Human dignity is a crucial concept in contemporary ethical, political and legal studies. However, people have different, even opposite understandings of human dignity, which has caused lots of confusion in related discourses. The Confucian notion of human dignity provides an important perspective for reflecting various theories of human dignity. In Confucian ethics, the basis of human dignity is the moral potential that every human being naturally has. Moral potential grants everyone universal dignity, while the development of moral potential grants people (...) acquired dignity. Since all human beings have moral potential to the same extent, everyone owns universal dignity equally. Different people develop their moral potential to different extents. One’s acquired dignity is positively associated with the development of her moral potential. Universal dignity is a moral status but acquired dignity is not. To pursue acquired dignity is the moral demand of universal dignity and protects people’s universal dignity. Confucian discussions on human dignity provide not only a way to justify the equality of human moral status, but also a way to justify the moral obligation of protecting and developing human nature, thereby constituting a reliable theoretical basis for coping with ethical issues caused by biomedical technologies today. (shrink)

In his Disrupted Dialogue: Medical Ethics and the Collapse of Physician-Humanist Communication Robert Veatch presents a scholarly tour de force of eighteenth- and nineteenth-century Anglophone medical ethics to demonstrate how the easy communication between physicians and humanists in the Scottish Enlightenment progressively dissipated as medicine became detached from humanistic disciplines. In this paper I offer two comments—that the discourse of medical ethics in the Scottish Enlightenment was a discourse of Baconian moral science and that nineteenth-century medical ethics in the United (...) States became detached from that discourse. The result was that a principal resource for physicians at the birth of bioethics, the American Medical Association’s Principles of Medicine Ethics of 1957, did not equip physicians with the conceptual tools they needed to formulate and address the ethical challenges that became the agenda of bioethics. The paper opens with a brief portrait of Robert Veatch, the author’s connections to him, and his little-known role as an impresario of the classical music of the Blue Ridge and Appalachia. (shrink)

Juridical councils that render rulings on bioethical issues for Muslims living in non-Muslim lands may have limited familiarity with the foundational concept of wilāyah (authority and governance) and its implications for their authority and functioning. This paper delineates a Sunni Māturīdi perspective on the concept of wilāyah, describes how levels of wilāyah correlate to levels of responsibility and enforceability, and describes the implications of wilāyah when applied to Islamic bioethical decision making. Muslim health practitioners and patients living in (...) the absence of political wilāyah may be tempted to apply pragmatic and context-focused approaches to address bioethical dilemmas without a full appreciation of significant implications in the afterlife. Academic wilāyah requires believers to seek authentication of uncertain actions through scholarly opinions. Fulfilling this academic obligation naturally leads to additional mutually beneficial discussions between Islamic scholars, healthcare professionals, and patients. Furthermore, an understanding derived from a Māturīdi perspective provides a framework for Islamic scholars and Muslim health care professionals to generate original contributions to mainstream bioethics and public policy discussions. (shrink)

This paper examines the ‘justice’ and ‘care’ orientations in ethical theory as characterized in Carol Gilligan's research on moral development and the philosophical work it has inspired. Focus is placed on challenges to the justice orientation – in particular, to the construal of impartiality as the mark of the moral point of view, to the conception of moral judgment as essentially principle-driven and dispassionate, and to models of moral responsibility emphasizing norms of formal equality and reciprocity. Suggestions are made about (...) the implications of these challenges, and of the care orientation in ethics, for the ethical theory taught, the issues addressed, and the skills and sensitivities encouraged through bioethical education. Keywords: bioethical education, ethics of care, impartiality, moral judgment, moral psychology CiteULike Connotea Del.icio.us What's this? (shrink)

There are competing accounts of the birth of bioethics. Despite the differences among them, these accounts share the claim that bioethics was not born in a single disciplinary home or in a single social space, but in numerous, including hospitals, doctors' offices, research laboratories, courtrooms, medical schools, churches and synagogues, and philosophy classrooms. This essay considers the interdisciplinarity of bioethics and the contribution of new disciplines to bioethics. It also explores the implications of interdisciplinarity for (...) bioethics education. As bioethics develops, it will be helpful to identify essential elements in the education of bioethicists and to distinguish between members of other disciplines who make important contributions to bioethics and bioethicists. (shrink)

In this paper, I argue for two theses. First, if Christianity is true, then morality should depend on the metaphysics of the afterlife. Second, if Christianity is true, then contemporary moral theory is mistaken. The argument for the first thesis rests on two premises. If rightness depends on an act’s effects on an individual, then—at least in part—it depends on the long-term effects on him. If rightness depends—at least in part—on the long-term effects on an individual, then it depends on (...) the metaphysics of the afterlife. The argument for the second thesis rests on how heaven or hell swamp other considerations. By changing assumptions about the nature of heaven or hell, who goes there, and standard mathematics, we end up with different ethical theories. Some of these assumptions conflict with contemporary moral theory regarding killing, letting die, and saving. (shrink)

