Is there only one bioethics? Is a global bioethics possible? Or, instead, does one encounter a plurality of bioethical approaches shaped by local cultural and national traditions? Some thirty years ago a field of applied ethics emerged under the rubric `bioethics'. Little thought was given at the time to the possibility that this field bore the imprint of a particular American set of moral commitments. This volume explores the plurality of moral perspectives shaping (...) class='Hi'>bioethics. It is inspired by Kazumasa Hoshino's critical reflections on the differences in moral perspectives separating Japanese and American bioethics. The essays include contributions from Hong Kong, China, Japan, Texas, the United States, Germany, Switzerland, and Italy. The volume offers a rich perspective of the range of approaches to bioethics. It brings into question whether there is unambiguously one ethics for bioethics to apply. (shrink)

This chapter contains sections titled: Bioethics in a New Key Relationship and Recognition in Dementia Care Quality of Life and Agency References.

The rapidly changing field of genetics affects society through advances in health-care and through implications of genetic research. This study addresses the impacts of new genetic discoveries and technologies on different segments of today's society. The book begins with a chapter on genetic complexity, and subsequent chapters discuss moral and ethical questions arising from today's genetics from the perspectives of health care professionals, the media, the general public, special interest groups and commercial interests.

This article provides a reflection about the concept of «care», from philosophy, for it to develop in relation with the ethics of the sanitary professions, as in relation with the development of certain practices as with the reflection and theoretical configuration that is in the basis, especially from the field of the bioethics. With regard to the philosophical dimension of the concept in question, this will be seen from the perspective of a notable contemporary author: Alasdair (...) MacIntyre, whose approaches allow a nutritional analysis about the possibilities and certain restrictions in relation with the reflection proposed. (shrink)

In response to the many changes currently going on in health care, this book offers the combined insight and wisdom of a stellar group of scholars and professionals with extensive experience in the health care field. The book opens with a look at people's actual experience of health care today, from four different perspectives. It then addresses foundational questions, including the nature of medicine, nursing, and justice. Surveyed next are the changing economics of health care as (...) well as the impact of these changes on such areas as mental health care, long-term care, health care for minorities, and legal malpractice. The closing section of the book assesses from a Christian perspective available constructive alternatives, including creative funding strategies with special attention to the needs of poor persons, physician unions, and the use of "alternative medicine" therapies. (shrink)

“Ethics” is used as a label for a new kind of expertise in the field of science and technology. At the same time, it is not clear what ethical expertise consists in and what its political status in modern democracies can be. Starting from the “participatory turn” in recent social research and policy, we will argue that bioethical reasoning has to include public views of and attitudes towards biomedicine. We will sketch the outlines of a bioethical conception of “public (...) understanding of ethics,” addressing three different issues: the methodological relevance of moral questions and problems raised by lay persons in everyday life regarding biomedicine and technology, the normative relevance of such lay moralities for the justification of ethical decisions, and the necessity of public deliberation in this context. Finally, we draw conclusions in view of the concepts and methods such a conception of “public understanding of ethics” should employ. (shrink)

Appeals to the dignity of people with dementia are widespread in the current literature on dementia care. One influential account of dignity in the wider philosophical and bioethical literature that has remained underexplored in the context of dementia care is that of Martha Nussbaum. This paper critically examines Nussbaum’s account of dignity and aims to determine what moral guidance this account can offer for the provision of care to people with dementia. To (...) that end, first, I identify four possible objections to appeals to dignity in dementia care. These objections are (1) redundancy of the dignity talk, (2) exclusionary implications, (3) reliance on (suspect forms of) speciesism and (4) unclear practical implications. Then, I discuss whether, and to what extent, Nussbaum’s account of dignity can overcome these objections. I argue that Nussbaum’s account, in its original form, struggles to overcome the problem of exclusionary implications and consequently the problem of unclear practical implications. I argue for a modified version of Nussbaum’s account of dignity. I demonstrate that this modified version can better overcome all of the four objections, and it provides relatively clearer moral guidance for the provision of care to people with dementia. The modified version of Nussbaum’s account is predicated on a novel dementia-specific model of flourishing, which draws on Kitwood and Bredin’s empirically informed list of indicators of well-being for people with dementia. (shrink)

Contemporary bioethics pays considerable attention to the ethical aspects of dementia care. However, ethical issues of sexuality especially as experienced by institutionalized persons with dementia are often overlooked. The relevant existing ethics literature generally applies an implicit philosophical anthropology that favors the principle of respect for autonomy and the concomitant notion of informed consent. In this article we will illustrate how this way of handling the issue fails in its duty to people with dementia. (...) Our thesis is that a more inclusive philosophical anthropology is needed that also heeds the fate of this growing population. Drawing on the tradition of phenomenology, we will chalk out an anthropological framework that rests on four fundamental characteristics of human existence: the decentered self, human embodiment, being-in-the-world and being-with-others. Our aim in this article is thus to tentatively put forward a broader perspective for looking at aged sexuality in institutionalized people with dementia. Hopefully the developed framework will mark the beginning of a new and refreshed ethical reflection on the topic at hand. (shrink)

