This chapter contains sections titled: Case Studies and Mid‐level Principles Justifying the Choice of an Ethical Theory References Further reading.

It is commonplace that care should be patient-centered. Nevertheless, no universally agreed-upon definition of patient-centered care exists. By consequence, the relation between patient-centered care as such and ethical principles cannot be investigated. However, some research has been performed on the relation between specific models of patient-centered care and ethical principles such as respect for autonomy and beneficence. In this article, I offer a detailed case study on the relationship between specific measures of patient-centered (...) care and the ethical principle of respect for autonomy. Decision Quality Instruments (DQIs) are patient-centered care measures that were developed by Karen Sepucha and colleagues. The model of patient-centered care that guided the development of these DQIs pays special attention to the ethical principle of respect for autonomy. Using Jonathan Pugh’s theory of rational autonomy, I will investigate how the DQIs relate to patient autonomy. After outlining Pugh’s theory of rational autonomy and framing the DQIs accordingly (Part I), I will investigate whether the methodological choices made while developing these DQIs align with respect for autonomy (Part II). My analysis will indicate several tensions between DQIs and patient autonomy that could result in what I call “structural paternalism.” These tensions offer us sufficient reasons, especially given the importance of the ethical principle of respect for autonomy, to initiate a more encompassing debate on the normative validity of Decision Quality Instruments. The aim of the present paper is to highlight the need for, and to offer a roadmap to, this debate. (shrink)

Some of Michel Foucault’s work focusses on an archeological and genealogical analysis of certain aspects of the medical episteme, such as ‘Madness and Civilization’ (1964/2001), ‘The Birth of the Clinic’ (1973) and ‘The History of Sexuality’ (1978/2020a). These and other Foucauldian works have often been invoked to characterize, but also to normatively interpret mechanisms of the currently existing medical episteme. Writers conclude that processes of patient objectification, power, medicalization, observation and discipline are widespread in various areas where the medical specialty (...) operates and that these aspects have certain normative implications for how our society operates or should operate. The Foucauldian concepts used to describe the medical episteme and the normative statements surrounding these concepts will be critically analyzed in this paper.By using Foucault’s work and several of his interpreters, I will focus on the balance between processes of subjectification and objectification and the normative implications of these processes by relating Foucault’s work and the work of his interpreters to the current medical discipline. Additionally, by focusing on the discussion of death and biopower, the role of physicians in the negation and stigmatization of death is being discussed, mainly through the concept of biopower. Lastly, based on the discussion of panopticism in the medical discipline, this paper treats negative and positive forms power, and a focus will be laid upon forms of resistance against power. The discussed aspects will hopefully shed a different and critical light on the relationship between Foucault’s work and medicine, something that eventually can also be deduced from Foucault’s later work itself. (shrink)

For decades there has been a controversial debate over how far religious faith communities are specifically engaged in ecological practices (EP). Therefore we studied four Austrian and two German Benedictine monasteries religious ethics and spirituality as a means of a driving force for initiating EP. We draw upon theories of organizational learning processes and capacity-building of sustainability to interpret our empirical findings. The majority of monasteries are highly engaged in EP, initiated either as an outcome of individual activities or through (...) a specific mostly informally acting group, but rarely an organizationally or systematically integrated goal of the monasteries, or a focus of capacity building. Monasteries follow a technical and economic decision-making process in implementing EP. Spirituality plays a limited role in the initiation of EP. The environment of monasteries–acceptance or critique against ecological practices–influences the monasteries decisions. Institutionalization of ecological practices into the monasteries organizational structure is rare. (shrink)

Natura 2000 is a network of natural sites whose aim is to preserve species and habitats of relevance in the European Union. The policy underlying Natura 2000 has faced widespread opposition from land users and received extensive support from environmentalists. This paper addresses the ethical framework for Natura 2000 and the probable moral assumptions of its main stakeholders. Arguments for and against Natura 2000 were analyzed and classified according to “strong” or “weak” versions of the three main theories of (...) environmental ethics – anthropocentrism, biocentrism, and ecocentrism. Weak (intergenerational) anthropocentrism was found to underlie the Natura 2000 network itself and the positions of environmentalists, while strong (traditional) anthropocentrism pervaded the positions of economic developers. Land users seemed to fall somewhere between weak and strong anthropocentrism. The paper discusses the relation between ethics and different attitudes towards Natura 2000, highlighting some of the implications for the network’s ongoing implementation. It is shown that Natura 2000 achieves a strong reversal of the burden of proof from conservation to economic development and land use change under anthropocentrism. It is argued that the alleged theoretical divide between anthropocentrism and non-anthropocentrism in relation to the burden of proof does not seem to hold in practice. Finally, it is predicted that the weak versions of anthropocentrism, biocentrism, and ecocentrism, are likely to converge extensively in respect to nature conservation policy measures. (shrink)

Bioethics urges us to question and debate fundamental moral issues that arise in health-related sciences. However, as a result of Western dominance and globalization, bioethical thinking and practice has inevitably been shaped and defined by Western theories. With recent discussions centering on the relationship between culture and bioethics, it is important to consider how and to what extent can bioethics reflect and accommodate non-Western values and beliefs? Debatably, many scholars working in the field of ‘African (...) class='Hi'>bioethics’ seek to construct a bioethical practice that is grounded in indigenous African values. Yet, how relevant are ancient African cultural norms to the lives and realities of the 21st century Sub-Saharan-Africans? This edited volume explores bioethics in Africa from pluralistic and inter-cultural perspectives. The selected papers offer diverse theoretical and practical perspectives on the bioethical challenges that are common and specific to the lives of Sub-Sahara Africans. The contributors define bioethics broadly (beyond ethical issues relating to biomedical and biotechnological science) to include applied ethics that concern all aspects of life. Multidisciplinary in approach, the contributions to this book consider bioethics in relation to philosophy, social work, psychiatry, African studies, religious studies, psychology, and medicine. The broad scope of this volume means it will be of interest to those studying and working in bioethics as well as the fields mentioned above. (shrink)

Instrumental values are often considered to be inferior to intrinsic values. One reason for this is that instrumental values are extrinsic and rely on two factors: (a) a means–end relationship that is (b) conducive to something of final or intrinsic value. In this paper, I will investigate the conditions under which bearers of instrumental value are given different value or owed different levels of respect. Such conditions include the number of means that are conducive to something of final or intrinsic (...) value as well as the form of causality that is implied. It will be suggested that different numbers and causal relations will imply different degrees of reverence or respect to the bearers of instrumental value. I will also critically investigate recent proposals such as relational values that allegedly go beyond the distinction between instrumental and intrinsic value. Drawing from this critical analysis, a nuanced picture of instrumental value will be provided. (shrink)

The difficulty of explaining the outputs of artificial intelligence (AI) models and what has led to them is a notorious ethical problem wherever these technologies are applied, including in the medical domain, and one that has no obvious solution. This paper examines the proposal, made by Luciano Floridi and colleagues, to include a new ‘principle of explicability’ alongside the traditional four principles of bioethics that make up the theory of ‘principlism’. It specifically responds to a recent set (...) of criticisms that challenge the supposed need for such a principle to perform an enabling role in relation to the traditional four principles and therefore suggest that these four are sufficient without the addition of explicability. The paper challenges the critics’ premise that explicability cannot be an ethical principle like the classic four because it is explicitly subordinate to them. It argues instead that principlism in its original formulation locates the justification for ethical principles in a midlevel position such that they mediate between the most general moral norms and the contextual requirements of medicine. This conception of an ethical principle then provides a mold for an approach to explicability on which it functions as an enabling principle that unifies technical/epistemic demands on AI and the requirements of high-level ethical theories. The paper finishes by anticipating an objection that decision-making by clinicians and AI fall equally, but implausibly, under the principle of explicability’s scope, which it rejects on the grounds that human decisions, unlike AI’s, can be explained by their social environments. (shrink)

