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

How important is the concept of solidarity in our society's calculus of consent as regards the legitimacy and ethical and political support for public health, health policy, and health services? By the term “calculus of consent,” we refer to the answer that people give to rationalize and justify their obedience to laws, rules, and policies that benefit others. The calculus of consent answers questions such as, Why should I care? Why should I help? Why should I contribute to the public (...) provision of others? Consent here does not have to be a deliberate, explicit act of informed agreement. And a calculus does not have to be a quantifiable, quasimathematical operation; more often, such a calculus takes narrative form in stories that a society tells about itself and that individuals tell about their place in it. One vital function of bioethics is to inform and shape those stories. Bioethics has the potential to offer society a keener insight into and perception of what is ethically at stake in controversies concerning health, science, and society. This insight is what we shall refer to as a “moral imagination,” by which we do not mean make-believe or fantasy but, rather, the capacity to take a critical distance from the given, to think reality otherwise. The moral imagination enables one to see connections between factors at work in history, in large social and communal structures, and in the shape of one's own life, thoughts, and feelings. Here we are especially concerned with the contribution that the concept of solidarity can make to the moral imagination of bioethics. We contend that solidarity must become more widely active and explicit in bioethics analysis and argumentation as it endeavors to shape reasons for obeying norms and rules of common benefit in an open, diverse society. (shrink)

This article defends ‘relational theorizing’ in bioethics and public health ethics and describes its importance. It then offers an interpretation of solidarity and care understood as normatively patterned and psychologically and socially structured modes of relationality; in a word, solidarity and care understood as ‘practices.’ Solidarity is characterized as affirming the moral standing of others and their membership in a community of equal dignity and respect. Care is characterized as paying attention to the moral being of others and their needs, (...) suffering, and vulnerability. The wager of relational theorizing in health care and public health is that substantive ethical visions of solidarity and care will provide support for more just and egalitarian health care and public health policies. (shrink)

Center for Humans and Nature, 109 West 77th Street, Suite 2, New York, NY 10024, USA. Tel.: 212 362 7170; Fax: 212 362 9592; Email: brucejennings{at}humansandnature.org ' + u + '@' + d + ' '//--> . Abstract A fundamental question for the ethical foundations of public health concerns the moral justification for limiting or overriding individual liberty. What might justify overriding the individual moral claim to non-interference or to self-realization? This paper argues that the libertarian justification for limiting individual (...) liberty known as the ‘harm principle’ or the ‘Millian paradigm’ is inadequate as a basis of public health ethics and policy. But simply pitting some collectivist value or utilitarian criterion over against individual liberty is not theoretically satisfactory, either. John Stuart Mill himself was not a Millian, in this sense, and his utilitarianism does not pit itself against individual liberty as a situation of balancing conflicting values. A reconsideration of Mill, particularly in light of the later work of Berlin on liberty, points toward a conception of relational liberty that is crucial for public health ethics because it contains within itself the basis for its own moral limitation. CiteULike Connotea Del.icio.us What's this? (shrink)

Public health involves the use of power to change institutions and redistribute resources and deliberately to shape individual thought and behavior. This requires normative legitimation and demands ethical critique. This article explores concepts that are vital to public health ethics, but have been relatively neglected. These are membership, solidarity and the concept of place. The article argues that the practice of public health should recognize the equal rights of membership in communities of health justice. Public health should also rely on (...) a sense of obligation and mutual aid in a world of shared vulnerability and reciprocal recognition. Finally, public health achieves its goals not merely—and perhaps not most fundamentally—through information and altering the logical ratiocination of individuals or groups, but rather through the reformation of sense and sensibility. (shrink)

The concept of consensus is often appealed to in discussions of biomedical ethics and applied ethics, and it plays an important role in many influential ethical theories. Consensus is an especially influential notion among theorists who reject ethical realism and who frame ethics as a practice of discourse rather than a body of objective knowledge. It is also a practically important notion when moral decision making is subject to bureaucratic organization and oversight, as is increasingly becoming the case in medicine. (...) Two models of consensus are examined and criticized: pluralistic consensus and overlapping consensus. As an alternative to these models, the paper argues that consensus refers to the dialogic aspects of a broader normative conception of democratic moral agency. When the preconditions for that dialogic democratic practice are met, consensus has a justificatory role in ethics; when they are not, consensus, as distinct from mere agreement, does not emerge and can have no moral authority. Keywords: applied ethics, bioethics, consensus, contract theory, democracy, discourse ethics, liberalism CiteULike Connotea Del.icio.us What's this? (shrink)

No single concept has been more important in the contemporary development of bioethics, and the revival of medical ethics, than the concept of autonomy, and none better reflects both the philosophical and the political currents shaping the field. This article proposes to consider autonomy in three of its facets and functions: first, as a concept in ethical theory; second, as a concept in applied ethics; and finally, as what might be called an ideological concept — that is, one that both (...) draws from and reinforces non-philosophical interests at work in the profession of medicine, biomedical science and technology, and the broader liberal individualistic culture of Anglophone countries, particularly the United States, where a bioethical discourse centred on autonomy has flourished. (shrink)

Volume 20, Issue 5, June 2020, Page 64-66.