Background As the UK’s main healthcare priority-setter, the National Institute for Health and Care Excellence (NICE) has good reason to want to demonstrate that its decisions are morally justified. In doing so, it has tended to rely on the moral plausibility of its principle of cost-effectiveness and the assertion that it has adopted a fair procedure. But neither approach provides wholly satisfactory grounds for morally defending NICE’s decisions. In this study we adopt a complementary approach, based on the proposition that (...) a priority-setter's claim to moral justification can be assessed, in part, based on the coherence of its approach and that the reliability of any such claim is undermined by the presence of dissonance within its moral system. This study is the first to empirically assess the coherence of NICE’s formal approach and in doing so to generate evidence-based conclusions about the extent to which this approach is morally justified. Methods The study is grounded in the theory, methods and standards of empirical bioethics. Twenty NICE policy documents were coded to identify and classify the normative commitments contained within NICE technology appraisal policy as of 31 December 2021. Coherence was systematically assessed by attempting to bring these commitments into narrow reflective equilibrium (NRE) and by identifying sources of dissonance. Findings Much of NICE policy rests on coherent values that provide a strong foundation for morally justified decision-making. However, NICE’s formal approach also contains several instances of dissonance which undermine coherence and prevent NRE from being fully established. Dissonance arises primarily from four sources: i) NICE’s specification of the principle of cost-effectiveness; ii) its approach to prioritising the needs of particular groups; iii) its conception of reasonableness in the context of uncertainty, and iv) its concern for innovation as an independent value. Conclusion At the time of analysis, the level of coherence across NICE policy provides reason to question the extent to which its formal approach to technology appraisal is morally justified. Some thoughts are offered on why, given these findings, NICE has been able to maintain its legitimacy as a healthcare priority-setter and on what could be done to enhance coherence. (shrink)

Cohen’s article (2023) on the significance of ChatGPT for bioethics suggests that little is known about the development of generative AI (“GAI”) in China and other national markets. It warns about...

This paper examines the Japanese notion of relationality, that is, the idea that the individual is defined primarily within a web of relationships. Furthermore, it proposes that this relationality provides an ontological basis for morality, particularly the critical need for achieving consensus. This need for consensus is evident in the dispute over brain death. It was also conspicuous in the long-standing debate regarding heart transplantation. By reviewing key features of relationality, the study also demonstrates that the Japanese approach toward consensus (...) reflects certain cultural values such as the importance of nemawashi. This inquiry thereby evokes the brain death and heart transplantation controversy in order to illustrate the critical need for consensus in the decision-making process. (shrink)

Discussions about assisted suicide have hitherto been based on accounts of dignity conceived only as an inherent value or as a status; accounts of dignity in which it appears as a (contingent) attitude, by contrast, have been neglected. Yet there are two good reasons to consider dignity to be an attitude. First, this concept of dignity best allows us to grasp a crucial aspect of everyday language: people often express fears of losing their dignity—and it is not possible to explain (...) this with an account in which dignity is inherent. Second, such a concept allows us to adduce new argumentation where the argument based on status ends. Dignity considered as a status provides grounds to argue for the moral permissibility of assisted suicide, in the sense that in such an account individuals possess the normative power to waive their right to life. But the question then remains of how to decide what counts as a good reason for assisted suicide—and this is where an argument based on dignity as an attitude can provide illumination. (shrink)

The question of what constitutes personhood is controversial in Western bioethical literature especially in relation to its implications for healthcare. Godfrey Tangwa explores the traditional African perspective of a person and maintains that it is different totally from the Western perception as there is no dichotomy between a person and a human being in the African context. He defends a conception of personhood as a moral agent rather than a moral patient, which the Western view focuses on. The basic (...) justification he offers in support of his position is the eco-biocommunitarian worldview. This paper seeks to respond to Tangwa by arguing that his positions on person are not only metaphysically superfluous; they are also ethically incoherent. This paper argues that Tangwa’s theses on “the traditional African perception of a person” are inaccurate representations and misapprehension of the common notion of personhood in sub-Saharan Africa. In reconstructing an African concept of personhood, this paper explores its plausible implications for global clinical bioethics relevance. (shrink)

Private companies are data-rich. But market pressures to collect more, store more, and analyze more consumer data can often make them ethically bankrupt in the way of proactively protecting consume...

This article is an analysis of the relationship between US hospice structure and the feeling of being a burden to others. A goal of US hospice care is to reduce the FBO. But in America, hospice is limited in its ability to do so because of the high caregiver burden it places on family members of dying people. Through a historical study, I show that this burden was excessive when the hospice system was created and has worsened over time. Through (...) three ethnographic vignettes, I demonstrate how this burden inculcates in dying people the FBO. I then examine the bioethical implications of this finding for the existing US debate about physician-assisted suicide. The presence of FBO due to insufficient hospice care supports arguments made by PAS opponents about the social pressure placed on dying people. This finding is not itself sufficient to resolve the “right to die” debate. But it provides the ground for a compromise, across the debate, to reduce the FBO by changing US hospice structure. The resulting consensus will further the goals of both PAS proponents and opponents. (shrink)

In this paper we begin with a reference to the work of Hernando de Soto The Mystery of Capital: Why Capitalism Triumphs in the West and Fails Everywhere Else, and his characterization of the Western institution of formal property. We note the linkages that he sees between the institution and successful capitalist enterprise. Therefore, given the appropriateness of his analysis, it would appear to be worthwhile for developing and less developed countries to adjust their systems of ownership to conform more (...) closely to the Western system of formal property. However, we go on to point out that property relationships within the Western system have become subject to redefinition through the expansion of Intellectual Property rights in ways that ultimately work to the disadvantage of the developing and less developed countries. We point out that this restructuring has been given global application through the implementation of the TRIPS agreement by the WTO. In the final section of the paper I suggest ways in which IP rights and relevant institutions can be reformed in order to avoid the disadvantages to the developing and less developed countries. (shrink)

Effective evaluation of any activity requires, first, that we understand what its objectives are, and second, that we can define and measure these objectives. For instance, a publicly listed compan...