A relational-self theory claims that one’s self is constituted by one’s relationships. The type of ethics that is said to arise from this concept of self is often called an ethics of care, whereby the focus of ethical deliberation is on preserving and nurturing those relationships. Some environmental philosophers advocating a relational-self theory tend to assume that the particular relationships that constitute the self will prioritize the natural world. I question this assumption by introducing the problem of (...) artifact relationships. It is unclear whether a relational-self theory recognizes relationships with the artificial world as beingmeaningful in any moral sense, and whether such relationships, if they can exist, should be accorded equal value to relationships with the natural world. The problem of artifact relationships becomes particularly apparent when the relational-self theory is linked to place-based ethics. If our ethics are to develop from our relations to place, and our place is largely an artificial world, is there not a danger that our ethical deliberations will tend to neglect the natural world? I adapt Holmes Rolston’s concept of “storied residence” to show how the inclusion of the artificial world will lead to different questions regarding one’s resident environment, and perhaps a different emphasis on what is valued. My aim in raising these questions is to challenge the optimism that writers such as Karen Warren and Jim Cheney have shown in supporting relational-self theories and place-based ethics. I conclude that the challenge to develop a relational-self/place-based ethic does not appear to have been met within Western environmental philosophy, which has perpetuated a silence on the matter of our embedment in the artificial world. (shrink)

A relational-self theory claims that one’s self is constituted by one’s relationships. The type of ethics that is said to arise from this concept of self is often called an ethics of care, whereby the focus of ethical deliberation is on preserving and nurturing those relationships. Some environmental philosophers advocating a relational-self theory tend to assume that the particular relationships that constitute the self will prioritize the natural world. I question this assumption by introducing the problem of (...) artifact relationships. It is unclear whether a relational-self theory recognizes relationships with the artificial world as beingmeaningful in any moral sense, and whether such relationships, if they can exist, should be accorded equal value to relationships with the natural world. The problem of artifact relationships becomes particularly apparent when the relational-self theory is linked to place-based ethics. If our ethics are to develop from our relations to place, and our place is largely an artificial world, is there not a danger that our ethical deliberations will tend to neglect the natural world? I adapt Holmes Rolston’s concept of “storied residence” to show how the inclusion of the artificial world will lead to different questions regarding one’s resident environment, and perhaps a different emphasis on what is valued. My aim in raising these questions is to challenge the optimism that writers such as Karen Warren and Jim Cheney have shown in supporting relational-self theories and place-based ethics. I conclude that the challenge to develop a relational-self/place-based ethic does not appear to have been met within Western environmental philosophy, which has perpetuated a silence on the matter of our embedment in the artificial world. (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)

In order to open new possibilities for bioethics, I argue that we need to rethink our concept of nature. The established cognitive framework determines in advance how new technologies will become visible. Indeed, in this dualistic approach of metaphysics, nature is posited as limitless, as material endowed with force which causes us to lose the sense of nature as arising out of itself, of having limits, an end. In contrast, drawing upon the example of the gender assignment and construction (...) of intersexed infants, I want to suggest for bioethics an understanding of nature that arises not from our scientific explorations, but rather from attending to our situated perceptual encounters with the world which underlie such experimentation; these encounters are too easily overlooked, and yet they are crucial for opening up new ways of thinking. (shrink)

“Ethics” is used as a label for a new kind of expertise in the field of science and technology. At the same time, it is not clear what ethical expertise consists in and what its political status in modern democracies can be. Starting from the “participatory turn” in recent social research and policy, we will argue that bioethical reasoning has to include public views of and attitudes towards biomedicine. We will sketch the outlines of a bioethical conception of “public (...) understanding of ethics,” addressing three different issues: (a) the methodological relevance of moral questions and problems raised by lay persons in everyday life regarding biomedicine and technology, (b) the normative relevance of such lay moralities for the justification of ethical decisions, and (c) the necessity of public deliberation in this context. Finally, we draw conclusions in view of the concepts and methods such a conception of “public understanding of ethics” should employ. (shrink)

A relational-self theory claims that one’s self is constituted by one’s relationships. The type of ethics that is said to arise from this concept of self is often called an ethics of care, whereby the focus of ethical deliberation is on preserving and nurturing those relationships. Some environmental philosophers advocating a relational-self theory tend to assume that the particular relationships that constitute the self will prioritize the natural world. I question this assumption by introducing the problem of (...) artifact relationships. It is unclear whether a relational-self theory recognizes relationships with the artificial world as beingmeaningful in any moral sense, and whether such relationships, if they can exist, should be accorded equal value to relationships with the natural world. The problem of artifact relationships becomes particularly apparent when the relational-self theory is linked to place-based ethics. If our ethics are to develop from our relations to place, and our place is largely an artificial world, is there not a danger that our ethical deliberations will tend to neglect the natural world? I adapt Holmes Rolston’s concept of “storied residence” to show how the inclusion of the artificial world will lead to different questions regarding one’s resident environment, and perhaps a different emphasis on what is valued. My aim in raising these questions is to challenge the optimism that writers such as Karen Warren and Jim Cheney have shown in supporting relational-self theories and place-based ethics. I conclude that the challenge to develop a relational-self/place-based ethic does not appear to have been met within Western environmental philosophy, which has perpetuated a silence on the matter of our embedment in the artificial world. (shrink)

The Handbook of Bioethical Decisions Volume II addresses and analyzes the most important ethical concerns and moral quandaries related to scientific integrity and institutional ethics. It counts on two parts, Part One: Research Ethics, which addresses issues related to Scientific Integrity, Research Misconduct and Conducting Ethical Research, and Part Two: Institutional Ethics and Bioethics Committees, which explores Institutional Ethics issues, Ethics and Bioethics Committees’ roles and scopes, and Bioethical Issues in Institutional (...) class='Hi'>Ethics. Consequently, the Handbook, Vol. II, offers a remarkable collection of works by outstanding international experts on institutional and research ethics, in order for bioethics practitioners to obtain better elements to address key issues related to integrity in research as well as to decision-making processes. In this fashion, this volume is a valuable resource for professionals working on different bioethical and biomedical fields, such as, ethics and bioethics committees, health care institutions, biomedical and pharmacological companies, and academic settings, among others. Chapter 26 is available open access under a Creative Commons Attribution 4.0 International License via link.springer.com. (shrink)

