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PubMed1999

Bioethics committees--a health communication approach.

The modern health care system is being transformed as a consequence of scarce resources and better informed consumers. In this transformed health care system human communication has become a crucially important process. This essay examines the health communication functions performed by bioethics committees in health care delivery and makes recommendations for promoting the effective use of these groups within the modern health care system. The essay describes how bioethics committee can help establish a climate in which physicians and other committee members can share relevant health information, learn about patient and family concerns, promote health education and informed consent, and facilitate effective decision making about complex health care practice issues. It is argued that clear recognition and attention to the central role of effective communication within the bioethics committee is essential for the survival of the modern health care system since ethics committees depend on sharing relevant information to diagnose health problems, provide health care, promote health education, help in the formulation of new health care policies, and provide much-needed decision-making support to health care providers and consumers. The role that health communication expertise can perform in the effective operation and utilization of bioethics committees is described. We conclude that in order to provide needed support in addressing the many complexities of modern health care, bioethics committees must develop clear communication processes, norms, and roles.

Bioethics↗
PubMedDate not supplied

[Care at the patient's bedside. Non-invasive bioethics].

This paper aims at describing the circumstances of the birth of Bioethics. In the first section, the paper points out some historical data supporting the widely diffused opinion according to which Bioethics started in the USA at the beginning of the '70s. In the second section, one of the most important factors in the birth of Bioethics is discussed: namely, the changes in medical enterprise and health care ethics. In the third section the impact of Bioethics on clinical medicine at the bedside is discusses, and, in the last section, one of the most important practical application of bioethical reflection is presented: the creation of Hospital Ethics Committees.

Bioethics↗
PubMed2001

[Is bioethics the Circe of medicine?].

BACKGROUND: Recent development in the biomedical fields have led to considerable moral perplexity, about the rights and duties of health professionals, patients and research subjects. Since about 1970 bioethics have become involved in an ongoing discussion of the complex ethical issues raised by these developments. OBJECTIVE: To review the precise relationship between Nietzsche's ontology and an eventual bioethics. METHOD: The author intends to give a picture of how ontological factors have influenced the beginnings of bioethics. RESULTS: Ethics for Nietzsche symbolizes Circe, the enchantress in Homer's Odyssey. Nietzsche's task is to proclaim the emptiness (devaluation) of all traditional values, thus soliciting a rejection of them. But bioethics must not be content with merely replacing the old values by new ones. v.g. by filling the place left by the supreme values. CONCLUSIONS: Despite the efforts to overcome technic, bioethics remains locked in the subject-ism of which technic is but a consequence. Nietzsche's special insight is to perceive that the interpretation of beings currently prevalent is valueless for it is an interpretation that has returned to values that are precisely without an value at all.

Bioethics↗
PubMedDate not supplied

[Dynamics of the dialogue on bioethics in a Spain in transition].

The bioethics dialogue began in Spain in 1975 in private institutions and developed in a society in transition toward democracy. Nostalgia for a nationalist Catholicism by some and the fervor of others to demonstrate that a break with the past had taken place have been important factors in bioethics legislation. Imitation of legislation considered progressive prevailed in the debate taking place in the country's bioethics centers, although in the case of assisted reproduction a commission of experts was set up to advise the government. The public has not participated in the debates, despite their coverage by the communications media. The medical schools have attempted to reform the deontological codes as a basis for formulating, promoting, and protecting the values of a pluralistic society. Results have been minimal, but the work of the bioethics centers is gradually being recognized and evaluated, and it is hoped that this ongoing bioethical dialogue will gradually mature.

Bioethics↗
PubMed1993

The European Convention on Bioethics.