Molecular genetic engineering technologies such as CRISPR/Cas9 have made the accurate and safe genetic engineering of human embryos possible. Further advances in genomics have isolated genes that predict qualities and traits associated with intelligence. Given these advances, prospective parents could use these biotechnologies to genetically engineer future children for genes that enhance their intelligence. While Julian Savulescu’s Principle of Procreative Beneficence (PPB) argues for the moral obligation of prospective parents to use in-vitro fertilization and preimplantation genetic diagnosis to make eugenic (...) selections of embryos for intelligence, the PPB could imply obligations to genetically engineer selected embryos for intelligence as well. I argue that the PPB implies an additional moral obligation for prospective parents to genetically engineer the embryonic germline identity of selected embryos for genes that predict intelligence. Objections to my argument for the PPB’s extension are also discussed. (shrink)

RésuméIntroductionLa motivation est. un thème crucial et répandu en médecine. Que. ce soit pour un scénario clinique ou chirurgical, l’acceptation de prendre une pilule ou de se rendre à une consultation est. essentielle au succès du traitement médical. La “décennie du cerveau” a fourni aux praticiens des données neuroscientifiques substantielles sur le comportement humain, a aidé à expliquer pourquoi les gens font ce qu’ils font et a créé le concept de “cerveau motivé”. Les résultats de la psychologie empirique ont stratifié (...) la motivation en étapes de changement, qui sont devenues plus complexes au fil des décennies. Cette recherche vise à améliorer la compréhension de la façon dont les gens prennent des décisions concernant leur santé et comment mieux comprendre les stratégies et les techniques pour les aider à résoudre les problèmes d’ambivalence de manière efficace et ciblée.MéthodesNous établissons un dialogue avec la phénoménologie de la volonté de Ricoeur afin de comprendre le sens de ces découvertes scientifiques. À partir de la phénoménologie husserlienne, Paul Ricoeur a développé sa pensée en s’éloignant de l’idéalisme transcendantal en émancipant les structures intentionnelles de la volonté du domaine de la perception. Résultats: En introduisant les concepts de volontaire et d’involontaire, Ricoeur s’est. écarté du dualisme cartésien, qui fait du corps un corps d’objet, cible de vicissitudes naturelles. Le nouveau dualisme entre volontaire et involontaire est. traité par référence à ce que Ricoeur a appelé le mystère central de l’existence incarnée, qui considère l’homme “double dans l’humanité, simple dans lavitalité”. Cette dualité permet de considérer le cerveau comme l’organe naturel du comportement dans le corps humain et d’utiliser la psychologie empirique comme moyen d’échapper aux subjectivations superficielles des concepts.ConclusionLa simplicité (ou unité) d’existence invite la médecine à repenser certaines de ses hypothèses philosophiques, de telle sorte que les patients puissent être considérés comme des sujets autonomes avec des projets de vie d’auteur. L’anthropologie ricourienne a un impact éthique profond sur la manière dont la médecine devrait utiliser la technologie, ce qui découle de résultats de psychologie empirique. L’utilisation de ces nouvelles connaissances doit également faire l’objet d’une inspection minutieuse, car elle modifie le rôle social de la science médicale. (shrink)

More than thirty-four years after the United States Supreme Court initially recognized a woman’s constitutional right to choose whether or not to terminate a pregnancy (at least within the first two trimesters) in its landmark abortion decision Roe v. Wade, the issue of whether women ought to have this right continues to affect public debate. Presidential candidates are asked about the issue, and potential Supreme Court nominees and their prior judicial decisions, academic writings, and speeches are thoroughly scrutinized for any (...) inkling of how they would likely rule in a future case on the issue. Perhaps even more important is the way the debate over this issue has impacted federal funding for stem cell research in the United States. Because of moral concerns regarding the personhood status and level of dignity owed to the human embryo as a form of human life, in September of 1999, the National Bioethics Advisory Commission recommended against providing federal funding for the use and derivation of embryonic stem (ES) cells and embryonic germ (EG) cells except when obtained from “cadaveric fetal tissue” or “embryos remaining after infertility treatment.” In this article, I will suggest that the abortion debate and its offshoots into embryonic medical research persist because of a failure to properly separate human personhood from human biology. I will argue further that a proper analysis of the problem will not only enlighten the abortion and fetal tissue research debate, but will have implications for end-of-life issues as well. (shrink)

A subcategory of medical tourism, reproductive tourism has been the subject of much public and policy debate in recent years. Specific concerns include: the exploitation of individuals and communities, access to needed health care services, fair allocation of limited resources, and the quality and safety of services provided by private clinics. To date, the focus of attention has been on the thriving medical and reproductive tourism sectors in Asia and Eastern Europe; there has been much less consideration given to more (...) recent ‘players’ in Latin America, notably fertility clinics in Chile, Brazil, Mexico and Argentina. In this paper, we examine the context-specific ethical and policy implications of private Argentinean fertility clinics that market reproductive services via the internet. Whether or not one agrees that reproductive services should be made available as consumer goods, the fact is that they are provided as such by private clinics around the world. We argue that basic national regulatory mechanisms are required in countries such as Argentina that are marketing fertility services to local and international publics. Specifically, regular oversight of all fertility clinics is essential to ensure that consumer information is accurate and that marketed services are safe and effective. It is in the best interests of consumers, health professionals and policy makers that the reproductive tourism industry adopts safe and responsible medical practices. (shrink)