Bioethics and humanities (inclusive of medical ethics, health care ethics, environmental ethics, research ethics, philosophy and medicine, literature and medicine, and so on) seems like one field; yet colleagues come from different academic disciplines with distinct languages, methods, traditions, core curriculum and competency examinations. The author marks six related "framework" features that unite and make it one distinct field. It is a commitment to (1) work systematically on some of the momentous and well-defined (...) sets of problems about the human condition that drive our field (such as death and dying, disability, confidentiality, professionalism, informed consent, abortion, euthanasia, assisted suicide, personhood, health-care resource allocation and environmental ethics, as well as the impact of new technologies, including genetic and reproductive); (2) use interdisciplinary approaches to unravel them; (3) employ cases and practical reasoning to understand problems and solve answers; (4) apply teaching methods and goals associated with John Dewey to make students better problem-solvers; (5) find morally justifiable solutions to the problems driving our field; and (6) seek interdisciplinary and collaborative scholarship, service or teaching. (shrink)

The development of bioethics primarily at the cognitive level further perpetuates the tendency to construe all aspects of our lives, including our bodies, as technical systems. For example, if we consider the moral issue of organ sales without taking our embodiment into account, there appear to be no sound arguments for opposing such sales. However, it is important to consider the aspects of the phenomenal body that challenge rational deliberation by exploring an embodied approach to the ethical dilemma (...) produced by a proposed kidney exchange as presented in one of Krzysztof Kieslowski's Dekalog films. What is sought is a description of a body-measure that would serve as a critique of strictly cognitive bioethical deliberations. (shrink)

Clinical ethics, like bioethics more generally, until recently has tended to focus on the present and future, with little attention to the history of moral thought about health care that preceded bioethics. As a consequence, clinical ethics and bioethics lack maturity as fields of the humanities. The papers in this year's clinical ethics issue of the Journal put contemporary clinical ethics in critical dialogue with the past, making the former accountable (...) to the latter. The six papers in this issue of the Journal are briefly described, with an emphasis on how they contribute to the maturation of clinical ethics as a field of the humanities. (shrink)

In the field of medically assisted reproduction (MAR), there is a growing emphasis on the importance of introducing new assisted reproductive technologies (ARTs) only after thorough preclinical safety research, including the use of animal models. At the same time, there is international support for the three R’s (replace, reduce, refine), and the European Union even aims at the full replacement of animals for research. The apparent tension between these two trends underlines the urgency of an explicit justification of the use (...) of animals for the development and preclinical testing of new ARTs. Considering that the use of animals remains necessary for specific forms of ART research and taking account of different views on the moral importance of helping people to have a genetically related child, we argue that, in principle, the importance of safety research as part of responsible innovation outweighs the limited infringement of animal wellbeing involved in ART research. (shrink)

The main trends of the bioethics development in Belarus have been analyzed on the basis of the materials collected by the Ethics Documentation Center (ISEU, Minsk, Belarus). A critical review of the most important publications in the field since 2000 suggests that development of bioethics in Belarus has occurred in two parallel directions distantly connected to each other: a theoretical direction and a practical one. Despite there are objective and subjective reasons for introducing bioethics in Belarus (...) as an institutionally-organized system based on liberal values such as individual rights and freedom, a range of essential problems could be identified. Non-equivalent regulation of ethical issues in health care and other fields of biomedical research has been emphasized, as well as the problem of unclear hierarchical relationships among institutions dealing with various aspects of bioethics in the country and low ethical and educational level of the social and professional groups involved in further expansion of bioethical knowledge. The contextual aspects of the development of bioethics in the country such as the consequences of the Chernobyl disaster, the prevalence of the authoritarian social morality and traditionally paternalistic nature of the relations between physicians and their patients are discussed. (shrink)

In this paper, we develop a neo-Humean response to the problem of moral inclusion by bringing Humean moral philosophy into deep and serious dialogue with Latin American philosophy. Our argument for achieving this two-fold aim unfolds as follows. In section one, we elucidate Mia Sosa-Provencio’s conception of a mestiza ethics of care. We begin by highlighting its fundamental elements, especially its concern with what we refer to as the cultural embeddedness both of moral (...) agents and of moral patients. We then explain how this aspect of the mestiza ethic poses a distinctive challenge for Humean moral philosophy. In section two, we develop a neo-Humean response to this challenge. We begin by highlighting the strengths and limits of trying to develop a response by appealing to Hume’s conceptions of sympathy and humanity. We then present what we take to be the most plausible way for a neo-Humean conception of moral philosophy to offer a satisfactory reply to the challenge posed by the mestiza ethics of care, by appealing to two key concepts from outside the system of Hume’s moral philosophy: namely, sympathetic understanding and relational humility. (shrink)

Bioethics is, as is moral philosophy in general, a field spanning a range of different philosophical approaches, normative standpoints, methods and styles of analysis, metaphysics, and ontologies. In discussing bioethics, it is often seen as useful to introduce some kind of order on the field by categorizing individual philosophers or specific arguments into a relatively small number of categories. Such categorization or classification has several functions. It may help to show the relationship between basic assumptions and (...) specific arguments or it may be used argumentatively by arguing not against a single philosopher or her arguments but against the category to which she or they belong or are claimed to belong. In this way, whole lines of argument can be disposed of in one fell swoop and whole groups of philosophers dismissed by showing that they belong to some category that can, in some way, be discounted because it is fallacious. Or, conversely, lines of arguments and groups of philosophers can be celebrated and appropriated as support for yet new arguments. (shrink)

