This study investigates the three major educational philosophies behind the medical humanities programs in the United States. It summarizes the characteristics of the Cultural Transmission Approach, the Affective Developmental Approach, and the Cognitive Developmental Approach. A questionnaire was sent to 415 teachers of medical humanities asking for their perceptions of the amount of time and effort devoted by their programs to these three philosophical approaches. The 234 responses constituted a 54.6% return. The approximately 80:20 gender ratio of males to females (...) and other demographic data on age and educational background were consistent with other studies of the field of medical humanities.Reflections on the results in Table II indicate that some changes need to take place in the teaching of the medical humanities if the perceived ideal is to be achieved. In order for the current teachers of the medical humanities to think that the appropriate philosophies behind the teaching of the medical humanities are being implemented as they should be, much less time and effort need to be devoted to the Cultural Transmission Approach. With no other published reports on the educational philosophies behind the medical humanities programs, this study created a new knowledge base about this relatively young and rapidly emerging field. (shrink)

The idea of the Internet as Gutenberg 2.0—a true revolution in disseminating information—is now a routine part of how bioethics education works. The Internet has become indispensable as a channel for sharing teaching materials and connecting learners with a central platform that houses materials to support an online or hybrid curriculum or a traditional course. A newer idea in bioethics education reflects developments in web-based medical education more broadly and draws on design principles developed for the Internet. This approach to (...) online bioethics education requires thinking about web-based learning as an engaging, potentially immersive experience, about learners' expectations concerning web-based learning, and about differences between self-directed learning and teaching to support group learning. In clinician education in bioethics, the interrelated goals of ethical reflection and practice for professionals and of continuous quality improvement in health care are supported by a focus on real-world challenges and by encouraging the habits of self-directed learning. In this paper, we describe how an international, interdisciplinary team used a web-based framework to develop a health care ethics casebook whose content, design, and pedagogy were tailored to the needs and expectations of health care professionals and other audiences in Singapore; we also explain how they used this framework to make the casebook accessible nationwide and to support cross-cultural learning. (shrink)

This chapter contains sections titled: Feminism and Gender Gender and Health Care Gender and Ethics Moral Persons and Moral Deliberation Bioethical Self‐reflection References Further reading.

Translational ethics (TE) has been developed into a specific approach, which revolves around the argument that strategies for bridging the theory‐practice gap in bioethics must themselves be justified on ethical terms. This version of TE incorporates normative, empirical and foundational ethics research and continues to develop through application and in the face of new ethical challenges. Here, I explore the idea that the academic field of bioethics has not yet sufficiently analysed its own philosophical foundation for how it can, and (...) should, be practically relevant; neither has it comprehensively discussed the limitations on what impacts bioethicists should pursue. As a result, there has not been adequate training on how to suitably and appropriately impact real‐world practices. Moreover, bioethical perspectives are often competing with other strong interests, for example, economic and political, which may weaken their impact on policy‐making. The TE approach I propose can not only facilitate practical impacts of academic bioethics by being better informed by real‐world ethical issues but it also supports targeted and ethical justifications of the actual impact of academic work in real‐world contexts. In this paper, I clarify the premises for this TE approach, identify further challenges and sketch out potential solutions for the implementation of this methodological framework. (shrink)

Our approach to global bioethics will depend, among other things, on how we answer the questions whether global bioethics is possible and whether it, if it is possible, is desirable. Our approach to global bioethics will also vary depending on whether we believe that the required bioethical deliberation should take as its principal point of departure that which we have in common or that which we have in common and that on which we differ. The aim of this article (...) is to elaborate a theoretical underpinning for a bioethics that acknowledges the diversity of traditions and experiences without leading to relativism. The theoretical underpinning will be elaborated through an exploration of the concepts of sameness, otherness, self and other, and through a discussion of the conditions for understanding and critical reflection. Furthermore, the article discusses whether the principle of respect for the other as both the same and different can function as the normative core of this global bioethics. The article also discusses the New Jersey Death Definition Law and the Japanese Transplantation Law. These laws are helpful in order to highlight possible implications of the principle of respect for the other as both the same and different. Both of these laws open the door to more than one concept of death within one and the same legal system. Both of them relate preference for a particular concept of death to religious and/or cultural beliefs. (shrink)

Germund Hesslow has argued that concepts of health and disease serve no important scientific, clinical, or ethical function. However, this conclusion depends upon the particular concept of disease he espouses; namely, on Boorse's functional notion. The fact/value split embodied in the functional notion of disease leads to a sharp split between the science of medicine and bioethics, making the philosophy of medicine irrelevant for both. By placing this disease concept in the broader context of medical history, I shall show that (...) it does capture an essential part of modern medical ideology. However, it is also a self-contradictory notion. By making explicit the value desiderata of medical nosologies, a reconfiguration of the relation between medicine, bioethics, and the philosophy of medicine is initiated. This, in turn, will involve a recovery of the caring dimensions of medicine, and thus a more humane practice. (shrink)

The following article analyzes the process of conception, elaboration, and adoption of the Universal Declaration of Bioethics and Human Rights, and reflects on the lessons it might hold for public bioethics on the international level. The author was involved in the process at a variety of levels: he provided advice to the IBC on behalf of the President's Council of Bioethics; he served as the U.S. representative to UNESCO's Intergovernmental Bioethics Committee; and led the U.S. Delegation in the multilateral negotiation (...) of Government experts that culminated in the adoption of the declaration in its final form. The author is currently serving a 4-year term as a member of UNESCO's International Bioethics Committee. (shrink)