Bioethicists have recently expressed concern over a lack of quality control within the field. This apprehension focuses on bioethics expanding in ways that obscure its distinctive ethical remit and the specialist reasoning skills it requires. This thesis about the quality and conduct of bioethics may have particular relevance for clinical ethics. As one of the youngest offshoots of bioethics, the field focuses on the ethical issues that arise specifically in a clinical context. However, non-ethics specialists are increasingly (...) involved in this field. This means that clinical ethics could be especially vulnerable to the quality control concerns articulated within bioethics. The growing public profile of clinical ethics means that concerns over quality in this area warrant specific attention by those concerned with declining standards in bioethics and those working in clinical ethics. (shrink)

In the last several months, several major disciplines have started their initial reckoning with what ChatGPT and other Large Language Models (LLMs) mean for them – law, medicine, business among other professions. With a heavy dose of humility, given how fast the technology is moving and how uncertain its social implications are, this article attempts to give some early tentative thoughts on what ChatGPT might mean for bioethics. I will first argue that many bioethics issues raised by (...) ChatGPT are similar to those raised by current medical AI – built into devices, decision support tools, data analytics, etc. These include issues of data ownership, consent for data use, data representativeness and bias, and privacy. I describe how these familiar issues appear somewhat differently in the ChatGPT context, but much of the existing bioethical thinking on these issues provides a strong starting point. There are, however, a few “new-ish” issues I highlight – by new-ish I mean issues that while perhaps not truly new seem much more important for it than other forms of medical AI. These include issues about informed consent and the right to know we are dealing with an AI, the problem of medical deepfakes, the risk of oligopoly and inequitable access related to foundational models, environmental effects, and on the positive side opportunities for the democratization of knowledge and empowering patients. I also discuss how races towards dominance (between large companies and between the U.S. and geopolitical rivals like China) risk sidelining ethics. (shrink)

This paper discusses the ethical implications of racism and some of the various costs associated with racism occurring at the institutional level. We argue that, in many ways, the laws, social structures, and institutions in Western society have operated to perpetuate the continuation of historical legacies of racial inequities with or without the intention of individuals and groups in society. By merely maintaining existing structures, laws, and social norms, society can impose social, economic, and health costs on racial minorities (...) that impinge on their well-being and human dignity. Based on a review of multidisciplinary research on racism, particularly focusing on healthcare, we demonstrate how institutional racism leads to social and economic inequalities in society. By positing institutional racism as the inherent cause of avoidable disparities in healthcare, this paper draws attention to the ethical significance of racism, which remains a relatively neglected issue in bioethics research. (shrink)

The question of whether nursing ethics is a distinct entity within bioethics is an important and thought-provoking one. Though fundamental bioethical principles are appreciated and applied within the practice of nursing ethics, there exist distinct considerations which make nursing ethics a unique subfield of bioethics. In this article, we focus on the importance of relationships as a distinguishing feature of the foundation of nursing ethics, evidenced in its education, practice, and science. Next, we consider two objections to our (...) claim of distinctiveness: first, that nursing ethics is merely an application of bioethical principles; second, that many bioethical subfields emphasize relationships. We respond by highlighting that throughout nursing education and generally in every career path that follows, the creation and nurturing of relationships is emphasized. Compassion and respect for the dignity of every patient is the framework upon which these therapeutic relationships are built. Much of the focus of nursing science rests on creating meaningful interpersonal experiences and human connection. After responding to each objection, we turn to the implications of this distinctiveness on clinical ethics practice, arguing that the strengths of our approach outweigh the limitations. The deep emphasis on creating meaningful interpersonal experiences and human connection supports a greater integration of relationships and social contexts into the evaluation of whether an action is ethically permissible, which is an important benefit in addressing the challenging human situations that patients face. Moreover, this perspective allows nurse ethicists to account for diverse and complex social structures and their influence in making ethical determinations. These strengths outweigh the limitations of potential inconsistencies between nurse and non-nurse clinical ethicists on the same service, a result we attribute to nursing ethics—and, in turn, the practice of the nurse ethicist—being framed by relationships to a larger extent than other bioethical subfields. (shrink)

The failure to maintain a canonical Christian understanding of the family as a microcosm of the church oriented toward deification instead of a microcosm of society aimed at social ends has opened Christians up to an uncritical adoption of non-Christian approaches in medical decision making. This article begins by identifying the Christian family crisis not as a liberal versus conservative debate centered on the form and function of the family, but more fundamentally as an ecclesial versus sociological understanding of the (...) Christian family. The article presents a historical sketch of the circumstances that have led to this contemporary crisis in the Western Christian family, followed by an analysis that provides a canonical account of the Christian family as exemplified in the thought of Gregory the Theologian. This article concludes by looking at the specific issue of labor and delivery in the United States, and the implications for a canonical Christian understanding of labor and delivery in light of contemporary medical practices. (shrink)

This book deals with the topic that has been understudied of what Bioethics of Displacement is and what are their implications, subverting the anthropocentric moral view for the resulting loving, knowing and experiencing from the displaced ones, those who have lost their center and offering a case study from the Salvadorian humanitarian crises that will shed a new light on how political decision-making works.