Should organ transplants be given to patients who have waited the longest, or need it most urgently, or those whose survival prospects are the best? The rationing of health care is universal and inevitable, taking place in poor and affluent countries, in publicly funded and private health care systems. Someone must budget for as well as dispense health care whilst aging populations severely stretch the availability of resources. The Ethics of Health Care Rationing is a (...) clear and much-needed introduction to this increasingly important topic, considering and assessing the major ethical problems and dilemmas about the allocation, scarcity and rationing of health care. Beginning with a helpful overview of why rationing is an ethical problem, the authors examine the following key topics: What is the value of health? How can it be measured? What does it mean that a treatment is "good value for money"? What sort of distributive principles - utilitarian, egalitarian or prioritarian - should we rely on when thinking about health care rationing? Does rationing health care unfairly discriminate against the elderly and people with disabilities? Should patients be held responsible for their health? Why does the debate on responsibility for health lead to issues about socioeconomic status and social inequality? Throughout the book, examples from the US, UK and other countries are used to illustrate the ethical issues at stake. Additional features such as chapter summaries, annotated further reading and discussion questions make this an ideal starting point for students new to the subject, not only in philosophy but also in closely related fields such as politics, health economics, public health, medicine, nursing and social work. (shrink)

This essay aims to broaden the understanding of the nature of the physician–patient relationship. To do so, the concept of medical philia that Pedro Laín Entralgo proposes is analysed and is considered taking into consideration the relational trait of the human being and the structure of human action as a story of the permanent tension that exists between freedom and truth, where the ontological foundation of the hermeneutic of the "Gift" and the analogy of “Love” as the central dynamic of (...) this action, helps explain the nature of the doctor-patient relationship as a "friendship relationship". This understanding offers a perspective differing from just the utilitarian considerations of current "patient-centred" approaches and proposed the redirection of the teaching of medicine to more humanistic approaches. The dynamic of the doctor-patient relationship proposed here in its most genuine essence is effectively expressed in physician concrete attitudes that the patient usually captures and relates as the “the doctor’s way of being”. Goya's painting, Self-portrait with Dr Arrieta (1820), can be taken as an outstanding artistic representation of this expanded dimension of the medical act, capturing the “medical friendship” in action. (shrink)

Stem cell research. Drug company influence. Abortion. Contraception. Long-term and end-of-life care. Human participants research. Informed consent. The list of ethical issues in science, medicine, and public health is long and continually growing. These complex issues pose a daunting task for professionals in the expanding field of bioethics. But what of the practice of bioethics itself? What issues do ethicists and bioethicists confront in their efforts to facilitate sound moral reasoning and judgment in a variety of (...) venues? Are those immersed in the field capable of making the right decisions? How and why do they face moral challenge -- and even compromise -- as ethicists? What values should guide them? In The Ethics of Bioethics, Lisa A. Eckenwiler and Felicia G. Cohn tackle these questions head on, bringing together notable medical ethicists and people outside the discipline to discuss common criticisms, the field's inherent tensions, and efforts to assign values and assess success. Through twenty-five lively essays examining the field's history and trends, shortcomings and strengths, and the political and policy interplay within the bioethical realm, this comprehensive book begins a much-needed critical and constructive discussion of the moral landscape of bioethics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Oxford Handbook of Jewish Ethics and Morality Edited by Elliot N. Dorff and Jonathan K. CraneLouis E. NewmanThe Oxford Handbook of Jewish Ethics and Morality EDITED BY ELLIOT N. DORFF AND JONATHAN K. CRANE New York: Oxford University Press, 2012. 499 pp. $150The Oxford Handbook of Jewish Ethics and Morality addresses what has long been a major lacuna in the field of Jewish studies. (...) No one who studies the history of Judaism would deny that ethics has always occupied a central place in Jewish thought and practice. Yet the scope and range of Jewish ethical reflection, the variety of ethical theories that have animated this tradition, and the diversity of ethical viewpoints represented by major thinkers across the centuries remain far less widely understood than they should be. With the publication of this outstanding and highly readable collection of essays, however, Elliot Dorff and Jonathan Crane have given us the most definitive and encyclopedic presentation of Jewish ethics ever assembled.This latest addition to the Oxford Handbook series encompasses twenty-nine essays that span the history of Jewish ethics from biblical times to the present, but that also introduce readers to its applied and theoretical dimensions as well as the practitioners and scholars who collectively define the field of Jewish ethics. Part 1, “Jewish Ethical Theories,” which is more accurately a comprehensive history of Jewish ethics, includes insightful pieces on biblical, rabbinic, and medieval ethics, but also pieces on key figures in the modern period from Baruch Spinoza to Martin Buber, Abraham Isaac Kook, and Joseph B. Soloveitchik, among others. This section also includes important explications of the ethics of the various modern movements of Judaism (Orthodox, Conservative, Reform, and Reconstructionist) as well as essays on specific events and theoretical perspectives that have shaped Jewish ethical discourse in the postwar period—the Holocaust, feminism, and postmodernism. What emerges from these short but remarkably focused and accessible essays is a rich tapestry in which the wide array of genres and methods that characterize the ethics of Judaism are on full display.The second half of the volume is devoted to applied ethics, and here again the diversity of Jewish ethics is showcased. The topics covered include bioethics, the ethics of speech, sexuality, business, the treatment of animals and the environment, politics (both in America and in Israel), criminal justice, and war. The topic of bioethics is wisely subdivided so that we find separate treatments of beginning and end of life, of access to health care, and of genetic technologies. [End Page 219] While some of these essays rehearse positions that will be familiar to those within the tradition, each is an original contribution designed to present the spectrum of positions on that issue that have been articulated by contemporary Jewish ethicists. Accordingly, this volume will now become the first place to look for broad, representative presentations on the most commonly discussed ethical issues of our time.The value of the whole collection is further enhanced by the editors’ introductions, which place the individual essays in context and explain their editorial decisions in selecting and arranging the contributions as they have. Each essay is accompanied by a substantial list of suggestions for further reading that will be valuable to readers in their own right. The entire volume is rounded out with a subject index and a list of references to classical Jewish literature. One could simply not ask for a more carefully constructed or broadly useful handbook on this subject.In any edited collection of this nature, the quality of the individual contributions will vary to some extent. In this instance, the overall quality is extremely high, which is a tribute both to the individual contributors and to the editorial guidance provided by Dorff and Crane. Still, one cannot help but notice that some essays in the second section of the book are more descriptive (e.g., Daniel Sinclair’s essay on end-of-life issues) while others are more ideologically driven (e.g., Arthur Waskow’s essay on environmental ethics). Similarly, while the essays average approximately fifteen to twenty pages each, a few are shorter and more cursory (e.g., Aaron Mackler’s essay on... (shrink)

