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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↗

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↗

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↗

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↗

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↗

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↗

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↗

Overview of bioethics in Mexico.

In Mexico, as in many other countries, there are numerous situations involving bioethics that are not necessarily covered by officially sanctioned policies or guidelines. In such cases, it is reasonable to describe commonly accepted rules, opinions, and practices in a general way so as to illustrate how bioethical questions are being managed. This article describes certain goals and practices relating to education in bioethics in Mexico. It then outlines Mexican laws and procedures governing research on human subjects, cites certain official rules and activities relating to regulation of human reproduction, quotes literature dealing with intervention in human procreation, discusses artificial prolongation of life, describes laws and practices governing organ transplants, considers ethical issues relating to such transplants, reviews the AIDS situation, and describes how the need for confidentiality is dealt with in managing AIDS cases and related data. In this manner it indicates how bioethical questions in these various areas are being handled and points out certain priority areas needing work.

Acquired Immunodeficiency Syndrome↗

Bioethics in Peru.

To date the application of bioethics in Peru has been rudimentary. The discipline has not yet acquired a distinct identity; only a few committees review ethical problems that arise in the course of medical practice, and bioethics is still taught mainly at schools of philosophy and theology. At the same time, situations in various health fields have raised bioethics questions or indicated areas where bioethical approaches might be effectively applied. Among others, the activities involved include research on human subjects, interventions relating to human reproduction, treatment of AIDS patients, treatment of dying patients, organ transplants, and management of handicapped children. This article reviews developments in each of these areas, with an eye to specific matters of ethical concern.

Bioethical Issues↗

Bioethics: past, present, and an open future.

The development of bioethics, spurred by the Nazi era and initiated in recent times largely in the United States, appears to be taking hold across at least the Western world. To date it lacks the necessary trappings of a true profession: that is, it lacks self-definition, criteria, and a method of assuring that those who call themselves bioethicists not only have appropriate training but function appropriately. Partly this is because the very term "appropriate" has not been defined! These are tasks that the new guard, with perhaps the advice and help of those of us from the old guard, will have to address. The development of bioethics has been mainly focused on those who had good access to healthcare. Those with a lack of access have been given short shrift. Basic healthcare provided to all within a given society has been the case in virtually all industrialized countries except for the United States since at least World War II, and even longer in most cultures. Here in the United States, our main bioethics societies, and bioethicists as individuals, have tended to concentrate on individualistic ethics and its problems (euthanasia, abortion, termination of care, IVF, etc.) and have, to a large measure, practiced "rich man's ethics." The lack of access to healthcare as well as many other faults have been labeled "system errors" and are in general considered to be beyond the responsibility of the bioethical profession. They tend to be shrugged off. We have been inclined to "join the establishment" and in so doing have often forgotten our own mission. We have spent a good deal of time discussing the ownership of a dead man's sperm and have made relatively little contribution to an equitable distribution of healthcare. In many respects, we have sold out. In my view, this is an evasion of social responsibility--social responsibility being one of the hallmarks of an honest profession. Until we come to terms with our mission--a mission that cannot merely be self-serving--we shall not be regarded as a profession. And that is a shame.

Bioethics↗

What feminism can do for bioethics.

Feminist criticism of health care and of bioethics has become increasingly rich and sophisticated in the last years of the twentieth century. Nonetheless, this body of work remains quite marginalized. I believe that there are (at least) two reasons for this. First, many people are still confused about feminism. Second, many people are unconvinced that significant sexism still exists and are therefore unreceptive to arguments that it should be remedied if there is no larger benefit. In this essay I argue for a thin, "core" conception of feminism that is easy to understand and difficult to reject. Core feminism would render debate within feminism more fruitful, clear the way for appropriate recognition of differences among women and their circumstances, provide intellectually compelling reasons for current non-feminists to adopt a feminist outlook, and facilitate mutually beneficial cooperation between feminism and other progressive social movements. This conception of feminism also makes it clear that feminism is part of a larger egalitarian moral and political agenda, and adopting it would help bioethics focus on the most urgent moral priorities. In addition, integrating core feminism into bioethics would open a gateway to the more speculative parts of feminist work where a wealth of creative thinking is occurring. Engaging with this feminist work would challenge and strengthen mainstream approaches: it should also motivate mainstream bioethicists to explore other currently marginalized parts of bioethics.

Bioethics↗

Towards a feminist global bioethics: addressing women's health concerns worldwide.

In this paper I argue that a global bioethics is possible. Specifically, I present the view that there are within feminist approaches to bioethics some conceptual and methodological tools necessary to forge a bioethics that embraces the health-related concerns of both developing and developed nations equally. To support my argument I discuss some of the challenges that have historically confronted feminists. If feminists accept the idea that women are entirely the same, then feminists present as fact the fiction of the essential "Woman." Not only does "Woman" not exist, -she" obscures important racial, ethnic, cultural, and class differences among women. However, if feminists stress women's differences too much, feminists lose the power to speak coherently and cogently about gender justice, women's rights, and sexual equality in general. Analyzing the ways in which the idea of difference as well as the idea of sameness have led feminists astray, I ask whether it is possible to avoid the Scylla of absolutism (imperialism, colonialism, hegemony) on the one hand and the Charybdis of relativism (postmodernism, fragmentation, Balkanization) on the other. Finally, after reflecting upon the work of Uma Narayan, Susan Muller Okin, and Martha Nussbaum, I conclude that there is a way out of this ethical bind. By focusing on women's, children's, and men's common human needs, it is possible to lay the foundation for a just and caring global bioethics.

