The question of autonomy in maternal health in Africa: a rights-based consideration.

PubMed

Amzat, Jimoh

2015-06-01

Maternal mortality is still very high in Africa, despite progress in control efforts at the global level. One elemental link is the question of autonomy in maternal health, especially at the household level where intrinsic human rights are undermined. A rights-based consideration in bioethics is an approach that holds the centrality of the human person, with a compelling reference to the fundamental human rights of every person. A philosophical and sociological engagement of gender and the notion of autonomy within the household reveals some fundamental rights-based perplexities for bioethical considerations in maternal health. The right to self-determination is undermined, and therefore women's dignity, freedom and autonomy, capacities, and choices are easily defiled. This study applies a rights-based approach to maternal health and demonstrates how rights concerns are associated with negative outcomes in maternal health in Africa. The discussion is situated at the household level, which is the starting point in health care. The paper submits that beyond legal and political rights within the context of the state, rights-based issues manifest at the household level. Many of those rights issues, especially relating to women's autonomy, are detrimental to maternal health in Africa. Therefore, a rights-based approach in the social construction of maternal health realities will contribute to alleviating the burden of maternal mortality in Africa.

Climate change is a bioethics problem.

PubMed

Macpherson, Cheryl Cox

2013-07-01

Climate change harms health and damages and diminishes environmental resources. Gradually it will cause health systems to reduce services, standards of care, and opportunities to express patient autonomy. Prominent public health organizations are responding with preparedness, mitigation, and educational programs. The design and effectiveness of these programs, and of similar programs in other sectors, would be enhanced by greater understanding of the values and tradeoffs associated with activities and public policies that drive climate change. Bioethics could generate such understanding by exposing the harms and benefits in different cultural, socioeconomic, and geographic contexts, and through interdisciplinary risk assessments. Climate change is a bioethics problem because it harms everyone and involves health, values, and responsibilities. This article initiates dialog about the responsibility of bioethics to promote transparency and understanding of the social values and conflicts associated with climate change, and the actions and public policies that allow climate change to worsen. © 2013 John Wiley & Sons Ltd.

[Autonomy, Trust and Medical Ethics in Onora O'Neill's Work].

PubMed

Jaramillo, Carlos Alberto López; Lew, Jorge Carlos Holguín

2013-03-01

Autonomy has become a key concept in bioethics. Onora O'neill is perhaps the most representative author and researcher in the philosophical and bioethical fields regrding the concept of autonomy. To review the concept of autonomy in Onora O'Neill's work so as to understand its relevance in current bioethics. The concept of bioethics is reviewed in relation to three fundamental quesions: 1) Which are the main limitations of the individualistic conception of autonomy? 2) How to understand the relations between trust and autonomy together with their implications? and 3) Which are the implications of principled autonomy for aspects such as doctor-patient relationship and informed consent. The main works by O'Neill are reviewed, specifically regarding medical bioethics. O'neill's approach is original and relates Kantian autonomy to her own conceptions about trust, and both the individual and social levels of bioethics. The author has developed a Kantian non indvidualistic view of autonomy. Her conceptulization of trust and the crises this concept is currently undergoing complement and strengthen the concept of principled autonomy. The implications of O'Neill's concepts go beyond theoretical discussions and in her work she uses examples and analyzes circumstances which demonstrate the applicability of her proposals. O'Neill's work contributes to dealing with the challenges posed by the socio-political context of cost-efficiency oriented health systems and of the so-called defensive medicine. Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Global Bioethics and Culture in a Pluralistic World: How does Culture influence Bioethics in Africa?

PubMed Central

Chukwuneke, FN; Umeora, OUJ; Maduabuchi, JU; Egbunike, N

2014-01-01

Bioethics principles and practice can be influenced by different cultural background. This is because the four globally accepted bioethics principles are often based on basic ethical codes such as autonomy, beneficence, nonmaleficence and justice. Beneficence/nonmaleficence requires us to maximize possible benefits, while minimizing possible harms and consequently secure the well-being of others by refraining from harming them. Autonomy gives individuals the right to self-actualization and decision-making, while justice is concerned with the fair selection and distribution of the burdens and benefits of research among participants. Applications of these principles in cultural settings vary more often from one cultural perspective to the other because of the different understanding and practices of “what is good.” The proponents of global ethics may argue that these principles should be universally generalizable and acceptable, but this is not possible because of the existing cultural diversities. In the African set-up, despite the existence of major common cultural practices, there are other norms and practices, which differ from one society to the other within the communities. Therefore, the word “global” bioethics may not be applicable generally in practice except if it can account for the structural dynamics and cultural differences within the complex societies in which we live in. However, the extent to which cultural diversity should be permitted to influence bioethical judgments in Africa, which at present is burdened with many diseases, should be of concern to researchers, ethicist and medical experts taking into considerations the constantly transforming global society. This topic examines the cultural influence on principles and practice of bioethics in Africa. PMID:25328772

Community Bioethics: The Health Decisions Community Council.

ERIC Educational Resources Information Center

Gallegos, Tom; Mrgudic, Kate

1993-01-01

Sees health care decision making posing variety of complex issues for individuals, families, and providers. Describes Health Decisions Community Council (HDCC), community-based bioethics committee established to offer noninstitutional forum for discussion of health care dilemmas. Notes that social work skills and values for autonomy and…

Trust-Based Cooperative Games and Control Strategies for Autonomous Military Convoys

DTIC Science & Technology

2013-01-01

52] S. Goering, "Postnatal Reproductive Autonomy: Promoting Relational Autonomy and Self-Trust in New Parents," Bioethics , vol. 23, no. 1, pp. 9-19...Systems," Proceedings of the IEEE, vol. 95, no. 1, pp. 215-233, January 2007. [105] O. O’Neill, Autonomy and Trust in Bioethics . Cambridge: Cambridge

[Bioethics of principles].

PubMed

Pérez-Soba Díez del Corral, Juan José

2008-01-01

Bioethics emerges about the tecnological problems of acting in human life. Emerges also the problem of the moral limits determination, because they seem exterior of this practice. The Bioethics of Principles, take his rationality of the teleological thinking, and the autonomism. These divergence manifest the epistemological fragility and the great difficulty of hmoralñ thinking. This is evident in the determination of autonomy's principle, it has not the ethical content of Kant's propose. We need a new ethic rationality with a new refelxion of new Principles whose emerges of the basic ethic experiences.

Bioethics for clinicians: 28. Protestant bioethics

PubMed Central

Pauls, Merril; Hutchinson, Roger C.

2002-01-01

“PROTESTANT” IS A TERM APPLIED TO MANY DIFFERENT Christian denominations, with a wide range of beliefs, who trace their common origin to the Reformation of the 16th century. Protestant ideas have profoundly influenced modern bioethics, and most Protestants would see mainstream bioethics as compatible with their personal beliefs. This makes it difficult to define a uniquely Protestant approach to bioethics. In this article we provide an overview of common Protestant beliefs and highlight concepts that have emerged from Protestant denominations that are particularly relevant to bioethics. These include the sovereignty of God, the value of autonomy and the idea of medicine as a calling as well as a profession. Most Canadian physicians will find that they share certain values and beliefs with the majority of their Protestant patients. Physicians should be particularly sensitive to their Protestant patients' beliefs when dealing with end-of-life issues, concerns about consent and refusal of care, and beginning-of-life issues such as abortion, genetic testing and the use of assisted reproductive technologies. Physicians should also recognize that members of certain Protestant groups and denominations may have unique wishes concerning treatment. Understanding how to elicit these wishes and respond appropriately will allow physicians to enhance patient care and minimize conflict. PMID:11868645

Autonomy-Facilitation or Autonomy-Promotion? The Case of Sex Education

ERIC Educational Resources Information Center

Corngold, Josh

2012-01-01

This article offers a critique of Harry Brighouse's "autonomy-facilitating education", which aims to enable students to reflect critically on their lives and society without disposing them to do so. Because it is "character-neutral", this kind of education purportedly avoids some of the controversy surrounding autonomy-promotion. At the same time,…

On a communitarian approach to bioethics.

PubMed

Etzioni, Amitai

2011-10-01

A communitarian approach to bioethics adds a core value to a field that is often more concerned with considerations of individual autonomy. Some interpretations of liberalism put the needs of the patient over those of the community; authoritarian communitarianism privileges the needs of society over those of the patient. Responsive communitarianism's main starting point is that we face two conflicting core values, autonomy and the common good, and that neither should be a priori privileged, and that we have principles and procedures that can be used to work out this conflict but not to eliminate it. This discussion uses the debate in the US over funding for entitlements as a case study to apply the values of communitarian bioethics.

Documenting different domains of promotion of autonomy in families.

PubMed

Manzi, Claudia; Regalia, Camillo; Pelucchi, Sara; Fincham, Frank D

2012-04-01

Parental promotion of autonomy for offspring well-being has been widely recognized in developmental psychology. Recent studies, however, show that this association varies across cultures. Such variation may reflect inappropriate measurement of this dimension of parenting. Therefore, three existing measures of promotion of autonomy were used to derive different dimensions related to the promotion of autonomy in three different domains - promotion of autonomous thought, promotion of autonomous decision-making, and promotion of physical separation. The cross-cultural significance of this three-component model was tested in samples of late adolescents (n = 1361) from four nations- the US, Belgium, Italy and China. Data from all four countries best fit a three dimensional model but the covariance between the three dimensions was moderated by culture. Culture also moderated the impact of promotion of autonomy on offspring well-being. Copyright © 2011 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

The Need for Authenticity-Based Autonomy in Medical Ethics.

PubMed

White, Lucie

2017-08-11

The notion of respect for autonomy dominates bioethical discussion, though what qualifies precisely as autonomous action is notoriously elusive. In recent decades, the notion of autonomy in medical contexts has often been defined in opposition to the notion of autonomy favoured by theoretical philosophers. Where many contemporary theoretical accounts of autonomy place emphasis on a condition of "authenticity", the special relation a desire must have to the self, bioethicists often regard such a focus as irrelevant to the concerns of medical ethics, and too stringent for use in practical contexts. I argue, however, that the very condition of authenticity that forms a focus in theoretical philosophy is also essential to autonomy and competence in medical ethics. After tracing the contours of contemporary authenticity-based theories of autonomy, I consider and respond to objections against the incorporation of a notion of authenticity into accounts of autonomy designed for use in medical contexts. By looking at the typical problems that arise when making judgments concerning autonomy or competence in a medical setting, I reveal the need for a condition of authenticity-as a means of protecting choices, particularly high-stakes choices, from being restricted or overridden on the basis of intersubjective disagreement. I then turn to the treatment of false and contestable beliefs, arguing that it is only through reference to authenticity that we can make important distinctions in this domain. Finally, I consider a potential problem with my proposed approach; its ability to deal with anorexic and depressive desires.

The Evolution of Autonomy.

PubMed

Stammers, Trevor

2015-01-01

There can be little doubt, at least in the Western world, that autonomy is theruling principle in contemporary bioethics. In spite of its 'triumph' however,the dominance of the utilitarian concept of autonomy is being increasinglyquestioned. In this paper, I explore the nature of autonomy, how it came todisplace the Hippocratic tradition in medicine and how different conceptsof autonomy have evolved. I argue that the reduction of autonomy to'the exercise of personal choice' in medicine has led to a 'tyranny of autonomy' which can be inimical to ethical medical practice rather than conducive to it.I take the case of Kerrie Wooltorton as an illustration of how misplacedadherence to respect for patient autonomy can lead to tragic consequences.An analysis of autonomy based on the work of Rachel Haliburton isdescribed and applied to the role of autonomy in a recent bioethicaldebate--that arising from Savulescu's proposal that conscientious objection by health-care professionals should not be permitted in the NHS. Inconclusion, I suggest Kukla's concept of conscientious autonomy as onepromising pathway to circumvent both the limitations and adverse effectsof the dominance of current (mis)understandings of autonomy in biomedical ethics.

Supplemental care from a bioethical perspective.

PubMed

Carvalho, Regina Ribeiro Parizi; Fortes, Paulo Antônio de Carvalho; Garrafa, Volnei

2013-01-01

To describe and analyze, from the perspective of Intervention Bioethics, the legal, institutional and ethical contexts, the conflicts and regulations of supplemental health care in Brazil, since the approval of the regulatory law in 1998 until 2010. Qualitative research, using Intervention Bioethics as the theoretical reference. Bibliographical and documental study of the legislation, regulations and assistential framework, as well as interviews with members of the Supplemental Health Board. There was improvement in the records and rules of action in private health companies, as well as flow of information, contractual and financial guarantees provided to consumers. Conflicts persist regarding access to services and procedures, price increases, policies on autonomy and medical fees. There is a dispute with the public sector regarding the network of health services, with rising costs and no improvement in quality of care. Private participation in health demands comparative assessments and improvement of public-private care regulation, as well as promoting greater balance in the funding and reevaluation of the health care model. It is necessary to review the regulatory framework considering the supplementary, complementary or duplicate characteristic of assistance, the social actors involved, bioethical and political issues regarding associations between Supplemental Health Care and the National Health System (SUS). Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

[Twenty years of bioethics in Mexico: development and perspectives of the National Bioethics Commission].

PubMed

Ruiz de Chávez-Guerrero, Manuel Hugo

2014-01-01

Bioethics in Mexico has a history that reveals the vision and ethical commitment of iconic characters in the fields of health sciences and humanities, leading to the creation of the National Bioethics Commission responsible for promoting a bioethics culture in Mexico. Its development and consolidation from the higher perspective of humanism had the aim to preserve health, life and its environment, while at the same time the bases of ethics and professional practice from different perspectives have been the building blocks of medical practice.

Autonomy in medical ethics after O'Neill

PubMed Central

Stirrat, G; Gill, R

2005-01-01

Following the influential Gifford and Reith lectures by Onora O'Neill, this paper explores further the paradigm of individual autonomy which has been so dominant in bioethics until recently and concurs that it is an aberrant application and that conceptions of individual autonomy cannot provide a sufficient and convincing starting point for ethics within medical practice. We suggest that revision of the operational definition of patient autonomy is required for the twenty first century. We follow O'Neill in recommending a principled version of patient autonomy, which for us involves the provision of sufficient and understandable information and space for patients, who have the capacity to make a settled choice about medical interventions on themselves, to do so responsibly in a manner considerate to others. We test it against the patient–doctor relationship in which each fully respects the autonomy of the other based on an unspoken covenant and bilateral trust between the doctor and patient. Indeed we consider that the dominance of the individual autonomy paradigm harmed that relationship. Although it seems to eliminate any residue of medical paternalism we suggest that it has tended to replace it with an equally (or possibly even more) unacceptable bioethical paternalism. In addition it may, for example, lead some doctors to consider mistakenly that unthinking acquiescence to a requested intervention against their clinical judgement is honouring "patient autonomy" when it is, in fact, abrogation of their duty as doctors. PMID:15738430

What does respect for the patient's autonomy require?

PubMed

Cheng, Kam-Yuen

2013-11-01

Personal autonomy presupposes the notion of rationality. What is not so clear is whether, and how, a compromise of rationality to various degrees will diminish a person's autonomy. In bioethical literature, three major types of threat to the rationality of a patient's medical decision are identified: insufficient information, irrational beliefs/desires, and influence of different framing effects. To overcome the first problem, it is suggested that patients be provided with information about their diseases and treatment choices according to the objective standard. I shall explain how this should be finessed. Regarding the negative impact of irrational beliefs/desires, some philosophers have argued that holding irrational beliefs can still be an expression of autonomy. I reject this argument because the degree of autonomy of a decision depends on the degree of rationality of the beliefs or desires on which the decision is based. Hence, to promote patient autonomy, we need to eliminate irrational beliefs by the provision of evidence and good arguments. Finally, I argue that the way to smooth out the framing effects is to present the same information in different perspectives: it is too often assumed that medical information can always be given in a complete and unadorned manner. This article concludes with a cautionary note that the protection of patient autonomy requires much more time and effort than the current practice usually allows. © 2012 John Wiley & Sons Ltd.

Applying bioethical principles to human biomonitoring.

PubMed

Harrison, Myron

2008-06-05

Bioethical principles are widely used as a normative framework in areas of human research and medical care. In recent years there has been increasing formalization of their use in public health decisions. The "traditional bioethical principles" are applied in this discussion to the important issue human biomonitoring for environmental exposures. They are: (1) Autonomy--Also known as the "respect for humans" principle, people understand their own best interests; (2) Beneficence--"do good" for people; (3) Nonmaleficence--"do no harm"; (4) Justice--fair distribution of benefits and costs (including risks to health) across stakeholders.Some of the points made are: (1) There is not a single generic bioethical analysis applicable to the use of human biomonitoring data, each specific use requires a separate deliberation; (2) Using unidentified, population-based biomonitoring information for risk assessment or population surveillance raises fewer bioethical concerns than personally identified biomonitoring information such as employed in health screening; (3) Companies should proactively apply normative bioethical principles when considering the disposition of products and by-products in the environment and humans; (4) There is a need for more engagement by scholars on the bioethical issues raised by the use of biomarkers of exposure; (5) Though our scientific knowledge of biology will continue to increase, there will always be a role for methods or frameworks to resolve substantive disagreements in the meaning of this data that are matters of belief rather than knowledge.

Applying bioethical principles to human biomonitoring

PubMed Central

Harrison, Myron

2008-01-01

Bioethical principles are widely used as a normative framework in areas of human research and medical care. In recent years there has been increasing formalization of their use in public health decisions. The "traditional bioethical principles" are applied in this discussion to the important issue human biomonitoring for environmental exposures. They are: (1) Autonomy – Also known as the "respect for humans" principle, people understand their own best interests; (2) Beneficence – "do good" for people; (3) Nonmaleficence – "do no harm"; (4) Justice – fair distribution of benefits and costs (including risks to health) across stakeholders. Some of the points made are: (1) There is not a single generic bioethical analysis applicable to the use of human biomonitoring data, each specific use requires a separate deliberation; (2) Using unidentified, population-based biomonitoring information for risk assessment or population surveillance raises fewer bioethical concerns than personally identified biomonitoring information such as employed in health screening; (3) Companies should proactively apply normative bioethical principles when considering the disposition of products and by-products in the environment and humans; (4) There is a need for more engagement by scholars on the bioethical issues raised by the use of biomarkers of exposure; (5) Though our scientific knowledge of biology will continue to increase, there will always be a role for methods or frameworks to resolve substantive disagreements in the meaning of this data that are matters of belief rather than knowledge. PMID:18541074

[The issue of autonomy in medical ethics: philosophy of Karol Wojtyła].

PubMed

Niebrój, Lesław T; Olejniczak, Marek; Kruźlak, Agnieszka

2007-01-01

The issue of autonomy seems to play a very central and fundamental role in contemporary medical ethics. However, it should be emphasized, that there is no agreement on how the concept of autonomy ought to be understood. Although as the main intellectual framework to describe the meaning of "autonomy" is the use of philosophical system of John St. Mill or Immanuel Kant, one could identify the tendency to redefine the concept under study. The aim of this article was to find out if the philosophy of Karol Wojtyla could provide--interesting from the bioethical point of view--insights into understanding of the idea of autonomy. The Wojtyla's critique of Kant's and Mill's understanding of autonomy was shortly described and the main elements of Wojtyla's concept of autonomy were analyzed. On the basis of these considerations it was assumed that philosophical background of Wojtyla is so different from those which are used in the contemporary, especially so called Anglo-American, bioethics that introducing it "elements" of his thinking would lead to misunderstandings and indeed even serious errors. On the other hand, however, philosophical works of Wojtyla seems to be very influential in developing 'personalistic' bioethics. But this bioethics could be accepted only by people who share Wojtyla's ontological and probably also theological or religious assumptions.

Documenting Different Domains of Promotion of Autonomy in Families

ERIC Educational Resources Information Center

Manzi, Claudia; Regalia, Camillo; Pelucchi, Sara; Fincham, Frank D.

2012-01-01

Parental promotion of autonomy for offspring well-being has been widely recognized in developmental psychology. Recent studies, however, show that this association varies across cultures. Such variation may reflect inappropriate measurement of this dimension of parenting. Therefore, three existing measures of promotion of autonomy were used to…

The bioethical principles and Confucius' moral philosophy.

PubMed

Tsai, D F-C

2005-03-01

This paper examines whether the modern bioethical principles of respect for autonomy, beneficence, non-maleficence, and justice proposed by Beauchamp and Childress are existent in, compatible with, or acceptable to the leading Chinese moral philosophy-the ethics of Confucius. The author concludes that the moral values which the four prima facie principles uphold are expressly identifiable in Confucius' teachings. However, Confucius' emphasis on the filial piety, family values, the "love of gradation", altruism of people, and the "role specified relation oriented ethics" will inevitably influence the "specification" and application of these bioethical principles and hence tend to grant "beneficence" a favourable position that diminishes the respect for individual rights and autonomy. In contrast, the centrality of respect for autonomy and its stance of "first among equals" are more and more stressed in Western liberal viewpoints. Nevertheless, if the Confucian "doctrine of Mean" (chung-yung) and a balanced "two dimensional personhood" approach are properly employed, this will require both theorists and clinicians, who are facing medical ethical dilemmas, of searching to attain due mean out of competing moral principles thus preventing "giving beneficence a priority" or "asserting autonomy must triumph".

Teaching global bioethics.

PubMed

Dwyer, James

2003-10-01

We live in a world with enormous disparities in health. The life expectancy in Japan is 80 years; in Malawi, 40 years. The under-five mortality in Norway is 4/1000; in Sierra Leone, 316/1000. The situation is actually worse than these figures suggest because average rates tend to mask inequalities within a country. Several presidents of the IAB have urged bioethicists to attend to global disparities and to broaden the scope of bioethics. For the last six years I have tried to do just that. In this paper, I report and reflect on my attempts to teach bioethics in ways that address global health and justice. I then discuss ways to address key ethical issues in global health: the problem of inequalities; the nature of the duty to assist; the importance of the duty not to harm; the difference between a cosmopolitan and a political view of justice. I also discuss how teaching about global health may help to shift the emphasis in bioethics--from sensational cases to everyday matters, from autonomy and justice, and from access to healthcare to the social determinants of health. At the end of my paper, I reflect on questions that I have not resolved: how to delineate the scope of bioethics, whether my approach over-politicises bioethics, and how to understand the responsibilities of bioethicists.

Opportunities in Reform: Bioethics and Mental Health Ethics.

PubMed

Williams, Arthur Robin

2016-05-01

Last year marks the first year of implementation for both the Patient Protection and Affordable Care Act and the Mental Health Parity and Addiction Equity Act in the United States. As a result, healthcare reform is moving in the direction of integrating care for physical and mental illness, nudging clinicians to consider medical and psychiatric comorbidity as the expectation rather than the exception. Understanding the intersections of physical and mental illness with autonomy and self-determination in a system realigning its values so fundamentally therefore becomes a top priority for clinicians. Yet Bioethics has missed opportunities to help guide clinicians through one of medicine's most ethically rich and challenging fields. Bioethics' distancing from mental illness is perhaps best explained by two overarching themes: 1) An intrinsic opposition between approaches to personhood rooted in Bioethics' early efforts to protect the competent individual from abuses in the research setting; and 2) Structural forces, such as deinstitutionalization, the Patient Rights Movement, and managed care. These two themes help explain Bioethics' relationship to mental health ethics and may also guide opportunities for rapprochement. The potential role for Bioethics may have the greatest implications for international human rights if bioethicists can re-energize an understanding of autonomy as not only free from abusive intrusions but also with rights to treatment and other fundamental necessities for restoring freedom of choice and self-determination. Bioethics thus has a great opportunity amid healthcare reform to strengthen the important role of the virtuous and humanistic care provider. © 2015 John Wiley & Sons Ltd.

The Porosity of Autonomy: Social and Biological Constitution of the Patient in Biomedicine.

PubMed

Beever, Jonathan; Morar, Nicolae

2016-01-01

The nature and role of the patient in biomedicine comprise issues central to bioethical inquiry. Given its developmental history grounded firmly in a backlash against 20th-century cases of egregious human subjects abuse, contemporary medical bioethics has come to rely on a fundamental assumption: the unit of care (and the unit of value) is the autonomous self-directing patient. In this article we examine first the structure of the feminist social critique of autonomy. Then we show that a parallel argument can be made against relational autonomy as well, demonstrating how this second concept of autonomy fails to take sufficiently into account an array of biological determinants, particularly those from microbial biology. Finally, in light of this biological critique, we question whether or to what extent any relevant and meaningful view of autonomy can be recovered in the contemporary landscape of bioethics.

Bioethics for clinicians: 18. Aboriginal cultures

PubMed Central

Ellerby, Jonathan H.; McKenzie, John; McKay, Stanley; Gariépy, Gilbert J.; Kaufert, Joseph M.

2000-01-01

Although philosophies and practices analogous to bioethics exist in Aboriginal cultures, the terms and categorical distinctions of "ethics" and "bioethics" do not generally exist. In this article we address ethical values appropriate to Aboriginal patients, rather than a preconceived "Aboriginal bioethic." Aboriginal beliefs are rooted in the context of oral history and culture. For Aboriginal people, decision-making is best understood as a process and not as the correct interpretation of a unified code. Aboriginal cultures differ from religious and cultural groups that draw on Scripture and textual foundations for their ethical beliefs and practices. Aboriginal ethical values generally emphasize holism, pluralism, autonomy, community- or family-based decision-making, and the maintenance of quality of life rather than the exclusive pursuit of a cure. Most Aboriginal belief systems also emphasize achieving balance and wellness within the domains of human life (mental, physical, emotional and spiritual). Although these bioethical tenets are important to understand and apply, examining specific applications in detail is not as useful as developing a more generalized understanding of how to approach ethical decision-making with Aboriginal people. Aboriginal ethical decisions are often situational and highly dependent on the values of the individual within the context of his or her family and community. PMID:11033715

Bioethics for clinicians: 18. Aboriginal cultures.

PubMed

Ellerby, J H; McKenzie, J; McKay, S; Gariépy, G J; Kaufert, J M

2000-10-03

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

The Practice of Promoting Primary Pupils' Autonomy: Examples of Teacher Feedback

ERIC Educational Resources Information Center

Hargreaves, Eleanore

2014-01-01

Background: Some authors consider the ultimate purpose of Assessment for Learning to be the promotion of pupils' autonomy. But the concept of autonomy is problematic and teachers' attempts to promote autonomy in the classroom can seem both vague and impractical. Purpose: In this paper, following Ecclestone (2002), I suggest that a full definition…

Forced to be free? Increasing patient autonomy by constraining it

PubMed Central

2014-01-01

It is universally accepted in bioethics that doctors and other medical professionals have an obligation to procure the informed consent of their patients. Informed consent is required because patients have the moral right to autonomy in furthering the pursuit of their most important goals. In the present work, it is argued that evidence from psychology shows that human beings are subject to a number of biases and limitations as reasoners, which can be expected to lower the quality of their decisions and which therefore make it more difficult for them to pursue their most important goals by giving informed consent. It is further argued that patient autonomy is best promoted by constraining the informed consent procedure. By limiting the degree of freedom patients have to choose, the good that informed consent is supposed to protect can be promoted. PMID:22318413

Forced to be free? Increasing patient autonomy by constraining it.

PubMed

Levy, Neil

2014-05-01

It is universally accepted in bioethics that doctors and other medical professionals have an obligation to procure the informed consent of their patients. Informed consent is required because patients have the moral right to autonomy in furthering the pursuit of their most important goals. In the present work, it is argued that evidence from psychology shows that human beings are subject to a number of biases and limitations as reasoners, which can be expected to lower the quality of their decisions and which therefore make it more difficult for them to pursue their most important goals by giving informed consent. It is further argued that patient autonomy is best promoted by constraining the informed consent procedure. By limiting the degree of freedom patients have to choose, the good that informed consent is supposed to protect can be promoted.

Caring in nursing homes to promote autonomy and participation.

PubMed

Hedman, Maria; Häggström, Elisabeth; Mamhidir, Anna-Greta; Pöder, Ulrika

2017-01-01

Autonomy and participation are threatened within the group of older people living in nursing homes. Evidence suggests that healthcare personnel act on behalf of older people but are still excluding them from decision-making in everyday care. The purpose was to describe registered nurses' experience of caring for older people in nursing homes to promote autonomy and participation. A descriptive design with a phenomenological approach was used. Data were collected by semi-structured individual interviews. Analysis was inspired by Giorgi's method. Participants and research context: A total of 13 registered nurses from 10 nursing homes participated. Ethical considerations: Ethical approval was obtained from the Regional Research Ethics Committee. Informed consent was achieved and confidentiality guaranteed. The essence of caring for older people in nursing homes to promote autonomy and participation consisted of registered nurses' awareness of older people's frailty and the impact of illness to support health and well-being, and awareness of acknowledgement in everyday life and trusting relationships. Paying attention to older people by being open to the persons' wishes were aspects that relied on registered nurses' trusting relationships with older people, their relatives and surrounding healthcare personnel. The awareness reflected challenges in caring to promote older people's right to autonomy and participation in nursing homes. Registered nurses' strategies, hopes for and/or concerns about development of everyday life in nursing homes were revealed and mirrored their engagement in caring for older people. Awareness of older people's frailty in nursing homes and the importance of maintained health and well-being were described as the main source for promoting autonomy and participation. Everyday life and care in nursing homes needs to be addressed from both older people's and healthcare personnel's perspectives, to promote autonomy and participation for residents

Conceptualizing Parental Autonomy Support: Adolescent Perceptions of Promotion of Independence versus Promotion of Volitional Functioning

ERIC Educational Resources Information Center

Soenens, Bart; Vansteenkiste, Maarten; Lens, Willy; Luyckx, Koen; Goossens, Luc; Beyers, Wim; Ryan, Richard M.

2007-01-01

In current research on parenting, 2 ways of conceptualizing perceived parental autonomy support can be distinguished. Parental autonomy support can be defined in terms of promotion of independence (PI) or in terms of promotion of volitional functioning (PVF). This study aimed to establish the empirical distinctiveness of both conceptualizations…

Finding autonomy in birth.

PubMed

Kukla, Rebecca; Kuppermann, Miriam; Little, Margaret; Lyerly, Anne Drapkin; Mitchell, Lisa M; Armstrong, Elizabeth M; Harris, Lisa

2009-01-01

Over the last several years, as cesarean deliveries have grown increasingly common, there has been a great deal of public and professional interest in the phenomenon of women 'choosing' to deliver by cesarean section in the absence of any specific medical indication. The issue has sparked intense conversation, as it raises questions about the nature of autonomy in birth. Whereas mainstream bioethical discourse is used to associating autonomy with having a large array of choices, this conception of autonomy does not seem adequate to capture concerns and intuitions that have a strong grip outside this discourse. An empirical and conceptual exploration of how delivery decisions ought to be negotiated must be guided by a rich understanding of women's agency and its placement within a complicated set of cultural meanings and pressures surrounding birth. It is too early to be 'for' or 'against' women's access to cesarean delivery in the absence of traditional medical indications--and indeed, a simple pro- or con- position is never going to do justice to the subtlety of the issue. The right question is not whether women ought to be allowed to choose their delivery approach but, rather, taking the value of women's autonomy in decision-making around birth as a given, what sorts of guidelines, practices, and social conditions will best promote and protect women's full inclusion in a safe and positive birth process.

Understanding collective agency in bioethics.

PubMed

Beier, Katharina; Jordan, Isabella; Wiesemann, Claudia; Schicktanz, Silke

2016-09-01

Bioethicists tend to focus on the individual as the relevant moral subject. Yet, in highly complex and socially differentiated healthcare systems a number of social groups, each committed to a common cause, are involved in medical decisions and sometimes even try to influence bioethical discourses according to their own agenda. We argue that the significance of these collective actors is unjustifiably neglected in bioethics. The growing influence of collective actors in the fields of biopolitics and bioethics leads us to pursue the question as to how collective moral claims can be characterized and justified. We pay particular attention to elaborating the circumstances under which collective actors can claim 'collective agency.' Specifically, we develop four normative-practical criteria for collective agency in order to determine the conditions that must be given to reasonably speak of 'collective autonomy'. For this purpose, we analyze patient organizations and families, which represent two quite different kinds of groups and can both be conceived as collective actors of high relevance for bioethical practice. Finally, we discuss some practical implications and explain why the existence of a shared practice of trust is of immediate normative relevance in this respect.

"Eugenics talk" and the language of bioethics.

PubMed

Wilkinson, S

2008-06-01

In bioethical discussions of preimplantation genetic diagnosis and prenatal screening, accusations of eugenics are commonplace, as are counter-claims that talk of eugenics is misleading and unhelpful. This paper asks whether "eugenics talk", in this context, is legitimate and useful or something to be avoided. It also looks at the extent to which this linguistic question can be answered without first answering relevant substantive moral questions. Its main conclusion is that the best and most non-partisan argument for avoiding eugenics talk is the Autonomy Argument. According to this, eugenics talk per se is not wrong, but there is something wrong with using its emotive power as a means of circumventing people's critical-rational faculties. The Autonomy Argument does not, however, tell against eugenics talk when such language is used to shock people into critical-rational thought. These conclusions do not depend on unique features of eugenics: similar considerations apply to emotive language throughout bioethics.

Bioethics and Moral Agency: On Autonomy and Moral Responsibility.