The field of bioethics is increasingly coming into contact with empirical research findings. In this article, we ask what role empirical research can play in the process of ethical clarification and decision-making. Ethical reflection almost always proceeds in three steps: the description of the moral question,the assessment of the moral question and the evaluation of the decision-making. Empirical research can contribute to each step of this process. In the description of the moral object, first of all, (...) empirical research has a role to play in the description of morally relevant facts. It plays a role in answering the “reality-revealing questions” (what, why,how, who, where and when), in assessing the consequences and in proposing alternative courses of action. Secondly, empirical research plays a role in assessing the moral question. It must be acknowledged that research possesses “the normative power of the factual,” which can also become normative by suppressing other norms. However, inductive normativity should always be balanced out by a deductive form of normativity. Thirdly, empirical research also has a role to play in evaluating the decision-making process. It can rule out certain moral choices by pointing out the occurrence of certain unexpected consequences or effects. It can also be useful, however, as a sociology of bioethics in which the discipline of bioethics itself becomes an object of research. (shrink)

Western society today is less unified by a set of core values than ever before. Undoubtedly, the concept of moral consensus is a difficult one in a liberal, democratic and pluralistic society. But it is imperative to avoid a rigid majoritarianism where sensitive personal values are at stake, as in bioethics. Bioethics has become an influential part of public and professional discussions of health care. It has helped frame issues of moral values and medicine as (...) part of a more general effort to find consensus about some of the most perplexing questions of our time. But why is it thought that a moral consensus is important or that it deserves respect? How does moral consensus acquire legitimacy in a society that includes diverse value systems? How is moral consensus possible and how do small groups help create or distort consensus processes? Written by a medical school professor trained in philosophy, this timely work tackles these questions from philosophical, historical, and social scientific standpoints. It begins by describing the traditional ambivalence about consensus in Western culture as well as the uncertain relationship in modernity between consensus and expertise. After outlining the current bioethical consensus, the book gives philosophical and political analyses of the idea of consensus, then assesses the role of consensus in national ethics commissions and in the ethics committee movement. Moreno constructs an original, naturalistic philosophy of moral consensus, referred to as "bioethical naturalism", and then applies sociology and social psychology to actual consensus processes. The book concludes with an account of bioethics as a consensus-oriented social reform movement. This insightful volume will be essential reading for bioethicists, philosophers, physicians, members of ethics committees, and all those concerned with ethical and social issues in health care. (shrink)

Wandering is a symptom of dementia that can have devastating consequences on the lives of persons living with dementia and their families and caregivers. Increasingly, caregivers are turning towards electronic tracking devices to help manage wandering. Ethical questions have been raised regarding these location-based technologies and although qualitative research has been conducted to gain better insight into various stakeholders' views on the topic, developers of these technologies have been largely excluded. No qualitative research has focused on developers’ perceptions (...) of ethics related to electronic tracking devices. To address this, we performed a qualitative semi-structured interview study based on grounded theory. We interviewed 15 developers of electronic tracking devices to better understand how they perceive ethical issues surrounding the design, development, and use of these devices within dementia care. Our results reveal that developers are strongly motivated by moral considerations and believe that including stakeholders throughout the development process is critical for success. Developers felt a strong sense of moral obligation towards topics within their control and a weaker sense of moral obligation towards topics outside their control. This leads to a perceived moral boundary between development and use, where some moral responsibility is shifted to end-users. (shrink)

Research in moral psychology has recently raised questions about the impact of context and the environment on the way the human mind works. In a 2012 call to action, Paley wrote: “If some of the conclusions arrived at by moral psychologists are true, they are directly relevant to the way nurses think about moral problems, and present serious challenges to favoured concepts in nursing ethics, such as the ethics of care, virtue, and the unity (...) of the person” (p. 80). He urges nurse ethicists and scholars to evaluate the impact these findings may have for moral theory.In this paper, I review some of Paley's (Nursing Philosophy, 13, 2012, 80) critique, focusing on the argument that theories of nursing ethics have failed to account for the role of context; both in terms of its impact on the way nurses make moral judgements and in terms of the environment's influence on the way the mind works. I then examine nursing literature on moral agency, and focus on the role of the environment and context play within existing theory. I argue that theories of moral agency have often accounted for the role of context on the way nurses make decisions; however, less attention has been paid to its impact on the mind. With this background, I use insights from the fields of moral philosophy and moral psychology to refine the conceptualization of nurse moral agency in a way that is reflective of current cognitive, philosophical and nursing practice‐based science. (shrink)

