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PubMed1996

The evolution of caring within bioethics: provision for relationship and context.

Given the complexity of modern health care, there exists an urgent need to discover how best to resolve complex bioethical issues. Traditionally, principle based ethics provided the benchmark for guiding ethical decision-making. More recently, however, it has become apparent that this traditional approach is often inadequate in dealing with current health care dilemmas. The notion of caring was advanced initially as an alternative to, then as a complement to, principle based ethics. In this article, caring is conceptualized as an attitude and is viewed as integral to the advancement of a coherent and integrated moral approach to ethical decision-making. First, a brief historical description of bioethics is presented. Next, an evolutionary account of caring within bioethics is described. Four fundamental problems associated with the use of caring within bioethics are then outlined. Finally, caring as an attitude is delineated and a case study is used to illustrate the proposed conceptualization of caring. The case study demonstrates that a caring attitude provides for relationship and context, which are elements often neglected by traditional approaches.

Adolescent↗
PubMed2004

The "nation's conscience:" assessing bioethics commissions as public forums.

As the fifth national bioethics commission has concluded its work and a sixth is currently underway, it is time to step back and consider appropriate measures of success. This paper argues that standard measures of commissions' influence fail to fully assess their role as public forums. From the perspective of democratic theory, a critical dimension of this role is public engagement: the ability of a commission to address the concerns of the general public, to learn how average citizens resolve moral issues in healthcare, and to monitor public opinion on the topics addressed in the commission. Such a public forum role is supported by the critical literature within bioethics, which has deemed some commissions successful, supported more generally by the history of bioethics as a reform discourse that has brought socially important values into the medical domain, and supported more generally still by the example of the great social issues commissions of the 1960s.

Advisory Committees↗
PubMed2005

The Baroness's Comittee and the President's Council: ambition and alienation in public bioethics.

The President's Council on Bioethics has tried to make a distinctive contribution to the methodology of such public bodies in developing what it has styled a "richer bioethics." The Council's procedure contrasts with more modest methods of public bioethical deliberation employed by the United Kingdom's Warnock Committee. The practices of both bodies are held up against the backdrop of concerns about moral and political alienation, prompted by the limitations of moral reasoning and by moral dissent from state policy under even the most democratic of governments. Although the President's Council's rhetoric is often scrupulously conciliatory, recurring features of its argumentative practice are regrettably divisive. They order these things better in Britain.

Advisory Committees↗
PubMed2005

"Bioethics in action" and human population genetics research.

Recent disputes about human population genetics research have been provoked by the field's political vulnerability (the historic imbalance of power between the geneticists and the people they study) and conceptual vulnerability (the mismatch between scientific and popular understandings of the genetic basis of collective identity). The small, isolated groups often studied by this science are now mobilizing themselves as political subjects, pressing sovereignty claims, and demanding control over the direction and interpretation of research. Negotiations between the geneticists and the people asked to donate DNA have resulted not only in explicit bioethics protocols but also in diffuse anxiety over the incommensurability between expert and non-expert views about genetic evidence for identity claims. This article compares two disputes over genetics research: the Human Genome Diversity Project and the use of genetics to prove identity claims among the Melungeons of Tennessee. The case studies illustrate "bioethics in action": how particular controversies and interests drive the production of bioethics discourses and techniques (such as informed consent protocols). They also illustrate some limits on the usual apparatus of bioethics in overcoming this science's multiple vulnerabilities.

Bioethics↗
PubMed2006

Bioethics as ideology: conditional and unconditional values.

For all its apparent debate bioethical discourse is in fact very narrow. The discussion that occurs is typically within limited parameters, rarely fundamental. Nor does it accommodate divergent perspectives with ease. The reason lies in its ideology and the political and economic perspectives that ideology promotes. Here the ideology of bioethics' fundamental axioms is critiqued as arbitrary and exclusive rather than necessary and inclusive. The result unpacks the ideological and political underpinnings of bioethical thinking and suggests new avenues for a broader debate over fundamentals, and a different approach to bioethical debate.

Persons with Disabilities↗
PubMed2000

Towards a public health approach to bioethics.

