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UNESCO conference on human rights and bioethics.

UNESCO's Division of Human Rights and Peace, together with the USSR Academy of Science and the USSR Academy of Medicine, held an international bioethics conference in Moscow May 13-15, 1991. Twenty participants from the United States, Europe, Asia, and South America participated....The Moscow conference, which took place on the new campus of the USSR Academy of Social Sciences, addressed four topics: (1) organ transplantation; (2) informed consent; (3) bioethics and the law; and (4) institutionalization of bioethics....

Bioethical Issues↗

The word "bioethics": its birth and the legacies of those who shaped it.

Extensive historical sleuthing reveals that the word "bioethics" and the field of study it names experienced, in 1970/1971, a "bilocated birth" in Madison, Wisconsin, and in Washington, D.C. Van Rensselaer Potter, at the University of Wisconsin first coined the term; and André Hellegers, at Georgetown University, at the very least, latched onto the already-existing word "bioethics" and first used it in an institutional way to designate the focused area of inquiry that became an academic field of learning and a movement regarding public policy and the life sciences. A further comparison of the Potter and the Hellegers/Georgetown understandings of bioethics and the relative acceptance of the two views will appear in the March 1995 issue of this journal.

Bioethics↗

Gert's moral theory and its application to bioethics cases.

Bernard Gert's theory of morality has received much critical attention, but there has been relatively little commentary on its practical value for bioethics. An important test of an ethical theory is its ability to yield results that are helpful and plausible when applied to real cases. An examination of Gert's theory and his own attempts to apply it to bioethics cases reveals that there are serious difficulties with regard to its application. These problems are sufficiently severe to support the conclusion that Gert's theory is unacceptable as an approach for resolving bioethics cases, even relatively noncontroversial cases.

Bioethical Issues↗

The historical contingency of bioethics.

The principles of bioethics have been historically contingent, a product of social values, circumstances, and experience. During the early twentieth century, they rested on a doctor-knows-best autonomy that permitted physicians to perform research on human subjects with a minimum degree, if any, of informed consent. The eugenics movement of the period embraced an implicit bioethics by presuming to sterilize individuals for the sake of a larger social benefit, a practice and doctrine that helped lead to the Nazi medical experiments and death camps. After World War II, the promulgation of the Nuremberg Code failed to halt eugenic sterilization and risky human experimentation without informed consent either in civilian or military venues. However, beginning in the 1960s, these practices came under mounting critical scrutiny, partly because of the increasing attention given to individual rights. By now, it is widely understood that concern for individual rights rather than an appeal to some national good belongs at the heart of bioethics.

Bioethical Issues↗

'Miracle in Iowa': metaphor, analogy, and anachronism in the history of bioethics.

The term 'bioethics' is commonly associated with debates prompted by innovations in medical technology, yet the issues raised by bioethics are not that new. They concern the extent to which medicine and social morality exist in harmony or opposition--issues routinely addressed in the social history of medicine. This paper will argue that historical thinking, understood broadly, has a significant role to play in understanding relations between medicine and social morality, and therefore in contemporary bioethics. It explores past and present uses of metaphor and analogy in shaping perceptions of scientific innovation, and argues for the validity of apparently anachronistic thinking in our judgments of the past. The aims of this paper are ultimately pedagogical: to enable students to look at media reports about developments in medicine and biotechnology in order to problematise what are presented as the self-evident terms of current debate.

Bioethics↗

Bioethics and Christian theology.

The authors of this essay suggest that the field of bioethics and Christian theology have a great deal to offer each other. The authors first argue that representatives from both fields must first make sure that they fully and correctly represent their respective position. In other words, scientists, ethicists, and theologians alike must make sure that they present their fields and not use their knowledge merely for personal gain at the stake of misguiding people. Once this is established, the authors then proceed to show the intimate relationship between Christianity and medicine that has existed throughout the ages. It is a call for a continuation of such a relationship that the authors suggest between bioethics and theology. Through an integration of bioethics and Christian theology, both scientists/physicians and theologians are able to gain greater insight into the human person--a focus in both fields.

Bioethics↗

Resourcifying human bodies--Kant and bioethics.

This essay roughly sketches two major conceptions of autonomy in contemporary bioethics that promote the resourcification of human body parts: (1) a narrow conception of autonomy as self-determination; and (2) the conception of autonomy as dissociated from human dignity. In this paper I will argue that, on the one hand, these two conceptions are very different from that found in the modern European tradition of philosophical inquiry, because bioethics has concentrated on an external account of patient's self-determination and on dissociating dignity from internal human nature. However, on the other hand, they are consistent with more recent European philosophy. In this more recent tradition, human dignity has gradually been dissociated from contextual values, and human subjectivity has been dissociated from objectivity and absolutized as never to be objectified. In the concluding part, I will give a speculative sketch in which Kant's internal inquiry of maxim of ends, causality and end, and dignity as iirreplaceability is recombined with bioethics' externalized one and used to support an extended human resourcification.