The Ethics of Need: Agency, Dignity, and Obligation argues for the philosophical importance of the notion of need and for an ethical framework through which we can determine which needs have moral significance. In the volume, Sarah Clark Miller synthesizes insights from Kantian and feminist care ethics to establish that our mutual and inevitable interdependence gives rise to a duty to care for the needs of others. Further, she argues that we are obligated not merely (...) to meet others’ needs but to do so in a manner that expresses "dignifying care," a concept that captures how human interactions can grant or deny equal moral standing and inclusion in a moral community. She illuminates these theoretical developments by examining two cases where urgent needs require a caring and dignifying response: the needs of the elderly and the needs of global strangers. Those working in the areas of feminist theory, women’s studies, aging studies, bioethics, and global studies should find this volume of interest. (shrink)

The bioethical principle of respect for a person’s bodily autonomy is central to biomedical and healthcare ethics. In this article, we argue that this concept of autonomy is often annulled in the maternity field, due to the maternal two-in-one body (and the obstetric focus on the foetus over the woman) and the history of medical paternalism in Western medicine and obstetrics. The principle of respect for autonomy has therefore become largely rhetorical, yet can hide all manner of unethical practice. (...) We propose that large institutions that prioritize a midwife–institution relationship over a midwife–woman relationship are in themselves unethical and inimical to the midwifery philosophy of care. We suggest that a focus on care ethics has the potential to remedy these problems, by making power relationships visible and by prioritizing the relationship above abstract ethical principles. (shrink)

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care (...) Ethics Consultants, the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

It seems obvious that phenomenally conscious experience is something of great value, and that this value maps onto a range of important ethical issues. For example, claims about the value of life for those in a permanent vegetative state, debates about treatment and study of disorders of consciousness, controversies about end-of-life care for those with advanced dementia, and arguments about the moral status of embryos, fetuses, and non-human animals arguably turn on the moral significance of various (...) facts about consciousness. However, though work has been done on the moral significance of elements of consciousness, such as pain and pleasure, little explicit attention has been devoted to the ethical significance of consciousness. In this book Joshua Shepherd presents a systematic account of the value present within conscious experience. This account emphasizes not only the nature of consciousness, but the importance of items within experience such as affect, valence, and the complex overall shape of particular valuable experiences. Shepherd also relates this account to difficult cases involving non-humans and those with disorders of consciousness, arguing that the value of consciousness influences and partially explains the degree of moral status a being possesses, without fully determining it. The upshot is a deeper understanding of both the moral importance of phenomenal consciousness and its relations to moral status. This book will be of great interest to philosophers and students of ethics, bioethics, philosophy of psychology, philosophy of mind and cognitive science. (shrink)

McCarthy et al. have made an important contribution to the field of ethics by identifying the important similarities between Christian and secular bioethics that can be drawn on to further s...

When many people think of bioethics, they think of gripping issues in clinical medicine such as end-of-life decision-making, controversies in biomedical research such as that over work with stem cells, or issues in allocating scarce health-care resources such as organs or money. The term “bioethics” may evoke images of moral controversies being discussed on news programs and talk shows. But this “controversy of the day” focus often treats ethical issues in medicine superficially, for it addresses them (...) as if they could be examined and discussed in isolation from the context in which they are situated. Such a focus on the latest controversies fails to take into account that medicine is a social institution and that the controversies in bioethics often reflect deeper social and moral issues that transcend the boundaries of medicine and ethics. If one moves beyond the issue-of-the-day approach to bioethics, one can see that the field must address these deeper issues. (shrink)

Various debates in bioethics have been focused on whether non-persons, such as marginal humans or non-human animals, deserve respectful treatment. It has been argued that, where we cannot agree on whether these individuals have moral status, we might agree that they have symbolic value and ascribe to them moral value in virtue of their symbolic significance. In the paper I resist the suggestion that symbolic value is relevant to ethical disputes in which the respect for individuals with (...) no intrinsic moral value is in conflict with the interests of individuals with intrinsic moral value. I then turn to moral status and discuss the suitability of personhood as a criterion. There some desiderata for a criterion for moral status: it should be applicable on the basis of our current scientific knowledge; it should have a solid ethical justification; and it should be in line with some of our moral intuitions and social practices. Although it highlights an important connection between the possession of some psychological properties and eligibility for moral status, the criterion of personhood does not meet the desiderata above. I suggest that all intentional systems should be credited with moral status in virtue of having preferences and interests that are relevant to their well-being. (shrink)

Agonizing care: care ethics, agonistic feminism and a political theory of care ‘Care’ is central to nursing theory and practice, and has been described in a variety of ways. Intense conversations about care have been developing in other fields of study as well, from the social sciences to the humanities. Care ethics has grown out of intellectual exchange between feminist thought, moral theory and the critique of traditional western political (...) class='Hi'>philosophy. However, care ethics is not without its critics, as these accounts of care have also sparked vigorous challenges. This paper traces the construct of care through nursing theory, care ethics, feminist critiques of moral and political theory and agonistic feminism to outline a set of problematics that a political theory of care should engage. It discusses how care is conventionally posited in more or less essentialist, universalizing and naturalizing terms. It introduces the ideas of feminist theorists who resist dichotomizing care and the political, and situate care in the context of power and politics. The tensions between care feminism and agonistic feminism are highlighted in order to explore the potential of theorizing both care and nursing in political terms. (shrink)

The response to feeding needs in advanced dementia patients is a subject of ethical inquiry. Advanced dementia is the debilitating result of a range of neurodegenerative diseases. As this terminal illness progresses, patients develop mild to severe dysphagia that can make swallowing difficult. Of the two available options, artificial tube feeding or oral hand feeding, an estimated one-third of these patients will receive artificial tube feeding. However, observational studies have failed to validate the clinical benefits of tube feeding. (...) Ethics of care, the feminist philosophical perspective, and Ubuntu philosophy offer arguments for the choice of oral hand-feeding as a preferrable first option by caregivers as far as possible. These moral theories acknowledge that human beings can be dependent for long periods, mostly early and later years of life. Both views reflect an approach that draws people into a system of interdependent caring relationships. They encourage hand feeding as a way of exhibiting solidarity and respecting human dignity even at the end of life. (shrink)

