Patient organizations are increasingly involved in national and international bioethical debates and health policy deliberations. In order to examine how and to what extent cultural factors and organizational contexts influence the positions of patient organizations, this study compares the positions of German and Israeli patient organizations (POs) on issues related to end-of-life medical care. We draw on a qualitative pilot study of thirteen POs, using as a unit of analysis pairs comprised of one German PO and one Israeli PO that (...) were matched on the basis of organizational category. Bioethical positions that emanated from the interviews concerned advance directives—general views, recent legal framework, and formalization; as well as active and passive euthanasia, withholding and withdrawing of treatment, and physician-assisted suicide. In addition to the unifying, within-country impact of cultural factors, we found that constituency-based organizations and partner organizations in both countries often share common views, whereas disease-based support organizations have very heterogeneous positions. We conclude by discussing how organizational contexts provide a source of uniformity as well as diversity in the positions of POs. (shrink)

In this article we address the social value of bioethics research and show how a participatory approach can achieve social impact for a wide audience of stakeholders, involving them in a process of joint moral learning. Participatory bioethics recognizes that research co-produced with stakeholders is more likely to have impact on healthcare practice. These approaches aim to engage multiple stakeholders and interested partners throughout the whole research process, including the framing of ideas and research questions, so that outcomes (...) are tailored to the interests and context, and the type of impact stakeholders envisage. There is an emphasis on realizing social change through the conduct of the research, and it is believed that the engagement of stakeholders in the research process will promote their intrinsic motivation to change their practice. Another distinctive feature of participatory bioethics research is that its central normative commitment is to reflection and dialogue, not to a particular substantive ethical approach. In reflection and dialogue there is an emphasis on inclusion and the co-production of knowledge. Furthermore, empirical and normative research are combined, and there is a deliberate attempt to give voice to otherwise marginalized positions. This provides a model of social impact which is relevant not only for bioethics research, but also for other areas of health care research. We will show the merits of a participatory approach to bioethics research with a case example. It concerns the reduction of coercion and in particular seclusion in Dutch mental healthcare. (shrink)

In this article I explore the underlying political philosophy of public bioethics by comparing it to technocratic authority, particularly the technocratic authority claimed by economists in Mexico in the 1980s and 1990s. I find that public bioethics - at least in the dominant forms - is implicitly designed for and tries to use technocratic authority. I examine how this type of bioethics emerged and has continued. I finish by arguing that, as claims to technocratic authority go, (...) class='Hi'>bioethics is in an incredibly weak position, which partly explains why it has never gained the degree of public legitimacy that other technocracies have gained. I conclude by arguing for a "technocracy-lite" orientation for public bioethics. (shrink)

This article presents the findings of qualitative research which explored, from the mothers’ perspective, the process of decision-making about mode of delivery for a subsequent birth after a previous Caesarean Section. In contradiction to the clinical literature, the majority of mothers in this study were strongly of the opinion that a vaginal birth after caesarean (VBAC) posed a higher risk than an elective caesarean (EC). From the mothers’ perspective, risk discussions were primarily valuable for gaining support for their pre-determined choice, (...) rather than obtaining information. The findings posit ethical concerns with regards to informed consent and professional obstetric practice at a time when there is a documented and worrying trend towards an increase in births by caesarean section (CS). (shrink)

Introduction: Public health ethics addresses moral dilemmas arising from balancing individual healthcare needs with societal interests. Ethical considerations in public health during pandemics and disasters aim to reduce mortality rates and minimize social injustice through fair principles. Objective: This paper analyzes public health ethics and ethical values in allocating resources during mass casualty incidents. The intersection of public health ethics, applied bioethics, and ethics of social consequences (through non-utilitarian consequentialism) guides addressing serious public health challenges in catastrophic scenarios. The (...) application of the given interaction is significant for professional medical ethics. Methodology: The paper employs inductive, deductive, and normative methods of bioethics and the methodology of ethics of social consequences. Conclusion: The paradigmatic disparity between the bioethics of pandemics and disaster bioethics lies in the fluid application of bioethical principles and the accentuation of utilitarian demands depending on the severity and scale of mass casualty incidents. Applied bioethics in crisis situations respects the approaches of public health ethics and attempts to increase positive social outcomes. The application of (scarce) resource allocation criteria and triage of patients is derived from ethical decisions beneficial to public health and lege artis approaches of medical bioethics. The paper presents professional and ethical criteria for medically inappropriate treatment within the framework of patient triage; we approach crisis ethics from the perspective of maximization of benefit. Age is not an exclusion criterion of acute healthcare provision in crisis situations. Ethics of social consequences as a form of non-utilitarian consequentialism allowing for social consequences bridges public health ethics and applied bioethics. (shrink)

Cheryl Cox MacPherson recently argued, in an article for this journal, that ‘Climate Change is a Bioethics Problem’. This article elaborates on that position, particularly highlighting bioethicists' potential ability to help reframe the current climate change discourse to give more attention to its health risks. This reframing process is especially important because of the looming problem of climate change skepticism. Recent empirical evidence from science framing experiments indicates that the public reacts especially positively to climate change messages framed in (...) public health terms, and bioethicists are particularly well positioned to contribute their expertise to the process of carefully developing and communicating such messages. Additionally, as climate framing research and practice continue, it will be important for bioethicists to contribute to the creation of that project's nascent ethical standards. The discourse surrounding antibiotic resistance is posited as an example that can lend insight into how communicating a public health-framed message, including the participation of bioethicists, can help to override public skepticism about the findings of politically contentious scientific fields. (shrink)

