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PubMed2002

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↗
PubMed2001

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↗
PubMed2001

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↗
PubMed2002

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↗
PubMed2003

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↗
PubMed2004

Does empirical research make bioethics more relevant? "The embedded researcher" as a methodological approach.

What is the status of empirical contributions to bioethics, especially to clinical bioethics? Where is the empirical approach discussed in bioethics related to the ongoing debate about principlism versus casuistry? Can we consider an integrative model of research in medical ethics and which empirical methodology could then be valuable, the quantitative or the qualitative? These issues will be addressed in the first, theoretical part of the paper. The concept of the "embedded researcher" presented in this article was stimulated by the two questions, (1) how can we safeguard that our research will yield valid and meaningful results to practice? and (2), how can we convince clinical colleagues that medical ethics offers relevant contributions to the analysis and solution of problems? One tentative answer has been our effort to elaborate a coherent methodological research approach in the field of end-of-life issues integrating qualitative and quantitative as well as casuistic methodologies. This development is characterized in the second part describing the ECOPE Study (short title) "Ethical Conditions Of Passive Euthanasia." The achievements and limitations of the suggested approach of the "embedded researcher" are discussed referring to 3 examples of our joint studies about ethical issues concerning (1) critical decision-making in neonatology (2) limitation of treatment in intensive care (3) problems with doctor-patient conversation at the end-of life in oncology. Conclusions from our studies are put to discussion in the final part of the paper about how to further develop research in the field of end-of-life care and, maybe, clinical bioethics as a whole.

Bioethical Issues↗
PubMedDate not supplied

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↗
PubMed1995

"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↗
PubMed1986

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↗
PubMed1993

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↗
PubMed1993

An Eastern Orthodox approach to bioethics.

This article seeks to identify some of the major perspectives in Eastern Orthodox Christianity which provide direction for bioethical-decision making. The article first identifies some historical, theological, and liturgical sources in the Eastern Orthodox tradition which have implications for bioethics. The manuscript also seeks to address the question of the place of religious bioethics within public discussion of issues in bioethics and health care policy.

Bioethics↗
PubMed1993

The intellectual basis of bioethics in Southern European countries.

Today the Western world harbors, at least, three very different ethical traditions, each with its own characteristics: the Anglo-Saxon, the Northern (or Central) European, and the Mediterranean. Because modern bioethics made its appearance in the Anglo-American culture, Europeans in general, and Mediterraneans in particular, have attempted not simply to "import" or "translate" bioethics, but rather to "recreate" or "remake" the discipline according to their own cultural and ethical traditions. In my presentation, I would like to explain the peculiarities of Mediterranean bioethics, analyzing the following seven points: First, how they think bioethics should be philosophically founded; Second, the Mediterranean ethics of virtue and the doctor-patient relationship; Third, the relationship between Ethics and Law; Fourth, Health Care Systems and Ethics, Fifth, the problems concerning patient rights; Sixth, ethics by Committees; and finally, some general conclusions.

Advisory Committees↗
PubMed2004

Does ethical theory have a future in bioethics?

Although there has long been a successful and stable marriage between philosophical ethical theory and bioethics, the marriage has become shaky as bioethics has become a more interdisciplinary and practical field. A practical price is paid for theoretical generality in philosophy. It is often unclear whether and, if so, how theory is to be brought to bear on dilemmatic problems, public policy, moral controversies, and moral conflict. Three clearly philosophical problems are used to see how philosophers are doing in handling practical problems: Cultural Relativity, and Moral Universality, Moral Justification, and Conceptual Analysis. In each case it is argued that philosophers need to develop theories and methods more closely attuned to practice. The work of philosophers such as Ruth Macklin, Norman Daniels, and Gerald Dworkin is examined. In the writings of each there is major methological gap between philosophical theory (or method) and practical conclusions. The future of philosophical ethics in interdisciplinary bioethics may turn on whether such gaps can be closed. If not, bioethics may justifiably conclude that philosophy is of little value.

Bioethics↗
PubMed1998

The utility of futility: the construction of bioethical problems.