This article offers a discussion of the relevance of empirical studies to normative ethics focusing on the new trend in bioethics called empirical bioethics. The author sees this trend as an answer to a call made by anthropologists decades ago that ethicists should be more aware of the situatedness of the moral institution of life. Through a discussion of two opposing views expressed in the final publications of the EU-funded EMPIRE-project, the middle way is sought between the (...) misconception of bioethics as pure philosophy on one side and the misconception of bioethics as sociology on the other. The author argues that empirical studies may be of relevance to the normative enterprise in at least three ways as illustrated in the EMPIRE-material. First, there is the relevance of empirical facts as descriptive premises in ethical arguments. Second, there is the relevance of empirical studies as means of mapping moral opinion and moral experience which ought to serve as one of two poles between which one oscillates in moral decision making – the other being the normative ethical theories. Third, there is the relevance of empirical studies of the capacity and function of the human mind, which may tell us something about the range of normative principles and rules.Keywords: Ethics, normative ethics, descriptive ethics, empirical bioethics. (shrink)

There has been much attention devoted in recent years to the question of whether our moral principles can be related to our biological nature. This collection of new essays focuses on the connection between biology, in particular evolutionary biology, and foundational questions in ethics. The book asks such questions as whether humans are innately selfish, and whether there are particular facets of human nature that bear directly on social practices. The volume is organised historically beginning with Aristotle (...) and covering such major figures as Hume and Darwin down to the present and the work of Harvard sociobiologist, E. O. Wilson. This is the first book to offer this historical perspective on the relation of biology and ethics, and has been written by some of the leading figures in the history and philosophy of science, whose work stands very much at the cutting edge of these disciplines. (shrink)

Studies of food waste claim that its main causes are technological and logistical deficiencies in the first stages of the agri-food chain. The present article discusses this statement using a specific case as a starting point: the production of fruit in Lleida (Catalonia, Spain). Since the 1980s, fruit production in this region has undergone a process of innovation and development. However, the agents who participate in the sector claim that the wasted volume of edible foodstuffs is greater than in previous (...) times. This article argues that studies of food waste do not consider the power relations existing within the agri-food chain. When these relations are asymmetrical, technological innovation and logistics optimisation do not improve the efficiency of the system; rather, they help the hegemonic players to monopolise the commercial margin and transfer some of their running costs to the weaker agents. The ethnographic data for the study were obtained between 2017 and 2019 using qualitative research techniques. (shrink)

ABSTRACT:The relationship between philosophy and bioethics remains a matter of perennial debate, but there does appear to be a consensus on one issue: whatever bioethics might want to borrow from philosophical ethics, it won't be normative theories. This essay argues that theories can have an important role to play in bioethics, though it might not be the one traditionally assumed by philosophers.

In lieu of an abstract, here is a brief excerpt of the content:Editors' Introduction to the Special Issue on the Translational Work of BioethicsElizabeth Lanphier and Larry R. ChurchillRecent essays in Perspectives and Biology and Medicine, including "Can Clinical Ethics Survive Climate Change" by Andrew Jameton and Jessica Pierce and "Ethical Maxims for a Marginally Inhabitable Planet" by David Schenck and Larry R. Churchill, both appearing in the Autumn 2021 issue, inspired conversations between us, among our (...) colleagues, and with various contributors to this symposium. We asked of ourselves and each other: where can, should, or must bioethics as a field go to make what bioethicists know and publish about in the academic literature relevant to public policy decisions, health and technological innovation, and a general public? In other words, where do we, practically speaking, go with our bioethical insights and discoveries to make a tangible impact on issues like climate change—though that is only one of the various topics that the authors in this symposium tackle.This translational work of connecting scholarly innovation back to overt practical innovation is often peripheral to academic bioethics. It is not the work the academy typically recognizes in its credit system. Yet this translational work is becoming a critical, central duty of bioethics for the 21st century, while the kinds of work the academy most valorizes may be the least important at this time. In particular, the need for translational initiatives is increasingly evident as pandemics linger into a new normal, the long history and ongoing impacts of racism become even more evident at institutional levels, and the devastating health implications of global warming emerge. [End Page 515]Bioethicists function in privileged proximity to the deleterious effects of failed health and social policy, as well the interplay between seemingly personal health choices, such as those related to diet or lifestyle, and inequitable conditions that impact the options available to individuals and groups. We are increasingly distressed by what we see from this privileged window into health. The COVID-19 pandemic has made preexisting social and policy inequities impacting health impossible to ignore. At the same time, the patterns of carbon pollution portend health crises of unprecedent severity and magnitude in the near future—and will likely deepen inequities and disparities already occurring between those most contributing to, and those most harmed by, climate change.As a field, bioethics has, since its start, been at the intersection of theory and practice. But it is not sufficient for the field to reside passively at this crossroads. The field must be constantly innovating new byways and highways, new offshoots from existing pathways and connector roads between them, that build out both the theory and practice of bioethics in a mutually innovative relationship to each other. Bioethics does not make sense without attention to the real-world practices and the lived realities of health and care. The practical engagement is what deepens and enriches theory, in ways that are more responsive to the real world in which bioethicists toil. But it also is not enough to merely contribute to the body of bioethics scholarship. The translational bioethics we envision is also about using novel theories and concepts to actively shape practices and realities; it is a bioethics in which theory and practices mutually influence each other, each reaching out to generate and change the other.This collection of essays, drawn from a diverse number of scholars, offers several promising paths forward. The essays were written in the spring of 2022, two years into the COVID-19 pandemic, two years after the murder of George Floyd and international attention to the movement for Black lives, and for the most part in the weeks just prior to a set of US Supreme Court decisions with enormous impacts on health, including the June 24 Dobbs v. Jackson Women's Health Organization and the June 30 West Virginia v. EPA decisions.The authors are diverse in age, spheres of work, discipline, sex, race, and ethnicity. They expand our vision for what bioethics can and should be. While we have grouped the essays by subject matter, most of the pieces speak to the field as a whole and invite cross-fertilization. We hope readers will find new ideas, old ideas... (shrink)

Relation between physicians and pharmaceutical industry is required for the benefit of the patient. But it may turn into business and overthrow the patients’ benefit. The relation might be in question at present and in future. Several questions are flowing in Bangladesh. To solve these queries we have explored the situation in developed and developing countries. The physicians and associations of pharmaceutical industries developed several ethical guidelines in those countries. They have addressed the long lasting issues (...) on gift provided to physician, cash back, sample, industry sponsored scientific meetings, research and hospitality. There are huge restrictions to ensure the right of the patient’s e.g. limitation of inexpensive gift by the pharmaceuticals, avoiding expensive medicine instead of equally effective low priced medicine. We are lacking behind to protect the patient right properly: regulation, adherence to existing guide line, lack of guidance from statutory bodies. The current scenario is far behind the right of patient. In Bangladesh it is not yet addressed either by professionals or by pharmaceutical associations. It is the immediate need to construct a guide line for physicians and pharmaceutical industry of Bangladesh.Bangladesh Journal of Bioethics 2015 Vol.6 (1):1-5. (shrink)

