public debate throughout the United States, is that federal oversight of health care is justified under a federal compact binding all citizens. This assumption is false because the federal compact precludes such oversight. Indeed, the ascendancy of national government (and demise of federalism) over the past 70 years was engineered through the subversion of the federal compact, (...) creating an expansive legitimation gap. The second assumption—that political legitimacy can be established through appeals to expert consensus about fundamental conceptions of justice or human rights—is prevalent among bioethicists. I argue that this assumption is illicit because it hinges on a weak, rationalistic form of majoritarian democracy that conflates public acquiescence with public approval. If the public mission of academic bioethics involves protecting the integrity of public deliberation, then these two basic assumptions should be challenged. (shrink)

The doctor's use of deception in appropriate circumstances has commonly been considered a necessity of the medical art. Resistance to full and frank communication is typical of many traditionally Catholic countries, and particularly of Italy, a western country where Catholicism remains particularly influential. The Catholic teaching on truth and lies, and the problem of telling the truth to a severely ill patient is discussed. It is suggested that the contemporary Catholic model of gradually telling a terminal patient the truth, which (...) looks reasonable and feasible in theory, is rarely followed in practice, as in the majority of cases the truth is not told tout court. Problems stem from the way in which medicine is currently practiced in Italy; from the synergism between Catholicism and the medical tradition's grounded paternalism; and from the ambiguity of the term ?hope?. Catholic ethics in fact recommends that the truth must be told without destroying hope, but the Catholic meaning of ?hope? is very different from its meaning in current language. (shrink)

This article presents various developments in Dutch health care policy toward a greater role for individual financial responsibility, such as cost-control measures, priority setting, rationing, and market reform. Instead of the collective responsibility that is characteristic of previous times, one can observe in government policies an increased emphasis on the need for individuals to take care of one’s own health and health care needs. Moreover, surveys point to decreasing levels of public support for “unlimited” solidarity and “irresponsible” health behavior. This (...) article attempts to answer the question of how these policies and public attitudes are limiting the ethical principles of solidarity and equal access to care that have long guided Dutch health care policy making. The authors argue that from a moral point of view, the increased emphasis on individual responsibility is acceptable as long as it does not affect solidarity with those weak and vulnerable groups who are not able to take individual responsibility, such as the demented and mentally handicapped. (shrink)

Three metaphors appear to guide contemporary thinking about organ transplantation. Although the gift is the sanctioned metaphor for donating organs, the underlying perspective from the side of the state, authorities and the medical establishment often seems to be that the body shall rather be understood as a resource . The acute scarcity of organs, which generates a desperate demand in relation to a group of potential suppliers who are desperate to an equal extent, leads easily to the gift’s becoming, in (...) reality, not only a resource, but also a commodity . In this paper, the claim is made that a successful explication of the gift metaphor in the case of organ transplantation and a complementary defence of the ethical primacy of the giving of organs need to be grounded in a philosophical anthropology which considers the implications of embodiment in a different and more substantial way than is generally the case in contemporary bioethics. I show that Heidegger’s phenomenology offers such an alternative, with the help of which we can understand why body parts could and, indeed, under certain circumstances, should be given to others in need, but yet are neither resources nor properties to be sold. The phenomenological exploration in question is tied to fundamental questions about what kind of relationship we have to our own bodies, as well as about what kind of relationship we have to each other as human beings sharing the same being-in-the-world as embodied creatures. (shrink)

The new methods of modern sciences can contribute to understand the genesis of mental illness, the disturbances in brain chemistry, physiology, anatomy or genetical information underlying different diseases of the nervous system. Understanding mental illness is not only challenging to science, but is also of great social importance. Moreover, the new developments of neurosciences put new lights on discussions such as brain-mind concepts, unity of mind, definition of consciousness and even definition of the person.For the majority of the scientists, it (...) is clear today that the mind can not be conceived any more as unique and indivisible. For philosophers, it is clear also that neuroscience influenced their vision of life and death: neurosciences are not strange to the debate whole-body death versus whole-brain death for instance. Modern scientific achievements have expanded our vision, allowing us to percieve previously unanticipated interrelationships between biological and psychological phenomena. The boundary between some behavioural and higher neural function studies and biology is arbitrary and changing. It has been imposed not by the natural contours of the disciplines, but by lack of knowledge. (shrink)

