Cultural historians and historians of medicine are a rarity in bioethics. Even those who write histories of bioethics are philosophers, sociologists, or theologians. Where have all the historians gone? If bioethics is to contribute to the urgent work of addressing social justice, structural racism, and health inequity, we bioethicists need to embrace history as a fully constituent part of our field. Historians can help us apprehend the ideas that shaped bioethics, and health policy more broadly, (...) and discover the dissenting arguments that might inspire us now. Given our annus horribilis, history has become an instrumental necessity. It is only through the study of history that we can understand the past so as to reimagine how bioethics can influence health policy and work toward health equity. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical Bioethics at NIH:History and A New VisionJohn C. Fletcher (bio)On July 3, 1995, Dr. John I. Gallin, Director of the Magnuson Clinical Center of the National Institutes of Health (NIH), convened a one-day "Conference on the Future of Clinical Bioethics at the National Institutes of Health Intramural Program." Conferees included NIH officials and a panel of consultants from bioethics programs around the nation.1 The (...) subject was the future of NIH's intramural bioethics program and specifically a vision of a new multi-component program, presented by Dr. Gallin, the first speaker. Dr. Harold Varmus, Director of NIH, was there to assure his support for Dr. Gallin's vision. This author, honored to be second speaker, was invited to sketch a brief history of bioethics at NIH. The present article reviews some of this history and then reports on Dr. Gallin's proposal, points of consensus among speakers and conferees, and the search for a Chief of the Clinical Bioethics Program.History of Bioethics at NIHIt is often said that NIH is a well-kept secret as the nation's leading biomedical research facility. Also, few people know that NIH has a long history in bioethics. Some key events in that history are shown in Figure 1, beginning with two that occurred prior to the birth of bioethics. NIH made an early policy response to protect human subjects of research and to find acceptable limits for scientific freedom. The Clinical Center (CC), a 550-bed research hospital, opened in 1953. A subcommittee of the Medical Board, the Clinical Research Committee (CRC), was formed for prior group review of all studies with normal volunteers. The traditional practice was for researchers themselves to decide when studies would begin, which subjects to recruit, and whether informed consent would be sought. The CRC intervention bit into this tradition. In addition, patient studies that posed significant risks or departed widely from medical practice were reviewed by referral from the Clinical Directors of the various Institutes. Was this CRC an early institutional review [End Page 355] board (IRB)? As a guest researcher, I was permitted to observe the CRCs meetings between 1966 and 1969. It functioned much like an IRB but had no community or non-scientist members. Other IRB-like review groups undoubtedly existed prior to the CRC. Robert Levine (personal communication, September 7, 1995) recalls that Beth Israel Hospital in Boston had one in 1938. Historical research is clearly needed on the earliest forms of research review.Table 1. Bioethics at NIHEventYearClinical Research Committee1953Surgeon-General's PPO #1291966NIGMS funds Hastings Genetics Group1973OPRR's Mission1974NLM's grant to KennedyInstitute for Bibliography of Bioethics1974Recombinant DNA Advisory Committee1974STEP Series Bioethics Speakers1975Pre-IRBs at the CC1975-76Assistant for Bioethics to Director, CC1977RAC-Human Gene Therapy Subcommittee1983Lipsett Proposal (ICD)1983Liaison Group, CC1983Bioethics Program, CC1985Durable Power of Attorney for Researchwith Incapacitated Subjects1985-86NLM funds National Reference Centerfor Bioethics Literature1985National Institute for Nursing Research1986Bioethics Post-Doctoral Fellows Program1989ELSI Program1989Bioethicists on CC-IRBs1989CC-Ethics Committee1990Office of Human Subjects Research1992 [End Page 356]Between 1963 and 1967, the media exposed instances of ethically troubling research, and Beecher (1966) and Pappworth (1967) published sharp criticisms of the weak state of research ethics. In 1966, Surgeon-General William Stewart and NIH Director James Shannon issued a policy requiring local group review of all research involving human subjects before making an application for NIH peer review (Surgeon General 1966). The policy was the first in any nation to mandate ethics committees for clinical research. However, it did not apply to the NIH intramural program until Congress passed the National Research Act in 1974 (Public Law 93-348; 202, 88 Stat. 342, 1974). This lag permitted NIH intramural investigators the luxury of feeling above the norms imposed on ordinary mortals and guaranteed more resistance to the inevitable change to come. Resistance to change marked the intramural program from the mid-1960s to the mid-1970s... (shrink)

Standard bioethics textbooks present the field to students and non-experts as a form of "applied ethics." This ahistoric and rationalistic presentation is similar to that used in philosophy of science textbooks until three decades ago. Thomas Kuhn famously critiqued this self-conception of the philosophy of science, persuading the field that it would become deeper, richer, and more philosophical, if it integrated the history of science, especially the history of scientific change, into its self-conception. This essay urges a (...) similar reconceptualization for bioethics, arguing that the analysis of moral change ought to be integral to bioethics (and to ethics generally). It proceeds by suggesting the sterility of the ahistoric, rationalist applied ethics model of bioethics embraced by standard bioethics textbooks. It also suggests the fecundity of alternative conceptions of the bioethics that focus on the history of successful and failed attempts to negotiate moral change, and the history of multifaceted relations between moral philosophy and practical ethics. (shrink)

Objective: To present a narrative review of the history of bioethics in Latin America and of scientific output in this interdisciplinary field. Methods: This was a mixed-methods study. Results: A total of 1458 records were retrieved, of which 1167 met the inclusion criteria. According to the Web of Science classification, the predominant topics of study were medical ethics, social sciences and medicine, and environmental and public health topics. Four themes of bioethics output in the Latin American literature (...) have emerged: issues involving the beginning and end of life, ethics in human research, patient–provider relationships, and ethics training for health professionals. Conclusion: Although bioethics is a growing interdisciplinary field in Latin America, its academic impact is still very low, and programmes are highly concentrated in large urban centres in a few countries. Challenges includes the regional and international impact of local scientific output. (shrink)