The ethics review of qualitative health research poses various challenges that are due to a mismatch between the current practice of ethics review and the nature of qualitative methodology. The process of obtaining ethics approval for a study by a research ethics committee before the start of a research study has been described as “procedural ethics” and the identification and handling of ethical issues by researchers during the research process as “ethics in practice.” While some authors dispute and (...) other authors defend the use of procedural ethics in relation to qualitative health research, there is general agreement that it needs to be supplemented with ethics in practice. This article aims to provide an illustration of research ethics in practice by reflecting on the ways in which we identified and addressed ethical and methodological issues that arose in the context of an interview study with mental health service users and relatives. We describe the challenges we faced and the solutions we found in relation to the potential vulnerability of research participants, the voluntariness of consent, the increase of participant access and the heterogeneity of the sample, the protection of privacy and internal confidentiality, and the consideration of personal and contextual factors. (shrink)

BackgroundUmbilical cord banks are a central component, as umbilical cord tissue providers, in both medical treatment and scientific research with stem cells. But, whereas the creation of umbilical cord banks is seen as successful practice, it is perceived as a risky style of play by others. This article examines and discusses the ethical, medical and legal considerations that arise from the operation of umbilical cord banks in Mexico.DiscussionA number of experts have stated that the use of umbilical cord goes (...) beyond the mere utilization of human tissues for the purpose of treatment. This tissue is also used in research studies: genetic studies, studies to evaluate the effectiveness of new antibiotics, studies to identify new proteins, etc. Meanwhile, others claim that the law and other norms for the functioning of cord banks are not consistent and are poorly defined. Some of these critics point out that the confidentiality of donor information is handled differently in different places. The fact that private cord banks offer their services as "biological insurance" in order to obtain informed consent by promising the parents that the tissue that will be stored insures the health of their child in the future raises the issue of whether the consent is freely given or given under coercion. Another consideration that must be made in relation to privately owned cord banks has to do with the ownership of the stored umbilical cord.SummaryConflicts between moral principles and economic interests (non-moral principles) cause dilemmas in the clinical practice of umbilical cord blood storage and use especially in privately owned banks. This article presents a reflection and some of the guidelines that must be followed by umbilical cord banks in order to deal with these conflicts. This reflection is based on the fundamental notions of ethics and public health and seeks to be a contribution towards the improvement of umbilical cord banks' performance. (shrink)

As the price of pharmaceuticals and biologicals rises so does the number of patients who cannot afford them. In this article, we argue that physicians have a moral duty to help patients access affordable medicines. We offer three grounds to support our argument: (i) the aim of prescribing is to improve health and well-being which can only be realized with secure access to treatment; (ii) there is no morally significant difference between medicines being unavailable and medicines being unaffordable, so (...) the steps physicians are willing to take in the first case should extend to the second; and (iii) as the primary stakeholder with a duty to put the individual patient’s interests first, the medical professional has a duty to address cost-barriers to patient care. In articulating this duty, we take account of important epistemic and control conditions that must be met for the attribution of this duty to be justified. (shrink)

The concept of paternalism is intricately tied to the concept of autonomy. It is commonly assumed that when paternalistic interventions are wrong, they are wrong because they impede individuals’ autonomy. Our aim in this paper is to show that the recent shift towards conceiving of autonomy relationally highlights a separate conceptual space for a nonpaternalistic kind of interpersonal intervention termed maternalism. We argue that maternalism makes a twofold contribution to the debate over the ethics of interpersonal action and decision-making. Descriptively, (...) it captures common experiences that, while not unusual in everyday life, are largely absent from the present discussion. Normatively, it describes a type of intervention with justification conditions distinct from the standard framework of paternalism. We explicate these contributions by describing six key differences between maternalism and paternalism, and conclude by anticipating and responding to potential objections. (shrink)

We invite systematic consideration of the metaphors of cycles and circulation as a long-term theme in the history of the life and environmental sciences and medicine. Ubiquitous in ancient religious and philosophical traditions, especially in representing the seasons and the motions of celestial bodies, circles once symbolized perfection. Over the centuries cyclic images in western medicine, natural philosophy, natural history and eventually biology gained independence from cosmology and theology and came to depend less on strictly circular forms. (...) As potent ‘canonical icons’, cycles also interacted with representations of linear and irreversible change, including arrows, arcs, scales, series and trees, as in theories of the Earth and of evolution. In modern times life cycles and reproductive cycles have often been held to characterize life, in some cases especially female life, while human efforts selectively to foster and disrupt these cycles have harnessed their productivity in medicine and agriculture. But strong cyclic metaphors have continued to link physiology and climatology, medicine and economics, and biology and manufacturing, notably through the relations between land, food and population. From the grand nineteenth-century transformations of matter to systems ecology, the circulation of molecules through organic and inorganic compartments has posed the problem of maintaining identity in the face of flux and highlights the seductive ability of cyclic schemes to imply closure where no original state was in fact restored. More concerted attention to cycles and circulation will enrich analyses of the power of metaphors to naturalize understandings of life and their shaping by practical interests and political imaginations. (shrink)

Philosophy textbooks typically treat bioethics as a form of "applied ethics"-i.e., an attempt to apply a moral theory, like utilitarianism, to controversial ethical issues in biology and medicine. Historians, however, can find virtually no cases in which applied philosophical moral theory influenced ethical practice in biology or medicine. In light of the absence of historical evidence, the authors of this paper advance an alternative model of the historical relationship between philosophical (...) ethics and medical ethics, the appropriation model. They offer two historical case studies to illustrate the ways in which physicians have "appropriated" concepts and theory fragments from philosophers, and demonstrate how appropriated moral philosophy profoundly influenced the way medical morality was conceived and practiced. (shrink)

The widespread use of online search engines to answer the general public’s needs for information has raised concerns about possible biases and the emerging of a ‘filter bubble’ in which users are isolated from attitude-discordant messages. Research is split between approaches that largely focus on the intrinsic limitations of search engines and approaches that investigate user search behavior. This work evaluates the findings and limitations of both approaches and advances a theoretical framework for empirical investigations of cognitive biases in (...) online search activities about health-related topics. We aim to investigate the interaction between the user and the search engine as a whole. Online search activity about health-related topics is considered as a hypothesis-testing process. Two questions emerge: whether the retrieved information provided by the search engines are fit to fulfill their role as evidence, and whether the use of this information by users is cognitively and epistemologically valid and unbiased. (shrink)

