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PubMed2000

[Development of bioethics. Analysis of practices in 20 hospital departments].

OBJECTIVE: In order to analyze the constitution and management of DNA banks and the limitations on procedures currently used in France, we conducted a study in a sample of French hospital units. A DNA bank was defined as any facility where individual samples of DNA, irrespective of the form, are stored for ongoing or future gene studies. The aim of this work was to focus attention on the need for in-depth thought on the ethical issues involved in storing and using DNA as part of everyday clinical practice and research and to provide elements for a debate on the interest and limitations of the French bioethics laws whose revision is currently being considered. METHODS: A questionnaire was sent to the heads of departments in two university hospitals. Five areas were retained for evaluation: the nature and degree of DNA storage activities, procedures followed for reporting the DNA bank, procedures used to protect confidentiality, information given to patients and procedures used for informed consent, and finally, internal rules governing the bank's operation. The answers to the questionnaires were analyzed anonymously. RESULTS: Among 20 hospital units collecting DNA samples, 70% also stored other samples (DNA, blood, tissue, cell lines) including a large proportion of tissue samples. These samples were collected for purposes of fundamental research and clinical practice. The number of samples stored was quite variable, ranging from a few dozen samples to more than 40,000. Only 55% of the units had reported the facility to a control body, in compliance with current law. Seventy percent maintained computerized data bases but only 50% used an anonymous code. Seventy-five percent obtained written consent but patients were not always informed of the site of the storage or the transfer of their DNA. In addition, the validity of the consent over time, the duration of storage and the types of studies that could be conducted on the DNA were poorly detailed. Internal rules governing the bank's activities were not implemented by most of the units (65%). CONCLUSION: The responses to our questionnaire survey show that there is currently a gap between everyday practice and regulatory procedures concerning DNA banks in France. Further analysis of current practices would appear to be necessary so professionals could become more aware of the human and social issues involved with the use of DNA banks. These data on everyday practices should be made available to health care workers, public officials and law makers in order to promote ethical practices that, as has been observed, are not dictated solely by legislation which often lags behind everyday activities. All those involved in the management of DNA banks must be aware of their responsibilities in protecting patients' rights within the framework of a system based on information, consent, and over-the-board trustworthiness regularly submitted to short and long term assessments. A correct response to ethical issues is the only means of developing a real process of social interaction which cannot be achieved by revision of the bioethics laws alone.

Confidentiality↗
PubMed2002

[Bioethics and the 21st century, viewpoint of the jurist].

It is essential to approach the question of protection of human life from a legal point of view, because the developments in reproductive biology and the new research fields on the embryo and the so called 'stem' cells, imply the establishment of new laws. This is a real challenge, since to infer rights to the onset of life means that the embryo or the foetus has to have a status. The European Ethics Group has to provide propositions concerning the ethical aspects of embryo research, related to research on the 'stem' cells. In fact, Europe is confronted with several problems related to the cultural, legal and religious pluralism and the market regulations. Reflections on embryos must no longer be based on the search of means to improve reproduction techniques, but on their use as simple cell producers. Some suggestions can be made in favour of a mutual European approach to bioethics: research and medicine devoted to the onset of life must be submitted to strict public control; the status of the embryo must be clarified; recommendations have to be drawn-up regarding so-called 'therapeutic' cloning; and International laws concerning bioethics must be established.

Cloning, Organism↗
PubMed1995

Informed consent, parental permission, and assent in pediatric practice. Committee on Bioethics, American Academy of Pediatrics.

The statement on informed consent, parental permission, and patient assent has a long and extraordinary history. The first draft of this document, prepared by William G. Bartholome, MD, was presented to the original American Academy of Pediatrics (AAP) Committee on Bioethics in 1985. Bill put his soul into the manuscript and has watched over it carefully ever since. Now, a decade later, those who have worked on its continued development and urged its adoption as Academy policy applaud its publication. No one is more gratified than its primary author and champion. Those who have had the privilege to know Dr Bartholome share his sense of accomplishment, but cannot help but experience a cruel sense of irony. Just as the work Bill considers his most important contribution has become available for public appreciation, Dr Bartholome suffers from a serious illness that threatens his life. Bill always wanted "the experience, perspective, and power of children" to be taken most seriously. Through the years of the statement's revisions and re-presentation within the Academy, Bill "had faith in the power of the text and the ideas it contained, ... that its time would come." The statement embodies Bill Bartholome's dedication to children. Throughout his career, he worked to make medicine and medical research safer and more friendly for children. The AAP and its Committee on Bioethics, on behalf of all our colleagues, extend heartful thanks to Dr William G. Bartholome for helping us more fully appreciate that children are in the process of becoming, in his words, "intelligent, observant, capable, and responsible persons" who deserve our utmost respect.

Adult↗
PubMedDate not supplied

Collaborative interdisciplinary bioethical decision making in intensive care units.

