Despite enthusiasm for patient-centered care, the practice of patient-centered care is proving challenging. Further, it is curious that the literature about this subject does not explicitly address patient autonomy, since patients guide care in patient-centered care, and respect for patient autonomy is a prominent health-care value. We argue that by explicitly adopting a relational conception of autonomy as an essential component, patient-centered care becomes more coherent, is strengthened, and could help practitioners to make better use of a principle of respect (...) for autonomy. Hence, its use appears promising to narrow the theory–practice gap. (shrink)

The purpose of this paper is to show that the standard notion of informed choice is unacceptable and must be replaced. To do so, I examine Foucault's analysis of people in contemporary society, drawing attention to the ways power relations act upon us, and to the possibility of resistance. I show how feminist moral theory can be enriched by Foucault's analysis. Applying this new understanding of people and moral theory to an analysis of informed choice, I claim that the standard (...) notion of informed choice is unacceptable, in part because it relies on a false conception of people. Its “necessary” features—intention, understanding, and absence of controlling influences—are much more difficult, if not impossible, to obtain than proponents of the standard notion believe. I end by offering direction for creating a new, Foucault-inspired, feminist theory of informed choice. (shrink)

The Declaration of Helsinki is recognised worldwide as a cornerstone of research ethics. Working in the wake of the Nazi doctors’ trials at Nuremberg, drafters of the Declaration set out to codify the obligations of physician-researchers to research participants. Its significance cannot be overstated. Indeed, it is cited in most major guidelines on research involving humans and in the regulations of over a dozen countries.Although it has undergone five revisions,1 and most recently incorporated language aimed at addressing concerns over research (...) carried out in resource-poor countries,2–5 the Declaration could go much farther in addressing the profoundly altered landscape of research with humans. Research involving humans is now a global enterprise and often involves participants from resource-poor countries. Rather than being carried out at single institutions by veteran researchers, many studies are now conducted at many locations—including sites that are not academic medical centres—by new and relatively inexperienced investigators. A growing number of projects involve novel agents, based on innovative work in genomics and proteomics. Increasingly, research is sponsored by the for-profit sector. National governments and professional organisations around the globe provide laws, regulations and standards for the conduct of research involving humans. Considerable scholarship also critiques and guides this endeavour.In light of the current effort of the World Medical Association to revise the Declaration, we offer ideas on how to re-conceive the concept of “vulnerability” and its links with the principle of justice and, in turn, redirect the attention of researchers towards those who might be so designated.In the research context, “vulnerability” is associated with an inability partly or totally to protect one’s own interests. Typically, conceptions of vulnerability centre upon characteristics associated with particular groups that …. (shrink)

(2010). Levels of Intervention: Communicating with More Precision About Planned Use of Critical Interventions. The American Journal of Bioethics: Vol. 10, No. 1, pp. 78-79.

Some feminists have been critical about the dominant conception of autonomy, questioning, for example, its conception of persons and ideal of personhood. Tom Beauchamp and James Childress (BC), the major proponents of the dominant conception of autonomy, believe that these feminists have misunderstood their theory and, moreover, that their theory is immune to feminist attack. Their response to feminist critics, however, has been dismissive and does nothing to assuage these critics concerns. In this paper I briefly review the state of (...) play in this debate about autonomy, showing that BC are not without positive rejoinders to objections raised by feminist critics. These rejoinders rest on the notion that feminist concerns are a matter of what is logically entailed by BCs theory of autonomy and attempt to show that feminist commitments are logically consistent with that theory. However, these rejoinders are less than convincing for reasons illuminated by Cheshire Calhoun. Calhoun reminds us that feminists are sensitive to ways in which the shape of discourse is influenced by non-epistemic considerations. In particular, Calhoun draws our attention to the cumulative effect of a whole tradition of moral reasoning that focuses on too narrow a range of moral problems and too narrow an understanding of people and the human condition. BCs conception of autonomy relies on and reinforces ideologies of the moral life created in just this way. Following Calhoun, I show that criticism of their theory as ideology is not criticism of its logical implications, but something far more damaging, something without available rejoinders. (shrink)

