More and more areas of medicine involve subjects donating tissues to another — blood, organs, bone marrow, sperm, ova and embryos can all be transferred from one person to another. Within the technical frameworks of biomedicine, such fragments are generally treated as detachable things, severed from social identity once they are removed from a particular body. However an abundant anthropological and sociological literature has found that, for donors and patients, human tissues are not impersonal. They retain some of the (...) values of personhood and identity, and their incorporation often has complex effects on embodied identity. This article draws on feminist philosophy of the body to think through the implications of some of these practices. Specifically, it draws on the idea of intercorporeality, wherein the body image is always the effect of embodied social relations. While this approach is highly productive for considering the stakes involved in tissue transfer, it is argued that the concept of body image has been too preoccupied with the register of the visual at the expense of introceptive data and health/illness events. Empirical data around organ transplant and sperm donation are used to demonstrate that the transfer of biological fragments involves a profound kind of intercorporeality, producing identifications and disidentifications between donors and recipients that play out simultaneously at the immunological, psychic and social levels. (shrink)

Though ubiquitous across the medical social sciences literature, the term “biomedicine” as an analytical concept remains remarkably slippery. It is argued here that this imprecision is due in part to the fact that biomedicine is comprised of three interrelated ontological spheres, each of which frames biomedicine as a distinct subject of investigation. This suggests that, depending upon one’s ontological commitment, the meaning of biomedicine will shift. From an empirical perspective, biomedicine takes on the appearance of (...) a scientific enterprise and is defined as a derivative category of Western science more generally. From an interpretive perspective, biomedicine represents a symbolic-cultural expression whose adherence to the principles of scientific objectivity conceals an ideological agenda. From a conceptual perspective, biomedicine represents an expression of social power that reflects structures of power and privilege within capitalist society. No one perspective exists in isolation and so the image of biomedicine from any one presents an incomplete understanding. It is the mutually-conditioning interrelations between these ontological spheres that account for biomedicine’s ongoing development. Thus, the ontological dissection of biomedicine that follows, with particular emphasis on the period of its formal crystallization in the latter nineteenth and early twentieth century, is intended to deepen our understanding of biomedicine as an analytical concept across the medical social sciences literature. (shrink)

Biomedicine's technological achievements also provide for the expansion of medicine's role as an agent of social regulation.

This volume offers interdisciplinary perspectives on contemporary biomedicine as a cultural practice.

In times of global economic and political crises, the notion of solidarity is gaining new currency. This book argues that a solidarity-based perspective can help us to find new ways to address pressing problems. Exemplified by three case studies from the field of biomedicine: databases for health and disease research, personalised healthcare, and organ donation, it explores how solidarity can make a difference in how we frame problems, and in the policy solutions that we can offer.

An analysis of current biomedical research misconduct policy that proposes a new approach emphasizing the context of misconduct and improved oversight. Federal regulations that govern research misconduct in biomedicine have not been able to prevent an ongoing series of high-profile cases of fabricating, falsifying, or plagiarizing scientific research. In this book, Barbara Redman looks critically at current research misconduct policy and proposes a new approach that emphasizes institutional context and improved oversight. Current policy attempts to control risk at the (...) individual level. But Redman argues that a fair and effective policy must reflect the context in which the behavior in question is embedded. As journalists who covered many research misconduct cases observed, the roots of fraud “lie in the barrel, not in the bad apples that occasionally roll into view.” Drawing on literature in related fields—including moral psychology, the policy sciences, the organizational sciences, and law—as well as analyses of misconduct cases, Redman considers research misconduct from various perspectives. She also examines in detail a series of clinical research cases in which repeated misconduct went undetected and finds laxity of oversight, little attention to harm done, and inadequate correction of the scientific record. Study questions enhance the book's value for graduate and professional courses in research ethics. Redman argues that the goals of any research misconduct policy should be to protect scientific capital (knowledge, scientists, institutions, norms of science), support fair competition, contain harms to end users and to the public trust, and enable science to meet its societal obligations. (shrink)