BackgroundThe COVID-19 pandemic has changed the healthcare landscape drastically. Stricken by sharp surges in morbidity and mortality with resource and manpower shortages confounding their efforts, the medical community has witnessed high rates of burnout and post-traumatic stress amongst themselves. Whilst the prevailing literature has offered glimpses into their professional war, no review thus far has collated the deeply personal reflections of physicians and ascertained how their self-concept, self-esteem and perceived self-worth has altered during this crisis. Without adequate intervention, this may (...) have profound effects on their mental and physical health, personal relationships and professional efficacy.MethodsWith mentions of the coronavirus pervading social media by the millions, this paper set out to collate and thematically analyse social media posts containing first-person physician reflections on how COVID-19 affected their lives and their coping mechanisms. A consistent search strategy was employed and a PRISMA flowchart was used to map out the inclusion/exclusion criteria.ResultsA total of 590 social media posts were screened, 511 evaluated, and 108 included for analysis. Salient themes identified include Disruptions to Personal Psycho-Emotional State, Disruptions to Professional Care Delivery, Concern for Family, Response from Institution, Response from Society and Coping Mechanisms.ConclusionIt is evident that the distress experienced by physicians during this time has been manifold, multi-faceted and dominantly negative. Self-concepts were distorted with weakened self-esteem and perceived self-worth observed. The Ring Theory of Personhood (RToP) was adopted to explain COVID-19’s impact on physician personhood as it considers existential, individual, relational and social concepts of the self. These entwined self-concepts serve as ‘compensatory’ to one another, with coping mechanisms buffering and fortifying the physician’s overall personhood. With healthcare institutions playing a vital role in providing timely and targeted support, it was further proposed that a comprehensive assessment tool based on the RToP could be developed to detect at-risk physicians and evaluate the presence and effectiveness of established support structures. (shrink)

edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.The section is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people's actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are therefore particularly appreciated.The themes covered in the section so far include dignity, (...) naturalness, public interest, community, disability, autonomy, parity of reasoning, symbolic appeals, and toleration.All submitted papers are peer reviewed. To submit a paper or to discuss a suitable topic, contact Tuija Takala at [email protected]. (shrink)

In this paper I argue that bioethics is in crisis and that it will not have a future unless it begins to embrace a more Socratic approach to its leading assumptions. The absence of a critical and sceptical spirit has resulted in little more than a dominant ideology. I focus on three key issues. First, that too often bioethics collapses into medical ethics. Second, that medical ethics itself is beset by a lack of self-reflection that I characterize here as a (...) commitment to three dogmas. Third, I offer a more positive perspective by suggesting how bioethics may benefit from looking towards public health ethics as a new source of inspiration and direction. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Origins and Evolution of Bioethics: Some Personal ReflectionsEdmund D. Pellegrino (bio)AbstractBioethics was officially baptized in 1972, but its birth took place a decade or so before that date. Since its birth, what is known today as bioethics has undergone a complex conceptual metamorphosis. This essay loosely divides that metamorphosis into three stages: an educational, an ethical, and a global stage. In the educational era, bioethics focused on a (...) perceived “dehumanization” of medicine by the rising power of science and technology. Remedies were sought by introducing humanities, ethics, and human “values” into the medical curriculum. Ethics was one among the humanistic disciplines, but not the dominant one. In the second era, ethics assumed a dominant role as ever more complex dilemmas emerged from the rapid pace of biological research. As such dilemmas were applied to medical practice, the need for a more rigorous and more formal analysis of their moral status was clear. Philosophically-trained ethicists had an obvious role. They began to teach, write, and profoundly influence medical education and practice. In the third—and present—period, the breadth of problems has become so broad that ethicists must, themselves, draw on disciplines well beyond their expertise—e.g., law, religion, anthropology, economics, political science, psychology, and the like. The era of bioethics as a global enterprise is upon us. The original hope for humanizing medicine has not been overtly successful; however, much has been accomplished of value to patients, the profession, and society. Medical morality has been transformed into a formal, systematic study of a whole range of issues of the greatest significance to humanity. Now the major challenge is one of identity, or inter-relationships and connections between the theoretical and the practical. Bioethics has outgrown its beginnings.I have been invited to give a “personal recollection” of the early development of bioethics. Such invitations are notoriously hard to resist, but also problematic when they are the recollections of a participant [End Page 73] in the events to be described. We need only be reminded of the vagaries common to the plethora of memoirs on the book stands today. Few have escaped the perils of selective memory, self-promotion, or the settling of old scores. Yet their perils notwithstanding, memoirs may serve some useful purpose. They are the raw material—verbal kitchen middens so to speak—out of which historians can later sift fact from fancy. They enable “tribal elders” to give witness to the past from which the present can fashion some sense of continuity.I will organize my reflections around three very arbitrary time periods that represent my own way of thinking about the evolution of bioethics: (1) an era of “proto-bioethics” (1960–1972), (2) an era of philosophical bioethics (1972–1985), and (3) an era of global bioethics (1985-present). Each era, of course, overlaps with the others, and the dominant strand of each runs through the others as well.In the proto-bioethics period, the language of human values predominated; in the era of bioethics philosophically construed, it was the language of philosophical ethics; and in the era of bioethics globally construed, the social and behavioral sciences have gained greater prominence. In each period, interest in the traditional humanities other than philosophy waxed and waned. In the earlier years, religion and theology predominated. Beginning in the 1970s, philosophy took a dominant role. In the last two decades, other disciplines, like law, literature, and the social sciences, have exerted more and more influence (McNeur 1963; Pellegrino 1997; Barker 1987).I make no pretense here of writing any part of the formal “history” of bioethics. Works of this nature are beginning to appear (Rothman 1991; Jonsen 1998 ; Dell’Oro and Viafora 1996). Thomas McElhinney and I are preparing our own account of the work and influence of the Institute on Human Values in Medicine, one of the influential programs of the Society for Health and Human Values (Pellegrino and McElhinney, n.d.). Space limitations as well as prudence preclude any attempt to do justice to all the events, institutions, and people who have made the field of bioethics what it is today. I apologize for these omissions, for any unintentional lapses of... (shrink)

