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PubMed1994

Bioethics and the limits of tolerance.

Since 1989 there has been an ongoing controversy about the limits of public discussion of bioethical issues in the German-speaking world. While a number of scholars have been involved, Peter Singer and Helga Kuhse have been the principal targets of those seeking to limit bioethical debates. Those who have supported silencing discussion of certain issues have argued that such public discussion leads to a loss of freedom. In the article we argue that toleration is not based on subjectivism but rather on reason. Furthermore, the efforts to suppress debate are often based on a failure to understand our position. Such efforts at suppression also rest on an elitist view of society that must assume that the general public cannot debate such topics.

Attitude↗
PubMed1997

Bioethics in a legal forum: confessions of an "expert" witness.

This article reflects on the author's modest experience as an expert witness in two trials: Osheroff vs. Greenspan (1983), and In the Matter of Baby K (1994). Bioethicists' expertise as scholar-teachers and consultants on particular issues merits qualification by judges as expert witnesses. The article argues that a different kind of expertise-strong moral advocacy-is required to be an effective expert witness. The major lessons of expert witnessing for the author concern the demands and strains on the bioethicist's role as scholar, teacher, and consultant. The Baby K case is analyzed in some detail, due to its importance for bioethics, ethics consultation, and the testimony of bioethicists on either side of the case. Rules of thumb are offered to guide decisions as to choices regarding expert witnessing, as well as a discussion of the interaction of law and bioethics.

Bioethical Issues↗
PubMed1993

Bioethics in a low key: a report from Germany.

I now, by way of reporting rather than analysing (see my title) would like to do two things; first to give a sketch of bioethical priorities as implied in public political debate and legislation, and second to mention some of the bioethical research activities on the academic level. Important under the first heading seem to me three contexts of activity: the passing of a genetic engineering law (Gentechnikgesetz)in 1990, the passing of a law for the protection of embryos (Embryonenschutzgesetz) in 1990 too, [and] the reforming of the presently divided status of the penal code on abortion this year, 1992 (Schwangerschaftsabbruch).

Abortion, Induced↗
PubMed1996

Bioethics: an African perspective.

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 [Cameroon] -- 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-communitarianism 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.

Abortion, Induced↗
PubMed2004

Libertarian bioethics and religion: the case of H. Tristram Engelhardt, Jr.

This paper is a critique of certain moral perspectives that are found in the second edition of Engelhardt's Foundation of Bioethics. These views are spelled out in explicit detail in his second edition, and follow on the heels of a profound religious conversion. Engelhardt is an eminent bioethicist with strong religious convictions that overlay much of his writing. The author wishes to question some of the conclusions that Engelhardt reaches as they touch upon moral frameworks, pluralism, and a 'secular' bioethics.

Bioethics↗
PubMed2005

How infectious diseases got left out--and what this omission might have meant for bioethics.

In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as autonomy and the harm principle, to infectious examples. We argue that this is insufficient, however. Taking infectious disease into account requires understanding the patient as victim and as vector. Infectiousness reminds us that as autonomous agents we are both embodied and vulnerable in our relationships with others. We conclude by applying this reunderstanding of agency to the examples of informed consent and distributive justice in health care.

Bioethical Issues↗
PubMed2005

Clinical bioethics integration, sustainability, and accountability: the Hub and Spokes Strategy.

The "lone" clinical bioethicist working in a large, multisite hospital faces considerable challenges. While attempting to build ethics capacity and sustain a demanding range of responsibilities, he or she must also achieve an acceptable level of integration, sustainability, and accountability within a complex organisational structure. In an effort to address such inherent demands and to create a platform towards better evaluation and effectiveness, the Clinical Ethics Group at the Joint Centre for Bioethics at the University of Toronto is implementing the Hub and Spokes Strategy at seven hospitals. The goal of the Hub and Spokes Strategy is to foster an ethical climate and strengthen ethics capacity broadly throughout healthcare settings as well as create models in clinical bioethics that are excellent and effective.