With attention to the experiences, agency, and rights of tuberculosis patients, this symposium on TB and ethics brings together a range of different voices from the social sciences and humanities. To develop fresh insights and new approaches to TB care and prevention, it is important to incorporate diverse perspectives from outside the strictly biomedical model. In the articles presented in this issue of the Journal of Bioethical Inquiry, clinical experience is married with historical and cultural context, ethical concerns are brought (...) to bear on global health, and structural analyses shed light upon the lived experience of people living with TB. The relational and reciprocal dimensions of care feature strongly in these discussions, which serve as a poignant reminder that behind each of the yearly deaths from TB is a deeply personal story. No single discipline holds a monopoly on how to care for each of these people, but strong cases are made for support from mental health and social workers in addressing the kaleidoscope of needs in TB prevention. As the World Health Organization moves towards the goal of eliminating TB globally by 2050, attending to the needs of TB patients serves global interests to lower disease burden and to develop better integrated communities worldwide. (shrink)

Comprehensive overview of Catholic teaching on practical issues in modern medicine and bioethics. This second edition includes a new chapter on bodily modifications and a series of new figures, as well as bringing the original text up to date in light of the teachings of Pope Francis and recent events such as the covid-19 pandemic.

Often celebrated as a model of development in Africa, Botswana nonetheless endured a severe HIV epidemic. This article describes the singularity of the Botswana experience in facing AIDS and creating the widest possible access to antiretroviral medications for its citizens. Through exploration of different sets of actors and the construction of their ethics of treatment, it is possible to examine how free and universal access was created within the national antiretroviral program. This article underscores the importance of the site and (...) the local dynamics in the advent of an ethics of access to treatment for Botswana citizens. At the intersection of national citizenship, pharmaceutical philanthropy, and biomedical collaborations, Botswana is an exemplary case (one of the first and unique in its kind) of global health programs for access to drugs in which patients' rights are tied to science and pharmaceutical development. As such it also bears some limitations and concerns over its sustainability. (shrink)

Microbiome research shows that human health is foundationally intertwined with the ecology of microbial communities living on and in our bodies. This challenges the categorical separation of organisms from environments that has been central to biomedicine, and questions the boundaries between them. Biomedicine is left with an empirical problem: how to understand causal pathways between host health, microbiota and environment? We propose a conceptual tool – environmentality – to think through this problem. Environmentality is the state or quality (...) of being an environment for something else in a particular context: a fully perspectival proposition. Its power lies partly in what Isabelle Stengers has called the efficacy of the word itself, contrasting the dominant sense of the word environment as something both external and fixed. Through three case studies, we argue that environmentality can help think about the causality of microbiota vis-a-vis host health in a processual, relational and situated manner, across scales and temporalities. We situate this intervention within historical trajectories of thought in biomedicine, focusing on the challenge microbiome research poses to an aperspectival body. We argue that addressing entanglements between microbial and human lives requires that the environment is brought into the clinic, thus shortening the conceptual gap between medicine and public health. (shrink)

This volume examines the impact of advances in genetics and assisted reproduction technologies on family law, human rights and the rights of the child, ...

This article critically explores the notion of those sociopolitical spaces that are 'disability', 'holism' and 'genetics', arguing from the perspectives of someone who identifies as having a disability. Medical genetics is seen to reflect the ideology and dominant biomedical reductionist thought. In contrast with this, it is proposed that disability and health are inherently social. A nursing approach is seen to recognize the social and holistic nature of the human person and to present a critical reflection on the reductionistic applications (...) of medical genetics. (shrink)

How to avoid disease, how to breed successfully, and how to live to a reasonable age are questions that have perplexed humankind throughout history. This book explores our progress in understanding these challenges, and the risks and rewards of devising solutions. A broad range of topics are covered, including reproduction, the development of human progeny from conception to adulthood, staying healthy, ageing, cancer, infection and the burden of our genetic legacy.

