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PubMed1996

Bioethics in Ibero-America and the Caribbean.

Bioethics has become a field of new challenges for Ibero-America and the Caribbean. A seeming uniformity in the region hides a rich heterogeneous society. A brief survey of bioethical developments in different Ibero-American countries is provided as well as the bioethical problems and approaches peculiar to the region. Some of the unique features of bioethics in this region, it is suggested, could infuse new life into the U.S. and European bioethics discussion. Finally, a bibliography of Ibero-American bioethics literature is provided for North American and European readers.

Bioethical Issues↗
PubMed1992

A nursing bioethics program.

In 1985 the Seattle Veterans' Administration Medical Center nursing service implemented a nursing program for bioethics with three goals: (1) to expand the nurse's knowledge of bioethical principles, (2) to develop the nurse's ability and confidence in analyzing bioethical dilemmas, and (3) to increase bioethical application at the bedside. Two psychosocial clinical nurse specialists (CNSs) led this highly successful nursing program that prepared nurses to more actively and responsibly participate in bioethical decision making within the medical center. The program offers an annual workshop for new members, holds a monthly discussion group, conducts a yearly enrichment program, and completes an annual evaluation report. This article describes nursing service bioethics program from planning through evaluation and the role of the CNS as program coordinator, facilitator, and educator in the expanding field of bioethics.

Education, Nursing, Continuing↗
PubMed1996

Accounting for context: future directions in bioethics theory and research.

Many physicians have found that the traditional approach to bioethics fails to account for important aspects of their moral experience in practice. New approaches to bioethics theory are challenging the traditional application of universal moral principles based in liberal moral theory. At the same time, a shift in both the goals and methods of bioethics education has accompanied its "coming of age" in the medical school curriculum. Taken together, these changes challenge both bioethics educators and theorists to come closer to the details and nuances of real clinical encounters. The emerging trend emphasizes the importance of context in bioethics education and in the moral theory and research undergirding it. This article introduces one research approach examining the practical life contexts of medical students' ethical experiences and learning. It calls for increased attention to research and theory in bioethics that more adequately accounts for the ways different contexts produce significant changes in meaning and understanding in medical encounters.

Bioethics↗
PubMed1992

Policy arguments in a public church: Catholic social ethics and bioethics.

This paper is an analysis of the relationship of social ethics and bioethics in Roman Catholic theology. The argument of the paper is that the character of both Catholic moral theology and ecclesiology shape the broadly defined interest of the church in bioethics. The paper examines the common elements of social ethics and bioethics in Catholic teaching, describes how ecclesiology shapes Catholic public policy and uses the examples of abortion and health care to illustrate the relationship of Catholic social thought and bioethics. In developing the relationship of these two dimensions of Catholic moral argument the article highlights how the appeal to natural law categories differs in social ethics and bioethics and how the two topics are received differently in the theological community. It also seeks to illustrate how the premises of Catholic social ethics remain central to public positions taken on bioethics.

Abortion, Induced↗
PubMed1991

Clinical judgment and bioethics: the decision making link.

The literature on bioethics is diverse and confusing in its treatment of appropriate components for decision making. As a result, the literature on teaching bioethics is also confusing, even contradictory, in presenting an 'appropriate' framework within which learners may come to understand the nature and process of bioethics. The article sets out five decision components which are seen as common to all decision making. These components are then shown to have a significant influence both on bioethics decision making and on bioethics teaching. They are also shown to play a role in breaking down the separatism evidenced in contemporary bioethics literature aimed at individual professions.

Beneficence↗
PubMedDate not supplied

[Current status and perspectives of bioethics in Argentina].

The study of bioethics in Argentina owes much to the efforts of José Alberto Mainetti, who in 1972 founded the Institute of Medical Humanities, devoted to researching, teaching, and publicizing the discipline. Because of growing interest in the field of bioethics, a Bioethics Center was created in the Institute in 1987 and it has stimulated the organization of several groups in various provinces in the country. One of the most important of them, located at the National University of Mar del Plata, is responsible for designing a graduate-level specialization in bioethics and for organizing the First Mar del Plata Bioethics Workshop. This interdisciplinary group examines the bioethical implications of concrete scientific and professional activities as well as legislative measures and decisions affecting the public.

Argentina↗
PubMed1998

The foundations of bioethics: contingency and relevance.

In this essay, I proceed by, first, laying out H. Tristram Engelhardt's argument for the principle of permission as the proper foundation for a secular bioethic. After considering how a number of commentators have tried to undermine this argument, I show why it is immune to some of these advances. I then offer my own critique of Engelhardt's project. This critique is two pronged. First, I argue that Engelhardt is unable to establish his own foundation for a secular bioethic. This inability leaves him with only contingent points of departure for a secular bioethic, some of the more salient of which he has ignored. Second, I argue that even if Engelhardt's project succeeds, it is in danger of being irrelevant in a practical sense because it ignores important contextual dimensions of the peculiar enterprise we call bioethics. Ultimately, the proper foundations for a relevant secular bioethic. I argue, must appeal to certain contingent features of the context that gives rise to the need for it.