This article details the relationship between history and bioethics. I argue that historians' reluctance to engage with bioethics rests on a misreading of the field as solely reducible to applied ethics, and overlooks previous enthusiasm for historical perspectives. I claim that seeing bioethics as its practitioners see it – as an interdisciplinary meeting ground – should encourage historians to collaborate in greater numbers. I conclude by outlining how bioethics might benefit from new histories of the (...) field, and how historians can lend a fresh perspective to bioethical debates. (shrink)

A comprehensive analysis of the evolving conditions that provided for the emergence and autonomization of the field of bioethical inquiry, as well as the social, cultural and political background against which its birth can be set, should enlighten us about the problematic nature that characterises it from its very onset. Those conditions are: abuses in experimentation on human subjects, availability of new biomedical technologies, the challenging of prevalent medical paradigms and the ultimate meaning and purpose of medical care, new scientific (...) and social fields of concern dealing with ecology and environmental health, genetic engineering and biotechnologies, demographics, behavioural manipulation, reproductive medicine, etc., the upsurge of social movements raising issues of medical importance, and the need for an ethics for the technological age. The scope and meaning of bioethics is best defined by the overriding questions that open up the field of both theoretical and practical bioethical inquiry rather than by the individual responses given to such questions by the most prominent spokesmen in bioethics. (shrink)

Contemporary Bioethics: A Reader with Cases is the most cutting-edge bioethics anthology/casebook available. Incorporating introductions, readings, and cases that span the breadth of the discipline, this exceptional volume captures the spirit of bioethics as a rich, exciting, and continuously evolving field. Addressing all of the essential topics--including abortion, reproductive ethics, end-of-life care, research ethics, and the allocation of resources--it also moves beyond the "classic" approach of other books by extending into timely and provocative issues like terrorism, cosmetic (...) surgery, immigration, genetic manipulations, links between first- and third-world health, and--unique to this book--environmental sustainability and climate change. In addition, Contemporary Bioethics is the only book of its kind that includes both philosophical and religious perspectives.The text opens with a substantial introduction that presents key ethical principles, theories, and methods and shows students how to use these tools to frame and address ethical dilemmas in medicine. Covering the brief yet captivating history of the field, the introduction also considers the role of religion in the development of bioethics and examines differences between secular and religious modes of argumentation. Each of the seven topical chapters contains an in-depth introduction, a selection of concise readings representing a diverse range of moral perspectives, discussion questions, and a collection of full-length and provocative case studies that enable students to further explore the issues.Ideal for introductory courses in bioethics and biomedical ethics, Contemporary Bioethics is supplemented by a Instructor's Manual on CD and a Companion Website containing resources for both students and professors, including chapter summaries, additional cases with discussion questions, ideas for further reading, vocabulary flashcards, self-quizzes, and more. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 10.3 (2000) 265-281 [Access article in PDF] Scope Note 39 Genes, Patents, and Bioethics-Will History Repeat Itself? Susan Cartier Poland Gene patenting--the very notion sounds absurd! How can anyone claim to have invented the genes with which one is born? To make matters worse, genetic makeup precedes birth, meaning the existence of the invention predates the existence of the inventor. So, do (...) we really own our genes, or do they belong to our parents, or our governments, or a Supreme Being? Ownership is only one bioethical issue involved in gene patenting. But before looking at the issues, some essential and basic terms must be understood, namely genes and patents. Genes In his book On the Origin of Species, published in 1859, the biologist Charles Darwin proposed a theory called "natural selection," whereby living things changed over time or evolved through generations due to competition and variation. By experimenting with the garden pea in the 1860s, Gregor Mendel, a monk and accomplished horticulturalist, provided the mechanism of inheritance supporting the natural selection theory of his contemporary Darwin. That mechanism is the gene, or, as Mendel described it, a discrete "factor." The gene has also been defined as "the fundamental unit of heredity" (United States 1987, p. 157). Each individual has two copies of a gene, one from each parent, but that individual passes down to offspring only one of the two copies. Because of Mendel, the gene has become a scientific concept and the basis of a new scientific field: genetics.David C. Page (2000) of the Whitehead Institute for Biomedical Research at the Massachusetts Institute of Technology explained today's terms for genetics structures using an analogy taken from the home. In his view, the cell is a kitchen, the genome is a shelf in the kitchen, the chromosome is a cookbook on the shelf, the gene is a recipe in the cookbook, and a base-pair (either adenine with thymine or guanine with cytosine) is a single letter in the recipe. A protein, the [End Page 265] working molecule blueprinted by a gene, is a dish ready to eat, and an ingredient in the dish is an amino acid, which is a building block of the protein as specified by a string of base-pairs.Colin Tudge (1993), a British science journalist, would disagree with Page's description of the gene as a recipe. A recipe is like a blueprint: both are directions that precede the work. But a gene is not passive according to Tudge; it actively administers the cell's work, and it also responds to cellular events (Aldridge 1996).The current focus of scientific research and funding is on the gene and the completion of the sequencing of all the genes that comprise the human genome, portrayed in the press as a race between the U.S. government's Human Genome Project and the private corporation Celera Genomics. The real action, however, is at the protein level. The gene only holds the information to produce a protein; it is the three-dimensional shaped protein that does the work. In order to produce energy, eliminate waste, and perform other functions specific to a cell or tissue, proteins must bind, thus creating "biological pathways." Proteins bind (or not) and detach as a function of their shapes, which are determined by their precise chemical composition as spelled out in their genetic code. IBM will spend the next five years making one computer, Blue Gene, that will then take an entire year to come up with the chemical map for only one protein (Gillis 2000). It is estimated that there are about 40,000 proteins in the human body.Despite these overwhelming numbers, modern biology has been able to achieve significant results within the Human Genome Project's 15-year time frame, from 1990 to 2005. The genetic map was completed in 1993; the physical map was completed in 1995; and the genetic sequence is expected to be completed in 2002, with 97 to 99 percent completed as of 26 June 2000. This... (shrink)