In this paper we examine the central commitments of bioethical enquiry and reasoning from a public health perspective. We argue that a core element of American national culture is individualism, which resonates in scholarly and popular debates. Our contention is that the habitus of bioethical debate is in large measure animated by an overriding concern with the individual, and the resulting social practice of the community has been to downplay the importance and legitimacy of group-level health care dilemmas. This paper calls for re-focusing of bioethics by employing a public health perspective, which would include a population focus, evidence-based research topics, and engagement of the ethical dilemmas that arise from decisions concerning prevention. Racial and ethnic health disparities throughout the life span of a population in central New York State are used to illustrate the need for a public health focus in bioethics.

Bioethics↗
PubMedDate not supplied

[Bioethical focus in the scientific production of nurses: characterization and analysis].

Bioethics raises ethical questions inherent to life, stimulated by biomedical and technological advances. Nursing has taken an interest in bioethical studies with the appearance of the first ethical studies based on gender relations. Here we undertake a quantitative-qualitative study of the scientific production of nurses in Brazil into Bioethics. The bibliographical survey considered postgraduate studies through CEPEn catalogs and articles published in national Nursing journals between 1990 and 2002. Reading and analysis of the material revealed that bioethical studies carried out by nurses are principally focused on the nursing professional. Production is seen to be sparse, with post-graduate studies containing the most examples.

Bioethical Issues↗
PubMedDate not supplied

[Bioethics and internal medicine].

Medicine should concern also with theoretical and practical aspects of Bioethics. In fact, in medical research and in clinical practice Bioethics knowledges are essential. A cultural project is underlined. We will neglect the method of reductionism, whereas we will consider the holistic one. We will consider also the real significance of specialisations, so that their role become ancillary to Internal Medicine. Particularly, we should try to find and define some fundamental principles which consider the man on a realistic anthropology, a point of view, where the whole has its importance. Medicine should be seen sub specie totius. In fact the best ethical theory seems to be the ontologically founded personalism, which, through its principles, represents the classic and realistic conception of the man. The person is unity, the whole and not a part of the whole. Furthermore, we propose to discover the virtues ethic. The physicians should not ask themselves: "What have I to do?", but "What kind of physicians do I want to become?" The relations between medicine and Bioethics will produce important results, which through the integral Humanism of medicine, will be reflect on the integral physic and psychic health of each patient and on the integrity of our profession. For these reasons Internal Medicine, which is structured on an holistic epistemology, with its cultural and experimental traditions, should not disappoint to concern with Bioethics and its problems.

Bioethics↗
PubMed1999

[Ethics and life: bioethics studies].

A year ago, in June 1998, Diego Gracia published four volumes under the general title of Bioethics and Life: Studies of Bioethics. These volumes are the continuation of two other books published by the same author during the last years: Foundations of Bioethics (1989) and Decision procedures in clinical ethics (1991). The present article is a short presentation of the four volumes written by the author, followed by the transcription of the foreword of the book. Due to the fact that this book is one of the most important contributions made to bioethics in the Spanish speaking world, it will have a very wide influence not only in Spain but also in Latin America.

Bioethics↗
PubMed2000

Evaluation of a workshop to teach clinical bioethics in the clinical setting.

That the teaching of medical ethics must extend into the clinical years in order for medical students to effectively acquire the knowledge and skills required for dealing with clinical bioethical issues has been widely recognized. A limiting factor has been the lack of physicians able to teach bioethics in the clinical setting. This paper describes the structure and evaluation of a workshop for teaching clinicians how to teach bioethics in the clinical setting. 80 physicians participated in 4 workshops in which they were provided with the ethical principles needed to deal with clinical bioethical issues and appropriate teaching methods. Methods such as paper cases, videotaped standardized patient interactions and live standardized patients were presented. The workshops have been highly evaluated. Post workshop evaluation showed that a significant number of physicians taught ethical issues during rounds and seminars. The frequency of teaching ranged from once per month to one or more times per week.

Attitude of Health Personnel↗
PubMed2002

Bioethical conflicts between Muslim patients and German physicians and the principles of biomedical ethics.

