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PubMed1998

Body measures: phenomenological considerations of corporeal ethics.

The development of bioethics primarily at the cognitive level further perpetuates the tendency to construe all aspects of our lives, including our bodies, as technical systems. For example, if we consider the moral issue of organ sales without taking our embodiment into account there appear to be no sound arguments for opposing such sales. However, it is important to consider the aspects of the phenomenal body that challenge rational deliberation by exploring an embodied approach to the ethical dilemma produced by a proposed kidney exchange as presented in one of Krzysztof Kieślowski's Dekalog films. What is sought is a description of a body-measure that would serve as a critique of strictly cognitive bioethical deliberations.

Bioethics↗
PubMed2004

Ethics in technological culture: a programmatic proposal for a pragmatist approach.

Neither traditional philosophy nor current applied ethics seem able to cope adequately with the highly dynamic character of our modern technological culture. This is because they have insufficient insight into the moral significance of technological artifacts and systems. Here, much can be learned from recent science and technology studies (STS). They have opened up the black box of technological developments and have revealed the intimate intertwinement of technology and society in minute detail. However, while applied ethics is characterized by a certain "technology blindness," the most influential approaches within STS show a "normative deficit" and display on agnostic or even antagonistic attitude toward ethics. To repair the blind spots of both applied ethics and STS, the authors sketch the contours of a pragmatist approach. They will explore the tasks and tools of a pragmatist ethics and pay special attention to the exploration of future worlds disclosed and shaped by technology and the management of deep value conflicts inherent in a pluralistic society.

Bioethical Issues↗
PubMed2003

Autonomy, subject-relativity, and subjective and objective theories of well-being in bioethics.

Among the different approaches to questions of biomedical ethics, there is a view that stresses the importance of a patient's right to make her own decisions in evaluative questions concerning her own well-being. This approach, the autonomy-based approach to biomedical ethics, has usually led to the adoption of a subjective theory of well-being on the basis of its commitment to the value of autonomy and to the view that well-being is always relative to a subject. In this article, it is argued that these two commitments need not lead to subjectivism concerning the nature of well-being.

Ethical Relativism↗
PubMed2005

What kind of doing is clinical ethics?

This paper discusses the importance of Richard M. Zaner's work on clinical ethics for answering the question: what kind of doing is ethics consultation? The paper argues first, that four common approaches to clinical ethics -- applied ethics, casuistry, principlism, and conflict resolution cannot adequately address the nature of the activity that makes up clinical ethics; second, that understanding the practical character of clinical ethics is critically important for the field; and third, that the practice of clinical ethics is bound up with the normative commitments of medicine as a therapeutic enterprise.

Ethical Theory↗
PubMed2000

Technology in medicine: ontology, epistemology, ethics and social philosophy at the crossroads.

In reference to the different approaches in philosophy (of medicine) of the nature of (medical) technology, this article introduces the topic of this special issue of Theoretical Medicine and Bioethics, that is, the way the different forms of medical technology function in everyday medical practice. The authors elaborate on the active role technology plays in shaping our views on disease, illness, and the body, whence in shaping our world.

Biomedical Technology↗
PubMedDate not supplied

Reductionism, eclecticism, and pragmatism in psychiatry: the dialectic of clinical explanation.

Explanatory models in psychiatry reflect what clinicians deem valuable in rendering people's behavior intelligible and thus help guide treatment choices for mental illnesses. This article outlines some key scientific and ethical principles of clinical explanation in twenty-first century psychiatry. Recent work in philosophy of science, clinical psychiatry, and psychiatric ethics are critically reviewed in order to elucidate conceptual underpinnings of contemporary explanatory models. Many explanatory models in psychiatry are reductionistic or eclectic. The former restrict options for diagnostic and therapeutic paradigm choice, while the latter lack a well-defined theoretical basis. These two methodological approaches stand in a dialectical relation to one another insofar as clinicians often move from one approach to its antithesis, ultimately seeking a synthesis of the two approaches that satisfies clinical needs. Pragmatic considerations can help to transcend the reductionism/eclecticism dialectic. In the absence of a completed science of mental disorders, psychiatrists must tolerate ambiguity and uncertainty as they strive to integrate diverse explanatory concepts in a rigorous and evidence-based fashion. A pragmatic explanatory model in clinical psychiatry must focus on favorable treatment outcomes for patients by respecting the pluralistic, participatory, and provisional nature of psychiatric explanation.

Bioethics↗
PubMed2004

Strong holism, weak holism, and health.