Background This analysis is about practical living bioethics and how law, ethics and sociology understand and respect children’s consent to, or refusal of, elective heart surgery. Analysis of underlying theories and influences will contrast legalistic bioethics with living bioethics. In-depth philosophical analysis compares social science traditions of positivism, interpretivism, critical theory and functionalism and applies them to bioethics and childhood, to examine how living bioethics may be encouraged or discouraged. Illustrative examples are drawn from research (...) interviews and observations in two London paediatric cardiac units. This paper is one of a series on how the multidisciplinary cardiac team members all contribute to the complex mosaic of care when preparing and supporting families’ informed consent to surgery. Results The living bioethics of justice, care and respect for children and their consent depends on theories and practices, contexts and relationships. These can all be undermined by unseen influences: the history of adult-centric ethics; developmental psychology theories; legal and financial pressures that require consent to be defined as an adult contract; management systems and daily routines in healthcare that can intimidate families and staff; social inequalities. Mainstream theories in the clinical ethics literature markedly differ from the living bioethics in clinical practices. Conclusion We aim to contribute to raising standards of respectful paediatric bioethics and to showing the relevance of virtue and feminist ethics, childhood studies and children’s rights. (shrink)

The complexities of modern science are not adequately reflected in many bioethical discussions. This is especially problematic in highly contested cases where there is significant pressure to generate clinical applications fast, as in stem cell research. In those cases a more integrated approach to bioethics, which we call systems bioethics, can provide a useful framework to address ethical and policy issues. Much as systems biology brings together different experimental and methodological approaches in an integrative way, systems bioethics (...) integrates aspects of the history and philosophy of science, social and political theory, and normative analysis with the science in question. In this paper we outline how a careful analysis of the science of stem cell research can help to refocus the discussions related to the clinical applications of stem cells. We show how inaccurate or inadequate scientific assumptions help to create a set of unrealistic expectations and badly inform ethical deliberations and policy development. Systems bioethics offers resources for moving beyond the current impasse. (shrink)

Bioethics has a founding story in which medical paternalism, the interference with the autonomy of patients for their own clinical benefit, was an accepted ethical norm in the history of Western medical ethics and was widespread in clinical practice until bioethics changed the ethical norms and practice of medicine. In this paper I show that the founding story of bioethics misreads major texts in the history of Western medical ethics. I also show that a major (...) source for empirical claims about the widespread practice of medical paternalism has been misread. I then show that that bioethics based on its founding story deprofessionalizes medical ethics. The result leaves the sick exposed to the predatory power of medical practitioners and healthcare organizations with only their autonomy-based rights to non-interference, expressed in contracts, to protect them. The sick are stripped of the protection afforded by a professional, fiduciary relationship of physicians to their patients. Bioethics based on its founding story reverts to the older model of a contractual relationship between the sick and medical practitioners not worthy of intellectual or moral trust (because such trust cannot be generated by what I call ‘deprofessionalizing bioethics’). On closer examination, bioethics based on its founding story, ironically, eliminates paternalism as a moral category in bioethics, thus causing bioethics to collapse on itself because it denies one of the necessary conditions for medical paternalism. Bioethics based on its founding story should be abandoned. (shrink)

Background This analysis is about practical living bioethics and how law, ethics and sociology understand and respect children’s consent to, or refusal of, elective heart surgery. Analysis of underlying theories and influences will contrast legalistic bioethics with living bioethics. In-depth philosophical analysis compares social science traditions of positivism, interpretivism, critical theory and functionalism and applies them to bioethics and childhood, to examine how living bioethics may be encouraged or discouraged. Illustrative examples are drawn from research (...) interviews and observations in two London paediatric cardiac units. This paper is one of a series on how the multidisciplinary cardiac team members all contribute to the complex mosaic of care when preparing and supporting families’ informed consent to surgery. Results The living bioethics of justice, care and respect for children and their consent depends on theories and practices, contexts and relationships. These can all be undermined by unseen influences: the history of adult-centric ethics; developmental psychology theories; legal and financial pressures that require consent to be defined as an adult contract; management systems and daily routines in healthcare that can intimidate families and staff; social inequalities. Mainstream theories in the clinical ethics literature markedly differ from the living bioethics in clinical practices. Conclusion We aim to contribute to raising standards of respectful paediatric bioethics and to showing the relevance of virtue and feminist ethics, childhood studies and children’s rights. (shrink)

Two articles published in Bioethics recently have explored the ways that bioethics can contribute to the climate change debate. Cheryl Cox Macpherson argues that bioethicists can play an important role in the climate change debate by helping the public to better understand the values at stake and the trade-offs that must be made in individual and social choices, and Sean Valles claims that bioethicists can contribute to the debate by framing the issues in terms of the public health (...) impacts of climate change. While Macpherson and Valles make valid points concerning a potential role for bioethics in the climate change debate, it is important to recognize that much more than ethical analysis and reflection will be needed to significantly impact public attitudes and government policies. (shrink)

