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PubMed2001

Disability: an agenda for bioethics.

Contemporary bioethics has been somewhat skewed by its focus on high-tech medicine and the resulting development of ethical frameworks based on an acute-care model of healthcare. Research and scholarship in bioethics have payed only cursory attention to ethical issues related to disability. I argue that bioethics should concern itself with the full range of theoretical and practical issues related to disability. This encounter with the disability community will enrich bioethics and, potentially, society as well. I suggest a number of items that the bioethics agenda should include, such as the development of a casuistry of the right to healthcare and to community integration and an advocacy role in fostering an understanding among the public and policy makers of the need to reform research and treatment related to disability.

Bioethical Issues↗
PubMed1998

The foundations of bioethics: contingency and relevance.

In this essay, I proceed by, first, laying out H. Tristram Engelhardt's argument for the principle of permission as the proper foundation for a secular bioethic. After considering how a number of commentators have tried to undermine this argument, I show why it is immune to some of these advances. I then offer my own critique of Engelhardt's project. This critique is two pronged. First, I argue that Engelhardt is unable to establish his own foundation for a secular bioethic. This inability leaves him with only contingent points of departure for a secular bioethic, some of the more salient of which he has ignored. Second, I argue that even if Engelhardt's project succeeds, it is in danger of being irrelevant in a practical sense because it ignores important contextual dimensions of the peculiar enterprise we call bioethics. Ultimately, the proper foundations for a relevant secular bioethic. I argue, must appeal to certain contingent features of the context that gives rise to the need for it.

Bioethics↗
PubMed2001

Feminist bioethics and psychiatry.

Feminist bioethics is a relatively new field, the major works in which only started to appear in the late 1980s. At first feminist bioethicists focused mainly on issues of particular concern to women such as reproduction. Recently, papers have begun to appear that show that a feminist analysis can be brought to bear on any subject traditional bioethics discusses. So far, however, feminist bioethics has not been brought to bear on psychiatry. There have been feminist critiques of psychiatry and feminist discussions of certain diagnostic categories that disproportionately affect women, but these are concerned with women's issues within psychiatry and how psychiatry has been used to oppress women. Certainly these are important, but what has been missing is a discussion of psychiatry in the sense that feminist bioethics suggests a general critique of psychiatry and the rethinking of the practice of psychiatry, regardless of whether the specific instances involved are women's issues. In this paper I look at what such a feminist bioethical intervention into psychiatry would look like.

Bioethics↗
PubMed2002

Teaching bioethics in the new millennium: holding theories accountable to actual practices and real people.

Teaching bioethics in the new millennium requires its practitioners to confront a wide area of methodological alternatives. This essay chronicles the author's journey from the principlism of Beauchamp and Childress, through narrative and postmodern bioethics, to a complex feminist critique of postmodern bioethics that emphasizes functional human capabilities and the creation of structures that can facilitate free discussion of those capabilities and how best to realize them. Teaching bioethics concerns not only the acknowledgement of differences but also reminding ourselves of our samenesses. Sustained Habermasian democratic conversations might help us to escape the narrow confines of a postmodern bioethics of moral strangers for a richer world of moral friends.

Bioethics↗
PubMed2002

Teaching bioethics at (or near) the bedside.

Many teachers of bioethics often express concern, in their writings and otherwise, about the theoretical basis (or lack of it) of bioethics and the allied issue of relativism. The companion articles by Tong and Momeyer are in this vein and rightly address such issues within the context of a liberal arts education. This article addresses such issues in a different venue, i.e., bioethics teaching in the clinical sphere of health care institutions. It presumes to suggest that many of these theoretical concerns, as well as the threat of relativism, seldom arise in this sphere. Rather, a broad based, well accepted body of moral truth has been fashioned over the last quarter century and it is this that clinical bioethics regularly keys to and to which most moral dilemmas are referred for resolution. The various forms of this pedagogy, e.g., case consultations or institutional policy statements, are charted out in this regard, as well as the often tactical character of much of this teaching, i.e., not "what should we do?", but "how might we best do it?". The article then goes on to conclude with a reflection on the use and abuse of power in clinical bioethics teaching and consultation.

Bioethics↗
PubMed1995

Christian bioethics as non-ecumenical.

