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PubMedDate not supplied

Deliberating about bioethics.

In some sense, bioethics was built on conflicts. Abortion, physician-assisted suicide, patients' demand for autonomy all are staple and contentious issues. And the controversies continue to proliferate. What forum best serves such debates? A look at political theories of democracy can help answer that question. The most promising for bioethics debates are theories that ask citizens and officials to justify any demands for collective action by giving reasons that can be accepted by those who are bound by the action. This conception has come to be known as deliberative democracy.

Bioethical Issues↗
PubMed2000

Jewish bioethics?

"Jewish Bioethics" as currently formulated has been criticized as being of parochial concern, drawing on obscure methodology, employing an authoritarian (and, to the modern mind, unintelligible) method of discourse and as being of little relevance to the wider community. We analyze Jewish bioethics in terms of rule and principle theory and demonstrate that it is based on rational consideration and reproducible reasoning. This approach allows methodological and terminological translation into a Western method of discourse that, in turn, has much to contribute to clarifying underlying principles and methods of application of modern bioethics.

Ethics, Medical↗
PubMedDate not supplied

Bioethics, medicine, and the moral ground.

"Bioethics" and "biomedical ethics" are new expressions, conveying new ideas and new concerns. They entered the language in the 1960s. "Ethics," of course, is an ancient word meaning the study of applied moral philosophy. Bioethics is an interdisciplinary field of study that considers ethical issues in wellness and illness. Some would strongly argue that it even embraces our entire natural ecology. It certainly concerns the profession of medicine. Bioethics, like ethics itself, seeks to know and understand "goodness."

Decision Making, Organizational↗
PubMed1998

Issues in organ procurement: presumed consent, bioethical type II errors, and organ registries.

In an effort to alleviate the current imbalance between the many in need of an organ transplant and the limited number of organs procured, a policy of presumed consent has been recently debated. Presumed consent assumes that potential organ donors agree to donate their organs in the absence of known objections to the contrary. The authors examine the bioethical principles and consequences involved in such a policy and apply hypothesis testing, borrowed from clinical epidemiology, to a "bioethical test" of presumed consent in a hypothetical clinical scenario. A possible bioethical alternative to presumed consent, an organ donor registry of advanced directives as has been established in British Columbia, is also discussed.

Advance Directives↗
PubMed2002

Developments in the storage of embryos in France and the limitations of the laws of bioethics. Analysis of procedures in 17 storage centres and the destiny of stored embryos.

BACKGROUND TO THE STUDY: 1985 witnessed the first transfers of frozen embryos resulting in live births in France. Since this time the number of embryos obtained by in vitro fertilisation (IVF) has increased each year. In 1999 each IVF attempt obtains, on average, 4.5 embryos that can be successfully implanted. In this paper we consider only those couples who have successfully obtained embryos (either by ICSI or traditional IVF techniques). The aims of the study are: To show how developments in embryo production and conservation have influenced the number of embryos stored. To address the socio-medical and ethical issues raised and to provide practitioners with some thoughts for reflection when consulting with couples based on the study findings To discuss the results of our findings in the light of those ethical questions raised by the imminent revision of the Laws of Bioethics. METHOD: In the first instance we did a retrospective analysis of quantitative data that 17 storage centres had collected over a period of 5 years. This period was marked by the implementation in 1994 of Laws described as Bioethics' Laws in France. During a second period we conducted a qualitative study regarding the fate of stored embryos. In order to do this, we began an analysis of the "status" of embryos and the decisions of those couples whose embryos were still in storage. For this a questionnaire was used. FINDINGS: The number of embryos that remain in storage in the 17 storage centres has increased reaching a total of 17,592 embryos involving 3,888 couples. The results show a consistent and persistent increase in the number of embryos stored before and after 1994. The qualitative study shows that: 51% of couples with embryos in storage can no longer be found, 23.6% request a continuance of storage, 12% would accept donating their embryos to medical research, 9.1% would wish for other couples to take eventual ownership of the embryo in 7.2% of cases the storage centre has can provide no information concerning the continuing of storage of such embryos. INTERPRETATION: The Bioethics Laws have therefore not succeeded in limiting the inflation in the number of embryos stored despite that the fact that this was one of the major concerns of those involved in formulating the laws and the medical professionals involved. Our study shows that the guidelines provided by these Laws remain ambiguous and that the objectives defined therein are thus difficult to achieve. Our study highlights the impact of such developments on the possible eventual "destiny" of such embryos, the behaviour of and the advice provided to couples, and the management practice of the storage centres involved. We present these results in the light of the laws established in 1994 in order to define not only the benefits but also the potential limitations of such legislation. No guidelines were laid down regarding the future of embryos belonging to a couple that no longer wishes to embark upon a "parental project". As a result it is not possible to terminate the conservation of such embryos which therefore remain in storage awaiting the revision of the current laws. The major objectives of our study assess the impact of the Laws and their impact on practice and to contribute to the debate which has yet to take place in the social and political arena.

Biomedical Research↗
PubMed2002

Bioethics, sport and the genetically enhanced athlete.