In this paper I have attempted to open a window on an African approach to Bioethics — that of the Nso' of the Bamenda Highlands of Kamerun — from the vantage position of someone who has familiarity with both African and Western cultures. Because of its scientific‐cum‐technological sophistication and its proselytising character, Western culture, as well as Western systems of thought and practice, have greatly affected and influenced other cultures, particularly African culture. But Western culture, systems of thought and (...) practice, have been highly impervious and immune to influences from other cultures, philosophies, systems of thought and practice, even where these might have been salutary and enriching to Western culture and systems. What I have here termed Nso' eco‐bio‐cummunitarianism clearly indicates a viable alternative world‐view within which some of the bioethical perplexities and controversies of today might be more satisfactorily resolved than within a Western framework. I have further attempted to show, by way of example, how within such a world‐view, abortion and suicide, for instance, would be disapproved of while euthanasia, in its etymological purity, is approved of. (shrink)

Who should define what constitutes ethical and lawful medical practice? Judges? Doctors? Scientists? Or someone else entirely? This volume analyses how effectively criminal law operates as a forum for resolving ethical conflict in the delivery of health care. It addresses key questions such as: how does criminal law regulate controversial bioethical areas? What effect, positive or negative, does the use of criminal law have when regulating bioethical conflict? And can the law accommodate moral controversy? By exploring criminal law in (...) theory and in practice and examining the broad field of bioethics as opposed to the narrower terrain of medical ethics, it offers balanced arguments that will help readers form reasoned views on the ethical legitimacy of the invocation and use of criminal law to regulate medical and scientific practice and bioethical issues. (shrink)

Current symptom-based DSM and ICD diagnostic criteria for mental disorders are prone to yielding false positives because they ignore the context of symptoms. This is often seen as a benign flaw because problems of living and emotional suffering, even if not true disorders, may benefit from support and treatment. However, diagnosis of a disorder in our society has many ramifications not only for treatment choice but for broader social reactions to the diagnosed individual. In particular, mental disorders impose a sick (...) role on individuals and place a burden upon them to change; thus, disorders decrease the level of respect and acceptance generally accorded to those with even annoying normal variations in traits and features. Thus, minimizing false positives is important to a pluralistic society. The harmful dysfunction analysis of disorder is used to diagnose the sources of likely false positives, and propose potential remedies to the current weaknesses in the validity of diagnostic criteria. (shrink)

ABSTRACT In establishing National Bioethics Organisations (NBOs), liberal democracies seek to acknowledge the diversity of strongly held ethical positions and the imperative to engage in public debate about important bioethical decisions. NBOs are typically given a range of responsibilities, including contributing to and stimulating public debate; providing expert opinion on relevant issues for policy deliberations; and developing public policy. The state is now found to have an interest in areas previously thought to be a matter of individual choice. NBOs (...) can provide one way of opening up public debate to allow the diversity of views to be heard in a manner that is well‐informed, articulate and responsive to both expert and ‘lay’ public views. We draw on debates in political theory about democratic decision‐making and on the policy making roles of some key NBOs. We are particularly interested in examining the capacity of NBOs to meet the democratic ideal of effective participation by the public, or citizenry, especially by those who are directly affected by the policies, in the development of effective public policy. We provide a basic framework for policy development involving NBOs that can begin to meet this ideal, a process of ‘contested deliberation’. (shrink)

At the beginning of the twenty-first century, with vocations to the Christian religious orders of the West in marked decline, an authentic Christian presence in health care is threatened. There are no longer large numbers of women willing to offer their life labors bound in vows of poverty, chastity, and obedience, so as to provide a real preferential option for the poor through supporting an authentic Christian mission in health care. At the same time, the frequent earlier death of men (...) leaves a large number of widows, some in need of care and some able to provide care. Drawing on the role of widows sketched in I Timothy 2, one can envision Christian widows entering a life of prayer and service in health care settings. As female monastics, such widows could reintroduce a salient Christian presence in health care. How one ties this response to the message of I Timothy 2 will depend on one’s understanding of the status of Scripture, the significance of tradition, the nature of theological epistemology, the meaning of theology, the nature of the Church, and the ontology of gender. The position taken on these issues will define the character of a Christian bioethics of care. (shrink)

In bioethics there is an ongoing debate about the ethical case for human enhancement through new biomedical technologies. In this debate there are both supporters and opponents of human enhancement technologies such as genetic improvements of cognitive abilities (eg, intelligence). The supporters argue that human enhancement will lead to healthier and therefore better lives, meaning that any delays to the introduction of such technologies is problematic. In contrast, the opponents argue that new technologies will not solve problems such as (...) inequality and social justice. In order to overcome opposition to human enhancement, Bostrom and Ord have outlined a test to evaluate ethical arguments for "status quo bias" or what they call "intuitive judgements" in the assessment of human enhancement. This article is a response to their paper in which I raise a number of problems with their position, particularly with their "status quo bias" test and the incorporation of economistic thinking into their ethical arguments. (shrink)