Bioethics↗
PubMed2004

Beyond a western bioethics?

Like theology and ethics generally, bioethics has increasingly developed a global consciousness. Controversies over AIDS research and access to affordable AIDS treatment have generated new awareness about the importance of international collaboration as well as the difficulty of achieving moral consensus across economic, political, and cultural divides. Advances in scientific and medical knowledge through initiatives such as the Human Genome Project invite new questions about the nature of health care as a common good. This budding global consciousness serves as a starting point for examining contemporary challenges to the secular, principle-based Western bioethics that has dominated national and international debate for three decades.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Politics and bioethical commissions: "muddling through" and the "slippery slope".

When they have addressed highly controversial subjects, the bioethical commissions of the last decade have tended to avoid explaining the ethical justifications for their recommendations. This omission is consistent with the typical preference of policymakers for "muddling through," because it is often possible to reach agreement on specific decisions even when disagreeing sharply on principles. In bioethical policy, this omission of reasons has some special consequences. It allows commission members to ignore "slippery slope" arguments, which are based on the claim that the logic of justification adopted to address the current problem will ultimately lead us to great harms. Case-by-case decision-making--along with the omission of reasons for decisions--will tend to highlight the benefits of innovation, and downplay possible long-term effects that might be ethically upsetting.

Advisory Committees↗
PubMedDate not supplied

Equity and population health: toward a broader bioethics agenda.

Bioethics' traditional focus on clinical relationships and exotic technologies has led the field away from population health, health disparities, and issues of justice. The result: a myopic view that misses the institutional context in which clinical relationships operate and can overlook factors that affect health more broadly than do exotic technologies. A broader bioethics agenda would take up unresolved questions about the distribution of health and the development of fair policies that affect health distribution.

Bioethical Issues↗
PubMed1996

Feminist bioethics: toward developing a "feminist" answer to the surrogate motherhood question.

Although a wide variety of feminist approaches to bioethics presently share a common feminist methodology (sometimes referred to as "raising the woman question"), they do not all share the same feminist politics, ontology, epistemology, and ethics. As a result of their philosophical differences, feminist bioethicists do not always agree on which biomedical principles, practices, and policies are best suited to serving women's interests. In other words, some feminist bioethicists insist that so-called "assisted reproduction" enhances women's procreative liberty, while others claim that it does nothing of the sort. Although such disagreement among feminist bioethicists reassures the general public that the feminist "program" for bioethics is not ideologically monolithic, it also confuses the public, especially women. In order to overcome this confusion, feminist bioethicists should work toward developing the kind of shared theoretical base that will foster frequent consensus on the biomedical principles, practices, and policies most likely to serve the interests of most women in the U.S. today.

Bioethical Issues↗
PubMed1996

Revisiting the launching of the Kennedy Institute: re-visioning the origins of bioethics.

Twenty-five years ago, on October 1, 1971, at a press conference held at Georgetown University, the Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics, later called the Kennedy Institute of Ethics, was offically inaugurated. To revisit that event -- and the Institute's five founding collaborators who spoke at it -- provides an opportunity to re-vision some of the most significant intellectual, moral, cultural, and political factors that shaped both this Institute and the then-nascent field of bioethics.

Academies and Institutes↗
PubMed1999

Bioethics in the third millennium: some critical anticipations.

Its promises to the contrary notwithstanding, bioethics is plural. There is a diversity of content-full moral undertandings of the good and the right. Moreover, there is no secular means in principle to set this diversity aside without begging the question. This moral diversity exists both as a sociological condition and as a moral epistemological constraint. Without succumbing to a metaphysical scepticism or moral relativism, the bioethics of the future, if it is to be honest, should learn how to live with robust moral diversity.

Advisory Committees↗
PubMed2005

Bioethics as politics: the limits of moral expertise.