The health theories of Nordenfelt and Boorse are compared. Critical attention is focused on Nordenfelt's description of his theory as one of holistic welfare, contrasting with Boorse's analytical and statistical approach. Neither theory is found to give an entirely satisfactory account of 'health' in scientific medicine or common usage. Because Nordenfelt attenuates the ontological significance of organs and organ parts and simplifies the role of statistics, his theory is regarded as weakly holistic. Boorse underrates the importance of non-statistical evaluation. A mediating position, termed 'strong holism' is suggested as a way of integrating normative and statistical elements in a more adequate health concept.

Health↗
PubMed2005

Health and autonomy.

Individual autonomy is a prominent value in Western medicine and medical ethics, and there it is often accepted that the only way to pay proper respect to autonomy is to let the patients themselves determine what is good for them. Adopting this approach has, however, given rise to some unwanted results, thus motivating a quest for an objective conception of health. Unfortunately, the purportedly objective conceptions of health have failed in objectivity, and if a conception of health is not acceptable for all agents, the threat of offending the patients' autonomy arises. This article sketches an objective conception of health that is able to respect individual autonomy.

Age Factors↗
PubMed1996

Can phronesis save the life of medical ethics?

There has been a growing interest in casuistry since the ground breaking work of Jonsen and Toulmin. Casuistry, in their view, offers the possibility of securing the moral agreement that policy makers desire but which has proved elusive to theory driven approaches to ethics. However, their account of casuistry is dependent upon the exercise of phronesis. As recent discussions of phronesis make clear, this requires attention not only to the particulars of the case, but also to the substantive goods at stake in the case. Without agreement on these goods attention to cases is unlikely to secure the productive consensus that Jonson and Toulmin seek.

Casuistry↗
PubMed2005

Ethical care of the critically ill child: a conception of a 'thick' bioethics.

In this article I argue for an interpretive approach to bioethics with critically ill children. I begin by highlighting the dominant Anglo-American bioethical framework that defines standards for ethical care in critically ill children and then outline a critique of this framework. Drawing predominantly on the ideas of Charles Taylor, Michael Walzer and Richard Zaner, I call for a reconception of bioethics and propose an interpretive 'thick' framework that is centred on culture and context. Finally, I illustrate this interpretive approach through a comparative study of two cases in pediatric intensive care: the narratives of Marc and Larry. These case studies reveal that ethical dilemmas in pediatric critical care can be traced to relational tensions over respect, trust and power rooted in the disparity of moral horizons among the persons involved.

Attitude of Health Personnel↗
PubMed2002

Reflections on a new medical cosmology.

Since the nineteenth century the theory and practice of mainstream Western medicine has been grounded in the biomedical model. In the later years of the twentieth century, however, it has faced a range of serious problems, which when viewed collectively, remain unresolved despite a variety of responses. The question we now face is whether these problems can be dealt with by modifying and extending the principles underlying the biomedical model, or whether a more radical solution is required. Recent critiques of Western medicine have focused mainly on the biopsychosocial model in relation to the former approach, but it will be contended that this cannot deal adequately with the challenges that medicine currently faces, because although it addresses both the scientific and humanistic aspects of medicine it fails to harmonise them. I shall therefore argue for the necessity of a more radical approach, and suggest that what is required to accomplish this is the development of a new medical cosmology, rooted in an older and more global framework. Such a fundamental change would inevitably involve a long term process which it is not yet possible to fully comprehend let alone specify in detail. Some of the necessary features of such a new medical cosmology can, however, already be distinguished and the outline of these is described.

Bioethical Issues↗
PubMed2005

Timing invitations to participate in clinical research: preliminary versus informed consent.

This article addresses the impact of the potential conflict between the roles of physicians who are both clinicians and researchers on the recruitment of persons into research trials. It has been proposed (1) that a physician breaches inter-role confidentiality when he or she uses information gathered in his or her clinical role to inform patients about trials for which they may be eligible and (2) that clinician-researchers should adopt a model of preliminary consent to be approached about research prior to commencing a clinical relationship. This article argues that even if we grant the legitimacy of inter-role confidentiality (which is open to question), there are circumstances in which other obligations physicians bear override the obligation of inter-role confidentiality. Moreover, it is argued that the practice of preliminary consent is morally suspect and that such consent cannot be deemed valid. The article concludes with a series of recommendations of ways in which the legitimate concern regarding the conflicting roles of clinician-researchers can be addressed in the recruitment stage of research.

Beneficence↗
PubMed2000

Health of organisms and health of persons: an embedded instrumentalist approach.

In a time when we as a society are in the process of deciding what our basic rights to health care are, it is critically important for us to have a full and complete understanding of what constitutes health. We argue for an analysis of health according to which certain states are healthy not in themselves but because they allow an individual to reach actual goals. Recognizing that the goals of an individual considered from the point of view of biology and the goals of the same individual considered as an agent in the world might be different, we introduce a distinction between the health of an individual qua organism and the health of an individual qua person. We then argue that this distinction characterizes the evaluations made by patients and healthcare providers better than the widely discussed distinction between disease and illness.

