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The history and development of the Centre for Human Bioethics at Monash University is briefly sketched. This is followed by a description of the Centre's aims, its structure, its staff, and its principal fields of research. Some recent publications of the Centre are then listed.
Daniel Callahan, in an autobiographical reflection, describes how the unfolding secularization of bioethics has culminated in a speculative and linguistic narrowness. The pluralism we celebrate as a moral achievement may become oppressive if it is not open to the insights of particular traditions and communities.
Courtney S. Campbell observes that the practical dilemmas of bioethics often presuppose common questions of meaning about human nature, suffering, dying, and human destiny that are central to religious traditions.
During the period between the early 1980s to the mid 1990s, the U.S. was distinguished from most other developed countries by its lack of a national-level public body to assist the government in its policy-making on topics of biomedical ethics. While Canada, Denmark, France, Spain, and other countries regularly sought advice from public commissions on issues ranging from reproductive technologies to euthanasia, the U.S. relied on myriad state commissions, court decisions, and academic bodies. The result was a pattern of policy-making that was slower and more unpredictable than that of its peers. With the 1996 appointment of the National Bioethics Advisory Commission (NBAC) by President Clinton, there has been a change in the process of U.S. public policy development. This article provides an overview of the NBAC and highlights recent areas of focus and related recommendations.
The results of teaching trials among students in Japan are reported, examining their attitudes towards prenatal diagnosis and ART over a course of lectures. The students tended to be more negative than the general public over the use of prenatal diagnosis. The results of attitude changes, and example comments to explain the categorization process are given. The students had a diversity of comments and could reason about the examples of technology used, but were characterized by a higher percentage of uncertainty than in the general public even after lectures on bioethics.
Religion's fundamental involvement with questions of disease, health, and medicine has given rise to concepts making substantial contributions to the field of bioethics. The purpose of this article is to examine such ongoing contributions in a general way, and then to review how the issue of whether medical technology should be used to prolong life might be approached from the standpoint of several different religious traditions.
This article analyzes moral issues involving professional ethics in Brazil and provides appropriate up-to-date references to Brazil's Code of Deontology (1984), Code of Medical Ethics (1988), and civil and criminal codes. The analysis considers various trends that have emerged as a result of recent medical advances and discusses bioethical issues in the areas of family planning, abortion, medical research on human subjects, euthanasia, transplants, and professional confidentiality.
Colombia in recent decades has been exposed first-hand to a broad spectrum of important medical advances ranging from organ transplants to techniques for assisting human reproduction. It has also confronted an array of modern problems--including the abortion issue and the AIDS epidemic. Many of these matters have bioethical implications. This article describes the more important measures that have been and are being taken in Colombia to deal with those implications.
Chile's health system has been evolving rapidly in recent years. Among other things, profit-making enterprises have assumed a growing role, medical care has become increasingly technical, and the importance of less highly trained health workers has grown. Also, the assigned role of the Chilean Medical Association in deciding matters of medical misconduct has diminished, while that of the courts has grown; the nature of the doctor-patient relationship has changed; and clear divergences between medical ethics codes, laws, and prevailing social practices have emerged. Within this context, bioethics has come to be regarded as a necessary element in the teaching and practice of medicine. So while this discipline has not yet become fully institutionalized in Chile, it seems likely to play a growing role in dealing with the aforementioned changes and could make a substantial contribution toward solution of associated problems in the future.
The recent unprecedented expansion of scientific knowledge and the greater awareness and involvement of the public in medical matters, as well as additional causes described here, have impelled the development of a new form of bioethics over the past three decades. Jewish law and philosophy have always dealt with medical issues. In recent years, however, a voluminous body of literature devoted to Jewish medical ethics has developed. It covers all relevant issues and offers Jewish solutions to many complex problems arising from the recent scientific breakthroughs. This article analyzes the differences between Jewish and secular philosophies regarding fundamental moral theories relevant to modern medical ethics.