BackgroundThe COVID-19 pandemic has presented extraordinary challenges to worldwide healthcare systems, however, prevalence remains low in some countries. While the challenges of conducting research in high-prevalence countries are well published, there is a paucity from low COVID-19 countries.MethodsA PRISMA guided systematic review was conducted using the databases Ovid-Medline, Embase, Scopus and Web of Science to identify relevant articles discussing ethical issues relating to research in low prevalence COVID-19 countries.ResultsThe search yielded 133 original articles of which only 2 fit the inclusion (...) criteria and aim, with neither specific to low prevalence. Most of the available literature focused on clinical management and resource allocation related to high prevalence countries. These results will be discussed under the ethical dimensions of equity, individual liberty, privacy and confidentiality, proportionality, public protection, provision of care, reciprocity, stewardship and trust..ConclusionsA systematic review failed to identify articles relating to COVID-19 research ethics, specific to low prevalence countries. It shows that there is a significant gap in the literature that warrants further investigation. Common ethical principles were used to present a distinct set of challenges experienced by a country with a low prevalence of COVID-19. This unique perspective of some of the common ethical problems surrounding research, may help guide further discussion and guide research in similar countries. (shrink)

This second part of a two-part series exploring implications of the natural differences between the sexes for the cultural evolution of marriage considers how the institution of marriage might evolve, if Kant’s reasons for defending monogamy are extended and applied to a future culture. After summarizing the philosophical framework for making cross-cultural ethical assessments that was introduced in Part I and then explaining Kant’s portrayal of marriage as an antidote to the objectifying tendencies of sex, I summarize Kant’s reasons (...) for rejecting polygamy and for viewing monogamy as the only ethically acceptable form of marriage. Finally, I argue that if we apply Kantian principles to the real situation of marriage in many modern cultures, and if we wish to maintain a legitimate place for marriage in the future evolution of human culture, then the future evolution of marriage laws must recognize polyfidelity (i.e., plural marriages for both men and women) as being just as legitimate as monogamy. (shrink)

Despite flourishing as a multidisciplinary subject, the predominant view in bioethics today is based on Anglo-American thought. This has serious implications for a global bioethics that needs to be contextualized to local cultures and circumstances in order to be relevant. Being the largest continent on the earth, Asia is home to a variety of cultures, religions and countries of different economic statuses. While the practice of medicine in the East and West may be similar, its ethical practices (...) do differ. Thus, the Western understanding of autonomy may not be wholly applicable in the Asian setting, especially in the setting of breaking bad news, giving consent, determining best interests and deciding on end-of-life care. This article explores these topics in depth, attempting to find shared integrating factors, but at the same time arguing for a modified ethical application of autonomy, based on Asian beliefs. (shrink)

Empirical moral psychology is sometimes dismissed as normatively insignificant because it plays no decisive role in settling ethical disputes. But that conclusion, even if it is valid for normative ethics, does not extend to bioethics. First, in contrast to normative ethics, bioethics can legitimately proceed from a presupposed moral framework. Within that framework, moral psychology can be shown to play four significant roles: it can improve bioethicists’ understanding of the decision situation, the origin and legitimacy of their moral (...) concepts, efficient options for implementing decisions, and how to change and improve some parts of their moral framework. Second, metaethical considerations suggest that moral psychology may lead to the radical revision of entire moral frameworks and thus prompt the radical revision of entire moral frameworks in bioethics. However, I show that bioethics must either relinquish these radical implications of moral psychology and accept that there are limits to progress in bioethics based on moral psychology or establish an epistemic framework that guides radical revision. (shrink)

At its core, public health introduces tensions between individuals' autonomy and the need to account for the perspectives and needs of communities and populations. It further raises social justice issues, including fair allocation of limited resources. This article examines and elaborates on these tensions and their resolutions using specific public health examples. Experiences in the 1980s and 1990s with HIV/AIDS provide a particularly rich collection of issues that brought ethical issues in public health to the public's attention, and in so (...) doing challenged previously held assumptions about the appropriate consideration of individual rights in the context of population health objectives. Lastly, the article examines some of the ethical challenges arising in public health applications of recent science and technology advances, specifically the emerging area of public health genomics and the large scale collection and analysis of health information. (shrink)

My interest is in the application of Rawls’ principles of distributive justice to the allocation of health care. In developing an interpretation of those principles I encountered the problem I present below. Although this issue is problematic for Rawlsian theories, it also has implications for any distributive theory that measures the impact of health care distribution via the mechanism of incremental movements in health or its absence.

Vulnerability and politics are among the relevant and key topics of discussion in the Ethiopian healthcare context. Attempts by the formal bioethics structure in Ethiopia to deliberate on ethical issues relating to vulnerability and politics in healthcare have been limited, even though the informal analysis of bioethical issues has been present in traditional Ethiopian communities. This is reflected in religion, social values, and local moral underpinnings. Thus, the aim of this paper is to discuss the bioethical implications of (...) vulnerability and politics for healthcare in Ethiopia and to suggest possible ways forward. First, we will briefly introduce what has been done to develop bioethics as a field in Ethiopia and what gaps remain concerning its implementation in healthcare practice. This will give a context for our second and main task – analyzing the healthcare challenges in relation to vulnerability and politics and discussing their bioethical implications. In doing so, and since these two concepts are intrinsically broad, we demarcate their scope by focusing on specific issues such as poverty, gender, health governance, and armed conflicts. Lastly, we provide suggestions for the ways forward. (shrink)