Disease↗
PubMed2003

Medicine and the humanities--theoretical and methodological issues.

Engel's biopsychosocial model, Cassell's promotion of the concept "person" in medical thinking and Pellegrino's and Thomasma's philosophy of medicine are attempts to widen current biomedical theory of disease and to approach medicine as a form of human activity in pursuit of healing. To develop this approach further we would like to propose activity theory as a possible means for understanding the nature of medical practice. By "activity theory" we refer to developments which have evolved from Vygotsky's research on socially mediated mental functions and processes. Analysing medicine as activity enforces the joint consideration of target and subject: who is doing what to whom. This requires the use of historical, linguistic, anthropological, and semiotic tools. Therefore, if we analyse medicine as an activity, humanities are both theoretically and methodologically "inbound" (or internal) to the analysis itself. On the other hand, literature studies or anthropological writings provide material for analysing the various forms of medical practices.

Humanities↗
PubMed2005

The nature of relative subjectivity: a reflexive mode of thought.

Ethical principles including autonomy, justice and equality function in the same paradigm of thought, that is, logocentrism--an epistemological predilection that relies on the analytic power of deciphering between binary oppositions. By studying observable behavior with an analytical approach, however, one immediately limits any recognition and possible understanding of modes of thought based on separate epistemologies. This article seeks to reveal an epistemological predilection that diverges from logocentrism yet continues to function as a fundamental component of ethical behavior. The issue of cancer disclosure in Japan is used to exemplify the nature of relative subjectivity (kankeiteki-shukansei), a term I define and believe to be an epistemological predisposition fundamental to ethical behavior. Relative subjectivity denotes an epistemology quintessential to the behavior of individuals who attend to the respective tides of each particular situation, each interpersonal relationship or, in the context of clinical medicine, to the needs and values of each patient.

Ethics, Clinical↗
PubMed2005

The human body as field of conflict between discourses.

The approach to AIDS as a disease and a threat for social discrimination is used as an example to illustrate a conceptual thesis. This thesis is a claim that concerns what we call a medical issue or not, what is medicalised or needs to be demedicalised. In the friction between medicalisation and demedicalisation as discursive strategies the latter approach can only be effected through the employment of discourses or discursive strategies other than medicine, such as those of the law and of economics. These discourses each realise different values, promote a different subject, and have a different concept of man. The concept of discourse is briefly outlined against concepts such as the linear growth concept of science and the growth model of science as changes in paradigm. The issue of testing for AIDS shows a conflict between the medical and the legal discourse and illustrates the title of our contribution: the human body as field of conflict between discourses.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

What good is a pragmatic bioethic?

Do bioethicists need yet another theoretical approach with which to frame their disagreements? Many pragmatists contend that pragmatism, unlike its liberal and utilitarian counterparts, is uniquely commendable in (a) beginning from our lived experiences and (b) locating those experiences amid our social relations. In place of an "abstract principlism," pragmatism offers a practical "bedside-bioethic"; in lieu of "autonomy run amuk," pragmatism proposes an ethic rooted in our communal resources. To date, however, efforts to develop such a bioethic have been stymied by pragmatists' own abstract theoretical commitments, commitments that prevent them, most directly, from beginning with the lived experiences and communal resources of those who hold theological commitments. This self-imposed methodological constraint, I argue, has needlessly thwarted pragmatism's most striking methodological promise: its potential to cultivate productive debates among secular and theologically-informed participants.

Bioethics↗
PubMed2005

Bioethics and cara sui.

Cara sui (care of the self) is a guiding thread in Foucault's later writings on ethics. Following Foucault in that inquiry, we are urged beyond our fairly superficial conceptions of consequences, harms, benefits, and the rights of persons, and led to examine ourselves and try to articulate the sense of life that animates ethical reasoning. The result is a nuanced understanding with links to virtue ethics and post-modern approaches to ethics and subjectivity. The approach I have articulated draws on the phenomenology of Levinas and Heidegger, the Virtue ethics of Baier, and the post-structuralist writing of Michel Foucault. The subject is seen as negotiable, embodied, provisional and able to be transformed in a way that denies essentialism about human beings, their moral status, and the idea of the good. The human being emerges as responsible because, properly, responsive to the context of discourse in which morality becomes articulated. When we import this style of thinking into bioethics we find that it reaches beyond issues of policy or right conduct and allows us to use the biomedical sciences and the clinical world to revise and interrogate our understanding of ourselves and the theoretical foundations of health care ethics.

Bioethics↗