For nearly 20 years, the Council of Europe, the organization for intergovernmental cooperation of the great Europe (26 countries are members of the council) has worked in the different fields of what is now called bioethics (reproductive technologies, organ transplants, human experimentation, etc). The council mainly proposes recommendations to member states in order to implement harmonized legislation. During the past ten years, this activity has been concentrated in a unique and multidisciplinary committee of experts; the CAHBI (ad hoc Committee of Experts on Bioethics). The recent development of national and very diverse legislation related to bioethical issues emphasized the necessity of adopting common binding principles at the European level. It was then decided at the end of 1991 by the Committee of Ministers of the council that the CAHBI would prepare a European Convention on Bioethics. This text, which is now being drafted, will in fact be composed of three documents. The Convention itself will list a set of general principles such as respect for human dignity, respect for the integrity of the person, the prohibition of any commercial arrangement on the human body and the principle of nondiscrimination. Two protocols will specifically deal with two important bioethical issues: organ transplants and human experimentation, but other topics could be covered in the future. All these texts will create obligations for member states and others that would like to ratify them to implement national regulations. An independent committee will have the duty to control how these obligations will be respected.

Bioethics↗
PubMed1995

[Introduction to bioethics in contemporary medicine].

The author makes a historical revision of his 50 years experience in medical ethics as a student and physician. In 1944, medical ethics was traditional and resolved simple problems based on Hippocrates postulates and christian humanism. The present scientific and cultural revolution has impelled the rise of bioethics defined as "the systematic study of human behavior in life sciences, based on moral principles". The bioethical methods attempt to facilitate the application of universal ethical principles to the solution of complex cases, generated by the new medical technology. These ethical problems were posed in Chile in 1962 by the french professor Jean Cheymol, who reported the serious human rights abused derives from new scientific experiments. Later in 1973, Dr. Motulsky predicted the advent of "a brave new world" and the need to create a new biological ethic. These challenges were faced by the professors of the faculty of Medicine, who created ethics commissions in 1975 and edited medical ethics code texts. There are three players in the bioethic context. Physicians apply beneficence; patients defend their autonomy: the State and the society defends justice. A conflict of values lies in the bottom of bioethics. The author vindicates the coherence of traditional medical ethics. Philosophers, theologians and lawyers can only help physicians, but are not responsible. Bioethics must allow a frank dialogue between these professionals, respecting their roles and responsibilities.

Bioethics↗
PubMed2002

Theological discourse and the postmodern condition: the case of bioethics.

Bioethics reflects--like many other disciplines--the cultural fragmentation and the complexity of what has come to be known as the postmodern condition. The case of bioethics is particularly acute because of its epistemological indeterminacy and the moral pluralism characterizing postliberal societies. A provisional solution to this situation is the retrieval of a neo-Kantian version of ethical formalism in which concern for a consensus on rules replaces universal dialogue on moral content. The article analyzes the possible consequences of this solution with reference to theological ethics. In particular, the reduction of ethical rationality to a function of political regulation on the one hand, and the implicit legitimization of ethical relativism on the other, push any theological contribution to bioethics to the margins. The central methodological issue for the articulation of theological discourse in bioethics is how to avoid the pitfall of privatism while creating the conditions for ethical dialogue across different traditions.

Bioethical Issues↗
PubMed1999

Bioethics as several kinds of writing.

Three different models are described of the relationship of bioethics to the press. The first two are familiar: bioethicists often are interviewed by journalists seeking background and short quotes to insert in a story; alternately, bioethicists sometimes themselves act as journalists of a sort, writing op-eds, articles or even longer works designed for wide readership. These models share the notion that bioethicists can provide information and ideas that increase the quality of people's thinking on moral matters. They share also a common difficulty: do the constraints the media impose on bioethical discourse keep bioethicists from deepening public reflection, and if not, how can those constraints be most effectively kept from distorting what bioethicists wish to say? The third model reverses--in part--the presupposition that bioethics bestows moral sophistication on a public naive about ethical issues, holding rather that matters run both ways; bioethicists stand to learn a great deal from their interactions with various publics and the media that serve them. On this view, the constraints imposed by media conventions constitute opportunities for new and potentially important forms of bioethical writing. Various concerns generated by the first two models are surveyed. It is concluded that while none of the difficulties constitute knock-down arguments against these forms of collaborating with the press, the worries are problematic enough to provide some support for considering the less familiar third approach. Further reason for taking the third model seriously draws on moral theoretic considerations.