At its core, nonideal theory is an attempt not only to address issues of justice, but it also provides us a lens through which we can articulate our limitations as knowers and reasoners, the ways in which we are relational in our autonomy needs, and the ways in which we are deeply dependent upon institutions and social supports for our agency and identities. Bringing this lens into bioethics means shifting our orientation in our scholarship and our practice. This shift (...) will have implications in how bioethical evaluations are taken up and played out in policies, institutional structures that inform the clinical encounter, and avenues for protection and redress for marginalized and vulnerable populations. It will also allow theorists and researchers to interrogate the status quo, revealing how many standard policies and practices are embedded in social and institutional arrangements that privilege the few or are built on exclusionary norms. The path forward, and the aim of this volume, is to extend the scholarship of nonideal approaches to bioethics. The volume is divided into two main parts. The first is focused on philosophically unpacking nonideal theory as an approach in bioethics. The second offers applications of nonideal theory in environmental ethics, healthcare ethics, public heath ethics, and genetic ethics. Our collective aim is to expand what has been considered nonideal bioethics. The history of nonideal theory has as its point of reference a turn away from Rawlsian justice, but the future of nonideal theory is ripe with possibilities. (shrink)

People who discuss medical ethics or bioethics come to very different conclusions about the levels of agreement in the field and the implications of consensus among health care professionals. In this paper I argue that these disagreements turn on a confusion of two distinct senses of medical ethics. I differentiate (1) medical ethics as a subject in applied ethics from (2) medical ethics as the professional moral commitments of health care professions. I then use the distinction to explain (...) its significant implications for medical ethics education. Drawing on the recent work of John Rawls, I also show the centrality of philosophy in medical ethics by illustrating how contemporary philosophy can be used to construct an ethical framework for the medical professions. (shrink)

Contemporary critical approaches to bioethics increasingly present themselves as “relational,” though the meaning of relationality and its implications for bioethics seem to be many and varying. I argue that this confusion is due to a multiplicity of relational approaches originating from distinct theoretical lineages. In this article, I identify four key differences among commonly referenced relational approaches: the scope and nature of relationships considered, the extent of the determining influence on individual selfhood, and the integrity of individual (...) selfhood. Importantly, these four differences carry consequences for the usage of relational approaches within academic and clinical bioethics. I show that these differences attach to multiple objects of critique within mainstream bioethics and imply distinct metaethical commitments. Although I issue a cautionary note about combining relational approaches from distinct lineages, I close by suggesting that many such approaches may have their use, drawing on Susan Sherwin's sense of bioethical theories as lenses. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:THE MEANING OF VIRTUE IN THE CHRISTIAN MORAL LIFE: ITS SIGNIFICANCE FOR HUMAN LIFE ISSUES RoMANUS CESSARIO, O.P. Dominican House of Stuaies Washington, D.a. RCENTLY, AN International Congress of moral theology convened in Rome brought together some three hundred academicians. They participated in an open forum devoted to current questions in moral theology and bioethics. Held at the Lateran University, the Congress, "Humanae vita,e: 20 Anni Dopo," was (...) divided into two parts. Although a majority of the presentations concerned the relevance of the Church's teaching on artificial contraception, the membership did devote the second part of the Congress to a sustained discussion of some new issues raised by Donum vitae (1987), the recent instruction of the Congregation for the Doctrine of the Faith on " Respect for Human Life in its Origin and on the Dignity of Procreation." To be sure, both documents emphasize the Church's constant teaching concerning the providence of God in human life and the dignity of the human person. Nevertheless, procedures such as GIFT (gamete intra.-fallopian transfer), LTOT (low tubal ovum transfer ), TOT (tubal ovum transfer) provide the moral theologian with new challenges to interpret the Church's position which insists on identifying the procrea.tive and unitive aspects of Christian marriage. The following article discusses the papal documents from the perspective of a realist moral theology. First of all, I would like to recall a principle which Paul VI, however obliquely, enunciated in the course of Humanae Vitae, for I consider the principle an axiomatic one in the present discussion. At the beginning of section 8 entitled "Pastoral 178 174 ROMANUS CESSARIO, O.P. Directives," we find a statement of theological purpose which should guide all Catholic moral practice. Hence, I would like to quote this text as a way of introducing the meaning of virtue in the Christian moral life. The Church, in fact, cannot have a different conduct toward men [and women] than that of the Redeemer: she knows their weaknesses, has compassion on the crowd, receives sinners; but she cannot renounce the teaching of the law which is, in reality, that law proper to a human Zife restored to its original truth and conducted by the Spirit of God.1 I am especially struck by the phrase " that law proper to a human life restored to its original truth," for I believe it actually describes the kind of life which develops in those who practice the virtues. Yet, before speaking about the implications of a virtue-centered morality for the difficult issues of bioethics, I would like to remark briefly on the way certain contemporary theologians misinterpret what Paul VI calls the " law proper to a human life restored to its original truth." In order to do so I have divided this paper into three parts. Thus, the first section of the paper examines several themes in contemporary moral methodology. The second section provides a general statement about the relationship between moral theology and the sa,cra domrina. Finally, the third section briefly considers why the life of virtue remains the only legitimate means for fulfilling the " law proper to a human life restored to its original truth." First, then, to contemporary themes. I Proportionate Reason and the Ethics of Personal Responsibility In an earlier draft of this paper, I titled this section "St. Ignatius, St. Alphonsus, and St. Elsewhere." I had considered actually outlining the moral methodologies of two Roman theo1 Paul VI, Humanae vitae, n. 20. VIRTUE THEORY AND HUMAN LIFE ISSUES 175 logians, the German Jesuit Josef Fuchs 2 and the Redemptorist Bernard Haring.3 These authors have influenced most leading revisionist moral theologians in America, especially Charles Curran.4 One could argue, therefore, that they figure among the principals in the current debate over bioethical norms. Upon reflection, however, it seemed rpreferable simply to signal two or three basic themes which appear in most revisionist moral theology, especially as it has been developed in the United States. In brief, these themes focus principally on (1) the freedom of the individual, and (2) the consequences or end results of an action. Revisionist moral theologians receive their name from the fact that their announced purpose... (shrink)