Bioethics↗

The ground of dialogical bioethics.

Dialogical ethics are a procedural alternative to substantive ethics such as consequentialism, deontology, principlism, casuistry, virtue ethics and care ethics. Dialogical ethics are procedural in that they do not establish goods in advance, unlike substantive ethics, but rather determine goods through a procedure enacted by the actual parties involved (although some substantive notion of justice may still be required); and they are dialogical in that the procedure is that of dialogue, involving both empathic critical discussion and negotiation. A fundamental tenet of dialogical ethics may be the use of appropriate rules of order regulating dialogue among the parties involved. Some of the central characteristics of such rules of order are that they are reciprocally regulated by dialogue, that they override other ethical considerations, and that they institute empathic critical discussion and negotiation within the ethical dialogue. Dialogical bioethics are the application of dialogical ethics to ethical problems in medicine. The approach of dialogical bioethics has proven fruitful for resolving bioethical problems such as that of medical futility, where approaches of substantive ethics have reached an impasse. There is room for further study of special challengeswithin dialogical bioethics, such as the incompetence of some involved parties, conflicts of interests of third parties, and the cost-effectiveness of this ethical approach.

Bioethics↗

Education, practice and bioethics: growing barriers to ethical practice.

While Bioethics is now taught at all medical colleges in the United States as well as in other nations, and while discussions about Bioethics have become frequent in most medical journals there are increasing barriers to teaching and incorporating what has been taught into daily practice. I shall discuss some of these barriers and suggest that integrating the teaching of Bioethics throughout the curriculum after presenting some of the basic theory and methodology is the most effective way of teaching this vital subject. Furthermore, courses in health care ethics are often taught as something distinct and distinguishable from one's medical practice. I shall emphasize what I consider to be the failure of Bioethics to participate effectively in creating a context whereby what has been taught can be put into praxis. In this brief article I will discuss such barriers and suggest several approaches and remedies.

Bioethics↗

Rorty's pragmatism and bioethics.

In spite of the routine acknowledgement of Richard Rorty's ubiquitous influence, those who have invoked his name en route to advancing their case for a pragmatist bioethics have not given us a very clear picture of exactly how Rorty's work might actually contribute to methodological discussion in this field. I try to provide such an account here. Given the impressive depth and scope of Rorty's work during the past two decades, I make no pretense of presenting either a comprehensive or novel interpretation of his project. My primary aim here is simply to sketch what I take to be the implications of Rorty's neopragmatism for our methodological debates within bioethics. I conclude that the yield of Rorty's pragmatism for current methodological debates in bioethics is primarily negative, knocking the props out from under any pretensions to foundations and universal principles of right and wrong. His "professorial pragmatism" and philosophical trash disposal efforts would clearly sweep away some approaches based upon appeals to nature or universal human dignity, and his deflationary nominalist view of principles would threaten the foundations of some influential principlist approaches to bioethics.

Bioethics↗

"Help must first come from the divine:" a response to Fr. George Eber's claim of the so-called incommensurability of Orthodox and non-Orthodox Christian bioethics.

Orthodox bioethics is distinctive in how it reflects on issues in bioethics. This distinctiveness is found in the relationship of spirituality and liturgy to ethics. Eber's essay, however, treats the distinctiveness as absolute uniqueness. In so focusing on the incommensurability of Orthodox bioethics Eber fails to tell his reader what Orthodox bioethics is about. Furthermore, his description of Western Christian ethics is seriously inaccurate.

Attitude to Death↗

Methodological concerns in bioethics.

Methodological concerns are moving to the top of the bioethics agenda for the next decade. This paper examines some of those concerns: medical ethics as a subset of bioethics versus medical ethics as a subset of professional ethics; a more in-depth examination of some methodological problems in treating medical ethics as professional ethics; the senses in which bioethics constitutes an inquiry into secular undertakings in a pluralistic society; 'federal ethics', the emergence to prominence of public commissions and study groups; and the institutional impact of bioethics on the relationship between medical schools and the liberal arts core of their sponsoring universities.

Advisory Committees↗

A qualified bioethic: particularity in James Gustafson and Stanley Hauerwas.

Most theoretical approaches in bioethics begin with a theory that articulates and defends basic principles or rules that are more or less systematically related and that seek to yield more or less precise conclusions with regard to specific acts, cases, or policies. Concerns about the agent and descriptions of the context of action stand on the margins of the theory. This is ironic, given the overwhelming importance and impact the training of health care professionals has upon them and upon the practice of health care as a whole, and given the fact that many advocates of the theories themselves concede that one's beliefs and how one describes a situation and weighs "facts" and values relevant to the case strongly determine one's conclusions. While morality may not lead ineluctably to religion, as Kant believed, bioethics does appear inevitably to involve particularity. I examine the work of James M. Gustafson and Stanley Hauerwas to analyze two views of the role of particularity in bioethics. I then show the relevance of their work for addressing some problems with the practicality and concreteness of current models in bioethics.

Bioethics↗