Human experimentation can have different meanings: indeed, with the development of medical research, therapeutic acts have to be distinguished from acts of cognitive values. For each kind of acts, specific conditions of acceptability and specific protections of human beings have to be defined.Human experimentation must be envisaged at different levels to evaluate ethical aspects: its scientific value, the risks, benefits envisaged, the populations implicated, etc…The individual consent must be present too in the relationship between the subject and the doctors. In (...) fact, is a real consent possible?Instead to insist on problems in terms of medical research, one would have to insist perhaps more on the fact that the medical practice in general would have to answer more to ethical grounds and to scientific rules. It is the non scientific medicine which is immoral and dangerous, as well the medicine with financial interests, or also the medecine without experimentation.The main arguments must remain at the level of the dignity of the persons, autonomy and freedom of choice must remain the fundamental values. (shrink)

“I know only one thing, that I know nothing” SocratesMost of the religions put human life above all other kind of animal life, enclose the complexity of human life in a dogma and give a finality to life and death. When biologists are not more following the security of the road of systematic analysis of animal or plant kingdom or of ecological studies of biotopes, but when they are giving a chemical and mechanical explanation of life, they become disturbing for (...) whom prefer not to explore the ordinary of human life but is preferring to believe in the extraordinary.A pluralist ethics does not consist to build up new dogmas, to contra balance in a sense some fundamentalist positions. Interpellated by the medicine and the new technologies, we have to discuss the way it is influencing our new ways of life. We must look for more autonomy of individuals, and for more individual and collective responsibilities.Continuing education is the only guarantee of our freedoms, it is the pedagogy of pluralist discussions which can preserve our societies from dehumanisation. Education must help humans to keep freedom and probity, and to move away from pseudosciences and prejudices. (shrink)

This paper is a criticalexamination of the development of thephilosophy of medicine as a discipline. Ithighlights two major themes in the contemporarydebate about the philosophy of medicine: thescope of the discipline and the relation of thediscipline to its cognate disciplines. A broadview of the philosophy of medicine is defendedand the philosophy of medicine is seen as aphilosophical sub-discipline. These viewsdepend in important ways on three factors: ageneral metaphysical world view, particularunderstandings of the cognate disciplines, andthe perspective from which one asks (...) thequestions about the nature of the discipline. It is proposed that the future of thephilosophy of medicine may follow thephilosophy of science in that philosophical,sociological and historical studies may combinein a mutually enriching way to form ‘‘medicinestudies.’‘. (shrink)

This paper is a response to Christopher Boorse's recent defense of his Biostatistical Theory of health and disease. Boorse maintains that his concept of theoretical health and disease reflects the "considered usage of pathologists." I argue that pathologists do not use "disease" in the purely theoretical way that is required by the BST. Pathology does not draw a sharp distinction between theoretical and practical aspects of medicine.

McCarthy, Homan, and Rozier’s article seeks to bridge a gap between theological and secular bioethics. It should be noted that the “theological” emphasis in the a...

This essay surveys four recent theological works on the issue of personhood: John F. Crosby's The Selfhood of the Human Person, Stanley Rudman's Concepts of Person and Christian Ethics, Metropolitan Hierotheos Vlachos' The Person in the Orthodox Tradition, and James Walter's What is a Person? An Ethical Exploration.

Allyne L. Smith, Jr.; Personhood: Beginnings and Endings, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 6, Issue 1, 1 January 2000, Pa.