Background There has been debate on whether a global or unified field of bioethics exists. If bioethics is a unified global field, or at the very least a closely shared way of thinking, then we should expect bioethicists to behave the same way in their academic activities anywhere in the world. This paper investigates whether there is a 'global bioethics' in the sense of a unified academic community. Methods To address this question, we study the web-linking patterns (...) of bioethics institutions, the citation patterns of bioethics papers and the buying patterns of bioethics books. Results All three analyses indicate that there are geographical and institutional differences in the academic behavior of bioethicists and bioethics institutions. Conclusion These exploratory studies support the position that there is no unified global field of bioethics. This is a problem if the only reason is parochialism. But these regional differences are probably of less concern if one notices that bioethics comes in many not always mutually understandable dialects. (shrink)

The question that this paper tries to answer is Q: “Can good academic bioethics be done without commitment to moral theory?” It is argued that the answer to Q is an unequivocal “Yes” for most of what we could call “critical bioethics,” that is, the kind of bioethics work that primarily criticizes positions or arguments already in the literature or put forward by policymakers. The answer is also “Yes” for much of empirical bioethics. The second part (...) of the paper then provides an analysis of Q in relation to “constructive bioethics,” that is, bioethics work aimed at providing an argument for a particular position. In this part, it is argued that a number of the approaches or methods used that initially look like they involve no commitment to moral theory, nevertheless, involve such a commitment. This is shown to be the case for reflective equilibrium, mid-level theory, the use of theory fragments, and argument by analogy. (shrink)

There is a perpetrator historiography of the Holocaust and a Jewish historiography of the Holocaust. The former has received the lion’s share of attention in bioethics, particularly in the form of warnings about medicine’s potential for complicity in human atrocity. However, stories of Jewish physicians during the Holocaust are instructive for positive bioethics, one that moves beyond warnings about what not to do. In exercising both explicit and introspective forms of resistance, the heroic work of Jewish physicians (...) in the ghettos and concentration camps tells us a great deal about the virtues and values of medicine. In this article, we frame the stories of four of these Jewish physicians in ways that are instructive for contemporary medicine. By far, the most widely recognized and discussed figure is Viktor Frankl, whose work on hope and the meaning of suffering remains essential insofar as medicine inherently confronts disease and death. Less discussed in bioethics and medical humanities are the cases of Mark Dworzecki, Karel Fleischmann, and Gisella Perl. Dworzecki’s efforts to encourage others in the Vilna Ghetto to document their experiences illustrates the power of narrative for the human experience and the notion of ethics as narrative in the face of suffering. Fleischmann’s art underscores not only the importance of reflective practices for professionals as a form of simultaneous introspection and testimonial, but illuminates hope amid sheer hopelessness. This hope, which was comparatively implicit in much of Fleishmann’s art, is explicated as a method by Frankl, becoming a form of therapy for both physicians wrestling with their professional work, and patients wrestling with their illnesses and diseases. Finally, Perl’s resistance to Mengele’s orders highlights the importance of moral action, not just reflective reaction. The experiences of each of these figures, while certainly located in the unique horrors of Holocaust Germany, portends lessons for today’s physicians faced with moral distress and ethical dilemma in the face of suffering, interpersonal relationships, and socio-political conflicts that increasingly test the professed ideals of medicine. In this article we briefly tell the story of each of these physicians and connect the lessons therein to contemporary medical practice. (shrink)

In 1785, George Washington described a “knowing farmer” as “one who can convert every thing he touches into manure, as the first transmutation towards Gold.” With these words, Washington linked the “knowing farmer” to the alchemist who endeavored to transform base metals into gold with the aid of a philosopher's stone. In each instance, the challenge was to convert raw materials into something new and precious.Today, the “knowing bioethicist” is in a similar position. American bioethics harbors a variety of (...) ethical methods that emphasize different ethical factors, including principles, circumstances, character, interpersonal needs, and personal meaning. Each method reflects an important aspect of ethical experience, adds to the others, and enriches the ethical imagination. (shrink)

All persons, while different from one another, have the same value: this is the author's relatively uncontroversial starting point. Her end point is not uncontroversial: an ideal of justice as human flourishing, based on each person's unique set of capabilities. Because the book's focus is women's health care, gender justice, a necessary component of justice, is central to examination of the issues. Classical pragmatists and feminist standpoint theorists are enlisted in support of a strategy by which gender justice is promoted. (...) Two features of the book are unique: (1) the topics presented cover the entire life span of women, not just those related to reproduction; (2) a range views about moral status are applied not only to fetuses but also to individuals already born. Attention to these features is intended to facilitate ethical consistency or moral integrity and respect for those who hold different moral views. While delineating and defending the book's perspective, the first section provides an overview of bioethics, critiques prevalent approaches to bioethics and models of the physician-patient relationship, and sketches distinguishing aspects of women's health care that are prevalently neglected. Positions about moral status are also presented. The second section identifies topics that are indirectly as well as directly related to women's health, such as domestic violence and caregiving. Brief cases illustrate variables relevant to each topic. Empirical and theoretical considerations follow each set of cases; these are intended to precipitate more expansive and critical examination of the issues raised. The last section is devoted to an egalitarian ideal that may be pursued through an ethic of virtue or supererogation rather than obligation. By embracing this ideal, according to the author, moral agents support a more demanding level of morality than guidelines or laws require. (shrink)

