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In the present work a detailed study is given of the European Convention on Bioethics, with discussion of its guiding principles--protection of human beings, their dignity and identity-, its objectives and the limits imposed by the Convention on the exercise of rights and freedoms in the case of the application of biology and medicine.
This is the perfect example of the problems which are the consequences of the actual medicine. We carried out an ovocyte donation study at the Tenon Hospital, in Paris, between 1994 and 1999 involving 177 cryopreserved thawed embryo transfers among 300 recipients. This study enables us to stress the ethical difficulties posed by the so called bioethical laws of 1994. Simultaneously two consequences became clearly evident: a paucity of donors, and the necessity to only transfer frozen embryos due to decree of 1996 upon sanitary security that imposes the quarantine of embryos for six months. On the other hand, the use of this method has yielded important new information regarding embryo implantation and the importance of ovocyte quality that is closely correlated to donor age.
Just as what we can all "technoscience" is emerging in our everyday life, a reflection should be conducted concerning the implications of the scientific and technical progress within our society from now on globalised. We will tackle successively: 1. The ambiguities and paradoxes related to the development of new technologies: in the field of bioethics: artificial reproduction, mammal cloning, genetically modified organisms. towards the ethics of new technologies: ethics of information and communication technologies and ethics of space policy; 2. Nature, foundation and characteristics of the ethical approach; the precaution principle must be completed with two other principles: the principle of experience and the principle of vigilance; 3. The modalities of a democratic management of the ethical approach: it is a matter of defining the role of the three main actors, i.e.: experts, politicians and citizens representing public opinion. It is necessary to promote the ethical approach within a democratic context, that is to ensure a dialogue between experts, policy decision-makers and public opinion on all of the applications of science and technology. It is from such a permanent and renewed dialogue that will emerge the image we give from ourselves in the present world.
Bioethics is becoming a major current in modern medical thought and action. Given the youth of this field of enquiry, there are still important debates and controversies on its proper role in medicine and in medical education, but the need to foster its integral incorporation into the formative process of the physician is unreservedly accepted, on an equal footing with the scientific, technical, and humanistic components of medical training.
For a variety of historical and professional reasons the field of bioethics has paid little attention to the market. It has tended to treat the market with suspicion or hostility. Now, however, the market must be taken seriously. It has become a world-wide force in health care, and there is every reason to believe it will remain strong in the future. For that reason, it is wise to see what can be taken from the market, rather than simply dismiss it altogether. The market has various aspects: a theory of human nature, a view of human behavior, and an ideological aspect, with proponents stressing the necessary connection between political and market freedom. This article argues that only its view of human behavior should be accepted, particularly the possibility of using incentives, positive and negative, to change behavior. That can be helpful in health care, whereas the market's view of human nature should be rejected.
The model of the physician as a caregiver and as a researcher has been given extensive attention in the bioethical debate. There has been a transition in the last decades from the traditional idea of a physician inserted in the hippocratic ethos to a more technical and contractarian model; we contend that the latter fails to capture the essential features of the clinical encounter, in that its presuppositions are abstract and lead to unintended results. Other models have been proposed (beneficence, covenant, care) which seem to better fit the reality of the clinical encounter. In the experimental setting there is a particularly illuminating example of the type of relationship which we find more convincing.
An anonymous questionnaire was filled by 129 patients with pulmonary tuberculosis to study bioethical aspects. It contained questions concerning a patient's attitude to obtaining full information on his/her disease, treatments, and physician-patient relations, keeping his/her disease confidential from the relatives, controlled and obligatory treatments.