My relationship to the guitar can be characterized by the Friday evening distortion of Kirk Hammett (of Metallica) and Dan Auerbach (of The Black Keys) and Sunday morning’s soaring chords of classical musicians Julian Bream and Rafael Andia to anything in between the rest of the week. I have, however, kept my writing and my music away from my professional practice. I am one of those for whom music and poetry offer a refuge, a source of compensation for the emotions (...) built up during clinical work. I need to look outside of my practice for the beauty of the world, in all its harsh reality and breadth, reveling in the splendor to bring me peace. Reading Bryan Sisk’s (2011) reflection on bringing his guitar, his songs, and his free time to the Cleveland Clinic Children’s Hospital challenged me to immerse myself in a different musical and literary universe. A Lasting Effect: Reflections on Music and Medicine is a collection of reflective pieces written when Sisk was a medical student. He des .. (shrink)

In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This ‘empirical turn’ is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of the moral experiences (...) of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions?In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self‐justification and bias and can increase the credibility of the RE reached. (shrink)

ABSTRACT In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This ‘empirical turn’ is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of the moral (...) experiences of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions? In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self‐justification and bias and can increase the credibility of the RE reached. (shrink)

Background Intersectionality is a concept that originated in Black feminist movements in the US-American context of the 1970s and 1980s, particularly in the work of feminist scholar and lawyer Kimberlé W. Crenshaw. Intersectional approaches aim to highlight the interconnectedness of gender and sexuality with other social categories, such as race, class, age, and ability to look at how individuals are discriminated against and privileged in institutions and societal power structures. Intersectionality is a “traveling concept”, which also made its way into (...) bioethical research. Methods We conducted a systematic review to answer the question of where and how the concept of intersectionality is applied in bioethical research. The PubMed and Web of Science databases were systematically searched and 192 articles addressing bioethical topics and intersectionality were finally included. Results The qualitative analysis resulted in a category system with five main categories: (1) application purpose and function, (2) social dimensions, (3) levels, (4) health-care disciplines and academic fields, and (5) challenges, limitations, and critique. The variety of academic fields and health-care disciplines working with the concept ranges from psychology, through gynaecology to palliative care and deaf studies. Important functions that the concept of intersectionality fulfils in bioethical research are making inequities visible, creating better health data collections and embracing self-reflection. Intersectionality is also a critical praxis and fits neatly into the overarching goal of bioethics to work toward social justice in health care. Intersectionality aims at making research results relevant for respective communities and patients, and informs the development of policies. Conclusions This systematic review is, to the best of our knowledge, the first one to provide a full overview of the reference to intersectionality in bioethical scholarship. It creates a basis for future research that applies intersectionality as a theoretical and methodical tool for analysing bioethical questions. (shrink)

Definition of the problem: Referring to the current critique of bioethics from the point of view of medical anthropology in North America, implications for moral philosophy and health care ethics are questioned. Arguments: The intrinsic and extrinsic flaws of common biomedical ethics as theory-driven ethics of principles and norms are also demonstrated in the German discussion of medical ethics (by reference to ’ethos’ and ’responsibility’) and ethical theory (especially phenomenology or hermeneutics). Objections to the Western bias of Bioethics from the (...) perspective of cross-cultural research are not only a radical critique of biomedicine but a challenge to philosophy and ethics becoming ’intercultural’. Conclusions: Cultural and social studies of life, context and ethos could be helpful in developing the ethical sensitivity, intercultural perception and motivations of health care personnel. In return, the field workers’ self-reflection of their normative preconditions will become an issue. (shrink)

Next SectionThe principle of respect for autonomy has shaped much of the bioethics' discourse over the last 50 years, and is now most commonly used in the meaning of respecting autonomous choice. This is probably related to the influential concept of informed consent, which originated in research ethics and was soon also applied to the field of clinical medicine. But while available choices in medical research are well defined, this is rarely the case in healthcare. Consideration of ordinary medical practice (...) reveals that the focus on patient choice does not properly grasp the moral aspects involved in healthcare. Medical decisions are often portrayed as if doctors and patients in confidence confront specific decisions about examinations or treatment, yet the reality often involves many different participants, with decisions being made over time and space. Indeed, most of the decisions are never even presented to patients, as it would be unethical to suggest something that is not medically justifiable. The options patients do confront are somewhat arbitrarily constructed within the narrow framework of both what is deemed to be medically appropriate and how the healthcare system is organised practically. While the autonomy discourse has proven valuable, a failure to distinguish between the fields of medical research and clinical medicine has generated a focus on patient choice that does not reflect what is really at stake in healthcare settings. This is alarming, because the current discourse misrepresents medical practice in a way that actually contributes to bioethical self-delusion. (shrink)