One area of bioethics education with direct impact on the lives of patients, families, and providers is the training of clinical ethics consultants who practice in hospital‐based settings. There is a universal call for increased skills and knowledge among practicing consultants, broad recognition that many are woefully undertrained, and a clear consensus that CECs must avoid an “authoritarian approach” to consultation—an approach, that is, in which the consultant imposes his or her values, ethical priorities, or religious convictions on the (...) stakeholders in an ethics conflict. Yet little work has been done on how to teach CECs not to impose their values in an ethics consultation, or even on the dimensions of this problem. In this essay, I propose a tool for bioethical instruction that targets this question: how can CECs be taught a nonauthoritarian mode of ethical analysis and consultation that can avert the problem of values imposition? (shrink)

In this book, public health ethicist Daniel S. Goldberg sets out to characterize the subjective experience of pain and its undertreatment within the US medical establishment, and puts forward public policy recommendations for ameliorating the undertreatment of pain. The book begins from the position that the overwhelming focus on opioid analgesics as a means for improving the undertreatment of pain is flawed, and argues instead that dominant Western models of biomedicine and objectivity delegitimize subjective knowledge of the body and pain (...) in the US. This general intolerance for the subjectivity of pain is part of a specific American culture of pain in which a variety of actors take part, including not only physicians and health care providers, but also pain sufferers, caregivers, and policymakers. Concentrating primarily on bioethics, history, and public policy, the book brings a truly interdisciplinary approach to an urgent practical ethical problem. Taking up the practical challenge, the book culminates in a series of policy recommendations that provide pathways for moral agents to move beyond contests over drug policy to policy arenas that, based on the evidence, hold more promise in their capacity to address the devastating and inequitable undertreatment of pain in the US. (shrink)

In 1785, George Washington described a “knowing farmer” as “one who can convert every thing he touches into manure, as the first transmutation towards Gold.” With these words, Washington linked the “knowing farmer” to the alchemist who endeavored to transform base metals into gold with the aid of a philosopher's stone. In each instance, the challenge was to convert raw materials into something new and precious.Today, the “knowing bioethicist” is in a similar position. American bioethics harbors a variety of (...) ethical methods that emphasize different ethical factors, including principles, circumstances, character, interpersonal needs, and personal meaning. Each method reflects an important aspect of ethical experience, adds to the others, and enriches the ethical imagination. (shrink)

Bioethicists have virtually assumed that Tarasoff generated a duty to warn the sexual partners of an HIV‐positive man that they risked infection. Yet given the views of sex and of AIDS that have evolved in the gay community, in many cases the parallels to Tarasoff do not hold. Bioethicists should at the least attend to the community's views, and indeed should go beyond doing mere “professional ethics” to participate in the moral self‐exploration in which these views are located.

Bioethics seeks to answer questions and resolve problems that change along with developments in medicine and biology. Ethical justification plays a crucial role in bioethical analysis by clarifying the reasons that support complex judgments about particular actions and general policies.1 It helps bioethicists to determine what to allow, forbid, support, and minimize. When there is disagreement, it can also aid understanding of competing positions. However, at times, disagreement on particular issues becomes so entrenched that understanding seems impossible. In such (...) circumstances, how might bioethicists proceed? In answering this question, this paper considers a particularly significant area of.. (shrink)

ABSTRACT In establishing National Bioethics Organisations (NBOs), liberal democracies seek to acknowledge the diversity of strongly held ethical positions and the imperative to engage in public debate about important bioethical decisions. NBOs are typically given a range of responsibilities, including contributing to and stimulating public debate; providing expert opinion on relevant issues for policy deliberations; and developing public policy. The state is now found to have an interest in areas previously thought to be a matter of individual choice. NBOs (...) can provide one way of opening up public debate to allow the diversity of views to be heard in a manner that is well‐informed, articulate and responsive to both expert and ‘lay’ public views. We draw on debates in political theory about democratic decision‐making and on the policy making roles of some key NBOs. We are particularly interested in examining the capacity of NBOs to meet the democratic ideal of effective participation by the public, or citizenry, especially by those who are directly affected by the policies, in the development of effective public policy. We provide a basic framework for policy development involving NBOs that can begin to meet this ideal, a process of ‘contested deliberation’. (shrink)

Bioethics is quickly developing into a vast discipline, with rapidly expanding areas of study and practice, and a rapidly expanding literature. Creating anthologies that provide useful overviews of bioethics is, consequently, a daunting task: many areas important to bioethics must be left out and depth of critical analysis must suffer. The editors of this volume—now in paperback in the Blackwell Companions to Philosophy series—skilfully address these challenges. The result is a comprehensive and authoritative anthology, providing balanced analyses (...) of major debates and trends in bioethics. Unlike in most bioethics anthologies, each of the 46 articles in this volume is written specifically for the anthology. The authors comprise an impressive group of international scholars, most with well established expertise in the subjects about which they write. Rather than merely articulating a position and defending it, …. (shrink)

This article provides a critical evaluation of the central components of Integrative Bioethics, a project aiming at a bioethical framework reconceptualization. Its proponents claim that this new system of thought has developed a better bioethical methodology than mainstream Western bioethics, a claim that we criticize here. We deal especially with the buzz words of Integrative Bioethics – pluriperspectivism, integrativity, orientational knowledge, as well as with its underlying theory of moral truth. The first part of the paper looks (...) at what the claims of a superior methodology consist in. The second reveals pluriperspectivism and integrativity to be underdeveloped, hazy terms, but which seem to be underpinned by two theses – the incommensurability and the inclusiveness theses. These theses we critically scrutinize. We then consider strategies the project's proponents might apply to curb these theses in order to acquire minimal consistency for their framework. This part of the article also deals with the conception of moral truth that drives the theory, a position equally burdened with inconsistencies. In the last part of the article, we observe the concept of orientational knowledge, and develop two interpretations of its possible meaning. We claim that, following the first interpretation, Integrative Bioethics is completely descriptive, in which case it is informative and important, but hardly bioethics; if it is normative, following the second interpretation, it is bioethics as we already know it, but merely clad in rhetorical embellishments. We conclude that there is nothing new about this project, and that its inconsistencies are reason enough for its abandonment. (shrink)