Welfare-friendly outdoor poultry husbandry systems are associated with potentially higher public health risks for certain hazards, which results in a dilemma: whether to choose a system that improves chicken welfare or a system that reduces these public health risks. We studied the views of citizens and poultry farmers on judging the dilemma, relevant moral convictions and moral arguments in a practical context. By means of an online questionnaire, citizens (n = 2259) and poultry farmers (n = 100) judged three practical (...) cases, which illustrate the dilemma of improving chicken welfare or reducing public health risks for Campylobacter, avian influenza and dioxin. Furthermore, they scored the importance of moral arguments and to what extend they agreed with moral convictions related to humans and chickens. Citizens were more likely than farmers to choose a system that benefits chicken welfare at the expense of public health. These different judgments could be explained by differing moral convictions and valuations of moral arguments. Judgments of citizens and farmers were associated with moral arguments and convictions, predominantly with those regarding the value of chickens and naturalness. Citizens agreed stronger with moral convictions regarding the intrinsic value of chickens and regarding naturalness than farmers did, while farmers agreed stronger with conviction regarding fairness. We argue that opinions of citizens and farmers are context-dependent, which may explain the differences between these groups. It implies that opinions of different stakeholder groups should be considered in order to achieve successful innovations in poultry husbandry, which are supported by society. (shrink)

Ethical questions have traditionally been approached through conceptual analysis. Inspired by the rapid advance of modern brain imaging techniques, however, some ethical questions appear in a new light. For example, hotly debated trolley dilemmas have recently been studied by psychologists and neuroscientists alike, arguing that their findings can support or debunk moral intuitions that underlie those dilemmas. Resulting from the wedding of philosophy and neuroscience, neuroethics has emerged as a novel interdisciplinary field that aims at drawing conclusive relationships (...) between neuroscientific observations and normative ethics. A major goal of neuroethics is to derive normative ethical conclusions from the investigation of neural and psychological mechanisms underlying ethical theories, as well as moral judgments and intuitions. The focus of this article is to shed light on the structure and functioning of neuroethical arguments of this sort, and to reveal particular methodological challenges that lie concealed therein. We discuss the methodological problem of how one can—or, as the case may be, cannot—validly infer normative conclusions from neuroscientific observations. Moreover, we raise the issue of how preexisting normative ethical convictions threaten to invalidate the interpretation of neuroscientific data, and thus arrive at question-begging conclusions. Nonetheless, this is not to deny that current neuroethics rightly presumes that moral considerations about actual human lives demand empirically substantiated answers. Therefore, in conclusion, we offer some preliminary reflections on how the discussed methodological challenges can be met. (shrink)

This essay appreciatively and critically engages the late Robert Veatch’s extensive and important contributions to transplantation ethics, in the context of his overall ethical theory and his methods for resolving conflicts among ethical principles. It focuses mainly on ways to obtain and allocate organs from deceased persons, with particular attention to express donation, mandated choice, and presumed consent/routine salvaging in organ procurement and to conflicts between medical utility and egalitarian justice in organ allocation. It concludes by (...) examining the unclear relations between Veatch’s ideal moral theory and his nonideal moral theory, especially in organ allocation. (shrink)

Wildlife Ethics A systematic account of the ethical issues related to wildlife management and conservation Wildlife Ethics is the first systematic, book-length discussion of the ethics of wildlife conservation and management, and examines the key ethical questions and controversies. Tackling both theory and practice, the text is divided into two parts. The first describes key concepts, ethical theories, and management models relating to wildlife; the second puts these concepts, theories, and models to work, illustrating their significance (...) through detailed case studies on controversies in wildlife management and conservation. The book explores pressing topics including human responsibilities due to climate change, tradeoffs when managing zoonotic disease risks, the ethics of the wildlife trade, culling non-native species, indigenous wildlife use, and zoo-based conservation programs. Readers are encouraged to explore different ways of valuing wild animals and their practical implications. This essential text: Explains and explores relationships between valuing biodiversity, human utility, ecosystems, species, and animal welfare Describes established approaches to wildlife management, such as sustainable use, and emerging concepts, such as compassionate conservation Discusses key ethical theories, including utilitarianism, ecocentrism, and animal rights Offers a practical model of how to analyze ethical issues in wildlife management and conservation Wildlife Ethics: The Ethics of Wildlife Management and Conservation is an accessible introduction to complex ethical issues, making the book an important resource for students in fields such as conservation biology, ecology, environmental science and policy, game management, public health and veterinary medicine. It will also be an invaluable tool for wildlife managers, conservationists, One Health practitioners, practicing veterinarians and animal rehabilitation staff, contemporary wildlife professionals and other stakeholders. (shrink)

Research on gender and antimicrobial resistance (AMR) beyond women’s biological susceptibility is limited. A gender and equity lens in AMR research is necessary to promote gender equality and support the effectiveness, uptake, and sustainability of real-world AMR solutions. We argue that it is an ethical and social justice imperative to include gender and related intersectional issues in AMR research and implementation. An intersectional exploration of the interplay between people’s diverse identities and experiences, including their gender, socio-economic status, race, (...) disability, age, and sexuality, may help us understand how these factors reinforce AMR risk and vulnerability and ensure that interventions to reduce the risk of AMR do not impact unevenly. This paper reports on the findings of a systematic scoping review on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. The review focused on peer-reviewed and grey literature published between 2017 and 2022. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours. Research that fails to account for gender and its intersections with other lines of disadvantage, such as race, class and ability, risks being irrelevant and will have little impact on the continued and dangerous spread of AMR. We provide recommendations for integrating an intersectional gender lens in AMR research, policy and practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Theory of International Bioethics: Multiculturalism, Postmodernism, and the Bankruptcy of Fundamentalism 1Robert Baker (bio)AbstractThis first of two articles analyzing the justifiability of international bioethical codes and of cross-cultural moral judgments reviews “moral fundamentalism,” the theory that cross-cultural moral judgments and international bioethical codes are justified by certain “basic” or “fundamental” moral principles that are universally accepted in all cultures and eras. Initially propounded by the (...) judges at the 1947 Nuremberg Tribunal, moral fundamentalism has become the received justification of international bioethics, and of cross-temporal and cross-cultural moral judgments. Yet today we are said to live in a multicultural and postmodern world. This article assesses the challenges that multiculturalism and postmodernism pose to fundamentalism and concludes that these challenges render the position philosophically untenable, thereby undermining the received conception of the foundations of international bioethics. The second article, which follows, offers an alternative model—a model of negotiated moral order—as a viable justification for international bioethics and for transcultural and transtemporal moral judgments.Man in the Twentieth Century can not be circumscribed by the standards of any single culture.American Anthropological Association (1948) in a statement officially denouncing the 1948 United Nation’s Declaration of Human Rights.Recently... so-called “liberal” medicine has revived the old rights of a clinic understood in terms of a special contract, a tacit pact made between one man and another. This patient gaze has even been attributed the power of assuming [a role in clinical decision making].Miracles are not so easy to come by....Michel Foucault (1975, p. 5) [End Page 201]An Overview of the AnalysisInternational bioethics originated in the trauma of the Holocaust, specifically, in the 1946–1947 Nuremberg “Doctors Trial” when a tribunal of three American judges convicted Nazi medical researchers of “crimes against humanity.” In justifying their judgment, the Nuremberg Tribunal cited 10 principles for morally permissible research, which, they claimed, were based on “fundamental” principles that civilized societies “all agree” upon and accept as the foundations of their “moral, ethical, and legal” norms. Foremost among the principles was one stating that morally permissible human experiments require the informed voluntary consent of the subject. The Nuremberg judgment soon became associated with the ideal of human rights declared in the 1948 United Nations Charter. These two ideas—fundamental principles of morality and human rights—have been linked in all major formulations of international bioethics promulgated in the past 50 years, including the Council of Europe’s 1997 Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Biomedicine (Council of Europe 1997; Dommel and Alexander 1997). In this paper, I explore the received justification for international bioethics—the idea that it is grounded in fundamental principles accepted in all societies—tracing it from its initial, almost off-hand, promulgation by the Nuremberg Tribunal, through its more thoughtful development by such bioethicists as Ruth Macklin, to its more complex use by the President’s Advisory Committee on Human Radiation Experiments.After a brief review of the evolution of the received justification, I discuss the viability of this justification in the face of the critique implicit in two important intellectual movements: multiculturalism and postmodernism. In the international context, multiculturalism asserts the claim that there are no common moral principles shared by all cultures. Postmodernism asserts a similar claim against all universal standards, moral and nonmoral. In the 1990s, bioethicists have attempted to respond to these claims in various ways. These responses are documented, analyzed, and then shown to be “bankrupt,” in the sense that they undercut the most important objective of moral fundamentalism: the justification of transcultural moral judgments, such as the condemnation of the Nazi doctors.A second article, which follows the present one in the same issue of the Kennedy Institute of Ethics Journal, revisits the contractarian tradition [End Page 202] of Hobbes and Locke, as it has been reinterpreted by David Gauthier (1986), John Rawls (1971, 1993), and Robert Nozick (1974), to develop the idea of negotiated moral order as the basis of international bioethics. When conceptualized as a negotiated moral order, international bioethics can accept the genuine insights... (shrink)