Understanding the basics of ethics is essential for a physical therapist. Diagnostic skills, technical expertise, and knowledge of the body are insufficient; being a good clinician requires a moral education as well. Bioethics in Physical Therapy: A Reader helps students develop a deeper understanding of moral principles and their philosophical underpinnings. The text encourages readers to exercise their moral imaginations and prepares them to respond to professional conflicts in an ethical manner. The reader is organized in seven units. The (...) text begins with an introduction to classical moral theories, the fundamental philosophical pillars of biomedical ethics, and a history of ethics in physical therapy. Additional units explore such topics as moral distress and the choice to be ethical, acting with integrity in the face of uncertainty, and the importance of hope in the patient encounter. Students learn about moral courage, the broad reach of justice in the medical field, and the lived experience of illness. Each unit features an opening scenario, a section on cultivating professional values, introductions to the key topic and the readings, comprehension questions, and post-reading critical thinking questions that reference the opening scenario. Written to be engaging and accessible, Bioethics in Physical Therapy: A Reader is designed to help future therapists understand the importance of ethics in practice. It is an ideal resource for all courses in the discipline. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Another Bioethics Commission?Renie Schapiro (bio)Ever Since the Ill-Fated Biomedical Ethics Advisory Committee (BEAC) ended almost before it began a few years ago, bioethicists and the members of Congress who take an interest in them have wondered whether a governmental commission is still a feasible way to address bioethics issues.The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in the 1970s, and the (...) President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in the early 1980s, have generally received high marks for their work. But since the expiration of the President's Commission in 1983, no federal body has been able to sustain the momentum.Tempers around the abortion issue couldn't be tamed enough even to elect a board chairman for the BEAC, or for the body to begin studying the issues. From its inception, abortion politics threatened to dog its work.Both the National Commission and the President's Commission studied issues touching on the abortion question. The President's Commission reported on genetic screening. The National Commission looked at fetal research. Both were able to produce respected reports that largely steered clear of the abortion acrimony.But that was then. The question facing policy makers inside the Beltway is how we can learn from the past experiences to make some new body work now. The question extends far beyond the abortion issue, of course.When certain people in Washington start asking questions, the answer usually comes by way of a study. Sometimes, as in this case, more than one study.In the March 1992 issue, this Journal reported on an Institute of Medicine study on ethics commissions. That study is still underway. It is scheduled to be completed in January 1994.More recently, the Office of Technology Assessment (OTA), an arm of Congress, also took on the issue. The OTA project is intended to be a quicker, more confined study. It began last fall and a final report is expected later this month.The primary force behind the OTA study is Senator Mark Hatfield. In a September 8, 1992 letter, co-signed by Senators Edward Kennedy and Dennis DeConcini, he asked OTA to prepare a background report to assist Congress in [End Page 77] "determining what is the best approach to explaining policy problems with biomedical and ethical dimensions."The letter noted: "As the 21st Century approaches, Congress will face policy dilemmas for which an informed decision can only be made through understanding not just the legal or economic dimensions of the questions, but the ethical considerations as well."Hatfield's interest in bioethics issues over the past few years has centered largely on biotechnology, and particularly patent rights. He had planned to introduce legislation to put a moratorium on patenting of genetically altered organisms, which according to Hatfield staffer Douglas Pahl caused a "firestorm" in the biotechnology community.As a result, Kennedy and DeConcini said they would hold hearings on the issue if Hatfield would withdraw the amendment. The three agreed to request a short-term OTA report on possible governmental structures for dealing with bioethics issues and a longer report looking at patenting issues.In their letter, the three senators asked OTA to prepare a history of bioethics in public policy. Referring specifically to the past commissions, they asked, "What lessons can we learn from each of these—or similar—entities? What worked, or did not work, and why?" The request also asked OTA to examine international institutions.In response to the request, OTA held a workshop entitled "Biomedical Ethics in U.S. Public Policy" on December 4, 1992. It brought together 15 people who had participated in commissions—from local to international—as well as observers of these bodies and health professionals who used their products.1According to project director Robyn Nishimi, the workshop was meant to be a free-wheeling discussion. Although there was no total consensus, the focus of the discussion tended to be on how to make a commission function effectively, rather than on whether there should be one. That workshop will be part of a report of about 40-60 pages OTA hopes to... (shrink)

The U.S. healthcare system has a long history of displaying racist contempt toward Black people. From medical schools’ use of enslaved bodies as cadavers to the widespread hospital practice of reporting suspected drug users who seek medical help to the police, the institutional practices and policies that have shaped U.S. healthcare systems as we know them cannot be minimized as coincidence. Rather, the very foundations of medical discovery, diagnosis, and treatment are built on racist contempt for Black people and (...) have become self-perpetuating. Yet, I argue that bioethics and bioethicists have a role in combatting racism. However, in order to do so, bioethicists have to understand the workings of contemptuous racism and how that particular form of racism manifests in U.S. healthcare institutions. Insofar as justice is part of the core mission of bioethics, then antiracism must also be part of the mission of bioethics. (shrink)

Engelhardt invites readers to understand what it means to live in a world after God, where questions of sin and virtue have been replaced with life-and-death-style choices. After God provides a dark prophetic vision. But there is still hope. As Engelhardt argues, In this culture, children now grow up apart from and defended against a recognition of the God Who lives. They are nurtured in a social fabric that is structured so as to avoid a recognition of, much less an (...) encounter with, God. Nevertheless... a traditional Christianity has endured, even though its morality and bioethics have become ever more strongly counter-cultural. The source of this traditional Christian otherness over against the surrounding post-theistic culture lies in the origins of Christianity itself, in the Christianity of the Apostles and the Fathers, namely, in Orthodox Christianity. Against the tenor of the times, disregarding the animus to set traditional Christianity aside, and despite heretics prominent within its fold, Orthodox Christianity remains a light in a world after God. --! From back cover. (shrink)

February is Black History Month and so healthcare practitioners will soon rummage history books for information about famous African Americans, like Onesimus, the African slave who...

_Engaging Bioethics: An Introduction with Case Studies_ draws students into this rapidly changing field, helping them to actively untangle the many issues at the intersection of medicine and moral concern. Presuming readers start with no background in philosophy, it offers balanced, philosophically based, and rigorous inquiry for undergraduates throughout the humanities and social sciences as well as for health care professionals-in-training, including students in medical school, pre-medicine, nursing, public health, and those studying to assist physicians in various capacities. Written (...) by an author team with more than three decades of combined experience teaching bioethics, this book offers Flexibility to the instructor, with chapters that can be read independently and in an order that fits the course structure Up-to-date coverage of current controversies on topics such as vaccination, access to health care, new reproductive technologies, genetics, biomedical research on human and animal subjects, medically assisted death, abortion, medical confidentiality, and disclosure Attention to issues of gender, race, cultural diversity, and justice in health care Integration with case studies and primary sources Pedagogical features to help instructors and students, including Chapter learning objectives Text boxes and figures to explain important terms, concepts, and cases End-of-chapter summaries, key words, and annotated further readings Discussion cases and questions Appendices on moral reasoning and the history of ethical issues at the end and beginning of life An index of cases discussed in the book and extensive glossary/index A companion website with a virtual anthology linking to key primary sources, a test bank, topics for papers, and PowerPoints for lectures and class discussion. (shrink)