Abstract:This article deals with the question as to what makes bioethics a critical discipline. It considers different senses of criticism and evaluates their strengths and weaknesses. A primary method in bioethics as a philosophical discipline is critical thinking, which implies critical evaluation of concepts, positions, and arguments. It is argued that the type of analytical criticism that restricts its critical role to critical thinking of this type often suffers from other intellectual flaws. Three examples are taken to demonstrate this: premature (...) criticism, uncritical self-understanding of theoretical assumptions, and narrow framing of bioethical issues. Such flaws can lead both to unfair treatment of authors and to uncritical discussion of topics. In this context, the article makes use of Häyry’s analysis of different rationalities in bioethical approaches and argues for the need to recognize the importance of communicative rationality for critical bioethics. A radically different critical approach in bioethics, rooted in social theory, focuses on analyses of power relations neglected in mainstream critical thinking. It is argued that, although this kind of criticism provides an important alternative in bioethics, it suffers from other shortcomings that are rooted in a lack of normative dimensions. In order to complement these approaches and counter their shortcomings, there is a need for a bioethics enlightened by critical hermeneutics. Such hermeneutic bioethics is aware of its own assumptions, places the issues in a wide context, and reflects critically on the power relations that stand in the way of understanding them. Moreover, such an approach is dialogical, which provides both a critical exercise of speech and a normative dimension implied in the free exchange of reasons and arguments. This discussion is framed by Hedgecoe’s argument that critical bioethics needs four elements: to be empirically rooted, theory challenging, reflexive, and politely skeptical. (shrink)

Knowing, either by the light of natural reason or by the light of Christian revelation, that homosexuality is a disordered condition is not sufficient for its being ethically permissible to direct self-identified homosexual persons toward just any treatment that aims to modify sexual orientation. For example, such an undertaking would be morally impermissible in cases where the available “treatments” are known to be both futile and potentially damaging to persons undertaking them. I, therefore, introduce this edition of Christian Bioethics by (...) reflecting on (a) the position of homosexuality in our current psychiatric nosology, (b) problems with drawing causal inferences from the outcomes of psychotherapy studies, and (c) the advantages and disadvantages of appealing to traditional categories of sexual orientation in this discussion, all with an eye toward more deeply elucidating core ethical concerns involving the intentional psychotherapeutic modification of sexual orientation. (shrink)

A new context for ethics and ethics education is evident in a rapidly changing world and our threatened planet. The current focus on considerations of inter-personal ethics within an anthropocentric perspective on life should be extended to embrace considerations of global and ecological ethics within an eco-centric perspective on global and planetary health. The pathway to understanding and adapting to this new context includes promoting shifts in life styles from selfish hyper-individualism and wasteful consumerism towards cautious use of limited resources (...) within an increasingly interdependent world in which the equal moral worth of all and sustainability are valued. Critical scholarly approaches to global politics and to the global political economy could facilitate such change and encourage iterative interactive processes instead of seeking conclusive definitive ‘scientific’ solutions to all problems. Hopefully this shift in perspective could be achieved firstly through sensitization to new and increasingly challenging ethical dilemmas, and then by encouraging rational thinking and action based on global and ecological considerations rather than on false economic dogma and the distorted workings of a market civilization. Moving ahead with these activities must begin with promotion of education, learning and self-reflection to foster the widespread development of a global state of mind. Such a shift would require an expanded ethical discourse, with consideration of ethical dilemmas beyond human inter-personal relationships. These should include intra-institutional and inter-institutional relationships, as well as relational ethics between nations in a post-Westphalian world, and between humans and nature in an era now called the Anthropocene, to ensure survival on a planet undergoing entropy.The adverse effects of intense competition could be reduced by encouraging greater cooperation, linking security issues to global health and social justice issues, and using inspirational narratives and examples of moral imagination/moral leadership. These educational programs should be initiated in schools and become mandatory for all first-year College and University students. Such an agenda is feasible given human ingenuity, determination, resilience and adequate resources, but will also require political and social will as its drivers. (shrink)

In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This 'empirical turn' is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of the moral experiences (...) of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions? In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self-justification and bias and can increase the credibility of the RE reached. (shrink)

Definition of the problem: Contemporary bioethics as an academic discipline mainly focuses on moral questions – according to its articulated self-concept and the explicit arguments in most areas of bioethical reflection. Concepts and theories of the good life are hardly considered. Arguments: In reality the ‘good life’ plays a much more important role than it is assumed, but mostly only in an implicit way. The article demonstrates this by referencing three selected fields of bioethical discussion. Hence the article (...) argues that bioethics should turn the ‘good life’ into an issue of intense, explicit and systematic consideration. Furthermore, the article provides an initial answer to the questions as to why the ‘good life’ has been marginalized within bioethics up to this point and which function it can assume in future bioethical reflection. Conclusion: The ‘good life’ is the blind spot of bioethics. A more intensive and systematic consideration of the ‘good life’ is a challenge for contemporary and future bioethics. (shrink)

Leah, created over the last three years, is a self-styled, autonomous avatar collaboratively developed with Dr Mark Sagar at the Laboratory for Animate Technologies, Auckland Bioengineering Institute at the University of Auckland, New Zealand. Using ‘Leah’ as a technoscientific art case study, this paper will address the practical and theoretical considerations underlying the project, showing complex posthuman and bioethical relations. Leah is exhibited as an intra-active screen-based installation. It is the product of a shifting transdisciplinary collaborative process, involving artists, (...) engineers, computer scientists and neuroscientists. Leah was developed as part of the Auckland Face Simulator project where adult faces are realistically and precisely modelled to show accurate expression. These can be used for neurophysiological and neuropsychological research into emotion, agency and empathy. This artwork engages with a deep questioning of the posthuman through bioengineering self-imaging practices and reflects on our co-evolution with technology. (shrink)