The increasing reliance upon, and perhaps the growing public and professional skepticism about, the special expertise of bioethicists suggests the need to consider the limits of moral expertise. For all the talk about method in bioethics, we, bioethicists, are still rather far off the mark in understanding what we are doing, even when we may be going about what we are doing fairly well. Quite often, what is most fundamentally at stake, but equally often insufficiently acknowledged, are inherently political, essentially contested visions of the most compelling and attractive forms of life for individuals and social organization. The current situation in bioethics parallels similar debates in eighteenth-century jurisprudence, especially Jeremy Bentham's withering critique of the prevalent forms of judicial argument and his own, equally unsuccessful, attempt to develop a decision-making procedure in ethics that would operate on a plane above politics. The risk, both then and now, is that we will fail to appreciate the wide range of reasonable disagreement that will remain past the point of extended reflection and discussion.

Advisory Committees↗
PubMed2003

Individual good and common good: a communitarian approach to bioethics.

The field of bioethics emerged in the late 1960s and early 1970s. Among its early issues were the protection of human research subjects, the rights of patients, abortion, and reproductive issues. Partly as a reflection of the times, and of those issues, the field became focused on autonomy and individual rights, and liberal individualism came to be the dominant ideology in the 1980s and 1990s. Communitarianism, as an alternative ideology focused more on the common good and the public interest than on autonomy, was a neglected approach. But many bioethical issues can not reasonably be reduced to questions of individualism and choice only. Issues of genetics and reproduction will of necessity touch on the society as a whole, its values, and its social institutions. Serious ethical analysis must take the social implications seriously and not simply assume that they should be left to autonomous choices of individuals. Human beings are social animals and our nature is distorted if we think of ourselves only as co-existing social atoms. Various approaches to communitarianism are outlined, and the question of the relationship between individual good and common good is confronted.

Bioethical Issues↗
PubMed1992

The design and use of the bioethics consultation form.

The emergence of the ethics consultation as a means to resolve moral crises in clinical medicine has revealed the need for a worksheet that would facilitate intake and analysis. The author developed the "Bioethics Consultation Form" as an attempt to remedy this need. The form is arranged in an outline format and is a useful asset to ethics committee discussions and record keeping. The first section covers basic intake data concerning the patient's medical and personal information, advance directives, and values, as well as the values of the physician and family. After the intake section is completed with the above data, the ethics consultant then turns to the analysis section. This second section allows for (1) the discussion of conflicting values, (2) the identification of priorities, and (3) the elucidation of ethical norms relevant to the case. The Bioethics Consultation Form was adopted by the Patient Care Advisory Committee of the Franklin Square Hospital Center in Baltimore, Maryland in 1986. The methodology in the use of the form will be discussed. Further, the potential spectrum of consultative cases that can be analyzed using the form will be highlighted.

Advance Directives↗
PubMed1990

Current bioethics trends in Canada.

Canadian bioethicists have long enjoyed access to bioethics programs in the United States and have collaborated with U.S. organizations working in this field. Nevertheless, special features of Canada's multicultural society and public health services are increasingly seen as raising distinctive issues requiring special attention. The purpose of this article is to provide an overview of current Canadian bioethics trends in various areas--including those of training, research on human subjects, human reproduction, termination of life, biotechnology, organ transplants, and AIDS. Comparison of this work with other articles in this issue will show that while some of the trends involved have paralleled similar ones in the United States, some trends (such as that regarding confidentiality and the reporting of HIV infection) have been quite different.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Dynamics of the bioethics dialogue in a Spain in transition.

Serious work on bioethics at private Spanish institutions began in 1975, when the Spanish Government was in transition toward democracy. Since then the country has developed significant centers of bioethics study and a wide-ranging community of experts in this field. Reasons relating partly to Spain's recent history and partly to the nature of its health system have kept the discipline from attracting the support and collaboration of much of the nation's medical fraternity. This could change, however, in response to a changing legal picture, creation of hospital ethics committees, and a growing need for stronger ties between bioethicists and the medical community at large.

Bioethical Issues↗