Participants in the long-running bioethical debate over human germline genetic modification (HGGM) tend to imagine future people abstractly and on the basis of conventionalized characteristics familiar from science fiction, such as intelligence, disease resistance and height. In order to distinguish these from scientifically meaningful terms like “phenotype” and “trait,” this article proposes the term “persemes” to describe the units of difference for hypothetical people. In the HGGM debate, persemes are frequently conceptualized as similar, modular entities, like building blocks to be (...) assembled into genetically modified people. They are discussed as though they each would be chosen individually without affecting other persemes and as though they existed as components within future people rather than being imposed through social context. This modular conceptual framework appears to influence bioethical approaches to HGGM by reinforcing the idea of human capacities as natural primary goods subject to distributive justice and supporting the use of objective list theories of well-being. As a result, assumptions of modularity may limit the ability of stakeholders with other perspectives to present them in the HGGM debate. This article examines the historical trends behind the modular framework for genetically modified people, its likely psychological basis, and its philosophical ramifications. (shrink)

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a “living (...) ethics”, described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process. (shrink)

This paper aims to bring a novel approach to the discussion of unfair advantages in sport by looking for a local criterion of fairness instead of a universal criterion. A local criterion of fairness would not solve the general dispute over what counts as an unfair advantage, but it would be beneficial in evaluating specific cases and could guide further discussion about them. We seek a local criterion of fairness by comparing the specific property advantages of Caster Semenya and Eero (...) Mäntyranta. South African Semenya is a middle‐distance runner whose right to compete in the female category has been challenged owing to her assumed difference of sex development and related high level of testosterone. Finnish Mäntyranta was a cross‐country skier with an exceptionally high haematocrit level. We examine whether there is a relevant difference between their advantages that would justify treating the athletes differently. We propose that the criterion ‘not attainable by other athletes in the same category’ could stand as a local criterion of fairness under certain conditions. However, its proper application requires further discussion on how to justify categories in sport. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 10.2 (2000) 175-188 [Access article in PDF] Scope Note 38 Bioethics Resources on the Web * Once described as an "enormous used book store with volumes stacked on shelves and tables and overflowing onto the floor" (Pool, Robert. 1994. Turning an Info-Glut into a Library. Science 266 (7 October): 20-22, p. 20), Internet resources now receive numerous levels of organization, from basic directory (...) listings to elaborate "links" (cross-references to other Internet documents) that flash and glow in the dark. In many ways, the Internet functions as a direct extension of the traditional library. Following linked references across various sites is an electronic version of browsing library stacks, and the serendipitous discoveries made while "surfing the Net" recall the wonders of physically going "book-to-book." Although many of the Internet's best aspects augment library strengths by eliminating physical distance from sources, Net resources pose unique problems for researchers. It is not always clear who is responsible for the content of Web documents, when the document was produced, or how often (if ever) it is updated. Internet resource tools, then, must enable researchers to identify appropriate resources and to evaluate what they find when they get there. Web Research as Taking "Snapshots" Given the Internet's visual nature and fluid content, the process of conducting research on the Web has been likened to taking an informal picture of information on a specific date at a particular time. This metaphor also conveys the "zoom-in" aspect of searching through Web pages by going from general to specific categories. In the first section of this Scope Note, National Reference Center for Bioethics Literature (NRCBL) staff present a snapshot of bioethics resources taken during the spring months of 2000. Entries are divided into the categories of directories, electronic journals, full-text documents, news/current awareness, and teaching resources. In the two subsequent sections, this series of categories is repeated for entries on a specific topic within bioethics-genetics-and again for general search and evaluation tools. Where a Web site may contain pages applicable [End Page 175] to more than one category, multiple entries are made for that site with appropriate information for each category.Much as telecommunication advances have strengthened the relationship of patients and providers as partners, the dynamic nature of the Internet acknowledges that the researcher functions as a librarian whenever accessing the Web. It is our hope that BIOETHICSLINE and the other NRCBL databases not only will enable researchers to search the Web more efficiently, but also will help them to evaluate what they find when they get there. Bioethicsline on the Web: An International Plan in Progress Once only available through libraries, the U.S. National Library of Medicine (NLM), the funding agency for the ongoing development of the BIOETHICS LINE® database from the Kennedy Institute, has provided free Web access to that database of 63,000 citations since September 1998 through Internet Grateful Med. Plans are now underway to eliminate such specialty databases and incorporate all citations into PubMed (for journal articles) or LOCATORplus (for book-like materials and chapters in books). Both of these databases are likewise available at no cost on the Web. In the transition to PubMed and LOCATORplus some features of BIOETHICSLINE that presently are available may be lost. Researchers are encouraged to contact the National Reference Center for Bioethics Literature with search requests or for search strategy assistance with either the current or the future system ([email protected]).The inclusion of bioethics citations in PubMed and LOCATORplus will have several advantages. First, unique keywords from the Bioethics Thesaurus will be considered for inclusion in Medical Subject Headings (MeSH), the indexing vocabulary for PubMed and LOCATORplus, thereby enhancing retrieval of relevant clinical literature by offering more precise terminology covering ethical issues. Second, it will be easier to identify foreign-language materials, which are not currently included in the scope of BIOETHICSLINE. Third, the updating schedule will become more frequent. On the other hand, there may be some loss of searching precision because certain specialized features... (shrink)