This essay examines the goals of care and the exercise of guardianship authority in the long-term care of persons with Alzheimer's disease and other forms of chronic, progressive dementia. It counters philosophical views that deny both agency and personhood to individuals with Alzheimer's on definitional or analytic conceptual grounds. It develops a specific conception of the quality of life and offers a critique of hedonic conceptions of quality of life and models of guardianship that are based on a hedonic legal (...) standard of “best interests.” As an alternative, it proposes a conception of quality of life based on the notions of “semantic agency” and “memorial personhood.”. (shrink)

The social sciences playa variety of multifaceted roles in the policymaking process. So varied are these roles, indeed, that it is futile to talk in the singular about the use of social science in policymaking, as if there were one constant relationship between two fixed and stable entities. Instead, to address this issue sensibly one must talk in the plural about uses of dif ferent modes of social scientific inquiry for different kinds of policies under various circumstances. In some cases, (...) the influence of social scientific research is direct and tangible, and the connection between the find ings and the policy is easy to see. In other cases, perhaps most, its influence is indirect-one small piece in a larger mosaic of politics, bargaining, and compromise. Occasionally the findings of social scientific studies are explicitly drawn upon by policymakers in the formation, implementation, or evaluation of particular policies. More often, the categories and theoretical models of social science provide a general background orientation within which policymakers concep tualize problems and frame policy options. At times, the in fluence of social scientific work is cognitive and informational in nature; in other instances, policymakers use social science primarily for symbolic and political purposes in order to le gitimate preestablished goals and strategies. Nonetheless, amid this diversity and variety, troubling general questions persistently arise. (shrink)

Discussions of research involving vulnerable populations have left the homeless comparatively ignored. Participation by these subjects in drug studies has the potential to be upsetting, inconvenient, or unpleasant. Participation occasionally produces injury, health emergencies, and chronic health problems. Nonetheless, no ethical justification exists for the categorical exclusion of homeless persons from research. The appropriate framework for informed consent for these subjects of pharmaceutical research is not a single event of oral or written consent, but a multi-staged arrangement of disclosure, dialogue, (...) and permission-giving. Payments and other rewards in biomedical research raise issues of whether it is ethical to offer inducements to the homeless in exchange for participation in drug studies. Such inducements can influence desperate persons who are seriously lacking in resources. The key is to strike a balance between a rate of payment high enough that it does not exploit subjects by underpayment and low enough that it does not create an irresistible inducement. This proposal does not underestimate the risks of research, which are often overestimated and need to be appraised in light of the relevant empirical literature. (shrink)

The further development of public health ethics will be assisted by a more direct engagement with political theory. In this way, the moral vocabulary of the liberal tradition should be supplemented—but not supplanted—by different conceptual and normative resources available from other traditions of political and social thought. This article discusses four lines of further development that the normative conceptual discourse of public health ethics might take. The relational turn. The implications for public health ethics of the new ‘ecological’ or ‘relational’ (...) interpretation that is emerging for concepts such as agency, self-identity, autonomy, liberty and justice. Governing the health commons. The framework of collective action problems is giving way to notions of democratic governance and management of common resources. The concept of membership. Membership is specified by the notions of equal respect and parity of voice and agency. The concept of mutuality. Mutuality is specified by the notions of interdependent concern and care. (shrink)

Across the world, an authoritarian and exclusionary form of populism is gaining political traction. Historically, some populist movements have been democratic and based on a sense of inclusive justice and the common good. But the populism on the rise at present speaks and acts otherwise. It is challenging constitutional democracies. The polarization seen in authoritarian populism goes beyond the familiar left-right political spectrum and generates disturbing forms of extremism, including the so-called alternative right in the United States and similar ethnic (...) and nationalistic political movements in other countries. The field of bioethics will be profoundly affected if authoritarian populism displaces constitutional democracy. But the field has a significant contribution to make to rebuilding the communal and civic foundations upon which constitutional democracy rests. (shrink)

This paper argues that more attention should be paid to the civic functions of ethical discourse about the professions and to the moral virtues inherent in their practice and traditions. The ability of professional ethics to articulate civic ideals and virtues is discussed in relation to three issues. First, should professional ethics aim to enlighten ethical understanding or to motivate ethical conduct? Second, how should professional ethics define the professional's moral responsibilities in the face of ethical dilemmas — should the (...) professional attempt to resolve the dilemma ethically or to change the social conditions that create the dilemma in the first place? The third issue discussed in the paper is whether professional ethics should be based on the model of regulation and rational self-interest or on the model of virtue and a fundamental personal commitment to the ideal of a certain form of life? In order for work in professional ethics to attain intellectual credibility among a non-philosophical audience, it must develop a coherent and convincing position on each of these issues. (shrink)