Bioethics↗

A randomized trial of teaching bioethics to surgical residents.

BACKGROUND: Bioethics education has been recommended as a formal component of surgical residency training. The best method for teaching bioethics to residents is unclear. We compared the effectiveness of a standardized patient (SP)-based seminar to a traditional seminar format for teaching bioethics to surgical residents. METHODS: We randomized 31 first- and second-year surgical residents to either a SP-based seminar or a traditional seminar on informed consent. Immediately after the seminars, we evaluated resident performance in patient encounters on informed consent by using an objective structured clinical examination. Their knowledge of informed consent was also evaluated by using a 20-question short-answer written examination immediately after the seminars and then 3 weeks later. RESULTS: Twenty-nine residents completed the study; two withdrew because of an emergency. The SP seminar group had lower SP interview scores on the 22 item checklist compared with the traditional seminar group (57% versus 66%; difference -9%; 95% confidence interval [CI], -17% to -1%, P=.03). The SP seminar group also had lower knowledge scores on the questionnaire immediately after the seminar (60% versus 73%; difference -13%; 95% CI, -21% to -4%, P=.003). The difference in knowledge scores persisted at 3 weeks (41% for the SP group, 59% for the traditional seminar group; difference -18%; 95% CI, -29% to -7%; P=.002). CONCLUSIONS: A traditional seminar was superior to an SP-based seminar for teaching informed consent to surgical residents.

Adult↗

The chaplain's role in bioethical decision-making.

With advances in medical technology, difficult questions of "What should be done?" and "Who should decide?" are a daily occurrence in hospitals. This paper reports the results of a survey of Canadian chaplains with respect to their involvement in bioethical decision-making. The survey suggests that chaplains make a significant contribution to discussion and resolution of bioethical dilemmas. Using a case study, the paper elaborates on the chaplain's role in bioethical decision-making, and indicates how such participation can influence both cost containment and risk management.

Adult↗

A synthetic approach to bioethical inquiry.

This paper attempts to sort out some of the current tensions and ambiguities inherent in the field of bioethics as it continues to mature. In particular it focuses on the question of the methodological relevance of theory or ethical principles to the domain of clinical ethics. I offer an approach to reasoning about moral conflict that combines the insights of contemporary moral theorists, the philosophy of American pragmatism, and the skills of rhetorical deliberation. This synthetic approach locates a proper role for moral theory in the practice of clinical ethics, thus linking abstract philosophical ideas about morality, humanity, suffering, and health to specific deeds, actions, and decisions in the concrete lives of particular individuals. The aim of this synthetic approach of bioethical inquiry is a rapprochement between theoretical knowledge in moral philosophy and the contextualized, relational, and practical understanding of what morality demands of us in our daily lives. I argue for a conception of bioethical inquiry that takes morality to be a study of certain practical, socially embedded concerns about matters of right and wrong, good and evil, as well as a study of the moral theories by which these actual concerns can be explored and critically evaluated.

Bioethics↗

Freestanding pragmatism in law and bioethics.

This paper represents the first installment of a larger project devoted to the relevance of pragmatism for bioethics. One self-consciously pragmatist move would be to return to the classical pragmatist canon of Peirce, James and Dewey in search of substantive doctrines or methodological approaches that might be applied to current bioethical controversies. Another pragmatist (or neopragmatist) move would be to subject the regnant principlist paradigm to Richard Rorty's subversive assaults on foundationalism in epistemology and ethics. A third pragmatist method, dubbed "freestanding pragmatism" by its proponents, embraces a "pragmatist" approach to practical reasoning without discernable moorings either to the classical canon or to Rorty's neopragmatism. This third pragmatist approach to method in practical ethics is the subject of this article. I begin with an examination of freestanding pragmatism in the theory of judicial decision making. I argue that this version of legal pragmatism--so described on account of its commitments to contextualism, instrumentalism, eclecticism, and freedom from grand theory--bears a striking resemblance to much self-described pragmatist work in bioethics today. I further argue that if this is what we mean by "pragmatism," then in a certain sense "we are all pragmatists now."

Bioethics↗

Understanding the trusted doctor and constructing a theory of bioethics.

This paper offers a constructivist account of bioethics as an alternative to previous discussions that explained the ethics of medicine by an extrapolation of principles or virtues from ordinary morality. Taking medicine as a higher and special calling, I argue that the practice of medicine would be impossible without the trust of patients. Because trust is a necessary condition for medical practice, the ethics of the profession must provide the principles for guiding physician behavior and the profession toward promoting trust and being trustworthy. In a phrase, that principle is "seek trust and deserve it." I sketch out how the concept of trust provides a different justification for common sense principles of bioethics and explain how the concept of trust provides reasonable guidance for resolving moral conflicts within medicine. The trust-seeking approach provides a new and unexpected ordering of some traditional medical values, it reveals the weightiness of previously undervalued bioethical precepts, and illuminates the centrality of some largely ignored obligations of medicine. It also has the power to guide clinical practice and to inform the profession about standards for medical institutions.