Translational research in medicine requires researchers to identify the steps to transfer basic scientific discoveries from laboratory benches to bedside decision-making, and eventually into clinical practice. On a parallel track, philosophical work in ethics has not been obliged to identify the steps to translate theoretical conclusions into adequate practice. The medical ethicist A. Cribb suggested some years ago that it is now time to debate ‘the business of translational’ in medical ethics. Despite the very interesting and useful perspective on (...) the field of medical ethics launched by Cribb, the debate is still missing. In this paper, I take up Cribb’s invitation and discuss further analytic distinctions needed to base an ethics aiming to translate between theory and practice. (shrink)

Medicalization is frequently defined as a process by which some non-medical aspects of human life become to be considered as medical problems. Overdiagnosis, on the other hand, is most often defined as diagnosing a biomedical condition that in the absence of testing would not cause symptoms or death in the person’s lifetime. Medicalization and overdiagnosis are related concepts as both expand the extension of the concept of disease. They are both often used normatively to critique unwarranted or contested expansion of (...) medicine and to address health services that are considered to be unnecessary, futile, or even harmful. However, there are important differences between the concepts, as not all cases of overdiagnosis are medicalizations and not all cases of medicalizations are overdiagnosis. The objective of this article is to clarify the differences between medicalization and overdiagnosis. It will demonstrate how the subject matter of medicalization traditionally has been non-medical (social or cultural everyday life) phenomena, while the subject matter of overdiagnosis has been biological or biomolecular conditions or processes acknowledged being potentially harmful. They also refer to different types of uncertainty: medicalization is concerned with indeterminacy, while overdiagnosis is concerned with lack of prognostic knowledge. Medicalization is dealing with sickness (sick role) while overdiagnosis with disease. Despite these differences, medicalization and overdiagnosis are becoming more alike. Medicalization is expanding, encompassing the more “technical” aspects of overdiagnosis, while overdiagnosis is becoming more ideologized. Moreover, with new trends in modern medicine, such as P4 (preventive, predictive, personal, and participatory) medicine, medicalization will become all-encompassing, while overdiagnosis more or less may dissolve. In the end they may converge in some total “iatrogenization.” In doing so, the concepts may lose their precision and critical sting. (shrink)

Using a case-study involving bioethics and LGBTQ+ family-making, I demonstrate the appeal of a pragmatist ethics approach to bioethics. On the specific pragmatist view I offer, ethical progress is a matter of overcoming ethical problems. Ethical problems are here understood as conflicts that arise as we attempt to live out our values in the natural and social world and which prompt us to reflect upon and sometimes reinterpret or revise our values or practices. Pragmatism is (...) inherently nonideal in its theoretical approach, since it holds that the relevant conflicts that prompt moral inquiry are not conflicts among abstract ideals, but practical conflicts that arise from our interaction with the world. Ideals alone, then, cannot be a proper guide to bioethical progress. After laying out this approach to moral theorizing in more detail, I take up a case study, focusing on the value of genetic relations within families and the use of reproductive technologies to allow LGBTQ+ people to produce biologically related children. I use this case to show the value of nonideal approaches to bioethics. More specifically, I argue that pragmatism—as a nonideal theory—instructs us to evaluate these issues and family-making practices by considering the situatedness of LGBTQ+ people in a heteronormative society, and the ways in which that particular context produces practical conflicts as LGBTQ+ people and families attempt to live out their values in the social world. (shrink)

This article presents a part of the results of an empirical study conducted at a Parisian hospital between 2011 and 2014. It aimed at understanding the women and couples’ motivations to terminate or not a pregnancy once a prenatal diagnosis has revealed a genetically related disease in the embryo or fetus. The article first presents the social and legal context of the study, the methodology used and the pathologies that were encountered. Then, it examines the results of the interviews (...) conducted with 5 women alone and 23 couples explaining their reasons for deciding to terminate or not the pregnancy. Finally, it explores the patients’ views about the doctor’s involvement in the decision-making process. The findings reveal the reasons they formulate when they ponder whether to terminate or not the pregnancy. It highlights the process of their deliberation, their hierarchisation of arguments and concerns. They also show how patients, though often consumed in sorrow, claim to be the legitimate decision-makers, especially women, in a social and legal context in which the rejection of eugenics is viewed as an undisputable principle. (shrink)

Biobank research and genomic information are changing the way we look at health and medicine. Genomics challenges our values and has always been controversial and difficult to regulate. In the future lies the promise of tailored medical treatments and pharmacogenomics but the borders between medical research and clinical practice are becoming blurred. We see sequencing platforms for research that can have diagnostic value for patients. Clinical applications and research have been kept separate, but the blurring lines challenges existing (...) regulations and ethical frameworks.Then how do we regulate it? This book contains an overview of the existing regulatory landscape for biobank research in the Western world and some critical chapters to show how regulations and ethical frameworks are developed and work. How should international sharing work? How design an ethical informed consent? An underlying critique: the regulatory systems are becoming increasingly complex and opaque. The international community is building systems that should respond to that. According to the authors in fact, it is time to turn the ship around. Biobank researchers have a moral responsibility to look at and assess their work in relation to the bigger picture: the shared norms and values of current society. Research ethics shouldn't only be a matter of bioethicists writing guidelines that professionals have to follow. Ethics should be practiced through discourse and regulatory frameworks need to be part of that public discourse. Ethics review should be then not merely application of bureaucracy and a burden for researchers but an arena where researchers discuss their projects, receive advice and practice their ethics skills. (shrink)