This paper begins by acknowledging the interest taken by various international organisations in genetic enhancement and sport, including the US President's Council on Bioethics (July, 2002) and the World Anti-Doping Agency (March, 2002). It is noticed how sporting organisations have been particularly concerned to emphasize the 'threat' of genetics to sport, whereas other institutions have recognised the broader bioethical issues arising from this prospect, which do not readily reject the use of genetic technology in sport. Sports are identified as necessarily 'human' and 'moral' practices, the exploration of which can reveal greater insight into the intuitive fears about genetic modification. It is argued that anti-doping testing measures and sanctions unacceptably persecute the athlete. While there are substantial reasons to be concerned about the use of genetic modification in sport, the desire for policy ought not diminish the need for ethical research; nor ought such research embody the similar guise of traditional 'anti' doping strategies. Rather, the approach to genetics in sport must be informed more by broader social policies in bioethics and recognition of the greater goods arising from genetic technology.

Doping in Sports↗
PubMed1993

Bioethics in nephrology: definitions and practices.

Ethical theory and principles can be applied and adapted for use in health care; individuals or groups may be making bioethical decisions regarding patient care in a number of settings. The current bioethical debates in the nephrology community and for ESRD patients center on issues of patient selection for treatment and criteria for the discontinuation of treatment after it has been initiated. This article defines bioethical theory and principles and their application to these two issues of patient care.

Decision Making, Organizational↗
PubMed1998

[Bioethics in severely neurologically disturbed children].

Informed consent is essential for bioethical considerations when physicians treat severely neurologically disturbed children. Because these patients are immature for their decision-making, proxy consent must be given to their physicians by their guardian to accept within agreeable limits of treatments and care for them. Prior to obtaining the consent, given by their guardians, physicians are obliged to provide their guardians with necessary informations regarding patients' physical conditions and details of procedures for proposed treatments, as well as possible risks involved in these treatments and care to be provided. Clinical applications of bioethical considerations are given to the patients with following diseases: spina bifida cystica and other neural tube defects, congenital metabolic disorders such as cretinism and phenylketonuria, malignant tumors such as neuroblastoma and retinoblastoma, and intractable epilepsy. Bioethical considerations are also given to prenatal diagnosis for early discovery, diagnosis and possible treatments of severely neurologically disturbed fetuses.

Child↗
PubMed1992

Gender in bioethics: theory and practice -- an introduction.

Does the care perspective make a difference? Can it reach as far as we would like? It is the goal of this special issue on Gender in Bioethics: Theory and Practice to begin to address some of these important questions. In the first article, Virginia Sharpe provides a comprehensive and thoughtful analysis of how the orientations of justice and care are played out in medical ethical theory. In the second article, James Nelson argues that the more traditional approach in Bioethics to maternal-fetal conflicts is not useful, and that a care perspective is more appropriate. Thoughtful commentary on Nelson's article is provided by Rosemarie Tong. For readers new to the justice-care debate in moral theory, the following articles will provide an informative introduction. For those who are more familiar, it is hoped that you will be challenged by the extension of the debate to the practical issue of maternal-fetal conflicts.

Bioethics↗
PubMed2001

The 'redefinition of death' debate: western concepts and western bioethics.

Biomedicine is a global enterprise constructed upon the belief in the universality of scientific truths. However, despite huge scientific advances over recent decades it has not been able to formulate a specific and universal definition of death: In fact, in its attempt to redefine death, the concept of death appears to have become immersed in ever increasing vagueness and ambiguity. Even more worrisome is that bioethics, in the form of principlism, is also endeavouring to become a global enterprise by claiming neutrality. It appears that the discourse within both disciplines have similarly manipulated the boundaries of death to include the "dying". This paper argues that the redefinition of death debate in biomedicine reveals a concept of personhood which is profoundly western in origin and which is in accordance to the concept adhered to within principlism. Biomedicine and bioethics do not appear to acknowledge the limitations of their own world view and hence lack an understanding of their applicability and appropriateness in diverse social and cultural contexts; a situation which adds credence to claims as to the hegemonic and imperialistic nature of all such global enterprises.

Bioethics↗
PubMed2001

The Institute on Human Values in Medicine: its role and influence in the conception and evolution of bioethics.

For ten years, 1971-1981, the Institute on Human Values in Medicine (IHVM) played a key role in the development of Bioethics as a field. We have written this history and analysis to bring to new generations of Bioethicists information about the development of their field within both the humanities disciplines and the health professions. The pioneers in medical humanities and ethics came together with medical professionals in the decade of the 1960s. By the 1980s Bioethics was a fully recognized discipline. We show the role that IHVM programs played in defining the field, training faculty and helping schools to develop programs. We review, the beginnings of the IHVM in the crucible of social and technological change that led to the establishment of the IHVM's parent organization, the Society for Health and Human Values. We then turn to the IHVM programs through which Faculty members received fellowships to explore new crossovers between the humanities and the health professions. We have not only described the Fellows Program as it existed in 1973-1980, but have completed a survey of the fellows a quarter of a century after they held their fellowships. We describe other IHVM programs designed to facilitate the initiation and development of new humanities programs, to explore conceptual issues between medicine and five humanities fields, to conduct issue driven or educational method conferences and to advance humanities programs into graduate education through the Directors of Medical Education.