Critiquing many areas of medical practice and research whilst making constructive suggestions about medical education, this book extends the scope of medical ethics beyond sole concern with regulation. Illustrating some humanistic ways of understanding patients, this volume explores the connections between medical ethics, healthcare and subjects, such as philosophy, literature, creative writing and medical history and how they can affect the attitudes of doctors towards patients and the perceptions of medicine, health and disease which have become part of contemporary (...) culture. The authors examine a range of ideas in medical practice and research, including: the idea that patient status or the doctor/patient relationship can be understood via quantitative scales the illusion fostered by medical ethics that doctors, unlike those in other professions, are uniquely beneficent and indeed altruistic. An excellent text for undergraduate and postgraduate students of law, medical ethics and medical healthcare law, Bioethics and the Humanities shows the real ethical achievements, problems and half-truths of contemporary medicine. (shrink)

La Segunda Guerra Mundial y las atrocidades cometidas en investigaciones con los prisioneros en los campos de concentración nazis y japoneses, despertaron la conciencia por el desarrollo de los derechos humanos que se habían conquistado paulatinamente a lo largo de la historia. Por ello se conforman una serie de leyes, normas y declaraciones donde se tratan los aspectos bioéticos en los ensayos clínicos. Se debe prestar vital atención a la relación médico-paciente en el curso de las investigaciones y considerar la (...) relación beneficio/riesgo cuando se va a experimentar en seres humanos. La retinopatía diabética proliferativa es una de las afecciones oftalmológicas que más ensayos ha suscitado. El objetivo de este trabajo consiste en analizar algunos aspectos éticos en la experimentación en pacientes con esta afección. The Second World War and the atrocities committed in research with prisoners in Japanese and Nazi concentration camps, awakened consciousness for the development of human rights that had gradually been conquered throughout history. That´s why a series of laws, rules and statements that deal with bioethical aspects in clinical trials, were passed. Special attention must be given to the doctor-patient relationship during the research and consider the benefit/risk ratio when conducting experiments on human beings. Proliferative Diabetic Retinopathy is one of the ophthalmological disorders that has given rise to more trials. The research goal is to analyze some ethical aspects when experimenting on patients with this condition. (shrink)

Researchers, scientists, and physicians in Uganda have become increasingly aware of the need to develop a systematic approach to reviewing bio-medical research conducted in their country. Much of this awareness and their concern stems from Uganda's high seroprevalence of human immunodeficiency virus and the consequent large influx of research monies and HIV researchers from developed countries, including the United States and Great Britain.We report on the proceedings of a five-day symposium on bioethical principles governing clinical trials, which convened in Jinja, (...) Uganda in September 1994. The thirteen male and female workshop participants included representatives from the Uganda Ministry of Health, Makerere University, the Uganda AIDS Commission, Uganda's National Council of Science and Technology, and the National Chemotherapeutic Laboratory. These representatives included ethicists, physicians, researchers, and pharmacists, all of whom have conducted research themselves. Initial workshop sessions focused on the history of human experimentation and the development of protections for human participants in medical research, both in the United States and internationally. (shrink)

The Global Forum on Bioethics in Research (GFBR) served as a global platform for debate on ethical issues in international health research between 1999 and 2008, bringing together research ethics experts, researchers, policy makers and community members from developing and developed countries. In total, nine GFBR meetings were held on six continents. Work is currently underway to revive the GFBR. This paper describes the purpose and history of the GFBR and presents key elements for its reinstatement, future functioning (...) and sustainability. Potential participants and sponsors are encouraged to contribute actively to the future of this unique international research ethics event. (shrink)

This chapter contains sections titled: Medical Ethics Nursing Ethics Bioethics References.

This article by one of the Editors of Bioethics, published in the 25th anniversary issue of the journal, describes some of the revolutionary changes academic publishing has undergone during the last decades. Many humanities journals went from typically small print-runs, counting by the hundreds, to on-line availability in thousands of university libraries worldwide. Article up-take by our subscribers can be measured efficiently. The implications of this and other changes to academic publishing are discussed. Important ethical challenges need to be (...) addressed in areas such as the enforcement of plagiarism-related policies, the so-called ‘impact factor’ and its impact on academic integrity, and the question of whether on-line only publishing can currently guarantee the integrity of academic publishing histories. (shrink)

The primary contribution of feminism to bioethics is to note how imbalances of power in the sex‐gender system play themselves out in medical practice and in the theory surrounding that practice. I trace the ten‐year history of feminist approaches to bioethics, arguing that while feminists have usefully critiqued medicine's biases in favor of men, they have unmasked sexism primarily in the arena of women's reproductive health, leaving other areas of health care sorely in need of feminist scrutiny. (...) I note as well that feminist bioethicists have contributed very little to bioethical theory. In the second part of the paper I suggest two future directions for feminist bioethics. The first is to expand its critique of gender bias beyond reproductive medicine, devoting attention to the same issues raised by advances in biomedical technology as are taken up by mainstream bioethicists. The second is to develop bioethical theory that is more responsive than are mainstream moral theories to the social practices that subordinate women and minority groups. (shrink)

Avons-nous une bioéthique véritablement canadienne – et pas seulement une pratique de la bioéthique au Canada? Cette question, et le présent article, portent sur le lien entre la bioéthique et les expériences réelles des Canadiens en matière de soins de santé, de recherche et de santé publique. En l’abordant, je m’inspire du pragmatisme philosophique qui souligne l’importance de l’expérience quotidienne comme point de départ de l’éthique, et de l’épanouissement humain comme objectif de l’éthique. À travers cette optique, un idéal bioéthique (...) canadien est un idéal qui s’enracine dans les expériences vécues par les Canadiens ; il reflète l’idéal d’épanouissement projeté par les individus canadiens, y compris leurs opinions sur leurs communautés politiques. Toutefois, il n’est pas certain qu’une bioéthique canadienne à part entière ait pris forme, étant donné l’uniformisation croissante des recherches dans le monde entier, qui crée des attentes quant aux types de problèmes moraux qui méritent d’être étudiés et aux types de solutions à adopter. Dans un esprit de réflexion sur cette question, j’aborde les aspects de la société canadienne qui pourraient façonner le développement d’une bioéthique canadienne : (a) l’existence de récits politiques canadiens concurrents, (b) le caractère distinct des systèmes de santé et des expériences en matière de soins de santé au Canada, (c) l’engagement des Canadiens envers certaines valeurs et aspirations, (d) les aspects institutionnels et procéduraux de la sphère publique canadienne, (e) les défis posés par l’uniformisation croissante de l’enseignement dans les différents contextes géographiques et nationaux, et (f) les obstacles pratiques au développement d’une bioéthique canadienne. Ces défis auxquels la bioéthique canadienne fait face sont probablement pertinents à l’échelle internationale pour tous les contextes dans lesquels des problèmes moraux d’origine sociale sont discutés et des solutions envisagées. (shrink)