PubMed

Skalko, John; Cherry, Mark J

2016-10-01

Two clusters of essays in this issue of The Journal of Medicine and Philosophy provide a critical gaze through which to explore central moral, phenomenological, ontological, and political concerns regarding human moral agency and personal responsibility. The first cluster challenges common assumptions in bioethics regarding the voluntariness of human actions. The second set turns the debate towards morally responsible choice within the requirements of distributive justice. The force of their collective analysis leaves us with a well-founded basis critically to approach any account of bioethics or health policy that is insufficiently attentive to the central challenges of human freedom and responsible free choice. © The Author 2016. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Finding Autonomy in Birth*

PubMed Central

Kukla, Rebecca; Kuppermann, Miriam; Little, Margaret; Lyerly, Anne Drapkin; Mitchell, Lisa M; Armstrong, Elizabeth M.; Harris, Lisa

2009-01-01

Over the last several years, as cesarean deliveries have grown increasingly common, there has been a great deal of public and professional interest in the phenomenon of women ‘choosing’ to deliver by cesarean section in the absence of any specific medical indication. The issue has sparked intense conversation, as it raises questions about the nature of autonomy in birth. Whereas mainstream bioethical discourse is used to associating autonomy with having a large array of choices, this conception of autonomy does not seem adequate to capture concerns and intuitions that have a strong grip outside of this discourse. An empirical and conceptual exploration of how delivery decisions ought to be negotiated must be guided by a rich understanding of women’s agency and its placement within a complicated set of cultural meanings and pressures surrounding birth. It is too early to be ‘for’ or ‘against’ women’s access to cesarean delivery in the absence of traditional medical indications - and indeed, a simple pro- or con- position is never going to do justice to the subtlety of the issue. The right question is not whether women ought to be allowed to choose their delivery approach, but rather, taking the value of women’s autonomy in decision-making around birth as a given, what sorts of guidelines, practices, and social conditions will best promote and protect women’s full inclusion in a safe and positive birth process. PMID:19076937

The bioethics and law paradox: an argument to maintain separateness with a hint of togetherness.

PubMed

Werren, Julia

2007-10-01

This article analyses how bioethics and law interact and work together. The first half of the article provides definitions of both ethics and bioethics. The article then considers a number of different bioethical standpoints to demonstrate the variance of views in relation to bioethics. In addition, the first half of the article focuses on the different regulatory possibilities in regard to bioethical contexts. This demonstrates that law is of central importance to bioethics. This part also shows that even though law and ethics are often used simultaneously to achieve bioethical goals, law and ethics cannot be used interchangeably. Thus, even though it is somewhat inevitable that law will be used in the pursuit of the goals of bioethics, bioethics and bioethical principle should not be merely a vehicle for law-makers to utilise. The second half of the article focuses on the issues of autonomy and consent to demonstrate how law and ethics have developed in one of the foundation areas of bioethics.

“Eugenics talk” and the language of bioethics

PubMed Central

Wilkinson, S

2008-01-01

In bioethical discussions of preimplantation genetic diagnosis and prenatal screening, accusations of eugenics are commonplace, as are counter-claims that talk of eugenics is misleading and unhelpful. This paper asks whether “eugenics talk”, in this context, is legitimate and useful or something to be avoided. It also looks at the extent to which this linguistic question can be answered without first answering relevant substantive moral questions. Its main conclusion is that the best and most non-partisan argument for avoiding eugenics talk is the Autonomy Argument. According to this, eugenics talk per se is not wrong, but there is something wrong with using its emotive power as a means of circumventing people’s critical–rational faculties. The Autonomy Argument does not, however, tell against eugenics talk when such language is used to shock people into critical–rational thought. These conclusions do not depend on unique features of eugenics: similar considerations apply to emotive language throughout bioethics. PMID:18511622

[Euthanasia and the paradoxes of autonomy].

PubMed

Siqueira-Batista, Rodrigo; Schramm, Fermin Roland

2008-01-01

The principle of respect for autonomy has proved very useful for bioethical arguments in favor of euthanasia. However unquestionable its theoretical efficacy, countless aporiae can be raised when conducting a detailed analysis of this concept, probably checkmating it. Based on such considerations, this paper investigates the principle of autonomy, starting with its origins in Greek and Christian traditions, and then charting some of its developments in Western cultures through to its modern formulation, a legacy of Immanuel Kant. The main paradoxes of this concept are then presented in the fields of philosophy, biology, psychoanalysis and politics, expounding several of the theoretical difficulties to be faced in order to make its applicability possible within the scope of decisions relating to the termination of life.

The moral agency of institutions: effectively using expert nurses to support patient autonomy.

PubMed

Charles, Sonya

2017-08-01

Patient autonomy-with an emphasis on informed consent and the right to refuse treatment-is a cornerstone of modern bioethics. Within discussions about patient autonomy, feminist bioethicists have argued for a relational approach to autonomy. Under a relational framework, we must look beyond the individual moment of choice to include the role relationships and specific contexts can play in supporting or undermining autonomy. Given the day-to-day interactions they have with patients, nurses play a significant role in helping patients understand the nature of their illnesses and make truly informed decisions. However, the skills of expert nurses also support patient autonomy in more subtle ways. Specifically, nurses develop skills of attunement that help them to find subtle ways to support patient autonomy. However, in order to effectively do this, nurses need institutions that support their professional autonomy. In this paper, I look at the ways nurses have been inhibited in their professional autonomy both as a profession and as individual practitioners. I argue that turning our attention to institutions and the role they play in supporting or undermining nurses' autonomy can help promote nurses' professional autonomy and thereby enhance patient autonomy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

[The law of rights and duties of persons in health care from the viewpoint of bioethics].

PubMed

León, Francisco Javier

2012-11-01

The enactment of Law 20.584 in April of 2012 promotes a change in the physician-patient relationship, with recognition of people's rights and duties in healthcare by all the health professional and entities. The legal obligation, and not only the ethical one, as it currently happens, for humane treatment and regard for the dignity of the sick, informed consent, medical data confidentiality, the possibility to reject treatments, etc., is established. This review analyzes the contents of this law, especially those parts affecting physicians. It exposes its limitations, especially those related to minors' consent, living wills and research in people with mental disabilities. It also highlights positive aspects such as the promotion of a humane healthcare. This Law begins to consider patients' autonomy shyly. However, from a bioethical viewpoint, there are still many issues to be perfected such as healthcare humanization, excellence of patient care, healthcare quality and medical professionalism, considering competence, social service, charity and solidarity. It is a first step that must be supplemented with a greater development of medical deontology, and the development of clinical and institutional bioethics.

Teaching Bioethics in High Schools

ERIC Educational Resources Information Center

Araújo, Joana; Gomes, Carlos Costa; Jácomo, António; Pereira, Sandra Martins

2017-01-01

Objective: The Bioethics Teaching in Secondary Education (Project BEST) aims to promote the teaching of bioethics in secondary schools. This paper describes the development and implementation of the programme in Portugal. Design: Programme development involved two main tasks: (1) using the learning tools previously developed by the US Northwest…

Experiencing everyday ethics in context: frontline data collectors perspectives and practices of bioethics.

PubMed

Kingori, Patricia

2013-12-01

Data collectors play a vital role in producing scientific knowledge. They are also an important component in understanding the practice of bioethics. Yet, very little attention has been given to their everyday experiences or the context in which they are expected to undertake these tasks. This paper argues that while there has been extensive philosophical attention given to 'the what' and 'the why' in bioethics - what action is taken place and why - these should be considered along 'the who' - who are the individuals tasked with bioethics and what can their insights bring to macro-level and abstract discussions of bioethics. This paper will draw on the philosophical theories of Paul Ricoeur which compliments a sociological examination of data collectors experiences and use of their agency coupled with a concern for contextual and institutional factors in which they worked. In emphasising everyday experiences and contexts, I will argue that data collectors' practice of bioethics was shaped by their position at the frontline of face-to-face interactions with medical research participants and community members, alongside their own personal ethical values and motivations. Institutional interpretations of bioethics also imposed certain parameters on their bioethical practice but these were generally peripheral to their sense of obligation and the expectations conferred in witnessing the needs and suffering of those they encountered during their quotidian research duties. This paper will demonstrate that although the principle of autonomy has dominated discussions of bioethics and gaining informed consent seen as a central facet of ethical research by many research institutions, for data collectors this principle was seldom the most important marker of their ethical practice. Instead, data collectors were concerned with remedying the dilemmas they encountered through enacting their own interpretations of justice and beneficence and imposing their own agency on the

Lessons Learned from Undergraduate Students in Designing a Science-Based Course in Bioethics

PubMed Central

Loike, John D.; Rush, Brittany S.; Schweber, Adam; Fischbach, Ruth L.

2013-01-01

Columbia University offers two innovative undergraduate science-based bioethics courses for student majoring in biosciences and pre–health studies. The goals of these courses are to introduce future scientists and healthcare professionals to the ethical questions they will confront in their professional lives, thus enabling them to strategically address these bioethical dilemmas. These courses incorporate innovative pedagogical methods, case studies, and class discussions to stimulate the students to think creatively about bioethical issues emerging from new biotechnologies. At the end of each course, each student is required to submit a one-page strategy detailing how he or she would resolve a bioethical dilemma. Based on our experience in teaching these courses and on a qualitative analysis of the students’ reflections, we offer recommendations for creating an undergraduate science-based course in bioethics. General recommendations include: 1) integrating the science of emerging biotechnologies, their ethical ramifications, and contemporary bioethical theories into interactive class sessions; 2) structuring discussion-based classes to stimulate students to consider the impact of their moral intuitions when grappling with bioethical issues; and 3) using specific actual and futuristic case studies to highlight bioethical issues and to help develop creative problem-solving skills. Such a course sparks students’ interests in both science and ethics and helps them analyze bioethical challenges arising from emerging biotechnologies. PMID:24297296

Relational autonomy or undue pressure? Family's role in medical decision-making.

PubMed

Ho, Anita

2008-03-01

The intertwining ideas of self-determination and well-being have received tremendous support in western bioethics. They have been used to reject medical paternalism and to justify patients' rights to give informed consent (or refusal) and execute advanced directives. It is frequently argued that everyone is thoroughly unique, and as patients are most knowledgeable of and invested in their own interests, they should be the ones to make voluntary decisions regarding their care. Two results of the strong focus on autonomy are the rejection of the image of patients as passive care recipients and the suspicion against paternalistic influence anyone may have on patients' decision-making process. Although the initial focus in western bioethics was on minimizing professional coercion, there has been a steady concern of family's involvement in adult patients' medical decision-making. Many worry that family members may have divergent values and priorities from those of the patients, such that their involvement could counter patients' autonomy. Those who are heavily involved in competent patients' decision-making are often met with suspicion. Patients who defer to their families are sometimes presumed to be acting out of undue pressure. This essay argues for a re-examination of the notions of autonomy and undue pressure in the contexts of patienthood and relational identity. In particular, it examines the characteristics of families and their role in adult patients' decision-making. Building on the feminist conception of the relational self and examining the context of contemporary institutional medicine, this paper argues that family involvement and consideration of family interests can be integral in promoting patients' overall agency. It argues that, in the absence of abuse and neglect, respect for autonomy and agency requires clinicians to abide by patients' expressed wishes.

Bioethical and Other Philosophical Considerations in Positive Psychiatry

PubMed Central

Singh, Ajai R.; Singh, Shakuntala A.

2016-01-01

The paper begins by asserting the need for bioethical and related philosophical considerations in the emerging subspecialty Positive Psychiatry. Further discussion proceeds after offering operational definitions of the concepts fundamental to the field – Bioethics, Positive Psychology, Positive Psychiatry and Positive Mental Health - with their conceptual analysis to show their areas of connect and disconnect. It then studies the implications of positive and negative findings in the field, and presents the Positive Psychosocial Factors (PPSFs) like Resilience, Optimism, Personal Mastery, Wisdom, Religion/Spirituality, Social relationships and support, Engagement in pleasant events etc. It then evaluates them on the basis of the 4-principled bioethical model of Beneficence, Non-malfeasance, Autonomy and Justice (Beauchamp and Childress, 2009[5], 2013[6]), first offering a brief clarification of these principles and then their bioethical analysis based on the concepts of ‘Common Morality’, ‘Specific Morality’, ‘Specification’, ‘Balancing’ and ‘Double Effects’. The paper then looks into the further development of the branch by studying the connectivity, synergy and possible antagonism of the various Positive Psychosocial Factors, and presents technical terms in place of common terms so that they carry least baggage. It also takes note of the salient points of caution and alarm that many incisive analysts have presented about further development in the related field of Positive Mental Health. Finally, the paper looks at where, and how, the field is headed, and why, if at all, it is proper it is headed there, based on Aristotle's concept of the four causes - Material, Efficient, Formal and Final. Suitable case vignettes are presented all through the write-up to clarify concepts. PMID:28031624

Bioethical and Other Philosophical Considerations in Positive Psychiatry.

PubMed

Singh, Ajai R; Singh, Shakuntala A

2016-01-01

The paper begins by asserting the need for bioethical and related philosophical considerations in the emerging subspecialty Positive Psychiatry. Further discussion proceeds after offering operational definitions of the concepts fundamental to the field - Bioethics, Positive Psychology, Positive Psychiatry and Positive Mental Health - with their conceptual analysis to show their areas of connect and disconnect. It then studies the implications of positive and negative findings in the field, and presents the Positive Psychosocial Factors (PPSFs) like Resilience, Optimism, Personal Mastery, Wisdom, Religion/Spirituality, Social relationships and support, Engagement in pleasant events etc. It then evaluates them on the basis of the 4-principled bioethical model of Beneficence, Non-malfeasance, Autonomy and Justice (Beauchamp and Childress, 2009[5], 2013[6]), first offering a brief clarification of these principles and then their bioethical analysis based on the concepts of 'Common Morality', 'Specific Morality', 'Specification', 'Balancing' and 'Double Effects'. The paper then looks into the further development of the branch by studying the connectivity, synergy and possible antagonism of the various Positive Psychosocial Factors, and presents technical terms in place of common terms so that they carry least baggage. It also takes note of the salient points of caution and alarm that many incisive analysts have presented about further development in the related field of Positive Mental Health. Finally, the paper looks at where, and how, the field is headed, and why, if at all, it is proper it is headed there, based on Aristotle's concept of the four causes - Material, Efficient, Formal and Final. Suitable case vignettes are presented all through the write-up to clarify concepts.

The many faces of autonomy.

PubMed

Gracia, Diego

2012-02-01

What does autonomy mean from a moral point of view? Throughout Western history, autonomy has had no less than four different meanings. The first is political: the capacity of old cities and modern states to give themselves their own laws. The second is metaphysical, and was introduced by Kant in the second half of the 18th century. In this meaning, autonomy is understood as an intrinsic characteristic of all rational beings. Opposed to this is the legal meaning, in which actions are called autonomous when performed with due information and competency and without coercion. This last meaning, the most frequently used in bioethics, is primarily legal instead of moral. Is there a proper moral meaning of the word autonomy? If so, this would be a fourth meaning. Acts can only be called moral when they are postconventional (using the terminology coined by Lawrence Kohlberg), inner-directed (as expressed by David Riesman), and responsible (according to Hannah Arendt). Such acts are autonomous in this new, fourth, and to my mind, the only one proper, moral meaning. The goal of ethics cannot be other than forming human beings capable of making autonomous and responsible decisions, and doing so because they think this is their duty and not because of any other nonmoral motivation, like comfort, convenience, or satisfaction. The goal of ethics is to promote postconventional and mature human beings. This was what Socrates tried to do with the young people of Athens. And it is also the objective of every course of ethics and of any process of training.

Bioethical Considerations of Advancing the Application of Marine Biotechnology and Aquaculture

PubMed Central

Harrell, Reginal M.

2017-01-01

Normative ethical considerations of growth of the marine biotechnology and aquaculture disciplines in biopharming, food production, and marine products commercialization from a bioethical perspective have been limited. This paucity of information begs the question of what constitutes a bioethical approach (i.e., respect for individuals or autonomy; beneficence, nonmaleficence, and justice) to marine biotechnology and aquaculture, and whether it is one that is appropriate for consideration. Currently, thoughtful discussion on the bioethical implications of use, development, and commercialization of marine organisms or their products, as well as potential environmental effects, defaults to human biomedicine as a model. One must question the validity of using human bioethical principlism moral norms for appropriating a responsible marine biotechnology and aquaculture ethic. When considering potential impacts within these disciplines, deference must be given to differing value systems in order to find common ground to advance knowledge and avoid emotive impasses that can hinder the science and its application. The import of bioethical considerations when conducting research and/or production is discussed. This discussion is directed toward applying bioethical principles toward technology used for food, biomedical development (e.g., biopharming), or as model species for advancement of knowledge for human diseases. PMID:28672802

Bioethical Considerations of Advancing the Application of Marine Biotechnology and Aquaculture.

PubMed

Harrell, Reginal M

2017-06-24

Normative ethical considerations of growth of the marine biotechnology and aquaculture disciplines in biopharming, food production, and marine products commercialization from a bioethical perspective have been limited. This paucity of information begs the question of what constitutes a bioethical approach (i.e., respect for individuals or autonomy; beneficence, nonmaleficence, and justice) to marine biotechnology and aquaculture, and whether it is one that is appropriate for consideration. Currently, thoughtful discussion on the bioethical implications of use, development, and commercialization of marine organisms or their products, as well as potential environmental effects, defaults to human biomedicine as a model. One must question the validity of using human bioethical principlism moral norms for appropriating a responsible marine biotechnology and aquaculture ethic. When considering potential impacts within these disciplines, deference must be given to differing value systems in order to find common ground to advance knowledge and avoid emotive impasses that can hinder the science and its application. The import of bioethical considerations when conducting research and/or production is discussed. This discussion is directed toward applying bioethical principles toward technology used for food, biomedical development (e.g., biopharming), or as model species for advancement of knowledge for human diseases.

The origins and consequences of patient autonomy: a 25-year retrospective.

PubMed

Rothman, D J

2001-01-01

This essay explores the evolution of the tension between the principles of autonomy and beneficence in American health care over the past several decades. In retrospect it is clear that the social movements of the 1960s and 70s set the tone and the goals for the emergence of a new emphasis on patient autonomy. Indeed, the impact of civil liberties-minded lawyers on the promotion of a commitment to autonomy is far more vital than the term "bioethics" commonly suggests. Tracing the impact of this principle on clinical encounters over the past 25 years makes apparent that consumers have extended their influence over a wide range of treatment decisions. This influence is now being reinforced by an extraordinary information revolution, which includes the computer, the web, the dot.coms, the search engines, and such novel practices as Direct-to-Consumer advertising by pharmaceutical companies. The impact of these developments may be seen in such diverse issues as physician-assisted suicide and the failure of national health insurance initiatives.

[Bioethics of protection and the laic compassion: the moral debate on euthanasia].

PubMed

Siqueira-Batista, Rodrigo; Schramm, Fermin Roland

2009-01-01

The bioethical debate on euthanasia (good death) has been classically polarized between the principles of sacredness of life--the argumentation against--and the quality of life, represented by the vicarious principle of respect for autonomy--the argumentation in favor. In both cases the question is built around the pertinence and moral legitimacy--or not--of the individual possibility to decide about the termination of ones own existence, demanding for oneself a good death. Undoubtedly, euthanasia always implies besides the self, the other, who will either carry out the action--or hold to non-action--culminating in the abbreviation of life. To propose a discussion about this last referred issue, based on the bioethics of protection theoretical references and the concept of laic compassion is the scope of the present essay.

Why Bioethics Needs a Disability Moral Psychology.

PubMed

Stramondo, Joseph A

2016-05-01

The deeply entrenched, sometimes heated conflict between the disability movement and the profession of bioethics is well known and well documented. Critiques of prenatal diagnosis and selective abortion are probably the most salient and most sophisticated of disability studies scholars' engagements with bioethics, but there are many other topics over which disability activists and scholars have encountered the field of bioethics in an adversarial way, including health care rationing, growth-attenuation interventions, assisted reproduction technology, and physician-assisted suicide. The tension between the analyses of the disabilities studies scholars and mainstream bioethics is not merely a conflict between two insular political groups, however; it is, rather, also an encounter between those who have experienced disability and those who have not. This paper explores that idea. I maintain that it is a mistake to think of this conflict as arising just from a difference in ideology or political commitments because it represents a much deeper difference-one rooted in variations in how human beings perceive and reason about moral problems. These are what I will refer to as variations of moral psychology. The lived experiences of disability produce variations in moral psychology that are at the heart of the moral conflict between the disability movement and mainstream bioethics. I will illustrate this point by exploring how the disability movement and mainstream bioethics come into conflict when perceiving and analyzing the moral problem of physician-assisted suicide via the lens of the principle of respect for autonomy. To reconcile its contemporary and historical conflict with the disability movement, the field of bioethics must engage with and fully consider the two groups' differences in moral perception and reasoning, not just the explicit moral and political arguments of the disability movement. © 2016 The Hastings Center.

Bioethics and its gatekeepers: does institutional racism exist in leading bioethics journals?

PubMed

Chattopadhyay, Subrata; Myser, Catherine; De Vries, Raymond

2013-03-01

Who are the gatekeepers in bioethics? Does editorial bias or institutional racism exist in leading bioethics journals? We analyzed the composition of the editorial boards of 14 leading bioethics journals by country. Categorizing these countries according to their Human Development Index (HDI), we discovered that approximately 95 percent of editorial board members are based in (very) high-HDI countries, less than 4 percent are from medium-HDI countries, and fewer than 1.5 percent are from low-HDI countries. Eight out of 14 leading bioethics journals have no editorial board members from a medium- or low-HDI country. Eleven bioethics journals have no board members from low-HDI countries. This severe underrepresentation of bioethics scholars from developing countries on editorial boards suggests that bioethics may be affected by institutional racism, raising significant questions about the ethics of bioethics in a global context.

Respect for Autonomy in Light of Neuropsychiatry.

PubMed

Müller, Sabine

2017-06-01

Bioethics needs an elaborated concept of autonomy based on empirical knowledge about the prerequisites of the capacity of autonomy. Whereas Beauchamp and Childress, and many other bioethicists have discussed social influences on the capacity of autonomy in depth, neurobiological influences have received less attention. A comprehensive concept of autonomy should consider both social and biological factors that can diminish the capacity of autonomy. This article focuses on neurobiological influences that can reduce the capacity of autonomy. The thesis of this article is that the integration of neuropsychiatric knowledge into the concept of autonomy is essential for (1) evaluating demands for harmful medical treatments which might be caused by a brain disease, and (2) deciding on involuntary treatments of patients who suffer from substantial lack of autonomy due to neuropsychiatric disorders. Diametrically opposed to such a comprehensive concept of the capacity of autonomy is the concept of 'liberty of illness'. In Germany, this concept is supported not only by anti-psychiatric groups but also by the Federal Constitutional Court. Several real cases demonstrate how the brain can be 'hijacked' by parasites, antibodies or technical devices. Applying the concept of 'liberty of illness' to persons whose decision-making capacity is severely affected by neuropsychiatric disorders is cynical. These patients neither chose their disease nor would refuse effective treatment if their will was not disturbed by the disease. Respect for autonomy should be understood as the positive obligation to save, support or restore the biological prerequisites of the capacity for autonomous decision-making. © 2017 John Wiley & Sons Ltd.

The role of 'accompagnement' in the end-of-life debate in France: from solidarity to autonomy.

PubMed

Gaille, Marie; Horn, Ruth

2016-12-01

This article traces the way autonomy has become a recognised value in health care in France. In a country that based its social fundamentals on the very idea of solidarity for many years, autonomy has long been considered a foreign 'Anglo-American principle'. Taking the example of the end-of-life debate, the article shows, however, how the use of the French term 'accompagnement' allowed autonomy to be redefined and to be associated with the concept of solidarity. Exploring the arguments used over the past 25 years in professional guidelines, parliamentary reports, ethics committee reports, and legal texts, the authors describe the shift that took place in public and legal discourses on end-of-life care. The analysis demonstrates how the scope of autonomy has been limited by other social values, such as the protection of the dying person, in order to become an accepted social value in its own right. The example of the French end-of-life debate shows that depending on how the concept of autonomy is adapted and applied in a specific context, it can be compatible with the idea of solidarity. Such compatibility has been challenged previously in the international bioethics debate. By demonstrating the possibility of combining autonomy and solidarity, this article makes an important contribution to the international bioethics debate and to the dialogue between countries that are often perceived as significantly different.

OPPORTUNITIES IN REFORM: BIOETHICS AND MENTAL HEALTH ETHICS

PubMed Central

WILLIAMS, ARTHUR ROBINSON

2015-01-01

This year marks the first year of implementation for both the Patient Protection and Affordable Care Act and the Mental Health Parity and Addiction Equity Act in the United States. Resultantly healthcare reform is moving in the direction of integrating care for physical and mental illness, nudging clinicians to consider medical and psychiatric comorbidity as the expectation rather than the exception. Understanding the intersections of physical and mental illness with autonomy and self-determination in a system realigning its values so fundamentally therefore becomes a top priority for clinicians. Yet Bioethics has missed opportunities to help guide clinicians through one of medicine’s most ethically rich and challenging fields. Bioethics’ distancing from mental illness is perhaps best explained by two overarching themes: 1) an intrinsic opposition between approaches to personhood rooted in Bioethics’ early efforts to protect the competent individual from abuses in the research setting; and 2) structural forces, such as deinstitutionalization, the Patient Rights Movement, and managed care. These two themes help explain Bioethics’ relationship to mental health ethics and may also guide opportunities for rapprochement. The potential role for Bioethics may have the greatest implications for international human rights if bioethicists can re-energize an understanding of autonomy as not only free from abusive intrusions but also with rights to treatment and other fundamental necessities for restoring freedom of choice and self-determination. Bioethics thus has a great opportunity amid healthcare reform to strengthen the important role of the virtuous and humanistic care provider. PMID:26424211

What deserves our respect? Reexamination of respect for autonomy in the context of the management of chronic conditions.

PubMed

Enzo, Aya; Okita, Taketoshi; Asai, Atsushi

2018-05-29

The global increase in patients with chronic conditions has led to increased interest in ethical issues regarding such conditions. A basic biomedical principle-respect for autonomy-is being reexamined more critically in its clinical implications. New accounts of this basic principle are being proposed. While new accounts of respect for autonomy do underpin the design of many public programs and policies worldwide, addressing both chronic disease management and health promotion, the risk of applying such new accounts to clinical setting remain understudied. However, the application of new accounts of respect for autonomy to clinical settings could support disrespectful attitudes toward or undue interference with patients with chronic conditions. Reconsidering autonomy and respect using Kantian accounts, this paper proposes respect for persons as an alternative basic bioethical principle to respect for autonomy. Unlike the principle of respect for persons in the Belmont Report, our principle involves respecting any patient's decisions, behaviors, emotions, or life-style regardless of his or her "autonomous" capabilities. Thus, attitudes toward patients should be no different irrespective of the assessment of their decisional or executive capabilities.

A half century of electronic fetal monitoring and bioethics: silence speaks louder than words.

PubMed

Sartwelle, Thomas P; Johnston, James C; Arda, Berna

2017-01-01

Bioethics abolished the prevailing Hippocratic tenet instructing physicians to make treatment decisions, replacing it with autonomy through informed consent. Informed consent allows the patient to choose treatment after options are explained by the physician. The appearance of bioethics in 1970 coincided with the introduction of electronic fetal monitoring (EFM), which evolved to become the fetal surveillance modality of choice for virtually all women in labor. Autonomy rapidly pervaded all medical procedures, but there was a clear exemption for EFM. Even today, EFM remains immune to the doctrine of informed consent despite continually mounting evidence which proves the procedure is nothing more than myth, illusion and junk science that subjects mothers and babies alike to increased risks of morbidity and mortality. And ethicists have remained utterly silent through a half century of EFM misuse. Our article explores this egregious ethical failure by reviewing EFM's lack of clinical efficacy, discussing the EFM related harm to mothers and babies, and focusing on the reasons that this obstetrical procedure eluded the revolutionary change from the Hippocratic tradition to autonomy through informed consent.

Bioethics governance in Israel: an expert regime.

PubMed

Shalev, Carmel; Hashiloni-Dolev, Yael

2011-01-01

This paper provides an overview of bioethics governance in Israel through an analytical description of the legal framework for the interface between individuals and biomedical practices. There is no national agency with general oversight of bioethics policy and decision making, and the rules that apply to individual usage of biomedical technologies are laid down in a multitude of different statutes, regulations and administrative directives. Expert committees play a central role in this regulatory system in two capacities: as governmental advisory bodies that recommend policy; and as decision-making bodies that resolve conflicts around patients' rights or grant individual access to biomedical technologies. This decentralised system of governance through expert committees allows for adaptation to dynamic technological developments and flexibility in accommodating creative societal usage. At the same time the experts are the agents of the state's bio-power at the expense of personal autonomy and open public deliberation. The paper is part of a larger study investigating Israel's bioethics governance and its regime of experts, which includes an examination of the normative level of regulation, and an analysis of the composition of the expert committees. Our findings suggest that Israel has a decentralised system of governance with piecemeal regulation that has established a bioethics technocracy, governed by the ministry of health and dominated by the medical profession. The present paper is confined to a description and discussion of the legal framework of Israel's expert bioethics regime. Here, our major conclusion is that Israel has established a technocracy of official expert ethics committees, which controls life and death decisions.

Confronting as autonomy promotion: Speaking up against discrimination and psychological well-being in racial minorities.

PubMed

Sanchez, Diana T; Himmelstein, Mary S; Young, Danielle M; Albuja, Analia F; Garcia, Julie A

2016-09-01

Few studies have considered confrontation in the context of coping with discriminatory experiences. These studies test for the first time whether confronting racial discrimination is associated with greater psychological well-being and physical health through the promotion of autonomy. In two separate samples of racial minorities who had experienced racial discrimination, confrontation was associated with greater psychological well-being, and this relationship was mediated by autonomy promotion. These findings did not extend to physical health symptoms. These studies provide preliminary evidence that confrontation may aid in the process of regaining autonomy after experiencing discrimination and therefore promote well-being. © The Author(s) 2015.

The Role of Teachers in Promoting Learner Autonomy in Secondary Schools in Saudi Arabia

ERIC Educational Resources Information Center

Alonazi, Saleema M.

2017-01-01

Today, learner autonomy is considered as a desirable goal in language education. The movement towards learner-centered approaches has resulted in more emphasis on the benefits of learner autonomy in the success of language education. The objective of the study was to investigate the roles of the teachers in promoting learner autonomy in Saudi EFL…

Review of Feminist Bioethics At the Center, On the Margins, edited by Jackie Leach Scully, Laurel E. Baldwin-Ragaven, Petya Fitzpatrick

PubMed Central

2010-01-01

The anthology, Feminist Bioethics, edited by Jackie Leach Scully, Laurel E. Baldwin-Ragaven, and Petya Fitzpatrick, examines how feminist bioethics theoretically and methodologically challenges mainstream bioethics, and whether these approaches are useful for exploring difference in other contexts. It offers critical conceptual analyses of "autonomy", "universality", and "trust", and covers topics such as testing for hereditary cancer, prenatal selection for sexual orientation, midwifery, public health, disability, Indigenous research reform in Australia, and China's one child policy.

Promoting the Avoidance of High-Calorie Snacks: Priming Autonomy Moderates Message Framing Effects

PubMed Central

Pavey, Louisa; Churchill, Sue

2014-01-01

The beneficial effects of gain-framed vs. loss-framed messages promoting health protective behaviors have been found to be inconsistent, and consideration of potential moderating variables is essential if framed health promotion messages are to be effective. This research aimed to determine the influence of highlighting autonomy (choice and freedom) and heteronomy (coercion) on the avoidance of high-calorie snacks following reading gain-framed or loss-framed health messages. In Study 1 (N = 152) participants completed an autonomy, neutral, or heteronomy priming task, and read a gain-framed or loss-framed health message. In Study 2 (N = 242) participants read a gain-framed or loss-framed health message with embedded autonomy or heteronomy primes. In both studies, snacking intentions and behavior were recorded after seven days. In both studies, when autonomy was highlighted, the gain-framed message (compared to the loss-framed message) resulted in stronger intentions to avoid high-calorie snacks, and lower self-reported snack consumption after seven days. Study 2 demonstrated this effect occurred only for participants to whom the information was most relevant (BMI>25). The results suggest that messages promoting healthy dietary behavior may be more persuasive if the autonomy-supportive vs. coercive nature of the health information is matched to the message frame. Further research is needed to examine potential mediating processes. PMID:25078965

Promoting the avoidance of high-calorie snacks: priming autonomy moderates message framing effects.

PubMed

Pavey, Louisa; Churchill, Sue

2014-01-01

The beneficial effects of gain-framed vs. loss-framed messages promoting health protective behaviors have been found to be inconsistent, and consideration of potential moderating variables is essential if framed health promotion messages are to be effective. This research aimed to determine the influence of highlighting autonomy (choice and freedom) and heteronomy (coercion) on the avoidance of high-calorie snacks following reading gain-framed or loss-framed health messages. In Study 1 (N = 152) participants completed an autonomy, neutral, or heteronomy priming task, and read a gain-framed or loss-framed health message. In Study 2 (N = 242) participants read a gain-framed or loss-framed health message with embedded autonomy or heteronomy primes. In both studies, snacking intentions and behavior were recorded after seven days. In both studies, when autonomy was highlighted, the gain-framed message (compared to the loss-framed message) resulted in stronger intentions to avoid high-calorie snacks, and lower self-reported snack consumption after seven days. Study 2 demonstrated this effect occurred only for participants to whom the information was most relevant (BMI>25). The results suggest that messages promoting healthy dietary behavior may be more persuasive if the autonomy-supportive vs. coercive nature of the health information is matched to the message frame. Further research is needed to examine potential mediating processes.

Hospital Bioethics: A Beginning Knowledge Base for the Neonatal Social Worker.

ERIC Educational Resources Information Center

Silverman, Ed

1992-01-01

Notes that life-saving advances in medicine have created difficult ethical and legal dilemmas for health care professionals. Presents beginning knowledge base for bioethical practice, especially in hospital neonatal units. Outlines key elements of bioethical decision making and examines potential social work role from clinical and organizational…

Why the way we consider the body matters – Reflections on four bioethical perspectives on the human body

PubMed Central

Schicktanz, Silke

2007-01-01

Background Within the context of applied bioethical reasoning, various conceptions of the human body are focused upon by the author in relation to normative notions of autonomy. Results The author begins by descriptively exploring some main positions in bioethics from which the "body" is conceptualized. Such positions conflict: the body is that which is constitutive of the individual's experience and perception, or it is conceived of materially or mechanistically; or as a constructed locus, always historically and culturally transformed. The author goes on to suggest a methodological approach that dialectically considers embodiment from four different perspectives: as bodily self-determination, as respect for the bodily unavailability of the other, as care for bodily individuality; and lastly, as acknowledgement of bodily-constituted communities. These four perspectives encompass autonomy in two of its main interpretations: as the capability of a person to act independent of external forces, and as the moral ideal of pursuing individual wishes by means of role distance, self-limitation and universalization. Various bioethical cases are utilized to show how the four perspectives on the body can complement one another. Conclusion The way we consider the body matters. The author's dialectical method allows a premise-critical identification and exploration of bioethical problems concerning the body. The method is potentially applicable to other bioethical problems. PMID:18053201

Institute of Medical Ethics Guidelines for confirmation of appointment, promotion and recognition of UK bioethics and medical ethics researchers.