Academies and Institutes↗
PubMed2001

Bioethics at the crossroad.

Bioethics and its offspring Health-care Ethics have a variety of uses and obligations among which and perhaps most importantly is their social obligation. This paper raises questions as to Bioethics fulfilling the necessary criteria for a profession, suggests that it can serve as a link between individual and communal problems, discusses the task of health-care ethics as well as ways of teaching it, lists some of the obligations of health-care ethics professionals and discusses the dangers to and failings of these health-care professionals today. It concludes that we are at a crossroads in which we must choose between our own personal security and comfort and fulfilling our social role.

Bioethics↗
PubMed2002

The professional status of bioethics consultation.

Is bioethics consultation a profession? With few exceptions, the arguments and counterarguments about whether healthcare ethics consultation is a profession have ignored the historical and cultural development of professions in the United States, the ways social changes have altered the work and boundaries of all professions, and the professionalization theories that explain how modern societies institutionalize expertise in professions. This interdisciplinary analysis begins to fill this gap by framing the debate within a larger theoretical context heretofore missing from the bioethics literature. Specifically, the question of whether ethics consultation is a profession is examined from the perspectives of trait theory, Wilensky's five-stage process of professionalization, Abbott's interdependent system of professions, and Haug's deprofessionalization thesis. While healthcare ethics consultation does not meet the criteria to claim professional status, neither could most professions pass these ideal theoretical standards. Instead of a yes or no dichotomous response to the question, it is more helpful to envision a professionalization continuum with sales clerks or carpenters at one end and medicine or law at the other. During the past decade healthcare ethics consultation has been moving along this continuum toward greater professional status.

Bioethical Issues↗
PubMed2003

European values in bioethics: why, what, and how to be used?

Are there distinctly European values in bioethics, and if there are, what are they? Some Continental philosophers have argued that the principles of dignity, precaution, and solidarity reflect the European ethos better than the liberal concepts of autonomy, harm, and justice. These principles, so the argument goes, elevate prudence over hedonism, communality over individualism, and moral sense over pragmatism. Contrary to what their proponents often believe, however, dignity, precaution, and solidarity can be interpreted in many ways, and it is not clear which reading would, or should, be favored by popular opinion. It is therefore dangerous to think that any one understanding of "European", or any other, values could be legitimately imposed on those who have different ideas about morality in health care and related fields. Bioethical principles should be employed to promote discussion, not to suppress it.

Bioethics↗
PubMed2003

Bioethics in a multicultural world: medicine and morality in pluralistic settings.

Current approaches in bioethics largely overlook the multicultural social environment within which most contemporary ethical issues unfold. For example, principlists argue that the "common morality" of "society" supports four basic ethical principles. These principles, and the common morality more generally, are supposed to be a matter of shared "common sense." Defenders of case-based approaches to moral reasoning similarly assume that moral reasoning proceeds on the basis of common moral intuitions. Both of these approaches fail to recognize the existence of multiple cultural and religious traditions in contemporary multicultural societies. In multicultural settings, patients and their families bring many different cultural models of morality, health, illness, healing, and kinship to clinical encounters. Religious convictions and cultural norms play significant roles in the framing of moral issues. At present, mainstream bioethics fails to attend to the particular moral worlds of patients and their family members. A more anthropologically informed understanding of the ethical issues that emerge within health care facilities will need to better recognize the role of culture and religion in shaping modes of moral deliberation.

Anthropology, Cultural↗
PubMed2000

Specifying, balancing, and interpreting bioethical principles.

The notion that it is useful to specify norms progressively in order to resolve doubts about what to do, which I developed initially in a 1990 article, has been only partly assimilated by the bioethics literature. The thought is not just that it is helpful to work with relatively specific norms. It is more than that: specification can replace deductive subsumption and balancing. Here I argue against two versions of reliance on balancing that are prominent in recent bioethical discussions. Without meaning to address the substance or the overall merits of either view I criticize, I attack Gert, Culver and Clouser's implicit reliance on some overall dimension of balancing as a basis of resolving conflicts among norms and Beauchamp and Childress's residual acceptance of 'justified balancing'. The former authors' description of resolving conflicts depends upon a type of value commensurability that (as they otherwise seem to admit) does not obtain, while the latter authors' role for justified balancing would be better served by continued specification.

Bioethics↗
PubMed2000

The person in secular and in Orthodox-Catholic bioethics.

The following demarcates the sens of the human person in Orthodox-Catholic bioethics from the family of senses proper to secular bioethics and philosophy. The radically different sources of knowledge about the senses proper to each discipline suggest that the importation of philosophical and secular psychological distinctions and analyses into true Christianity's concern with the human person, is fundamentally misguided. This suggestion is confirmed by examination of the articles of Crosby, Glannon, Hoswepian, and Meador and Shuman.

Anencephaly↗