Specifying the moral demands of respect for the autonomy of people with dementia (PWD) in nursing homes (NHs) remains a challenging conceptual task. These challenges arise primarily because received notions of autonomous decision-making and informed consent do not straightforwardly apply to PWD in NHs. In this paper, I investigate whether, and to what extent, the influential account of autonomous decision-making and informed consent proposed by Beauchamp and Childress has applicability and relevance to PWD in NHs. Despite its otherwise (...) practical orientation and suitability for acute care settings, I identify three problems with this account when applied to PWD in NHs. These problems include (1) intentionality as an all-or-nothing condition of autonomous decision-making, (2) construing consent as one-off authorization, and (3) unresolved ambiguities around the primacy of precedent autonomy over best interest considerations. To address these problems, I propose and defend a number of revisions to Beauchamp and Childress’s account. First, I suggest that we consider intentionality as a non-binary criterion of autonomous decision-making. Second, I argue for a model of process consent to overcome the moral inadequacy of construing consent as one-off authorization in NHs. And, to overcome the third problem, I suggest accounting for both precedent and extant autonomy of PWD, considering mandates of precedent autonomy not as prescriptive but as informative, and drawing a less rigid distinction between autonomy considerations and best interest judgements. I conclude that this revised version of Beauchamp and Childress’s account fares better than the original version in capturing relevant autonomy considerations to care for PWD in NHs. (shrink)

Monitoring and assistive technologies (MATs) are being used more frequently in healthcare. A central ethical concern is the compatibility of these systems with the moral preferences of their users—an issue especially relevant to participatory approaches within the ethics-by-design debate. However, users’ incapacity to communicate preferences or to participate in design processes, e.g., due to dementia, presents a hurdle for participatory ethics-by-design approaches. In this paper, we explore the question of how the value preferences of users in (...) the field of dementia care can be integrated into AI-based MATs. First, we briefly introduce different ethics-by-design approaches and explain the challenges they face in dementia care. Next, we introduce a novel approach for addressing these challenges. Through a qualitative content analysis of interviews with persons with dementia and their family caregivers (n = 27), we identified multiple ideal–typical value preference profiles. We then applied these profiles in a computer simulation, by which we also introduce the concept of ethical compliance quantification to scale the moral preferences of the interviewees for the simulation. Finally, we discuss study results, the advantages of using computer simulations, and general study limitations before drawing conclusions for further research. The study contributes to the ongoing debate on participatory ethics-by-design by defining on the basis of empirical data ideal–typical value preference frameworks that can be used to guide MAT actions and their outcomes. Going forward, MAT end-users with dementia and other communication-impaired persons could be enabled to choose a value profile that best fits their moral preferences. (shrink)

The aim of the paper is to reveal the main methodological problems of neuroethics in the course of its development as an interdisciplinary approach to the study of morality, as well as to propose a critical analysis of the results of cognitive science (neurophysiol­ogy) in the context of moral philosophy. For this purpose, the author analyzes the modern subject field of neuroethical research from the point of view of philosophical ethics and discusses the main conceptions in which (...) the results of neurophysiological studies of the moral decision-making process are summarized. The author describes a general divi­sion of the subject field in terms of “neuroethics No. 1” (a part of bioethics) and “neu­roethics No. 2” (a proclaimed part of moral philosophy). The object of research of this ar­ticle is neuroethics No. 2. It is argued that in neuroethics No. 2 the conceptualization of the moral decision-making process is carried out everywhere in accordance with the scheme of “double processes”: intuitive / quick / associative and discursive / slow / calculation-based. Even if the role of intuition is denied, duality is still preserved. This is so because emotions, as an extra-rational part of the psyche, are considered the basis of a quick decision. It is shown that a non-reflexive borrowing of concepts and concep­tions of moral philosophy is carried out both at the level of formation of the subject of re­search and at the level of method. The qualitatively meaningful meaning of concepts is blurred or substituted. Such a language transition outside the boundaries of the subject area of neurophysiology only simulates the presence of interdisciplinarity. The research remains in the frames of the study of cognitive processes, without their moral component. It is concluded that for the development of neuroethics as an interdisciplinary direction, we need to obtain a synthesis of the meanings developed in the course of cultural devel­opment and of the data on human biological development. Further, in accordance with such a synthetic subject we need to adjust the research method, also we must avoid sub­stituting the concepts of philosophical ethics. (shrink)

When many people think of bioethics, they think of gripping issues in clinical medicine such as end-of-life decision-making, controversies in biomedical research such as that over work with stem cells, or issues in allocating scarce health-care resources such as organs or money. The term “bioethics” may evoke images of moral controversies being discussed on news programs and talk shows. But this “controversy of the day” focus often treats ethical issues in medicine superficially, for it addresses them (...) as if they could be examined and discussed in isolation from the context in which they are situated. Such a focus on the latest controversies fails to take into account that medicine is a social institution and that the controversies in bioethics often reflect deeper social and moral issues that transcend the boundaries of medicine and ethics. If one moves beyond the issue-of-the-day approach to bioethics, one can see that the field must address these deeper issues. (shrink)