Where feminist critiques of bioscience have uncovered a whole set of operations that range round the Foucauldian notions of biopower and normativity, and have explored genetic discourse in particular to question the stability of self-identity, feminist bioethics has lagged behind. Despite an engagement with the technologies of postmodernity, including those associated with genetic research (and especially in its relation to reproduction), there has been, with relatively few exceptions, a reluctance to explore the implications of postmodernist theory. The difficulty is that (...) bioscience itself is now throwing up a problematic that destabilizes the central agent of ethical theory - the modernist sovereign subject. Using the field of genetics and the mapping of the human genome as a focal point, this paper suggests that bioethics should move on from conventional analytic strategies and, like feminist science studies, embrace uncertainty and complexity. The task is to fashion a new form of ethical response grounded in the notions of embodied connection and fluidity. (shrink)

The new dilemmas and responsibilities which arise in bioethics both because of the unprecedented pace of scientific development and of growing moral pluralism are more and more difficult to grapple with. At the ‘global’ level, the call for the universal nature at least of some fundamental moral values and principles is often being contended as a testament of arrogance, if not directly as a new kind of subtler imperialism. The human rights framework itself, which provided the basis for the most (...) relevant international declarations and documents, is not exempt from the charge. However, the refusal of a top-down conception of the universal as a sort of product for exportation should not be confused with a relativistic landscape, where all the cows can be indifferently black or white. This contribution aims at outlining an approach, which reconciles universalism as enshrined in founding human rights declarations with respect for cultural diversity. In order to do so, two conceptual frameworks are discussed: the ‘tool-kit’ model and the morals/ethics difference. The example of the right to quality health care confirms the argument that striking a balance between cherishing pluralism and defending some fundamental rights and obligations does not amount to an assertion of moral imperialism. (shrink)

The article concerns itself with normative aspects of public health in light of recent debates. It starts out by introducing a few terminological and conceptual distinctions that set the stage for the subsequent discussion. This is followed by critical remarks on two proposals for developing an adequate public health ethics and the way that the growing health inequalities observed in much of the OECD-world are dealt with in parts of the pertinent literature. The article concludes with a cautionary note on (...) the ‘dangers’ of over-identification with a public health agenda and of over-moralization of empirical findings that give cause for concern. (shrink)

This paper attempts to address the general questionwhether information technologies, as applied in thearea of medicine and health care, have or are likelyto change fundamental concepts regarding disease andhealth. After a short excursion into the domain ofmedical informatics I provide a brief overview of someof the current theories of what a disease is from amore philosophical perspective, i.e. the ``valuefree'' and ``value laden'' view of disease. Next, Iconsider at some length, whether health careinformatics is currently modifying fundamentalconcepts of disease. To (...) this question I will answerlargely in the negative, and I will provide the sketchof some arguments from current research programs inmedical informatics why I think this is the case. Thisargumentation is supported by a detailed account ofhow the disease profile for beriberi heart disease,used in one of the major medical informaticsdiagnostic programs, QMR (and its ancestorINTERNIST-1), was developed, and why at least thisprogram essentially follows received views oftraditional medicine.The one main exception to theconformity of this program to ``received'' views of adisease occurs when the program's designers need tofine-tune a disease definition. This fine-tuning is tocomport with the expert's perspective on the disease,including his or her epistemic values, as well as theprogram's other resources for diagnosing components ofa disease. (shrink)

Prenatal care and the practice of prenatal genetic testing are about to be changed fundamentally. Due to several ground-breaking technological developments prenatal screening and diagnosis (PND) will soon be offered earlier in gestation, with less procedure-related risks and for a profoundly enlarged variety of targets. In this paper it is argued that the existing normative framework for prenatal screening and diagnosis cannot answer adequately to these new developments. In concentrating on issues of informed consent and the reproductive autonomy of the (...) pregnant women the ethical debate misses problems related to the clinical pathway as a whole and to implicit normative attributions to clinical actions or the function of health care professionals. If, however, ethical debate would focus on the clinical context and on the ends of PND to a larger extent, it would be able to provide a more comprehensive analysis of the ethical challenges especially of the new technologies in order to be more adequately prepared for their implementation. (shrink)

This article retraces progression of Engelhardt’s work so as to place After God in broader context. In The Foundations of Bioethics, Engelhardt argues that given the moral pluralism that is at the core of postmodernity, only a merely formal morality of permission can bind moral strangers in peaceful coexistence. In The Foundations of Christian Bioethics, Engelhardt presents a bioethics that binds Orthodox Christian moral friends. After God shows itself more pessimistic about the possibility of a merely formal morality of moral (...) friends and calls traditional Christians to wage a culture war. These reflections close with some criticisms of Engelhardt’s philosophical-theological project. (shrink)

This paper suggests that medical education be revised to assist in diffusing potential ethical dilemmas that arise during health care provision. A revised medical education would emphasize the role of the humanities in the training of physicians, especially in light of recent critiques of the canonical scientific model in general, and more specifically in the use of that model for medical training and practice.