Bioethics↗

What is the role of empirical research in bioethical reflection and decision-making? An ethical analysis.

The field of bioethics is increasingly coming into contact with empirical research findings. In this article, we ask what role empirical research can play in the process of ethical clarification and decision-making. Ethical reflection almost always proceeds in three steps: the description of the moral question, the assessment of the moral question and the evaluation of the decision-making. Empirical research can contribute to each step of this process. In the description of the moral object, first of all, empirical research has a role to play in the description of morally relevant facts. It plays a role in answering the "reality-revealing questions" (what, why, how, who, where and when), in assessing the consequences and in proposing alternative courses of action. Secondly, empirical research plays a role in assessing the moral question. It must be acknowledged that research possesses "the normative power of the factual," which can also become normative by suppressing other norms. However, inductive normativity should always be balanced out by a deductive form of normativity. Thirdly, empirical research also has a role to play in evaluating the decision-making process. It can rule out certain moral choices by pointing out the occurrence of certain unexpected consequences or effects. It can also be useful, however, as a sociology of bioethics in which the discipline of bioethics itself becomes an object of research.

Bioethical Issues↗

Human genetic technologies, European governance and the politics of bioethics.

With human genetic technologies now an important area of European research and development, bioethics is becoming increasingly important in its regulation and future. As regulatory decisions are also statements about who should get what, bioethics cannot avoid political controversy. Can bioethics sustain its claimed role as authoritative adviser to decision makers, or will its attempts to reach a consensus on human genetic technologies be perceived as the actions of an ambitious interest group? What, in short, is its political future in Europe and elsewhere?

Bioethics↗

Who should fund and control the direction of human behavior genetics? Review of Nuffield Council on Bioethics 2002 report, genetics and human behaviour: the ethical context.

In this (Nuffield Council on Bioethics 2002), the third in its series on ethics and related issues in genetics (see also Nuffield Council on Bioethics 1993 and Nuffield Council on Bioethics 1998), the Nuffield Council has focused on four'normal' behaviors; intelligence, personality, antisocial behavior and sexual orientation. This is a narrow range of behaviors and one where their discussion of the potential impact of predictive genetic testing is probably inappropriate. They also take an unduly narrow view of the purposes of behavior genetics in the 21st century. It is not simply to estimate heritability but to understand more about the structure of behavior and the processes which underlie it. Their narrow focus and their negative approach to the history and achievements of genetics is reflected in their less than positive support for future behavior genetic research. Behavior geneticists need to do more to publicize what their field has achieved in order to counter the very extensive antibehavior genetics initiatives which are almost unique in science. At the same time, organizations such as the Nuffield Council need to consider carefully the impact their deliberations may have on research funding.

Advisory Committees↗

What is bioethics without Christianity?

The author uses the essays in this issue as a springboard for making three points. First, he argues that most, if not all, current institutional versions of Christianity have failed to provide a meaningful framework for the spiritual life. Second, he argues that there is no ethics other than Judeo-Christian ethics and that there can be no bioethics other than Judeo-Christian bioethics. Finally, he argues that the overriding issue we face is not whether to address bioethical issues from a Christian perspective or from a non-Christian perspective, but rather whether we shall address biological and medical issues from an ethical or a scientific-technological perspective.

Bioethics↗

Critical care: why there is no global bioethics.

The high technology and the costs involved in critical care disclose the implausibility of applying the American standard version of bioethics in the developing world. The American standard version of bioethics was framed during the rapid secularization of the American culture, the emergence of a new image for the medical profession, the development of high technology medicine, an ever greater demand in resources, and a shift of focus from families and communities to individuals. This all brought with it a particular ideology of health care which promised Americans (1) the best of care, (2) equal care, and (3) physician/patient choice, without (4) runaway costs. This essay argues that this moral project is impossible in practice. This impossibility is especially salient in developing countries. In addition to the fact that it is financially impossible to provide all in the developing world with the standard of care accepted by law, policy, and convention in developed countries, different moral perspectives with different orderings of values will seem more or less plausible in different cultures. Indeed, such an approach would be harmful. A concrete bioethics applicable across the world does not appear possible.

Bioethics↗

The appearance of Kant's deontology in contemporary Kantianism: concepts of patient autonomy in bioethics.

Kant's concept of autonomy and the Kantian notion of autonomy are often conflated in bioethics. However, the contemporary Kantian notion has very little at all to do with Kant's original. In order to further bioethics discourse on autonomy, I critically distinguish the contemporary Kantian notion from Kant's original concept of moral autonomy. I then evaluate the practical relevance of both concepts of autonomy for use in bioethics. I argue that it is not appropriate to appeal to either concept toward assessing which patients we ought to respect as autonomous. Finally, I sketch criteria for what I take to be a more promising concept of autonomy for patients.

Bioethics↗