Increasingly, policymakers within biomedicine argue that “non-financial” interests should be given equal scrutiny to individuals’ financial relationships with industry. Problematized as “non-financial conflicts of interest,” interests, ranging from intellectual commitments to personal beliefs, are managed through disclosure, restrictions on participation, and recusal where necessary. “Non-financial” interests, though vaguely and variably defined, are characterized as important influences on judgment and thus, are considered risks to scientific objectivity. This article explores the ways that “non-financial interests” have been constructed as an ethical (...) problem and the implications for research integrity. I conducted an interpretive, qualitative study, which triangulated two data sources: documents (including published accounts of identifying and managing “non-financial” interests and conflict of interest policies) and in-depth interviews with 16 leaders within evidence-based medicine, responsible for contributing to, directing, or overseeing conflict of interest policy development and implementation. This article outlines how evolutions in the definition of conflict of interest have opened the door to include myriad “non-financial” interests, resulting in the generalisation of a statistical concept—risk of bias—to social contexts. Consequently, biases appear equally pervasive among participants while in reality, a politics of objectivity is at play, with allegations of conflict of interest used as a means to undermine others’ credibility, or even participation. Iterations of the concept of conflict of interest within biomedicine have thus consistently failed to articulate or address questions of accountability including whose interests are able to dominate or distort evidence-led processes and why. Consequently, current policy solutions meant to mitigate bias may instead serve exclusionary purposes under the guise of impartiality while remaining vulnerable to interference from powerful stakeholders. (shrink)

Many scientific disciplines rely on the construction and use of models: biomedical sciences are no exception. This PhD thesis addresses several aspects of the practice of scientific modeling. First, I discuss the nature of modeling as such, proposing a novel, complementary account of scientific modeling which I term the experimentation-driven modeling account and which drives the construction of mechanistic models in many fields of biological and biomedical research, such as cancer immunology. Second, I scrutinize an objection to the mechanistic account (...) of explanation according to which the account fails to accommodate the common practice of idealizing difference-making factors. I argue that this objection ultimately fails because it is riddled with a number of conceptual inconsistencies. Third, I analyze the roles of similarity judgments in some fields of cancer research which employ a variety of mouse models to learn about the disease mechanisms, arguing that by appreciating the epistemic complexities it is possible to shed new light on more general philosophical debates regarding scientific representation. Fourth, mechanisms can also be studied using more theoretical apparatus in the form of simulations. I investigate an example of an agent-based model used to model the outbreak of SARS-CoV-2... (shrink)

This book contains lectures from the International Conference on Human Rights and Biomedicine, held in Rotterdam, the Netherlands, December 10-12, 2008. The conference was organized by the Institute of Health Policy and Management, Erasmus University Rotterdam and the Erasmus Observatory on Health Law. Eminent scholars from a variety of disciplines - medicine, law, ethics, and philosophy - discuss the meaning of underlying principles of the Convention on Human Rights and Biomedicine (1997) and the fundamental rights in healthcare, contemporary (...) dilemmas in healthcare (policy), and the Convention's impact on national health legislation and daily practice. In particular, the contributions discuss the following topics: human rights and health ethics, equitable access to health care, medical research, human genetics, and organ transplants. (shrink)

A fundamental theme in Gilbert Meilaender’s work on bioethical issues is the relationship between the ethical claims of finitude and of freedom. This article identifies two ways in which Meilaender articulates this relationship and proposes a third way which avoids the limitations of the first two ways while serving Meilaender’s purpose, which is to redress what he sees as an imbalance in favor of the claims of freedom over those of finitude in contemporary biomedicine and bioethics. The article ends (...) by suggesting that Meilaender’s purpose would be best served by avoiding tensions between finitude and freedom as the third way does. (shrink)

The basic premise of today's scientific medicine is that the ‘book of man’ is written in the language of the biological sciences, ultimately molecular genetics and biochemistry. The patient is a complex biological organism and disease is a deviation from the norm of somatic parameters. At the same time, many major contemporary diseases are reported to have psychosocial and environmental components in their etiology. Hence the challenge: how can a medical model be both scientific and conceptually well-suited to today's disease (...) burden? I argue that certain contemporary "postmodern" sciences support alternative, non-reductionist (self-organizational) premises. So doing, they offer an infrastructure for a medical model at once scientific and responsive to the diseases at hand. Keywords: biomedicine (biological medicine), natural science paradigm, Cartesian dualism, self-organization, postmodern sciences, self-referentiality CiteULike Connotea Del.icio.us What's this? (shrink)