History's judgment on the success of bioethics will not depend solely on the conceptual creativity and innovation in the field at the level of ethical and political theory, but this intellectual work is not insignificant. One important new development is what I shall refer to as the relational turn in bioethics. This development represents a renewed emphasis on the ideographic approach, which interprets the meaning of right and wrong in human actions as they are inscribed in social and cultural practices (...) and in structures of lived meaning and interdependence; in an ideographic approach, the task of bioethics is to bring practice into theory, not the other way around. The relational turn in bioethics may profoundly affect the critical questions that the field asks and the ethical guidance it offers society, politics, and policy. The relational turn provides a way of correcting the excessive atomism of many individualistic perspectives that have been, and continue to be, influential in bioethics. Nonetheless, I would argue that most of the work reflecting the relational turn remains distinctively liberal in its respect for the ethical significance of the human individual. It moves away from individualism, but not from the value of individuality.In this review essay, I shall focus on how the relational turn has manifested itself in work on core concepts in bioethics, especially liberty and autonomy. Following a general review, I conclude with a brief consideration of two important recent books in this area: Jennifer Nedelsky's Law's Relations and Rachel Haliburton's Autonomy and the Situated Self. (shrink)

In this article, I focus on possibly impaired self-determination in addiction. After some methodological reflections, I introduce a phenomenological description of the experience of being self-determined. I argue that being self-determined implies effectivity of agency regarding three different behavioural domains. Such self-referential agency shall be called ‘self-effectivity’ in this article. In a second step, I will use this phenomenological description to understand the impairments of self-determination in addiction. While addiction does not necessarily imply a basic lack of control over one’s (...) life, this can well be the case during certain periods of time or in special situations. Addiction is herein described as an embodied custom—highly effective with respect to changing one’s lived experience—which is learned and developed while becoming addicted. Such a repeatedly performed custom, called a ‘psychotropic technique’, implies deep changes in one’s personal identity and alters an agent’s ‘self-effectivity’. In the closing section, I discuss the possible implications of a phenomenological approach to personal responsibility. (shrink)

This collection of papers explores one of the central debates in the field of bioethics in the new century. It evaluates the controversy between the claim that there is a common morality accepted by all and the opposing view that there are different moral visions and moral rationalities, within which complex bioethical issues demand a solution. Contributions within this volume offer different approaches and perspectives on the pursuit of global ethics in the new century. They are organized under five (...) major themes. The first theme explores the different plausible understandings of the foundations of bioethics and contemporary reflections on the nature and role of moral theory. The second theme analyses the impact of moral loss and moral diversity on the character of bioethics and the search for alternative perspectives in post-traditional and post-modern societies. The third theme examines a number of theoretical issues raised by concrete examples of bioethnological applications, which bear importantly on contemporary debates between the possibility and impossibility of global bioethics. The fourth theme discusses examples of moral conflicts and dilemmas in everyday health care practice regarding the permissible treatment of humans by humans under different ethical perspectives and cultural traditions. The fifth theme explores alternative suggestions for opening up new modes of self-understanding and new strategies for bioethical exploration in the new century. The volume is an important work of reference for philosophers, moral theologians, ethicists, counsellors, doctors, nurses, sociologists, journalists, health care professionals, public policy makers and everyone who is interested in the profound ethical issues arising from modern technological advancements which are not only transforming our lives but are also demanding urgent ethical decision-making and `pragmatic' solutions from a cross-cultural perspective. (shrink)

Japanese bioethics has created a variety of important ideas that have not yet been reflected on mainstream bioethics discourses in the English-speaking world, which include “the swaying of the confused self” in the field of feminism, “inner eugenic thought” concerning disability, and “human relationship-oriented approaches to brain death.” In this paper, I will examine them more closely, and consider what bioethics in Japan can contribute to the development of an international discussion on philosophy of life.

In lieu of an abstract, here is a brief excerpt of the content:Landmark Legal Cases in BioethicsSusan Cartier Poland (bio)Only a few decades old, the interdisciplinary field of bioethics has developed surrounded by centuries of legal tradition and moral philosophy. Bioethics and the law have weaved back and forth over time influencing each field. Sometimes ethics leads the debate on problematical issues; for example, the Recombinant DNA Advisory Committee at the National Institutes of Health established regulations prior to initiating human (...) gene therapy. At other times, law takes over; Roe v. Wade, for example, has polarized and closed public discussion on abortion. Most frequently, however, scientific developments initiate discussion in both fields, as when the announcement of the birth of Dolly—the first cloned mammal—sparked President Clinton to ask the National Bioethics Advisory Commission for a report on cloning.A back-and-forth pattern also exists within the law itself, this time between legislator and judge. Legislators enact statutes, which apply universally to regulate conduct in society. Judges, on the other hand, interpret statutes and apply them to particular cases to resolve disputes between parties. Case law, as judge-made law is called, that grows in the absence of legislation becomes the common law. Legislatures can change the course of common law development by enacting more law, usually as amendments, but sometimes as repeals. A judge who sees the facts of a case or the law differently may also change the common law. And so the counterpoint between legislator and judge goes.A legal case becomes a landmark in bioethics because of its historical or precedential value to the field. Historical cases reflect judicial reasoning or rationalization that lays the conceptual foundation for a bioethical principle. Perhaps the best known example of this is the focus on the right to self-determination in Schloendorff that led to the development of informed consent. The principle of autonomy in bioethics derives its legal impetus from this line of cases.A case that acquires landmark status because of its precedential value does so for one of two reasons based on legal precedents. First, the case may be one of “first impression.” In the legal sense, that means that the particular case with its [End Page 191] facts or issues is the first one that a particular court has confronted within that court’s jurisdiction or area of decision-making authority. To be a landmark in bioethics, however, the ordinary sense of “first impression” applies. The first time that a particular bioethical topic has appeared in court for legal resolution makes a case one of “first impression” for bioethics. The case of Baby M on surrogacy contracts illustrates this.The second way in which a case can achieve landmark status based on precedents involves legal precedent and the jurisdictional basis of the court system. Under the common law system, a preceding case that involves the same or similar facts or issues as a current case must be followed by lower—i.e., less authoritative—courts in the same jurisdiction. That judicial rule of decision making is called stare decisis. It creates an institution of continuity, yet allows for change due to differences in judicial interpretation of facts and issues, which is called distinguishing the case.All courts under United States jurisdiction must follow the U.S. Supreme Court. By its sheer power of authority, the Court issues opinions that, if they concern bioethical topics, make cases landmarks in bioethics. For example, Roe v. Wade made abortion legal and set off the debate between maternal and fetal rights. Casey later refined, or to some redefined with a discussion of stare decisis, the bioethical underpinnings of Roe by framing the debate as one between maternal rights and state interests.In law, precedents concern only appellate cases. Trial courts, like that in McFall v. Shimp, handle questions of both fact and law. Appellate courts, like that in Brotherton, hear appeals from the lower trial courts and address legal issues only. Trial judges apply the law to facts, and appellate judges reason about the trial judge’s legal interpretation.Appellate court decisions are the ones most frequently published, either in print or electronically online, for citation. Consequently they are the easiest to locate and retrieve. “Reporters” as... (shrink)