This book explores and elaborates three theories of public reason, drawn from Rawlsian political liberalism, natural law theory, and Confucianism. Drawing together academics from these separate approaches, the volume explores how the three theories critique each other, as well as how each one brings its theoretical arsenal to bear on the urgent contemporary debate of medical assistance in dying. The volume is structured in two parts: an exploration of the three traditions, followed by an in-depth overview of the conceptual and (...) historical background. In Part I, the three comprehensive opening chapters are supplemented by six dynamic chapters in dialogue with each other, each author responding to the other two traditions, and subsequently reflecting on the possible deficiencies of their own theories. The chapters in Part II cover a broad range of subjects, from an overview of the history of bioethics to the nature of autonomy and its status as a moral and political value. In its entirety, the volume provides a vibrant and exemplary collaborative resource to scholars interested in the role of public reason and its relevance in bioethical debate. (shrink)

Integrative Bioethics engages in descriptive and normative fields, or in two cultures, as Snow puts it in The Two Cultures and the Scientific Revolution, announcing though, in his later writings the emergence of a third culture that can mediate between the two. Thomas Kuhn in The Structure of Scientific Revolutions exposes the practice of a new paradigm of the teaching of history describing in fact the relation of science and humanities in the positivist era. The long standing reasons-causes (...) debate that lay the groundwork of the implied incompatibility of the two cultures, as it reflects on the Collingwoodian anti-causalism of the philosophy of history, against Davidsonian causalism, may elucidate the problem of the ‘marriage’ of cultures. Taking a look on Collingwood’s absolute presuppositions and Carnap’s external to linguistic frameworks questions, will help us investigate the possibility of a coherent framework for integrated Bioethics. Can we frame a transdisciplinary field, where science and humanities as collaborating social practices, or as a new ‘cultural policy’, will abstain from normative violence against each other? (shrink)

A hard difficulty in Astrobiology is the precise definition of what life is. All living beings have a cellular structure, so it is not possible to have a broader concept of life hence the search for extraterrestrial life is restricted to extraterrestrial cells. Earth is an astronomical rarity because it is difficult for a planet to present liquid water on the surface. Two antagonistic bioethical principles arise: planetary protection and terraforming. Planetary protection is based on the fear of interplanetary cross-infection (...) and possible ecological damages caused by alien living beings. Terraforming is the intention of modifying the environmental conditions of the neighbouring planets in such a way that human colonisation would be possible. The synthesis of this antagonism is ecopoiesis, a concept related to the creation of new ecosystems in other planets. Since all the multicellular biodiversity requires oxygen to survive, only extremophile microorganisms could survive in other planets. So, it could be carried out a simulation of a meteorite by taking to other planets portions of the terrestrial permafrost, or ocean or soil, so that if a single species could grow, a new ecosystem would start, as well as a new Natural History. As a conclusion, ecopoiesis should be the bioethical principle to guide practices and research in Astrobiology. (shrink)