There is a widely held view that the rules forbidding the use of performance enhancing drugs (PEDs) are justified on grounds that utilizing these drugs constitutes cheating . In this chapter we engage with this assumption. Relying on an interpretative approach borrowed from Ronald Dworkin, we offer a novel analysis of cheating, one that makes it out to be a matter of inhibiting the attainment of certain sorts of achievements. These achievements are the important goods at the centre of sport, (...) the telos of sport. We then argue that a given enhancement should be regarded as cheating only when it inhibits or prevents competitors from realizing these important goods. (shrink)

When research poses risks to non‐participant bystanders, it is not always practicable to obtain their consent. One approach to assessing how much research risk may be imposed on nonconsenting bystanders is to examine analogous circumstances, including risk thresholds deemed acceptable for nonconsenting research participants and for nonconsensual risks imposed outside the research setting. For nonconsenting participants, US research regulations typically limit risks to those deemed to be “minimal.” Outside the research context, US tort law tolerates a more flexible “reasonable” risk (...) threshold. This article advances a preliminary case that nonconsenting participants and nonconsenting bystanders exposed to similar research risks may be entitled to the same level of protection, but that risks generated by research may not be special in kind. Thus, limiting research risks to those that are “reasonable,” rather than demanding that they be held to the “minimal” standard, may be the best approach for both nonconsenting participants and nonconsenting bystanders. Further work is needed to establish whether the descriptive standards used to support the analogies relied on here are normatively justifiable, as well as the extent to which the minimal risk standard and the reasonable risk standard would lead to meaningfully different outcomes in practice. (shrink)

Although recent trends in politics and media make it appear that conspiracy theories are on the rise, in fact they have always been present, probably because they are sustained by natural dispositions of the human brain. This is also the case with medical conspiracy theories. This article reviews some of the most notorious health-related conspiracy theories. It then approaches the reasons why people believe these theories, using concepts from cognitive science. On the basis of that knowledge, the article makes normative (...) proposals for public health officials and health workers as a whole, to deal with conspiracy theories, in order to preserve some of the fundamental principles of medical ethics. (shrink)

This paper will take as its starting point the premise that developing translational bioethics is a worthwhile endeavour. I will develop an account of translational bioethics and discuss what implications this would have for the wider discipline of bioethics and argue that this would be a useful development for bioethics. The paper will conduct a form of ‘translational meta‐bioethics analysis’, in the words of Bærøe. I will argue that if we are serious about instituting (...) translational bioethics, then it will need to look and be organised in a very different way from current bioethics research, this will be a radically different form of bioethics from what we currently have. In this paper I will sketch what translational bioethics might look like. My proposal here is not that translational bioethics should supplant existing ways of doing bioethics, but rather that it should be an addition to it, another subdiscipline of bioethics. (shrink)

People who are unable to make decisions about participating in research rely on proxies to make a decision based on their wishes and preferences. However, patients rarely discuss their preferences about research and proxies find it challenging to determine what their wishes would be. While the process of informed consent has traditionally been the focus of research to improve consent decisions, the more conceptually complex area of what constitutes ‘good’ proxy decision-making for research has remained unexplored. Interventions are needed to (...) improve and support proxy decision-making for research but are hampered by a lack of understanding about what constitutes decision quality in this context. A global increase in conditions associated with cognitive impairment such as dementia has led to an urgent need for more research into these conditions. The COVID-19 pandemic and subsequent necessity to conduct research with large numbers of critically ill patients has made this need even more pressing. Much of the empirical research centres on the desire to improve decision accuracy, despite growing evidence that authenticity is more reflective of the aim of proxy decisions and concerns about the methodological flaws in authenticity-focused studies. Such studies also fail to take account of the impact of decision-making on proxies, or the considerable body of research on improving the quality of healthcare decisions. This paper reports a concept synthesis of the literature that was conducted to develop the first conceptualisation of ‘good’ proxy decisions about research participation. Elements of decision quality were identified across three stages of decision-making: proxy preparedness for decision-making which includes knowledge and understanding, and values clarification and preference elicitation; the role of uncertainty, decisional conflict, satisfaction and regret in the decision-making process; and preference linked outcomes and their effect. This conceptualisation provides an essential first step towards the future development of interventions to enhance the quality of proxy decision-making and ensure proxy decisions represent patients’ values and preferences. (shrink)

La Ética es la parte de la filosofía práctica que se ocupa del hecho moral y de los problemas filosóficos que nacen de la conducta humana, la bioética resulta la rama de la ética que se dedica a proveer los principios para la correcta conducta humana; respecto a la vida. En el proceso de atención a los pacientes con enfermedades reumáticas se emplean variados procedimientos. Las nuevas tecnologías han mejorado notablemente su tratamiento integral; estos adelantos científicos deben ser empleados con (...) la intención fundamental de no producir daño y previo consentimiento informado; por lo que resulta necesario argumentar acerca de las implicaciones bioéticas que resultan del empleo de los avances científico-tecnológicos en el tratamiento a los pacientes con enfermedades reumáticas. Ethics is the part of Practical Philosophy that deals with moral facts and philosophical problems that have their roots in human behavior. Bioethics is the branch of Ethics devoted to providing the principles for correct human behavior, with respect to life. Various procedures are used when treating patients with rheumatic diseases. New technologies have considerably improved their integral treatment; these scientific advances must be used with the main purpose of causing no harm and with prior informed consent. Therefore, it is necessary to argue on the bioethical implications that turn out from the use of scientific-technological advances in the treatment of patients with rheumatic diseases. (shrink)