I emphasize the difference between bioethics and sciences that are relevant to bioethics on the one hand and the lifeworld on the other hand, to which problems of bioethics apply. The difference between types of experience in the scientific realm and in the lifeworld is reflected by the different definitions of nature they tend to favor. Against this background, I will claim that the object domains of the natural and the artificial are indeed better separated in the context of everyday (...) perception than is commonly assumed in academic discourse. This capacity for differentiation in everyday contexts makes it possible to give weight to the positive connotations of naturalness used against technological interference in nature in the lifeworld discourse. I will start with some preliminary terminological and historical remarks. Then I will turn to possible scientific ways of separating the domains of the natural and the artificial. In everyday practice they usually can be neither reproduced nor understood. This situation has contributed to the need for an explanation of the moral appeal to naturalness that one encounters in the lifeworld. After a discussion of explanations that are given in the bioethical discourse, I will propose a lifeworld concept that allows for the use of a fundamental boundary between the natural and the artificial. (shrink)

Contemporary bioethics is usually notable for its focus on the uses and abuses of biomedical technology, on personal liberty and the on the formulation of ethical problems as dilemmas to be solved by utilitarian calculus within the frameworks of committees and institutional guidelines. It is argued that these developments actually reflect a technologization of medical ethics itself, which more often relies non-personal algorithms of utility.This is explained, from a historical point of view, by the impact of technology on the concepts (...) of nature and naturalism and by the triumphs of modern science, which obscures non-scientific modes of discourse. The article acknowledges some benefits of the technologization of ethics such as the democratization of decision-making but the discussion concentrates on five arguments against the dominance of utilitarianism in medical ethics. The common denominator of these arguments is that utilitarianism fails its own standards by undermining trust in the public domain. The loss of trust is brought about by the displacement of the phenomenological self and from fostering adversarialism in ethical discourse. (shrink)

In two of his great poems, “Ambulances” and “The Building,” Philip Larkin considers a deep fear about human individuality. The fear is that the human self is contingent and disjunctive, lacking any integrity or unity. The arrival of an ambulance on an urban curb and a visit to the hospital are the occasion of reflection on this form of human fragility. But more significant, the ambulance and the hospital are imagined as contexts in which the contingency of the human individual (...) is brought out and laid before us. (shrink)

In our pursuit of a good life (eubios), both individuals and societies, need to educate themselves on the pursuit of love of life in all domains, self-love, love of others, loving good and love of life. In this paper I reflect on my own journey through growing up in Christchurch, and experiences around the world, that are the basis for that conclusion. In our efforts to pursuit bioethics education we can enhance peaceful and harmonius coexistence in our world, through nurturing (...) good decisions that we should all make. (shrink)

Genomic and neuro-scientific research into the causes and course of antisocial behaviour triggers bioethical debate. Often, these new developments are met with reservation, and possible drawbacks and negative side-effects are pointed out. This article reflects on these scientific developments and the bioethical debate by means of an exploration of the perspectives of one important stakeholder group: juveniles convicted of a serious crime who stay in a juvenile justice institution. The views of juveniles are particularly interesting, as possible applications (...) of current and future scientific findings are considered to be most effective if applied early in life. Based on their statements we come to the following provisional conclusions. Concerns about labelling and stigmatization are recognized and widely shared. Possible effects on one's identity are acknowledged too. Yet, a possible biological underpinning of one's antisocial behaviour is not considered to result in the development of a criminal identity. Nonetheless, psychopharmacological interventions are experienced as endangering one's current self. Concerns regarding the refusal of responsibility and the blaming of one's genes or brain can be put into perspective. Instead, participants emphasize the motive of own choice as underlying their criminal behaviour. Moreover, bioethical debate should pay attention to the role of parents of children at risk and the parent-child relationship in families at-risk. We argue that the short-term and long-term interests of children at risk, as well as their interests and those of society at large, may conflict. In order to deal appropriately with newly arising dilemmas, a normative framework needs to be developed. (shrink)