A community's morality depends on the moral premises, rules of evidence, and rules of inference it acknowledges, as well as on the social structure of those in authority to rule knowledge claims in or out of a community's set of commitments. For Christians, who is an authority and who is in authority are determined by Holy Tradition, through which in the Mysteries one experiences the Holy Spirit. Because of the requirement of repentance and conversion to the message of Christ preserved in the Tradition, the authority of the community must not only exclude heretical teaching but heretical communities from communion. Understanding Christian bioethics requires a focus on the content of that bioethics in terms of its social context within a right-believing, right-worshipping community. Christian bioethics should be non-ecumenical by recognizing that true moral knowledge has particular moral content, is communal, and is not fully available outside of the community of right worship. The difficulty with Roman Catholicism's understandings of bioethics lies not just in its continued inordinate accent on the role of reason apart from repentance (as well as in its defining novel doctrines), but in Roman Catholicism's not recognizing that the contemporary, post-Christian age is in good measure the consequence of its post-Vatican II failure to call for a return to the traditional pieties and asceticisms of the Fathers so that all might know rightly concerning the requirements of Christian bioethics.

Abortion, Induced↗
PubMed2000

Talking about cases in bioethics: the effect of an intensive course on health care professionals.

Educational efforts in bioethics are prevalent, but little is known about their efficacy. Although previous work indicates that courses in bioethics have a demonstrable effect on medical students, it has not examined their effect on health care professionals. In this report, we describe a study designed to investigate the effect of bioethics education on health care professionals. At the Intensive Bioethics Course, a six-day course held annually at Georgetown University, we administered a questionnaire requiring open-ended responses to vignettes both before and after the course. Following the course, respondents defended their responses more carefully and articulated their thoughts more clearly. In addition, after the course respondents seemed to have a more subtle understanding of the relevant issues in the cases and applied theory to these cases more frequently. These findings help to formulate an understanding of the effect of bioethics education on health care professionals.

Adult↗
PubMed2003

Differences from somewhere: the normativity of whiteness in bioethics in the United States.

I argue that there has been inadequate attention to and questioning of the dominance and normativity of whiteness in the cultural construction of bioethics in the United States. Therefore we risk reproducing white privilege and white supremacy in its theory, method, and practices. To make my argument, I define whiteness and trace its broader social and legal history in the United States. I then begin to mark whiteness in U.S. bioethics, recasting Renee Fox's sociological marking of its American-ness as an important initial marking of its whiteness/WASP ethos. Furthermore, I consider the attempts of social scientists to highlight sociocultural diversity as a corrective in U.S. bioethics. I argue that because they fail to problematize white dominance and normativity and the white-other dualism when they describe the standpoints of African-American, Asian-American, and Native-American others, their work merely inoculates difference and creates or maintains minoritized spaces. Accordingly, the dominant white center of mainstream U.S. bioethics must be problematized and displaced for diversity research to make a difference. In conclusion, I give several examples of how we might advance the recommended endeavor of exploring our own ethnicity, class, and other social positioning and norms operating in U.S. bioethics, briefly highlighting "white talk" as one challenge.

Bioethics↗
PubMed1996

Bioethics in the twenty-first century: why we should pay attention to eighteenth-century medical ethics.

Those of us who work in the field of bioethics tend to think that, because the word "bioethics" is new, so too the field is new in all respects, but we are not the first to do bioethics. John Gregory (1724-1773) did bioethics just as we do it, at least two centuries before we thought to do it. He deployed philosophical methods as sophisticated as our own. Indeed, Gregory took up the very best moral philosophy available to thinkers of the Scottish Enlightenment, namely, David Hume's moral philosophy and its core concept of sympathy. Gregory also responded in a conceptually powerful and clinically applicable way to the problems of his time, just as we do. I want here to outline Gregory's accomplishment and to identify some aspects of its importance for bioethics in the twenty-first century.

Bioethics↗
PubMed1998

A theory of international bioethics: multiculturalism, postmodernism, and the bankruptcy of fundamentalism.