The field of bioethics is increasingly coming into contact with empirical research findings. In this article, we ask what role empirical research can play in the process of ethical clarification and decision-making. Ethical reflection almost always proceeds in three steps: the description of the moral question,the assessment of the moral question and the evaluation of the decision-making. Empirical research can contribute to each step of this process. In the description of the moral object, first of all, (...) empirical research has a role to play in the description of morally relevant facts. It plays a role in answering the “reality-revealing questions” (what, why,how, who, where and when), in assessing the consequences and in proposing alternative courses of action. Secondly, empirical research plays a role in assessing the moral question. It must be acknowledged that research possesses “the normative power of the factual,” which can also become normative by suppressing other norms. However, inductive normativity should always be balanced out by a deductive form of normativity. Thirdly, empirical research also has a role to play in evaluating the decision-making process. It can rule out certain moral choices by pointing out the occurrence of certain unexpected consequences or effects. It can also be useful, however, as a sociology of bioethics in which the discipline of bioethics itself becomes an object of research. (shrink)

Genome Editing Techniques are seen to be at the frontier of current research in the field of emerging biotechnologies. The latest revolutionary development, the so-called CRISPR technology, represents a paradigmatic example of the ambiguity of such techniques and has resulted in an international interdisciplinary debate on whether or not it is necessary to ban the application of this technique by means of a moratorium on its use for human germline modifications, particularly in human embryos in the reproduction process. However, given (...) that other germline engineering techniques like mitochondrial DNA transfer techniques are already permitted and applied, the question arises what lies at the root of the apparent social unease about the modification of the human germline by Genome Editing Techniques like CRISPR. Against this background, the book seeks to make a substantial contribution to the current debate about a responsible and participatory framework for research on emerging biotechnologies by analysing underlying perceptions, attitudes, arguments and the reasoning on Genome Editing Techniques. (shrink)

Over the past three or four decades, the concept of medical ethics has changed from a limited set of standards to a broad field of debate and research. We define medical ethics as an arena of moral issues in medicine, rather than a specific discipline. This paper examines how the disciplines of health care ethics and health care law have developed and operated within this arena. Our framework highlights the aspects of jurisdiction and the (...) assignment of responsibilities . This theoretical framework prompted us to study definitions and changing responsibilities in order to describe the development and interaction of health care ethics and health law. We have opted for the context of the Dutch debate about end-of-life decisions as a relevant case study. We argue that the specific Dutch definition of euthanasia as ‘intentionally taking the life of another person by a physician, upon that person’s request’ can be seen as the result of the complex jurisdictional process. This illustrates the more general conclusion that the Dutch debate on end-of-life decisions and the development of the two disciplines must be understood in terms of mutual interaction. (shrink)

Over the past three or four decades, the concept of medical ethics has changed from a limited set of standards to a broad field of debate and research. We define medical ethics as an arena of moral issues in medicine, rather than a specific discipline. This paper examines how the disciplines of health care ethics and health care law have developed and operated within this arena. Our framework highlights the aspects of jurisdiction and the (...) assignment of responsibilities. This theoretical framework prompted us to study definitions and changing responsibilities in order to describe the development and interaction of health care ethics and health law. We have opted for the context of the Dutch debate about end-of-life decisions as a relevant case study. We argue that the specific Dutch definition of euthanasia as ‘intentionally taking the life of another person by a physician, upon that person’s request’ can be seen as the result of the complex jurisdictional process. This illustrates the more general conclusion that the Dutch debate on end-of-life decisions and the development of the two disciplines must be understood in terms of mutual interaction. (shrink)

This book is a collection of articles about communication and ethics in the field of medicine and health care. Common to all the articles is that they are not directly based on empirical investigations. The discussions refer to research, but this is research that has already been carried out and documented in existing literature. In this sense the articles belong to what is often called applied philosophy. All the articles address communicative and ethical challenges in patient interaction (...) on the basis of assumptions in modern moral philosophy and philosophy of language. There is a great need for literature that deals more comprehensively with the themes in this book than many introductory books do. It is particularly difficult to find suitable reading material that can be used in teaching at graduate and master levels. This book is designed to meet this need. It is suitable for use in all higher-level courses where the aim is to give students a theoretical understanding of ethical dilemmas and communicative challenges in health care. (shrink)

BackgroundDementia care is essential to promote the well-being of patients but remains a difficult task prone to ethical issues. These issues include questions like whether manipulating a person with dementia is ethically permissible if it promotes her best interest or how to engage with a person who is unwilling to recognize that she has dementia. To help people living with dementia and their carers manage ethical issues in dementia care, we developed the CARE (...) intervention. This is an intervention focused on promoting the ethical self-efficacy of people living with dementia and carers, i.e., their confidence that they can manage ethical issues when they occur. The purpose of this paper is to explain and discuss how we have developed the CARE intervention to promote the ethical self-efficacy of people living with dementia, their family, and professional carers through a specific and, we believe, new use of literary texts.MethodsThe CARE intervention has been developed in two phases: First, we conducted a needs assessment of the occurrence of ethical issues in dementia care and the need for an intervention to support people living with dementia and their carers in managing such issues. Second, in a design phase, we developed the CARE intervention to meet identified needs.ResultsTo address identified ethical issues in dementia care we designed the CARE intervention as a workshop format where people living with dementia and carers can meet, discuss literary texts, and deliberate on how to solve such issues. The workshop is structured by the following elements: An agenda of ethical issues, a collection of literary cases exemplifying ethical issues, a moderator with an understanding of dementia care, and an overview of the ethical principles relevant to the discussion of ethical issues. >This workshop concept is operationalized in three applications tailored to meet the specific ethical issues of each of the study´s three target groups: people living with dementia and family carers, professional and family carers, and professional carers.ConclusionWe conclude the paper by stating that it is possible to develop an intervention that promotes the ethical self-efficacy of people living with dementia and family and professional carers. (shrink)