In the age of globalisation, more and more people who are members of different religions and cultures live in the same society. This situation tends to create many conflicts in different areas of life and not least in the health care system, a fact which raises a number of bioethical issues. The cultural and religious differences between patient and physician can be a cause of bioethical conflicts and therefore represent a challenge for biomedical ethics. The confrontation between Turkish Muslin patients and the German health care system is a convenient example of this situation. The Muslim Turks came to Germany 40 years ago as industrial workers. Their value system had been shaped by traditional and Islamic parameters in Turkey. With this value system, they now found themselves in the German modern health care system. In many fields of modern medicine there are areas of potential conflict of values, where a Muslin patient will argue differently from a secular or Christian person. In an ethical conflict between two individuals who are members of different cultures, it is necessary to make sure that the ethical concept which is to be used for resolving the problem is relevant. In this particular case, both the Islamic legal responses (fatwa) and the classical theories of biomedical ethics are often insufficient. This paper tries to give a brief outline of these bioethical conflicts and discuss these conflicts with regard to the principle of respect for autonomy in the concept of "principilism," as introduced by T.L. Beauchamp and J.F. Childress. The central question is whether this bioethical concept is able to analyse and to help solve the kinds of ethical conflicts which involve transcultural dimensions. This question is discussed with some consideration of the ongoing debate about universalism versus relativism in biomedical ethics.

Communication Barriers↗
PubMedDate not supplied

[Bioethical problems in contemporary physiology].

The review is devoted to problems of bioethics in modern physiology. Definition of bioethics is presented. One can find short history of the problem. Existing discripancies between interests of scientific research and modern rules of bioethics are discussed. Main principles of experiment in physiology organisation and role in its organisation of bioethics rules are formulated.

Animals↗
PubMed2004

[Survey on bioethics in a pediatric hospital. Basis for new strategies].

Although medical ethics is part of medicine since its beginning, it is only in the last decades that it is recognized as a necessary discipline. A survey of pediatricians of Hospital de Niños Ricardo Gutiérrez was carried out to determine a) the knowledge of basic concepts of bioethics b) the place and function of the committee. A total of 150 surveys were given out, 90 responses were obtained (60%). Basic concepts of bioethics (definition of bioethics, end of life, autonomy, justice, beneficence, and informed consent) were correctly answered by 75.2%; 97.8% knew of the existence of the committee in the hospital, it had been consulted by 61.1%. From the group that had consulted the recommendations suggested by the committee to solve the ethical dilemma was considered: useful by 23.6%, partially useful by 45.5% and not useful by 27.3%; 37.8% had never consulted the committee. Of these, 64.7% had never had a dilemma, 11.7% considered not useful any possible answer of the committee, and 11.7% did not give a reason. The majority of the responders had appropriate information of the basic bioethical concepts. Both the index of consultation to the committee and the assessment of its judgements as totally or partially useful (69.1%) guarantee its presence. It is peculiar that the principal argument for not consulting the committee was the absence of dilemmas. Both the committee in the hospital and the universities should intensify the teaching of medical ethics (mainly practical ethics), in order to facilitate the detection of ethical dilemmas by the health team.

Adult↗
PubMed2004

[Bioethics and adolescence. Reflections about corporeality, sexuality, health, education].

Bioethics plays an important role and has remarkable implications on all those who operate in the field of adolescentology at all levels. The forma mentis and the modus operandi that bioethics offers to each operator and educator will surely bring benefits towards the prevention of illness and the general well-being of adolescents, who will be tomorrow's adults. This paper, which analyses problems related to adolescence, such as corporeity, sexuality, health and education, underlines the need to consider them from a bioethical perspective. Furthermore, among the various bioethical approaches, the importance of the Aristotelian-Thomistic virtues is highlighted and should be preferred when dealing with the overall health, both physical and moral, of everyone and especially of every adolescent.

Adolescent↗
PubMedDate not supplied

[Current trends in bioethics in Canada].