This commentary was submitted to the World Medical Association on behalf of the International Network on Feminist Approaches to Bioethics. Our submission included a description of feminist research ethics, suggestions for specific revisions to the Declaration, and elements found in other international research ethics codes that are important from a feminist perspective. Our goals were to encourage the WMA to craft a declaration that: conceptualizes issues of vulnerability in richer and more nuanced ways, resists the influence of profit motives, and (...) extends the scope of responsibility for ethical research more broadly. (shrink)

Immigration medicine and the work carried out by Panel Physicians within the Canadian immigration system give rise to ethically troublesome practices and consequences. In this analysis in three parts, we explore the context of the immigration medical examination, characterize the observed and potential burdens and harms for immigrant and refugee applicants with HIV, and critically assess the possibilities for transforming immigration medical practices and policy to reduce inequities. We use the Code of Ethics of the Canadian Medical Association and the (...) Medical Ethics Manual of the World Medical Association to analyse six practices that fail to meet ethical expectations. This analysis opens up new lines of inquiry into the medico-administrative practices regulating immigration to Canada. It also extends knowledge about the functioning of immigration medical policy and the collection and uses of HIV-related health information. We argue that to reduce burdens and harms to prospective immigrants and refugees to Canada with HIV, changes must occur in how Citizenship and Immigration Canada asks Panel Physicians to work with these applicants. This argument is empirically informed by institutional ethnographic research results of the Canadian immigration system and its treatment of applicants with HIV. (shrink)

Numerous issues confront women's healthcare today, among them the medicalization of women's bodies, cosmetic genital surgery, violence against women, HIV, perinatal mental health disorders. This volume uniquely explores such difficult topics and others at the intersection of clinical practice, policy, and bioethics in women's health care through a feminist ethics lens. With in-depth discussions of issues in women's reproductive health, it also broadens scholarship by responding to a wider array of ethical challenges that many women experience in accessing health care. (...) Contributions touch on many themes previously tackled by feminist ethics, but in new, contemporary ways. Some chapters expand into new fields in the bioethics literature, such as the ethical issues related to the care of Indigenous women, uninsured refugees and immigrants, women engaged in sex work, and those with HIV at different life stages and perinatal mental health disorders. Authors seek to connect theory and practice with users of the health system by including women's voices in their research. Bringing to bear their experience in active clinical practice in medicine, nursing, and ethics, the authors contemplate new conceptual approaches to important issues in women's healthcare, and make ethical practice recommendations for those grappling with these issues. Topical and up-to-date, this book provides a valuable resource for physicians, nurses, clinical ethicists, and researchers working in some of the most critical areas of women's health and applied ethics today. (shrink)

Lisa A. Eckenwiler and Felicia G. Cohn, The ethics of bioethics: Mapping the moral landscape, Baltimore: The Johns Hopkins University Press, 2009, reviewed by Carolyn Ells.

The Ethics of Bioethics: Mapping the Moral Landscape is a compelling, thoughtful, sobering examination of the moral practice of bioethics. Jonathan D. Moreno sets the tone in the foreword by unsettling the reader with questions from critics about the intellectual legitimacy of bioethics (e.g., the frequent tensions of political ideology with normative expertise in the public debate) and the practices of some in bioethics (e.g., the controversial roles in for-profit industry or health care). Twenty-five essays follow, addressing issues and activities (...) that mark the relatively brief history and much of the scope of bioethics practice. Each essay turns bioethics practice inward to lay bare, explore, and possibly .. (shrink)

Ethical review and analysis of health policy may help to ensure policies address the needs of society and align with relevant values and principles. Indeed, researchers and bioethicists have recognized the need for ethical frameworks specifically for public health applications. The objective of this research was to compile structured tools for ethical review of health policy and to analyze these tools for their scope and philosophical underpinnings. A systematic search and review of academic and grey literature was conducted to compile (...) existing tools designed for health policy ethics review. The search yielded 13 health policy ethical review tools. Qualitative content analysis revealed that all of the tools were influenced by multiple ethical values and that a majority were influenced by more than one ethical theory. The most common values were non-maleficence and beneficence. The most common influencing ethical theory was the Principles Approach. The structure of the tools demonstrates a heterogeneity of methodology designs to approach policy ethics review. This research offers a unique contribution to the bioethics field that provides a useful resource and understanding of the current ethical review tools for health policy. (shrink)