Our aim in this article is to bring some clarity to the clinical ethics expertise debate by critiquing and replacing the taxonomy offered by the Core Competencies report. The orienting question for our taxonomy is: Can clinical ethicists offer justified, normative recommendations for active patient cases? Views that answer “no” are characterized as a “negative” view of clinical ethics expertise and are further differentiated based on (a) why they think ethicists cannot give justified normative recommendations and (b) what they think (...) ethicists can offer, if they cannot offer recommendations. Views that answer “yes” to the orienting question are characterized as a “positive” view of clinical ethics expertise. Positive views are distinguished according to four additional questions. First (P1), how are those recommendations generated? Second (P2), what is the nature of the recommendations? Third (P3), we ask, how are the recommendations justified? And finally (P4), how are the recommendations communicated? (shrink)

Proposed solutions to the problems of this country's health care system range along a spectrum from central planning to free market. Central planners and free market advocates provide various ethical justifications for the policies they propose. The crucial flaw in the philosophical rationale of central planning is failure to distinguish between normative and metanormative principles, which leads to mistaken understanding of the nature of rights. Natural rights, based on the principle of noninterference, provide the link between individual morality and social (...) order. Free markets, the practical expression of natural rights, are uniquely capable of achieving the goals that central planners seek but find beyond their grasp. The history of this country's health care system and the experiences of other nations provide evidence of the superiority of free markets in reaching for the goals of universal access, control of costs, and sustaining the quality of health care. (shrink)

Respect for Autonomy has been a mainstay of medical ethics since its enshrinement as one of the four principles of biomedical ethics by Beauchamp and Childress’ in the late 1970s. This paper traces the development of this modern concept from Antiquity to the present day, paying attention to its Enlightenment origins in Kant and Rousseau. The rapid C20th developments of bioethics and RFA are then considered in the context of the post-war period and American socio-political thought. The validity and utility (...) of the RFA are discussed in light of this philosophical-historical account. It is concluded that it is not necessary to embrace an ethic of autonomy in order to guard patients from coercion or paternalism, and that, on the contrary, the dominance of autonomy threatens to undermine those very things which have helped doctors come to view and respect their patients as persons. (shrink)

Bioethics uses various theories, methods and institutions for its decision-making. Lately, a dialogical, i.e., dialogue-based, approach has been argued for in bioethics. The aim of this paper is to explore some of the decision-making processes that may be involved in this dialogical approach, as well as related pitfalls that may have to be addressed in order for this approach to be helpful, particularly in clinical ethics. Using informal logic, an analysis is presented of the notion of dialogue and of the (...) stages of dialogical decision-making, and then processes and related pitfalls associated with these stages in the context of clinical ethics are examined. The results of this exploration are expected to facilitate the implementation and empirical testing of dialogical bioethics. (shrink)

The scope and role of theological bioethics has become a growing controversial topic. For instance, some bioethicists have adopted a strong stance on the meaning of “Christian bioethics,” as not ex...

In this paper three models of teaching and learning medical ethics are discussed critically, the traditional and revised vocational models, and the patient-centred model. The autonomy-oriented patient-centred ethics of Beauchamp and Childress is rejected in favour of a hermeneutic practical ethics. A performative conception of ethics teaching is recommended as the most appropriate model for use in the theory and practice of ethics pedagogy.

The attempt to critique the profession of clinical ethics consultation by establishing the impossibility of ethics expertise has been a red herring. Decisions made in clinical ethics cases are almost never based purely on moral judgments. Instead, they are all-things-considered judgments that involve determining how to balance other values as well. A standard of justified decision-making in this context would enable us to identify experts who could achieve these standards more often than others, and thus provide a basis for expertise (...) in clinical ethics consultation. This expertise relies in part on what Richard Zaner calls the “expert knowledge of ethical phenomena”. (shrink)