PubMed

Frith, Lucy; Hooper, Carwyn; Camporesi, Silvia; Douglas, Thomas; Smajdor, Anna; Nottingham, Emma; Fritz, Zoe; Ekberg, Merryn; Huxtable, Richard

2018-05-01

This document is designed to give guidance on assessing researchers in bioethics/medical ethics. It is intended to assist members of selection, confirmation and promotion committees, who are required to assess those conducting bioethics research when they are not from a similar disciplinary background. It does not attempt to give guidance on the quality of bioethics research, as this is a matter for peer assessment. Rather it aims to give an indication of the type, scope and amount of research that is the expected in this field. It does not cover the assessment of other activities such as teaching, policy work, clinical ethics consultation and so on, but these will be mentioned for additional context. Although it mentions the UK's Research Excellence Framework (REF), it is not intended to be a detailed analysis of the place of bioethics in the REF. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Hard times, hard choices: founding bioethics today.

PubMed

Gracia, Diego

1995-07-01

The discussions of these past twenty years have significantly improved our knowledge about the foundation of bioethics and the meaning of the four bioethical principles with concern to at least three different points: that they are organised hierarchically, and therefore not "prima facie" of the same level; that they have exceptions, and consequently lack of absolute character; and that they are neither strictly deontological nor purely teleological. The only absolute principle of moral life can be the abstract and unconcrete respect of human beings. But when determining the material content of this respect, principles become contingent and relative. Therefore, moral reasoning must have necessarily no less than three moments, one absolute but merely formal, namely respect for all human beings, and the other two relative and material. The first material moment is comprised of the four bioethical principles, divided into two levels, one private, including the principles of autonomy and beneficence, and the other one public, including those of nonmaleficence and justice. The second material moment deals with specific cases, and requires analysis of their context, including their circumstances and consequences. Only when following these steps, and therefore balancing principlism and contextualism, can moral reasoning be correct and complete.

Bioethics for clinicians: 22. Jewish bioethics

PubMed Central

Goldsand, Gary; Rosenberg, Zahava R.S.; Gordon, Michael

2001-01-01

Jewish bioethics in the contemporary era emerges from the traditional practice of applying principles of Jewish law (Halacha) to ethical dilemmas. The Bible (written law) and the Talmud (oral law) are the foundational texts on which such deliberations are based. Interpretation of passages in these texts attempts to identify the duties of physicians, patients and families faced with difficult health care decisions. Although Jewish law is an integral consideration of religiously observant Jews, secularized Jewish patients often welcome the wisdom of their tradition when considering treatment options. Jewish bioethics exemplifies how an ethical system based on duties may differ from the secular rights-based model prevalent in North American society. PMID:11332319

Health equality, social justice and the poverty of autonomy.

PubMed

Newdick, Christopher

2017-10-01

How does the concept of autonomy assist public responses to 'lifestyle' diseases? Autonomy is fundamental to bioethics, but its emphasis on self-determination and individuality hardly supports public health policies to eat and drink less and take more exercise. Autonomy rejects a 'nanny' state. Yet, the cost of non-communicable diseases is increasing to individuals personally and to public health systems generally. Health care systems are under mounting and unsustainable pressure. What is the proper responsibility of individuals, governments and corporate interests working within a global trading environment? When public health care resources are unlikely to increase, we cannot afford to be so diffident to the cost of avoidable diseases.

Authorship policies of bioethics journals

PubMed Central

Resnik, David B; Master, Zubin

2014-01-01

Inappropriate authorship is a common problem in biomedical research and may be becoming one in bioethics, due to the increase in multiple authorship. This paper investigates the authorship policies of bioethics journals to determine whether they provide adequate guidance for researchers who submit articles for publication, which can help deter inappropriate authorship. It was found that 63.3% of bioethics journals provide no guidance on authorship; 36.7% provide guidance on which contributions merit authorship, 23.3% provide guidance on which contributions do not merit authorship, 23.3% require authors to take responsibility for their contributions or for the article as a whole, 20% provide guidance on which contributions merit an acknowledgement but not authorship, 6.7% require authors to describe their contributions, and only 3.3% distinguish between authorship in empirical and conceptual research. To provide authors with effective guidance and promote integrity in bioethics research, bioethics journals should adopt authorship policies that address several important topics, such as the qualifications for authorship, describing authorship contributions, taking responsibility for the research and the difference between authorship in empirical and conceptual research. PMID:21266387

Bioethical concerns are global, bioethics is Western

PubMed Central

Chattopadhyay, Subrata; De Vries, Raymond

2009-01-01

Modern bioethics was born in the West and thus reflects, not surprisingly, the traditions of Western moral philosophy and political and social theory. When the work of bioethics was confined to the West, this background of socio-political theory and moral tradition posed few problems, but as bioethics has moved into other cultures - inside and outside of the Western world - it has become an agent of moral imperialism. We describe the moral imperialism of bioethics, discuss its dangers, and suggest that global bioethics will succeed only to the extent that it is local. PMID:19593391

The anthropological approach challenges the conventional approach to bioethical dilemmas: a Kenyan Maasai perspective.

PubMed

Sharif, Thikra; Bugo, John

2015-06-01

The cultural background, religion and societal norms have a huge influence on the decision making process for physicians, patients and their families, when faced with medical ethical dilemmas. While the medical professionals, through their training, can rely on the principles of autonomy, justice, beneficence and non-maleficence to guide them, the patients can only draw from their personal and cultural experiences. To explore some of the challenges that face physicians when presented with ethical dilemmas. A review of the literature on the principles of medical ethics and the cultural practices of the Maasai tribe, as well as, interview, interaction and observation of the patients and family during patient. management. In the Maasai community in Kenya, where family is the center of all attention and decision-making, the listed ethical principles and rules have a very different understanding of the self-determination, and autonomy becomes collective rather than individualistic. Medical practitioners when faced with ethical medical dilemmas are neither comfortable in adopting the conventional bioethical guidelines, nor in offering a health care purely based on cultural and historical practice. In our set up, developing culturally relevant principles of bioethics appears to be the most effective solution in addressing medical ethical dilemmas.

The Exercise of Autonomy by Older Cancer Patients in Palliative Care: The Biotechnoscientific and Biopolitical Paradigms and the Bioethics of Protection

PubMed Central

Niemeyer-Guimarães, Márcio; Schramm, Fermin Roland

2017-01-01

Toward the end of life, older cancer patients with terminal illness often prefer palliative over life-extending care and also prefer to die at home. However, care planning is not always consistent with patients’ preferences. In this article, discussions will be centered on patients’ autonomy of exercising control over their bodies within the current biotechnoscientific paradigm and in the context of population aging. More specifically, the biopolitical strategy of medicine in the context of hospital-centered health care control and of the frail condition of cancer patients in the intensive care unit will be considered in terms of the bioethics of protection. This ethical principle may provide support to these patients by ensuring that they receive appropriate treatment of pain and other physical, psychosocial, and spiritual problems in an attempt to focus attention on the values of the ill person rather than limiting it to the illness. PMID:28469440

Epigenetics and the environment in bioethics.

PubMed

Dupras, Charles; Ravitsky, Vardit; Williams-Jones, Bryn

2014-09-01

A rich literature in public health has demonstrated that health is strongly influenced by a host of environmental factors that can vary according to social, economic, geographic, cultural or physical contexts. Bioethicists should, we argue, recognize this and--where appropriate--work to integrate environmental concerns into their field of study and their ethical deliberations. In this article, we present an argument grounded in scientific research at the molecular level that will be familiar to--and so hopefully more persuasive for--the biomedically-inclined in the bioethics community. Specifically, we argue that the relatively new field of molecular epigenetics provides novel information that should serve as additional justification for expanding the scope of bioethics to include environmental and public health concerns. We begin by presenting two distinct visions of bioethics: the individualistic and rights-oriented and the communitarian and responsibility-oriented. We follow with a description of biochemical characteristics distinguishing epigenetics from genetics, in order to emphasize the very close relationship that exists between the environment and gene expression. This then leads to a discussion of the importance of the environment in determining individual and population health, which, we argue, should shift bioethics towards a Potterian view that promotes a communitarian-based sense of responsibility for the environment, in order to fully account for justice considerations and improve public health. © 2012 John Wiley & Sons Ltd.

Autonomy in the medico-legal courtroom: a principle fit for purpose?

PubMed

Foster, C

2014-01-01

This article examines the way that the principle of autonomy is handled in (mostly English) law. The law pays loud lip-service to autonomy, saying that it is the governing principle in many areas. This is particularly true for cases involving bioethics. The courts are rarely philosophically explicit about which account of autonomy is favoured, but three accounts (Millian self-determination, Kantian deontology, and relational autonomy-in which the social nexus of the subject is explicitly recognised) can be identified. Despite the law's traditional rhetorical insistence that autonomy rules absolutely, that rule is, in practice, unworkable. Other principles, such as beneficence and dignity, have to be drafted in to help. Much of the philosophical work that autonomy should do in the law is delegated to the notion of capacity, but that notion too is insufficiently examined by the courts, and is problematic.

[Ethics in anorexia nervosa: autonomy, beneficence or responsibility?].

PubMed

Figueroa, Gustavo

2008-05-01

In patients with anorexia nervosa, ethical dilemmas will appear in case of difficult and serious medical situations. Although the principle of beneficence could be used to argue for the use of coercive medical therapies, the respect for autonomy must take precedence. The latter is a central principle of bioethics. However, the interactions between autonomy, beneficence, non-maleficence, and justice become quite complex when these patients need to be treated. Difficulties must be overcome and a balance between these considerations must be reached. This paper gives an account of ethical values relevant to moral assessment in anorexia nervosa: conviction, responsibility and care.

The importance of supporting adolescents' autonomy in promoting physical-sport exercise.

PubMed

Moreno-Murcia, Juan Antonio; Hernández, Elisa Huéscar

2013-01-01

This study was conducted toward the objective of analyzing certain factors that influence physical activity in Spanish adolescent students using self-determination theory (Deci & Ryan, 1985; 2000) as a framework. Participants included 698 physical education students whose perception of the autonomy support provided by their teachers was assessed in and out of the class context. Also assessed were social goals of responsibility and relationship with others, basic psychological needs, and intrinsic motivation, which is part of self-determination theory (SDT). Finally, the "intention" factor posited by the theory of planned behavior (TPB) and students' rate of exercise in the last twelve months were considered. The results of structural equations modeling suggest autonomy education, autonomy support, and social goals positively predicted certain psychological mediators, which in turn positively predicted students' intrinsic motivation, which was a positive predictor of intention, and that of rate of exercise. The results also highlight the benefit of promoting autonomy to enhance students' physical exercise practice.

Gender context of personalism in bioethics.

PubMed

Amzat, Jimoh; Grandi, Giovanni

2011-12-01

Personalism is one of the philosophical perspectives which hold that the reality in person and the human person has the highest intrinsic value. This paper makes reference to Louis Janssens' eight criteria in adequate consideration of the human person but further argues that there is need to consider people as situated agents especially within gender relational perspectives. The paper identifies gender as an important social construction that shapes the consideration of the human persons within socio-spatial spheres. The main crux of the paper is that there is a gender context of personalism and this has profound implications for bioethical agendas. Gender is part of the human condition, especially when we philosophically or sociologically engage the notion of equity and equality within the social system, because social realities in the relational perspective are not impartial, impersonal and equal. Gender does not determine morality but it plays a role in morality and expectations from moral agents. Women have been categorised as a sociological group because their integrity, freedom/autonomy and dignity (which are basic concerns of bioethics) are capable of being threatened. A gender perspective provides important incentives for moral theory which searches for possible conceptual imbalances or blind spots in ethical reflections. The paper refers to Sen's faces of gender inequality and expands on the notion that natality inequality is one of the fundamental levels of gender inequality, which in turn is the primary starting agenda in bioethics. The paper avers that the recognition of the fundamental importance of gender to the organization of social reality and the development of personal identities have important practical implications for bioethics. © 2011 Blackwell Publishing Ltd.

The Evolving Ethics of Dialysis in the United States: A Principlist Bioethics Approach

PubMed Central

Mehrotra, Rajnish; Tonelli, Mark R.; Lam, Daniel Y.

2016-01-01

Throughout the history of dialysis, four bioethical principles — beneficence, nonmaleficence, autonomy and justice — have been weighted differently based upon changing forces of technologic innovation, resource limitation, and societal values. In the 1960s, a committee of lay people in Seattle attempted to fairly distribute a limited number of maintenance hemodialysis stations guided by considerations of justice. As technology advanced and dialysis was funded under an amendment to the Social Security Act in 1972, focus shifted to providing dialysis for all in need while balancing the burdens of treatment and quality of life, supported by the concepts of beneficence and nonmaleficence. At the end of the last century, the importance of patient preferences and personal values became paramount in medical decisions, reflecting a focus on the principle of autonomy. More recently, greater recognition that health care financial resources are limited makes fair allocation more pressing, again highlighting the importance of distributive justice. The varying application and prioritization of these four principles to both policy and clinical decisions in the United States over the last 50 years makes the history of hemodialysis an instructive platform for understanding principlist bioethics. As medical technology evolves in a landscape of changing personal and societal values, a comprehensive understanding of an ethical framework for evaluating appropriate use of medical interventions enables the clinician to systematically negotiate and optimize difficult ethical situations. PMID:26912540

[Bioethical analysis of the Brazilian Dentistry Code of Ethics].

PubMed

Pyrrho, Monique; do Prado, Mauro Machado; Cordón, Jorge; Garrafa, Volnei

2009-01-01

The Brazilian Dentistry Code of Ethics (DCE), Resolution CFO-71 from May 2006, is an instrument created to guide dentists' behavior in relation to the ethical aspects of professional practice. The purpose of the study is to analyze the above mentioned code comparing the deontological and bioethical focuses. In order to do so, an interpretative analysis of the code and of twelve selected texts was made. Six of the texts were about bioethics and six on deontology, and the analysis was made through the methodological classification of the context units, textual paragraphs and items from the code in the following categories: the referentials of bioethical principlism--autonomy, beneficence, nonmaleficence and justice -, technical aspects and moral virtues related to the profession. Together the four principles represented 22.9%, 39.8% and 54.2% of the content of the DCE, of the deontological texts and of the bioethical texts respectively. In the DCE, 42% of the items referred to virtues, 40.2% were associated to technical aspects and just 22.9% referred to principles. The virtues related to the professionals and the technical aspects together amounted to 70.1% of the code. Instead of focusing on the patient as the subject of the process of oral health care, the DCE focuses on the professional, and it is predominantly turned to legalistic and corporate aspects.

Reflections on bioethics: consolidation of the principle of autonomy and legal aspects.

PubMed

Segre, M

1999-01-01

The author highlights the importance of emotions in all ethical reflections. He describes the most common positions of ethicists employing duties and rights as the basis for ethical thought. The author, goes to Freudian theory as viewed by the utilitarians, stating that the 'quest for pleasure' is not necessarily egocentric, especially for adults. For example, the feeling of solidarity emerges 'from the inside out', making irrelevant all the emphasis laid on obedience to duty (from the outside in). The article questions the essence of Kantian theory, based exclusively on 'reason' with disregard for feelings, by establishing what he considers a 'positivist' view of rational thought. It emphasizes the principle of autonomy, which it seen as basically opposing the principles of beneficence and fairness. It is proposed that the latter should be seen as what he calls heteronomy (a concept different from that of the rational ethicists). In theory, autonomy is not assigned to anyone on the basis of an external assessment. Any intervention in individual autonomy must be made (by the intervenor) when it becomes imperative in the defense of social or cultural values. The article distinguishes between ethics and morals) and states that the sole acceptable ethical principle is that ethics (theoretically) has no principle.

Evaluation of a standard provision versus an autonomy promotive exercise referral programme: rationale and study design.

PubMed

Jolly, Kate; Duda, Joan L; Daley, Amanda; Eves, Frank F; Mutrie, Nanette; Ntoumanis, Nikos; Rouse, Peter C; Lodhia, Rekha; Williams, Geoffrey C

2009-06-08

The National Institute of Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the utility of a Self Determination Theory (SDT)-based exercise referral consultation. An exploratory cluster randomised controlled trial comparing standard provision exercise on prescription with a Self Determination Theory-based (SDT) exercise on prescription intervention. 347 people referred to the Birmingham Exercise on Prescription scheme between November 2007 and July 2008. The 13 exercise on prescription sites in Birmingham were randomised to current practice (n = 7) or to the SDT-based intervention (n = 6).Outcomes measured at 3 and 6-months: Minutes of moderate or vigorous physical activity per week assessed using the 7-day Physical Activity Recall; physical health: blood pressure and weight; health status measured using the Dartmouth CO-OP charts; anxiety and depression measured by the Hospital Anxiety and Depression Scale and vitality measured by the subjective vitality score; motivation and processes of change: perceptions of autonomy support from the advisor, satisfaction of the needs for competence, autonomy, and relatedness via physical activity, and motivational regulations for exercise. This trial will determine whether an exercise referral programme based on Self Determination Theory increases physical activity and other health outcomes compared to a standard programme and will test the underlying SDT-based process model (perceived autonomy support, need satisfaction, motivation regulations, outcomes) via structural equation modelling. The trial is registered as Current Controlled trials ISRCTN07682833.

A Republican Egalitarian Approach to Bioethics: The Case of the Unrecognized Bedouin Villages in Israel.

PubMed

Filc, Dani; Davidovich, Nadav; Gottlieb, Nora

2016-10-01

This article argues that current, mainstream, liberal approaches to the right to health and to bioethics are not adequately aware of the structural and political character of health and illness. We propose a radical egalitarian definition of the right to health as the basis for the discussion of a republican egalitarian perspective on bioethics that redefines autonomy and stresses the importance of equality, political participation, and the common good. The violations of the right to health in unrecognized Bedouin villages in Israel are analyzed to exemplify the possibilities opened by the republican egalitarian approach. © The Author(s) 2015.

The virtue ethics approach to bioethics.

PubMed

Holland, Stephen

2011-05-01

This paper discusses the viability of a virtue-based approach to bioethics. Virtue ethics is clearly appropriate to addressing issues of professional character and conduct. But another major remit of bioethics is to evaluate the ethics of biomedical procedures in order to recommend regulatory policy. How appropriate is the virtue ethics approach to fulfilling this remit? The first part of this paper characterizes the methodology problem in bioethics in terms of diversity, and shows that virtue ethics does not simply restate this problem in its own terms. However, fatal objections to the way the virtue ethics approach is typically taken in bioethics literature are presented in the second section of the paper. In the third part, a virtue-based approach to bioethics that avoids the shortcomings of the typical one is introduced and shown to be prima facie plausible. The upshot is an inviting new direction for research into bioethics' methodology. © 2009 Blackwell Publishing Ltd.

Is there such a thing as Latin bioethics?

PubMed

Carlioz, Antoine; Wolyniak, Joseph G; Le Coz, Pierre

2012-11-01

This paper reflects on the presumption that there are distinct ethical differences between the supposedly 'Anglo-Saxon liberal' and 'Latin (Southern European) paternalist' ethical traditions. The predominance of the bioethical paradigm (principalism) is measured by a comparative analysis of regional moral opinion reflected in nation-state health laws. By looking at the way the ethico-legal concept figures into various national ordinances, we attempt to ascertain the extent and nature of variation (if any) between localities by exploring the understanding and application of principalism's keystone: patient autonomy.

Not just autonomy--the principles of American biomedical ethics.

PubMed Central

Holm, S

1995-01-01

The Principles of Biomedical Ethics by Tom L Beauchamp and James F Childress which is now in its fourth edition has had a great influence on the development of bioethics through its exposition of a theory based on the four principles: respect for autonomy; non-maleficence; beneficence, and justice (1). The theory is developed as a common-morality theory, and the present paper attempts to show how this approach, starting from American common-morality, leads to an underdevelopment of beneficence and justice, and that the methods offered for specification and balancing of principles are inadequate. PMID:8778456

Evaluation of a standard provision versus an autonomy promotive exercise referral programme: rationale and study design

PubMed Central

Jolly, Kate; Duda, Joan L; Daley, Amanda; Eves, Frank F; Mutrie, Nanette; Ntoumanis, Nikos; Rouse, Peter C; Lodhia, Rekha; Williams, Geoffrey C

2009-01-01

Background The National Institute of Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the utility of a Self Determination Theory (SDT)-based exercise referral consultation. Methods/Design Design: An exploratory cluster randomised controlled trial comparing standard provision exercise on prescription with a Self Determination Theory-based (SDT) exercise on prescription intervention. Participants: 347 people referred to the Birmingham Exercise on Prescription scheme between November 2007 and July 2008. The 13 exercise on prescription sites in Birmingham were randomised to current practice (n = 7) or to the SDT-based intervention (n = 6). Outcomes measured at 3 and 6-months: Minutes of moderate or vigorous physical activity per week assessed using the 7-day Physical Activity Recall; physical health: blood pressure and weight; health status measured using the Dartmouth CO-OP charts; anxiety and depression measured by the Hospital Anxiety and Depression Scale and vitality measured by the subjective vitality score; motivation and processes of change: perceptions of autonomy support from the advisor, satisfaction of the needs for competence, autonomy, and relatedness via physical activity, and motivational regulations for exercise. Discussion This trial will determine whether an exercise referral programme based on Self Determination Theory increases physical activity and other health outcomes compared to a standard programme and will test the underlying SDT-based process model (perceived autonomy support, need satisfaction, motivation regulations, outcomes) via structural equation modelling. Trial registration The trial is registered as Current Controlled trials ISRCTN07682833. PMID:19505293

The new genetics and informed consent: differentiating choice to preserve autonomy.

PubMed

Bunnik, Eline M; de Jong, Antina; Nijsingh, Niels; de Wert, Guido M W R

2013-07-01

The advent of new genetic and genomic technologies may cause friction with the principle of respect for autonomy and demands a rethinking of traditional interpretations of the concept of informed consent. Technologies such as whole-genome sequencing and micro-array based analysis enable genome-wide testing for many heterogeneous abnormalities and predispositions simultaneously. This may challenge the feasibility of providing adequate pre-test information and achieving autonomous decision-making. At a symposium held at the 11th World Congress of Bioethics in June 2012 (Rotterdam), organized by the International Association of Bioethics, these challenges were presented for three different areas in which these so-called 'new genetics' technologies are increasingly being applied: newborn screening, prenatal screening strategies and commercial personal genome testing. In this article, we build upon the existing ethical framework for a responsible set-up of testing and screening offers and reinterpret some of its criteria in the light of the new genetics. As we will argue, the scope of a responsible testing or screening offer should align with the purpose(s) of testing and with the principle of respect for autonomy for all stakeholders involved, including (future) children. Informed consent is a prerequisite but requires a new approach. We present preliminary and general directions for an individualized or differentiated set-up of the testing offer and for the informed consent process. With this article we wish to contribute to the formation of new ideas on how to tackle the issues of autonomy and informed consent for (public) healthcare and direct-to-consumer applications of the new genetics. © 2013 John Wiley & Sons Ltd.

Psychoanalysis and bioethics: a Lacanian approach to bioethical discourse.

PubMed

Zwart, Hub

2016-12-01

This article aims to develop a Lacanian approach to bioethics. Point of departure is the fact that both psychoanalysis and bioethics are practices of language, combining diagnostics with therapy. Subsequently, I will point out how Lacanian linguistics may help us to elucidate the dynamics of both psychoanalytical and bioethical discourse, using the movie One flew over the Cuckoo's Nest and Sophocles' tragedy Antigone as key examples. Next, I will explain the 'topology' of the bioethical landscape with the help of Lacan's three dimensions: the imaginary, the symbolical and the real. This will culminate in an assessment of the dynamics of bioethical discourse with the help of Lacan's theorem of the four discourses. Bioethics, I will argue, is not a homogeneous discourse. Rather, four modalities of bioethical discourse can be distinguished, all of them displaying specific weaknesses and strengths, opportunities and threats. This will be elucidated with the help of two case studies, namely the debates on human reproductive technologies and on the use of animals as biomedical research models.

Overstating values: medical facts, diverse values, bioethics and values-based medicine.

PubMed

Parker, Malcolm

2013-02-01

Fulford has argued that (1) the medical concepts illness, disease and dysfunction are inescapably evaluative terms, (2) illness is conceptually prior to disease, and (3) a model conforming to (2) has greater explanatory power and practical utility than the conventional value-free medical model. This 'reverse' model employs Hare's distinction between description and evaluation, and the sliding relationship between descriptive and evaluative meaning. Fulford's derivative 'Values Based Medicine' (VBM) readjusts the imbalance between the predominance of facts over values in medicine. VBM allegedly responds to the increased choices made available by, inter alia, the progress of medical science itself. VBM attributes appropriate status to evaluative meaning, where strong consensus about descriptive meaning is lacking. According to Fulford, quasi-legal bioethics, while it can be retained as a kind of deliberative framework, is outcome-based and pursues 'the right answer', while VBM approximates a democratic, process-oriented method for dealing with diverse values, in partnership with necessary contributions from evidence-based medicine (EBM). I support the non-cognitivist underpinnings of VBM, and its emphasis on the importance of values in medicine. But VBM overstates the complexity and diversity of values, misrepresents EBM and VBM as responses to scientific and evaluative complexity, and mistakenly depicts 'quasi-legal bioethics' as a space of settled descriptive meaning. Bioethical reasoning can expose strategies that attempt to reduce authentic values to scientific facts, illustrating that VBM provides no advantage over bioethics in delineating the connections between facts and values in medicine. © 2011 Blackwell Publishing Ltd.

The Bioethics of Music, the Music of Bioethics.

PubMed

Lubet, Alex

2015-12-01

Bioethics is rarely referenced in the scholarship of performing arts medicine (PAM). This essay argues that bioethical concerns loom far larger in the care of PAM patients than might typically be understood. This essay presents Beauchamp and Childress's four principles of bioethics, with examples pertinent to PAM, drawn from the author's research and personal experience.

[Is it possible a bioethics based on the experimental evidence?].

PubMed

Pastor, Luis Miguel

2013-01-01

For years there are different types of criticism about principialist bioethics. One alternative that has been proposed is to introduce empirical evidence within the bioethical discourse to make it less formal, less theoretical and closer to reality. In this paper we analyze first in synthetic form diverse alternative proposals to make an empirical bioethics. Some of them are strongly naturalistic while others aim to provide empirical data only for correct or improve bioethical work. Most of them are not shown in favor of maintaining a complete separation between facts and values, between what is and what ought to be. With different nuances these proposals of moderate naturalism make ethical judgments depend normative social opinion resulting into a certain social naturalism. Against these proposals we think to make a bioethics in that relates the empirical facts with ethical duties, we must rediscover empirical reality of human action. Only from it and, in particular, from the activity of discernment that makes practical reason, when judged on the object of his action, it is possible to integrate the mere descriptive facts with ethical judgments of character prescriptive. In conclusion we think that it is not possible to perform bioethics a mode of empirical science, as this would be contrary to natural reason, leading to a sort of scientific reductionism. At the same time we believe that empirical data are important in the development of bioethics and to enhance and improve the innate ability of human reason to discern good. From this discernment could develop a bioethics from the perspective of ethical agents themselves, avoiding the extremes of an excessive normative rationalism, accepting empirical data and not falling into a simple pragmatism.

Bioethics in China.

PubMed

Li, En-Chang

2008-09-01

Historically, the preconditions for the emergence of bioethics in China. were political reforms and their applications. The Hanzhong Euthanasia Case and the publication of Qiu Ren-zong's academic work Bioethics played a significant role in the development of bioethics in China. Other contributory factors include the establishment of the Chinese Society of Medical Ethics/Chinese Medical Association (C.M.A), the publication of the Journal of Chinese Medical Ethics, and the teaching and education of bioethics in China. Major achievements of bioethics in China include the establishment of ethics committee and ethics review system, active international communication and cooperation among the academic circles, and the successful management of the 8th World Congress of Bioethics in Beijing in 2006. Chinese bioethics focus on native Chinese realities and conditions, absorb the international research achievements in relevant fields, and combine international ideas with traditional Chinese doctrines. Admittedly, there are still some aspects to be improved, yet bioethics has attracted a lot of attention from the core leadership in China and has gained sound financial support, which augers well for its further development. This article also briefly introduces the development of bioethics in Hong Kong and Taiwan, China.

Geneticization and bioethics: advancing debate and research.

PubMed

Arnason, Vilhjálmur; Hjörleifsson, Stefán

2007-12-01

In the present paper, we focus on the role that the concept of geneticization has played in the discussion about health care, bioethics and society. The concept is discussed and examples from the evolving discourse about geneticization are critically analyzed. The relationship between geneticization, medicalization and biomedicalization is described, emphasizing how debates about the latter concepts can inspire future research on geneticization. It is shown how recurrent themes from the media coverage of genetics portray typical traits of geneticization and thus contribute to the process. We look at examples of small-scale studies from the literature where geneticization of medical practice has been demonstrated. Methodological disputes about the relevance of empirical evidence for the geneticization thesis and the normative status of the concept are discussed. We consider arguments to the effect that ideas from mainstream bioethics have facilitated geneticization by emphasizing individualistic notions of autonomy and responsibility while ignoring the role of genetics in the wider social context. It is shown how a concept like geneticization, which can be used to draw the attention of philosophers, social scientists and others to challenges that tend to be neglected by mainstream bioethics, also has the potential to move people's attention away from other pertinent issues. This may happen if researchers become preoccupied with the transformative effects of genetics, and we argue that a wider reading of geneticization should inspire critical analysis of the sociocultural preconditions under which genetics is currently evolving.

Bioethics: A Rationale and a Model

ERIC Educational Resources Information Center

Barman, Charles R.; Rusch, John J.

1978-01-01

Discusses the rationale for and development of an undergraduate bioethics course. Based on experiences with the course, general suggestions are offered to instructors planning to add bioethics to existing curricula. (MA)

Integrating Bioethics into Clinical and Translational Science Research: A Roadmap

PubMed Central

Shapiro, Robyn S.; Layde, Peter M.

2008-01-01

Abstract Recent initiatives to improve human health emphasize the need to effectively and appropriately translate new knowledge gleaned from basic biomedical and behavioral research to clinical and community application. To maximize the beneficial impact of scientific advances in clinical practice and community health, and to guard against potential deleterious medical and societal consequences of such advances, incorporation of bioethics at each stage of clinical and translational science research is essential. At the earliest stage, bioethics input is critical to address issues such as whether to limit certain areas of scientific inquiry. Subsequently, bioethics input is important to assure not only that human subjects trials are conducted and reported responsibly, but also that results are incorporated into clinical and community practices in a way that promotes and protects bioethical principles. At the final stage of clinical and translational science research, bioethics helps to identify the need and approach for refining clinical practices when safety or other concerns arise. The framework we present depicts how bioethics interfaces with each stage of clinical and translational science research, and suggests an important research agenda for systematically and comprehensively assuring bioethics input into clinical and translational science initiatives. PMID:20443821

Evidence-based ethics? On evidence-based practice and the "empirical turn" from normative bioethics

PubMed Central

Goldenberg, Maya J

2005-01-01

Background The increase in empirical methods of research in bioethics over the last two decades is typically perceived as a welcomed broadening of the discipline, with increased integration of social and life scientists into the field and ethics consultants into the clinical setting, however it also represents a loss of confidence in the typical normative and analytic methods of bioethics. Discussion The recent incipiency of "Evidence-Based Ethics" attests to this phenomenon and should be rejected as a solution to the current ambivalence toward the normative resolution of moral problems in a pluralistic society. While "evidence-based" is typically read in medicine and other life and social sciences as the empirically-adequate standard of reasonable practice and a means for increasing certainty, I propose that the evidence-based movement in fact gains consensus by displacing normative discourse with aggregate or statistically-derived empirical evidence as the "bottom line". Therefore, along with wavering on the fact/value distinction, evidence-based ethics threatens bioethics' normative mandate. The appeal of the evidence-based approach is that it offers a means of negotiating the demands of moral pluralism. Rather than appealing to explicit values that are likely not shared by all, "the evidence" is proposed to adjudicate between competing claims. Quantified measures are notably more "neutral" and democratic than liberal markers like "species normal functioning". Yet the positivist notion that claims stand or fall in light of the evidence is untenable; furthermore, the legacy of positivism entails the quieting of empirically non-verifiable (or at least non-falsifiable) considerations like moral claims and judgments. As a result, evidence-based ethics proposes to operate with the implicit normativity that accompanies the production and presentation of all biomedical and scientific facts unchecked. Summary The "empirical turn" in bioethics signals a need for

Autonomy, consent and responsability. Part 1: limitations of the principle of autonomy as a foundation of informed consent.

PubMed

Mellado, J M

2016-01-01

Legal recognition of patient's rights aspired to change clinical relationship and medical lex artis. However, its implementation has been hampered by the scarcity of resources and the abundance of regulations. For several years, autonomy, consent, and responsibility have formed one of the backbones of the medical profession. However, they have sparked controversy and professional discomfort. In the first part of this article, we examine the conceptual and regulatory limitations of the principle of autonomy as the basis of informed consent. We approach the subject from philosophical, historical, legal, bioethical, deontological, and professional standpoints. In the second part, we cover the viability of informed consent in health care and its relationship with legal responsibility. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

A Bridge Back to the Future: Public Health Ethics, Bioethics, and Environmental Ethics.

PubMed

Lee, Lisa M

2017-09-01

Contemporary biomedical ethics and environmental ethics share a common ancestry in Aldo Leopold's and Van Rensselaer Potter's initial broad visions of a connected biosphere. Over the past five decades, the two fields have become strangers. Public health ethics, a new subfield of bioethics, emerged from the belly of contemporary biomedical ethics and has evolved over the past 25 years. It has moved from its traditional concern with the tension between individual autonomy and community health to a wider focus on social justice and solidarity. Public health has a broad focus that includes individual, community, and environmental health. Public health ethics attends to these broad commitments reflected in the increasing concern with the connectedness of health of individuals to the health of populations, to the health of animals, to the health of the environment; it is well situated to reconnect all three "fields" of ethics to promote a healthier planet.

