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Casuistry as bioethical method: an empirical perspective.

This paper examines the role that casuistry, a model of bioethical reasoning revived by Jonsen and Toulmin, plays in ordinary moral reasoning. I address the question: 'What is the evidence for contemporary casuistry's claim that everyday moral reasoning is casuistic in nature?' The paper begins with a description of the casuistic method, and then reviews the empirical arguments Jonsen and Toulmin offer to show that every-day moral decision-making is casuistic. Finally, I present the results of qualitative research conducted with 15 general practitioners (GPs) in South Australia, focusing on the ways in which these GP participants used stories and anecdotes in their own moral reasoning. This research found that the GPs interviewed did use a form of casuistry when talking about ethical dilemmas. However, the GPs' homespun casuistry often lacked one central element of casuistic reasoning--clear paradigm cases on which to base comparisons. I conclude that casuistic reasoning does appear to play a role in every-day moral decision-making, but that it is a more subdued role than perhaps casuists would like.

Adult↗

How useful is Leuven personalism in the world of bioethics? The test case of artificial insemination.

Personalism in ethics denotes any system based upon the value of the person. Several versions of personalist morals have been developed over the past 50 years. Some have had particular interest in the field of medical ethics. Here the question is being studied about one such system, the so-called Leuven personalist morals and its usefulness in today's world of bioethics. In order to test the usefulness of this system the case of artificial insemination is examined both in the early 1970s in the context of the Leuven clinics and, subsequently, in the 1990s in a US policy document. The investigation reveals strengths and weaknesses of this personalism. Regarding AID it reveals unresolved oppositions. The conclusion seems to be that this personalism had, no doubt, a profound impact upon medical ethics within its own circle but, as regards the universal usefulness of the system, serious doubts remain.

Bioethics↗

Global bioethics.

Because there is a large agenda of work that needs to be done to help ethicists to be better able to address ethical questions in healthcare from an environmentally conscious and globally coherent point of view, Cambridge Quarterly of Healthcare Ethics is initiating this occasional column on global bioethics to provide a space to publish and discuss environmental issues in healthcare. We are initiating this section with a paper of my own outlining some broad concerns about healthcare ethics in a global context ["Casuist or Cassandra? Two conceptions of the bioethicist's role," p. 451-466] and are inviting readers to submit philosophical and multidisciplinary papers taking a global perspective on ethical issues in healthcare....

Bioethics↗

Virginia Bioethics Network.

The Virginia Bioethics Network (VBN), a self-governing, self-supporting organization of Virginia healthcare institutions and other interested groups and individuals, was officially incorporated in the state of Virginia in December 1993.... The mission of the VBN is to advance the knowledge of biomedical ethics within Virginia healthcare institutions and their communities and to support the development of local institutional ethics programs and regional ethics networks throughout the state. The ultimate goal is enhancement of ethical decision making in the clinical setting with all pertinent factors, including community values, being given due consideration during the decision-making process....

Communication↗

The epistemology of communitarian bioethics: traditions in the public debates.

I consider the problem liberalism poses for bioethics. Liberalism is a view that advocates that the state remain neutral to views of the good life. This view is sometimes supported by a skeptical moral epistemology that tends to propel liberalism toward libertarianism. I argue that the possibilities for shared agreement on moral matters are more promising than is sometimes appreciated by such a view of liberalism. Using two examples of public debates of moral issues, I show that commonly shared intuitions may ground moral principles even if they may be given different weight by persons of different moral and religious traditions. Nevertheless, the fact that the intuition and principle is widely shared may be sufficient to chart some directions for public policy or cooperative action even if they do not lead to complete agreement. As a result, I argue that a liberal communitarianism that presupposes a fairly minimalist epistemology is a legitimate approach to achieving shared agreement in a pluralistic society.

Abortion, Legal↗

Bioethics and religions: religious traditions and understandings of morality, health, and illness.