This book is aimed at analyzing the foundations of medical ethics by considering different moral theories and their implications for judgments in clinical practice and policy-making. It provides a review of the major types of ethical theory that can be applied to medical and bioethical issues concerning reproductive genetics. In response to the debate on the most adequate ethical doctrine to guide biomedical decisions, this book formulates views that capture the best elements in each, bearing in mind (...) their differences and taking into account the specific character of medicine. No historically influential position in ethics is by itself adequate to be applied to reproductive decisions. Thus, this book attempts to offer a pluralistic approach to biomedical research and medical practice. One usually claims that there are some basic principles which constitute the foundations of bioethics and medical ethics. Yet these principles conflict with each other and one needs some criteria to solve these conflicts and to specify the scope of application of these principles. Exploring miscellaneous ethical approaches as introduced to biomedicine, particularly to reproductive genetics, the book shall elucidate their different assumptions concerning human nature and the relations between healthcare providers, recipients, and other affected parties. The book attempts to answer the question of whether the tension between these ethical doctrines generates conflict in the field of biomedicine or if these competing approaches could in some way complement each other. In this respect, lecturers and researchers in bioethics would be interested in this reading this book. (shrink)

There is a global shortage of nurses that affects healthcare delivery, which will be exacerbated with the increasing demand for healthcare professionals by the aging population. The growing shortage requires an ethical exploration on the issue of nurse migration. In this article, we discuss how migration respects the autonomy of nurses, increases cultural diversity, and leads to improved patient satisfaction and health outcomes. We also discuss the potential for negative impacts on public health infrastructures, lack of respect for cultural (...) diversity, and ethical concerns related to autonomy and justice, including coercion and discrimination. This analysis is written from a rights-based ethics approach by referring to rights held by nurses and patient populations. Nurse migration highlights conflicts between nurses and between nurses and healthcare systems. Increased awareness of ethical challenges surrounding nurse migration must be addressed to enhance the well-being of nurses and patient populations. (shrink)

This volume links three different theoretical approaches that have a common focus on the relationship between biopolitics and bioethics. This collection of papers can be categorized into different domains that are representative of the contemporary usage of biopolitics as a concept. On the one hand, several chapters develop a clear and up-to-date understanding of the primary sources of the concept and related theories of Agamben, Negri or Foucault and approach the question of relevance within the field of (...) class='Hi'>bioethics. Another group of papers apply the philosophical concepts and theories of biopolitics (biopower, Homo Sacer, biocitizenship) on very specific currently debated bioethical issues. Some scholars rely on the more mundane understanding of (bio)politics and investigate how its relationship with bioethics could be philosophically conceptualized. Additionally, this work also contains papers that follow a more legally oriented analysis on the effects of contemporary biopolitics on human rights and European law. The authors are philosophers, legal scholars or bioethicists. The major strength of this volume is to provide the reader with major insights and orientation in these different contemporary usages of the concept and theories of biopolitics, within the context of its various ethically relevant applications. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Organizational Ethics and Health Care: Expanding Bioethics to the Institutional Arena **Laura Jane Bishop (bio), M. Nichelle Cherry (bio), and Martina Darragh* (bio)In 1995, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) expanded its patient rights standards to include requirements for assuring that hospital business practices would be ethical. Renamed “Patient Rights and Organization Ethics,” these standards are based on the realization that a hospital’s obligation (...) to its patients is derived from two relationships: the patient-provider relationship governed by “clinical ethics,” and the customer-supplier relationship governed by “business ethics.” “[This] boundary between ‘clinical’ ethics and ‘business’ ethics is not clear and in many cases is nonexistent. While marketing and admission practices are seen as issues related to ‘business’ ethics, they can lead to unneeded admissions or demand for unneeded services, both of which can unnecessarily expose the patient to the risk of side effects or complications. Likewise, underutilization of needed services is likely to lead to less than optimal health outcomes” (I. Schyve 1996, p. 17). “These new standards arose out of well-publicized concerns about abuses in which patients were admitted to hospitals unnecessarily and were discharged or transferred only after their insurance expired” (I. Schyve 1996, pp. 15–16).These abuses also sparked eloquent protests against threats to patient well-being and to the nature of the patient-provider relationship in the bioethics literature. The fiduciary responsibility of the provider to inform and to protect the patient was fragmented by insurer business practices such as gag clauses and economic credentialing of providers (VII. Scope Note 31, 1996). The background role that the institution plays, though poorly articulated historically, has been brought sharply into focus by the explosive growth of the managed practice of medicine. The context of medical ethics is no longer limited to the resolution of individual cases, but instead encompasses the adoption of institutional structures to protect and promote patient welfare (IV. Emanuel 1995, p. 335). In this new configuration, the institution and the providers are co-fiduciaries for populations [End Page 189] of patients, and the medicine that is practiced is “appropriately economically disciplined.” The expression “My patient always comes first” is no longer “... intellectually serious or morally responsible.” But, “... to be sure, both conceptually and in practice, being an economically disciplined fiduciary professional or institution is ethically unstable.... The task is to identify the boundaries outside of which institutional policy and behavior will not count as an ethically defensible form of being... [a] fiduciary.” (IV. McCullough 1997, pp. 143–44). This process of delimiting and enforcing boundaries requires the development of “... a language for talking about the ethical values of the organization. If such a language does not exist, discussions about ethics become cumbersome and unlikely to occur” (IV. Cleveland Clinic Foundation 1998, p. 2).As with bioethics generally, the literature addressing organizational ethics is multidisciplinary. JCAHO’s compliance guide for its revised standards, Ethical Issues and Patient Rights, draws on a wealth of ideas from both clinical ethics and business ethics. This is often an awkward alliance. “Because the study of organizational ethics is in its infancy compared to other areas of healthcare ethics, discussions about it often seem like hot air with no palpable payoff” (I. Boyle 1998, p. 2). The fact that “... there is an ancient history that reflects widespread doubt about the moral probity of business” (II. Frederick 1995, p. 209) does not help. To begin, “Aristotle had rude things to say about business” (II. Jackson 1998, p. 401). A brief review of introductions to several of the business ethics textbooks cited in this bibliography reveals that a rebuttal of “business ethics as an oxymoron” is the standard opening paragraph. This stigma is unfounded, and “increased stability” has characterized the state of business ethics literature during the 1990s (II. Beauchamp and Bowie 1997, p. ix). Significant attention has been given to elaborating two often overlapping theories—stakeholder and social contractarian.Originating in the 1960s as a pun on “stockholder,” proponents of stakeholder theory claim that a corporation’s fiduciary responsibility extends beyond increasing its profitability to protecting the rights of individuals or groups affected by its actions. Popular as a strategic planning tool in the... (shrink)

