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Agreeing in large part with Cameron, Robert D. Orr nonetheless raises some questions. He points out the theological origins of bioethics in the 1960s, while admitting that the field has since become secularized. Autonomy's challenge to Hippocratic paternalism has brought real benefits but also abuses. Bioethics addresses more than procedural matters; it deals in issues of real substance.
Some of the major problematic issues in contemporary ethical discourse are highlighted in the field of bioethics. The need to incorporate new understandings and foundational shifts in essential criteria because of technological advances in the areas of medicine and human sciences increasingly challenges traditional and accepted notions of ethics. As the possibilities of technical progress increase, more and more pressure is put on traditional understandings of the human person, identity, and value. In the face of ethical relativism and emotivism, which are already widespread in social and political discourse, the immediacy of bioethics as a response to technology and its impact on human lives reinforces the need for ethics to become interdisciplinary, while attempting to provide some coherence to both the questions and the responses that contemporary life generates. In this paper, the author intends to sketch the outlines of some of these problems, and suggest one approach which might allow a certain methodical intelligibility to emerge which takes into account shifts in consciousness and the dependence on historically grounded perspective.
A familiar criticism of bioethics charges it with being more conceptual than practical--having little application to the "real world." In order to answer its critics and keep its feet on the ground, bioethics must utilize the social sciences more effectively. Empirical research can provide the bridge between conceiving a moral vision of a better world, and actually enacting it.
The merger of bioethics and epidemiology reflects the established idea that values are important for epidemiologic practice. It also reflects the more recent realization that standards of conduct are a timely addition to the profession. The thesis of this paper goes somewhat further and asserts that this merger represents an essential cornerstone in the foundation of a philosophy of epidemiology. Historical reflection reveals existing ontological and epistemological components to this same foundation. The union of bioethics and epidemiology suggests an important philosophical problem: selecting a method for unifying ethical and scientific reasoning. Solutions are proposed including: dialectic and critical rationalism.
The key concepts of modern medical bioethics can be traced back to ideas developed in the course of the history of medicine and to political concepts harkening back as far as Plato. This work reviews these historical developments and demonstrates their relevance to current bioethics.
A formal curriculum for the teaching of bioethics was instituted within an obstetric and gynecologic residency program. The curriculum included an introductory lecture series, an ongoing series of case presentations, and occasional grand rounds on particular issues. An emphasis was placed on physician responsibilities within contemporary bioethical parameters. A summary of the first year of such an effort is presented.
Nearly fifteen years after the Council of Europe first called for a pan-European convention on issues in bioethics to harmonize disparate national regulations, in November 1996 the council's Committee of Ministers approved the Convention on Human Rights and Biomedicine for formal adoption. The draft convention, released in July 1994, provoked strong public, professional, and governmental debate among European nations, particularly regarding provisions for biomedical research with subjects unable to give informed consent. If ratified, the "bioethics convention" will become the first such document to have binding force internationally.
The assumptions of philosophy need scrutiny as much the assumptions of medicine do. Scrutiny shows that the philosophical method of bioethics is compromised, for it shares certain fundamental assumptions with medicine itself. To show this requires an unorthodox style of philosophy--a literary one. To show the compromised status of bioethics the paper discusses some seminal utilitarian discussions of the definition of death, of whether it is a bad thing, and of when it ought to occur.
The aim of this study is to bring to the fore some issues concerning human rights unleashed by the bioethical laws of July 1994, regarding the application of biotechnologies to reproduction. To achieve this aim, an analysis is offered of the legal arrangements, set by law in order to determine the procedures related to the selection of embryos and the transformation of their genetic characteristics. These analyses are then compared to the eugenic procedures instituted in the West during the first half of the xxth century. As a result, the idea is challenged, that eugenics is a category fit for the characterizing the biopolitical project contained in the bioethical laws. To conclude, the aim is made that what is a stake, as far as human rights are concerned, is the fate of the idea of man and of the subject of rights that is involved in these laws.
Bioethical considerations increasingly affect the process of integrating scientific and medical findings into the moral conceivabilities of a society and, consequentially, into the stock of laws. In a natural science like parasitology a social consensus must be reached in the areas of species protection, of the red biotechnology, of human prenatal diagnosis, and of animal experiments. The crucial problem is the social value of an individual's dignity and the conjoined question of the admissibility of an exploitation of a creature. The responsibility of man for other organisms, in that particular case parasites and their hosts, is brought up for discussion in a bioethic debate.
Narrative bioethics is primarily understood to involve storytelling through the use of literature. This article suggests that other forms of media are necessary to convey stories of an ethical nature to an audience broader than one being trained as medical professionals. "Documentary bioethics" is a manner to present and interpret stories of an ethical nature using forms of popular electronic media in a reality-based documentary style to society at large, specifically Generations X and Y.
