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The concept of global, Asian and Chinese bioethics are discussed in this paper and the difficulty in applying universal bioethics within different cultures and countries is addressed. The traditional beliefs and values in China are described with particular reference to medicine, and the implications for bioethics and research ethics within the country are considered.
Embryonic stem cell (ESC) has been recognized as one of the most promising therapeutic tools for the next decade. However, there are many controversial issues in bioethics for this challenging research area. Each country has its own distinct regulations and policies for ESC research due to their differences in cultural background, religious belief and political influence. These differences will eventually play an important role on international ESC research collaboration. The present article will provide a concise summary of the different policies and regulations regarding bioethical points for ESC research worldwide and show current progress towards establishing standard bioethical guidelines for ESC research on the international level.
The knowledge of the national legislation and the key concepts of bioethics are necessary for medical practice. The four principles of bioethics are autonomy, beneficence, non-maleficence, and justice. General internal medicine is the speciality of comprehensive care for often elderly patients with multiple chronic illnesses. This care is related to many ethically difficult decisions. In our article, we discuss common ethical problems in general internal medicine, including ethical aspects of the patient-physician relationship and medical decision making, the ethical significance of time management, research in bioethics and medical education.
Religion is concerned with problems of health, medicine, and disease. Conversely, concepts of health and disease reflect values that are often influenced by religious postulates. Thus, the complex ways in which religion refers to and describes health, medicine, and disease help to explain its many-sided relationship to bioethics. This article examines the manner in which religion, as a descriptive and empirical entity, and also a normative and conceptual one, has moral meaning for bioethics and can enrich it. An analysis is also made of how a particularly complex problem in bioethics--whether the medical technology available for prolonging life should be used--could be approached from the standpoint of different religious traditions.
Current problems with the decision-making process for bioethical dilemmas are described, with emphasis on the social roles taken in this process by medical experts and laypersons. An approach is presented to improve bioethical decision making. Two consecutive steps are required. First, branching logic is used to separate the bioethical dilemmas into a series of independent, sequential decision points along a decision-making tree. This allows complex dilemmas to be dealt with more easily by resolving the individual component issues in a logical, stepwise fashion. Secondly, explicit criteria are used to decide whether each individual component is ethical or technical in nature. Using these two steps increases the likelihood that the professional and the layperson will assume their appropriate social roles and improve the overall decision-making process. How this approach can be applied to policy-making decisions, in addition to case-by-case deciding, is discussed, as are some of the settings in which the approach might be particularly helpful.
Only recently medicine has emphasized the importance of major ethical principles (autonomy, beneficence, justice and non-malificence) and only recently they have come to play an important role in medical and public policy discussions. Until the 70's, medical dilemmas and disagreements were rarely discussed in terms of rights and duties. However, at this point in history, crucial new ideas were introduced, including the notion of Medical Bioethics. What seems important at this stage is to show if Bioethics has made a significant difference in the field of medicine. This article intends to give a picture of how ethical, historical and medical factors have influenced the beginning of Bioethics, in an attempt to determine how much it has been able to fulfill a genuine need.
The author introduces the Bioethics for Clinicians series, which begins in this issue with an article on patient consent to medical care (see pages 177 to 180). This 14-part series is intended to elucidate key concepts in bioethics and to help clinicians to integrate bioethical knowledge into daily practice. In educational terms, the goal is to support performance: what clinicians actually do.
An anonymous survey was done to know the level of Bioethics elementary knowledge existing among the nursing personnel, as well as the effectiveness in that sense of a postgraduate course on this topic imparted to 110 nurses from the Provincial Clinical and Surgical Hospital in Cienfuegos. 84 of them had no previous training on this regard, and the other 26 had attended postgraduate courses. It was demonstrated that the first group only answered correctly for a general mark of 39.5%, whereas the second group obtained 86.9%. This shows that there is a low level of Bioethics knowledge among the nursing personnel, and reaffirms the need to conduct systematic Bioethics courses for this health personnel, taking into account that its efficacy may lead to a better and more human attention to the patients and their relatives.
In an age when the ever-expanding limits of sciences are requiring an adjustment of moral principles and values, the Bioethics file is an essential tool for those who are in need of updated guidelines on bioethical issues. This database--produced by the Kennedy Institute of Ethics (KIE) in collaboration with the National Library of Medicine (NLM)--is distributed online by different hosts and is also available in print version and on CD-ROM. Structure and contents of the online version of the Bioethics file searchable through MEDLARS are described in details.
The authors analyse and assess the Universal Draft Declaration on Bioethics and Human Rights published by UNESCO. They argue that the Draft has two main weaknesses. It unnecessarily confines the scope of bioethics to life sciences and their practical applications. And it fails to spell out the intended role of human dignity in international ethical regulation.