Although the field of bioethics usually emphasizes ethical dilemmas arising from contemporary biomedical research, at another level the foundation of ethical judgments can be explored in the light of evolutionary biology. Two scientific approaches illuminate the relationships between human nature, social environments, and standards of ethical judgment: first, ethology and the observational study of nonhuman primates; second, evolutionary theory and new developments in the understanding of natural selection. Ethology shows that humans, like the (...) species most closely related to us, are naturally both cooperative and competitive. Evolutionary theory can "explain" cooperation at diverse levels of social organization , suggesting which forms of social cooperation are to be expected in specific cases. By focusing on the emotions underlying the sense of justice, moreover, an evolutionary approach can provide a more realistic assessment of the motivations and intentions underlying ethical controversies. Because individuals inevitably have competing claims as well as competing moral obligations, evolutionary bioethics thus teaches the need for balance and judgment. Emotions elicited by the all-too-human tendency to engage in moralistic aggression need to be balanced by reasoned judgment of the consequences of our own actions. The ethicist, no more or less than any other human, needs to be aware of the risks of deceptions and self-deception. Or, to put it more simply, an evolutionary bioethics leads back to the humility of the Socratic injunction: know thyself. Im allgemein üblichen Sinne befaßt sich Bioethik meist mit ethischen Problemstellungen, die durch die Fortschritte der biologischen Forschung hervorgerufen werden. Unter einem anderen Blickwinkel kann sie aber auch die Grundlage ethischer Urteile im Licht der Entwicklungsbiologie untersuchen. Zwei Wissenschaftszweige befassen sich mit dem Verhältnis zwischen der menschlichen Natur, dem sozialen Umfeld und den Standards für ethische Urteile; erstens, die Ethologie und Verhaltensstudien an nichtmenschlichen Primaten; zweitens, die Evolutionstheorie und neue Entwicklungen beim Verständnis der natürlichen Selektion. Die Ethologie zeigt, daß Menschen genauso wie die Tiere, die ihnen am nächsten verwandt sind, von Natur aus sowohl zur Kooperation als auch zur Konkurrenz miteinander neigen. Die Evolutionstheorie kann die verschiedenen Weisen von Kooperation auf den verschiedenen Ebenen sozialer Organisation "erklären" und dabei Hypothesen aufstellen, welche Formen sozialer Zusammenarbeit in spezifischen Fällen erwartet werden können. Soweit sie sich mit den Emotionen befaßt, die dem Sinn für Gerechtigkeit zugrunde liegen, kann die Evolutionstheorie darüber hinaus eine realistischere Einschätzung der Beweggründe und Intentionen vermitteln, die hinter ethischen Kontroversen stehen. Weil Individuen unvermeidlich konkurrierende Ansprüche, aber auch konkurrierende moralische Verpflichtungen haben, zeigt die evolutionäre Bioethik das Bedürfnis nach Ausgleich und Schlichtung. Die Emotionen, die durch die allzu menschliche Neigung zu Aggression im Namen der Moral hervorgerufen werden, rufen nach Ausgleich durch begründete Urteile über die Folgen unserer eigenen Handlungen. Der Ethiker muß sich, nicht mehr und nicht weniger als jeder andere Mensch, des Risikos von Täuschung und Selbsttäuschung bewußt sein. Oder, um es einfacher auszudrücken, evolutionäre Ethik führt zurück zu der Bescheidenheit der Sokratischen Forderung: Erkenne dich selbst. (shrink)

the structure of medical science with a special focus on the role of generalizations and universals in medicine, and (2) philosophy of medicine's relation with the philosophy of science. I argue that a usually overlooked aspect of Kuhnian paradigms, namely, their characteristic of being "exemplars", is of considerable significance in the biomedical sciences. This significance rests on certain important differences from the physical sciences in the nature of theories in the basic and the clinical medical sciences. I (...) describe those differences and maintain that they are these differentiating features that require the use of more comparative and analogical reasoning in medicine. I suggest that Kitcher's recent introduction of the notion of a ‘practice’ may have similar implications if it is construed to contain more analogical elements than he appears to recognize in his initial formulation. Finally I argue that though Gorovitz and MacIntyre's characterization of medicine as a "science of particulars" bears some similarities with my thesis, I maintain that such a position without careful qualification can lead to ignoring both the nature of generalizations in these sciences and their role as positive analogies tying together a family of overlapping models. Keywords: medical reasoning, biomedical theories/paradigms, science of particulars, philosophy of medicine CiteULike Connotea Del.icio.us What's this? (shrink)

This book is aimed at analyzing the foundations of medical ethics by considering different moral theories and their implications for judgments in clinical practice and policy-making. It provides a review of the major types of ethical theory that can be applied to medical and bioethical issues concerning reproductive genetics. In response to the debate on the most adequate ethical doctrine to guide biomedical decisions, this book formulates views that capture the best elements in each, bearing in mind (...) their differences and taking into account the specific character of medicine. No historically influential position in ethics is by itself adequate to be applied to reproductive decisions. Thus, this book attempts to offer a pluralistic approach to biomedical research and medical practice. One usually claims that there are some basic principles which constitute the foundations of bioethics and medical ethics. Yet these principles conflict with each other and one needs some criteria to solve these conflicts and to specify the scope of application of these principles. Exploring miscellaneous ethical approaches as introduced to biomedicine, particularly to reproductive genetics, the book shall elucidate their different assumptions concerning human nature and the relations between healthcare providers, recipients, and other affected parties. The book attempts to answer the question of whether the tension between these ethical doctrines generates conflict in the field of biomedicine or if these competing approaches could in some way complement each other. In this respect, lecturers and researchers in bioethics would be interested in this reading this book. (shrink)

Since the revolutionary mood of the 1960s, patient-centered mental health care and a research emphasis on service users as experts by experience have emerged hand in hand with a view of service users as consumers. What happens to knowledge derived from firsthand experience when mental health users become experts and actively choose care? What kind of perspective do service users pursue on psychological distress? These are important questions in a field where psychiatric expertise on mental illness is socially structured and (...) constrained as an intra-personal disturbance of the mind. We argue that experience experts have lost a coherent perspective on care and health. We illustrate this by rationally reconstructing how the interpersonal view of mental health first gained and then lost coherence between the conception of mental health, the practice of mental health care, and the user experience. Harry Stack Sullivan’s interpersonal theory was a paradigm case for such coherence. The inclusion of mental health consumers as ‘experts by experience’ in the mental health field took place at the cost of Sullivan’s coherent interpersonal theory. Service users who interact side by side with medical experts as experience experts are constrained by the evidence-based imperative and consumerism. Service users are caught up in a race among experts to gain knowledge about mental problems from a third-person perspective instead of from first-person experience. To make a contribution service users have more to gain from a research approach that appreciates that they are persons among persons rather than experts among experts. (shrink)

Despite recommendations from the Cartwright Report ethical review by health ethics committees has continued in New Zealand without health practitioners ever having to acknowledge their dual roles as health practitioners researching their own patients. On the other hand, universities explicitly identify doctor/research-patient relations as potentially raising conflict of role issues. This stems from the acknowledgement within the university sector itself that lecturer/research-student relations are fraught with such conflicts. Although similar unequal relationships are seen to exist between health researchers (...) and their patients, the patient/subjects are not afforded the levels of protection that are afforded student/subjects. In this paper we argue that the difference between universities and health research is a result of the failure of the Operational Standard Code for Ethics Committees to explicitly acknowledge the vulnerability of the patient and conflict of interests in the dual roles of health practitioner/researcher. We end the paper recommending the Ministry of Health consider the rewriting of the Operational Standard Code for Ethics Committees, in particular in the rewriting of section 26 of the Operational Standard Code for Ethics Committees. We also identify the value of comparative ethical review and suggest the New Zealand's Health Research Council's trilateral relationship with Australia's NHMRC (National Health and Medical Research Council) and Canada's CIHR (Canadian Institute of Health Research) as a useful starting point for such a process. (shrink)