Pain medication is one of the responses to the mercy argument that utilitarian ethicists use for justifying active euthanasia on the grounds of prevention of cruelty and appeal to beneficence. The researcher reinforces the significance of pain medication in meeting this challenge and considers it the most preferred response among various other responses. It is because of its realism and effectiveness. In exploring the mechanism and considerations related to pain medication, the researcher briefly touches the Catholic ethical position on the (...) issue, a position that cannot be ignored in the development of contemporary bioethics. The researcher particularly deliberates on the contemporary Islamic discourse on the issue; by furthering the debate in line with the Islamic legal maxims and general guidance from the primary sources of Islamic law and ethics. The resolution on the issue is sought by synthesizing the views and legal maxims (al-Qawaid al-Fiqhiyyah) on the issue, which in conclusion provide justification for pain medication by considerably regarding pain as necessity and pressing need. However, such resolution allows pain medication to the limit and proportion that removes the pain and prohibits overdosing the patient with medication that may directly cause the death. (shrink)

As bioethics gains more prominence in public policy debates, it is time to more fully reflect on the following: what is its role in the public square, and what limitations relate to and barriers impede its fulfilment of this role? I contend we should consider the how of bioethics (as a policy influencer) rather than simply focus on the who or what of bioethical enquiry. This is not to suggest considerations of latter categories are not important, only that (...) too little attention has been paid to parallel or resulting policy involvement—involvement that will require specialised skills and knowledge that we can develop with a proactive (vs reactive) stance. Moreover, and equally critically, this how of public policy involvement will require more transparency regarding influences (eg, philosophical, ideological, cultural, socio-political) on what bioethicists bring to the table and what constituency base each represents—a humility as to the scope of one's role. In this vision, bioethics is not one single person or belief system for a policymaker to call to guide or give support to a position; rather, it offers tools—formed and utilised by a diverse disciplinary range of individuals—to help guide ethical analysis of biomedical endeavours, with the goal of infusion and diffusion of ethical enquiry and prioritisation in health policymaking, and greater humility among bioethicists who inform this discussion. (shrink)

ABSTRACT There is a growing interest in various forms of naturalism in bioethics, but there is a clear need for further clarification. In an effort to address this situation, I present three epistemological stances: anti‐naturalism, strong naturalism, and moderate pragmatic naturalism. I argue that the dominant paradigm within philosophical ethics has been a form of anti‐naturalism mainly supported by a strong ‘is’ and ‘ought’ distinction. This fundamental epistemological commitment has contributed to the estrangement of academic philosophical ethics from major (...) social problems and explains partially why, in the early 1980s, ‘medicine saved the life of ethics’. Rejection of anti‐naturalism, however, is often associated with strong forms of naturalism that commit the naturalistic fallacy and threaten to reduce the normative dimensions of ethics to biological imperatives. This move is rightly dismissed as a pitfall since ethics is, in part, a struggle against the course of nature. Rejection of naturalism has drawbacks, however, such as detering bioethicists from acknowledging the implicit naturalistic epistemological commitments of bioethics. I argue that a moderate pragmatic form of naturalism represents an epistemological position that best embraces the tension of anti‐naturalism and strong naturalism: bioethics is neither disconnected from empirical knowledge nor subjugated to it. The discussion is based upon historical writings in philosophy and bioethics. (shrink)

Bioethical debates such as those surrounding the manipulation of human embryos are often based on metaphysical assumptions that lack a foundation in the natural sciences. In this paper we support a gradualist position whereby the embryo progressively takes on the form and associated ethical significance of a human being. We support this position by introducing a concept of biological structure or form to show how the gradualist position has its metaphysical foundations in modern biology. The conceptual basis for form and (...) structure are outlined and their compatibility with and basis in current empirical biology is demonstrated by some recent advances in our understanding of the processes of development from single cell to organism. We then briefly explore the ethical significance of accepting a form or structure based conception of biology for the status of the early embryo. (shrink)

A trend called ‘African bioethics’ is growing on the continent due to perceptions of existing bioethics, especially guidelines for international collaborative research, as ‘ethical imperialism’. As a potential alternative to ‘Western Principlism,’ ‘African bioethics’ is supposed to be indigenous to Africa and reflective of African identity. However, despite many positive insights in the on-going discussions, it is feared that the growth of bioethics in Africa lacks a clear direction. Some of the views threaten to distort (...) the essence of bioethics and its development on the continent. This paper presents some of the dominant views on ‘African bioethics’, an examination of which reveals some valuable insights into the direction bioethics in Africa ought to take, but at the same time confirms some methodological challenges in some contributions to the discussion. On top of acknowledging critical insights in the discussion, the paper reveals that some views are characterized by arbitrariness and rhetorical discussions based on a strong negative and yet hard-to-accept assumption; doubtful designation; lack of a clearer problem being addressed and consequently obscure question and aim of the discourse. Finally, some methodological insights are proposed to guide bioethics research and scholarship in Africa. Specifically, the paper proposes that in search for the legitimacy of bioethics in Africa, we ought to protect the essence of bioethics by giving considerable attention to the utility of subsequent bioethics. To achieve this we need to specify the problem and proper designation for the discourse; focus on principles qua principles with impartiality and how to ensure their strict implementation; and encourage critical thinking as part of bioethics. In cultivating bioethics in Africa, the pursuit of identity is legitimate but must be conditional in light of other competing considerations. We should focus on an objective search for bioethical principles that can be effective in responding to African and global health challenges of moral significance, irrespective of the origin of the principles and at the same time focus more on strategies for ensuring compliance with resulting principles. (shrink)