Althought the literature--medical, philosophical, religious, and legal-- on personhood is vast, there is little evidence that writers on this topic are approaching a consensus on the meaning of the concept or on criteria for its application. Some writers set low, or minimal, standards for personhood - others posit higher, more normative standards. But throughout, the moral values writers antecedently embrace determine the definition they arrive at by way of conclusion. Personhood has not been a useful concept for resolving dilemmas in bioethics.
Law provides a rich language for thinking about bioethical issues and is a tool for action as well as talk. But the language of the law, often inapt, regularly fails to achieve its desired effect.
Because the ethical choices of medicine become more and more complex each year, the Pennsylvania Medical Society Commission on Bioethics in 1992 sponsored a survey to assess the need for a statewide ethics network. This article discusses the results of that survey.
For the last several years, the National Bioethics Advisory Commission (NBAC) has considered several complex issues relating to biomedical research. Prominent among these considerations has been the protection of the rights and welfare of human research subjects, and the NBAC recently submitted to the president a report entitled Research Involving Persons With Mental Disorders That May Affect Decisionmaking Capacity. The importance of careful protection of vulnerable populations from undue or inappropriate risk in human subject research cannot be overemphasized, and the NBAC report includes recommendations that would strengthen such protection. However, the creation of workable mechanisms that allow appropriate risk-benefit judgments and that preserve respect for the autonomy of participating research subjects is challenging indeed. We believe that the NBAC has developed recommendations that strengthen protections for individual research participants. However, several key elements of the report are stigmatizing to persons with psychiatric disorders, and they could, if adopted as new federal regulations, inappropriately impede critical categories of psychiatric research.
This paper critically appraises the applied action-guide approach to bioethics and finds it wanting in two ways: it is tethered to a social contract view of the doctor-patient relationship that is largely incompatible with experiences of illness and care; and, as a formalist doctrine, it lacks critical edge and tends toward accommodationism. An alternative approach is recommended that involves interpreting moral experience by means once associated with the rhetorical arts--practical reasoning, hermeneutics, casuistry, and thick description.
Cara sui (care of the self) is a guiding thread in Foucault's later writings on ethics. Following Foucault in that inquiry, we are urged beyond our fairly superficial conceptions of consequences, harms, benefits, and the rights of persons, and led to examine ourselves and try to articulate the sense of life that animates ethical reasoning. The result is a nuanced understanding with links to virtue ethics and post-modern approaches to ethics and subjectivity. The approach I have articulated draws on the phenomenology of Levinas and Heidegger, the Virtue ethics of Baier, and the post-structuralist writing of Michel Foucault. The subject is seen as negotiable, embodied, provisional and able to be transformed in a way that denies essentialism about human beings, their moral status, and the idea of the good. The human being emerges as responsible because, properly, responsive to the context of discourse in which morality becomes articulated. When we import this style of thinking into bioethics we find that it reaches beyond issues of policy or right conduct and allows us to use the biomedical sciences and the clinical world to revise and interrogate our understanding of ourselves and the theoretical foundations of health care ethics.
The first part of this paper describes the nature of a Moot Court (or Mock Trial) and how it has been used in recent years as a teaching method for students in medicine and nursing at the Memorial University of Newfoundland. A whole day is spent in the enactment of an imaginary court case in which issues in bioethics are raised. Civil and criminal cases are used in alternate years. A considerable degree of realism is maintained except for the occasions when the presiding judge needs to make comments to the students in order to explain what is going on. The realism is helped by the fact that the roles of judge and of legal counsel are played by members of the judiciary and lawyers from the Newfoundland bar. In the second part of the paper there is a discussion of the principal issue that arose in the 1988 Moot Court, namely informed consent. In the third part the secondary legal and moral issues that arose are described and in the fourth part there is a discussion of the interface between law and morality that is illustrated by the issues that came up in the Moot Court.
Hospital ethics committees consist of representatives from multiple disciplines who discuss potential issues and real-life ethical dilemmas that confront patients, their family members, and the health care professionals involved in patient care. Bioethical issues may provoke strong emotional responses from ethics committee members. Recognizing the difficulty of resolving issues that address moral beliefs is imperative. Nurses are in key positions to help health care professionals navigate these troublesome ethical waters.