There is strong support in the literature for involvement of nurses with patients and physicians in bioethical decision making about patient care. There are indications that nurses and physicians have different beliefs about decisions made and about the decision-making processes, such as who should be involved and what factors should influence such decisions. The literature also demonstrates that nurses often disagree with physicians or are not involved in ethical decision making or both. Interdisciplinary collaboration has been proposed to improve decision making and recommended for health care giving generally. There is research support for the benefit of collaboration in care giving. Ethical principles also support collaborative decision making, involving nurses, as well as physicians, patients, and family. With collaboration there is sharing of information and perspectives, respect for patient and family autonomy, and disclosure. More studies of interdisciplinary bioethical decision making are needed, measuring both professions' perceptions of their roles in ethical decision making, as well as examining the effects of collaboration on care outcomes.

Decision Making, Organizational↗
PubMed1977

Bioethics: occupational therapy attitudes toward the prolongation of life.

A comprehensive array of bioethical issues have emerged from advances in biological technology. This report assesses the views of individuals at three occupational therapy levels concerning one such issue: The option of painless death for the incurable. A battery of measures used to study beliefs in occupational therapy students included an item dealing with euthanasia. Item analysis revealed that the mean response to the euthanasia item by groups of occupational therapy juniors, seniors, and supervising clinicians from two schools indicated approval of voluntary painless death for the incurably ill. The article concludes with a discussion of the inclusion of bioethical issues in occupational therapy educational programs.

Adult↗
PubMed1994

Bioethics and the body politic.

... To the extent that bioethics is a social movement, we have been successful in having brought to the table issues that are worthy of policy initiatives. We have sensitized a highly medicalized culture to the limits of that science and to its humane purpose. As some of the insights of the movement are being transformed by social policy, we must assume a vigilant posture: to know, to guide, to criticize, to initiate. This Health Policy Watch section is a vehicle for that endeavor.

Bioethical Issues↗
PubMed1998

Bioethics and humanities: what makes us one field?

Bioethics and humanities (inclusive of medical ethics, health care ethics, environmental ethics, research ethics, philosophy and medicine, literature and medicine, and so on) seems like one field; yet colleagues come from different academic disciplines with distinct languages, methods, traditions, core curriculum and competency examinations. The author marks six related "framework" features that unite and make it one distinct field. It is a commitment to (1) work systematically on some of the momentous and well-defined sets of problems about the human condition that drive our field (such as death and dying, disability, confidentiality, professionalism, informed consent, abortion, euthanasia, assisted suicide, personhood, health-care resource allocation and environmental ethics, as well as the impact of new technologies, including genetic and reproductive); (2) use interdisciplinary approaches to unravel them; (3) employ cases and practical reasoning to understand problems and solve answers; (4) apply teaching methods and goals associated with John Dewey to make students better problem-solvers; (5) find morally justifiable solutions to the problems driving our field; and (6) seek interdisciplinary and collaborative scholarship, service or teaching.

Bioethical Issues↗
PubMed2005

The significance of the concept of sin for bioethics.

After a period during which the theological categories of sin and forgiveness were ignored or trivialized, presently these notions are being rediscovered. What could their impact be on bioethics, either in the narrow sense of medical ethics, or in the more encompassing sense of the ethics of the life sciences? This essay begins with describing the processes of transcending and ethitization, which gave rise to the biblical notion of sin. It portrays the theological foundation of sin in terms of a twofold refusal of proper relations to God and other humans. Through the practise of confession in the face of God (coram deo), sin is placed into a horizon of hope for forgiveness and reconciliation. The heuristic and hermeneutical significance of these categories results from their introducing a "surplus value," which transcends biological and ethical considerations. This additional dimension is illustrated in view of care (cura) for the injured, and in view of individual as well as collective willingness to forgive.

Bioethical Issues↗
PubMed1985

The emergence of bioethics in social work.

Ethical issues in health care, or bioethics, are not new to social work, but the maturation of the profession no less than scarce resources and advances in technology are focusing increased attention on social workers' responses to complex moral questions. A review of the history and scope of these issues provides a framework for addressing them.

Bioethical Issues↗
PubMed1989

Australian commissions and committees on issues in bioethics.

We examine the role of Australian state and federal committees and law reform commissions in bioethics. Most have been concerned with in vitro fertilization and embryo research. We find deficiencies in the standards of reasoning about the underlying ethical issues raised by these techniques. We suggest stronger representation of those with a background in ethics.

Advisory Committees↗
PubMed1997

Bioethics and law: a developmental perspective.