The first of two articles analyzing the justifiability of international bioethical codes and of cross-cultural moral judgments reviews "moral fundamentalism," the theory that cross-cultural moral judgments and international bioethical codes are justified by certain "basic" or "fundamental" moral priniciples that are universally accepted in all cultures and eras. Initially propounded by the judges at the 1947 Nuremberg Tribunal, moral fundamentalism has become the received justification of international bioethics, and of cross-temporal and cross-cultural moral judgments. Yet today we are said to live in a multicultural and postmodern world. This article assesses the challenges that multiculturalism and postmodernism pose to fundamentalism and concludes that these challenges render the position philosophically untenable, thereby undermining the received conception of the foundations of international bioethics. The second article, which follows, offers an alternative model -- a model of negotiated moral order -- as a viable justification for international bioethics and for transcultural and transtemporal moral judgments.

Advisory Committees↗
PubMed1998

Negotiating international bioethics: a response to Tom Beauchamp and Ruth Macklin.

Can the bioethical theories that have served American bioethics so well, serve international bioethics as well? In two papers in the previous issue of the Kennedy Institute of Ethics Journal, I contend that the form of principlist fundamentalism endorsed by American bioethicists like Tom Beauchamp and Ruth Macklin will not play on an international stage. Deploying techniques of postmodern scholarship, I argue that principlist fundamentalism justifies neither the condemnation of the Nazi doctors at Nuremberg, nor, as the Report of the Advisory Committee on the Human Radiation Experiments (ACHRE) demonstrates, condemnation of Cold War radiation researchers. Principlist fundamentalism thus appears to be philosophy bankrupt. In this issue of the Journal, Beauchamp and Macklin reject this claim, arguing that I have misread the ACHRE report and misunderstood Nazism. They also argue that the form of post-postmodern negotiated human rights theory that I proffer is adequate only insofar as it is itself really fundamentalist; insofar as I take postmodernism seriously, however, I mire international bioethics in relativism. In this response, I reaffirm my anti-fundamentalism, provide further evidence in support of my reading of the ACHRE report, and defend my post-postmodern version of rights theory. I also develop criteria for a minimally adequate theoretical framework for international bioethics.

Advisory Committees↗
PubMed1999

The origins and evolution of bioethics: some personal reflections.

Bioethics was officially baptized in 1972, but its birth took place a decade or so before that date. Since its birth, what is known today as bioethics has undergone a complex conceptual metamorphosis. This essay loosely divides that metamorphosis into three stages: an educational, an ethical, and a global stage. In the educational era, bioethics focused on a perceived "dehumanization" of medicine by the rising power of science and technology. Remedies were sought by introducing humanities, ethics, and human "values" into the medical curriculum. Ethics was one among the humanistic disciplines, but not the dominant one. In the second era, ethics assumed a dominant role as ever more complex dilemmas emerged from the rapid pace of biological research. As such dilemmas were applied to medical practice, the need for a more rigorous and more formal analysis of their moral status was clear. Philosophically-trained ethicists had an obvious role. They began to teach, write, and profoundly influence medical education and practice. In the third -- and present -- period, the breadth of problems has become so broad that ethicists must, themselves, draw on disciplines well beyond their expertise -- e.g., law, religion, anthropology, economics, political science, psychology, and the like. The era of bioethics as a global enterprise is upon us. The original hope for humanizing medicine has not been overtly successful; however, much has been accomplished of value to patients, the profession, and society. Medical morality has been transformed into a formal, systematic study of a whole range of issues of the greatest significance to humanity. Now the major challenge is one of identity, or inter-relationships and connections between the theoretical and the practical. Bioethics has outgrown its beginnings.

Academies and Institutes↗
PubMedDate not supplied

Theology, religious traditions, and bioethics.

The social and medical ethos within which bioethics emerged in the late 1960s and early 1970s was constituted in part by religious questions and religious thinkers. However, this identifiably religious influence on bioethics subsequently seemed to decline. How has this diminished impact come about, and what significance, if any, does it hold for the ways we now do bioethics? What difference, finally, do religious perspectives make for bioethics? These were the overarching questions that led the Hastings Center to initiate a research project on the relation of Religion and Bioethics, culminating in this special supplement to the Hastings Center Report.

Bioethics↗
PubMedDate not supplied

Medical bioethics and cultural diversity.