Significant changes in the natural environment over the past 40 years pose key challenges to health and health care in the 21st century. Health care has not yet given serious attention to what the current environmental situation means for human health, or for maintaining an effective health care system. Bioethics is in a good position to help health professionals engage environmental questions. But bioethics, as a field, will first need to explore and integrate ecological thinking —thinking based in (...) the concept of connectedness and committed to viewing humans are part of nature rather than exempt from it. (shrink)

This article provides a critical evaluation of the central components of Integrative Bioethics, a project aiming at a bioethical framework reconceptualization. Its proponents claim that this new system of thought has developed a better bioethical methodology than mainstream Western bioethics, a claim that we criticize here. We deal especially with the buzz words of Integrative Bioethics – pluriperspectivism, integrativity, orientational knowledge, as well as with its underlying theory of moral truth. The first part of the paper looks (...) at what the claims of a superior methodology consist in. The second reveals pluriperspectivism and integrativity to be underdeveloped, hazy terms, but which seem to be underpinned by two theses – the incommensurability and the inclusiveness theses. These theses we critically scrutinize. We then consider strategies the project's proponents might apply to curb these theses in order to acquire minimal consistency for their framework. This part of the article also deals with the conception of moral truth that drives the theory, a position equally burdened with inconsistencies. In the last part of the article, we observe the concept of orientational knowledge, and develop two interpretations of its possible meaning. We claim that, following the first interpretation, Integrative Bioethics is completely descriptive, in which case it is informative and important, but hardly bioethics; if it is normative, following the second interpretation, it is bioethics as we already know it, but merely clad in rhetorical embellishments. We conclude that there is nothing new about this project, and that its inconsistencies are reason enough for its abandonment. (shrink)

This critical notice argues for the existence of a new trend in bioethics, a complex and dynamic field of philosophical enquiry that goes beyond applied ethics and professional deontological codes. This trend supplements their traditionally “minimalist” ethics—and its concern with harm, rights or justice—with “inflationary” positions open to an integration of medicine with the humanities. By comparing and contrasting the views of two quite different philosophers, Diego Gracia and Alfred Tauber, and placing them within the theoretical background delineated by (...) George Khushf, I argue that the main contribution of this “inflationary bioethics” is an understanding of health and disease as intrinsically normative concepts, which in turn brings about a blurring of the distinction between facts and values. By refusing to construe the distinction as a dichotomy, a post-positivist philosophy of medicine must become more epistemological in order to help us clarify concepts in which the evaluative and the factual are impossible to separate. As a result, the “language of principles” in standard bioethics is being substituted by a more encompassing “language of values”; health and disease are increasingly understood as biopsychosocial phenomena; and the field is open to a process of moralization that challenges traditional models of patient autonomy and physician responsibility. (shrink)

Bioethics, neuroscience, medicine are contributing to a debate on the definition and criteria of death. This topic is very controversial, and it demonstrates clashing views on the meaning of human life and death. Official medical and legal positions agree upon a biological definition of death as irreversible cessation of integrated functioning of the organism as a whole, and whole-brain criterion to ascertain death. These positions have to face many criticisms: some scholars speak of logical and practical inconsistency, some others (...) of invalid scientific theory about the supreme integrator. In this paper some criticisms are exposed and discussed in order to reconstruct the state of the art in bioethical debate. -/- . (shrink)

In understanding the implicative resonance of biotech applications research and development, it is necessary to apply the intricate consonance of bioethics studies like behaviourome studies in the form of mental mapping in diverse groups of society for trying to resolve moral issues such as IPR or biosafety. Social perception analysis being the subjective domain of bioethics and related biotechnological issues are the functional epitome in ensuring benevolent biotechnological entrepreneurship development. In this pursuit studies of social genomics can ascertain (...) the positive implications of functional genomics being one of the most important fragments of science of biotechnology. The development of guidelines should be culturally sensitive in the way ethical, social and legal aspects are considered. Having a map of human ideas will enable us to reflect more diversity of ideas into policy frameworks. (shrink)

This dissertation is an attempt to show that, and how, an inter-species morality of compassion may be grounded reasonably in a phenomenology of body. It provides a literature survey of relevant works and authors, largely drawn from the modern European traditions of philosophic existentialism, phenomenology, and hermeneutics . The ontology and axiology presupposed by a somatically based bioethic are outlined in advance of the latter's presentation . Relevance of the embodied bioethic to actual affairs is demonstrated through exercises in practical (...) philosophy . An extended summary, as well as comparisons with other positions or outlooks and suggestions for further reflection or research, are also supplied . Appropriate propaedeutics, furnishing preliminary context for the project, can be found in the introduction. (shrink)