Bioethics↗
PubMed1996

Educating nurses for their future role in bioethics.

The emerging new multidisciplinary and crosscultural field of bioethics will require sensitive, open-minded professionals to take the lead in hospital ethics, in genetic counselling, and in the teaching of bioethics to students in nursing, medicine and the basic sciences. Nurses with ward experience who return to university to gain an MA or PhD in bioethics are eminently suited for this leadership role, for they may be more likely than physicians to study for a liberal education to supplement their professional knowledge; their first-hand experience in nursing is an antidote to the pointless subtleties into which philosophical ethics so often degenerates. When teaching ethics to nurses one must remember that, while some will simply use this knowledge in their own clinical work, others will go on to be teachers and researchers in bioethics. Their training must therefore be broad and interdisciplinary, including real substantive philosophy (as opposed to philosophical ethics), as well as mystical bioethics, religious law, ethics of genetic counselling, clinical approaches to ethical pseudo problems, research skills, etc.

Cultural Diversity↗
PubMedDate not supplied

[Dynamics of the dialogue on bioethics in a Spain in transition].

The bioethics dialogue began in Spain in 1975 in private institutions and developed in a society in transition toward democracy. Nostalgia for a nationalist Catholicism by some and the fervor of others to demonstrate that a break with the past had taken place have been important factors in bioethics legislation. Imitation of legislation considered progressive prevailed in the debate taking place in the country's bioethics centers, although in the case of assisted reproduction a commission of experts was set up to advise the government. The public has not participated in the debates, despite their coverage by the communications media. The medical schools have attempted to reform the deontological codes as a basis for formulating, promoting, and protecting the values of a pluralistic society. Results have been minimal, but the work of the bioethics centers is gradually being recognized and evaluated, and it is hoped that this ongoing bioethical dialogue will gradually mature.

Bioethics↗
PubMed1993

The European Convention on Bioethics.

For nearly 20 years, the Council of Europe, the organization for intergovernmental cooperation of the great Europe (26 countries are members of the council) has worked in the different fields of what is now called bioethics (reproductive technologies, organ transplants, human experimentation, etc). The council mainly proposes recommendations to member states in order to implement harmonized legislation. During the past ten years, this activity has been concentrated in a unique and multidisciplinary committee of experts; the CAHBI (ad hoc Committee of Experts on Bioethics). The recent development of national and very diverse legislation related to bioethical issues emphasized the necessity of adopting common binding principles at the European level. It was then decided at the end of 1991 by the Committee of Ministers of the council that the CAHBI would prepare a European Convention on Bioethics. This text, which is now being drafted, will in fact be composed of three documents. The Convention itself will list a set of general principles such as respect for human dignity, respect for the integrity of the person, the prohibition of any commercial arrangement on the human body and the principle of nondiscrimination. Two protocols will specifically deal with two important bioethical issues: organ transplants and human experimentation, but other topics could be covered in the future. All these texts will create obligations for member states and others that would like to ratify them to implement national regulations. An independent committee will have the duty to control how these obligations will be respected.

Bioethics↗
PubMed1995

[Introduction to bioethics in contemporary medicine].

The author makes a historical revision of his 50 years experience in medical ethics as a student and physician. In 1944, medical ethics was traditional and resolved simple problems based on Hippocrates postulates and christian humanism. The present scientific and cultural revolution has impelled the rise of bioethics defined as "the systematic study of human behavior in life sciences, based on moral principles". The bioethical methods attempt to facilitate the application of universal ethical principles to the solution of complex cases, generated by the new medical technology. These ethical problems were posed in Chile in 1962 by the french professor Jean Cheymol, who reported the serious human rights abused derives from new scientific experiments. Later in 1973, Dr. Motulsky predicted the advent of "a brave new world" and the need to create a new biological ethic. These challenges were faced by the professors of the faculty of Medicine, who created ethics commissions in 1975 and edited medical ethics code texts. There are three players in the bioethic context. Physicians apply beneficence; patients defend their autonomy: the State and the society defends justice. A conflict of values lies in the bottom of bioethics. The author vindicates the coherence of traditional medical ethics. Philosophers, theologians and lawyers can only help physicians, but are not responsible. Bioethics must allow a frank dialogue between these professionals, respecting their roles and responsibilities.

Bioethics↗
PubMed1990

Quality of scholarship in bioethics.

This paper identifies four major forms of scholarship in bioethics: empirical research, the articulation of mid-level principles of bioethics, the relating of these principles to fundamental moral theories, and discussions of the bioethical implications of legal principles and health delivery policies. It develops a reflective equilibrium approach to the relation between these four forms of scholarship. It then presents, in light of this approach, criteria for quality research in each of these forms of scholarship in bioethics.