In Canada, interest in bioethics intensified during the 1980s when a number of public and private agencies published papers on the opportunities and consequences presented by biotechnology in the industrial, agricultural, and medical fields. Bioethics is now a common subject in the universities, especially in the philosophy and religion study programs. It is also growing in importance as part of the training of health professionals. Several important bioethics centers and the Canadian Bioethics Society constitute a dynamic focus for the promotion of research and academic studies in this field. As in other countries, debate has centered around research involving human subjects, reproductive technologies, abortion, the dying process, organ transplants, and AIDS. Various guidelines and legislative measures have been established to deal with these questions.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The teaching of bioethics to the health care team: the neurologist's role.

The term 'bioethics' connotes not only the complexity of the subject but also the importance of adopting an interdisciplinary approach to it. Any given bioethical issue should be considered from a biological as well as anthropological and social perspective. Treating and evaluating ethical ideas without regard for these three aspects means diminishing and limiting them. Owing to the progress in intensive care and thanks to our increased sensitivity towards patients affected by irreversible diseases, many ethical problems have emerged relating to new conditions (for instance persistent vegetative state) or to already known ones (for example the later stages of amyotrophic lateral sclerosis or dementias). In future, it is likely that neurologists will be called upon to address an increasing number of ethical concerns, as primary care givers, consultants or members of ethics consultative teams, given that they are the most qualified to throw light on individual cases with regard to their diagnostic and prognostic, as well as on ethical, rational and emotional aspects. Neurologists are eminently suitable to play a crucial part in medical decision making regarding issues such as the administration or withdrawal of life-sustaining treatment. Furthermore, neurologists have much to contribute to the education of the health care team. This is because they are used to formulating judgments grounded on their professional experience in dealing with problems both physical and psychological. On the basis of these considerations, the author believes that neurologists are among the most qualified to bridge the gap between the two major components of bioethics: natural and human science. These components should find their synthesis and completeness in the bioethical debate.

Coma↗
PubMed1994

[Cultural background of the Japanese bioethics].

We attended the 11th Liaison Society of Ethics Committees in Medical Schools in Japan. Three symposiums were held under the themes of quality of life (QOL), stopping medical cure and the Japanese bioethics. Symposists were medical practitioners, teaching staffs in universities and a person of religion. In the first symposium, the definition of QOL, the usage of the term and the method of its evaluation were discussed. In the second symposium, an internist and a neonatologist reported several cases and stated problems and countermeasures in terminal care in cases that they could not maintain QOL. A person of religion made his opinion on the problems. In the final symposium were stated Japanese bioethics from the aspects of ethics and cultural anthropology. They emphasized differences in bioethical view between the Japanese and the Europeans and Americans, and a need to reform medical education in Japan. It is difficult to define QOL and to care patients at terminal stage, because present-day persons have various senses of value. Especially, Japanese have taken Western culture into our traditional social structures with its original style. Therefore, we have dual culture, as recognized in communication. Although it is very important to communicate sufficiently between patients and doctors, we consider that the dual communication has interrupted their mutual understandings. Incidentally, Western medicine had originally dual structure of art and technology. But we have taken only the technological aspect. That is probably the reason why human relations have been getting worse. It would be necessary for us to attend to these two dual structures in order to solve bioethical problems in Japan.

Bioethics↗
PubMed1997

[Bioethics in contemporary medicine].

Bioethics arose in a delicate social and political moment in the United States of America. With time, it has become a social and perhaps political movement. Its scope is wider and different than that of medical ethics. Bioethics appeared in the second half of the twentieth century, in the middle of a spectacular advance in biological knowledge and technology. Meanwhile, medical ethics was formulated in the fifth century B.C. in relation to medical care. This defines the main focus of their respective interests. Anglo-Saxon philosophers, deriving from moral philosophy, applied the principles of beneficence, no maleficence, justice and autonomy to medicine. The Hippocratic oath refers specifically to the first three and to a number of other ethical principles. Nothing in its contents, contradicts the principle of autonomy. The emphasis in the principle of autonomy that some specialists in bioethics pose, even over the principle of beneficence, is determined, according to our judgment, by inherent factors of the North American culture. We believe that medical ethics should be distinguished even though not separated from bioethics. Physicians should go back to the Hippocratic oath as the fundamental guide for their professional activity.

Bioethics↗