Bioethical Issues↗
PubMed1990

Quality of scholarship in bioethics.

This paper identifies four major forms of scholarship in bioethics: empirical research, the articulation of mid-level principles of bioethics, the relating of these principles to fundamental moral theories, and discussions of the bioethical implications of legal principles and health delivery policies. It develops a reflective equilibrium approach to the relation between these four forms of scholarship. It then presents, in light of this approach, criteria for quality research in each of these forms of scholarship in bioethics.

Bioethical Issues↗
PubMed1991

Getting down to cases: the revival of casuistry in bioethics.

This article examines the emergence of casuistical case analysis as a methodological alternative to more theory-driven approaches in bioethics research and education. Focusing on The Abuse of Casuistry by A. Jonsen and S. Toulmin, the article articulates the most characteristic features of this modern-day casuistry (e.g., the priority allotted to case interpretation and analogical reasoning over abstract theory, the resemblance of casuistry to common law traditions, the 'open texture' of its principles, etc.) and discusses some problems with casuistry as an 'anti-theoretical' method. It is argued that casuistry so defined is 'theory modest' rather than 'theory free' and that ethical theory can still play a significant role in casuistical analysis; that casuistical analyses will encounter conflicting 'deep' interpretations of our social practices and institutions, and are therefore unlikely sources of increased social consensus on controversial bioethical questions; that its conventionalism raises questions about casuistry's ability to criticize norms embedded in the societal consensus; and that casuistry's emphasis upon analogical reasoning may tend to reinforce the individualistic nature of much bioethical writing. It is concluded that, not-withstanding these problems, casuistry represents a promising alternative to the regnant model of 'applied ethics' (i.e., to the ritualistic invocation of the so-called 'principles of bioethics'). The pedagogical implications of casuistry are addressed throughout the paper and include the following recommendations: (1) use real cases, (2) make them long, richly detailed and comprehensive, (3) present complex sequences of cases, (4) stress the problem of 'moral diagnosis', and (5) be ever mindful of the limits of casuistical analysis.

Bioethical Issues↗
PubMed1994

Observations on the epistemological status of bioethics.

Different definitions of bioethics in American and Italian literature are reported. It is argued that they refer to three different conceptions of the epistemological status of bioethics: the first conceives of it as an application of moral principles to biomedical problems, the second as a methodology for the working out of clinical judgement, the third as a broader and interdisciplinary public inquiry. It is suggested that each approach grasps a part of the truth, for each singles out one level of the bioethical work. Bioethics is in fact a complex, three-level form of knowledge. The misunderstanding of this complexity has led to some confusion and to conflicts of attribution among those who are concerned with it.

Beneficence↗
PubMed2001

Constitution and common law in bioethics.

In recent years legal intervention in bioethical matters has increased notably following various paths: court decisions, parliamentary acts, codes of conduct and solemn declarations (i.e. European Bioethics Convention, 1997, or the UNESCO Genome Declaration, 1997). Body and liberty, as a question of fundamental legal rights, are constitutionalized along two paths. The former is vertical (a text created at central level is open to ratification and domestic implementation to finally become the rule in concrete cases). The latter is, above all, horizontal. It is characterized by the existence at world level of a number of centres and institutions, with the judiciary and judge-made law playing a major role. The most important new rights and freedoms in bioethics have been recognized in this ever-changing and troubled environment. The horizontal way has the great advantage of considering the differences as a resource and not as a limit. In the case law on bioethics a sort of jurisprudential model seems to be at work, that goes some way toward a judge-made law at a universal level. Cases such as Cruzan, Bland and Massimo held the fundamental concept of self-determination with surprising similarity. But we don't know if one of them has influenced the others, always supposing that the judges were aware of them. Today's first duty is to raise the consciousness of judges as to how common their problems are and how often their rulings are similar to each other's.

Bioethical Issues↗
PubMed1995

An 'ethics gap' in writing about bioethics: a quantitative comparison of the medical and the surgical literature.

