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PubMed1998

Autonomy, discourse, and power: a postmodern reflection on principlism and bioethics.

In recent years there has been an increasing critique of the philosophically based reasoning in bioethics which is known as principlism. This article seeks to make a postmodern contribution to this emerging debate by using notions of power and discourse to highlight the limits and superficiality of this abstract, rationalistic mode of reflection. The focus of the discussion will be on the principle of autonomy. Recent doctoral research on a hospice organization (Karuna Hospice Service) will be used to contextualize the debate to end-of life ethical dilemmas. The conclusion will be reached that the discursive richness of this organization's notion of autonomy or choice, which incorporates a holistic respect for the individual and the active creation of alternatives, can provide important insights to our understanding of autonomy in bioethics. The concern is raised that if autonomy is reified as a principle outside of the context of discourse, it may only complement the hegemonic power of biomedicine.

Bioethics↗
PubMed2001

Understanding autonomy relationally: toward a reconfiguration of bioethical principles.

Principle-based formulations of bioethical theory have recently come under increasing scrutiny, particularly insofar as they give prominence to personal autonomy. This essay critiques the dominant conceptualization of autonomy and urges an alternative formulation freed from the individualistic assumptions that pervade the prevailing framework. Drawing on feminist perspectives, I discuss the need for a vision of patient autonomy that joins relational experiences to individuality and acknowledges the influence of patterns of power and authority on the exercise of patient agency. Deficiencies in the current models of science and social relations guiding medical practice are analyzed, particularly (1) the tendency to disregard the patient's self-knowledge and (2) failure to recognize limitations on the generalizability of medical knowledge. Models of social relations such as mothering and friendship are explored to advance a conception of autonomy better suited to the practical activities of medicine. In conclusion, I consider how acknowledgement of the specificity and complexity of social relations can contribute to reconfiguration of other principles comprising the standard framework of bioethics, particularly beneficence, justice, and equality.

Bioethics↗
PubMed2001

The concept of a feminist bioethics.

Feminist bioethics poses a challenge to bioethics by exposing the masculine marking of its supposedly generic human subject, as well as the fact that the tradition does not view women's rights as human rights. This essay traces the way in which this invisible gendering of the universal renders the other gender invisible and silent. It shows how this attenuation of the human in 'man' is a source of sickness, both cultural and individual. Finally, it suggests several ways in which images drawn from women's experience and women's bodies might contribute to a constructive rethinking of basic ethical concepts.

Bioethics↗
PubMed2002

What conception of moral truth works in bioethics?

For the most part, philosophers have regarded moral truth as propositional and as what follows from the application of moral theory to particular problematic cases. Here I maintain that this is not a useful way of conceiving moral truth in bioethics. Rather, we are better off conceiving of moral truth as what emerges from a process of inquiry conducted in a certain manner. There are four elements to this process: (1) careful exploration of the embedded norms of medical practice, research, and delivery; (2) recognition of the irreducible plurality of ultimate moral values within and between these practices; (3) the cultivation and exercise of moral imagination; and (4) the attainment, however temporarily, of wide reflective equilibrium. This process, I argue, is reflected in the way bioethics is most fruitfully practiced, and it is further to be recommended by being true to the character of moral conscientiousness generally. This analysis suggests that moral truth is "unstable," but that this is not a bad thing. Further, the implication is drawn that moral theory would be better informed if formulated on the basis of paying more attention to lived moral practices.

Bioethical Issues↗
PubMedDate not supplied

What good is a pragmatic bioethic?

Do bioethicists need yet another theoretical approach with which to frame their disagreements? Many pragmatists contend that pragmatism, unlike its liberal and utilitarian counterparts, is uniquely commendable in (a) beginning from our lived experiences and (b) locating those experiences amid our social relations. In place of an "abstract principlism," pragmatism offers a practical "bedside-bioethic"; in lieu of "autonomy run amuk," pragmatism proposes an ethic rooted in our communal resources. To date, however, efforts to develop such a bioethic have been stymied by pragmatists' own abstract theoretical commitments, commitments that prevent them, most directly, from beginning with the lived experiences and communal resources of those who hold theological commitments. This self-imposed methodological constraint, I argue, has needlessly thwarted pragmatism's most striking methodological promise: its potential to cultivate productive debates among secular and theologically-informed participants.

Bioethics↗
PubMedDate not supplied

Pragmatic bioethics and the big fat moral community.