Medical bioethics has developed as a new field of study in the US in the past quarter decade, focusing upon the moral principles of autonomy, beneficence, nonmaleficence, and justice. These principles may, however, reflect biases in American culture, rather than a truly universal approach to ethical problems in medicine and health care. Alternative models for bioethics may take the cultural beliefs and practices of different countries more seriously. These different models of bioethics may have important implications for the study of ethical issues in pediatrics. Effective dialogue between America and other countries such as India, especially when focused on particular clinical cases, should expand the understanding of bioethics in those other countries, as well as bringing new light upon American bioethical principles.

Bioethics↗
PubMed1998

Bioethics education in a clinical pastoral education program.

Notes that contemporary health care delivery and the interface of clinical professionals with patients and families are marked by complexity and pluralism and that within this modern matrix patients, families, professionals, and administrators frequently struggle with difficult ethical issues. Observes that these realities have significant implications for chaplains and for chaplains-in-training, a factor which has received the attention of the Bioethics Committee of the Professional Chaplains Association through its Bioethics Committee and resulting in a set of guidelines for the chaplain's appropriate roles in bioethical issues and for their role on bioethics committees. Describes the establishment of a bioetchics modulate at the Cleveland Clinic Foundation (CCF) in which chaplain residents are enabled to function as professional peers with other healthcare professionals and as competent chaplains with patients and families in bioethical decision making. Reports on the methods and the results of a pilot study based on the model described.

Chaplaincy Service, Hospital↗
PubMed1996

Educating nurses for their future role in bioethics.

The emerging new multidisciplinary and crosscultural field of bioethics will require sensitive, open-minded professionals to take the lead in hospital ethics, in genetic counselling, and in the teaching of bioethics to students in nursing, medicine and the basic sciences. Nurses with ward experience who return to university to gain an MA or PhD in bioethics are eminently suited for this leadership role, for they may be more likely than physicians to study for a liberal education to supplement their professional knowledge; their first-hand experience in nursing is an antidote to the pointless subtleties into which philosophical ethics so often degenerates. When teaching ethics to nurses one must remember that, while some will simply use this knowledge in their own clinical work, others will go on to be teachers and researchers in bioethics. Their training must therefore be broad and interdisciplinary, including real substantive philosophy (as opposed to philosophical ethics), as well as mystical bioethics, religious law, ethics of genetic counselling, clinical approaches to ethical pseudo problems, research skills, etc.

Cultural Diversity↗
PubMed1999

Bioethical language and its dialects and idiolects.

In their search for answers to the relevant theoretical questions on importing knowledge in practical ethics, the authors take an instrumental approach to metaphor. This figure of language allows one to compare language and linguistic variants to bioethics and knowledge. As defined by the dictionary, an 'idiom' is the official language of a nation, a 'dialect' is a regional variant of an idiom, and an 'idiolect' is an individual variant of a dialect. The bioethical idiom is thus seen as a linguistic set constituting a 'bioethical nation'. Since it is situated above particular dialects, it exercises more than a regulatory role over the discipline. In this article, in order to focus on the process of transmission of knowledge in bioethics, the authors chose Diego Gracia's work as a paradigmatic reference to the question on the transculturation of dialects and the relations in bioethics which are considered 'peripheral' or 'central'. Although this researcher found the key question pointing to the core of the problem of importing dialects, he is still searching for a proper answer to the cultural/bioethical context/contradiction.

Bioethics↗
PubMed2003

Framework for bioethical assessment of an article on therapy.

OBJECT: Frameworks for scientific assessment of articles on therapy published in the medical literature have become available and will likely enhance the quality of medical research that is published in peer-reviewed journals. Comprehensive frameworks do not exist for the assessment of bioethical issues pertaining to research on human volunteers. METHODS: The authors have developed a framework consisting of ethical dimensions or questions that they suggest should be applied to assess the bioethical integrity of articles on therapy. Thirteen questions were developed and discussed in the context of current bioethical principles, and examples were applied where possible. CONCLUSIONS: The simple framework the authors have developed offers a method to assess key bioethical issues surrounding an article on therapy and probably defines the minimum standard to which such articles should be held. Many ethical questions cannot yet be answered based on available information or bioethical theories. The authors are not suggesting that their framework is comprehensive; refinements and individualization of it to fit specific studies are probably required by each clinician-researcher who designs a therapy trial and reports its results.

Bioethical Issues↗