The novelty of the article is related to the use of the resources of the philosophy of transdisciplinarity to justify the relevance and heuristic importance of the concept of "Mathetiks", introduced by the Czech pedagogue-humanist Jan Amos Comenius (Komensky) to refer to practices of self-education. The aim of the article is to use resources of the philosophy of transdisciplinarity to justify the relevance and heuristic importance of the concept of "Mathetiks", introduced by the Czech pedagogue-humanist J. A. Kоmensky three centuries (...) ago to distinguish and establish coordination in the unified educational process of pedagogical practices of teaching and self-learning of students. The modern interpretation of the ideas of mathetiks (on the example of the problems of bioethical education) is carried out with the implementation of the concepts of the philosophy of science Th. Kuhn and R. Merton in the context of post-nonclassical studies. The notion of "paradigmatic syndrome", which arises as a result of philosophical reflection on the peculiarities of the formation of the post-classical matrix of the development of modern scientific knowledge, is introduced. One of its defining factors is the conceptualization and institutionalization of processes to ensure continuity of knowledge (education) and constant innovative changes taking place in society. The most adequate form of philosophical and methodological reflection in this situation, according to the author, is the philosophy of transdisciplinarity as an integrating mechanism not only of the disciplinary knowledge, but also of education and innovation, the necessary components of the social system aimed at self-renewal. The philosophy of transdisciplinarity and the philosophy of education have in many ways similar paradigm structures, oriented target cause of the actor on self – education -mathetiks. The target specifies the reason for the project-based nature of the paradigmatic constructs in education and bioethics. First of all, this is the clarification of the problem field, training and teaching to act in it according to the existing rules and the creative nature of project activities. Orientation to the value priorities of the community expressed both in symbolic generalizations and implicit forms (M. Polanyi) of personal knowledge and practice. (shrink)

With the increasing number of human disasters in recent years, disaster service workers are faced with an ever-growing challenge of criticism concerning their professional competence. The workers also realize the limitation inherent in their practice, as well as bioethics problems regarding autonomy and heteronomy. Therefore, professionals and researchers of human service devote to the issue of post-disaster rehabilitation of the people so as to identify an effective way and practice to aid the post-disaster individual, family and community. This study explores (...) the effectiveness of rehabilitative function of disaster service workers through the action research of Typhoon Morakot and the 2014 Gas Explosion in Kaohsiung City, Taiwan. The case studies serves as a platform for thediscussion of principles of bioethics and the analysis of the process of self-discipline of the workers of human services in hope of ultimately establishing bioethical principles for heteronomy during disasters and work indicators for post-disaster community restoration. Discuss Issues are 1. How can self-discipline in bioethics be achieved for the human service workers during times of disaster? 2. In post-disaster reconstruction, how does the human service worker take into? account bioethical principles to serve and partake in the restoration of the postdisaster life of community residents? 3. During the process of a disaster research, what are the bioethical considerations to be taken into for the test subjects? Conclusion and suggestions: To formulate indicators for a post-disaster “community of health and wellness;” to establish bioethical principles of heteronomy for disaster service workers. (shrink)

Disease in wildlife raises a number of issues that have not been widely considered in the bioethical literature. However, wildlife disease has major implications for human welfare. The majority of emerging human infectious diseases are zoonotic: that is, they occur in humans by cross-species transmission from animal hosts. Managing these diseases often involves balancing concerns with human health against animal welfare and conservation concerns. Many infectious diseases of domestic animals are shared with wild animals, although it is often unclear (...) whether the infection spills over from wild animals to domestic animals or vice versa. Culling is the standard means of managing such diseases, bringing economic considerations, animal welfare and conservation into conflict. Infectious diseases are also major threatening processes in conservation biology and their appropriate management by culling, vaccination or treatment raises substantial animal ethics issues. One particular issue of great significance in Australia is an ongoing research program to develop genetically modified pathogens to control vertebrate pests including rabbits, foxes and house mice. Release of any self-replicating GMO vertebrate pathogen gives rise to a whole series of ethical questions. We briefly review current Australian legal responses to these problems. Finally, we present two unresolved problems of general importance that are exemplified by wildlife disease. First, to what extent can or should 'bioethics' be broadened beyond direct concerns with human welfare to animal welfare and environmental welfare? Second, how should the irreducible uncertainty of ecological systems be accounted for in ethical decision making? (shrink)

WHAT COULD BE WRONG WITH SEEKING TO RESHAPE OURSELVES IN WAYS that we genuinely value? Jewish textual and cultural perspectives may add clarity and substance to the wider secular discussion of using genetic technologies for human enhancement. Judaism does not share the naturalism of Anglo-American bioethics; instead, it emphasizes covenantal responsibility for co-creation and stewardship of the body. Judaism tends to be more permissive about social uses of technology but more restrictive about personal aspirations and behavior. Enhancement technologies threaten the (...) moral universals of humility, personal responsibility, and social solidarity, which are embodied in Jewish tradition as duties to God, self, and others. The tradition demands that we seek self-perfection while humbly and cautiously acknowledging that we can never arrive at it nor even know exactly what we seek. (shrink)

Is it possible to trace the contours of a bioethical reflection on nutrition? The present study tries to do so, relying on the metaphorical and symbolic value that food often takes. Indeed, eating does not mean just getting sufficient nutrition, because through the offer and exchange of food, people recognize and welcome each other. In this sense we are all, in some way, cannibals, because in eating, we eat the other, even if the introjection of the other is only (...) symbolic and not literal, as in the case of actual cannibals. Eating habits are also very rooted in various cultures and sometimes resist migratory flows to a greater extent than language and religion do. Consequently, the disgust for, or the refusal of, other people’s food may be an indicator of a more general rejection of the diversity of other people. The conclusion reached by this study is that eating is taking care of the self and of the other and, therefore, as Jacques Derrida observes, it is necessary to “eat well” and also “eat the good.”. (shrink)