Bioethical Issues↗
PubMed1991

Getting down to cases: the revival of casuistry in bioethics.

This article examines the emergence of casuistical case analysis as a methodological alternative to more theory-driven approaches in bioethics research and education. Focusing on The Abuse of Casuistry by A. Jonsen and S. Toulmin, the article articulates the most characteristic features of this modern-day casuistry (e.g., the priority allotted to case interpretation and analogical reasoning over abstract theory, the resemblance of casuistry to common law traditions, the 'open texture' of its principles, etc.) and discusses some problems with casuistry as an 'anti-theoretical' method. It is argued that casuistry so defined is 'theory modest' rather than 'theory free' and that ethical theory can still play a significant role in casuistical analysis; that casuistical analyses will encounter conflicting 'deep' interpretations of our social practices and institutions, and are therefore unlikely sources of increased social consensus on controversial bioethical questions; that its conventionalism raises questions about casuistry's ability to criticize norms embedded in the societal consensus; and that casuistry's emphasis upon analogical reasoning may tend to reinforce the individualistic nature of much bioethical writing. It is concluded that, not-withstanding these problems, casuistry represents a promising alternative to the regnant model of 'applied ethics' (i.e., to the ritualistic invocation of the so-called 'principles of bioethics'). The pedagogical implications of casuistry are addressed throughout the paper and include the following recommendations: (1) use real cases, (2) make them long, richly detailed and comprehensive, (3) present complex sequences of cases, (4) stress the problem of 'moral diagnosis', and (5) be ever mindful of the limits of casuistical analysis.

Bioethical Issues↗
PubMed1994

Observations on the epistemological status of bioethics.

Different definitions of bioethics in American and Italian literature are reported. It is argued that they refer to three different conceptions of the epistemological status of bioethics: the first conceives of it as an application of moral principles to biomedical problems, the second as a methodology for the working out of clinical judgement, the third as a broader and interdisciplinary public inquiry. It is suggested that each approach grasps a part of the truth, for each singles out one level of the bioethical work. Bioethics is in fact a complex, three-level form of knowledge. The misunderstanding of this complexity has led to some confusion and to conflicts of attribution among those who are concerned with it.

Beneficence↗
PubMed1995

An 'ethics gap' in writing about bioethics: a quantitative comparison of the medical and the surgical literature.

In order to determine whether there is a significant difference between the medical literature and the surgical literature in terms of their bioethics content, we conducted a computerized search of the MEDLINE database. The journals searched were selected from the 'Medicine' and 'Surgery' sections of the 'Brandon-Hill List', and the search was limited to 1992 issues of these journals. Three hundred and seven bioethics bibliographic records (out of a total of 11,239 articles indexed) were retrieved from the 15 medical journals searched, while 17 bioethics bibliographic records (out of a total of 2,645 articles indexed) were retrieved from the 12 surgical journals searched. We conclude that there is a statistically significant (p < 0.001) difference between the medical literature and the surgical literature with respect to their quantitative bioethics content.

Bibliometrics↗
PubMed1991

What has bioethics to offer health policy?

The field of bioethics has quickly become a subject of intense public fascination; and, following on an earlier period of resistance and skepticism, bioethics has been welcomed by clinicians as well. Bioethics, however, is largely a practical activity rather than a scholarly one, and its pretensions as an academic discipline within health policy and health services research must be greeted cautiously. Continuing problems in moral theory suggest that the most secure contributions that bioethics can make to health policy research are analysis and criticism rather than positive moral claims.

Advisory Committees↗
PubMed1990

Present status and prospects of bioethics in Argentina.

Most developments supporting the study of bioethics in Argentina are of relatively recent vintage. This article is dedicated to describing those developments--including creation of Argentina's Institute of Medical Humanities, formation of a bioethics working group at the National University of Mar del Plata, initiation of a two-year graduate bioethics course at the same university, and the holding of an international symposium and workshop on bioethics at Mar del Plata in 1988. Particular attention is devoted to the graduate course, the detailed design of which is outlined in Annex 1.

Argentina↗
PubMed1990

Overview of bioethics in Mexico.

In Mexico, as in many other countries, there are numerous situations involving bioethics that are not necessarily covered by officially sanctioned policies or guidelines. In such cases, it is reasonable to describe commonly accepted rules, opinions, and practices in a general way so as to illustrate how bioethical questions are being managed. This article describes certain goals and practices relating to education in bioethics in Mexico. It then outlines Mexican laws and procedures governing research on human subjects, cites certain official rules and activities relating to regulation of human reproduction, quotes literature dealing with intervention in human procreation, discusses artificial prolongation of life, describes laws and practices governing organ transplants, considers ethical issues relating to such transplants, reviews the AIDS situation, and describes how the need for confidentiality is dealt with in managing AIDS cases and related data. In this manner it indicates how bioethical questions in these various areas are being handled and points out certain priority areas needing work.

Acquired Immunodeficiency Syndrome↗