In order to determine whether there is a significant difference between the medical literature and the surgical literature in terms of their bioethics content, we conducted a computerized search of the MEDLINE database. The journals searched were selected from the 'Medicine' and 'Surgery' sections of the 'Brandon-Hill List', and the search was limited to 1992 issues of these journals. Three hundred and seven bioethics bibliographic records (out of a total of 11,239 articles indexed) were retrieved from the 15 medical journals searched, while 17 bioethics bibliographic records (out of a total of 2,645 articles indexed) were retrieved from the 12 surgical journals searched. We conclude that there is a statistically significant (p < 0.001) difference between the medical literature and the surgical literature with respect to their quantitative bioethics content.

Bibliometrics↗
PubMed1995

The word "bioethics": the struggle over its earliest meanings.

An article by Warren Reich in the December 1994 issue of this journal concludes that the word "bioethics" and the field of study it names experienced a "bilocated birth" in 1970/1971 under Van Rensselaer Potter, at the University of Wisconsin, and André Hellegers, at Georgetown University. Further historical inquiry confirms (1) that there were, from the start, some major differences -- even clashes -- between the Potter and the Hellegers/Georgetown understandings of bioethics; and (2) that the Hellegers/Georgetown approach came to be the more widely accepted meaning of the term, while Potter's idea of bioethics remained largely marginalized. However, this inquiry also results in a third, unanticipated, conclusion: that Hellegers (in contrast to the dominant model offered by the Georgetown scholars) actually proposed a global approach to bioethics, bringing his vision much closer to Potter's evolving view than previously has been acknowledged.

Academies and Institutes↗
PubMed1998

The blossoming of bioethics at NIH.

The establishment of the Department of Clinical Bioethics at the Warren G. Magnuson Clinical Center of the National Institutes of Health (NIH) has coincided with a burgeoning of interest and activity related to bioethical issues at NIH. The department has precipitated a reexamination and revitalization of existing bioethics activities in the Clinical Center and has launched new programs especially in the areas of education and research. In addition, the department contributes to the work of others throughout NIH who address bioethical issues.

Academies and Institutes↗
PubMed2001

What happened to our free bioethics search service? The terrible and premature death of BIOETHICSLINE.

BIOETHICSLINE, in existence from 1973 thorough 2000, was a bibliographic database covering the English-language literature on bioethical issues. It reflected the cross-disciplinary field of bioethics. During 2001, the National Library of Medicine is expected to dismantle BIOETHICSLINE and incorporate its data into two of their other databases, PubMed and LOCATORplus. Once this is completed, BIOETHICSLINE, as a unified database, will be discontinued. The users of BIOETHICSLINE will no longer have access to this important and useful resource specifically targeted to the vocabulary and cross-disciplinary nature of the bioethics literature. As a scholar and student of bioethics, and as a trained and former reference librarian, I feel it is important to examine these changes and their consequences. There are good reasons to integrate BIOETHICSLINE into these other databases on the NLM Gateway, but I argue that, in addition this integration, BIOETHICSLINE should be continued as a distinct database.

Abstracting and Indexing↗
PubMed1991

What has bioethics to offer health policy?

The field of bioethics has quickly become a subject of intense public fascination; and, following on an earlier period of resistance and skepticism, bioethics has been welcomed by clinicians as well. Bioethics, however, is largely a practical activity rather than a scholarly one, and its pretensions as an academic discipline within health policy and health services research must be greeted cautiously. Continuing problems in moral theory suggest that the most secure contributions that bioethics can make to health policy research are analysis and criticism rather than positive moral claims.

Advisory Committees↗
PubMed1990

Present status and prospects of bioethics in Argentina.

Most developments supporting the study of bioethics in Argentina are of relatively recent vintage. This article is dedicated to describing those developments--including creation of Argentina's Institute of Medical Humanities, formation of a bioethics working group at the National University of Mar del Plata, initiation of a two-year graduate bioethics course at the same university, and the holding of an international symposium and workshop on bioethics at Mar del Plata in 1988. Particular attention is devoted to the graduate course, the detailed design of which is outlined in Annex 1.

Argentina↗