In most Western countries, health law [and] bioethics are strongly intertwined. This strong connection is the result of some specific factors that, in the early years of these disciplines, facilitated a rapid development of both. In this paper, I analyze these factors and construe a development theory existing of three phases, or ideal-typical models. In the moralistic-paternalistic model, there is almost no health law of explicit medical ethics, and the little law there is is usually based on traditional morality, combined with paternalist motives. The objections to this model are that its paternalism and moralism are unacceptable, that it is too static and knows no external control mechanisms. In the liberal model, which is now dominant in most Western countries, law and ethics closely cooperate and converge, both disciplines use the same framework for analysis: they are product-oriented rather than practice-oriented; they use the same conceptual categories, they focus on minimally decent rather than the ideal, and they are committed to the same substantive normative theory in which patient autonomy and patient rights are central. However, each of these four characteristics also results in a certain one-sidedness. In some countries, a third model is emerging. In this postliberal model, health law is more modest and acknowledges its inherent and normative limits, whereas ethics takes a richer and most ambitious self image. As a result health law and ethics will partly diverge again.

Bioethical Issues↗
PubMed1998

An anthropological exploration of contemporary bioethics: the varieties of common sense.

Patients and physicians can inhabit distinctive social worlds where they are guided by diverse understandings of moral practice. Despite the contemporary presence of multiple moral traditions, religious communities and ethnic backgrounds, two of the major methodological approaches in bioethics, casuistry and principlism, rely upon the notion of a common morality. However, the heterogeneity of ethnic, moral, and religious traditions raises questions concerning the singularity of common sense. Indeed, it might be more appropriate to consider plural traditions of moral reasoning. This poses a considerable challenge for bioethicists because the existence of plural moral traditions can lead to difficulties regarding "closure" in moral reasoning. The topics of truth-telling, informed consent, euthanasia, and brain death and organ transplantation reveal the presence of different understandings of common sense. With regard to these subjects, plural accounts of "common sense" moral reasoning exist.

Bioethical Issues↗
PubMed1992

Bioethics as a new human rights emphasis in European research policy.

Although issues of morals and ethics remain largely a national matter, the European Community (EC) and the Council of Europe have taken an increasing interest in identifying and harmonizing the often conflicting policies of the European countries on bioethical matters. This article examines the role these organizations are playing and identifies some of the initiatives that have been taken in specific areas.

Abortion, Induced↗
PubMed2005

The President's Council on Bioethics 2002-2004: an overview.

The President's Council on Bioethics, headed by Leon Kass, was created by President George W. Bush to advise the President on issues of ethical import raised by advances in biomedical science. Between 2002 and 2004, members of the Council from diverse disciplines addressed topics such as human cloning, stem cell research, assisted reproduction, and medical interventions intended to enhance human capability or appearance. This article provides background on the Council and reviews its published reports. It also considers key definitions and distinctions, specific recommendations of the Council, and positions articulated by members who contributed to the development of its reports.

Advisory Committees↗
PubMed1999

Bioethics in a liberal society--political, not moral.

This paper argues for the importance of the political context of a society for bioethics. In particular, I argue that in a liberal constitutional society, such as the one we find ourselves in, no particular moral perspective is granted a privileged position. Rather, individuals are allowed to live their lives according to values they adopt for themselves, and the rights granted to protect this ability "trump" social consensus, and place boundaries on the social application of personal moral beliefs and values.

Bioethical Issues↗
PubMed1991

Feminism and bioethics: an overview.

Despite differences in style, tone, and emphasis, the various schools of feminist thought share a primary concern with the stories and lives of women. This concern gives them distinctive perspectives on medical practice and the field of bioethics.

Bioethical Issues↗
PubMed1992

A libertarian critique of H. Tristram Engelhardt, Jr.'s The Foundations of Bioethics.

CONCLUSION: Although Engelhardt's The Foundations of Bioethics is an impressive work, it is plagued by problems of justification, conceptual confusion, and inconsistencies....A libertarian theory can arrive at the same basic requirements of mutual respect, autonomy, nonuse of force, and tolerance for a wide range of diverse life styles without relying on a lowest-common-denominator principle and without depriving fetuses, infants, and the mentally retarded of their status as persons. This can be done by taking a deontological approach to libertarian theory that denies that all moral beliefs are worthy of respect. Some beliefs, such as Engelhardt's belief that fetuses, infants, and the mentally retarded are nonpersons, simply fall beneath the floor of acceptable moral alternatives, even in a libertarian society, because such beliefs are based on a misunderstanding of personhood and violate the principle of mutual respect.

Abortion, Induced↗
PubMed1992

It never dies: assessing the Nazi analogy in bioethics.

... As should be evident from the foregoing analysis, I have significant reservations about the moral utility of the Nazi analogy in debates over bioethics issues. Nevertheless, I am unable to dismiss its force entirely. I want to suggest that the real threat to the moral and human values expressed by the analogy will come not from responsibly formulated and clearly articulated proposals that undergo debate and scrutiny in the public forum, and whose practical impact in a democratic society is limited by institutional review and procedural safeguards. My concern instead is with the psychology of moral distancing, in which moral conscience is compartmentalized from vocational interests, such as the pursuit of scientific knowledge through biomedical research. It is the kind of psychology that Robert Jay Lifton has referrred to as "doubling: the division of the self into two functioning wholes, so that a part-self acts as an entire self," and which Lifton believes enabled the transformation of physicians from healers to killers in Nazi Germany....

Bioethical Issues↗