SUMMARYBy examining the use of tissue culture in post-war American biomedicine, this paper investigates how scientists experience and manage failure. I study how Leonard Hayflick forged his new definition of failure and ways of managing it by refuting Alexis Carrel's definition of failure alongside his theory of the immortality of cultured cells. Unlike Carrel, Hayflick claimed that every vertebrate somatic cell should eventually die, unless it transformed into a tumour cell. This claim defined cell death, which had been a (...) problem leading to a laboratory failure, as a normal phenomenon. On the other hand, permanent life, which had been considered a normal cellular characteristic, became a major factor causing scientific failure, since it implied malignant transformation that scientists hoped to control. Hayflick then asserted that his cell strains and method would partly enable scientists to manage this factor—especially that occurred through viral infection—alongside other causes of failure in routine tasks, including bacterial contamination. I argue that the growing biomedical enterprise fostered this work of Hayflick's, which had repercussions in both his career and the uses of cells in diverse investigations. His redefinition of failure in the age of biomedicine resulted in the broad dissemination of his cells, medium, and method as well as his long struggle with the National Institutes of Health, which caused his temporarily failed career. (shrink)

RESUMOO presente artigo analisa processos de alterização na biologia humana e na biomedicina. A alterização é entendida aqui como o processo cultural de produção de alteridades por meio da delimitação, rotulação e categorização das formas possíveis de ser outro, desde um determinado marco de referência sócio-histórico. Ainda que a alterização faça parte de qualquer processo de delimitação de categorias de identidade no seio de uma cultura - e, nesse sentido, possa apresentar visões do outro tanto positivas quanto negativas -, aqui (...) nos interessamos especificamente na alterização como fator de marginalização e exclusão social de diferentes grupos humanos. São analisados diversos processos de alterização operantes nos discursos e nas práticas das ciências biomédicas ao longo de sua história recente, os quais têm conduzido à exclusão social de diferentes categorias de outros, ou a tratá-los como inferiores, em pretendidas bases científicas, ou em função de determinadas práticas institucionalizadas dentro da comunidade científica. Exemplos típicos de grupos marginalizados pelas ciências ocidentais ao longo de sua história incluem as raças não europeias, as mulheres, os homossexuais e os "pobres". O principal objetivo do presente artigo é analisar, na história recente das ciências biomédicas, esses processos de alterização que têm conduzido à marginalização de tais grupos e a considerá-los como inferiores. ABSTRACTThis article analyzes processes of "othering" in human biology and biomedicine. Othering is understood here as the cultural process of production of otherness by means of the delimitation, tagging, and categorization of the possible ways of being "other" within a given socio-historical context. Although othering can be considered as a constitutive aspect of any process of delimitation of identities within a given culture - and in this sense it can present both positive and negative views of the "other" -, in the present article we are specifically interested in processes of othering that lead to the marginalization and social exclusion of different human groups. We will analyze processes of othering, which have operated in the discourses and practices of biomedical sciences throughout their recent history, that have led to the social exclusion of different categories of "others", or to treating them as inferior, and that have supposedly scientific bases or as a consequence of the institutionalization of certain practices within the scientific community. Typical examples of these "others", marginalized by the Western sciences throughout their history, are the non-European "races", women, gay and lesbian people, and the "poor". The main objective of this article is to analyze, in the recent history of the biomedical technosciences, these different processes of othering that have led to the marginalization of such "others" and to treating them as inferior. (shrink)

Bioethical research has tended to focus on theoretical discussion of the principles on which the analysis of ethical issues in biomedicine should be based. But this discussion often seems remote from biomedical practice where researchers and physicians confront ethical problems. On the other hand, published empirical research on the ethical reasoning of health care professionals offer only descriptions of how physicians and nurses actually reason ethically. The question remains whether these descriptions have any normative implications for nurses and physicians? (...) In this article, we illustrate an approach that integrates empirical research into the formulation of normative ethical principles using the moral-philosophical method of Wide Reflective Equilibrium (WRE). The research method discussed in this article was developed in connection with the project ‘Bioethics in Theory and Practice’. The purpose of this project is to investigate ethical reasoning in biomedical practice in Denmark empirically. In this article, we take the research method as our point of departure, but we exclusively discuss the theoretical framework of the method, not its empirical results. We argue that the descriptive phenomenological hermeneutical method developed by Lindseth and Norberg (2004) and Pedersen (1999) can be combined with the theory of WRE to arrive at a decision procedure and thus a foundation for the formulation of normative ethical principles. This could provide health care professionals and biomedical researchers with normative principles about how to analyse, reason and act in ethically difficult situations in their practice. We also show how to use existing bioethical principles as inspiration for interpreting the empirical findings of qualitative studies. This may help researchers design their own empirical studies in the field of ethics. (shrink)