The aim of this article is to analyse the contemporary 'futility discourse' from a constructivist perspective. I will argue that bioethics discourse typically disregards the context from which controversies emerge and the processes that inform and constrain such discourse. Constructivists have argued that scientific knowledge is expressive of the dominant paradigm within which a scientific community is working. I will outline an analysis of 'medical futility' as a construction of biomedical and bioethical communities (and their respective paradigms). I will trace the emergence and utilization of futility in the literature. My analysis of the context (i.e. the historical circumstances, the particular actors involved) within which the futility discourse emerged suggests that medical futility was constructed, in part, as a means of enhancing physician domination of a context wherein medical authority was threatened. The actors in this debate express widely divergent frameworks of 'the good', arguing from distinctive representations of moral agency. At times, this controversy has been argued from incommensurate moral horizons wherein the discussants debate incomparable problems. This discussion is related to a study of the 'practice' of futility in the clinical context. Further studies on the construction of bioethical problems are a necessary condition for supporting the truth claims of bioethical arguments.

Adult↗
PubMed1999

The "wider view": André Helleger's passionate, integrating intellect and the creation of bioethics.

This article provides an account of how André Hellegers, founder and first Director of the Kennedy Institute of Ethics at Georgetown University, laid medicine open to bioethics. Helleger's approach to bioethics, as to morality generally and also to medicine and biomedical science, involved taking the "wider view" -- a value-filled vision that integrated and gave meaning to what otherwise was disparate, precarious, and conflicting. This article shows how Helleger's wider view of bioethics was shaped by events in his own life, his resultant sense of the precariousness of life and health, his commitment to religious inclusiveness, his research in fetal medicine, his clinical experience in obstetrics, his role in the struggle to change the teaching of the Roman Catholic Church on fertility control, and his developing concepts of health and disease. Hellegers was committed to and worked toward bioethics as a self-consciously interdisciplinary field in which the contributing disciplines adapt to each other -- rather than sustain themselves as autonomous disciplines -- to create a dynamic and complex intellectual, clinical, and social activity.

Academies and Institutes↗
PubMed2000

Bioethics for clinicians: 18. Aboriginal cultures.

Although philosophies and practices analogous to bioethics exist in Aboriginal cultures, the terms and categorical distinctions of "ethics" and "bioethics" do not generally exist. In this article we address ethical values appropriate to Aboriginal patients, rather than a preconceived "Aboriginal bioethic." Aboriginal beliefs are rooted in the context of oral history and culture. For Aboriginal people, decision-making is best understood as a process and not as the correct interpretation of a unified code. Aboriginal cultures differ from religious and cultural groups that draw on Scripture and textual foundations for their ethical beliefs and practices. Aboriginal ethical values generally emphasize holism, pluralism, autonomy, community- or family-based decision-making, and the maintenance of quality of life rather than the exclusive pursuit of a cure. Most Aboriginal belief systems also emphasize achieving balance and wellness within the domains of human life (mental, physical, emotional and spiritual). Although these bioethical tenets are important to understand and apply, examining specific applications in detail is not as useful as developing a more generalized understanding of how to approach ethical decision-making with Aboriginal people. Aboriginal ethical decisions are often situational and highly dependent on the values of the individual within the context of his or her family and community.

Aged↗
PubMed2003

Disability: a voice in Australian bioethics?

The rise of research and advocacy over the years to establish a disability voice in Australia with regard to bioethical issues is explored. This includes an analysis of some of the political processes and engagement in mainstream bioethical debate. An understanding of the politics of rejected knowledge is vital in understanding the muted disability voices in Australian bioethics and public policy. It is also suggested that the voices of those who are marginalised or oppressed in society, such as people with disability, have particular contribution to make in fostering critical bioethics.

Advisory Committees↗
PubMed1996

The evolution of caring within bioethics: provision for relationship and context.

Given the complexity of modern health care, there exists an urgent need to discover how best to resolve complex bioethical issues. Traditionally, principle based ethics provided the benchmark for guiding ethical decision-making. More recently, however, it has become apparent that this traditional approach is often inadequate in dealing with current health care dilemmas. The notion of caring was advanced initially as an alternative to, then as a complement to, principle based ethics. In this article, caring is conceptualized as an attitude and is viewed as integral to the advancement of a coherent and integrated moral approach to ethical decision-making. First, a brief historical description of bioethics is presented. Next, an evolutionary account of caring within bioethics is described. Four fundamental problems associated with the use of caring within bioethics are then outlined. Finally, caring as an attitude is delineated and a case study is used to illustrate the proposed conceptualization of caring. The case study demonstrates that a caring attitude provides for relationship and context, which are elements often neglected by traditional approaches.

Adolescent↗