In an age of global capitalism, pandemics, far-flung biobanks, multinational drug trials and telemedicine it is impossible for bioethicists to ignore the global dimensions of their field. However, if they are to do good work on the issues that globalisation requires of them, they need theoretical resources that are up to the task. This paper identifies four distinct understandings of ‘globalised’ in the bioethics literature: a focus on global issues; an attempt to develop a universal ethical theory that can transcend (...) cultural differences; an awareness of how bioethics itself has expanded, with new centres and journals emerging in nearly every corner of the globe; a concern to avoid cultural imperialism in encounters with other societies. Each of these approaches to globalisation has some merit, as will be shown. The difficulty with them is that the standard theoretical tools on which they rely are not designed for cross-cultural ethical reflection. As a result, they leave important considerations hidden. A set of theoretical resources is proposed to deal with the moral puzzles of globalisation. Abandoning idealised moral theory, a normative framework is developed that is sensitive enough to account for differences without losing the broader context in which ethical issues arise. An empirically nourished, self-reflexive, socially inquisitive, politically critical and inclusive ethics allows bioethicists the flexibility they need to pick up on the morally relevant particulars of this situation here without losing sight of the broader cultural contexts in which it all takes place. (shrink)

Many in academic bioethics worry that robust theological traditions, when articulated in the public square, damage the prospect of serious reflection about tough cases. Here we challenge that prevailing exclusion-by-default methodological impulse by correcting prevalent stereotypes about one particular Christian tradition that may offer relevant conceptual resources for bioethics. We briefly examine the man, John Calvin, and the Calvinist/Reformed Protestant tradition to show how it has been misconstrued in academic bioethics but can be reconstrued as a constructive, substantive theological starting (...) point for tough bioethical questions of our age. Core Calvinist doctrines about the nature of an all-sovereign God and human beings’ relation to that God, as well as related prominent themes from elements of the broader Reformed tradition, including the glory/sovereignty/majesty of God; the created goodness of the world; human beings as desiring/worshiping/image-bearing creatures; the pervasive influence of sin; the limitations of humanity for self-improvement; the completely gratuitous nature of redemption; the comprehensiveness of God’s redemptive purposes; and the pending final completion of his redemptive work could and should influence the tone and content of moral deliberation that can be a positive influence on twenty-first-century bioethics. (shrink)

New parents suddenly come face to face with myriad issues that demand careful attention but appear in a context unlikely to provide opportunities for extended or clear-headed critical reflection, whether at home with a new baby or in the neonatal intensive care unit. As such, their capacity for autonomy may be compromised. Attending to new parental autonomy as an extension of reproductive autonomy, and as a complicated phenomenon in its own right rather than simply as a matter to be balanced (...) against other autonomy rights, can help us to see how new parents might be aided in their quest for competency and good decision making. In this paper I show how a relational view of autonomy – attentive to the coercive effects of oppressive social norms and to the importance of developing autonomy competency, especially as related to self-trust – can improve our understanding of the situation of new parents and signal ways to cultivate and to better respect their autonomy. (shrink)

Growing powers to manipulate human bodies and minds, not merely to heal disease but to satisfy desires, control deviant behavior, and to change human nature, make urgent questions of whether and how to regulate their use, not merely to assure safety and efficacy but also to safeguard our humanity. Oversight in democratic societies rightly belongs to the polity, not merely to self-appointed experts, scientific or ethical. Yet the task of governing the uses of dangerous knowledge is daunting, and there is (...) little evidence that we have the will or the wisdom to do it well. (shrink)

Self-reflection plays a key role in healthy human adaptation. Self-reflection might involve different capacities which may be impaired to different degrees relatively independently of one another. Variation in abilities for different forms of self-reflection are commonly seen as key aspects of many adult mental disorders. Yet little has been written about whether there are different kinds of deficits in self-reflection found in mental illness, how those deficits should be distinguished from one another and how to characterize the extent to which (...) they are interrelated. We review clinical and experimental literature and suggest four different forms of deficits in self-reflection: sense of ownership of one’s own thoughts and actions, emotional awareness, distinction between fantasy and reality and the integration of a range of different views of oneself and others. We propose how these different impairments in self-reflection are linked with one another. (shrink)

Reducing non-core food advertising to children is an important priority in strategies to address childhood obesity. Public health researchers argue for government intervention on the basis that food industry self-regulation is ineffective; however, the industry contends that the existing voluntary scheme adequately addresses community concerns. This paper examines the operation of two self-regulatory initiatives governing food advertising to children in Australia, in order to determine whether these regulatory processes foster transparent and accountable self-regulation. The paper concludes that while both codes (...) appear to establish transparency and accountability mechanisms, they do not provide for meaningful stakeholder participation in the self-regulatory scheme. Accordingly, food industry self-regulation is unlikely to reflect public health concerns or to be perceived as a legitimate form of governance by external stakeholders. If industry regulation is to remain a feasible alternative to statutory regulation, there is a strong argument for strengthening government oversight and implementing a co-regulatory scheme. (shrink)

Patricia Churchland's Touching a Nerve: The Self as Brain is her most recent wide-ranging argument for mind-to-brain reductionism. It's one of the leading anti-dualist works in neurophilosophy. It thus deserves careful attention by anti-reductionists. We survey the main arguments in this book for her thesis that the self is nothing but the brain. These arguments are based largely on the self's dependence upon neural activities as reflected in its various impairments, its unified experiences, and its powers of agency. We show (...) that dualism is quite compatible with this neural dependence. We argue that dualism can not only counter--but also turn the tables on--her arguments. Unlike most other critics, we focus not only on her hard problems but also on her easy problems in explaining consciousness. A new non-Cartesian substance dualism is presented that avoids existing dualist causal issues. It may thus avoid perennial physicalist and dualist problems. -/- . (shrink)