In Research Misconduct Policy in Biomedicine: Beyond the Bad-Apple Approach, Barbara Redman recommends that policy perspectives on research misconduct extend beyond the individual wrongdoer to encompass institutional and broader contexts. She rails against what she sees as a pervasive focus on the misbehavior of individuals that neglects organizational and psychosocial aspects of bad conduct. Her primary targets are the misconduct policies of the U.S. federal government and research institutions. In the U.S., research misconduct policy is grounded in the federal (...) definition of research misconduct as fabrication, falsification, and plagiarism. The Office of Research.. (shrink)

In biology—as in other scientific fields—there is a lively opposition between big and small science projects. In this commentary, I try to contextualize this opposition in the field of biomedicine, and I argue that, at least in this context, big science projects should come first.

Chapter 1 Introduction The man was coughing again. Shocked he was as he discovered that his saliva had a reddish taint. Would he have a lung disease after all? Cancer perhaps? Long ago, relatives of his had died from LC, lung cancer.

Bringing together scholars from philosophy, bioethics, law, sociology, and anthropology, this topical collection explores how innovations in the field of biomedicine and the life sciences are challenging and transforming traditional understandings of human temporality and of the temporal duration, extension and structure of human life. The contributions aim to expand the theoretical debate by highlighting the significance of time and human temporality in different discourses and practical contexts, and developing concrete, empirically informed, and culturally sensitive perspectives. The collection is (...) structured around three main foci: the beginning of life, the middle of life, and later life. This structure facilitates an in-depth examination of specific technological and biographical contexts and at the same time allows an overarching comparison of relevant similarities and differences between life phases and fields of application. (shrink)

The nature and role of the patient in biomedicine comprise issues central to bioethical inquiry. Given its developmental history grounded firmly in a backlash against 20th-century cases of egregious human subjects abuse, contemporary medical bioethics has come to rely on a fundamental assumption: the unit of care is the autonomous self-directing patient. In this article we examine first the structure of the feminist social critique of autonomy. Then we show that a parallel argument can be made against relational autonomy (...) as well, demonstrating how this second concept of autonomy fails to take sufficiently into account an array of biological determinants, particularly those from microbial biology. Finally, in light of this biological critique, we question whether or to what extent any relevant and meaningful view of autonomy can be recovered in the contemporary landscape of bioethics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Convention for Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Biomedicine: Convention on Human Rights and BiomedicineCouncil of EuropePreambleThe Member States of the Council of Europe, the other States and the European Community signatories hereto,Bearing in mind the Universal Declaration of Human Rights proclaimed by the General Assembly of the United Nations on 10 December 1948;Bearing in mind (...) the Convention for the Protection of Human Rights and Fundamental Freedoms of 4 November 1950;Bearing in mind the European Social Charter of 18 October 1961;Bearing in mind the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights of 16 December 1966;Bearing in mind the Convention for the Protection of Individuals with Regard to Automatic Processing of Personal Data of 28 January 1981;Bearing also in mind the Convention on the Rights of the Child of 20 November 1989;Considering that the aim of the Council of Europe is the achievement of a greater unity between its members and that one of the methods by which that aim is to be pursued is the maintenance and further realisation of human rights and fundamental freedoms;Conscious of the accelerating developments in biology and medicine;Convinced of the need to respect the human being both as an individual and as a member of the human species and recognising the importance of ensuring the dignity of the human being; [End Page 277]Conscious that the misuse of biology and medicine may lead to acts endangering human dignity;Affirming that progress in biology and medicine should be used for the benefit of present and future generations;Stressing the need for international co-operation so that all humanity may enjoy the benefits of biology and medicine;Recognising the importance of promoting a public debate on the questions posed by the application of biology and medicine and the responses to be given thereto;Wishing to remind all members of society of their rights and responsibilities;Taking account of the work of the Parliamentary Assembly in this field, including Recommendation 1160 (1991) on the preparation of a Convention on bioethics;Resolving to take such measures as are necessary to safeguard human dignity and the fundamental rights and freedoms of the individual with regard to the application of biology and medicine;Have agreed as follows:Chapter IGeneral provisionsArticle 1. (Purpose and object)Parties to this Convention shall protect the dignity and identity of all human beings and guarantee everyone, without discrimination, respect for their integrity and other rights and fundamental freedoms with regard to the application of biology and medicine.Each Party shall take in its internal law the necessary measures to give effect to the provisions of this Convention.Article 2. (Primacy of the human being)The interests and welfare of the human being shall prevail over the sole interest of society or science.Article 3. (Equitable access to health care)Parties, taking into account health needs and available resources, shall take appropriate measures with a view to providing, within their jurisdiction, equitable access to health care of appropriate quality. [End Page 278]Article 4. (Professional standards)Any intervention in the health field, including research, must be carried out in accordance with relevant professional obligations and standards.Chapter IIConsentArticle 5. (General rule)An intervention in the health field may only be carried out after the person concerned has given free and informed consent to it.This person shall beforehand be given appropriate information as to the purpose and nature of the intervention as well as on its consequences and risks.The person concerned may freely withdraw consent at any time.Article 6. (Protection of persons not able to consent)1. Subject to Articles 17 and 20 below, an intervention may only be carried out on a person who does not have the capacity to consent, for his or her direct benefit.2. Where, according to law, a minor does not have the capacity to consent to an intervention, the intervention may only be carried out with the authorisation of his or her representative or an authority or a person or... (shrink)