This is a response to a short communication on our research presented in Solbrække et al. :89–103, 2017), which raises a series of serious allegations. Our article explored the rise of ‘the breast cancer gene’ as a field of medical, cultural and personal knowledge. We used the concept biological citizenship to elucidate representations of, and experiences with, hereditary breast cancer in a Norwegian context, addressing a research deficit. In our response to Møller and Hovig’s :239–242, 2018a) opinionated piece, we start (...) by questioning on which scientific grounds they base their knowledge claims and situate their criticism in a pre-determined positivist script, which exposes their incompetency when it comes to establishing a useful critique of our research. We tie this to an attitude of scientific supremacy, which reduces the complexity and specificity of different knowledges into a clichéd divide between ‘hard evidence’ and ‘fiction’—presented in a predictable narrative which seeks to establish research protagonists and antagonists. We elaborate on the rationale of our qualitative approach to analyzing and interpreting situated and mediated aspects of BRCA 1/2. We counter claims that our research does harm to patients. We refer to a medical scandal emerging from Norway where 21 women were wrongfully diagnosed and surgically treated for a mis-interpreted cancer gene mutation. In conclusion, we stand by the integrity of our research as reported in the original paper. Scientific supremacy and pre-scripted criticism impose considerable obstacles for the possibility of establishing interdisciplinary dialogue across knowledge paradigms in health care and medicine. We therefore urge readers to reflect on how we can establish and sustain ethically careful and truthful dialogue—without doing violence to epistemological differences—to protect and advance the interdisciplinarity that constitutes the journal’s scope. (shrink)

The phenomenological starting point of this paper is the world of the bioethical subject, the person engaged in moral deliberation about practices of intervention on living bodies. This paper develops a perspective informed by the hermeneutic tradition in phenomenology, approaching bioethical thinking as situated within specific contexts of meaning and conceptuality, frameworks through which the phenomena of the world are interpreted and made sense of by the reasoning subject. It focuses on one dimension of the hermeneutic world of contemporary (...) class='Hi'>bioethics, that of the relation between bioethics and biological science. This paper shows how taking a phenomenological-hermeneutic perspective can highlight an important but often overlooked way in which biology helps to structure spaces of bioethical sense-making, with substantive consequences for moral judgement. Bioscientific discourse provides us with interpretive resources for making sense of the living world around us and within us. Different interpretive resources reflect different assumptions about the ontology of living beings, humans included. Since, as is argued here, judgements about moral significance in bioethics can depend upon suppositions about the ontology of life, the way that scientific discourse interpretively constitutes the phenomena of life as intentional objects can thereby channel moral thinking in particular ways. The central thesis of this paper is that critical engagement with this ‘hermeneutics of biology’ is vital for contemporary bioethics. To illustrate, the paper explores the hermeneutic constitution of the genome and its relationship to issues of human identity in the context of genetic technology. Alternative interpretations of the genome—as ‘programme’ or as ‘developmental resource’—differently shape bioethical reasoning in this context. Choices of description in bioscience are in this way partly ethical questions, questions about how we ought to comport ourselves towards each other and the living world beyond. (shrink)

In production and consumption of food, several ethical values are at stake for different affected parties and value conflicts in relation to food choices are frequent. The aim of this article was to present an ethical framework for well-grounded decisions on production and consumption of food, guided by the following questions: Which are the affected parties in relation to production and consumption of food? What ethical values are at stake for these parties? How can conflicts (...) between the identified values be handled from different ethical perspectives? Four affected parties, relevant for both production and consumption of food, were identified, namely animals, nature, producers and consumers. Working form a bottom-up perspective, several values for these parties were identified and discussed. For animals: welfare, not being exposed to pain and natural behavior; for nature: low negative impact on the environment and sustainable climate; for producers: fair salaries and safe working conditions; and for consumers: access to food, autonomy, health and food as part of a good life. As several of these values can come into conflict when choices of what to eat should be made, the article argues for the need of weighing values from four different perspectives in food ethics dilemmas, namely duties, consequences, virtues and care. The suggested ethical framework can provide moral guidance to both producers of food and to consumers in a supermarket. Thereby, it can contribute to more well-grounded decisions concerning what to eat and make people feel a little bit more secure when reflecting over the question: What shall we eat? (shrink)

Introduction. The article raises the problem of eugenics as a direction of scientific thought and practice of improving the human species. The modern advances in reproductive medicine, the development of biology, the emergence of methods for editing the human genome have updated the debate around eugenics. The aim of the work is a comprehensive study of the discourse and practice of eugenics in the period of the 19th — 21st centuries. This aim involves solving a number of tasks: (...) 1) analysis of the historical context and prerequisites for the eugenics emergence; 2) the study of the institutionalization and practical implementation of its ideas in Western countries in the period until the end of World War II; 3) research on the position of eugenics after the war and the transition of discussions to the mainstream of genetics, bioethics, transhumanism; 4) study of the modern discourse of eugenics, ethical issues and the degree of government intervention in population reproduction. Methods. The author uses the historical-retrospective method, which makes it possible to comprehensively consider the context of the emergence and development of eugenics, the comparative method (when comparing the characteristic features of the «old» (authoritarian, forced) and «new» (democratic, based on personal choice) eugenics), the institutional approach ( when identifying the main institutions involved in the development, dissemination, implementation of the ideas of eugenics) and a discursive approach (to study modern discussions about the «new» eugenics and related ethical problems). Scientific novelty of the research. A comprehensive study of eugenics has been carried out, a connection has been established between the «old» and «new» eugenics, and their similarities and differences have been investigated. Results. The need to distinguish eugenics as a theory of human selection and as a practice has been proven, and the latter, depending on the political, cultural and socio-economic situation in the country, can take a variety of forms: from counseling and preventive measures to racial cleansing. It was found that population growth, urbanization, mass migration, instability in society, combined with the ideas of modernism about social order by the forces of science and technology, contributed to the spread of eugenics ideas in the late 19th - early 20th centuries. After the Nuremberg trials, the concept under study temporarily dropped out of scientific discourse. The article examines in detail the socio-economic and other preconditions that contributed to the revival of interest in eugenics in the 60s of XX century and at the present stage. It is shown that today part of the discussion has shifted to the mainstream of genetics, bioethics and transhumanism. Conclusions. It has been established that discussions about eugenics run up against the problem of breeding control, which means that they raise the question of who should perform selection, how, what are its criteria. The ethical aspects of introducing control are complicated by the fact that perceptions of the «norm» and the degree of permitted interference depend on the particular society. (shrink)

Welfare-friendly outdoor poultry husbandry systems are associated with potentially higher public health risks for certain hazards, which results in a dilemma: whether to choose a system that improves chicken welfare or a system that reduces these public health risks. We studied the views of citizens and poultry farmers on judging the dilemma, relevant moral convictions and moral arguments in a practical context. By means of an online questionnaire, citizens and poultry farmers judged three practical cases, which illustrate the dilemma of (...) improving chicken welfare or reducing public health risks for Campylobacter, avian influenza and dioxin. Furthermore, they scored the importance of moral arguments and to what extend they agreed with moral convictions related to humans and chickens. Citizens were more likely than farmers to choose a system that benefits chicken welfare at the expense of public health. These different judgments could be explained by differing moral convictions and valuations of moral arguments. Judgments of citizens and farmers were associated with moral arguments and convictions, predominantly with those regarding the value of chickens and naturalness. Citizens agreed stronger with moral convictions regarding the intrinsic value of chickens and regarding naturalness than farmers did, while farmers agreed stronger with conviction regarding fairness. We argue that opinions of citizens and farmers are context-dependent, which may explain the differences between these groups. It implies that opinions of different stakeholder groups should be considered in order to achieve successful innovations in poultry husbandry, which are supported by society. (shrink)