Bioethics and the Italian National Bioethics Committee: historical highlights.

PubMed

Conti, A A

2016-01-01

Though the term "bioethics" was coined in 1970-1, it was immediately after World War II that there emerged the idea that the voluntary consent of human beings was absolutely mandatory for medical interventions to be ethically acceptable. The 1964 Declaration of Helsinki asserted that only an explicit consent could morally and ethically justify research on human beings. In the 1978 "Encyclopedia of Bioethics", the US author Warren T. Reich defined bioethics as the systematic study of human behaviour in the fields of health care and life sciences, and carefully differentiated the epistemological profile of bioethics from that of traditional medical ethics deriving from the Hippocratic Oath. An institutional milestone in the Italian evolution of bioethical knowledge and competence was the foundation of the Italian National Bioethics Committee (NBC), established in 1990. The NBC, which answers to the Council of Ministers, provides methodological support to the Italian Government in the field of bioethical issues, elaborating legislative acts and also furnishing information and consultation for other bodies and associations and for the general public. The activity of the NBC is clearly discernible in its free and user-friendly website. Today, the Internet is often the first repository where individuals and patients look for bioethical information. Given that the quality of this information is extremely variable and not infrequently unreliable, initiatives such as that of the above mentioned NBC website are particularly useful and precious both for health care operators and the entire community.

Bioethics for clinicians: 21. Islamic bioethics

PubMed Central

Daar, Abdallah S.; Khitamy, A.

2001-01-01

ISLAMIC BIOETHICS DERIVES FROM A COMBINATION OF PRINCIPLES, duties and rights, and, to a certain extent, a call to virtue. In Islam, bioethical decision-making is carried out within a framework of values derived from revelation and tradition. It is intimately linked to the broad ethical teachings of the Qur'an and the tradition of the Prophet Muhammad, and thus to the interpretation of Islamic law. In this way, Islam has the flexibility to respond to new biomedical technologies. Islamic bioethics emphasizes prevention and teaches that the patient must be treated with respect and compassion and that the physical, mental and spiritual dimensions of the illness experience be taken into account. Because Islam shares many foundational values with Judaism and Christianity, the informed Canadian physician will find Islamic bioethics quite familiar. Canadian Muslims come from varied backgrounds and have varying degrees of religious observance. Physicians need to recognize this diversity and avoid a stereotypical approach to Muslim patients. PMID:11202669

The Belief that Alcohol Use Is Inconsistent with Personal Autonomy: A Promotive Factor for Younger Adolescents

ERIC Educational Resources Information Center

Henry, Kimberly L.; Shtivelband, Annette; Comello, Maria Leonora G.; Slater, Michael D.

2011-01-01

This study explored an understudied promotive factor, a belief that alcohol use is inconsistent with personal autonomy, which may reduce adolescent intention to drink and subsequent alcohol use. Autonomy was examined as an attitudinal construct within the Theory of Reasoned Action. Longitudinal data from 2,493 seventh grade students nested in 40…

Bioethics in Russia.

PubMed

Tishchenko, P D

2005-01-01

Ten years of development in Russian bioethics presents significant progress. At the beginning of the 90s bioethics was practically unknown for Russian medical doctors, philosophers and the public. Since the year 2000 bioethics has become an obligatory course for all medical students. The Russian Orthodox Church published the same year "The Social Doctrine" that included a special part "The Church and Problems of Bioethics." Different bioethical problems are often discussed in the mass media. The development of Russian bioethics proves the basic understanding of ethics presented by John Dewey--ethics is a function of the moral life of the community. Norms are good or bad mostly as instruments that could be used in everyday life to solve real problems people meet.

[Boundaries of the autonomy of local health administration: innovation, creativity and evidence-based decision-making].

PubMed

Silva, Silvio Fernandes da; Souza, Nathan Mendes; Barreto, Jorge Otávio Maia

2014-11-01

The scope of this article was to identify the boundaries of the autonomy of local administration in the context of the federal pact in the Brazilian Unified Health System and the importance and potential for promoting innovation, creativity and evidence-based decision-making by local governments. The methodology used was to ask questions that favored dialogue with the specific literature to identify the influence of centrally-formulated policies in spaces of local autonomy and then to identify strategies to foster innovation, creativity and the systematic use of evidence-based research in health policy implementation. A gradual reduction in municipal decision-making autonomy was detected due to increased financial commitment of the municipalities resulting from responsibilities assumed, albeit with the possibility of reverting this trend in the more recent context. Some determinants and challenges for the dissemination of innovative practices were analyzed and some relevant national and international experiences in this respect were presented. The conclusion drawn is that it is possible to make local decision-making more effective provided that initiatives are consolidated to promote this culture and the formulation and implementation of evidence-based health policies.

A critique of the principle of 'respect for autonomy', grounded in African thought.

PubMed

Behrens, Kevin G

2018-06-01

I give an account how the principle of 'respect for autonomy' dominates the field of bioethics, and how it came to triumph over its competitors, 'respect for persons' and 'respect for free power of choice'. I argue that 'respect for autonomy' is unsatisfactory as a basic principle of bioethics because it is grounded in too individualistic a worldview, citing concerns of African theorists and other communitarians who claim that the principle fails to acknowledge the fundamental importance of understanding persons within the nexus of their communal relationships. I defend the claim that 'respect for persons' is a more appropriate principle, as it is able to acknowledge both individual decision making and the essential relationality of persons. I acknowledge that my preference for 'respect for persons' is problematic because of the important debate around the definition of 'personhood' in bioethics discourse. Relying on Thaddeus Metz's conception of moral status, I propose a relational definition of personhood that distinguishes between persons with agency and persons without agency, arguing that we have different moral obligations to these distinct categories of persons. I claim that this conception of personhood is better able to accommodate our moral intuitions than conventional approaches, and that it is able to do so without being speciesist or question-begging. © 2017 John Wiley & Sons Ltd.

The micropolitics of responsibility vis-à-vis autonomy: parental accounts of childhood genetic testing and (non)disclosure.

PubMed

Arribas-Ayllon, Michael; Sarangi, Srikant; Clarke, Angus

2008-03-01

Genetic testing and (non)disclosure of genetic information present ethical and moral dilemmas for the management of parental responsibility vis-à-vis the child's autonomy. Ethical guidelines aimed at professionals currently seek to defer childhood testing where there is no clear medical or psychosocial benefit. This version of autonomy is derived from a bioethical paradigm which brackets the individual rights and capacities of the child. In this paper we focus on situated parental accounts of responsibility/autonomy to understand the complex forms of relational work -i.e. the micropolitics of balancing rights and responsibilities - involving a range of inherited genetic disorders. Interviews (n= 20) were conducted with parents whose genetic condition may have had consequences for their children. Using rhetorical discourse analysis, we show how parents draw upon a number of rhetorical/discoursal devices to produce accounts where genetic responsibility is actually or potentially transmitted to the child. We identify three kinds of accounting practice: (1) aligned responsibility; (2) deferred responsibility; and (3) misaligned responsibility. Each of these practices demonstrates how parents position themselves responsibly by foregrounding figures and events onto which the child's autonomy is selectively mapped. Rather than simple representations, we regard these accounts as complex moral performances that seek alignment with broader bioethical discourses.

Structure, coercive control, and autonomy promotion: A comparison of fathers' and mothers' food parenting strategies.

PubMed

Pratt, Mercedes; Hoffmann, Debra; Taylor, Maija; Musher-Eizenman, Dara

2017-05-01

This study explored differences in mothers' and fathers' food parenting strategies, specifically coercive control, structure, and autonomy promotion, and whether parenting style and parental responsibility for food parenting related to the use of these strategies. Parents of children aged 2.5-7.5 years ( N = 497) reported about their parenting practices and food parenting strategies. Parenting style accounted for the majority of the variance in food parenting. Fathers were more authoritarian than mothers. Authoritarian and permissive parenting practices were related to more coercive strategies. Mothers reported more food parenting responsibility. Responsibility was related to less coercive practices and more autonomy promotion and structure.

The Belief that Alcohol Use is Inconsistent with Personal Autonomy: A Promotive Factor for Younger Adolescents

PubMed Central

Henry, Kimberly L.; Shtivelband, Annette; Comello, Maria Leonora G.; Slater, Michael D.

2011-01-01

This study explored an understudied promotive factor, a belief that alcohol use is inconsistent with personal autonomy, which may reduce adolescent intention to drink and subsequent alcohol use. Autonomy was examined as an attitudinal construct within the Theory of Reasoned Action. Longitudinal data from 2,493 seventh grade students nested in 40 schools were analyzed using a structural equation model. Autonomy was negatively correlated with intention to use alcohol and subsequent alcohol use at a later wave, and intention to use fully mediated the effect of autonomy on subsequent alcohol use. These results are consistent with the proposition that when personal autonomy is perceived as inconsistent with alcohol use among younger adolescents, students indicate a lower intention to use alcohol and use less alcohol during the following school year. PMID:23519434

The Belief that Alcohol Use is Inconsistent with Personal Autonomy: A Promotive Factor for Younger Adolescents.

PubMed

Henry, Kimberly L; Shtivelband, Annette; Comello, Maria Leonora G; Slater, Michael D

2011-08-01

This study explored an understudied promotive factor, a belief that alcohol use is inconsistent with personal autonomy, which may reduce adolescent intention to drink and subsequent alcohol use. Autonomy was examined as an attitudinal construct within the Theory of Reasoned Action. Longitudinal data from 2,493 seventh grade students nested in 40 schools were analyzed using a structural equation model. Autonomy was negatively correlated with intention to use alcohol and subsequent alcohol use at a later wave, and intention to use fully mediated the effect of autonomy on subsequent alcohol use. These results are consistent with the proposition that when personal autonomy is perceived as inconsistent with alcohol use among younger adolescents, students indicate a lower intention to use alcohol and use less alcohol during the following school year.

[From virtue bioethics to bioethics personalistic: is integration possible?].

PubMed

Pastor, Luis Miguel

2013-01-01

In this article we analyze how the idea of virtue as an important element of human ethical action is slowly being lost. There are proposals both in ethics and in bioethics to rehabilitate virtue and to consider it as a very important element of human morality. In particular, in the health sector the rehabilitation of virtue, would imply greater focus on the ethical character of professionals and personal improvement rather than on training for the resolution of ethical cases. Such guidance would also improve the health professional-patient relationship with an increase not only in the technical quality but also in human dimension of health sciences. However, this orientation or tendency in bioethics suffers from a deficit in reasoning due to lack of a complete theory of human action that covers the good and also norms. The second part of the article looks at the relation between of virtue and personalistic bioethics. Virtue is considered as an important element of human action and is integrated with the good and norms. After analyzing and distinguishing between what is today considered personalistic bioethics and the contributions of personalism to bioethics, the paper concludes that the integration of virtue in personalistic bioethics is not only possible but desirable to overcome the ethical minimalism that has resulted from modern day principlism driven bioethics.

Feminist ethics and menopause: autonomy and decision-making in primary medical care.

PubMed

Murtagh, Madeleine J; Hepworth, Julie

2003-04-01

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners' accounts of menopause and treatment in Australia, women's 'choice', 'informed decision-making' and 'empowerment' were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of 'informed decision-making' in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an 'ethic of autonomy' and an 'offer of choice' in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part.

Does Parental Autonomy Support Relate to Adolescent Autonomy? An In-Depth Examination of a Seemingly Simple Question

ERIC Educational Resources Information Center

Fousiani, Kyriaki; Van Petegem, Stijn; Soenens, Bart; Vansteenkiste, Maarten; Chen, Beiwen

2014-01-01

In contemporary research on autonomy development, autonomy has been defined as independence (vs. dependence) or as self-endorsed (vs. controlled) functioning. Analogously, perceived parental autonomy support involves either perceived parental promotion of independence (PI) or perceived parental promotion of volitional functioning (PVF). The…

A relational perspective on autonomy for older adults residing in nursing homes.

PubMed

Sherwin, Susan; Winsby, Meghan

2011-06-01

To review critically the traditional concept of autonomy, propose an alternative relational interpretation of autonomy, and discuss how this would operate in identifying and addressing ethical issues that arise in the context of nursing home care for older adults. Respect for patient autonomy has been the cornerstone of clinical bioethics for several decades. Important though this principle is, there is debate on how to interpret the core concept of autonomy. We review the appeal of the traditional approach to autonomy in health care and then identify some of the difficulties with this conception. We use philosophical methods to explain and discuss the traditional and relational conceptions of autonomy and we illuminate our discussion with examples of various contextual applications. We support the relational conception of autonomy as offering a richer, more contextualized understanding of autonomy which attends to the social, political and economic conditions that serve as background to an agent's deliberations. To illuminate these ideas, we discuss the situation of frail older adults who frequently find their autonomy limited not only by their medical conditions but also by cultural prejudices against the aged and by the conditions commonly found within the nursing homes in which many reside. We propose ways of improving the relational autonomy of this population. © 2010 Blackwell Publishing Ltd.

Autonomy, Competence and Non-interference.

PubMed

Roberts, Joseph T F

2017-12-30

In light of the variety of uses of the term autonomy in recent bioethics literature, in this paper, I suggest that competence, not being as contested, is better placed to play the anti-paternalistic role currently assigned to autonomy. The demonstration of competence, I will argue, can provide individuals with robust spheres of non-interference in which they can pursue their lives in accordance with their own values. This protection from paternalism is achieved by granting individuals rights to non-interference upon demonstration of competence. In this paper, I present a risk-sensitive account of competence as a means of grounding rights to non-interference. On a risk-sensitive account of competence individuals demonstrate their competence by exercising three capacities to the extent necessary to meet a threshold determined by the riskiness of the decision. These three capacities are the capacity to (i) acquire knowledge, (ii) use instrumental rationality, and (iii) form and revise a life plan.

Disciplining Bioethics: Towards a Standard of Methodological Rigor in Bioethics Research

PubMed Central

Adler, Daniel; Shaul, Randi Zlotnik

2012-01-01

Contemporary bioethics research is often described as multi- or interdisciplinary. Disciplines are characterized, in part, by their methods. Thus, when bioethics research draws on a variety of methods, it crosses disciplinary boundaries. Yet each discipline has its own standard of rigor—so when multiple disciplinary perspectives are considered, what constitutes rigor? This question has received inadequate attention, as there is considerable disagreement regarding the disciplinary status of bioethics. This disagreement has presented five challenges to bioethics research. Addressing them requires consideration of the main types of cross-disciplinary research, and consideration of proposals aiming to ensure rigor in bioethics research. PMID:22686634

Relational autonomy in informed consent (RAIC) as an ethics of care approach to the concept of informed consent.

PubMed

Osuji, Peter I

2018-03-01

The perspectives of the dominant Western ethical theories, have dominated the concepts of autonomy and informed consent for many years. Recently this dominant understanding has been challenged by ethics of care which, although, also emanates from the West presents a more nuanced concept: relational autonomy, which is more faithful to our human experience. By paying particular attention to relational autonomy, particularity and Process approach to ethical deliberations in ethics of care, this paper seeks to construct a concept of informed consent from the perspective of ethics of care which is here called relational autonomy-in-informed consent (RAIC). Thus, providing a broader theoretical basis for informed consent beyond the usual theoretical perspectives that are particularly Western. Care ethics provides such a broader basis because it appeals to a global perspective that encompasses lessons from other cultures, and this will help to enrich the current ideas of bioethics principles of autonomy and informed consent. This objective will be achieved by exploring the ethics of care emphasis on relationships based on a universal experience of caring; and by contrasting its concept of autonomy as relational with the understanding of autonomy in the approaches of the dominant moral theories that reflect rational, individualistic, and rights-oriented autonomy of the American liberalism.

Parents' Promotion of Psychological Autonomy, Psychological Control, and Mexican-American Adolescents' Adjustment

ERIC Educational Resources Information Center

Sher-Censor, Efrat; Parke, Ross D.; Coltrane, Scott

2011-01-01

Mexican-American adolescents are at an elevated risk for adjustment difficulties. In an effort to identify parenting practices that can affect the adjustment of Mexican-American youth, the current study examined parents' promotion of psychological autonomy and parents' psychological control as perceived by Mexican-American early adolescents, and…

Bioethics Science: Is it?

PubMed Central

Azariah, Jayapaul

2009-01-01

Both western and eastern civilizations have linked moral teaching with theology followed by philosophy. New-knowledge-seekers about natural world, were called ‘natural philosophers’. There was a paradigm shift during industrial revolution in western world which culminated in modern science. The word “scientist” was coined during the 19th century. The paper examines whether natural philosophers could be called ‘scientists’? A short history of philosophical paradigm shift is given. Although written moral and “ethical principles” were in vogue from the time of Hammurabi (1750–1795 BC), the phenomenon of bioethics is very recent. Bioethics is a bridge among different sciences and a bridge to the future. The question is: Is bioethics, by itself, science? The present paper is concerned with the quality of bioethics and about the nature of science during the next 30–50 years. Science is value-free but bioethics is value-loaded. Science does not proclaim any value whereas bioethics underlines the moral life and its value to survive. The paper examines two issues: Can science be bioethics-friendly? and (ii) Can bioethics be science-friendly? It appears that both science and bioethics are incompatible. We need to develop a new system of knowledge to include/infuse the bioethical-notion of values in (into) science. Such a move may necessitate the development of an alternate but new model. Bioethics is not a science-discipline. A new term to replace science is needed. Elevating bioethics as an academic science may create job openings in India. PMID:23908732

Decolonizing Bioethics in Africa

PubMed Central

Macaulay-Adeyelure, O.C.

2017-01-01

The global spread of bioethics from its North-American and European provenance to non-Western societies is currently raising some concerns. Part of the concern has to do with whether or not the exportation of bioethics in its full Western sense to developing non-Western states is an instance of ethical imperialism or bioethical neocolonialism. This paper attempts an exploration of this debate in the context of bioethics in sub-Saharan Africa. Rather than conceding that bioethics has a colonial agenda in Africa, this paper defends the position that the current bioethics trend in sub-Saharan Africa is an unintended imperialistic project. It argues that its colonizing character is not entirely a product of the Western programmed goals of training and institution building; rather, it is a structural consequence of many receptive African minds and institutions. Though bioethics in Africa is turning out as a colonizing project, one serious implication of such trend, if unchecked urgently, is that bioethics’ invaluable relevance to Africa is being incapacitated. This paper, therefore, attempts a decolonizing trajectory of bioethics in Africa. Contrary to the pretense of ‘African bioethics,’ which some African scholars are now defending, this paper through the logic of decolonization makes case for ‘bioethics in Africa’. In such logic, the principle of existential needs is prioritized over the principle of identity and authenticity that define African voice in bioethics. PMID:28344985

Patient autonomy in chronic care: solving a paradox

PubMed Central

Reach, Gérard

2014-01-01

The application of the principle of autonomy, which is considered a cornerstone of contemporary bioethics, is sometimes in obvious contradiction with the principle of beneficence. Indeed, it may happen in chronic care that the preferences of the health care provider (HCP), who is largely focused on the prevention of long term complications of diseases, differ from those, more present oriented, preferences of the patient. The aims of this narrative review are as follows: 1) to show that the exercise of autonomy by the patient is not always possible; 2) where the latter is not possible, to examine how, in the context of the autonomy principle, someone (a HCP) can decide what is good (a treatment) for someone else (a patient) without falling into paternalism. Actually this analysis leads to a paradox: not only is the principle of beneficence sometimes conflicting with the principle of autonomy, but physician’s beneficence may enter into conflict with the mere respect of the patient; and 3) to propose a solution to this paradox by revisiting the very concepts of the autonomous person, patient education, and trust in the patient–physician relationship: this article provides an ethical definition of patient education. PMID:24376345

[Dynamics of the dialogue on bioethics in a Spain in transition].

PubMed

Abel, F

1990-01-01

The bioethics dialogue began in Spain in 1975 in private institutions and developed in a society in transition toward democracy. Nostalgia for a nationalist Catholicism by some and the fervor of others to demonstrate that a break with the past had taken place have been important factors in bioethics legislation. Imitation of legislation considered progressive prevailed in the debate taking place in the country's bioethics centers, although in the case of assisted reproduction a commission of experts was set up to advise the government. The public has not participated in the debates, despite their coverage by the communications media. The medical schools have attempted to reform the deontological codes as a basis for formulating, promoting, and protecting the values of a pluralistic society. Results have been minimal, but the work of the bioethics centers is gradually being recognized and evaluated, and it is hoped that this ongoing bioethical dialogue will gradually mature.

Criteria for Authorship in Bioethics

PubMed Central

Resnik, David B.; Master, Zubin

2011-01-01

Multiple authorship is becoming increasingly common in bioethics research. There are well-established criteria for authorship in empirical bioethics research but not for conceptual research. It is important to develop criteria for authorship in conceptual publications to prevent undeserved authorship and uphold standards of fairness and accountability. This article explores the issue of multiple authorship in bioethics and develops criteria for determining who should be an author on a conceptual publication in bioethics. Authorship in conceptual research should be based on contributing substantially to: (1) identifying a topic, problem, or issue to study; (2) reviewing and interpreting the relevant literature; (3) formulating, analyzing, and evaluating arguments that support one or more theses; (4) responding to objections and counterarguments; and (5) drafting the manuscript and approving the final version. Authors of conceptual publications should participate substantially in at least two of areas (1)–(5). PMID:21943265

Criteria for authorship in bioethics.

PubMed

Resnik, David B; Master, Zubin

2011-10-01

Multiple authorship is becoming increasingly common in bioethics research. There are well-established criteria for authorship in empirical bioethics research but not for conceptual research. It is important to develop criteria for authorship in conceptual publications to prevent undeserved authorship and uphold standards of fairness and accountability. This article explores the issue of multiple authorship in bioethics and develops criteria for determining who should be an author on a conceptual publication in bioethics. Authorship in conceptual research should be based on contributing substantially to: (1) identifying a topic, problem, or issue to study; (2) reviewing and interpreting the relevant literature; (3) formulating, analyzing, and evaluating arguments that support one or more theses; (4) responding to objections and counterarguments; and (5) drafting the manuscript. Authors of conceptual publications should participate substantially in at least two of areas (1)-(5) and also approve the final version. [corrected].

The history of autonomy in medicine from antiquity to principlism.

PubMed

Saad, Toni C

2018-03-01

Respect for Autonomy (RFA) has been a mainstay of medical ethics since its enshrinement as one of the four principles of biomedical ethics by Beauchamp and Childress' in the late 1970s. This paper traces the development of this modern concept from Antiquity to the present day, paying attention to its Enlightenment origins in Kant and Rousseau. The rapid C20th developments of bioethics and RFA are then considered in the context of the post-war period and American socio-political thought. The validity and utility of the RFA are discussed in light of this philosophical-historical account. It is concluded that it is not necessary to embrace an ethic of autonomy in order to guard patients from coercion or paternalism, and that, on the contrary, the dominance of autonomy threatens to undermine those very things which have helped doctors come to view and respect their patients as persons.

Family Resemblances: Human Reproductive Cloning as an Example for Reconsidering the Mutual Relationships between Bioethics and Science Fiction.

PubMed

Hansen, Solveig L

2018-03-08

In the traditions of narrative ethics and casuistry, stories have a well-established role. Specifically, illness narratives provide insight into patients' perspectives and histories. However, because they tend to see fiction as an aesthetic endeavour, practitioners in these traditions often do not realize that fictional stories are valuable moral sources of their own. In this paper I employ two arguments to show the mutual relationship between bioethics and fiction, specifically, science fiction. First, both discourses use imagination to set a scene and determine a perspective. Second, bioethics and science fiction share the family resemblance of expressing moral beliefs. I then consider how understanding bioethics and science fiction as interrelated discourses can be the basis of a methodology for inquiry into relational autonomy in the context of biotechnologies and medicine. As an example of this methodology, I analyse Fay Weldon's novel The Cloning of Joanna May (1989).

A relational perspective on autonomy for older adults residing in nursing homes

PubMed Central

Sherwin, Susan; Winsby, Meghan

2011-01-01

Abstract Aim  To review critically the traditional concept of autonomy, propose an alternative relational interpretation of autonomy, and discuss how this would operate in identifying and addressing ethical issues that arise in the context of nursing home care for older adults. Background  Respect for patient autonomy has been the cornerstone of clinical bioethics for several decades. Important though this principle is, there is debate on how to interpret the core concept of autonomy. We review the appeal of the traditional approach to autonomy in health care and then identify some of the difficulties with this conception. Methods  We use philosophical methods to explain and discuss the traditional and relational conceptions of autonomy and we illuminate our discussion with examples of various contextual applications. Conclusion  We support the relational conception of autonomy as offering a richer, more contextualized understanding of autonomy which attends to the social, political and economic conditions that serve as background to an agent’s deliberations. To illuminate these ideas, we discuss the situation of frail older adults who frequently find their autonomy limited not only by their medical conditions but also by cultural prejudices against the aged and by the conditions commonly found within the nursing homes in which many reside. We propose ways of improving the relational autonomy of this population. PMID:21029285

Teaching bioethics: the tale of a "soft" science in a hard world.

PubMed

Lovy, Andrew; Paskhover, Boris; Trachtman, Howard

2010-10-01

Although bioethics is considered essential to the practice of medicine, medical students often view it as a "soft" subject that is secondary in importance to the other courses in their basic science and clinical curriculum. This perspective may be a consequence of the heavy reliance on students' aptitude in the quantitative sciences as a criterion for entry into medical school and as a barometer of academic success after admission. It is exacerbated by the widespread impression that bioethics is imprecise and culturally relativistic. In an effort to redress this imbalance, we propose an approach to teaching bioethics to medical students which emphasizes that the intellectual basis and the degree of certainty of knowledge is comparable in all medical subjects ranging from basic science courses to clinical rotations to bioethics tutorials. Adopting these pedagogical steps may promote greater integration of the various elements-bioethics and clinical science-in the medical school curriculum.

A bioethical j’accuse: analysis of the discussion around thiomersal in Chile.

PubMed

Kottow, Miguel

2014-03-26

Chilean legislators have voted to ban vaccines preserved with thiomersal, an initiative that the Executive has vetoed. Most scientific evidence has dismissed the alleged toxicity of this substance, in accordance with the formal and publicly expressed opinion of local experts, and yet, medical authorities have issued contradictory statements. Some have argued that the principle of precaution suggests eliminating thiomersal preserved vaccines; others have declared that current vaccines should be maintained to protect the population. From the perspective of bioethics, this polemic is another example of the shortcoming of the deliberation process leading to controversial laws in lieu of including citizens in the discussion of regulations that harbor uncertainties, and respect for individual autonomy to accept or reject public immunization programs. The Chilean legal system has been unwilling to implement participatory democratic procedures like plebiscites or institutions such as the ombudsman. In 2006 a law was enacted that creates a National Commission of Bioethics, but successive governments have failed to create such a commission, which is an efficient social instrument to conduct deliberation on bioethical issues that require a balanced participation of the public, experts, and politicians.

The principle of respect for autonomy--concordant with the experience of oncology physicians and molecular biologists in their daily work?

PubMed

Ebbesen, Mette; Pedersen, Birthe D

2008-03-26

This article presents results from a qualitative empirical investigation of how Danish oncology physicians and Danish molecular biologists experience the principle of respect for autonomy in their daily work. This study is based on 12 semi-structured interviews with three groups of respondents: a group of oncology physicians working in a clinic at a public hospital and two groups of molecular biologists conducting basic research, one group employed at a public university and the other in a private biopharmaceutical company. We found that that molecular biologists consider the principle of respect for autonomy as a negative obligation, where the informed consent of patients or research subjects should be respected. Furthermore, molecular biologists believe that very sick patients are constraint by the circumstances to a certain choice. However, in contrast to molecular biologists, oncology physicians experience the principle of respect for autonomy as a positive obligation, where the physician in dialogue with the patient performs a medical prognosis based on the patient's wishes and ideas, mutual understanding and respect. Oncology physicians believe that they have a positive obligation to adjust to the level of the patient when providing information making sure that the patient understands. Oncology physicians experience situations where the principle of respect for autonomy does not apply because the patient is in a difficult situation. In this study we explore the moral views and attitudes of oncology physicians and molecular biologists and compare these views with bioethical theories of the American bioethicists Tom L. Beauchamp & James F. Childress and the Danish philosophers Jakob Rendtorff & Peter Kemp. This study shows that essential parts of the two bioethical theories are reflected in the daily work of Danish oncology physicians and Danish molecular biologists. However, the study also explores dimensions where the theories can be developed further to be

Global bioethics -- myth or reality?

PubMed

Holm, Søren; Williams-Jones, Bryn

2006-09-11

There has been debate on whether a global or unified field of bioethics exists. If bioethics is a unified global field, or at the very least a closely shared way of thinking, then we should expect bioethicists to behave the same way in their academic activities anywhere in the world. This paper investigates whether there is a 'global bioethics' in the sense of a unified academic community. To address this question, we study the web-linking patterns of bioethics institutions, the citation patterns of bioethics papers and the buying patterns of bioethics books. All three analyses indicate that there are geographical and institutional differences in the academic behavior of bioethicists and bioethics institutions. These exploratory studies support the position that there is no unified global field of bioethics. This is a problem if the only reason is parochialism. But these regional differences are probably of less concern if one notices that bioethics comes in many not always mutually understandable dialects.

[Bioethics and abortion. Debate].

PubMed

Diniz, D; Gonzalez Velez, A C

1998-06-01

Although abortion has been the most debated of all issues analyzed in bioethics, no moral consensus has been achieved. The problem of abortion exemplifies the difficulty of establishing social dialogue in the face of distinct moral positions, and of creating an independent academic discussion based on writings that are passionately argumentative. The greatest difficulty posed by the abortion literature is to identify consistent philosophical and scientific arguments amid the rhetorical manipulation. A few illustrative texts were selected to characterize the contemporary debate. The terms used to describe abortion are full of moral meaning and must be analyzed for their underlying assumptions. Of the four main types of abortion, only 'eugenic abortion', as exemplified by the Nazis, does not consider the wishes of the woman or couple--a fundamental difference for most bioethicists. The terms 'selective abortion' and 'therapeutic abortion' are often confused, and selective abortion is often called eugenic abortion by opponents. The terms used to describe abortion practitioners, abortion opponents, and the 'product' are also of interest in determining the style of the article. The video entitled "The Silent Scream" was a classic example of violent and seductive rhetoric. Its type of discourse, freely mixing scientific arguments and moral beliefs, hinders analysis. Within writings about abortion three extreme positions may be identified: heteronomy (the belief that life is a gift that does not belong to one) versus reproductive autonomy; sanctity of life versus tangibility of life; and abortion as a crime versus abortion as morally neutral. Most individuals show an inconsistent array of beliefs, and few groups or individuals identify with the extreme positions. The principal argument of proponents of legalization is respect for the reproductive autonomy of the woman or couple based on the principle of individual liberty, while heteronomy is the main principle of

I want to hold your hand: abstinence curricula, bioethics, and the silencing of desire.

PubMed

Wilkerson, Abby

2013-06-01

The abstinence approach to sex education remains influential despite its demonstrated ineffectiveness. One bill forbids the "promotion" of "gateway sexual activity," while requiring outright condemnation of "non-abstinence," defined so loosely as to plausibly include handholding. Bioethics seldom (if ever) contributes to sex-ed debates, yet exploring the pivotal role of medical discourse reveals the need for bioethical intervention. Sex-ed debates revolve around a theory of human flourishing based on heteronormative temporality, a developmental teleology ensuring the transmission of various supposed social goods through heterosexual marriage (Halberstam, 2005). Heteronormative temporality also constitutes a moralized discourse in which the values of health and presumed certainties of medicine serve to justify conservative religious dictates that otherwise would appear controversial as the basis for public policy. Overall, this analysis explores how moralized medical discourses compound existing injustices, while suggesting bioethics' potential contributions to moral and political analysis of sex-ed policies.

[Contribution of Stein's Anthropology to Personalistic Bioethics].

PubMed

Robles Morejón, Jeannette Beatriz

2016-01-01

Dr. Juan Manuel Burgos proposes ″a challenge″ to whom aims to consolidate the dignity of the human person as the center of a thought structure. Burgos presents a well-founded trilogy, citing Wojtyla, Sgreccia and he himself, as a perfect combination to support personalist bioethics. However, the possibility of giving a solid anthropological support to this bioethics remains open provided that a substantial list of personalistic authors is revised. This research seeks to collate Stein's anthropological proposal to personalist bioethics needs expressed by Burgos. The study aims to prove how Stein's anthropology can be assembled to the characteristics of personalism, and thus infer that more specific levels of the personalist bioethics can be based on this anthropology.

Interventional bioethics: epistemology for peripheral countries.

PubMed

Garrafa, Volnei; Porto, Dora

2008-01-01

Principlism, which originated in the United States based on four supposedly universal principles, brought international visibility to the field of bioethics over the final years of the twentieth century. Nevertheless, from 1990 onwards, criticism regarding the universal applicability of these principles emerged, especially concerning their limitations in dealing with collective macroproblems--social, sanitary and environmental--that are seen in poor developing countries every day. In this respect, the idea of Intervention Bioethics was presented at the University of Brasília, Brazil, in 1998, and was subsequently expanded to encompass other Latin American countries. From the outset, this epistemological proposal of third-world construction and perspective advocated politicisation of the international bioethics agenda, and this aim was achieved through the content of UNESCO's Universal Declaration on Bioethics and Human Rights, which was adopted in 2005. Grounded in a utilitarian and consequentialistic approach, Intervention Bioethics gives priority, ahead of vulnerabilities relating to gender, sexual orientation, ethnicity and similar considerations, to the fields of social and sanitary justice in order to defend the poorest and most disempowered populations in the asymmetrical contemporary world.

The principle of respect for autonomy – Concordant with the experience of oncology physicians and molecular biologists in their daily work?