Anti-Aging and Biomedicine: Critical Studies on the Pursuit of Maintaining, Revitalizing and Enhancing Aging Bodies Content Type Journal Article Category Editorial Notes Pages 187-195 DOI 10.1007/s12376-009-0021-9 Authors Antje Kampf, Johannes Gutenberg-Universität Mainz Mainz Germany Lynn A. Botelho, Indiana University of Pennsylvania Indiana PA USA Journal Medicine Studies Online ISSN 1876-4541 Print ISSN 1876-4533 Journal Volume Volume 1 Journal Issue Volume 1, Number 3.

Over the last two decades, the ethical implications of patents for biological materials and processes have been the subject of spirited public debate between the many individuals and groups on which the patent system impacts. Whereas copyright, trade marks, and other species of Intellectual Property Rights (IPR) are widely acceptable, the patent system evokes criticism from many quarters, especially in relation to the legal protection of inventions in the Life Sciences. Some of these criticisms expressed by prestigious public organisations are (...) addressed here from the patent professional standpoint. (shrink)

Do doctors fix patients? Or do they heal them? For all of modern medicine’s many successes, discontent with the quality of patient care has combined with a host of new developments, from aging populations to the resurgence of infectious diseases, which challenge medicine’s overreliance on narrowly mechanistic and technical methods of explanation and intervention, or “fixing’ patients. The need for a better balance, for more humane “healing” rationales and practices that attend to the social and environmental aspects of health and (...) illness and the experiencing person, is more urgent than ever. Yet, in public health and bioethics, the fields best positioned to offer countervailing values and orientations, the dominant approaches largely extend and reinforce the reductionism and individualism of biomedicine. The collected essays in To Fix or To Heal do more than document the persistence of reductionist approaches and the attendant extension of medicalization to more and more aspects of our lives. The contributors also shed valuable light on why reductionism has persisted and why more holistic models, incorporating social and environmental factors, have gained so little traction. The contributors examine the moral appeal of reductionism, the larger rationalist dream of technological mastery, the growing valuation of health, and the enshrining of individual responsibility as the seemingly non-coercive means of intervention and control. This paradigm-challenging volume advances new lines of criticism of our dominant medical regime, even while proposing ways of bringing medical practice, bioethics, and public health more closely into line with their original goals. Precisely because of the centrality of the biomedical approach to our society, the contributors argue, challenging the reductionist model and its ever-widening effects is perhaps the best way to press for a much-needed renewal of our ethical and political discourse. (shrink)