By articulating a Peircean strain of bioethical inquiry, Elizabeth Cooke admirably attempts to avert the anti-realism, subjectivism and focus on consensus that afflict much so-called "pragmatic" bioethics. Yet, like many of her Deweyan colleagues, she falls prey to the egalitarian conviction that inquiry should be undertaken by huge numbers of like-minded individuals, proceeding in accordance with an authoritative canon of rules of discourse. In this essay, I argue that Cooke's egalitarianism is inconsistent with her apparent commitment to Peirce, and that an alternative, libertarian account of inquiry is better and truer to Peirce.

Bioethics↗
PubMed2006

Disability, bioethics, and rejected knowledge.

In this article I explore disability as far more than individual private tragedy, suggesting it has a social location and reproduction. Within this context we look at the power relations associated with bioethics and its largely uncritical use of the biomedical model. Within that context the topics of genetics, euthanasia, and biotechnology are explored. In examining these topics a social account of disability is proposed as rejected knowledge. Accordingly we explore the political nature of bioethics as a project.

Attitude to Death↗
PubMed1995

Whose tradition? Which Enlightenment? What content? Engelhardt, Hauerwas, Capaldo, and the future of Christian bioethics.

The development of a content-full Christian bioethics requires an analysis of the particular contents and traditions which different Christians bring to morality. For Hauerwas, the content of Christian ethics is the speech and practices of the community. For Engelhardt, only a content-full tradition, such as the Orthodox tradition, will be able to arrive at closure on the moral issues presented by the contemporary practice of medicine. Capaldi calls, in contrast, for a Kantian society of autonomous self-legislators whose responsible freedom is grounded in a cosmic order that must be explicated and retrieved in particular practices. The manner in which we view our own traditions and the shortcomings of modernity determine the content that Christianity brings to bioethics.

Bioethics↗
PubMed1996

Suffering, meaning, and bioethics.

Suffering evokes moral and metaphysical reflection, the bioethics of suffering concerns the proper ethos of living with suffering. Because empirical and philosophical explorations of suffering are imprisoned in the world of immanent experience, they cannot reach to a transcendent meaning. Even if religious and other narratives concerning the meaning of suffering have no transcendent import, they can have aesthetic and moral significance. This understanding of narratives of suffering and of their custodians has substantial ecumenical implications: chaplains can function as general custodians of narratives and sustainers of a generic religious meaning. This understanding is contrary to traditional Christianity, which discloses a transcendent significance of human suffering found in a very particular history involving particular persons: Christ as the second Adam through the submission of the second Eve has taken on our nature so that we can be united with God. Human suffering is tied to human sin, not simply as a punishment for sin, much less as an opportunity to discharge a supposed temporal punishment due to sin. Human suffering is the result of our rebellious free choices. It provides an opportunity for humility and submission, so that, united to the cross of Christ, sin can be forgiven and suffering set aside in the Resurrection. Knowledge of this framing context for all human suffering is accessible not through rational argument. It is a knowledge garnered through repentance, purification of the heart, illumination by God's grace, and unification with God. Christian bioethics is embedded in the narrative of suffering, which is part of the history of salvation and which encompasses and places all of medicine in its terms.

Bioethics↗
PubMed1993

Community bioethics: the health decisions community council.

Health care decision making in modern society can pose a variety of complex issues for consideration by individuals, families, and providers. The Health Decisions Community Council (HDCC), a community-based bioethics committee, was established to offer a noninstitutional forum for discussion of difficult health care dilemmas. Social work skills and values for autonomy and self-determination are essential to the formation of the HDCC as a model for community bioethics discussions.

Bioethical Issues↗
PubMed1990

The limited relevance of analytical ethics to the problems of bioethics.

Philosophical ethics comprises metaethics, normative ethics and applied ethics. These have characteristically received analytic treatment by twentieth-century Anglo-American philosophy. But there has been disagreement over their interrelationship to one another and the relationship of analytical ethics to substantive morality--the making of moral judgments. I contend that the expertise philosophers have in either theoretical or applied ethics does not equip them to make sounder moral judgments on the problems of bioethics than nonphilosophers. One cannot "apply" theories like Kantianism or consequentialism to get solutions to practical moral problems unless one knows which theory is correct, and that is a metaethical question over which there is no consensus. On the other hand, to presume to be able to reach solutions through neutral analysis of problems is unavoidably to beg controversial theoretical issues in the process. Thus, while analytical ethics can play an important clarificatory role in bioethics, it can neither provide, nor substitute for, moral wisdom.

Abortion, Legal↗
PubMed1991

American moralism and the origin of bioethics in the United States.