PubMed Central

Ebbesen, Mette; Pedersen, Birthe D

2008-01-01

Background This article presents results from a qualitative empirical investigation of how Danish oncology physicians and Danish molecular biologists experience the principle of respect for autonomy in their daily work. Methods This study is based on 12 semi-structured interviews with three groups of respondents: a group of oncology physicians working in a clinic at a public hospital and two groups of molecular biologists conducting basic research, one group employed at a public university and the other in a private biopharmaceutical company. Results We found that that molecular biologists consider the principle of respect for autonomy as a negative obligation, where the informed consent of patients or research subjects should be respected. Furthermore, molecular biologists believe that very sick patients are constraint by the circumstances to a certain choice. However, in contrast to molecular biologists, oncology physicians experience the principle of respect for autonomy as a positive obligation, where the physician in dialogue with the patient performs a medical prognosis based on the patient's wishes and ideas, mutual understanding and respect. Oncology physicians believe that they have a positive obligation to adjust to the level of the patient when providing information making sure that the patient understands. Oncology physicians experience situations where the principle of respect for autonomy does not apply because the patient is in a difficult situation. Conclusion In this study we explore the moral views and attitudes of oncology physicians and molecular biologists and compare these views with bioethical theories of the American bioethicists Tom L. Beauchamp & James F. Childress and the Danish philosophers Jakob Rendtorff & Peter Kemp. This study shows that essential parts of the two bioethical theories are reflected in the daily work of Danish oncology physicians and Danish molecular biologists. However, the study also explores dimensions where the

Personal financial incentives in health promotion: where do they fit in an ethic of autonomy?

PubMed Central

Ashcroft, Richard E.

2011-01-01

Abstract Aim  This paper reviews the ethical controversy concerning the use of monetary incentives in health promotion, focussing specifically on the arguments relating to the impact on personal autonomy of such incentives. Background  Offering people small amounts of money in the context of health promotion and medical care has been attempted in a number of settings in recent years. This use of personal financial incentives has attracted a degree of ethical controversy. One form of criticism is that such schemes interfere with the autonomy of the patient or citizen in an illegitimate way. Methods  This paper presents a thematic analysis of the main arguments concerning personal autonomy and the use of monetary incentives in behaviour change. Results  The main moral objections to the uses of incentives are that they may be in general or in specific instances paternalistic, coercive, involve bribery, or undermine the agency of the person. Conclusion  While incentive schemes may engage these problems on occasion, there is no good reason to think that they do so inherently and of necessity. We need better behavioural science evidence to understand how incentives work, in order to evaluate their moral effects in practice. PMID:21348904

Personal financial incentives in health promotion: where do they fit in an ethic of autonomy?

PubMed

Ashcroft, Richard E

2011-06-01

This paper reviews the ethical controversy concerning the use of monetary incentives in health promotion, focussing specifically on the arguments relating to the impact on personal autonomy of such incentives. Offering people small amounts of money in the context of health promotion and medical care has been attempted in a number of settings in recent years. This use of personal financial incentives has attracted a degree of ethical controversy. One form of criticism is that such schemes interfere with the autonomy of the patient or citizen in an illegitimate way. This paper presents a thematic analysis of the main arguments concerning personal autonomy and the use of monetary incentives in behaviour change. The main moral objections to the uses of incentives are that they may be in general or in specific instances paternalistic, coercive, involve bribery, or undermine the agency of the person. While incentive schemes may engage these problems on occasion, there is no good reason to think that they do so inherently and of necessity. We need better behavioural science evidence to understand how incentives work, in order to evaluate their moral effects in practice. © 2011 Blackwell Publishing Ltd.

Autonomy and autonomy competencies: a practical and relational approach.

PubMed

Atkins, Kim

2006-10-01

This essay will address a general philosophical concern about autonomy, namely, that a conception of autonomy focused on freedom of the will alone is inadequate, once we consider the effects of oppressive forms of socialization on individuals' formation of choices. In response to this problem, I will present a brief overview of Diana Meyers's account of autonomy as relational and practical. On this view, autonomy consists in a set of socially acquired practical competencies in self-discovery, self-definition, self-knowledge, and self-direction. This account provides a distinction between choices that express unreflectively internalized social norms and those that are the result of a critical 'self-reading'. I conclude that this practical conception of autonomy makes much higher demands upon nurses (and patients) than has previously been thought. In fact, if nurses are to be expected to genuinely promote autonomy, they are going to need specific training in counselling-type communication skills.

Bioethics for clinicians: 25. Teaching bioethics in the clinical setting

PubMed Central

McKneally, Martin F.; Singer, Peter A.

2001-01-01

BIOETHICS IS NOW TAUGHT IN EVERY CANADIAN MEDICAL SCHOOL. Canada needs a cadre of teachers who can help clinicians learn bioethics. Our purpose is to encourage clinician teachers to accept this important responsibility and to provide practical advice about teaching bioethics to clinicians as an integral part of good clinical medicine. We use 5 questions to focus the discussion: Why should I teach? What should I teach? How should I teach? How should I evaluate? How should I learn? PMID:11338804

Autonomy and couples' joint decision-making in healthcare.

PubMed

Osamor, Pauline E; Grady, Christine

2018-01-11

Respect for autonomy is a key principle in bioethics. However, respecting autonomy in practice is complex because most people define themselves and make decisions influenced by a complex network of social relationships. The extent to which individual autonomy operates for each partner within the context of decision-making within marital or similar relationships is largely unexplored. This paper explores issues related to decision-making by couples (couples' joint decision-making) for health care and the circumstances under which such a practice should be respected as compatible with autonomous decision-making. We discuss the concept of autonomy as it applies to persons and to actions, human interdependency and gender roles in decision-making, the dynamics and outcomes of couples' joint decision-making, and the ethics of couples' joint decision-making. We believe that the extent to which couples' joint decision-making might be deemed ethically acceptable will vary depending on the context. Given that in many traditional marriages the woman is the less dominant partner, we consider a spectrum of scenarios of couples' joint decision-making about a woman's own health care that move from those that are acceptably autonomous to those that are not consistent with respecting the woman's autonomous decision-making. To the extent that there is evidence that both members of a couple understand a decision, intend it, and that neither completely controls the other, couples' joint decision-making should be viewed as consistent with the principle of respect for the woman's autonomy. At the other end of the spectrum are decisions made by the man without the woman's input, representing domination of one partner by the other. We recommend viewing the dynamics of couples' joint decision-making as existing on a continuum of degrees of autonomy. This continuum-based perspective implies that couples' joint decision-making should not be taken at face value but should be assessed against

The birth of the empirical turn in bioethics.

PubMed

Borry, Pascal; Schotsmans, Paul; Dierickx, Kris

2005-02-01

Since its origin, bioethics has attracted the collaboration of few social scientists, and social scientific methods of gathering empirical data have remained unfamiliar to ethicists. Recently, however, the clouded relations between the empirical and normative perspectives on bioethics appear to be changing. Three reasons explain why there was no easy and consistent input of empirical evidence in bioethics. Firstly, interdisciplinary dialogue runs the risk of communication problems and divergent objectives. Secondly, the social sciences were absent partners since the beginning of bioethics. Thirdly, the meta-ethical distinction between 'is' and 'ought' created a 'natural' border between the disciplines. Now, bioethics tends to accommodate more empirical research. Three hypotheses explain this emergence. Firstly, dissatisfaction with a foundationalist interpretation of applied ethics created a stimulus to incorporate empirical research in bioethics. Secondly, clinical ethicists became engaged in empirical research due to their strong integration in the medical setting. Thirdly, the rise of the evidence-based paradigm had an influence on the practice of bioethics. However, a problematic relationship cannot simply and easily evolve into a perfect interaction. A new and positive climate for empirical approaches has arisen, but the original difficulties have not disappeared.

The historical setting of Latin American bioethics.

PubMed

Gracia, D

1996-12-01

The historical stages through which Latin American society has passed are at least four: the first, dominated by a particular sort of ethic I have termed the "ethic of the gift;" then the period of conquest, in which the prevalent ethic was one of war and subjection by force, which I call the "ethic of despotism;" followed by the colonial age, in which a new ethical model of "paternalism" emerged; and finally the stage of the "ethic of autonomy," which began with the independence movements of the 18th and 19th centuries and is far from ended. Independence was won by the criollos from European domination with very little participation by the Indian population. The latter was left out of the democratic process and saw itself relegated to a worse situation than in the centuries of colonial rule, for it was no longer protected by the paternalism of the Laws of the Indies of 1542. This is the reason for the division of the Latin American society of the last century into two quite different social strata: one bourgeois, which has assimilated the liberal revolution, and enjoys a health care quite similar to that available in any other Western country and hence faces the same bioethical problems as any developed Western society; the other a very poor stratum, without any economic or social power and hence unable to exercise its civil rights, such as the rights to life and to humane treatment. In this population sector; which is numerically the larger, the major bioethical problems are those of justice and the distribution of scarce resources. The study of Latin American medical ethics can earn for these subjects, whose deplorable condition has been essentially ignored in the bioethics of the first-world countries, the importance they merit.

From integrative bioethics to pseudoscience.

PubMed

Bracanović, Tomislav

2012-12-01

Integrative bioethics is a brand of bioethics conceived and propagated by a group of Croatian philosophers and other scholars. This article discusses and shows that the approach encounters several serious difficulties. In criticizing certain standard views on bioethics and in presenting their own, the advocates of integrative bioethics fall into various conceptual confusions and inconsistencies. Although presented as a project that promises to deal with moral dilemmas created by modern science and technology, integrative bioethics does not contain the slightest normativity or action-guiding capacity. Portrayed as a scientific and interdisciplinary enterprise, integrative bioethics displays a large number of pseudoscientific features that throw into doubt its overall credibility. © 2012 Blackwell Publishing Ltd.

Global bioethics – myth or reality?

PubMed Central

Holm, Søren; Williams-Jones, Bryn

2006-01-01

Background There has been debate on whether a global or unified field of bioethics exists. If bioethics is a unified global field, or at the very least a closely shared way of thinking, then we should expect bioethicists to behave the same way in their academic activities anywhere in the world. This paper investigates whether there is a 'global bioethics' in the sense of a unified academic community. Methods To address this question, we study the web-linking patterns of bioethics institutions, the citation patterns of bioethics papers and the buying patterns of bioethics books. Results All three analyses indicate that there are geographical and institutional differences in the academic behavior of bioethicists and bioethics institutions. Conclusion These exploratory studies support the position that there is no unified global field of bioethics. This is a problem if the only reason is parochialism. But these regional differences are probably of less concern if one notices that bioethics comes in many not always mutually understandable dialects. PMID:16965631

Creating the ‘ethics industry': Mary Warnock, in vitro fertilization and the history of bioethics in Britain

PubMed Central

Wilson, Duncan

2011-01-01

Recent decades have seen a shift in the management and discussion of biomedicine. Issues once considered by doctors and scientists are now handled by a diverse array of participants, including philosophers, lawyers, theologians and lay representatives. This new approach, known as ‘bioethics', has become the norm in regulatory committees and public debate. In this article, I argue that bioethics emerged as a valued enterprise in Britain during the 1980s because it fulfilled, and linked, the concerns of several groups. My analysis centres on the moral philosopher Mary Warnock, who chaired a government inquiry into human fertilization and embryology between 1982 and 1984, and became a strong advocate of bioethics. I detail how Warnock's promotion of bioethics tallied with the Conservative government's desire for increased surveillance of hitherto autonomous professions – while fulfilling her own belief that philosophers should engage in public affairs. And I also show that Warnock simultaneously promoted bioethics to doctors and scientists as an essential safeguard against declining political and public trust. This stance, I argue, framed bioethics as a vital intermediary between politics, the public, and biomedicine, and explains the growth and endurance of what the Guardian identified as an ethics industry. PMID:22563348

A bioethics for all seasons

PubMed Central

Chan, Sarah

2015-01-01

The last four decades have seen the emergence and flourishing of the field of bioethics and its incorporation into wide-ranging aspects of society, from the clinic or laboratory through to public policy and the media. Yet considerable debate still exists over what bioethics is and how it should be done. In this paper I consider the question of what makes good bioethics. Drawing on historical and contemporary examples, I suggest that bioethics encompasses multiple modes of responding to moral disagreement, and that an awareness of which mode is operational in a given context is essential to doing good bioethics. PMID:25516926

[Bioethical issues involved in the prescription of levonorgestrel].

PubMed

2005-07-01

The use of levonorgestrel for emergency post coital contraception after rape, has raised strong and recurring discussions during 2004 and 2005 in Chile. The debate has been centered in its presumed post fertilization or anti implantation effect, that some consider an abortive action. There are no scientific evidences supporting this effect, with divergences about the ontological status of the embryo. Therefore, the use of levonorgestrel implies bioethical decisions that, in a democratic and pluralistic society, should be solved considering individual and collective responsibilities, conditions of equity and the informed autonomy of the affected women. Their moral values and their capacity to assume the consequences of an assault on their dignity, honor and self-esteem, in addition to physical and mental injuries, should also be considered.

Potter's notion of bioethics.

PubMed

ten Have, Henk A M J

2012-03-01

In 1970 Van Rensselaer Potter was the first to use the term "bioethics" in a publication to advocate the development of a new discipline to address the basic problems of human flourishing. This article analyzes Potter's notion of bioethics in order to understand its origins, sources, and substance. In early publications, Potter conceptualized bioethics as a bridge: between present and future, nature and culture, science and values, and finally between humankind and nature. In later publications, disappointed by a predominant focus on individual and medical issues, and with a wish to underscore the need for a broader perspective, Potter introduced the new term "global bioethics," meant to transcend ethics specialties and integrate them into a new interdisciplinary endeavor to address global problems. A growing interest in global bioethics today means that Potter's original insights are more timely than ever.

[Global Bioethics and Biocultural Ethics].

PubMed

Rozzi, Ricardo

2016-01-01

The biocultural ethic recovers an understanding of the vital links between the life habits of the coinhabitants (humans and other-than-human) that share a habitat. The ″3Hs″ formal framework of the biocultural ethics provides a conceptual and methodological tool to understand and to better manage complex eco-social or biocultural systems in heterogeneous regions of the planet. From the global bioethics originally proposed by V.R. Potter, the integration of theory and praxis promoted by Alfredo Pradenas in the Bioethics Society of Chile, and the conceptual framework of biocultural ethics (including traditions of philosophical thought, scientific and Amerindians), I develop a comparative analysis of: 1. an ecosystemic and intercultural concept of the human body, 2. an intercultural understanding of health with complementary Western and Native American medicinal practices, and 3. an appreciation and respect for the fundamental links among the life habits, the habitats where they take place, and the well-being and identity of the communities of cohabitants. Implicit links in the ″3Hs″ biocultural ethics are present in the archaic meanings of the term ethos. This understanding retrieves a primordial root in the genesis of Western ethics, which did not start bounded to how to inhabit or dwell, but also considered where to inhabit and with whom to co-inhabit. I propose to restore the complexity and breadth of the concept of ethics originated in Ancient Greece, to reaffirm the common roots of bioethics and environmental ethics contained in Potter's global bioethics, and to incorporate the systemic and contextual perspective of the biocultural ethic that values biological and cultural diversity (and their interrelationships), to sustain a conception of human health interconnected with the sustainability of the biosphere.

Respect for rational autonomy.

PubMed

Walker, Rebecca L

2009-12-01

The standard notion of autonomy in medical ethics does not require that autonomous choices not be irrational. The paper gives three examples of seemingly irrational patient choices and discusses how a rational autonomy analysis differs from the standard view. It then considers whether a switch to the rational autonomy view would lead to overriding more patient decisions but concludes that this should not be the case. Rather, a determination of whether individual patient decisions are autonomous is much less relevant than usually considered in determining whether health care providers must abide by these decisions. Furthermore, respect for rational autonomy entails strong positive requirements of respect for the autonomy of the person as a rational decision maker. The rationality view of autonomy is conceptually stronger than the standard view, allows for a more nuanced understanding of the practical moral calculus involved in respecting patient autonomy, and promotes positive respect for patient autonomy.

Tuskegee University Experience Challenges Conventional Wisdom: Is Integrative Bioethics Practice the New Ethics for the Public's Health?

PubMed Central

Sodeke, Stephen Olufemi

2013-01-01

The Tuskegee University National Center for Bioethics in Research and Health Care was established in 1999 in partial response to the Presidential Apology for the United States Public Health Service's Study of Untreated Syphilis in the Negro Male conducted in Macon County, Alabama, from 1932 to 1972. The Center's mission of promoting equity and justice in health and health care for African Americans and other underserved populations employs an integrative bioethics approach informed by moral vision. Etymological and historical analyses are used to delineate the meaning and evolution of bioethics and to provide a basis for Tuskegee's integrative bioethics niche. Unlike mainstream bioethics, integrative bioethics practice is holistic in orientation, and more robust for understanding the epistemic realities of minority life, health disparities, and population health. The conclusion is that integrative bioethics is relevant to the survival of all people, not just a privileged few; it could be the new ethics for the public's health. PMID:23124497

Tuskegee University experience challenges conventional wisdom: is integrative bioethics practice the new ethics for the public's health?

PubMed

Sodeke, Stephen Olufemi

2012-11-01

The Tuskegee University National Center for Bioethics in Research and Health Care was established in 1999 in partial response to the Presidential Apology for the United States Public Health Service's Study of Untreated Syphilis in the Negro Male conducted in Macon County, Alabama, from 1932 to 1972. The Center's mission of promoting equity and justice in health and health care for African Americans and other underserved populations employs an integrative bioethics approach informed by moral vision. Etymological and historical analyses are used to delineate the meaning and evolution of bioethics and to provide a basis for Tuskegee's integrative bioethics niche. Unlike mainstream bioethics, integrative bioethics practice is holistic in orientation, and more robust for understanding the epistemic realities of minority life, health disparities, and population health. The conclusion is that integrative bioethics is relevant to the survival of all people, not just a privileged few; it could be the new ethics for the public's health.

The UNESCO Bioethics Programme: a review.

PubMed

Langlois, Adéle

2014-01-01

UNESCO's Bioethics Programme was established in 1993. In twenty years it has adopted three international declarations, on the human genome (1997), human genetic data (2003) and bioethics (2005); produced reports on a wide range of bioethics issues; and developed capacity building and public education programmes in bioethics. Yet UNESCO has sometimes struggled to assert its authority in the wider bioethics world. Some bioethicists have criticized the 2005 declaration and suggested that the World Health Organization might be better placed to advance bioethics. In 2011, after four years of debate, UNESCO decided not to draft a convention on human reproductive cloning, because consensus on the issue proved impossible. This article reviews the standard setting and capacity building activities of the UNESCO Bioethics Programme. While the Programme faces challenges common to most intergovernmental organizations, its achievements in expanding international law and building bioethics capacity should not be underestimated.

Globalization of bioethics as an intercultural social tuning technology.

PubMed

Sakamoto, Hyakudai

2005-01-01

Now, in the beginning of the 21st century, bioethics must be urgently globalized into a Global Bioethics which combines the ongoing Bioethics based on the modern European humanism with the newly arising Environmental Ethics based on the rather communitarian (or Asian) ways of thinking. This does not always mean that the new global bioethics is necessarily universalistic, for we should stand on the recognition of the wide spread variety of value systems in the world, north and south, east and west. However, it is not particularistic either, for in order to establish a post-modern global ethics, we have to accept and harmonize every kind of antagonistic values on the Globe. For this purpose we have to cultivate a new social technology of tuning social disorder of not only international but also inter-ethnic and inter-cultural level of ideology beyond the modern European humanism. Here the concept of "human rights" or the concept of "human dignity" may lose its significance as it has held in the past bioethical thinking in the western world.

Choice is not the issue. The misrepresentation of healthcare in bioethical discourse

PubMed Central

Førde, Reidun; Wifstad, Åge

2010-01-01

The principle of respect for autonomy has shaped much of the bioethics' discourse over the last 50 years, and is now most commonly used in the meaning of respecting autonomous choice. This is probably related to the influential concept of informed consent, which originated in research ethics and was soon also applied to the field of clinical medicine. But while available choices in medical research are well defined, this is rarely the case in healthcare. Consideration of ordinary medical practice reveals that the focus on patient choice does not properly grasp the moral aspects involved in healthcare. Medical decisions are often portrayed as if doctors and patients in confidence confront specific decisions about examinations or treatment, yet the reality often involves many different participants, with decisions being made over time and space. Indeed, most of the decisions are never even presented to patients, as it would be unethical to suggest something that is not medically justifiable. The options patients do confront are somewhat arbitrarily constructed within the narrow framework of both what is deemed to be medically appropriate and how the healthcare system is organised practically. While the autonomy discourse has proven valuable, a failure to distinguish between the fields of medical research and clinical medicine has generated a focus on patient choice that does not reflect what is really at stake in healthcare settings. This is alarming, because the current discourse misrepresents medical practice in a way that actually contributes to bioethical self-delusion. PMID:21131609

Assessment of knowledge of nurses regarding bioethics.

PubMed

Saini, Radha; Saini, Parvesh; Alagh, Preety

2014-01-01

Nurses involved in research, whether as a principal investigator, a study coordinator, clinical trials nurse, or as a staff nurse caring for patients who are research subjects have a responsibility to promote the ethical conduct of clinical research. Will a registered nurse be ever able to challenge and infact unearth the unscrupulous medical practices which make poor patients guinea pigs in pharmaceutical company-sponsored clinical trials? Keeping this in view an exploratory study was carried out to assess the knowledge of bioethics among MSc Nursing students studying in recognised Nursing Colleges of North India. 92 percent of MSc nursing students scored below average knowledge regarding bioethics even after studying ethics in MSc (N) 1st year and B.Sc. Nursing degree programme. This research study strongly recommends the Indian Nursing Council-the statutory licensing body of nurses in India to ensure strict compliance of all researches (at masters as well as bachelors level) in nursing education with all the principles and components of bioethics. Need of the hour is to include at least one clinical nurse in the Institutional Ethics Committee in every medical and research institution.

Toward a Child Rights Theory in Pediatric Bioethics.

PubMed

Goldhagen, Jeffrey; Mercer, Raul; Webb, Elspeth; Nathawad, Rita; Shenoda, Sherry; Lansdown, Gerison

2016-01-01

This article offers a child rights theory in pediatric bioethics, applying the principles, standards, and norms of child rights, health equity, and social justice to medical and ethical decision-making. We argue that a child rights theory in pediatric bioethics will help pediatricians and pediatric bioethicists analyze and address the complex interplay of biomedical and social determinants of child health. These core principles, standards and norms, grounded in the U.N. Convention on the Rights of the Child (CRC), provide the foundational elements for the theory and a means for better understanding the complex determinants of children's health and well-being. Rights-based approaches to medical and ethical decision-making provide strategies for applying and translating these elements into the practice of pediatrics and pediatric bioethics by establishing a coherent, consistent, and contextual theory that is relevant to contemporary practice. The proposed child rights theory extends evolving perspectives on the relationship between human rights and bioethics to both child rights and pediatric bioethics.

Bioethics and the newspapers.

PubMed

Evans, M

1999-04-01

Many bioethics questions are resistant to journalistic exploration on account of their inherently philosophical dimensions. Such dimensions are ill-suited to what we may term the internal goods (in MacIntyre's sense) of the newspapers and mass media generally, which constrain newspaper coverage to an abbreviated form of narrative that, whilst not in itself objectionable, is nonetheless inimical to the conduct of philosophical reflection. The internal goods of academic bioethics, by contrast, include attention to philosophical questions inherent in bioethical issues and value-enquiry. The danger for bioethics is that its agenda for reflective enquiry will, if dictated by this abbreviated narrative, be distorted in terms of both range and priorities, to the inevitable neglect of questions having a philosophical dimension to them. This danger can be avoided by a constructive partnership between the media and academic bioethics. The success of this partnership relies on four suggested provisos, for the meeting of which both journalists and academics bear responsibility.

Bioethics for clinicians: 27. Catholic bioethics

PubMed Central

Markwell, Hazel J.; Brown, Barry F.

2001-01-01

THERE IS A LONG TRADITION OF BIOETHICAL REASONING within the Roman Catholic faith, a tradition expressed in scripture, the writings of the Doctors of the Church, papal encyclical documents and reflections by contemporary Catholic theologians. Catholic bioethics is concerned with a broad range of issues, including social justice and the right to health care, the duty to preserve life and the limits of that duty, the ethics of human reproduction and end-of-life decisions. Fundamental to Catholic bioethics is a belief in the sanctity of life and a metaphysical conception of the person as a composite of body and soul. Although there is considerable consensus among Catholic thinkers, differences in philosophical approach have given rise to some diversity of opinion with respect to specific issues. Given the influential history of Catholic reflection on ethical matters, the number of people in Canada who profess to be Catholic, and the continuing presence of Catholic health care institutions, it is helpful for clinicians to be familiar with the central tenets of this tradition while respecting the differing perspectives of patients who identify themselves as Catholic. PMID:11501460

ROBOTIC SURGERY: BIOETHICAL ASPECTS

PubMed Central

SIQUEIRA-BATISTA, Rodrigo; SOUZA, Camila Ribeiro; MAIA, Polyana Mendes; SIQUEIRA, Sávio Lana

2016-01-01

ABSTRACT Introduction: The use of robots in surgery has been increasingly common today, allowing the emergence of numerous bioethical issues in this area. Objective: To present review of the ethical aspects of robot use in surgery. Method: Search in Pubmed, SciELO and Lilacs crossing the headings "bioethics", "surgery", "ethics", "laparoscopy" and "robotic". Results: Of the citations obtained, were selected 17 articles, which were used for the preparation of the article. It contains brief presentation on robotics, its inclusion in health and bioethical aspects, and the use of robots in surgery. Conclusion: Robotic surgery is a reality today in many hospitals, which makes essential bioethical reflection on the relationship between health professionals, automata and patients. PMID:28076489

On the nature and sociology of bioethics.

PubMed

Sheehan, Mark; Dunn, Michael

2013-03-01

Much has been written in the last decade about how we should understand the value of the sociology of bioethics. Increasingly the value of the sociology of bioethics is interpreted by its advocates directly in terms of its relationship to bioethics. It is claimed that the sociology of bioethics (and related disciplinary approaches) should be seen as an important component of work in bioethics. In this paper we wish to examine whether, and how, the sociology of bioethics can be defended as a valid and justified research activity, in the context of debates about the nature of bioethics. We begin by presenting and arguing for an account of bioethics that does justice to the content of the field, the range of questions that belong within this field, and the justificatory standards (and methodological orientations) that can provide convincing answers to these questions. We then consider the role of sociology in bioethics and show how and under what conditions it can contribute to answering questions within bioethics. In the final section, we return to the sociology of bioethics to show that it can make only a limited contribution to the field.

The development and perspectives of Chinese bioethics.

PubMed

Li, Hongwen; Cong, Yali

2008-12-01

Bioethics began to emerge in the late 1980s in China, which was borrowed and introduced from western countries. But the Chinese bioethics has a different model from western bioethics in its philosophical basis and culture environment which have been influenced by Confucianism, Taoism and Buddhism. Academic researchers of bioethics, policy makers and the public have different opinions to the bioethical issues. Though sharing some similarities with those of western bioethics, the Chinese bioethics has certain different and urgent topics, such as health inequality in health care reform, physician-patient relationship, and different model of the informed consent.

Bioethics and Science.

PubMed

2018-03-01

Bioethics comes in for furious criticism in Stephen Pinker's new book, Enlightenment Now. Pinker argues that scientists are making human lives better and better, and that lives would get still better even faster if bioethicists did not use ideas like informed consent, dignity, sacredness, and social justice to hobble the scientists. Daniel Callahan, a cofounder of The Hastings Center and arguably of bioethics, is perhaps the best living embodiment of a bioethicist who has written about medical progress, and the March-April 2018 issue of the Hastings Center Report turns to him for a review of Pinker's book. In his essay, Callahan describes bioethics as guiding science, addressing problems generated by scientific developments and attempting to head off possible problems, rather than as broadly opposing science. That description of bioethics serves as well as anything to convey the flavor of much of this issue of the Report. © 2018 The Hastings Center.

WHAT CAN HISTORY DO FOR BIOETHICS?

PubMed Central

Wilson, Duncan

2013-01-01

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. PMID:22150828

A libertarian critique of H. Tristram Engelhardt, Jr.'s The Foundations of Bioethics.

PubMed

Fry-Revere, Sigrid

1992-01-01

Although Engelhardt's The Foundations of Bioethics is an impressive work, it is plagued by problems of justification, conceptual confusion, and inconsistencies....A libertarian theory can arrive at the same basic requirements of mutual respect, autonomy, nonuse of force, and tolerance for a wide range of diverse life styles without relying on a lowest-common-denominator principle and without depriving fetuses, infants, and the mentally retarded of their status as persons. This can be done by taking a deontological approach to libertarian theory that denies that all moral beliefs are worthy of respect. Some beliefs, such as Engelhardt's belief that fetuses, infants, and the mentally retarded are nonpersons, simply fall beneath the floor of acceptable moral alternatives, even in a libertarian society, because such beliefs are based on a misunderstanding of personhood and violate the principle of mutual respect.

A bioethics for all seasons.

PubMed

Chan, Sarah

2015-01-01

The last four decades have seen the emergence and flourishing of the field of bioethics and its incorporation into wide-ranging aspects of society, from the clinic or laboratory through to public policy and the media. Yet considerable debate still exists over what bioethics is and how it should be done. In this paper I consider the question of what makes good bioethics. Drawing on historical and contemporary examples, I suggest that bioethics encompasses multiple modes of responding to moral disagreement, and that an awareness of which mode is operational in a given context is essential to doing good bioethics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

"(East) Asia" as a Platform for Debate: Grouping and Bioethics.

PubMed

Sleeboom-Faulkner, Margaret

This article examines the use of the notions of "Asian" and "East Asian" in definitions of bioethics. Using examples from East Asia, I argue that the verbal Asianization of bioethics is based on the notion of "Asia" as a family metaphor and serves as a platform of bioethical debate, networking, and political change. I maintain that the use of "Asia" and "East Asia" to shape bioethics is not so much a sign of inward-looking regionalism, but an attempt to build bridges among Asian countries, while putting up a common stance against what educated elites interpret as undesirable global trends of Westernization through bioethics. Using the notions of "grouping" and "segmentary systems" to show the performative nature of characterizations of (East) Asian bioethics, allowing users to mark regional identity, share meanings, take political positions, and network. Deploying Peter Haas's notion of "epistemic communities," I argue that academic and political elites translate "home" issues into "Asia speak," while at the same time, introducing and giving shape to "new" bioethical issues. Although the "Asianisms" and group-marking activities of Asian networks of bioethics are ideological, thereby engaging in the politics of in/exclusion, they succeed in putting politically sensitive topics on the agenda.

What Is Bioethics Worth?

PubMed

Solomon, Mildred Z

2016-09-01

What is bioethics to do when it strives to assess the quality of its research and scholarship and when it needs to justify its work to prospective funders, especially a funder like the National Institutes of Health that privileges empirical discovery? In "A Conceptual Model for the Translation of Bioethics Research and Scholarship," Debra Mathews and colleagues take an important first step at advancing an answer. The authors describe what they call a translational process, whereby bioethics "outputs" are translated into changes of three types: in thinking, practice, and policy. It goes nearly without saying that bioethics research and scholarship must be held accountable for changes in thinking. What raison d'etre do we have if not to deepen thinking, question assumptions, and encourage ourselves and others to examine hard issues from novel approaches? Assuredly it is hard to assess quality, and even harder to assess specific changes in thinking for which high-quality scholarship may be responsible, but it is a necessary goal and one for which we should strive without reservation. Bioethics should also affect policy and practice. We should document how it does and the extent to which it does as often and as prominently as possible. However, let us be wary of pinning too much on practice and policy changes as the primary way of establishing bioethics' worth. © 2016 The Hastings Center.

An update on the "empirical turn" in bioethics: analysis of empirical research in nine bioethics journals.

PubMed

Wangmo, Tenzin; Hauri, Sirin; Gennet, Eloise; Anane-Sarpong, Evelyn; Provoost, Veerle; Elger, Bernice S

2018-02-07

A review of literature published a decade ago noted a significant increase in empirical papers across nine bioethics journals. This study provides an update on the presence of empirical papers in the same nine journals. It first evaluates whether the empirical trend is continuing as noted in the previous study, and second, how it is changing, that is, what are the characteristics of the empirical works published in these nine bioethics journals. A review of the same nine journals (Bioethics; Journal of Medical Ethics; Journal of Clinical Ethics; Nursing Ethics; Cambridge Quarterly of Healthcare Ethics; Hastings Center Report; Theoretical Medicine and Bioethics; Christian Bioethics; and Kennedy Institute of Ethics Journal) was conducted for a 12-year period from 2004 to 2015. Data obtained was analysed descriptively and using a non-parametric Chi-square test. Of the total number of original papers (N = 5567) published in the nine bioethics journals, 18.1% (n = 1007) collected and analysed empirical data. Journal of Medical Ethics and Nursing Ethics led the empirical publications, accounting for 89.4% of all empirical papers. The former published significantly more quantitative papers than qualitative, whereas the latter published more qualitative papers. Our analysis reveals no significant difference (χ2 = 2.857; p = 0.091) between the proportion of empirical papers published in 2004-2009 and 2010-2015. However, the increasing empirical trend has continued in these journals with the proportion of empirical papers increasing from 14.9% in 2004 to 17.8% in 2015. This study presents the current state of affairs regarding empirical research published nine bioethics journals. In the quarter century of data that is available about the nine bioethics journals studied in two reviews, the proportion of empirical publications continues to increase, signifying a trend towards empirical research in bioethics. The growing volume is mainly attributable to two

Advance directives and living wills: the role of patient's autonomy in the Brazilian experience.

PubMed

Dantas, Eduardo

2013-12-01

This paper aims to discuss the development of the notion that the patient has the right to refuse treatment, and how the Brazilian legal system is dealing with bioethical dilemmas, such as the possibility of exercising autonomy through advance directives. The paper discusses the lack of legislation to regulate important issues in the end of life healthcare, and what ethical guidelines exist, providing physicians with ethical and legal parameters to deal with the patient's will.

A Social Recognition Approach to Autonomy: The Role of Equality-Based Respect.