For many individuals, religious traditions provide important resources for moral deliberation. While contemporary philosophical approaches in bioethics draw upon secular presumptions, religion continues to play an important role in both personal moral reasoning and public debate. In this analysis, I consider the connections between religious traditions and understandings of morality, medicine, illness, suffering, and the body. The discussion is not intended to provide a theological analysis within the intellectual constraints of a particular religious tradition. Rather, I offer an interpretive analysis of how religious norms often play a role in shaping understandings of morality. While many late 19th and early 20th century social scientists predicted the demise of religion, religious traditions continue to play important roles in the lives of many individuals. Whether bioethicists are sympathetic or skeptical toward the normative claims of particular religious traditions, it is important that bioethicists have an understanding of how religious models of morality, illness, and healing influence deliberations within the health care arena.

Attitude to Health↗

Bioethics in pluralistic societies.

Contemporary liberal democracies contain multiple cultural, religious, and philosophical traditions. Within these societies, different interpretive communities provide divergent models for understanding health, illness, and moral obligations. Bioethicists commonly draw upon models of moral reasoning that presume the existence of shared moral intuitions. Principlist bioethics, case-based models of moral deliberation, intuitionist frameworks, and cost-benefit analyses all emphasise the uniformity of moral reasoning. However, religious and cultural differences challenge assumptions about common modes of moral deliberation. Too often, bioethicists minimize or ignore the existence of multiple traditions of moral inquiry. Careful consideration of the presence of multiple horizons for moral deliberation generates challenging questions about the capacity of bioethicists to effectively resolve complex cases and social policy disputes.

Bioethics↗

On the content and purview of Christian bioethics.

The author argues that to explore what is distinctly Christian about Christian bioethics requires clarity about what is Christian. He distinguishes between the Christian (that which can be identified as authentically Christian), Christianity (the sum of that which is authentically Christian), and ecclesiastical traditions (the historical communities of faith and practice that are predicated upon both Christian and extra-Christian tradition) to critically assess what it is to be declared Christian. In addition to exploring the role of New Testament scripture in identifying the Christian, the author emphasizes the need to recognize the extent to which the content of Christianity is Hebraic and Jewish.

Bioethics↗

Pragmatic principles--methodological pragmatism in the principle-based approach to bioethics.

In this paper it will be argued that Beauchamp and Childress' principle-based approach to bioethics has strongly pragmatic features. Drawing on the writings of William James, I first develop an understanding of methodological pragmatism as a method of justification. On the basis of Beauchamp's and Childress' most recent proposals concerning moral justification in the fifth edition of their Principles of Biomedical Ethics (2001), I then discuss different aspects that the principle-based approach and methodological pragmatism have in common.

Bioethics↗

The difference that difference makes: bioethics and the challenge of "disability".

Two rival paradigms permeate bioethics. One generally favors eugenics, euthanasia, assisted suicide and other methods for those with severely restricting physical and cognitive attributes. The other typically opposes these and favors instead ample support for "persons of difference" and their caring families or loved ones. In an attempt to understand the relation between these two paradigms, this article analyzes a publicly reported debate between proponents of both paradigms, bioethicist Peter Singer and lawyer Harriet McBryde Johnson. At issue, the article concludes, are two distinct axiomatic sets of values resulting in not simply different styles of rhetoric but different vocabularies, in effect two different languages of ethics.

Bioethics↗

From the local to the global: bioethics and the concept of culture.

Cultural models of health, illness, and moral reasoning are receiving increasing attention in bioethics scholarship. Drawing upon research tools from medical and cultural anthropology, numerous researchers explore cultural variations in attitudes toward truth telling, informed consent, pain relief, and planning for end-of-life care. However, culture should not simply be equated with ethnicity. Rather, the concept of culture can serve as an heuristic device at various levels of analysis. In addition to considering how participation in particular ethnic groups and religious traditions can shape moral reasoning, bioethicists need to consider processes of socialization into professional cultures, organizational cultures, national civic culture, and transnational culture. From the local world of the community clinic or oncology unit to the transnational workings of human rights agencies, attentiveness to the concept of culture can illuminate how patients, family members, and health care providers interpret illness, healing, and moral obligations.