This article reflects on the implications of the concept of health and the questions it poses for moral philosophy, psychology, and the panoply of professions that are involved in the practices of care and in the ethics of individual rights, dignity, and autonomy. Significant among these questions is what we call “the predicament of agency.” The predicament involves the ethical tensions—arising within the broad concept of health and flourishing, but also in concrete everyday practices and relationships—between supporting individual health outcomes (...) and supporting health and flourishing through respect for autonomy and self-direction. Three ways of addressing the predicament of agency are discussed: by reinterpreting the nature and requirements of autonomy (a) by appeal to reason, (b) by designing or curating contextual conditions influencing choice (often called “choice architecture” or “nudging”) in ways that constrain autonomy but do not violate its core value, and (c) by appeal to relational judgment and reflective professional practice. The article argues that each of these lines of thought is important, but none is a panacea, and none is free from conceptual confusions and ethical pitfalls of its own. The relational approach is the most promising in pointing beyond the predicament of agency—not so much by resolving it as by showing how it can be worked through without either turning our back on caring or turning caring into management and manipulation. (PsycINFO Database Record (c) 2016 APA, all rights reserved). (shrink)

Hastings Center Report, Volume 52, Issue 4, Page 46-47, July–August 2022.

ABSTRACT:Democracy—as a form of governance, a moral community, and a way of life—is under great stress. The prospects for democracy and bioethics are linked because bioethics relies on an open society and a democratic cultural environment in order to flourish. For its part, democracy can be restored and strengthened by widespread cultural and psychological support for the values of mutual recognition, equal dignity and respect for persons, and solidarity, interdependence, and the common good. Promoting values such as these is in (...) keeping with the founding vision of bioethics, which was a civic vision. At the present time, bioethics can and should continue to be a bioethics for democracy by engaging directly in civic learning and civic place-making. These have a significant impact on health as well as on democracy. (shrink)

hope of obtaining a comprehensive and coherent understand ing of the human condition, we must somehow weave together the biological, sociological, and psychological components of human nature and experience. And this cannot be done indeed, it is difficult to even make sense of an attempt to do it-without first settling our accounts with Darwin, Marx, and Freud. The legacy of these three thinkers continues to haunt us in other ways as well. Whatever their substantive philosophical differences in other respects, Darwin, (...) Marx, and Freud shared a common, overriding intellectual orientation: they taught us to see human things in historical, developmental terms. Phil osophically, questions of being were displaced in their works by questions of becoming. Methodologically, genesis replaced teleological and essentialist considerations in the explanatory logic of their theories. Darwin, Marx, and Freud were, above all, theorists of conflict, dynamism, and change. They em phasized the fragility of order, and their abiding concern was always to discover and to explicate the myriad ways in which order grows out of disorder. For these reasons their theories constantly confront and challenge the cardinal tenet of our modern secular faith: the notion of progress. To be sure, their emphasis on conflict and the flux of change within the flow of time was not unprecedented; its origins in Western thought can be traced back at least as far as Heraclitus. (shrink)

Volume 1: A-B -- Volume 2: C-E -- Volume 3: F-I -- Volume 4: J-O -- Volume 5: P-R -- Volume 6: S-X.

This book identifies and explores ethical themes in the structure and delivery of hospice care in the United States. As the fastest growing sector in the US healthcare system, in which over forty percent of patients who die each year receive care in their final weeks of life, hospice care presents complex ethical opportunities and challenges for patients, families, clinicians, and administrators. Thirteen original chapters, written by seventeen hospice experts, offer guidance and analysis that promotes best ethical practice for hospice (...) organizations and professionals. The book addresses common questions and issues faced by those who work in hospice care, a dynamic movement that, in only 30 years, has shifted from an all-volunteer care alternative at the end of life to a highly regulated industry in which over half of providers are for-profit enterprises in a very competitive health care marketplace. The chapters show how the history and philosophy of hospice care can inform the values and composition of care teams, the operations of inpatient units, and access to care for pediatric and long-term care populations. Various chapters propose frameworks for deliberating organizational approaches to ethical questions in changing regulatory and legal environments, including a model for hospice ethics committees. The final chapter outlines an expanded model of hospice as a community based, interdisciplinary, and holistic form of palliative care emphasizing advance planning, case management, and a flexible spectrum of services. This model can serve as a centrepiece for a new quality of life and social support approach, not only to terminal care, but also long-term care during the later stages of chronic illness and fraility. (shrink)

This chapter introduces readers to the aims and scope of the book. Readers are given the social and scholarly context in which the book emerges. The introduction suggests that the history and philosophy of hospice care contain moral values that can be resonant or dissonant with larger social values, giving those who work in hospice organizations an important place in the national discussion about terminal care. Finally, it offers a brief explanation of the goals of each chapter in the book.