OBJECTIVES: Renewed interest in living donor transplantation in France led us to survey French transplanters to determine their opinion concerning this technique and the ethical issues involved. Their concerns and suggestions about current legislation were examined. METHODS: An anonymous questionnaire was sent to physicians working in the different kidney, liver and lung transplantation units operating in France. RESULTS: French transplanters expressed a wide range of opinions concerning living donor transplantation and possible broadening of the current regulations. Sixty-two percent of the transplanters had a positive opinion on living donor transplantation compared with 22% who expressed a negative opinion. For 23% of the transplanters, it is preferable to transplant with a living donor graft compared with 64% who preferred cadaveric grafts. A living donor transplantation program is under study in 65% of the units. There is some debate concerning the legitimate nature of the emergency donation situation for spouses. About one-half of the transplanters were in favor of controlled extension of potential donors to second degree relatives and to the recipient's spouse or living partner. CONCLUSION: There is no real consensus among French transplanters concerning living donor transplantation due to the complexity of the ethical issues involved. Their opinions reflect medical tradition with background marked by autonomy and paternalism. This leads to a wide range of opinions concerning current bioethics legislation and the usefulness of more flexible laws.
Moving from the most recent progresses in some address international acts on bioethics of the research, the Convention of human rights and biomedicine and La declaration universelle sur le génome humain e les droits de l'homme, this paper describes the legislative acts which regard many aspects of theoretical and practical scientific research, both in the Italian national and supra-national fields. This legislation concerns mainly the following topics: rights of the human subjects of research, informed consent, privacy on the personal data, activity on organ transplantation, research in genetics, activity in the field of treatment of human gametes and embrios. The author here quotes these legislative acts referring briefly to national and international laws.
Most Americans would doubtless agree that positive change is a critical need in facilities providing long-term care. This article describes a project currently underway in which Midwest Bioethics Center (MBC) staff and Kansas City area experts in long-term care are doing their part to create meaningful change in the way residents of nursing homes are cared for in the last chapter of their lives.
In the field of human procreation, the problems raised by bioethics are multiple and complex. First, there is the request from couples and individuals with regards to the management of procreation, not only the negative requests, be it contraception or abortion, but also the positive requests concerning medically assisted procreation. Then there is the practitioner's response to the request, particularly for assisted procreation. The practitioner is at the heart of conflicting interests between the needs or desires of the patients and the reluctance, legitimate or not, of society, with the implication of a third person, embryo, fetus or newborn. And here again we are confronted with the aims of researchers wishing to obtain information concerning the efficacy, possibilities of application and potential dangers. The legists and magistrates are concerned with the legal status of the embryo and the fetus. However, if the fact of giving a legal status can solve many legal problems, it does not solve the problem of the eventual use of an embryo, and of its interpretation by philosophers and moralists. Moreover, public opinion should not be forgotten, including the attraction of rapid anathema, without recourse. Finally, there is also the role of the legislator who, here again, is confronted with several controversial conceptions.
The use of live animals for experiments plays an important role in many forms of research. This gives rise to an ethical dilemma. On the one hand, most of the animals used are sentient beings who may be harmed by the experiments. The research, on the other hand, may be vital for preventing, curing or alleviating human diseases. There is no consensus on how to tackle this dilemma. One extreme is the view taken by adherents of the so-called animal rights view. According to this view, we are never justified in harming animals for human purposes - however vital these purposes may be. The other extreme is the ruthless view, according to which animals are there to be used at our discretion. However, most people have a view situated somewhere between these two extremes. It is accepted that animals may be used for research - contrary to the animal rights view. However, contrary to the ruthless view, that is only accepted under certain conditions. The aim of this presentation is to present different ethical views which may serve as a foundation for specifying the circumstances under which it is acceptable to use animals for research. Three views serving this role are contractarianism, utilitarianism and a deontological approach. According to contractarianism, the key ethical issue is concern for the sentiments of other human beings in society, on whose co-operation those responsible for research depend. Thus it is acceptable to use animals as long as most people can see the point of the experiment and are not offended by the way it is done. According to utilitarianism, the key ethical issue is about the consequences for humans and animals. Thus it is justified to use animals for research if enough good comes out of it in terms of preventing suffering and creating happiness, and if there is no better alternative. In the deontological approach the prima facie duty of beneficence towards human beings has to be weighed against the prima facie duties not to harm animals and to respect their integrity. By weighing these prima facie duties, the moral problem of animal experimentation exists in finding which duty actually has to be considered as the decisive duty. It will be argued that these three views, even though they will all justify animal experimentation to some extent, will do so in practice under different conditions. Many current conflicts regarding the use of animals for research may be better understood in light of the conflict between the three bioethical perspectives provided by these views.