PubMed

Renger, Daniela; Renger, Sophus; Miché, Marcel; Simon, Bernd

2017-04-01

Inspired by philosophical reasoning about the connection between equality and freedom, we examined whether experiences of (equality-based) respect increase perceived autonomy. This link was tested with generalized experiences of respect and autonomy people make in their daily lives (Study 1) and with more specific experiences of employees at the workplace (Study 2). In both studies, respect strongly and independently contributed to perceived autonomy over and above other forms of social recognition (need-based care and achievement-based social esteem) and further affected (life/work) satisfaction. Study 3 experimentally confirmed the hypothesized causal influence of respect on perceived autonomy and demonstrated that this effect further translates into social cooperation. The respect-cooperation link was simultaneously mediated by perceived autonomy and superordinate collective identification. We discuss how the recognition approach, which differentiates between respect, care, and social esteem, can enrich research on autonomy.

[Autonomy in intensive care unit: let us start by caring ourselves].

PubMed

Vargas, Ambrosina Oliveira; Ramos, Flávia Regina Souza

2010-01-01

This study, a qualitative investigation anchored in Foucaltian analysis with approximations to post-structuralist theory, explores the question of autonomy as one of the tensions of nursing performance/knowledge which can be discursively articulated to bioethics and to techno biomedicine. From such perspective, from the multiples vies that may emerge to completing a critical reading of the analyzed texts (articles produced by nurses) and of the interviews with intensive care nurses, the theme of autonomy was analytically explored from the concept of self care, unfolding itself into categories which express privileging: morals as obedience to the Law; conduct and morals concerning technical knowledge; self-governing in its confront with technique. These are configured as ethical possibilities for the intensive care nurse/subject, not as sequential or competitive stages, but connected and confluent in the experience of the current historical period.

Bioethical pluralism and complementarity.

PubMed

Grinnell, Frederick; Bishop, Jeffrey P; McCullough, Laurence B

2002-01-01

This essay presents complementarity as a novel feature of bioethical pluralism. First introduced by Neils Bohr in conjunction with quantum physics, complementarity in bioethics occurs when different perspectives account for equally important features of a situation but are mutually exclusive. Unlike conventional approaches to bioethical pluralism, which attempt in one fashion or another to isolate and choose between different perspectives, complementarity accepts all perspectives. As a result, complementarity results in a state of holistic, dynamic tension, rather than one that yields singular or final moral judgments.

Global challenges and globalization of bioethics

PubMed Central

Nezhmetdinova, Farida

2013-01-01

This article analyzes problems and implications for man and nature connected with the formation of a new architecture of science, based on the convergence of nanotechnology, biotechnology, information technology, and cognitive science (NBIC). It also describes evolution and genesis of bioethics, a scientific discipline and social practice with a special role of ethical management of potential risks of scientific research. The aim was to demonstrate the necessity of bioethical social control in the development of a global bioeconomy driven by NBIC technologies. PMID:23447421

Bioethics and the whole: pluralism, consensus, and the transmutation of bioethical methods into gold.

PubMed

Martin, P A

1999-01-01

Arguing that a consensus-based method of bioethical decision making can transform ethical pluralism into an ethical whole, author examines the theory of three consensus-based models--clinical pragmatism, ethics facilitation, and mediation--and develops a practical guide to ethics facilitation that includes a hypothetical case.

Improving the Science Curriculum with Bioethics.

ERIC Educational Resources Information Center

Lundmark, Cathy

2002-01-01

Explains the importance of integrating bioethics into the science curriculum for student learning. Introduces a workshop designed for middle and high school science teachers teaching bioethics, its application to case studies, and how teachers can fit bioethics into their classroom. (YDS)

Bioethics and the rituals of media.

PubMed

Simonson, Peter

2002-01-01

Popular media may make short shrift of complex ideas and moral deliberations, but it can also serve bioethics well. Bioethics should embrace the ritual function of the media in bringing issues to public attention and in reinforcing bioethics as a field.

Enhancing the African bioethics initiative.

PubMed

Ogundiran, Temidayo O

2004-10-15

Medical ethics has existed since the time of Hippocrates. However, formal training in bioethics did not become established until a few decades ago. Bioethics has gained a strong foothold in health sciences in the developed world, especially in Europe and North America. The situation is quite different in many developing countries. In most African countries, bioethics - as established and practiced today in the west- is either non-existent or is rudimentary. Though bioethics has come of age in the developed and some developing countries, it is still largely "foreign" to most African countries. In some parts of Africa, some bioethics conferences have been held in the past decade to create research ethics awareness and ensure conformity to international guidelines for research with human participants. This idea has arisen in recognition of the genuine need to develop capacity for reviewing the ethics of research in Africa. It is also a condition required by external sponsors of collaborative research in Africa. The awareness and interest that these conferences have aroused need to be further strengthened and extended beyond research ethics to clinical practice. By and large, bioethics education in schools that train doctors and other health care providers is the hook that anchors both research ethics and clinical ethics. This communication reviews the current situation of bioethics in Africa as it applies to research ethics workshops and proposes that in spite of the present efforts to integrate ethics into biomedical research in Africa, much still needs to be done to accomplish this. A more comprehensive approach to bioethics with an all-inclusive benefit is to incorporate formal ethics education into health training institutions in Africa.

Enhancing the African bioethics initiative

PubMed Central

Ogundiran, Temidayo O

2004-01-01

Background Medical ethics has existed since the time of Hippocrates. However, formal training in bioethics did not become established until a few decades ago. Bioethics has gained a strong foothold in health sciences in the developed world, especially in Europe and North America. The situation is quite different in many developing countries. In most African countries, bioethics – as established and practiced today in the west- is either non-existent or is rudimentary. Discussion Though bioethics has come of age in the developed and some developing countries, it is still largely "foreign" to most African countries. In some parts of Africa, some bioethics conferences have been held in the past decade to create research ethics awareness and ensure conformity to international guidelines for research with human participants. This idea has arisen in recognition of the genuine need to develop capacity for reviewing the ethics of research in Africa. It is also a condition required by external sponsors of collaborative research in Africa. The awareness and interest that these conferences have aroused need to be further strengthened and extended beyond research ethics to clinical practice. By and large, bioethics education in schools that train doctors and other health care providers is the hook that anchors both research ethics and clinical ethics. Summary This communication reviews the current situation of bioethics in Africa as it applies to research ethics workshops and proposes that in spite of the present efforts to integrate ethics into biomedical research in Africa, much still needs to be done to accomplish this. A more comprehensive approach to bioethics with an all-inclusive benefit is to incorporate formal ethics education into health training institutions in Africa. PMID:15488145

Religious and cultural legitimacy of bioethics: lessons from Islamic bioethics.

PubMed

Shabana, Ayman

2013-11-01

Islamic religious norms are important for Islamic bioethical deliberations. In Muslim societies religious and cultural norms are sometimes confused but only the former are considered inviolable. I argue that respect for Islamic religious norms is essential for the legitimacy of bioethical standards in the Muslim context. I attribute the legitimating power of these norms, in addition to their purely religious and spiritual underpinnings, to their moral, legal, and communal dimensions. Although diversity within the Islamic ethical tradition defies any reductionist or essentialist reconstruction, legitimacy is secured mainly by approximation of Islamic ethical ideals believed to be inherent in the scriptural texts, rather than by the adoption of particular dogmatic or creedal views. With these characteristics, Islamic (bio) ethics may provide useful insights for comparative ethics and global bioethics.

Who is buying bioethics research?

PubMed

Sharp, Richard R; Scott, Angela L; Landy, David C; Kicklighter, Laura A

2008-08-01

Growing ties to private industry have prompted many to question the impartiality of academic bioethicists who receive financial support from for-profit corporations in exchange for ethics-related services and research. To the extent that corporate sponsors may view bioethics as little more than a way to strengthen public relations or avoid potential controversy, close ties to industry may pose serious threats to professional independence. New sources of support from private industry may also divert bioethicists from pursuing topics of greater social importance, such as the needs of medically underserved communities. To inform ongoing debates about the financing of bioethics and its transparency to those concerned about potential sources of bias, we examined funding disclosures appearing in original research reports in major bioethics journals. Reviewing research published over a 15-year period, we found little evidence that for-profit corporations are influencing bioethics research directly. Instead, we found evidence that a great number of organizations, both public and private, support bioethics research. These findings suggest that worries about the cooption of bioethics research by a few interested stakeholders are greatly overstated and undersupported by available data.

Taking representation seriously: rethinking bioethics through Clint Eastwood's Million Dollar Baby.

PubMed

Braswell, Harold

2011-06-01

In this article, I propose a new model for understanding the function of representation in bioethics. Bioethicists have traditionally judged representations according to a mimetic paradigm, in which representations of bioethical dilemmas are assessed based on their correspondence to the "reality" of bioethics itself. In this article, I argue that this mimetic paradigm obscures the interaction between representation and reality and diverts bioethicists from analyzing the tensions in the representational object itself. I propose an anti-mimetic model of representation that is attuned to how representations can both maintain and potentially subvert dominant conceptions of bioethics. I illustrate this model through a case study of Clint Eastwood's film Million Dollar Baby. By focusing attention on the film's lack of adherence bioethical procedures and medical science, critics missed how an analysis of its representational logic provides a means of reimagining both bioethics and medical practice. In my conclusion, I build off this case study to assess how an incorporation of representational studies can deepen-and be deepened by-recent calls for interdisciplinarity in bioethics.

[Interface between bioethics and international relations].

PubMed

Manchola-Castillo, Camilo; Garrafa, Volnei

2016-08-01

Recently, bioethics and international relations have gotten closer to one an other, probably as a result of the motivation of bioethics to intervene in global affairs. However, this relationship has only been on the practical level.This study's objective, through a literature review, is to highlight the huge potential that the epistemologies of both areas have to build a more fruitful dialogue. 18 articles relating both areas were retrieved from databases Scopus, Web of Science, Bireme and PubMed. The articles were then grouped in three categories of analysis: bioethics and global health; international organizations and bioethics; and international relations and bioethics. This study concludes that an epistemological approaching between these areas is desirable and proposes the establishment of two new areas of study: international relations in health and international relations from the South, drawing upon the conceptual basis developed by Latin-American bioethics.

[Why and how to promote decision-making autonomy of cancer patients?

PubMed

Mancini, Julien

2018-02-01

Involvement of patients in decision-making about their health has been promoted nationally and internationally since several years. Despite this, patient (and their relatives) participation remains insufficient and one of the objectives of the current French national cancer policy (Plan cancer 2014-2019) is to give everyone the possibility to play an active role in the management of their care. This overview focuses on decision-making autonomy of cancer patients through two main questions: why and how to promote it? After a brief review of the decision-making models described in the literature in the past decades insisting on the major role of the decisional context and the dynamic character of this context, this article presents a selection of published works which aimed to respond to those 2 questions. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Making a difference: incorporating theories of autonomy into models of informed consent.

PubMed

Delany, C

2008-09-01

Obtaining patients' informed consent is an ethical and legal obligation in healthcare practice. Whilst the law provides prescriptive rules and guidelines, ethical theories of autonomy provide moral foundations. Models of practice of consent, have been developed in the bioethical literature to assist in understanding and integrating the ethical theory of autonomy and legal obligations into the clinical process of obtaining a patient's informed consent to treatment. To review four models of consent and analyse the way each model incorporates the ethical meaning of autonomy and how, as a consequence, they might change the actual communicative process of obtaining informed consent within clinical contexts. An iceberg framework of consent is used to conceptualise how ethical theories of autonomy are positioned and underpin the above surface, and visible clinical communication, including associated legal guidelines and ethical rules. Each model of consent is critically reviewed from the perspective of how it might shape the process of informed consent. All four models would alter the process of obtaining consent. Two models provide structure and guidelines for the content and timing of obtaining patients' consent. The two other models rely on an attitudinal shift in clinicians. They provide ideas for consent by focusing on underlying values, attitudes and meaning associated with the ethical meaning of autonomy. The paper concludes that models of practice that explicitly incorporate the underlying ethical meaning of autonomy as their basis, provide less prescriptive, but more theoretically rich guidance for healthcare communicative practices.

The relationship between perceived promotion of autonomy/dependence and pain-related disability in older adults with chronic pain: the mediating role of self-reported physical functioning.

PubMed

Matos, Marta; Bernardes, Sónia F; Goubert, Liesbet

2016-08-01

Chronic pain is prevalent among older adults and is usually associated with high levels of functional disability. Social support for the promotion of functional autonomy and dependence has been associated with pain-related disability and self-reported physical functioning. Nevertheless, these relationships need further inquiry. Our aims were to investigate: (1) the relationship between perceived promotion of autonomy/dependence and pain-related disability and (2) the extent to which self-reported physical functioning mediated these relationships. 118 older adults (Mage = 81.0) with musculoskeletal chronic pain completed the Portuguese versions of the revised formal social support for Autonomy and Dependence in Pain Inventory, the pain severity and interference scales of the Brief Pain Inventory, and the physical functioning scale of the Medical Outcomes Study-Short-Form 36 v2. Higher levels of perceived promotion of autonomy were associated with lower pain-related disability; this relationship was partially mediated by self-reported physical functioning (B = -.767, p < .001 decreasing to B' = -.485, p < .01). Higher perceived promotion of dependence was associated with higher pain-related disability; this effect was also partially accounted for by self-reported physical functioning (B = .889, p < .01 decreasing to B' = .597, p < .05). These results highlight the importance of perceived promotion of autonomy and dependence for managing older adults' experience of chronic pain.

Lessons Learned from Undergraduate Students in Designing a Science-Based Course in Bioethics

ERIC Educational Resources Information Center

Loike, John D.; Rush, Brittany S.; Schweber, Adam; Fischbach, Ruth L.

2013-01-01

Columbia University offers two innovative undergraduate science-based bioethics courses for student majoring in biosciences and pre-health studies. The goals of these courses are to introduce future scientists and healthcare professionals to the ethical questions they will confront in their professional lives, thus enabling them to strategically…

Towards a bioethics of innovation.

PubMed

Lipworth, Wendy; Axler, Renata

2016-07-01

In recent years, it has become almost axiomatic that biomedical research and clinical practice should be 'innovative'-that is, that they should be always evolving and directed towards the production, translation and implementation of new technologies and practices. While this drive towards innovation in biomedicine might be beneficial, it also raises serious moral, legal, economic and sociopolitical questions that require further scrutiny. In this article, we argue that biomedical innovation needs to be accompanied by a dedicated 'bioethics of innovation' that attends systematically to the goals, process and outcomes of biomedical innovation as objects of critical inquiry. Using the example of personalised or precision medicine, we then suggest a preliminary framework for a bioethics of innovation, based on the research policy initiative of 'Responsible Innovation'. We invite and encourage critiques of this framework and hope that this will provoke a challenging and enriching new bioethical discourse. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Bioethics, power and injustice: for an ethics of intervention.

PubMed

Garrafa, Volnei; Porto, Dora

2003-01-01

Bioethics of the so-called "peripheral countries" should be preferably concerned with the persistent situations, that is, with those problems that are still happening, but should not happen anymore in the 21st century. The resulting conflicts cannot be exclusively analyzed based on the ethical theories (or bioethical) arriving from "central countries". The authors alert for the increasing depoliticization of moral conflicts and for the lack of capacity of human indignation. The indiscriminate utilization of bioethics justification as a neutral methodological tool softens and even cancels out the gravity of different problems, even those that might result in the most profound social distortion. The current study sets as a theoretical reference the finitude of natural resources (which are all of them...) and corporality, pleasures and pain. From these premises and the introduction of the concept that equity means "to treat unevenly the unequal", the authors introduced a proposal of a hard bioethics or intervention bioethics, in support of the interest and the historical rights of the population economically and socially excluded from the international development practice.

Global bioethics and communitarianism.

PubMed

ten Have, Henk A M J

2011-10-01

This paper explores the role of 'community' in the context of global bioethics. With the present globalization of bioethics, new and interesting references are made to this concept. Some are familiar, for example, community consent. This article argues that the principle of informed consent is too individual-oriented and that in other cultures, consent can be community-based. Other references to 'community' are related to the novel principle of benefit sharing in the context of bioprospecting. The application of this principle necessarily requires the identification and construction of communities. On the global level there are also new uses of the concept of community as 'global community.' Three uses are distinguished: (1) a diachronic use, including past, present, and future generations, (2) a synchronic ecological use, including nonhuman species, and (3) a synchronic planetary use, including all human beings worldwide. Although there is a tension between the communitarian perspective and the idea of global community, this article argues that the third use can broaden communitarianism. The current development towards cosmopolitanism is creating a new global community that represents humanity as a whole, enabling identification of world citizens and evoking a sense of global solidarity and responsibility. The emergence of global bioethics today demonstrates this development.

Maqasid al-shariah as a complementary framework to conventional bioethics.

PubMed

Saifuddeen, Shaikh Mohd; Rahman, Noor Naemah Abdul; Isa, Noor Munirah; Baharuddin, Azizan

2014-06-01

With the rapid advancements made in biotechnology, bioethical discourse has become increasingly important. Bioethics is a multidisciplinary and interdisciplinary field that goes beyond the realm of natural sciences, and has involved fields in the domain of the social sciences. One of the important areas in bioethical discourse is religion. In a country like Malaysia, where Muslims make up the majority of the population, Islam plays a crucial role in providing the essential guidelines on the permissibility and acceptability of biotechnological applications in various fields such as medicine, agriculture, and food processing. This article looks at the framework of a complementary model of bioethics derived from the perspective of Islam. The framework is based on 'maqasid al-shariah' (purposes or objectives of Islamic law) which aims to protect and preserve mankind's faith, life, intellect, progeny, and property. It is proposed that 'maqasid al-shariah' be used as a pragmatic checklist that can be utilized in tackling bioethical issues and dilemmas.

Accounting for culture in a globalized bioethics.

PubMed

Marshall, Patricia; Koenig, Barbara

2004-01-01

How might a global bioethics account for profound cultural difference in a world marked by porous borders? The authors endorse a critical, self-reflexive bioethics, suggesting that bioethics needs to change its fundamental orientation if it is going to remain relevant and intellectually vibrant throughout the twenty-first century. Bioethics must attend to issue of social justice and public health, while seriously considering the implications of social context for medical morality. Negotiating moral consensus across cultural boundaries will be difficult, but is is more likely to succeed if we critically engage with the cultural assumptions underlying bioethics itself.

Does company-sponsored egg freezing promote or confine women's reproductive autonomy?

PubMed

Mertes, Heidi

2015-08-01

A critical ethical analysis of the initiative of several companies to cover the costs of oocyte cryopreservation for their healthy employees. The main research question is whether such policies promote or confine women's reproductive autonomy. A distinction needs to be made between the ethics of AGE banking in itself and the ethics of employers offering it to their employees. Although the utility of the former is expected to be low, there are few persuasive arguments to deny access to oocyte cryopreservation to women who are well informed about the procedure and the success rates. However, it does not automatically follow that it would be ethically unproblematic for employers to offer egg banking to their employees. For these policies to be truly 'liberating', a substantial number of conditions need to be fulfilled, which can be reduced to three categories: (1) women should understand the benefits, risks and limitations, (2) women should feel no pressure to take up the offer; (3) the offer should have no negative effect on other family-friendly policies and should in fact be accompanied by such policies. Fulfilling these conditions may turn out to be impossible. Thus, regardless of companies' possible good intentions, women's reproductive autonomy is not well served by offering them company-sponsored AGE banking.

Telos versus Praxis in Bioethics.

PubMed

Chambers, Tod S

2016-09-01

The authors of "A Conceptual Model for the Translation of Bioethics Research and Scholarship" argue that bioethics must respond to institutional pressures by demonstrating that it is having an impact in the world. Any impact, the authors observe, must be "informed" by the goals of the discipline of bioethics. The concept of bioethics as a discipline is central to their argument. They begin by citing an essay that Daniel Callahan wrote in the first issue of Hastings Center Studies. Callahan argued in this 1973 piece that bioethics had yet to attain the status of a discipline, and he lauded the freedom of being able to define a new discipline. Callahan's essay shares with Mathews and colleague's a peculiarity: neither ever defines what it means to refer to something as a "discipline." To define a discipline does mean attending to the intended end product of scholarly activity, so I concur with Mathews et al.'s focus on outcomes. But I am concerned that in their argument they confusingly entangle their understanding of an academic discipline's internal goals, its telos, with its potential to have an impact on the external world, its praxis. The confusion that this can bring exposes what I believe is a profound problem within bioethics, the discipline's peculiar and at times intellectually hazardous relationship with its institutional hosts. © 2016 The Hastings Center.

The ethics of peer review in bioethics

PubMed Central

Wendler, David; Miller, Franklin

2014-01-01

A good deal has been written on the ethics of peer review, especially in the scientific and medical literatures. In contrast, we are unaware of any articles on the ethics of peer review in bioethics. Recognising this gap, we evaluate the extant proposals regarding ethical standards for peer review in general and consider how they apply to bioethics. We argue that scholars have an obligation to perform peer review based on the extent to which they personally benefit from the peer review process. We also argue, contrary to existing proposals and guidelines, that it can be appropriate for peer reviewers to benefit in their own scholarship from the manuscripts they review. With respect to bioethics in particular, we endorse double-blind review and suggest several ways in which the peer review process might be improved. PMID:24131903

Promotion of Learner Autonomy in a Freshmen's English Course at a Colombian University

ERIC Educational Resources Information Center

Ramírez, Alexander

2017-01-01

This paper presents the results of an Action-Research cycle conducted at Universidad del Valle, which aimed at fostering learner autonomy in freshmen from a foreign languages program, within an English course. The study established the freshmen's entrance profile regarding learner autonomy, and implemented a course based on the development of…

Bioethical conflicts between Muslim patients and German physicians and the principles of biomedical ethics.

PubMed

Ilkilic, Ilhan

2002-01-01

In the age of globalisation, more and more people who are members of different religions and cultures live in the same society. This situation tends to create many conflicts in different areas of life and not least in the health care system, a fact which raises a number of bioethical issues. The cultural and religious differences between patient and physician can be a cause of bioethical conflicts and therefore represent a challenge for biomedical ethics. The confrontation between Turkish Muslin patients and the German health care system is a convenient example of this situation. The Muslim Turks came to Germany 40 years ago as industrial workers. Their value system had been shaped by traditional and Islamic parameters in Turkey. With this value system, they now found themselves in the German modern health care system. In many fields of modern medicine there are areas of potential conflict of values, where a Muslin patient will argue differently from a secular or Christian person. In an ethical conflict between two individuals who are members of different cultures, it is necessary to make sure that the ethical concept which is to be used for resolving the problem is relevant. In this particular case, both the Islamic legal responses (fatwa) and the classical theories of biomedical ethics are often insufficient. This paper tries to give a brief outline of these bioethical conflicts and discuss these conflicts with regard to the principle of respect for autonomy in the concept of "principilism," as introduced by T.L. Beauchamp and J.F. Childress. The central question is whether this bioethical concept is able to analyse and to help solve the kinds of ethical conflicts which involve transcultural dimensions. This question is discussed with some consideration of the ongoing debate about universalism versus relativism in biomedical ethics.

Bioethics' gender.

PubMed

Lindemann, Hilde

2006-01-01

I argue that the field of bioethics is gendered feminine, but that the methods it uses to resist this gender identity pose real harm to actual women. Starting with an explanation of what I take 'gender' to be, I enumerate four drawbacks to being gendered feminine. I then argue that bioethics suffers from three of the same four drawbacks. I show how the field escapes the fourth disadvantage by adopting a masculine persona that inflicts damage on women, and conclude by urging bioethicists to reflect on their complicity in abusive power systems such as gender, race and class.

Fritz Jahr's 1927 concept of bioethics.

PubMed

Sass, Hans-Martin

2007-12-01

In 1927, Fritz Jahr, a Protestant pastor, philosopher, and educator in Halle an der Saale, published an article entitled "Bio-Ethics: A Review of the Ethical Relationships of Humans to Animals and Plants" and proposed a "Bioethical Imperative," extending Kant's moral imperative to all forms of life. Reviewing new physiological knowledge of his times and moral challenges associated with the development of secular and pluralistic societies, Jahr redefines moral obligations towards human and nonhuman forms of life, outlining the concept of bioethics as an academic discipline, principle, and virtue. Although he had no immediate long-lasting influence during politically and morally turbulent times, his argument that new science and technology requires new ethical and philosophical reflection and resolve may contribute toward clarification of terminology and of normative and practical visions of bioethics, including understanding of the geoethical dimensions of bioethics.

Heteronomous Citizenship: Civic Virtue and the Chains of Autonomy

ERIC Educational Resources Information Center

Swaine, Lucas

2010-01-01

In this article, I distinguish personal autonomy from heteronomy, and consider whether autonomy provides a suitable basis for liberalism. I argue that liberal government should not promote autonomy in all its citizens, on the grounds that not all members of liberal democracies require autonomy for a good life. I then outline an alternative option…

ROBOTIC SURGERY: BIOETHICAL ASPECTS.

PubMed

Siqueira-Batista, Rodrigo; Souza, Camila Ribeiro; Maia, Polyana Mendes; Siqueira, Sávio Lana

2016-01-01

The use of robots in surgery has been increasingly common today, allowing the emergence of numerous bioethical issues in this area. To present review of the ethical aspects of robot use in surgery. Search in Pubmed, SciELO and Lilacs crossing the headings "bioethics", "surgery", "ethics", "laparoscopy" and "robotic". Of the citations obtained, were selected 17 articles, which were used for the preparation of the article. It contains brief presentation on robotics, its inclusion in health and bioethical aspects, and the use of robots in surgery. Robotic surgery is a reality today in many hospitals, which makes essential bioethical reflection on the relationship between health professionals, automata and patients. A utilização de robôs em procedimentos cirúrgicos tem sido cada vez mais frequente na atualidade, o que permite a emergência de inúmeras questões bioéticas nesse âmbito. Apresentar revisão sobre os aspectos éticos dos usos de robôs em cirurgia. Realizou-se revisão nas bases de dados Pubmed, SciELO e Lilacs cruzando-se os descritores "bioética", "cirurgia", "ética", "laparoscopia" e "robótica". Do total de citações obtidas, selecionou-se 17 artigos, os quais foram utilizados para a elaboração do artigo. Ele contém breve apresentação sobre a robótica, sua inserção na saúde e os aspectos bioéticos da utilização dos robôs em procedimentos cirúrgicos. A cirurgia robótica é uma realidade, hoje, em muitas unidades hospitalares, o que torna essencial a reflexão bioética sobre as relações entre profissionais da saúde, autômatos e pacientes.

Scientific Autonomy and Public Oversight

PubMed Central

Resnik, David B.

2009-01-01

When scientific research collides with social values, science’s right to self-governance becomes an issue of paramount concern. In this article, I develop an account of scientific autonomy within a framework of public oversight. I argue that scientific autonomy is justified because it promotes the progress of science, which benefits society, but that restrictions on autonomy can also be justified to prevent harm to people, society, or the environment, and to encourage beneficial research. I also distinguish between different ways of limiting scientific autonomy, and I argue that government involvement in scientific decision-making should usually occur through policies that control the process of science, rather than policies that control the content of science. PMID:19777124

Erasmus Mundus Master of Bioethics: a case for an effective model for international bioethics education.

PubMed

Piasecki, Jan; Dirksen, Kevin; Inbadas, Hamilton

2018-03-01

Designing bioethics curriculum for international postgraduate students is a challenging task. There are at least two main questions, which have to be resolved in advance: (1) what is a purpose of a particular teaching program and (2) how to respectfully arrange a classroom for students coming from different cultural and professional backgrounds. In our paper we analyze the case of the Erasmus Mundus Master of Bioethics program and provide recommendations for international bioethics education. In our opinion teaching bioethics to postgraduate international students goes beyond curriculum. It means that such a program requires not only well-defined goals, including equipping students with necessary skills and knowledge, but also it should first and foremost facilitate positive group dynamics among students and enables them to engage in dialogue to learn from one another.

From bioethics to a sociology of bio-knowledge.

PubMed

Petersen, Alan

2013-12-01

Growing recognition of bioethics' shortcomings, associated in large part with its heavy reliance on abstract principles, or so-called principlism, has led many scholars to propose that the field should be reformed or reconceptualised. Principlism is seen to de-contextualise the process of ethical decision-making, thus restricting bioethics' contributions to debate and policy on new and emergent biotechnologies. This article examines some major critiques of bioethics and argues for an alternative normative approach; namely, a sociology of bio-knowledge focussing on human rights. The article discusses the need for such an approach, including the challenges posed by the recent rise of 'the bio-economy'. It explores some potential alternative bases for a normative sociology of bio-knowledge, before presenting the elements of the proposed human rights-focused approach. This approach, it is argued, will benefit from the insights and concepts offered by various fields of critical scholarship, particularly the emergent sociology of human rights, science and technology studies, Foucaultian scholarship, and feminist bioethics. Copyright © 2013 Elsevier Ltd. All rights reserved.

Evaluating non-disclosure of errors and healthcare organization: a case of bioethics consultation.

PubMed

Colucci, Massimiliano; Aprile, Anna; Pegoraro, Renzo

2015-11-01

Sometimes medical errors should not be disclosed. We report a case of semen samples exchange, during a homologous artificial insemination procedure, where a bioethics consultation was required. The bioethics consultation addressed ethical and legal elements in play, supporting non-disclosure to some of the subjects involved. Through a proper methodology, gathering factual and juridical elements, a consultant can show when a moral dilemma between values and rights-privacy versus fatherhood, in our case-is unsubstantial, in a given context, because of the groundlessness of the value or the right itself. However, being the error elicited by organizational factors, a broader ethical pronouncement was needed. Under such circumstances, ethical evaluation should engage in a sort of 'ethical-based root-cause analysis', linking ethical principles to quality aims and showing the opportunity to integrate ethical methodology in healthcare management. From this perspective, errors may become an incentive to promote high-quality organizations, attending to the central value of person even through the organizational process.

Why Bioethics Should Be Concerned With Medically Unexplained Symptoms.

PubMed

O'Leary, Diane

2018-05-01

Biomedical diagnostic science is a great deal less successful than we've been willing to acknowledge in bioethics, and this fact has far-reaching ethical implications. In this article I consider the surprising prevalence of medically unexplained symptoms, and the term's ambiguous meaning. Then I frame central questions that remain answered in this context with respect to informed consent, autonomy, and truth-telling. Finally, I show that while considerable attention in this area is given to making sure not to provide biological care to patients without a need, comparatively little is given to the competing, ethically central task of making sure never to obstruct access to biological care for those with diagnostically confusing biological conditions. I suggest this problem arises from confusion about the philosophical value of vagueness when it comes to the line between biological and psychosocial needs.

Drawing on Other Disciplines to Define Quality in Bioethics Education

ERIC Educational Resources Information Center

Avci, Ercan

2017-01-01

In light of the lack of scholarly studies on the determination of quality in bioethics education, this paper aims to elaborate the concept of quality, focus on its understanding in education and explore a definition of quality in bioethics education. The findings of the literature-based research indicate that quality is a multidimensional concept…

Debates in Teaching Bioethics

ERIC Educational Resources Information Center

Kedraka, Katerina; Kourkoutas, Yiannis

2018-01-01

In this small scale study in higher education, a good educational practice on the teaching of Bioethics based on transformative learning and accomplished by debates is presented. The research was carried out in June 2016 at the Department of Molecular Biology and Genetics, Democritus University of Thrace, Greece and it includes the assessment of…

From evidence based bioethics to evidence based social policies.

PubMed

Bonneux, Luc

2007-01-01

In this issue, Norwegian authors demonstrate that causes of early expulsion out the workforce are rooted in childhood. They reconstruct individual biographies in administrative databases linked by an unique national identification number, looking forward 15 years in early adulthood and looking back 20 years till birth with close to negligible loss to follow up. Evidence based bioethics suggest that it is better to live in a country that allows reconstructing biographies in administrative databases then in countries that forbid access by restrictive legislation based on privacy considerations. The benefits of gained knowledge from existing and accessible information are tangible, particularly for the weak and the poor, while the harms of theoretical privacy invasion have not yet materialised. The study shows once again that disadvantage runs in families. Low parental education, parental disability and unstable marital unions predict early disability pensions and premature expulsion out gainful employment. The effect of low parental education is mediated by low education of the index person. However, in a feast of descriptive studies of socio-economic causes of ill health we still face a famine of evaluative intervention studies. An evidence based social policy should be based on effective interventions that are able to break the vicious circles of disability handed down from generation to generation.

Global bioethics at UNESCO: in defence of the Universal Declaration on Bioethics and Human Rights.

PubMed

Andorno, R

2007-03-01

The Universal Declaration on Bioethics and Human Rights adopted by the United Nations Educational, Scientific, and Cultural Organisation (UNESCO) on 19 October 2005 is an important step in the search for global minimum standards in biomedical research and clinical practice. As a member of UNESCO International Bioethics Committee, I participated in the drafting of this document. Drawing on this experience, the principal features of the Declaration are outlined, before responding to two general charges that have been levelled at UNESCO's bioethical activities and at this particular document, are outlined. One criticism is to the effect that UNESCO is exceeding its mandate by drafting such bioethical instruments--in particular, the charge is that it is trespassing on a topic that lies in the responsibility of the World Health Organization. The second criticism is that UNESCO's reliance on international human rights norms is inappropriate.

Autonomy, consent and responsibility. Part II. Informed consent in medical care and in the law.