The term “globalization” was popularized by Marshall McLuhan in War and Peace in the Global Village. In the book, McLuhan described how the global media shaped current events surrounding the Vietnam War [1] and also predicted how modern information and communication technologies would accelerate world progress through trade and knowledge development. Globalization now refers to a broad range of issues regarding the movement of goods and services through trade liberalization, and the movement of people through migration. Much has also been (...) written on the global effects of environmental degradation, population growth, and economic disparities. In addition, the pace of scientific development has accelerated, with both negative and positive implications for global health. Concerns for national health transcend borders, with a need for shared human security and an enhanced role for international cooperation and development [2]. These issues have significant bioethical implications, and thus a renewed academic focus on the ethical dimensions of public health is needed. Future developments in science and health policy also require a firm grounding in bioethical principles. These core principles include beneficence; nonmaleficence ; respect for persons and human dignity ; and attention to equity and social justice. According to the World Health Organization [3], global ethical approaches should monitor and update ethical norms for research, as necessary; anticipate ethical implications of advances in science and technology for health; apply internationally accepted codes of ethics; ensure that agreed standards guide future work on the human genome; and ensure that quality in health systems and services is assessed and promoted. (shrink)

Duty and Healing positions ethical issues commonly encountered in clinical situations within Jewish law. The concept of duty is significant in exploring bioethical issues, and this book presents an authentic and non-parochial Jewish approach to bioethics, while it includes critiques of both current secular and Jewish literatures. Among the issues the book explores are the role of family in medical decision-making, the question of informed consent as a personal religious duty, and the responsibilities of caretakers. The exploration of contemporary (...) ethical problems in healthcare through the lens of traditional sources in Jewish law is an indispensable guide of moral knowledge. (shrink)

In this paper I have attempted to open a window on an African approach to Bioethics — that of the Nso' of the Bamenda Highlands of Kamerun — from the vantage position of someone who has familiarity with both African and Western cultures. Because of its scientific-cum-technological sophistication and its proselytising character, Western culture, as well as Western systems of thought and practice, have greatly affected and influenced other cultures, particularly African culture. But Western culture, systems of thought and (...) practice, have been highly impervious and immune to influences from other cultures, philosophies, systems of thought and practice, even where these might have been salutary and enriching to Western culture and systems. What I have here termed Nso' eco-bio-cummunitarianism clearly indicates a viable alternative world-view within which some of the bioethical perplexities and controversies of today might be more satisfactorily resolved than within a Western framework. I have further attempted to show, by way of example, how within such a world-view, abortion and suicide, for instance, would be disapproved of while euthanasia, in its etymological purity, is approved of. (shrink)

This book examines the relevance of modern medicine and healthcare in shaping the lives of elderly persons and ageing societies. Combining individual and social dimensions, Planning Later Life discusses the ethical, social, and political consequences of increasing life expectancies and demographic change in the context of biomedicine and public health. By focusing on the field of biomedicine and healthcare, the authors engage readers in a dialogue on the ethical and social implications of recent trends in dementia research and care, advance (...) healthcare planning, or the rise of anti-ageing medicine and prevention. Bringing together the largely separated debates of individualist bioethics on the one hand, and public health ethics on the other, the volume deliberately considers the entanglements of envisioning, evaluating, and controlling individual and societal futures. The process of devising and exploring the various positive and negative visions and strategies related to later life is rarely reflected systematically from a philosophical, sociological, and ethical point of view. As such, this book will be crucial to those working and studying in the life sciences, the humanities, and the social sciences, particularly in the areas of bioethics, social work, gerontology and aging studies, healthcare and social service, sociology, social policy, and geography and population studies. (shrink)

Each year, many young professionals forego advanced education in the traditional doctoral programs of medicine, law, and philosophy in favor of pursuing a PhD or professional doctorate in bioethics or healthcare ethics that is offered by several major institutes of higher education across the United States. These graduates often leverage their degrees into careers within the broader field of bioethics. As such, they represent a growing percentage of professional bioethicists in both academia and healthcare nationwide. Given the significant (...) role that doctoral bioethics programs play in the training of future professional bioethicists, it is imperative that programs conferring bioethics degrees are attuned to the knowledge and skills students will need as they transition to professional positions, especially where this training substantially differs from more traditional doctoral degree tracks. Yet, even given this need, there is nothing in the professional literature regarding doctoral bioethics graduates’ perspectives or the overall efficacy of a bioethics doctorate as compared to more traditional doctoral degree tracks for future professional bioethicists. This paper then gives the perspective of five recent doctoral bioethics graduates on the utility of a bioethics doctorate and areas where the doctorate prepared or underprepared them in their roles as early-career professional bioethicists. (shrink)

Jehovah's Witnesses' (JWs) refusal of blood transfusions has recently gained support in the medical community because of the growing popularity of "no-blood" treatment. Many physicians, particularly so-called "sympathetic doctors", are establishing a close relationship with this religious organization. On the other hand, it is little known that this blood doctrine is being strongly criticized by reform-minded current and former JWs who have expressed conscientious dissent from the organization. Their arguments reveal religious practices that conflict with many physicians' moral standards. They (...) also suggest that a certain segment of "regular" or orthodox JWs may have different attitudes towards the blood doctrine. The author considers these viewpoints and argues that there are ethical flaws in the blood doctrine, and that the medical community should reconsider its supportive position. The usual physician assumption that JWs are acting autonomously and uniformly in refusing blood is seriously questioned. (shrink)