Advance Care Planning↗

Sin and bioethics.

The essay starts out with defining the biblical concept of sin in the Old and the New Testaments. The literal knowledge of divine truth is distinguished from its truthful and spiritual interpretation. A further distinction should be made between the Creator of life (God) and the medium or "intermediary creator" (man) of life. I argue for the "single wholeness" of the human race and for the unity of human responsibility in bioethics. In delineating the teaching of the Church on abortion and family planning, I show that the healing of all human diseases, from traditional interventions to genetic ones, is a Christian duty and is in accordance with Christ's mission on earth as long as one has not been directly or indirectly involved in "reproducing" or "designing" one's descendants or destroying or damaging human life even at its very beginnings.

Abortion, Induced↗

Bioethics and sin.

On the basis of a historical reconstruction of the stages through which the Christian notion of sin took shape in Protestantism, the significance of this term for modern bioethics is derived from its opposition to a holiness of God and his creatures, which in turn translates into the secular moral concept of dignity. This dignity imposes obligations to respect and to relationships that are sustained by faithfulness and trust. In being based on the gratuitousness of God's grace, such relationships preclude attempts at instrumentalization, denial of singularity, and subjection to market forces. Accordingly, reproductive cloning as well as exposing medicine to economical considerations can be classified as sinful. The difference between sinful acts and humans' sinful state furthermore permits to address the problems of evil and misfortune in the world, and to acknowledge humans' responsibility for the threats to humanity entailed by those ills. While the Christian faith relies on God's mercy, it also imposes the task of following Christ by fighting against evil and misfortune.

Bioethics↗

What makes Christian bioethics Christian? Bible, story, and communal discernment.

Scripture is somehow normative for any bioethic that would be Christian. There are problems, however, both with Scripture and with those who read Scripture. Methodological reflection is necessary. Scripture must be read humbly and in Christian community. It must be read not as a timeless code but as the story of God and of our lives. That story moves from creation to a new creation. At the center of the Christian story are the stories of Jesus of Nazareth as healer, preacher of good news to the poor, and sufferer. The story shapes character and conduct and enables communal discernment.

Bible↗

Confronting deep moral disagreement: the President's Council on Bioethics, moral status, and human embryos.

The report of the President's Council on Bioethics, Human Cloning and Human Dignity, addresses the central ethical, political, and policy issue in human embryonic stem cell research: the moral status of extracorporeal human embryos. The Council members were in sharp disagreement on this issue and essentially failed to adequately engage and respectfully acknowledge each others' deepest moral concerns, despite their stated commitment to do so. This essay provides a detailed critique of the two extreme views on the Council (i.e., embryos have full moral status or they have none at all) and then gives theoretical grounding for our judgment about the intermediate moral status of embryos. It also supplies an account of how to address profound moral disagreements in the public arena, especially by way of constructing a middle ground that deliberately pays sincere respect to the views of those with whom it has deep disagreements.

Advisory Committees↗

Strange bedfellows? Reflections on bioethics' role in disaster response planning.

This essay considers the potential role of bioethics in disaster response planning and preparedness. Bioethicists can make substantial contributions, by ensuring that decision-making and distribution of resources during crises is carried out in a fair and just manner, as well as by examining the assumptions upon which disaster planning are based. Bioethicists should also be aware of potential pitfalls of overly-hasty engagement with this new field.

Bioethical Issues↗

Illness, the problem of evil, and the analogical structure of healing: on the difference Christianity makes in bioethics.

A Christian bioethic needs to place the medical approach to sickness, suffering, and death within the context of redemption and the renewal of humanity in the image of God. This can be done by accounting for the way in which the disruptions of the human life-world that attend the illness experience manifest the structure of the problem of evil and point toward an answer that transcends the individual and the medical community. Further, the disease-oriented approach to medicine, when understood in the context of the analogia entis, can be taken as an analogy for a deeper spiritual healing, and can thus become a vehicle through which one can minister to the disruptions of a patient's life-world. An appreciation of the analogical structure of healing provides the basis for a Christian ethic of care.

Attitude to Death↗