In one of Richard Zaner’s tales of ethics consultation practice, a moment occurs that might be comic, except for the gravity of the situation. Zaner goes to visit the parents of an infant with multiple problems who has been admitted to neonatal intensive care. He introduces himself awkwardly, and the child’s father responds: “‘Why,’ he bluntly asked, ‘are you here now?’ And with, again, exemplary frankness, he pointedly demanded, eyes narrowing in that knowing way, full of suspicion: ‘Has someone been (...) acting unethically?’”. Webb Keane’s Ethical Life: Its Natural and Social Histories never discusses bioethics and gives minimal attention to medical anthropologists who have contributed significantly... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Is Bioethics Applied Ethics?Robert M. VeatchBioethics is often referred to as a kind of applied ethics. The term applied ethics can be controversial if it is taken to imply that ethical theory from philosophy or religious ethics has to be the starting point for ethical analysis of some practical field such as medicine or law or politics. The term can be understood as requiring some premises from an (...) ethical theory that are then "applied" to some problem area, as a "top down" way of doing the work of moral reflection in a way that axioms in geometry are applied to present proofs of mathematical claim.The publication of an important work in the history of medical ethics, A History of Medical Ethics, provides an opportunity to reflect more carefully on what applied ethics means. That massive multi-authored volume edited by Robert Baker and Laurence McCullough (2007) is scheduled for publication this fall. With the permission of the Press, we have asked Baker and McCullough to prepare an article-length version of one of the central essays in that work. Their paper challenges the idea that ethical theory should be "applied" to medicine or other fields, putting forth an alternative of the "appropriation" of an ethical theory by the formulation of concepts, principles, moral rules, or other specifications that may turn out to be unique or at least modified for the particular field in question.In this issue of the Kennedy Institute of Ethics Journal, we publish the Baker-McCullough article together with five critical commentaries. We include two medical historians who have a sustained commitment to studying the history of ethics in medicine, two systematic ethicists who have an unusual level of commitment to studying ethics historically, and a physician with unusual sensitivity to the history of medical ethics. Each comments on the Baker-McCullough thesis and offers an alternative view of the link between ethical theory and the field of biomedical ethics.Daniel Fox triggered some of the initial reflection on the history of medical ethics in the 1970s. His work is discussed by Baker and McCullough. Fox is sympathetic with the Baker-McCullough appropriation thesis, viewing their position as complementary to his own, although he [End Page 1] urges more attention to the political aspects of medicine, professional dominance, and professional control of medical resources.Ulf Schmidt, a specialist on the historical aspects of research during the Nazi era, focuses on Baker and McCullough's use of that historical example of the appropriation of medical ethics.The two ethicists who comment both have had many years experience with historical aspects of medical ethics, and both worked on the historically important Belmont Report of the National Commission for the Protection of Human Subjects. Both question whether Baker and McCullough overstate the problem of the relation between application and appropriation. Albert Jonsen, as a member of the National Commission, concentrates on the Belmont Report, showing how he sees the report appropriating philosophical ethics.Tom Beauchamp, who was the primary staff person responsible for the report, provides a somewhat different read on the report and particularly on the role of Kantian ethics in the report's discussion of autonomy. Beauchamp accuses Baker and McCullough of having too narrow an understanding of the meaning of the term "applied," claiming that no people doing medical ethics today would simply apply ethical theory in a deductivist manner.Finally, Jeremy Sugarman, the physician ethicist, is, in a somewhat surprising turn, the cautious defender of the application that Baker and McCullough challenge. Although he ends up sympathetic with the appropriation that implies going beyond straight-forward top-down application, he outlines the value of ethical theory for the practical analysis of ethical problems in fields such as medicine.ReferenceBaker, Robert, and McCullough, Laurence, eds. 2007. A History of Medical Ethics. New York: Cambridge University Press, in press. [End Page 2]Google ScholarCopyright © 2007 Johns Hopkins University Press... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bioethics and Natural Law: The Relationship in Catholic TeachingJ. Bryan Hehir (bio)In the discipline of Catholic moral theology, bioethics (traditionally described as medical ethics) has held a major place. The systematic development of bioethics has drawn principally upon a natural law ethic, supported by broader religious arguments. The purpose of this essay is to examine the status and role of natural law in Catholic teaching as (...) it bears upon bioethics.Natural Law and Catholic TheologyThe role of natural law in Catholic theology is rooted in a prior conviction about the complementary relationship of faith and reason. The conviction finds initial expression in patristic authors, then preeminently in Thomas Aquinas and consistently in modern papal teaching of the twentieth century. Flowing from this conviction, as a premise of Catholic theology and teaching, is the [End Page 333] notion that a second source of moral wisdom exists along side the revealed wisdom of the Hebrew and Christian scriptures. This second source of wisdom is the product of rational reflection upon human nature and experience. In the tradition of natural law ethics (expressed in a plurality of versions), such reflection affirms an objective moral order, accessible to reason and based upon a conception of the person as both spiritual and social. The spiritual nature, expressed in the capacity for reflection and free choice, is the foundation of the natural law ethic, providing the human person a unique status in the created order. The social nature of the person locates each human being in a framework of social relationships, articulated in a complex of rights and duties and finding expression in three basic communities: the family, civil society, and the human community.The fully developed framework of a natural law ethic has five dimensions. It yields a theory of society, a doctrine of the state, a charter of duties and rights, a jurisprudence, and an applied ethic. At each level of this framework, the natural law ethic is contested by other contemporary philosophical positions. In this article, space demands that stress must be placed on the natural law affirmations without trying to engage the critics.The centrality of the social nature of the person yields a theory of society that is organic in character, laying strong emphasis on the social fabric of existence. Hence the theory has traditionally emphasized both order and justice more strongly than claims of freedom. The doctrine of the state, in contemporary natural law arguments, supports a limited yet activist state, limited by constitutional restraints and human rights claims, yet activist in its conception of a broad range of social obligations, particularly to the poor. The charter of rights affirms a range of both political-civil and socio-economic rights; the traditional natural law emphasis on a structure of duties has been complemented in the twentieth century by its stress on the role of human rights. The jurisprudential theory of natural law has been its most prominent aspect; it affirms a moral grounding for civil law, but distinguishes precisely between the comprehensive nature of moral law and the more limited scope of civil law, restricted to the maintenance of public order in society. Finally, the natural law framework finds expression in Catholic teaching in three areas of applied ethics: social ethics (civil society and international relations), sexual ethics, and bioethics.History and StatusWhile a natural law ethic has been a staple of Catholic social and bioethical teaching, it has not held similar status in the wider arena of contemporary philosophical or theological ethics. Through the 1950s, therefore, one could find a strong consensus supporting natural law within the Catholic community and ongoing debates within the wider world of philosophy and bioethics. Since the 1960s, any description of the status and role of natural law must consider the debates within Roman Catholicism itself about the role and status of natural law. [End Page 334]It is possible to distinguish two stages of these internal arguments in the church. In the period from 1960 to 1990, three events in Catholicism directly influenced the standing of a natural law position: John XXIII’s encyclical Pacem In Terris (1963), Paul XI’s encyclical Humanae Vitae (1968), and the teaching of... (shrink)

What are the resources and needs, the strengths and the vulnerabilities of patients, of society, or of nature? How do we evaluate the societal potential of scientific discovery? It is fairly well assured that we are influencing the terms of existence of many inhabitants of this planet, from flora to fauna to humans. Moreover, history has shown that while technologies can be used neutrally, they can be (and have been) used to the great benefit – or the great detriment (...) – of human life and the fate of the world as a whole. How various types of knowledge and technological ability will be deployed is up to us, individually and collectively. How such information and ability should be deployed, and for what reasons, are questions at the core of bioethical inquiry. These are the "expanding horizons in bioethics" to which this volume refers. This volume is comprised of fourteen essays. It is a rare gathering of scholarly opinion, featuring well-known experts from a diversity of disciplines. The topics addressed are of immediate concern to the public. The essays ask questions about human nature, genetic technologies, reproductive rights, human subjects research, and environmental issues – all in provocative and challenging new ways. Yet the themes that emerge throughout the volume are of enduring interest to anyone concerned about the interactions of scientific development, ethics, and society. This volume is of interest to students and teachers of bioethics and related topics, as well as to professionals working in these disciplines. (shrink)