Disputes in Bioethics tackles some of the most debated questions in contemporary scholarship about the beginning and end of life. This collection of essays takes up questions about the dawn of human life, including: Should we make children with three (or more) parents? Is it better never to have been born? and Is the so called 'after-birth' abortion wrong? This volume also asks about the dusk of human life: Is 'death with dignity' a dangerous euphemism? Should euthanasia be permitted (...) for children? and Does assisted suicide harm those who do not choose to die? Still other questions are asked concerning recent views that health care professionals should not have a right to conscientiously object to legal and accepted medical practices. Finally, the book addresses questions about separating conjoined twins as well as the issue of whether the species of an individual makes a difference for the individual's moral status. Christopher Kaczor critiques some of the most recent and influential positions in bioethics, while eschewing both consequentialism and principalism. Rooted in the Catholic principle that faith and reason are harmonious, this book shows how Catholic bioethical teaching is rationally defensible in terms that people of good will, secular or religious, can accept. Proceeding from a natural law perspective, Kaczor defends the inherent dignity of all human beings and argues that they merit the protection of their basic human goods because of that inherent dignity. Philosophers interested in applied ethics, as well as students and professors of law, will profit from reading Disputes in Bioethics. The book aims to be both philosophically sophisticated and accessible for students and experienced researchers alike. (shrink)

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

Feminist Bioethics: At the Center, on the Margins is a collection of essays that “reflect on the positioning of feminist bioethics” (xi). The volume editors suggest that the discipline of feminist bioethics, twenty years after it began, faces tension between becoming incorporated into mainstream bioethics, which would mean that it has greater influence on bioethics as a whole, and remaining “on the margins,” where it can perhaps better continue its critical project of drawing attention to (...) the ways in which “dominant ways of doing bioethics” are gendered and “thus contribute to culturally inscribed oppressive practices” (3). The volume includes papers with diverse theoretical and methodological approaches and .. (shrink)

The term and concept of bioethics (Bio-Ethik) originally were developed by Fritz Jahr, a Protestant Pastor in Halle an der Saale in 1927, long before in the 1970ties bioethics in the modern sense was recreated in the US and since has spread globally. Jahr’s bioethical imperative, influenced by Christian and humanist traditions from Assisi to Schopenhauer and by Buddhist philosophy holds its own position against Kant’s anthropological imperative and against dogmatic Buddhist reasoning: ‘Respect each living being as an (...) end in itself and treat it, if possible, as such’. Jahr interprets the 5th Commandment ‘Thou shalt not kill’ offensively and liberally as ‘common morality’ which includes the obligation of caring for one’s own health, public health and health education within the wider framework of a universal bioethical Sittengesetz. Pastor Fritz Jahr, who had no immediate influence during his times, built a strong first Protestant foundation for contemporary theological and ethical concepts in medical ethics, bioethics, and environmental ethics. (shrink)

This paper argues for the importance of the political context of a society for bioethics. In particular, I argue that in a liberal constitutional society, such as the one we find ourselves in, no particular moral perspective is granted a privileged position. Rather, individuals are allowed to live their lives according to values they adopt for themselves, and the rights granted to protect this ability “trump” social consensus, and place boundaries on the social application of personal moral beliefs and (...) values. (shrink)

This paper examines whether the modern bioethical principles of respect for autonomy, beneficence, non-maleficence, and justice proposed by Beauchamp and Childress are existent in, compatible with, or acceptable to the leading Chinese moral philosophy—the ethics of Confucius. The author concludes that the moral values which the four prima facie principles uphold are expressly identifiable in Confucius’ teachings. However, Confucius’ emphasis on the filial piety, family values, the “love of gradation”, altruism of people, and the “role specified relation oriented ethics” will (...) inevitably influence the “specification” and application of these bioethical principles and hence tend to grant “beneficence” a favourable position that diminishes the respect for individual rights and autonomy. In contrast, the centrality of respect for autonomy and its stance of “first among equals” are more and more stressed in Western liberal viewpoints. Nevertheless, if the Confucian “doctrine of Mean” and a balanced “two dimensional personhood” approach are properly employed, this will require both theorists and clinicians, who are facing medical ethical dilemmas, of searching to attain due mean out of competing moral principles thus preventing “giving beneficence a priority” or “asserting autonomy must triumph”. (shrink)

The shift towards "empirical bioethics" was largely triggered by a recognition that stakeholders' views and experiences are vital in ethical analysis where one hopes to produce practicable recommendations. Such perspectives can provide a rich resource in bioethics scholarship, perhaps challenging the researcher's perspective. However, overreliance on a picture painted by a group of research participants—or on pre‐existing literature in that field—can lead to a biased view of a given context, as the subjectivity of data generated in these ways (...) cannot (and should not wholly) be escaped. In response, we propose the implementation of a complementary approach of ethno‐immersion in bioethics research. By positioning oneself in the context being researched, the researcher can better understand the realities of that context. The researcher's understanding will, naturally, be subjective too. However, it will act as a better developed and more informed outsider view, when considering the picture painted by participants and previous studies, thus enabling the researcher to introduce more nuance when analysing data. We introduce this approach after examining what we call the context detachment problem, whereby some bioethics scholarship—empirical or otherwise—fails to reflect the reality of the healthcare setting it concerns. Our proposed ethno‐immersion (which differs from formal ethnography) is then explored as a response, highlighting its benefits, and answering the question of timing within a research project. Finally, we reflect on the applicability of our proposal to non‐empirical bioethics scholarship, concluding that it remains important but may require some adjustments. (shrink)