PubMed

Mellado, J M

Legal recognition of patient's rights aspired to change clinical relationship and medical lex artis. However, its implementation has been hampered by the scarcity of resources and the abundance of regulations. For several years, autonomy, consent, and responsibility have formed one of the backbones of the medical profession. However, they have sparked controversy and professional discomfort. In the first part of this article, we examine the conceptual and regulatory limitations of the principle of autonomy as the basis of informed consent. We approach the subject from philosophical, historical, legal, bioethical, deontological, and professional standpoints. In the second part, we cover the viability of informed consent in health care and its relationship with legal responsibility. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Medical and Nursing Students’ Television Viewing Habits: Potential Implications for Bioethics

PubMed Central

Czarny, Matthew J.; Faden, Ruth R.; Nolan, Marie T.; Bodensiek, Edwin; Sugarman, Jeremy

2011-01-01

Television medical dramas frequently depict the practice of medicine and bioethical issues in a strikingly realistic but sometimes inaccurate fashion. Because these shows depict medicine so vividly and are so relevant to the career interests of medical and nursing students, they may affect these students’ beliefs, attitudes, and perceptions regarding the practice of medicine and bioethical issues. We conducted a web-based survey of medical and nursing students to determine the medical drama viewing habits and impressions of bioethical issues depicted in them. More than 80% of medical and nursing students watch television medical dramas. Students with more clinical experience tended to have impressions that were more negative than those of students without clinical experience. Furthermore, viewing of television medical dramas is a social event and many students discuss the bioethical issues they observe with friends and family. Television medical dramas may stimulate students to think about and discuss bioethical issues. PMID:19085461

Disconnections Between Teacher Expectations and Student Confidence in Bioethics

NASA Astrophysics Data System (ADS)

Hanegan, Nikki L.; Price, Laura; Peterson, Jeremy

2008-09-01

This study examines how student practice of scientific argumentation using socioscientific bioethics issues affects both teacher expectations of students’ general performance and student confidence in their own work. When teachers use bioethical issues in the classroom students can gain not only biology content knowledge but also important decision-making skills. Learning bioethics through scientific argumentation gives students opportunities to express their ideas, formulate educated opinions and value others’ viewpoints. Research has shown that science teachers’ expectations of student success and knowledge directly influence student achievement and confidence levels. Our study analyzes pre-course and post-course surveys completed by students enrolled in a university level bioethics course ( n = 111) and by faculty in the College of Biology and Agriculture faculty ( n = 34) based on their perceptions of student confidence. Additionally, student data were collected from classroom observations and interviews. Data analysis showed a disconnect between faculty and students perceptions of confidence for both knowledge and the use of science argumentation. Student reports of their confidence levels regarding various bioethical issues were higher than faculty reports. A further disconnect showed up between students’ preferred learning styles and the general faculty’s common teaching methods; students learned more by practicing scientific argumentation than listening to traditional lectures. Students who completed a bioethics course that included practice in scientific argumentation, significantly increased their confidence levels. This study suggests that professors’ expectations and teaching styles influence student confidence levels in both knowledge and scientific argumentation.

Analysis and critical review of the development of bioethics in Belarus.

PubMed

Vishneuskaya, Yuliya A

2012-11-01

The main trends of the bioethics development in Belarus have been analyzed on the basis of the materials collected by the Ethics Documentation Center (ISEU, Minsk, Belarus). A critical review of the most important publications in the field since 2000 suggests that development of bioethics in Belarus has occurred in two parallel directions distantly connected to each other: a theoretical direction and a practical one. Despite there are objective and subjective reasons for introducing bioethics in Belarus as an institutionally-organized system based on liberal values such as individual rights and freedom, a range of essential problems could be identified. Non-equivalent regulation of ethical issues in health care and other fields of biomedical research has been emphasized, as well as the problem of unclear hierarchical relationships among institutions dealing with various aspects of bioethics in the country and low ethical and educational level of the social and professional groups involved in further expansion of bioethical knowledge. The contextual aspects of the development of bioethics in the country such as the consequences of the Chernobyl disaster, the prevalence of the authoritarian social morality and traditionally paternalistic nature of the relations between physicians and their patients are discussed.

Bioethics, bioweapons and the microbiologist.

PubMed

Anaya-Velázquez, Fernando

2002-01-01

The analysis of behavior of man in the field of biology is carried out through bioethics, considered the science of the survival. In the microbiology, there are numerous discoveries related with pathogenic microorganisms, including those that can be used as weapons in a biological war or in an attack considered bioterrorism. The scientist involved in microbiology can participate with his knowledge in the development and improvement of bioweapons, however from the point of view of bioethics it is not acceptable that he works in an investigation related with these topics, because the defense research can evolve in offensive one. The war is an antisurvival activity, therefore it is not acceptable. In the same way, the biological weapons composed with virus, fungi or alive bacteria, or with toxins from them, neither they are morally accepted. After the terrorist attacks with anthrax in the United States in 2001, the world scientific community in the field of microbiology should show against the use of the microorganisms like bioweapons, at the time of promoting the idea that the responsible use for the microorganisms is a moral imperative for all microbiologists around the world, since the biological weapons are a threat for the human life.

[Personalist bioethics and utilitarian bioethics].

PubMed

Ortiz Llueca, Eduardo

2013-01-01

This paper shows the insufficiency of a bioethics which would intend to derive its proposals from Utilitarianism, identifying some inadequacies in the ethics of John Stuart Mill, e.g., the difficulties of the utilitarian commitment with instrumentalism, the deficiency of an utilitarian moral psychology and the naiveté of the forensic dimension of the utilitarian submission.

Balancing bioethics by sensing the aesthetic.

PubMed

Macneill, Paul

2017-10-01

This article is critical of "bioethics" as it is widely understood and taught, noting in particular an emphasis given to philosophical justification, reason and rationality. It is proposed that "balancing" bioethics be achieved by giving greater weight to practice and the aesthetic: Defined in terms of sensory perception, emotion and feeling. Each of those three elements is elaborated as a non-cognitive capacity and, when taken together, comprise aesthetic sensitivity and responsiveness. This is to recognise the aesthetic as a productive element in bioethics as practice. Contributions from the philosophy of art and aesthetics are drawn into the discussion to bring depth to an understanding of "the aesthetic". This approach is buttressed by philosophers - including Foucault and 18th century German philosophers (in particular Kant) - who recognized a link between ethics and aesthetics. The article aims to give substance to a claim that bioethics necessarily comprises a cognitive component, relating to reason, and a non-cognitive component that draws on aesthetic sensibility and relates to practice. A number of advantages of bioethics, understood to explicitly acknowledge the aesthetic, are proffered. Having defined bioethics in conventional terms, there is discussion of the extent to which other approaches to bioethics (including casuistry, virtue ethics, and narrative ethics) recognize aesthetic sensitivity in their practice. It is apparent that they do so to varying extents although not always explicitly. By examining this aspect of applied ethics, the paper aims to draw attention to aesthetic sensitivity and responsiveness as integral to ethical and effective health care. © 2017 John Wiley & Sons Ltd.

Clinical autonomy, individual and collective: the problem of changing doctors' behaviour.

PubMed

Armstrong, David

2002-11-01

Evidence-based medicine enables the profession to resist at least some of the challenges to its traditional autonomy: if informed doctors provide what is scientifically proven to be the best care there is less justification for external constraints. Yet, this defensive strategy depends on enforcing a new discipline within the profession such that individual practitioners accept mechanisms of external 'decision support' in their clinical practice. A study of the ways in which general practitioners in British Primary Care change their clinical behaviour shows that an emphasis on a 'patient centred' approach establishes an alternative individualised autonomy that seems inimical to the logic of evidence-based medicine. A tension therefore emerges between the maintenance of the autonomy of the profession as a collectivity through the promotion of a therapeutic rationality and the maintenance of the autonomy of the individual practitioner through the rhetoric of patient-centredness.

The ethics of peer review in bioethics.

PubMed

Wendler, David; Miller, Franklin

2014-10-01

A good deal has been written on the ethics of peer review, especially in the scientific and medical literatures. In contrast, we are unaware of any articles on the ethics of peer review in bioethics. Recognising this gap, we evaluate the extant proposals regarding ethical standards for peer review in general and consider how they apply to bioethics. We argue that scholars have an obligation to perform peer review based on the extent to which they personally benefit from the peer review process. We also argue, contrary to existing proposals and guidelines, that it can be appropriate for peer reviewers to benefit in their own scholarship from the manuscripts they review. With respect to bioethics in particular, we endorse double-blind review and suggest several ways in which the peer review process might be improved. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Learner Autonomy: New Insights. = Autonomie de l'apprenant: nouvelles pistes.

ERIC Educational Resources Information Center

Dam, Leni, Ed.

2001-01-01

This book presents papers, written in both English and French, from a symposium entitled "Promoting Learner Autonomy: New Insights." After "Introduction" (Leni Dam), the eight papers include the following: "Examining the Discourse of Learner Advisory Sessions" (David Crabbe, Alison Hoffman, and Sara Cotteral);…

Autonomy and reason: treatment choice in breast cancer.

PubMed

Twomey, Mary

2012-10-01

The practice of offering choice to those women with breast cancer for whom either breast conserving surgery or mastectomy would be equally beneficial has come to be seen as an important aspect of medical care. As well as improving satisfaction with treatment, this is seen as satisfying the ethical principle of respect for autonomy. A number of studies, however, show that women are not always comfortable with such choice, preferring to leave treatment decisions to their surgeons. A question then arises as to the extent that these women can be seen as autonomous or as exercising autonomy. This paper argues, however, that the understanding of autonomy which is applied in current approaches to breast cancer care does not adequately support the exercise of autonomy, and that the clinical context of care means that women are not able to engage in the kind of reasoning that might promote the exercise of autonomy. Where respect for autonomy is limited to informed consent and choice, there is a danger that women's interests are overlooked in those aspects of their care where choice is not appropriate, with very real, long-term consequences for some women. Promoting the exercise of autonomy, it is argued, needs to go beyond the conception of autonomy as rational individuals making their own decisions, and clinicians need to work with an understanding of autonomy as relational in order to better involve women in their care. © 2012 Blackwell Publishing Ltd.

[When to consult the institutional bioethics committee? The deliberative method for resolving possible dilemmas].

PubMed

Rabadán, Alejandra T; Tripodoro, Vilma A

2017-01-01

In healthcare, an ethical concern that arises during the decision making process is considered to be a bioethical dilemma. It is often the case that in the absence of proper deliberation, the problem is transferred to a bioethics committee, not even representing precisely a dilemma. Bioethics emerged as a discipline in the mid-20th century. It is defined as a support to decision-making in ethical dilemmas centered on two aspects: ethics of clinical investigation, focused on protecting the rights of research subjects, and bioethics in medical practice, of an advisory nature. To recognize the difference among difficult or complex clinical circumstances and ethical dilemmas could allow knowing when it is necessary to request for advice of a committee. It is not so much a question of deciding what is right or wrong, but which is the most advisable solution to a problem. We review the history of Bioethics Committees in Argentina that are facing today the challenge of promoting social responsibility and opening deliberations to community and health professionals. In the 20th century two historical moments are recognized: a pioneering and slow first period, and a second one of legal regulatory framework. Considering deliberation as a method of ethics, this article proposes a case analysis procedure and the deliberative method to elucidate dilemmas, with or without the help of a Committee.

The Pedagogical Challenges of Teaching High School Bioethics: Insights from the Exploring Bioethics Curriculum.

PubMed

Solomon, Mildred Z; Vannier, David; Chowning, Jeanne Ting; Miller, Jacqueline S; Paget, Katherine F

2016-01-01

A belief that high school students have the cognitive ability to analyze and assess moral choices and should be encouraged to do so but have rarely been helped to do so was the motivation for developing Exploring Bioethics, a six-module curriculum and teacher guide for grades nine through twelve on ethical issues in the life sciences. A multidisciplinary team of bioethicists, science educators, curriculum designers, scientists, and high school biology teachers worked together on the curriculum under a contract between the National Institutes of Health and Education Development Center, a nonprofit research and development organization with a long history of innovation in science education. At the NIH, the Department of Bioethics within the Clinical Center and the Office of Science Education within the Office of the Director guided the project.Our overarching goal for Exploring Bioethics was to introduce students to bioethics as a field of inquiry and to enable them to develop ethical reasoning skills so they could move beyond "gut reactions" to more nuanced positions. © 2016 The Hastings Center.

Intervention bioethics: a proposal for peripheral countries in a context of power and injustice.

PubMed

Garrafa, Volnei; Porto, Dora

2003-10-01

The bioethics of the so-called 'peripheral countries' must preferably be concerned with persistent situations, that is, with those problems that are still happening, but should not happen anymore in the 21st century. Resulting conflicts cannot be exclusively analysed based on ethical (or bioethical) theories derived from 'central countries.' The authors warn of the growing lack of political analysis of moral conflicts and of human indignation. The indiscriminate utilisation of the bioethics justification as a neutral methodological tool softens and even cancels out the seriousness of several problems, even those that might result in the most profound social distortions. The current study takes as a theoretical reference the fact that natural resources (which affect us all) are relevant. Based on these premises, and on the concept that equity means 'treating unevenly the unequal', a proposal of a hard bioethics (or intervention bioethics) is introduced, in defence of the historical insights and rights of economically and socially excluded populations that are separated from the international developmental process.

Regarding Bioethics: A Sociology of Morality.

PubMed

De Vries, Raymond

2017-01-01

C. Wright Mills said that when done well, sociology illuminates the intersection of biography and history. This essay examines how the author's vocational choices and career path were shaped by historical circumstance, leading him to a degree in sociology and to participation in the odd and interesting interdiscipline of bioethics. Drawing on a distinction between sociology in bioethics and sociology of bioethics, the essay considers the value of sociology to the bioethical project.

Robotics supporting autonomy. 5th French Japanese Conference on Bio-ethics.

PubMed

Gelin, Rodolphe

2013-12-01

The aim of this paper is to propose a new vision on robots. Generally seen as a threat against humanity or at least against employment, we will demonstrate that this new kind of machine can be a support not only for people in loss of autonomy but even for everyone. They will not replace people, they will assist them. The mass production of these companion robots will create a new industry that could take the relay of the automotive and the computer industries in this century. This access to the mass market will require solving technological and acceptability problems by a common work of researchers, engineers, users and the major stakeholders of our society.

[Bioethics and environmental health].

PubMed

Velasco-Suárez, M

1993-01-01

Institutions such as World Health Organization and United Nations have considered the necessity to establish programs to control and preserve our environment. From the beginning, industrial development has polluted the air, water and soil, in some cases irreversibly affecting the ecosystems. Rampant use of natural resources and inattention to preventive measures have promoted environmental pollution, along with its hereditary effects, producing brain damage, intoxications, cancer, and respiratory and cardiovascular conditions, among other problems. It is necessary to put aside self-serving materialism and individualism and become aware of this problem. It is necessary to implement environmental policies, foster bioethical responsibility in environmental health research, conduct epidemiologic, biomedical and toxicologic environmental health research works if we are to have a worthy life and an optimal environment.

Bioethics and law: a developmental perspective.

PubMed

van der Burg, Wibren

1997-04-01

In most Western countries, health law [and] bioethics are strongly intertwined. This strong connection is the result of some specific factors that, in the early years of these disciplines, facilitated a rapid development of both. In this paper, I analyze these factors and construe a development theory existing of three phases, or ideal-typical models. In the moralistic-paternalistic model, there is almost no health law of explicit medical ethics, and the little law there is is usually based on traditional morality, combined with paternalist motives. The objections to this model are that its paternalism and moralism are unacceptable, that it is too static and knows no external control mechanisms. In the liberal model, which is now dominant in most Western countries, law and ethics closely cooperate and converge, both disciplines use the same framework for analysis: they are product-oriented rather than practice-oriented; they use the same conceptual categories, they focus on minimally decent rather than the ideal, and they are committed to the same substantive normative theory in which patient autonomy and patient rights are central. However, each of these four characteristics also results in a certain one-sidedness. In some countries, a third model is emerging. In this postliberal model, health law is more modest and acknowledges its inherent and normative limits, whereas ethics takes a richer and most ambitious self image. As a result health law and ethics will partly diverge again.

Connecting the East and the West, the Local and the Universal: The Methodological Elements of a Transcultural Approach to Bioethics.

PubMed

Nie, Jing-Bao; Fitzgerald, Ruth P

From the outset, cross-cultural and transglobal bioethics has constituted a potent arena for a dynamic public discourse and academic debate alike. But prominent bioethical debates on such issues as the notion of common morality and a distinctive "Asian" bioethics in contrast to a "Western" one reveal some deeply rooted and still popular but seriously problematic methodological habits in approaching cultural differences, most notably, radically dichotomizing the East and the West, the local and the universal. In this paper, a "transcultural" approach to bioethics and cultural studies is proposed. It takes seriously the challenges offered by social sciences, anthropology in particular, towards the development of new methodologies for comparative and global bioethics. The key methodological elements of "transculturalism" include acknowledging the great internal plurality within every culture; highlighting the complexity of cultural differences; upholding the primacy of morality; incorporating a reflexive theory of social power; and promoting changes or progress towards shared and sometimes new moral values.

[Bioethics in Russian neurology and epileptology].

PubMed

Mikhalkovska-Karlova, E P

2016-01-01

Historical roots and further development of bioethics in domestic neurology and epileptology are considered. The main bioethical principles were established during the formation of the Russian clinical school and neurosciences. It is most distinctly seen in the development of bioethics in neurology and epileptology. In the author's opinion, the Russian scientist V.M. Bekhterev had played a prominent role in the field. In the time when the term "bioethics" was not coined and its principles were not formulated, V.M. Bekhterev had created the Russian league against epilepsy and established the foundations of the International League Against Epilepsy (ILAE) as the organizations working on the problems of medical and social care to patients with epilepsy. In Russia, the Russian society of neurologists has been doing a great work in the field.

[School nutrition and autonomy - challenges and opportunities].

PubMed

Barbosa, Najla Veloso Sampaio; Machado, Neila Maria Viçosa; Soares, Maria Cláudia Veiga; Pinto, Anelise Regina Royer

2013-04-01

This study seeks to emphasize school food as an important policy to promote student autonomy by means of food and nutrition education included in the curriculum, integrated with different actors and based on the standpoint of citizenship. It seeks to return to fundamental concepts in the context of school food reflecting on them through theoretical assumptions to identify possible strategies to promote citizenship and autonomy in school. The strategies involved food and nutrition education with the daily presence of quality and suitability in school meals, discussions on the various dimensions of food in the curriculum and integrating food in the pedagogical project extended to various areas of the education system. School food fosters the need for integration of actions, actors and the various social spaces interested in the food issue, such as ministries, education systems, departments and schools, so that they may tackle the demands of contemporary reality in an integrated, systematic, consistent and efficient manner.

Surmounting elusive barriers: the case for bioethics mediation.

PubMed

Bergman, Edward J

2013-01-01

This article describes, analyzes, and advocates for management of clinical healthcare conflict by a process commonly referred to as bioethics mediation. Section I provides a brief introduction to classical mediation outside the realm of clinical healthcare. Section II highlights certain distinguishing characteristics of bioethics mediation. Section III chronicles the history of bioethics mediation and references a number of seminal writings on the subject. Finally, Section IV analyzes barriers that have, thus far, limited the widespread implementation of bioethics mediation.

In defense of bioethics.

PubMed

Baker, Robert

2009-01-01

Although bioethics societies are developing standards for clinical ethicists and a code of ethics, they have been castigated in this journal as "a moral, if not an ethics, disaster" for not having completed this task. Compared with the development of codes of ethics and educational standards in law and medicine, however, the pace of professionalization in bioethics appears appropriate. Assessed by this metric, none of the charges leveled against bioethics are justified. The specific charges leveled against the American Society for Bioethics and Humanities (ASBH) and its Core Competencies report are analyzed and rejected as artifacts of an ahistoric conception of the stages by which organizations professionalize. For example, the charge that the ASBH should provide definitive criteria for what counts as "medical ethics consultation" antecedent to further progress towards professionalization is assessed by comparing it with the American Medical Association's decades-long struggle to define who can legitimately claim the title "medical doctor." Historically, clarity about who is legitimately a doctor, a lawyer - or a "clinical ethicist"- is a byproduct of, and never antecedent to, the decades-long process by which a field professionalizes. The charges leveled against ASBH thus appear to be a function of impatient, ahistoric perfectionism.

How international is bioethics? A quantitative retrospective study.

PubMed

Borry, Pascal; Schotsmans, Paul; Dierickx, Kris

2006-01-13

Studying the contribution of individual countries to leading journals in a specific discipline can highlight which countries have the most impact on that discipline and whether a geographic bias exists. This article aims to examine the international distribution of publications in the field of bioethics. Retrospective quantitative study of nine peer reviewed journals in the field of bioethics and medical ethics (Bioethics, Cambridge Quarterly of Healthcare Ethics, Hastings Center Report, Journal of Clinical Ethics, Journal of Medical Ethics, Kennedy Institute of Ethics Journal, Nursing Ethics, Christian Bioethics, and Theoretical Medicine and Bioethics). In total, 4,029 articles published between 1990 and 2003 were retrieved from the nine bioethical journals under study. The United States (59.3%, n = 2390), the United Kingdom (13.5%, n = 544), Canada (4%, n = 160) and Australia (3.8%, n = 154) had the highest number of publications in terms of absolute number of publications. When normalized to population size, smaller affluent countries, such as New Zealand, Finland and Sweden were more productive than the United States. The number of studies originating from the USA was decreasing in the period between 1990 and 2003. While a lot of peer reviewed journals in the field of bioethics profile themselves as international journals, they certainly do not live up to what one would expect from an "international" journal. The fact that English speaking countries, and to a larger extent American authors, dominate the international journals in the field of bioethics is a clear geographic bias towards the bioethical discussions that are going on in these journals.

Documentary bioethics: visual narratives for Generations X and Y.

PubMed

Stys, John C

2006-01-01

Narrative bioethics is primarily understood to involve storytelling through the use of literature. This article suggests that other forms of media are necessary to convey stories of an ethical nature to an audience broader than one being trained as medical professionals. "Documentary bioethics" is a manner to present and interpret stories of an ethical nature using forms of popular electronic media in a reality-based documentary style to society at large, specifically Generations X and Y.

Experimental course of bioethics upon the bioethics core curriculum of UNESCO: methodoloy and result of investigation.

PubMed

Davtyan, S

2012-12-01

In October 2005 the General Conference of UNESCO adopted the Universal Declaration on Bioethics and Human Rights. The aim of this Declaration was to assist in the realization ofprinciples and support the thorough understanding of the consequences of the ethics of scientific and technical progress, especially for youth. In 2008, the Division of Ethics of Science and Technology Sector for Social and Human Sciences of UNESCO worked out an Educational Program (Bioethics Core Curriculum). On November 23, 2010 a Memorandum was signed between UNESCO and the Yerevan State Medical University after M. Heratsi. The Memorandum was aimed to test the Bioethics Core Curriculum of UNESCO. In this article we will analyze the aims and goals of studying the course, as well as disputable shortcomings of the Program, make recommendations for the improvement of the course of bioethics, and highlight the positive aspects of this Educational Program.

Against the integrative turn in bioethics: burdens of understanding.

PubMed

Savić, Lovro; Ivanković, Viktor

2018-06-01

The advocates of Integrative Bioethics have insisted that this recently emerging project aspires to become a new stage of bioethical development, surpassing both biomedically oriented bioethics and global bioethics. We claim in this paper that if the project wants to successfully replace the two existing paradigms, it at least needs to properly address and surmount the lack of common moral vocabulary problem. This problem points to a semantic incommensurability due to cross-language communication in moral terms. This paper proceeds as follows. In the first part, we provide an overview of Integrative Bioethics and its conceptual building blocks: mutlidisciplinarity, interdisciplinarity, and transdisciplinarity. In the second part, we disclose the problem of semantic incommensurability. The third part gives an overview of various positions on the understanding of interdisciplinarity and integration in interdisciplinary communication, and corresponding attempts at solving the lack of common moral vocabulary problem. Here we lean mostly on Holbrook's three theses regarding the character of interdisciplinary communication. Finally, in the fourth part, we discuss a particular bioethical case-that of euthanasia-to demonstrate the challenge semantic incommensurability poses to dialogues in Integrative Bioethics. We conclude that Integrative Bioethics does not offer a methodological toolset that would warrant optimism in its advocates' predictions of surpassing current modes of doing bioethics. Since Integrative Bioethics leaves controversial methodological questions unresolved on almost all counts and shows no attempts at overcoming the critical stumbling points, we argue for its rejection.

[Human dignity, human rights and bioethics: what is the connection?].

PubMed

Andorno, Roberto

2010-12-01

Human rights are closely related to the notion of human dignity, to such a point that it is very difficult, if not impossible, to promote them without appealing, at least implicitly, to the idea that each individual has intrinsic worth simply by virtue of being human. This relationship between dignity and rights is even stronger in the field of bioethics, which deals directly with some of the most basic human rights, such as the rights to life and to physical integrity. It is therefore not by chance that the international norms relating to bioethics give a central role to the concept of human dignity. However, one should not expect from dignity more than it can offer; dignity is a "principle", not a "rule"; it embodies a fundamental value, but it alone does not determine the content of a particular decision.

Authenticity-Sensitive Preferentism and Educating for Well-Being and Autonomy

ERIC Educational Resources Information Center

Haji, Ishtiyaque; Cuypers, Stefaan E.

2008-01-01

An overarching aim of education is the promotion of children's personal well-being. Liberal educationalists also support the promotion of children's personal autonomy as a central educational aim. On some views, such as John White's, these two goals--furthering well-being and cultivating autonomy--can come apart. Our primary aim in this paper is…

Autonomy, natality and freedom: a liberal re-examination of Habermas in the enhancement debate.

PubMed

Pugh, Jonathan

2015-03-01

Jurgen Habermas has argued that carrying out pre-natal germline enhancements would be inimical to the future child's autonomy. In this article, I suggest that many of the objections that have been made against Habermas' arguments by liberals in the enhancement debate misconstrue his claims. To explain why, I begin by explaining how Habermas' view of personal autonomy confers particular importance to the agent's embodiment and social environment. In view of this, I explain that it is possible to draw two arguments against germline enhancements from Habermas' thought. I call these arguments 'the argument from negative freedom' and 'the argument from natality'. Although I argue that many of the common liberal objections to Habermas are not applicable when his arguments are properly understood, I go on to suggest ways in which supporters of enhancement might appropriately respond to Habermas' arguments. © 2014 The Author. Bioethics published by John Wiley & Sons Ltd.

Bioethics Center: An Idea Whose Time Had Come

ERIC Educational Resources Information Center

Chemical and Engineering News, 1974

1974-01-01

The functioning of the Kennedy Institute, which aims at dealing with ethical and social questions raised by advances in biosciences and medicine, is described. Three major projects now underway are briefly discussed: a core reference library in bioethics, an Encyclopedia of Bioethics, and a bioethics information retrieval system. (DT)

Appropriate methodologies for empirical bioethics: it's all relative.

PubMed

Ives, Jonathan; Draper, Heather

2009-05-01

In this article we distinguish between philosophical bioethics (PB), descriptive policy orientated bioethics (DPOB) and normative policy oriented bioethics (NPOB). We argue that finding an appropriate methodology for combining empirical data and moral theory depends on what the aims of the research endeavour are, and that, for the most part, this combination is only required for NPOB. After briefly discussing the debate around the is/ought problem, and suggesting that both sides of this debate are misunderstanding one another (i.e. one side treats it as a conceptual problem, whilst the other treats it as an empirical claim), we outline and defend a methodological approach to NPOB based on work we have carried out on a project exploring the normative foundations of paternal rights and responsibilities. We suggest that given the prominent role already played by moral intuition in moral theory, one appropriate way to integrate empirical data and philosophical bioethics is to utilize empirically gathered lay intuition as the foundation for ethical reasoning in NPOB. The method we propose involves a modification of a long-established tradition on non-intervention in qualitative data gathering, combined with a form of reflective equilibrium where the demands of theory and data are given equal weight and a pragmatic compromise reached.

Christian bioethics as non-ecumenical.

PubMed

Engelhardt, H Tristram

1995-09-01

A community's morality depends on the moral premises, rules of evidence, and rules of inference it acknowledges, as well as on the social structure of those in authority to rule knowledge claims in or out of a community's set of commitments. For Christians, who is an authority and who is in authority are determined by Holy Tradition, through which in the Mysteries one experiences the Holy Spirit. Because of the requirement of repentance and conversion to the message of Christ preserved in the Tradition, the authority of the community must not only exclude heretical teaching but heretical communities from communion. Understanding Christian bioethics requires a focus on the content of that bioethics in terms of its social context within a right-believing, right-worshipping community. Christian bioethics should be non-ecumenical by recognizing that true moral knowledge has particular moral content, is communal, and is not fully available outside of the community of right worship. The difficulty with Roman Catholicism's understandings of bioethics lies not just in its continued inordinate accent on the role of reason apart from repentance (as well as in its defining novel doctrines), but in Roman Catholicism's not recognizing that the contemporary, post-Christian age is in good measure the consequence of its post-Vatican II failure to call for a return to the traditional pieties and asceticisms of the Fathers so that all might know rightly concerning the requirements of Christian bioethics.

Bioethics in biomedicine in the context of a global higher education area

PubMed Central

2010-01-01

The University is tasked with drawing together, transmitting and maintaining knowledge, while creating an area where the ethical "sense" required for working in the field of Biology and Biomedicine can be provided. Although scientific knowledge is present on an overwhelming scale in nature and, therefore, its discovery is unceasing, this does not mean that, as a human being, the researcher has no limitations. It is Bioethics that sets this limit. The successful spreading of knowledge, therefore, which is proclaimed with the creation of a Global Higher Education Area, should also pursue the establishment of the bioethical principles necessary for the credibility of science and its progress so that the society that it promotes and sustains becomes a reality. PMID:20540744

[Preimplantatory genetic diagnosis and ″saviour sibling″: ethical criteria found in the biomedical and bioethics literature].

PubMed

Arango Restrepo, Pablo; Sánchez Abad, Pedro José; Pastor, Luis Miguel

2012-01-01

A bibliographic review on was performed in order to find out the ethical criteria put forward by the authors on this issue. 23 biomedical and 10 bioethical journals were reviewed and authors for and against the procedure were found. In the Biomedical journals, the main arguments for this issue are that nobody should be hurt and that there is an ethical imperative that is to save a life and that this is preferable to abortion. Those against, believe that an inadequate discrimination against women is being exerted on one hand by subjecting them to a complex, inefficient and dangerous procedure, and on the other, against embryos when many healthy ones are rejected because they are not compatible, or because of the dangers to the embryo, and also the psychological problems for the sick child as well as the donor. In the bioethical journals, we found a higher proportion of papers that are in its favor than in biomedical journals. The arguments are similar to those of the bioethical ones, but there are some particular arguments such as that the autonomy of parents must be respected; that it is a success of the common sense; that it is not an invasive process as it is considered; that it only involves blood donation not a solid organ; that the child that donates will feel accompanied by the saved one and he/she will feel the satisfaction of since having helped someone to live because without this procedure, the baby child would probably not have been born. The arguments against are the discrimination women undergo when they are subjected to this procedure with potential risks for her, the embryos and children. a) the morality of medicine not has been debated in the bioethics and biomedical community before its implementation b) in both communities the majority of authors consider it to be ethically licit; c) paradoxically there is a greater relative percentage of authors who are critical of it within the biomedical field than in

Theorising the 'human subject' in biomedical research: international clinical trials and bioethics discourses in contemporary Sri Lanka.

PubMed

Sariola, Salla; Simpson, Bob

2011-08-01

The global spread of clinical trials activity is accompanied by a parallel growth in research governance and human subject protection. In this paper we analyse how dominant ideas of the 'human subject' in clinical trials are played out in countries that are deemed to be scientifically under-developed. Specifically, we show how rhetorics of individualism, rationality and autonomy implicit in international ethical guidelines governing human subject research are operationalised and localised. We give insights into the ways in which new knowledge forms become embedded in practice. Using the recent upsurge in clinical trials in Sri Lanka as a case study, based on interviews with 23 doctors and researchers carried out during ethnographic fieldwork between 2008-2009, this article explores the tensions that arise for doctors involved with the promotion of bioethics and the attempts to bring local research governance up to international standards. The doctors and researchers intercept, interpret and critique the notions of human subject implicit in new forms of research governance. From their accounts we have identified two concerns. The first is a critique of dominant ideas of the 'human subject' that is informed by ideas of patiency rooted in paternalistic notions of the doctor-patient relationship. Second, 'human subjects' are seen as gendered, and located within family relationships. Both of these bring into question the research subjects' ability to give informed consent and compromise the ideal of an autonomous subject. Copyright © 2010 Elsevier Ltd. All rights reserved.

Genome editing: Bioethics shows the way.

PubMed

Neuhaus, Carolyn P; Caplan, Arthur L

2017-03-01

When some scientists hear the word "bioethics," they break out in intellectual hives. They shouldn't. Good bioethics is about enabling science to move forward. Bioethics pushes scientists to acknowledge that they operate not within a vacuum but within a society in which diverse perspectives and values must be engaged. Bioethicists give voice to those divergent perspectives and provide a framework to facilitate informed and inclusive discussions that spur progress, rather than stall it. The field is needed to advance cutting-edge biomedical research in domains in which the benefits to be had are enormous, such as genome editing, but ethical concerns persist.

Islamic bioethics: a general scheme

PubMed Central

Shomali, Mohamamd Ali

2008-01-01

No doubt life in its all forms enjoys a very high status in Islam. Human life is one of the most sacred creatures of God. Therefore, it must be appreciated, respected and protected. In this regard, the paper refers to different parts. The first part studies the value of life in Islam. It helps to understand why life must be appreciated and respected. The second part sheds some light on the nature of the Islamic bioethics. Discussing the sources and authorities in the Islamic bioethics, in this part we will study the way of life protection which is regulated by the Islamic law and bioethics. Part three reflects on some important issues in bioethics from an Islamic perspective. Concerning the Islamic believes, physical health maintenance and disease treatment are two important aspects of the Islamic teachings. In respect to the beginning of human life; firstly, we will see that reproduction must occur in the context of a legitimate and stable family. Secondly, we will study family planning and abortion. With respect to the end of life, issues such as suicide and euthanasia will be studied. Finally organ transplantation will be discussed. PMID:23908711

The Global Governance of Bioethics: Negotiating UNESCO's Universal Declaration on Bioethics and Human Rights (2005).

PubMed

Langlois, Adèle

2011-01-01

UNESCO's Universal Declaration on Bioethics and Human Rights (2005) was drawn up by an independent panel of experts (the International Bioethics Committee) and negotiated by member states. UNESCO aimed for a participatory and transparent drafting process, holding national and regional consultations and seeking the views of various interest groups, including religious and spiritual ones. Furthermore, reflecting UNESCO's broad interpretation of bioethics, the IBC included medics, scientists, lawyers and philosophers among its membership. Nevertheless, several potential stakeholders-academic scientists and ethicists, government policy-makers and NGO representatives-felt they had not been sufficiently consulted or even represented during the Declaration's development. Better communications and understanding within and between national, regional and international layers of governance would help to avoid a recurrence of this problem in future negotiations.