This essay focuses on two underlying presumptions that impinge on the effort of UNESCO to engender universal agreement on a set of bioethical norms: the conception of universality that pervades much of the document, and its disregard of structural inequalities that significantly impact health. Drawing on other UN system documents and recent feminist bioethics scholarship, we argue that the formulation of universal principles should not rely solely on shared ethical values, as the draft document affirms, but also on differences in ethical values that obtain across cultures. UNESCO's earlier work on gender mainstreaming illustrates the necessity of thinking from multiple perspectives in generating universal norms. The declaration asserts the 'fundamental equality of all human beings in dignity and rights'(1) and insists that 'the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition'(2) yet it does not explicitly recognize disparities of power and wealth that deny equal dignity and rights to many. Without attention to structural (as opposed to merely accidental) inequities, UNESCO's invocation of rights is so abstract as to be incompatible with its avowed intention.
In the United States, controversy has raged about ethical public policies toward some potential sources of human stem cells for research, particularly human embryos left over from in vitro fertilization (IVF) or created through somatic cell nuclear transfer. This article critically examines the ethical and policy issues, particularly as they have emerged in the reports and recommendations of two presidentially appointed advisory bodies: The National Bioethics Advisory Commission (NBAC) and the President's Council on Bioethics (PCB).
Psychiatrists have been extensively involved in ethics in the general hospital over the past two decades and have functioned in that area in a variety of roles. The basis for psychiatry's strong interest in bioethics can be understood as related to three factors: familiarity with many of the clinical problems that lead to bioethics consultation, the frequent importance of psychiatric aspects of ethics, and the observation that psychiatrists already possess many of the clinical skills necessary for doing ethics work. The particular value of training psychiatrists to serve as ethics consultants, in addition to the importance of their continuing role on hospital ethics committees, is discussed.
For over 20 years the medical literature has carefully documented the undertreatment of all types of pain by physicians. During this same period, as the field of bioethics came of age, the phenomenon of undertreated pain received almost no attention from the bioethics literature. This article takes bioethicists to task for failing to recognize the undertreatment of pain as a major ethical, and not merely a clinical, failing of the medical profession. The nature and extent of the problem of undertreated pain is examined, as well as possible reasons for its disregard by bioethicists. The factors contributing to undertreated pain in the clinical setting are considered, as well as the hazards posed by recent failures to address ethically questionable clinical practices. Finally, suggestions are offered for refocusing the attention of bioethicists to this significant problem.
In the late 1950s and early 1960s, emerging advances in the biomedical sciences raised insufficiently noticed ethical issues, prompting science reporters to serve as a sort of Early Warning System. As awareness of bioethical issues increased rapidly everywhere, and bioethics itself arrived as a recognized discipline, the need for this early-warning press role has clearly diminished. A secondary but important role for the science journalist is that of investigative reporter/whistleblower, as in the Tuskegee syphilis trials and the government's secret plutonium experiments. Because the general public gets most of its information from the popular media, ways are suggested for journalists and bioethicists to work together.
Glenn McGee, Editor-in-chief of the American Journal of Bioethics offers a brief overview of the issues that have defined America's 'thirty years of bioethic,' and contends that genetics is the issue that now awakens bioethicists' concern.
The Thai concern for bioethics has been stimulated by the departure of Thai medicine from its long tradition through the introduction of Western medical models. Bioethics is now being taught to Thai medical students emphasizing moral insights and principles found within Thai culture. These are to a large extent Buddhist themes. Veracity is always a duty for people in general and medical personnel in particular. Falsehoods and deception cannot be morally justified simply on the grounds that we think it is good for another. Buddhism also prohibits killing. The doctrine of kamma holds that joys and sorrows are the result of one's own past actions. Kamma must run its course or will be manifest in a future life. Mercy-killing also violates the Buddhist psychology. A physician who kills subconsciously transfers his aversion to suffering to the one who embodies the suffering. Buddhist justice is understood in terms of impartiality and equal treatment. Compassion goes beyond justice to self-giving and self-denial. It is central to the path to the attainment of highest human fulfillment.
As various societies have created public commissions to help develop proposals for public policies relating to issues in bioethics, philosophers have sometimes been called upon to serve on the staff of, or to provide consultation to, these public bodies. This issue of the Journal is devoted to examining problems that arise as one tries to articulate the proper role of philosophers serving in these capacities. It includes articles by Frances M. Kamm ("The philosopher as insider and outsider"), Martin Benjamin ("Philosophical integrity and policy development in bioethics"), Richard W. Momeyer ("Philosophers and the public policy process: inside, outside, or nowhere at all?"), Paul T. Menzel ("Public philosophy: distinction without authority"), and E. Haavi Morreim (Physician investment and self-referral: philosophical analysis of a contentious debate").