This book clarifies the meaning of the most important and pervasive concepts and tools in bioethical argumentation and assesses the methodological suitability of the main methods for clinical decision-making and argumentation. The first part of the book is devoted to the most developed or promising approaches regarding bioethical argumentation, namely those based on principles, values and human rights. The authors then continue to deal with the contributions and shortcomings of these approaches and suggest further developments by means of substantive and (...) procedural elements and concepts from practical philosophy, normative systems theory, theory of action, human rights and legal argumentation. Furthermore, new models of biomedical and health care decision-making, which overcome the aforementioned criticism and stress the relevance of the argumentative responsibility, are included. (shrink)

Biotopes and Bioethics are highly complex and adaptable systems of Bios. Individual bios is terminal, but the stream of Bios goes on. Basic properties of Bios such as communication and cooperation, competence and competition, contemplation and calculation, compassion and cultivation come in different shades of light and dark in individuals and species, in history and ecology. Hans-Martin Sass discusses the territories of Bios and Bioethics, based on his involvement in decades of consulting in academia, business and politics. (...) Special attention is given to the vision and role of Bioethics in research and training, in religious and cultural traditions, and in the survival, happiness, and health of corporate, social and political bodies. Hans-Martin Sass is Senior Research Scholar Emeritus at Georgetown University, Washington DC, and Professor Emeritus of Philosophy at Ruhr University, Bochum. (Series: Practical Ethics - Studies / Ethik in der Praxis - Studien, Vol. 40) [Subject: Bioethics]. (shrink)

Post-war Japan has seen profound and rapid social change and transformation. One of the most visible areas of change in Japan has been medicine, and particularly the ethical practices and policies that guide medical decision-making. The formal discipline of bioethics, Seimei Rinri in Japanese, has grown by leaps and bounds since the late 1970s, when it began to appear in the curriculum and professional activities of Japanese medical schools and philosophy departments. The introduction of bioethics to Japan was (...) timely, as innovation in medicine and technology was evolving in ways that revealed that the intersection of medicine, traditional Japanese values, and new cultural trends was an area of great moral complexity. In its infancy, bioethics in Japan was more or less an import from the United States, where the discipline took its roots. Quickly, however, it became clear that Japan's history and tradition would call for a different approach, and the engagement of slightly different ethical issues. Organ transplantation, for example, sparked much greater controversy in Japan than it ever did in the United States. Today, Japan has one of the most dynamic bioethics programs in the world, and it is one that reflects both traditional Japanese culture and the need for inter-cultural engagement in an increasingly global world. Through a series of original chapters written by bioethicists and covering a range of ethical issues, this anthology shows that, in contrast to previous assumptions, Japanese bioethics has, in fact, taken on an identity that is undoubtedly separate from its American origins. Rich philosophical questions raised by medicine, human subjects research, and psychiatric care are being posed by scholars in a way that reflect Japanese tradition and is no longer simply reflective of, or shaped by, American traditions and philosophical problems. The book highlights and showcases these trends through a series of chapters written by some of the leading scholars in contemporary Japanese bioethics, many of whom were pioneers of the field when it began and are now nearing retirement. (shrink)

Introductory and advanced textbooks in bioethics focus almost entirely on issues that disproportionately affect disabled people and that centrally deal with becoming or being disabled. However, such textbooks typically omit critical philosophical reflection on disability, lack engagement with decades of empirical and theoretical scholarship spanning the social sciences and humanities in the multidisciplinary field of disability studies, and avoid serious consideration of the history of disability activism in shaping social, legal, political, and medical understandings of disability over the (...) last fifty years. For example, longstanding discussions on topics such as euthanasia, physician aid-in-dying, pre-implantation genetic diagnosis, prenatal testing, selective abortion, enhancement, patient autonomy, beneficence, non-maleficence, and health care rationing all tend to be premised on shared and implicit assumptions regarding disability, especially in relation to quality of life, yet with too little recognition of the way that “disability” is itself a topic of substantial research and scholarly disagreement across multiple fields. This is not merely a concern for academic and medical education; as an applied field tied to one of the largest economic sectors of most industrialized nations, bioethics has a direct impact on healthcare education, practice, policy, and, thereby, the health outcomes of existing and future populations. It is in light of these pressing issues that the Disability Bioethics Reader is the first reader to introduce students to core bioethical issues and concepts through the lens of critical disability studies and philosophy of disability. The Disability Bioethics Reader will include over thirty-five chapters covering key areas such as: critical histories and state-of-the-field analyses of modern medicine, bioethics, disability studies, and philosophy of medicine; methods in bioethics; concerns at the edge- and end-of-life; enhancement; disability, quality of life, and well-being; prenatal testing and abortion; invisible disabilities; chronic illness; healthcare justice; genetics and genomics; intellectual disability and neurodiversity; ethics and diagnosis; and epistemic injustice in healthcare. (shrink)

This symposium represents the first major foray of the Journal of Bioethical Inquiry into what may well become one of its significant strands of scholarship. The JBI has always encouraged critical and marginal areas of bioethics scholarship and particularly those which make use of contemporary continental philosophy and cultural theory in addition to traditional analytic methods. For that reason this symposium is an expression of a “natural fit” or a “match made in heaven” (or at least the Platonic version (...) of that idea). The authors span times and sites in history and culture, from ancient Greece to present day Brisbane. They draw on a variety of literary genres and figures, ranging from Greek tragedy to an epic Chinese novel; from Jane Austen to William Styron, a major American novelist and essayist; from the modern English science fiction of Kazuo Ishiguro, a Japanese expatriate in London, to the 20th-century English poetry of Philip Larkin. The symposium also engages with some recur. (shrink)

The coming of bioethics -- The coming of bioethicists -- "Choices on our conscience": the inauguration of the Kennedy Institute of Education -- "Hello, Dolly": bioethics in the media -- Celebrating bioethics and bioethicists -- Thinking socially and culturally in bioethics -- Reminiscences of observing participants -- Bioethics circles the globe -- Bioethics in France -- The development of bioethics in the Islamic Republic of Pakistan -- The coming of the culture wars to (...) American bioethics. (shrink)