The main claim of this paper is that the method outlined and used in Aristotle's Ethics is an appropriate and credible one to use in bioethics. Here "appropriate" means that the method is capable of establishing claims and developing concepts in bioethics and "credible" that the method has some plausibility, it is not open to obvious and immediate objection. It begins by suggesting why this claim matters and then gives a brief outline of Aristotle's method. The main argument is made in three stages. First, it is argued that Aristotelian method is credible because it compares favourably with alternatives. In this section it is shown that Aristotelian method is not vulnerable to criticisms that are made both of methods that give a primary place to moral theory (such as utilitarianism) and those that eschew moral theory (such as casuistry and social science approaches). As such, it compares favourably with these other approaches that are vulnerable to at least some of these criticisms. Second, the appropriateness of Aristotelian method is indicated through outlining how it would deal with a particular case. Finally, it is argued that the success of Aristotle's philosophy is suggestive of both the credibility and appropriateness of his method.
Bioethics needs to include study of the social and historical context in which ethical meanings in medical encounters make sense. It needs to do this in order to remain relevant, vibrant, and aware of how it might unwittingly facilitate the agendas of others. As an illustration, this paper critiques some of the accepted meanings and purposes of the idea of the Therapeutic Misconception (TM) which has been an increasingly attractive concept with which to organize thinking about experimentation ethics. By considering the history of alternative viewpoints against which TM was offered as a replacement, this paper suggests that TM, and bioethics more generally, may contribute to increasingly technocratic and standardized practices in medicine.
Psychiatric research has received intense ethical scrutiny during the past decade. Changes in how studies are designed, reviewed by ethics boards, conducted, and reported in the literature have created a need for a systematic approach to teaching psychiatric research ethics to clinical researchers in training. The purpose of this article is to describe a model curriculum and comprehensive background reading list for training in psychiatric research bioethics. The curriculum was designed as an interactive seminar in a research fellowship program but can be adapted and incorporated into existing medical school and psychiatry residency training curricula. Participants in the seminar provide formal and informal evaluations of each session and the seminar as a whole. The seminar, now in it's third year, has been regularly attended and highly regarded by the NIMH research fellows who have participated. In response to recommendations by the participants, the content and organization of the seminar has been modified. Clinical research is both scientifically and ethically complex. Our initial experience with a formal curriculum in psychiatric research bioethics suggests that this educational activity has been both meaningful and relevant for psychiatrists training to be clinical investigators.
Concerns about bioethical issues raised by scientific developments in genetics are a common feature of both public and policy debates in the UK. This article sets out how one such body, the Nuffield Council on Bioethics, contributes to public and policy debates, and provides information about similar bodies in the UK and around the world.
The increasing frequency with which bioethical issues arise in the medical care of pediatric patients with neuromuscular disease suggests a need for a working knowledge of the field for the clinical physician, Institutional Bioethics Committees are multidisciplinary groups that include medical, nursing, social service, legal, religious or chaplaincy, and community representation. The role and functioning of these committees vary widely according to institution. Inherent in the process of consent is that it must be an Informed consent. This requires that the person consenting has been given adequate information to understand and to appreciate the benefits and risks of the treatment. There are some instances in which consent by minor patients is necessary.
Problems posed by HIV/AIDS differ from those of past epidemics by virtue of unique properties of the causative agent, dramatic societal changes of the late 20th century, and the transition of medical practice from a professional ethic to a technology-dependent business ethic. HIV/AIDS struck during the coming-of-age of molecular biology and also of bioethics, and the epidemic stimulated the growth of both disciplines. The number of articles published about AIDS and ethics (as identified by a MEDLINE search) peaked in 1990, just before the peak incidence of AIDS in the United States. The character of ethical dialogue has now shifted from familiar moral quandaries such as civil liberty versus public welfare to concerns about vaccine trials and public policy toward the developing world. Physicians and other health care workers who were involved from the onset endured something of an emotional roller coaster. Their compassion-based work ethic was to a large extent replaced by a competence-based work ethic after the introduction in 1996 of highly active antiretroviral therapy. The abundant recent literature on "professionalism" in medicine makes scant mention of AIDS/HIV. The disruptive effect of AIDS/HIV on society would have been substantially greater had relevant technology such as the ability to isolate retroviruses and potent therapy against tuberculosis not been in place. This sobering consideration, along with such recent events as the use of bioterrorism against civilian populations, suggests new relevance for Potter's definition of "bioethics" as a science of survival in which the biology of ecosystems must be taken into account.
Bioethics, and indeed much ethical writing generally, makes its point through narratives. The religious parable no less than the medical teaching case uses a simple story to describe appropriate action or the application of a critical principle. While powerful, the telling story has limits. In this paper the authors describe a simple teaching case on "end-of-life" decision making that was ill received by its audience. The authors ill-received example, involving the disconnection of ventilation in a patient with ALS (Lou Gherig's Disease) was critiqued by audience members with long-term experience as ventilation users. In this case, the supposedly simple narrative of the presenters conflicted with the life histories of the audience. The lessons of this story, and the conflict that resulted, speak critically to the limits of simple teaching cases as well as the strengths of narrative analysis as a tool for the exploration of bioethical case histories.