The theology of John Calvin has deeply affected the American mentality through two streams of thought, Puritanism and Jansenism. These traditions formulate moral problems in terms of absolute, clear principles and avoid casuistic analysis of moral problems. This approach is designated American moralism. This article suggests that the bioethics movement in the United States was stimulated by the moralistic mentality but that the work of the bioethics has departed from this viewpoint.

Advisory Committees↗
PubMed1983

Experimentalism in bioethics research.

Basson's commentary on my proposals regarding the structure and function of research in bioethics provides a welcome opportunity for extended comparison of standard approaches with the suggestions made in 'What Bioethics Should Be.' I begin by noting a common assumption underlying our respective views. I then address points of fundamental difference, indicating why the experimental method proposed in my original essay presents a potentially more productive strategy for examining moral issues in biomedicine. In the latter respect, I certainly disagree with Basson's contention that "we are unable to test" metaethical hypotheses "against reality" (Basson, p. 185) - a proposition which seems no more defensible than the equally untenable claim that we cannot refine methods of natural science research through examination of their usefulness in advancing our understanding of the correlation of events in nature.

Bioethics↗
PubMed1983

Bioethical decision-making: a reply to Ackerman.

Terrence Ackerman has suggested that we ought to view general bioethical principles as generalizations which summarize our previous bioethical decisions rather than as moral rules. He would have us derive our ethical views instead principally from the facts of the cases in question and our intuitions about them. The proposal is attractive because of its similarity to medical decision-making, but it fails because it allows for no higher order standard of reference against which conflicting ethical intuitions may be judged.

Bioethics↗
PubMed1999

Foundations, frameworks, lenses: the role of theories in bioethics.

I explore the implications of the foundation metaphor for understanding the role of moral theories in ethics and bioethics and argue that its disadvantages outweigh its advantages. I then consider two other metaphors that might be used instead, those of frameworks and lenses. I propose that the metaphor of lenses is most promising in providing methodological guidance for drawing on moral theories when deliberating about bioethical problems.

Bioethics↗
PubMed1999

Is there an Asian bioethics?

Is there an Asian bioethics? Some people might consider it blasphemous even to ask this question. But this paper asks it not so much to seek an answer as to clarify what it could actually mean. The idea is to sort out the presuppositions and possible implications of asserting the existence of an Asian bioethics. In the end, this paper makes the following points: (1) In the attempt to assert an Asian identity, one must be careful not to commit the mistake of universalizing (among Asians) a single Asian perspective; and (2) In the face of pluralism and multi-culturalism, there is some room for a kind of universalist ethics that is founded on a collage of culturally inspired perspectives rather than on a single standard of morality.

Asia↗
PubMed2001

How rational should bioethics be? The value of empirical approaches.

Rational justification of claims with empirical content calls for empirical and not only normative philosophical investigation. Empirical approaches to bioethics are epistemically valuable, i.e., such methods may be necessary in providing and verifying basic knowledge about cultural values and norms. Our assumptions in moral reasoning can be verified or corrected using these methods. Moral arguments can be initiated or adjudicated by data drawn from empirical investigation. One may argue that individualistic informed consent, for example, is not compatible with the Asian communitarian orientation. But this normative claim uses an empirical assumption that may be contrary to the fact that some Asians do value and argue for informed consent. Is it necessary and factual to neatly characterize some cultures as individualistic and some as communitarian? Empirical investigation can provide a reasonable way to inform such generalizations. In a multi-cultural context, such as in the Philippines, there is a need to investigate the nature of the local ethos before making any appeal to authenticity. Otherwise we may succumb to the same ethical imperialism we are trying hard to resist. Normative claims that involve empirical premises cannot be reasonable verified or evaluated without utilizing empirical methods along with philosophical reflection. The integration of empirical methods to the standard normative approach to moral reasoning should be reasonably guided by the epistemic demands of claims arising from cross-cultural discourse in bioethics.

Anthropology, Cultural↗
PubMed2003

Reasoning in bioethics.

It is striking that some arguments in the bioethical literature seem implausible, counterintuitive, and even ridiculous when reported to competent moral agents. When examined, these arguments bear uncanny resemblances to the discourse of patients with debilitating mental disorders. I examine the kinds of irrationality involved, and discuss the fact that such irrationality is worrying in a discipline that purports to serve as a guide for real-life practical reasoning. I offer some thoughts about correctives that we might use to temper some of the odd opinions that bedevil our subject in the name of ethical analysis. It seems that one ought to be suspicious of neatly rational arguments that produce counterintuitive conclusions, but the alternative seems to be that we explore new constructions of old problems in Bioethics such that our discussion of them does justice to what we regard as of fundamental significance to our lives together as human beings.

Bioethics↗