Clinical bioethics may help ethics to pay deeper attention to the real phenomena of the moral life, with the aid of the psychological tradition, particularly of the psychoanalytic lesson. If we focus on the concrete moral experience of the patient, we recognize that rational justification of moral judgements (that is ethics) does not apply principles in a syllogistic way, but makes abstraction from a living emotional world, which is more rich and concrete than the theoretical precepts and axioms used.
Clinical bioethics applies moral norms to clinical situations, but this kind of application is not of an impersonal, deductive kind. In the stories of illness the suffering voices of the patients have to be heard and interpreted, to discover the real meaning of their resort to medicine. In a hermeneutical perspective, moral norms have a symbolic nature, because they command a good personal attitude toward the other persons and they prohibit an hostile intention of exploitation, domination, abuse.
Bioethics , which provides a new ethical outlook on human life, is a term used in public health and biomedical research issues. It is for this reason that, in this paper, we decided to analyse certain aspects associated with the ethical considerations we must bear in mind when conducting research in humans, although the purpose of doing so is to cure or to improve the quality of life of people who suffer from certain diseases, many of which are fatal. Reasons are put forward to make it necessary to doubt which is the strategy with the most favourable benefit/risk relation for those who will undergo such interventions. We describe Alzheimer s disease and discuss the possible use of neurotrophic drugs in the treatment of this disorder (NGF therapy). We also emphasise the care that will have to be taken in each of the stages of development of the research. That is why we are witnessing the emergence of a new culture that is needed to regulate the multiple interventions that can be performed on life, and to guarantee the primacy of what is good, both for the human being of today and those of generations to come.
This article surveys key texts in contemporary orthodox Jewish law (Halakha) with regard to end-of-life decision making. The author proposes twelve principles that govern Jewish law in that matter. The article proceeds to examine the Steinberg report in the light of Halakha. Orthodox Judaism regards human life as a prime value, which is always beyond consideration of economical means or quality of life. The avoidance of suffering is the only justification to shorten the life of the sufferer, provided that the acts performed do not fall within the Halakhic definition of murder, namely active and direct action that shortens life. It is argued that the main challenge of bioethics in Israel is the bridging between the positive law of Halakha whose fundamental value is submission to God's will as manifested in Halakha, and the rationalism, universalism, and egalitarianism which constitute naturalistic ethics. This challenge may produce ideas such as the "clock machine". It is too early to know if this is a trickery, or genuine ethical creativity.
Millions of people in various parts of the world and within each country are presently surviving in categories described as "mere," "miserable," "idealistic," "irresponsible," and "acceptable." The term "acceptable survival" is proposed as a bioethical goal of global survival, looking beyond the 21st century to the year 3000 and beyond. The frequently used alternative term is "sustainable development," but in most contexts this is an economic concept and does not imply any moral or ethical constraints, except where these are spelled out. Acceptable survival, broadly defined, means acceptable to a universal sense of what is morally right and good and what will continue in the long term. The expanding dominant, but irresponsible, world culture is not an acceptable type of development because it cannot survive in the long term.
Bioethical issues emerge each time health care reform projects are discussed. These affect diverse moral values and principles and have an impact on cultural, social and political areas. Thus, they demand more than just organizational, financial or administrative solutions. This review analyses discrimination, free election of professionals and informed consent. All three concepts are alluded in the legislative debate raised upon the actual process for health reform. Having clear ideas about these subjects is crucial to foresee the reactions expected to arise among physicians and the general public, when confronting the proposed changes.