Topics in Bioethics: A Development of Student Perspectives†

PubMed Central

Johnson, Keith A.

2014-01-01

Exposing students to current biotechnological and medical issues is eye-opening for many students in a way that is not always achieved through lecture-based learning. Lecture or investigative teaching styles provide a tremendous knowledge base for the students, but sometimes these teaching styles do not allow the student to fully develop, especially personal attitudes to issues in bioethics. Through online videos, Hollywood movies, guided readings and classroom discussions, students in this course are informed of some bioethical topics, encouraged to learn about other topics, and use this gained knowledge to develop personal positions regarding the value and/or risk of the issues. This course has been well-received by previous students as a favorite in terms of both topics covered and style. PMID:25574290

Lessons from Queer Bioethics: A Response to Timothy F. Murphy.

PubMed

Richie, Cristina

2016-06-01

'Bioethics still has important work to do in helping to secure status equality for LGBT people' writes Timothy F. Murphy in a recent Bioethics editorial. The focus of his piece, however, is much narrower than human rights, medical care for LGBT people, or ending the HIV/AIDS pandemic. Rather, he is primarily concerned with sexuality and gender identity, and the medical intersections thereof (i.e. DSM diagnosis; access to SrS or ARTs). It is the objective of this response to provide an alternate account of bioethics from a Queer perspective. I will situate Queer bioethics within Queer studies, and offer three 'lessons' that bioethics can derive from this perspective. These are not definitive rules for Queer bioethics, since it is a field which fundamentally opposes categorizations, favoring pastiche over principles. These lessons are exploratory examples, which both complement and contradict LGBT bioethics. My latter two lessons - on environmental bioethics and disability - overlap with some of Murphy's concerns, as well as other conceptions of LGBT bioethics. However, the first lesson takes an antithetical stance to Murphy's primary focus by resisting all forms of heteroconformity and disavowing reproduction as consonant with Queer objectives and theory. The first lesson, which doubles as a primer in Queer theory, does heavy philosophical lifting for the remainder of the essay. This response to Timothy F. Murphy, whose work is certainly a legacy in bioethics, reveals the multiplicity of discourses in LGBT/Queer studies, many of which are advantageous - even essential - to other disciplines like bioethics. © 2016 John Wiley & Sons Ltd.

Philosophy as news: bioethics, journalism and public policy.

PubMed

Goodman, K W

1999-04-01

News media accounts of issues in bioethics gain significance to the extent that the media influence public policy and inform personal decision making. The increasingly frequent appearance of bioethics in the news thus imposes responsibilities on journalists and their sources. These responsibilities are identified and discussed, as is (i) the concept of "news-worthiness" as applied to bioethics, (ii) the variable quality of bioethics reportage and (iii) journalists' reliance on ethicists to pass judgment. Because of the potential social and other benefits of high quality reporting on ethical issues, it is argued that journalists and their bioethics sources should explore and accommodate more productive relationships. An optimal journalism-ethics relationship will be one characterized by "para-ethics," in which journalistic constraints are noted but also in which issues and arguments are presented without oversimplification and credible disagreement is given appropriate attention.

Limits to relational autonomy--the Singaporean experience.

PubMed

Krishna, Lalit Kumar Radha; Watkinson, Deborah S; Beng, Ng Lee

2015-05-01

Recognition that the Principle of Respect for Autonomy fails to work in family-centric societies such as Singapore has recently led to the promotion of relational autonomy as a suitable framework within which to place healthcare decision making. However, empirical data, relating to patient and family opinions and the practices of healthcare professionals in Confucian-inspired Singapore, demonstrate clear limitations on the ability of a relational autonomy framework to provide the anticipated compromise between prevailing family decision-making norms and adopted Western led atomistic concepts of autonomy. Evidence suggests that despite a growing infusion of Western influence, there is still little to indicate any major shift to individual decision making, particularly in light of the way society and healthcare are structured. Similarly, the lack of employing a shared decision-making model and data that discredit the notion that the complex psychosocial and cultural factors that affect the decision making may be considered "content neutral" not only prevents the application of relational autonomy but questions the viability of the values behind the Principle of Respect for Autonomy. Taking into account local data and drawing upon a wider concept of personhood that extends beyond prevailing family-centric ideals along with the complex interests that are focused upon the preservation of the unique nature of personhood that arises from the Ring Theory of Personhood, we propose and "operationalize" the employing of an authoritative welfare-based approach, within the confines of best interest decision making, to better meet the current care needs within Singapore. © The Author(s) 2014.

Personal experience narratives by students: a teaching-learning tool in bioethics.

PubMed

Pandya, Radhika H; Shukla, Radha; Gor, Alpa P; Ganguly, Barna

2016-01-01

The principles of bioethics have been identified as important requirements for training basic medical doctors. Till now, various modalities have been used for teaching bioethics, such as lectures, followed by a small case-based discussion, case vignettes or debates among students. For effective teaching-learning of bioethics, it is necessary to integrate theory and practice rather than merely teach theoretical constructs without helping the students translate those constructs into practice. Classroom teaching can focus on the theoretical knowledge of professional relationships, patient-doctor relationships, issues at the beginning and end of life, reproductive technologies, etc. However, a better learning environment can be created through an experiencebased approach to complement lectures and facilitate successful teaching. Engaging students in reflective dialogue with their peers would allow them to refine their ideas with respect to learning ethics. It can help in the development both of the cognitive and affective domains of the teaching of bioethics. Real-life narratives by the interns, when used as case or situation analysis models for a particular ethical issue, can enhance other students' insight and give them a moral boost. Doing this can change the classroom atmosphere, enhance motivation, improve the students' aptitude and improve their attitude towards learning bioethics. Involving the students in this manner can prove to be a sustainable way of achieving the goal of deep reflective learning of bioethics and can serve as a new technique for maintaining the interest of students as well as teachers.

Linking international research to global health equity: the limited contribution of bioethics.

PubMed

Pratt, Bridget; Loff, Bebe

2013-05-01

Health research has been identified as a vehicle for advancing global justice in health. However, in bioethics, issues of global justice are mainly discussed within an ongoing debate on the conditions under which international clinical research is permissible. As a result, current ethical guidance predominantly links one type of international research (biomedical) to advancing one aspect of health equity (access to new treatments). International guidelines largely fail to connect international research to promoting broader aspects of health equity - namely, healthier social environments and stronger health systems. Bioethical frameworks such as the human development approach do consider how international clinical research is connected to the social determinants of health but, again, do so to address the question of when international clinical research is permissible. It is suggested that the narrow focus of this debate is shaped by high-income countries' economic strategies. The article further argues that the debate's focus obscures a stronger imperative to consider how other types of international research might advance justice in global health. Bioethics should consider the need for non-clinical health research and its contribution to advancing global justice. © 2011 Blackwell Publishing Ltd.

Bioethical Issues in Conducting Pediatric Dentistry Clinical Research.

PubMed

Garrocho-Rangel, Arturo; Cerda-Cristerna, Bernardino; Pozos-Guillen, Amaury

Pediatric clinical research on new drugs and biomaterials involves children in order to create valid and generalizable knowledge. Research on vulnerable populations, such as children, is necessary but only admissible when researchers strictly follow methodological and ethical standards, together with the respect to human rights; and very especially when the investigation cannot be conducted with other population or when the potential benefits are specifically for that age group. Clinical research in Pediatric Dentistry is not an exception. The aim of the present article was to provide the bioethical principles (with respect to the child/parents' autonomy, benefit/risk analysis, and distributive justice), and recommendations, including informed consent, research ethics committees, conflict of interest, and the "equipoise" concept. Current and future worldwide oral health research in children and adolescents must be conducted incorporating their perspectives in the decision-making process as completely as possible. This concept must be carefully considered when a dental clinical study research is going to be planned and conducted, especially in the case of randomized controlled trials, in which children will be recruited as participants.

Food labels, autonomy, and the right (not) to know.

PubMed

Bonotti, Matteo

2014-12-01

Food labelling has been overlooked in the emerging body of literature concerning the normative dimensions of food and drink policies. In this paper, I argue that arguments normally advanced in bioethics and medical ethics regarding the "right to know" and the "right not to know" can provide useful normative guidelines for critically assessing existing and proposed food labelling regimes. More specifically, I claim that food labelling ought to respect the legitimate interests and the autonomy of both consumers who seek knowledge about their food in order to make informed dietary choices and consumers who prefer to remain ignorant about the contents and effects of their food in order to avoid the emotional and psychological harm, or more simply the loss of enjoyment, which may result from receiving that information.

Assessing physiotherapists' communication skills for promoting patient autonomy for self-management: reliability and validity of the communication evaluation in rehabilitation tool.

PubMed

Murray, Aileen; Hall, Amanda; Williams, Geoffrey C; McDonough, Suzanne M; Ntoumanis, Nikos; Taylor, Ian; Jackson, Ben; Copsey, Bethan; Hurley, Deirdre A; Matthews, James

2018-02-27

To assess the inter-rater reliability and concurrent validity of the Communication Evaluation in Rehabilitation Tool, which aims to externally assess physiotherapists competency in using Self-Determination Theory-based communication strategies in practice. Audio recordings of initial consultations between 24 physiotherapists and 24 patients with chronic low back pain in four hospitals in Ireland were obtained as part of a larger randomised controlled trial. Three raters, all of whom had Ph.Ds in psychology and expertise in motivation and physical activity, independently listened to the 24 audio recordings and completed the 18-item Communication Evaluation in Rehabilitation Tool. Inter-rater reliability between all three raters was assessed using intraclass correlation coefficients. Concurrent validity was assessed using Pearson's r correlations with a reference standard, the Health Care Climate Questionnaire. The total score for the Communication Evaluation in Rehabilitation Tool is an average of all 18 items. Total scores demonstrated good inter-rater reliability (Intraclass Correlation Coefficient (ICC) = 0.8) and concurrent validity with the Health Care Climate Questionnaire total score (range: r = 0.7-0.88). Item-level scores of the Communication Evaluation in Rehabilitation Tool identified five items that need improvement. Results provide preliminary evidence to support future use and testing of the Communication Evaluation in Rehabilitation Tool. Implications for Rehabilitation Promoting patient autonomy is a learned skill and while interventions exist to train clinicians in these skills there are no tools to assess how well clinicians use these skills when interacting with a patient. The lack of robust assessment has severe implications regarding both the fidelity of clinician training packages and resulting outcomes for promoting patient autonomy. This study has developed a novel measurement tool Communication Evaluation in Rehabilitation Tool and a

A method of reflexive balancing in a pragmatic, interdisciplinary and reflexive bioethics.

PubMed

Ives, Jonathan

2014-07-01

In recent years there has been a wealth of literature arguing the need for empirical and interdisciplinary approaches to bioethics, based on the premise that an empirically informed ethical analysis is more grounded, contextually sensitive and therefore more relevant to clinical practice than an 'abstract' philosophical analysis. Bioethics has (arguably) always been an interdisciplinary field, and the rise of 'empirical' (bio)ethics need not be seen as an attempt to give a new name to the longstanding practice of interdisciplinary collaboration, but can perhaps best be understood as a substantive attempt to engage with the nature of that interdisciplinarity and to articulate the relationship between the many different disciplines (some of them empirical) that contribute to the field. It can also be described as an endeavour to explain how different disciplinary approaches can be integrated to effectively answer normative questions in bioethics, and fundamental to that endeavour is the need to think about how a robust methodology can be articulated that successfully marries apparently divergent epistemological and metaethical perspectives with method. This paper proposes 'Reflexive Bioethics' (RB) as a methodology for interdisciplinary and empirical bioethics, which utilizes a method of 'Reflexive Balancing' (RBL). RBL has been developed in response to criticisms of various forms of reflective equilibrium, and is built upon a pragmatic characterization of Bioethics and a 'quasi-moral foundationalism', which allows RBL to avoid some of the difficulties associated with RE and yet retain the flexible egalitarianism that makes it intuitively appealing to many. © 2013 John Wiley & Sons Ltd.

Assessing Analysis and Reasoning in Bioethics

ERIC Educational Resources Information Center

Pearce, Roger S.

2008-01-01

Developing critical thinking is a perceived weakness in current education. Analysis and reasoning are core skills in bioethics making bioethics a useful vehicle to address this weakness. Assessment is widely considered to be the most influential factor on learning (Brown and Glasner, 1999) and this piece describes how analysis and reasoning in…

Islamic bioethics: between sacred law, lived experiences, and state authority.

PubMed

Padela, Aasim I

2013-04-01

There is burgeoning interest in the field of "Islamic" bioethics within public and professional circles, and both healthcare practitioners and academic scholars deploy their respective expertise in attempts to cohere a discipline of inquiry that addresses the needs of contemporary bioethics stakeholders while using resources from within the Islamic ethico-legal tradition. This manuscript serves as an introduction to the present thematic issue dedicated to Islamic bioethics. Using the collection of papers as a guide the paper outlines several critical questions that a comprehensive and cohesive Islamic bioethical theory must address: (i) What are the relationships between Islamic law (Sharī'ah), moral theology (uṣūl al-Fiqh), and Islamic bioethics? (ii) What is the relationship between an Islamic bioethics and the lived experiences of Muslims? and (iii) What is the relationship between Islamic bioethics and the state? This manuscript, and the papers in this special collection, provides insight into how Islamic bioethicists and Muslim communities are addressing some of these questions, and aims to spur further dialogue around these overaching questions as Islamic bioethics coalesces into a true field of scholarly and practical inquiry.

Feeling right is feeling good: psychological well-being and emotional fit with culture in autonomy- versus relatedness-promoting situations.

PubMed

De Leersnyder, Jozefien; Kim, Heejung; Mesquita, Batja

2015-01-01

The current research tested the idea that it is the cultural fit of emotions, rather than certain emotions per se, that predicts psychological well-being. We reasoned that emotional fit in the domains of life that afford the realization of central cultural mandates would be particularly important to psychological well-being. We tested this hypothesis with samples from three cultural contexts that are known to differ with respect to their main cultural mandates: a European American (N = 30), a Korean (N = 80), and a Belgian sample (N = 266). Cultural fit was measured by comparing an individual's patterns of emotions to the average cultural pattern for the same type of situation on the Emotional Patterns Questionnaire (De Leersnyder et al., 2011). Consistent with our hypothesis, we found evidence for "universality without uniformity": in each sample, psychological well-being was associated with emotional fit in the domain that was key to the cultural mandate. However, cultures varied with regard to the particular domain involved. Psychological well-being was predicted by emotional fit (a) in autonomy-promoting situations at work in the U.S., (b) in relatedness-promoting situations at home in Korea, and (c) in both autonomy-promoting and relatedness-promoting situations in Belgium. These findings show that the experience of culturally appropriate patterns of emotions contributes to psychological well-being. One interpretation is that experiencing appropriate emotions is itself a realization of the cultural mandates.

Feeling right is feeling good: psychological well-being and emotional fit with culture in autonomy- versus relatedness-promoting situations

PubMed Central

De Leersnyder, Jozefien; Kim, Heejung; Mesquita, Batja

2015-01-01

The current research tested the idea that it is the cultural fit of emotions, rather than certain emotions per se, that predicts psychological well-being. We reasoned that emotional fit in the domains of life that afford the realization of central cultural mandates would be particularly important to psychological well-being. We tested this hypothesis with samples from three cultural contexts that are known to differ with respect to their main cultural mandates: a European American (N = 30), a Korean (N = 80), and a Belgian sample (N = 266). Cultural fit was measured by comparing an individual’s patterns of emotions to the average cultural pattern for the same type of situation on the Emotional Patterns Questionnaire (De Leersnyder et al., 2011). Consistent with our hypothesis, we found evidence for “universality without uniformity”: in each sample, psychological well-being was associated with emotional fit in the domain that was key to the cultural mandate. However, cultures varied with regard to the particular domain involved. Psychological well-being was predicted by emotional fit (a) in autonomy-promoting situations at work in the U.S., (b) in relatedness-promoting situations at home in Korea, and (c) in both autonomy-promoting and relatedness-promoting situations in Belgium. These findings show that the experience of culturally appropriate patterns of emotions contributes to psychological well-being. One interpretation is that experiencing appropriate emotions is itself a realization of the cultural mandates. PMID:26042063

Judging the Past: How History Should Inform Bioethics.

PubMed

Lerner, Barron H; Caplan, Arthur L

2016-04-19

Bioethics has become a common course of study in medical schools, other health professional schools, and graduate and undergraduate programs. An analysis of past ethical scandals, as well as the bioethics apparatus that emerged in response to them, is often central to the discussion of bioethical questions. This historical perspective on bioethics is invaluable and demonstrates how, for example, the infamous Tuskegee syphilis study was inherently racist and how other experiments exploited mentally disabled and other disadvantaged persons. However, such instruction can resemble so-called Whig history, in which a supposedly more enlightened mindset is seen as having replaced the "bad old days" of physicians behaving immorally. Bioethical discourse-both in the classroom and in practice-should be accompanied by efforts to historicize but not minimize past ethical transgressions. That is, bioethics needs to emphasize why and how such events occurred rather than merely condemning them with an air of moral superiority. Such instruction can reveal the complicated historical circumstances that led physician-researchers (some of whom were actually quite progressive in their thinking) to embark on projects that seem so unethical in hindsight. Such an approach is not meant to exonerate past transgressions but rather to explain them. In this manner, students and practitioners of bioethics can better appreciate how modern health professionals may be susceptible to the same types of pressures, misguided thinking, and conflicts of interest that sometimes led their predecessors astray.

A Pharmaceutical Bioethics Consultation Service: Six-Year Descriptive Characteristics and Results of a Feedback Survey.

PubMed

Van Campen, Luann E; Allen, Albert J; Watson, Susan B; Therasse, Donald G

2015-04-03

Background : Bioethics consultations are conducted in varied settings, including hospitals, universities, and other research institutions, but there is sparse information about bioethics consultations conducted in corporate settings such as pharmaceutical companies. The purpose of this article is to describe a bioethics consultation service at a pharmaceutical company, to report characteristics of consultations completed by the service over a 6-year period, and to share results of a consultation feedback survey. Methods : Data on the descriptive characteristics of bioethics consultations were collected from 2008 to 2013 and analyzed in Excel 2007. Categorical data were analyzed via the pivot table function, and time-based variables were analyzed via formulas. The feedback survey was administered to consultation requesters from 2009 to 2012 and also analyzed in Excel 2007. Results : Over the 6-year period, 189 bioethics consultations were conducted. The number of consultations increased from five per year in 2008 to approximately one per week in 2013. During this time, the format of the consultation service was changed from a committee-only approach to a tiered approach (tailored to the needs of the case). The five most frequent topics were informed consent, early termination of a clinical trial, benefits and risks, human biological samples, and patient rights. The feedback survey results suggest the consultation service is well regarded overall and viewed as approachable, helpful, and responsive. Conclusions : Pharmaceutical bioethics consultation is a unique category of bioethics consultation that primarily focuses on pharmaceutical research and development but also touches on aspects of clinical ethics, business ethics, and organizational ethics. Results indicate there is a demand for a tiered bioethics consultation service within this pharmaceutical company and that advice was valued. This company's experience indicates that a bioethics consultation service

A Pharmaceutical Bioethics Consultation Service: Six-Year Descriptive Characteristics and Results of a Feedback Survey

PubMed Central

Van Campen, Luann E.; Allen, Albert J.; Watson, Susan B.; Therasse, Donald G.

2015-01-01

Background: Bioethics consultations are conducted in varied settings, including hospitals, universities, and other research institutions, but there is sparse information about bioethics consultations conducted in corporate settings such as pharmaceutical companies. The purpose of this article is to describe a bioethics consultation service at a pharmaceutical company, to report characteristics of consultations completed by the service over a 6-year period, and to share results of a consultation feedback survey. Methods: Data on the descriptive characteristics of bioethics consultations were collected from 2008 to 2013 and analyzed in Excel 2007. Categorical data were analyzed via the pivot table function, and time-based variables were analyzed via formulas. The feedback survey was administered to consultation requesters from 2009 to 2012 and also analyzed in Excel 2007. Results: Over the 6-year period, 189 bioethics consultations were conducted. The number of consultations increased from five per year in 2008 to approximately one per week in 2013. During this time, the format of the consultation service was changed from a committee-only approach to a tiered approach (tailored to the needs of the case). The five most frequent topics were informed consent, early termination of a clinical trial, benefits and risks, human biological samples, and patient rights. The feedback survey results suggest the consultation service is well regarded overall and viewed as approachable, helpful, and responsive. Conclusions: Pharmaceutical bioethics consultation is a unique category of bioethics consultation that primarily focuses on pharmaceutical research and development but also touches on aspects of clinical ethics, business ethics, and organizational ethics. Results indicate there is a demand for a tiered bioethics consultation service within this pharmaceutical company and that advice was valued. This company's experience indicates that a bioethics consultation service raises

The Role of Empirical Research in Bioethics

PubMed Central

Kon, Alexander A.

2010-01-01

There has long been tension between bioethicists whose work focuses on classical philosophical inquiry and those who perform empirical studies on bioethical issues. While many have argued that empirical research merely illuminates current practices and cannot inform normative ethics, others assert that research-based work has significant implications for refining our ethical norms. In this essay, I present a novel construct for classifying empirical research in bioethics into four hierarchical categories: Lay of the Land, Ideal Versus Reality, Improving Care, and Changing Ethical Norms. Through explaining these four categories and providing examples of publications in each stratum, I define how empirical research informs normative ethics. I conclude by demonstrating how philosophical inquiry and empirical research can work cooperatively to further normative ethics. PMID:19998120

The role of empirical research in bioethics.

PubMed

Kon, Alexander A

2009-01-01

There has long been tension between bioethicists whose work focuses on classical philosophical inquiry and those who perform empirical studies on bioethical issues. While many have argued that empirical research merely illuminates current practices and cannot inform normative ethics, others assert that research-based work has significant implications for refining our ethical norms. In this essay, I present a novel construct for classifying empirical research in bioethics into four hierarchical categories: Lay of the Land, Ideal Versus Reality, Improving Care, and Changing Ethical Norms. Through explaining these four categories and providing examples of publications in each stratum, I define how empirical research informs normative ethics. I conclude by demonstrating how philosophical inquiry and empirical research can work cooperatively to further normative ethics.

Does autonomy for public hospitals in developing countries increase performance? Evidence-based case studies.

PubMed

De Geyndt, Willy

2017-04-01

Governments in middle and low income countries have sought ways for the past decades to make their public hospitals more performing. The objectives of this assessment are to: (a) synthesize the experience of eleven countries at granting autonomy to their public hospitals and the obstacles encountered; (b) deduce which autonomy policies have or have not been effective documenting successes and failures; and (c) propose evidence-based recommendations to policy makers. Data for five countries are derived from the author's participation in the autonomy process augmented by current updates provided by national colleagues. Data for the other six countries are derived from publications available in the literature. Policies granting autonomy to public hospitals have had limited success. In all cases Boards of Directors have been created. Governance of autonomized hospitals by Boards however is obstructed by the resistance of central level entities to have their authority diminished. The Ministry of Finance tends to maintain control over revenues and expenditures. The Public Service Commission resists abdicating its role to hire, promote, transfer and dismiss government employees. The Ministry of Health attempts to keep its authority to appoint hospital staff, procure medical supplies and equipment; it may do so directly or indirectly by selecting and appointing Board members. Management information systems continue to collect activity measures to be aggregated at the national level for statistical purposes and do not provide financial and clinical data useful for decision making by the Boards and by senior management. Decentralizing decision making to the operational level has had limited success. Stakeholders at the central level devise strategies to maintain their power. Two main obstacles are delegating authority over human resources and finances that are sine qua non conditions for governing and increasing the performance of public hospitals. Copyright © 2017 Elsevier

[Civil bioethics in pluralistics societies].

PubMed

Cortina, A

2000-01-01

The author examines how Bioethics should be approached in a pluralist society. She argues that through the gradual discovery of shared ethical values and principles for judging which practices are humanizing and which or not, ever-more dense civil Bioethics helps bring out--in contrast to relativism and subjectivism--an ethical intersubjectiveness, the fundaments of which should be addressed by moral philosophy if it hopes to fulfill one of its main tasks.

Confucian bioethics and cross-cultural considerations in health care decision-making.

PubMed

Kim, Su Hyun

2005-01-01

This article discusses the similarities and differences between Beauchamp and Childress's principlism and Confucian bioethics in terms of autonomy, beneficence, nonmaleficence, and justice. The author presents sensitive approaches for culturally diverse groups in health care areas and cautions against dichotomy in cross-cultural studies, which ignores the dynamic nature and intravariations of cultures. As a way of health care providers to become engaged in cultural diversity in nursing practice and research, the author suggests that they do not only have a general knowledge about the theoretical differences among groups through "normative analysis" but also learn to appreciate each individual's particular beliefs and values through narratives of morality. Health care providers as well as legal professionals need to cultivate "cultural humility," which is the willingness to explore the similarities and differences between their own and each client's priorities and values and to develop courses of action with patients.

Women's Autonomy and Attitudes toward Condom Use: A Multicountry Analysis.

PubMed

Sharma, Bonita B; Small, Eusebius; Mengo, Cecilia; Ude, Paula

2017-01-01

Autonomy gives women the ability to negotiate safe sex and make decisions on their health. This study explores the gender stratification framework to understand the intertwined nature of HIV and women's autonomy using the nationally representative Demographic Health Survey. It examines women's autonomy and attitudes toward condom use for prevention of HIV/AIDS in four culturally diverse countries. Findings from the logistic regression indicate that labor force participation, individual autonomy, and decision making significantly increased the odds of always using a condom during sex in all countries. Promoting prevention policies highlighting women's autonomy may contribute in reducing the spread of HIV infection.

Duty of care and autonomy: how support workers managed the tension between protecting service users from risk and promoting their independence in a specialist group home.

PubMed

Hawkins, R; Redley, M; Holland, A J

2011-09-01

In the UK those paid to support adults with intellectual disabilities must manage two potentially conflicting duties that are set out in policy documents as being vital to their role: protecting service users (their duty of care) and recognising service users' autonomy. This study focuses specifically on the support of people with the genetically determined condition, Prader-Willi syndrome (PWS). Due to the behaviours associated with PWS, the support of this group of people vividly illustrates the tension between respect for autonomy and duty of care. This article explores how support workers working in a residential group home managed their competing duties of managing risk and promoting independence in practice. An ethnographic study, comprising of qualitative observations, semi-structured interviews and documentary analysis, was undertaken to investigate the work of support workers in a UK residential group home specialising in the support of adults diagnosed with PWS. The study focused on how support workers attempted to reconcile the tension between protecting service users from the risks associated with the syndrome and acknowledging service users' autonomy by enabling independence. Findings demonstrate that risk was central to the structure of care delivery at the group home and support workers often adhered to standardised risk management procedures. The organisation also required support workers to promote service users' independence and many thought acknowledging service users' autonomy through the promotion of their independence was important. To manage tensions between their differing duties, some support workers deviated from standardised risk management procedures to allow service users a degree of independence. There is a tension between the duty of care and the duty to recognise autonomy at the level of service delivery in residential homes. Support workers attempt to manage this tension; however, further work needs to be done by both residential

Novel horizontal and vertical integrated bioethics curriculum for medical courses.

PubMed

D'Souza, Russell F; Mathew, Mary; D'Souza, Derek S J; Palatty, Princy

2018-02-28

Studies conducted by the University of Haifa, Israel in 2001, evaluating the effectiveness of bioethics being taught in medical colleges, suggested that there was a significant lack of translation in clinical care. Analysis also revealed, ineffectiveness with the teaching methodology used, lack of longitudinal integration of bioethics into the undergraduate medical curriculum, and the limited exposure to the technology in decision making when confronting ethical dilemmas. A modern novel bioethics curriculum and innovative methodology for teaching bioethics for the medical course was developed by the UNESCO Chair in Bioethics, Haifa. The horizontal (subject-wise) curriculum was vertically integrated seamlessly through the entire course. An innovative bioethics teaching methodology was employed to implement the curriculum. This new curriculum was piloted in a few medical colleges in India from 2011 to 2015 and the outcomes were evaluated. The evaluation confirmed gains over the earlier identified translation gap with added high student acceptability and satisfaction. This integrated curriculum is now formally implemented in the Indian program's Health Science Universities which is affiliated with over 200 medical schools in India. This article offers insights from the evaluated novel integrated bioethics curriculum and the innovative bioethics teaching methodology that was used in the pilot program.

Are the benefits of autonomy satisfaction and the costs of autonomy frustration dependent on individuals' autonomy strength?

PubMed

Van Assche, Jasper; van der Kaap-Deeder, Jolene; Audenaert, Elien; De Schryver, Maarten; Vansteenkiste, Maarten

2018-01-29

From a self-determination theory perspective, individuals are assumed to benefit and suffer from, respectively, the satisfaction and frustration of the psychological need for autonomy, even if they score low on autonomy strength. Yet, previous studies on need strength are scarce, operationalized need strength differently, and produced inconsistent findings. In two studies among 224 South African adults (M age  = 24.13, SD = 4.25; 54.0% male) and 156 Belgian prisoners (M age  = 38.60, SD = 11.68; 88.5% male), we investigated the moderating role of autonomy valuation and desire in the relations of autonomy satisfaction and frustration with a variety of well-being and ill-being indicators. Study 1 provided some evidence for the moderating role of mostly explicit autonomy desire (rather than explicit autonomy valuation). In Study 2, neither explicit nor implicit autonomy desire played a consistent moderating role. Overall, these findings are congruent with a moderate (albeit not with a strong) interpretation of the universality claim made within self-determination theory, provide initial evidence for a differentiation between deficit-based and growth-oriented interpersonal differences in need strength, and indicate that the potential moderating role of need strength deserves continued attention before any firm conclusions can be drawn. © 2018 Wiley Periodicals, Inc.

Professional autonomy.

PubMed

Aprile, A E

1998-02-01

Professional autonomy may represent the first step to implementing measures that will allow CRNAs to attain a level of independent practice consistent with their clinical and educational training. Autonomy is regarded as an essential ingredient of professionalism and confers independent function at the individual practitioner level. The principle of autonomy refers to the individual's capacity to make independent decisions based on the assumption that he or she possesses the cognitive, psychological, and emotional faculties to make rational decisions. Nursing practice meets the first two criteria of professionalism--competence and dedication to an important social good. The third criterion of professionalism, autonomy, has been a focal point for controversy since the late nineteenth century, in which obedience to supervisors and physicians remained a central focus of nursing ethics teaching until the advent of feminism in the 1970s. This article presents a thorough analysis of these concepts with some thoughts on how understanding the fundamental precepts and further research may not only help maintain the current level of CRNA professional autonomy but serve to guide us to become more autonomous in the future.

The Global Governance of Bioethics: Negotiating UNESCO’s Universal Declaration on Bioethics and Human Rights (2005)

PubMed Central

Langlois, Adèle

2012-01-01

UNESCO’s Universal Declaration on Bioethics and Human Rights (2005) was drawn up by an independent panel of experts (the International Bioethics Committee) and negotiated by member states. UNESCO aimed for a participatory and transparent drafting process, holding national and regional consultations and seeking the views of various interest groups, including religious and spiritual ones. Furthermore, reflecting UNESCO’s broad interpretation of bioethics, the IBC included medics, scientists, lawyers and philosophers among its membership. Nevertheless, several potential stakeholders—academic scientists and ethicists, government policy-makers and NGO representatives—felt they had not been sufficiently consulted or even represented during the Declaration’s development. Better communications and understanding within and between national, regional and international layers of governance would help to avoid a recurrence of this problem in future negotiations. PMID:22724045

Bioethics in the Laboratory: Synthesis and Interactivity.

ERIC Educational Resources Information Center

Murray, Kevin J.

1999-01-01

Describes the implementation of a bioethics laboratory exercise that incorporates a variety of instructional strategies. In the activity, General Biology students consider relevant and interesting topics of bioethical importance and prepare classroom presentations on the different viewpoints normally attendant to ethical topics. Includes an…

Bioethics, Religion, and Public Policy: Intersections, Interactions, and Solutions.

PubMed

Kahn, Peter A

2016-10-01

Bioethics in America positions itself as a totalizing discipline, capable of providing guidance to any individual within the boundaries of a health or medical setting. Yet the religiously observant or those driven by spiritual values have not universally accepted decisions made by "secular" bioethics, and as a result, religious bioethical thinkers and adherents have developed frameworks and rich counter-narratives used to fend off encroachment by policies perceived as threatening. This article uses brain death in Jewish law, the case of Jahi McMath, and vaccination refusal to observe how the religious system of ethics is presently excluded from bioethics and its implications.

[Bioethics destiny].

PubMed

Fagot-Largeault, Anne

2015-01-01

The paper is about the links between ethics and science, at a time (1974-2014) when the life sciences expanded rapidly. First (1974-1994), the development of a principlist ethics, set out by philosophers, sustained the research, and the scientists, expected to behave responsibly, felt like they could easily converge towards impeccable and consensual solutions to any problem arising from scientific innovations. Later on (1994-2014), however, while yielding ground to social sciences and ground work, bioethics took an empirical turn; then it became clear that behaving responsibly was compatible with a plurality of divergent normative convictions. Ethics crumbled. Local or national policies restored order, so-called bioethical laws short-circuited ethical reflection. And far from being respected as the wise men, apt to recommend the very best solutions to problems raised by new scientific advances, researchers happened to be deemed irresponsible, as some of them were suspected of lacking intellectual integrity. Copyright © 2015 Académie des sciences. Published by Elsevier SAS. All rights reserved.

Invited Article: Threats to physician autonomy in a performance-based reimbursement system.

PubMed

Larriviere, Daniel G; Bernat, James L

2008-06-10

Physician autonomy is currently threatened by the external application of pay for performance standards and required conformity to practice guidelines. This phenomenon is being driven by concerns over the economic viability of increasing per capita health care expenditures without a concomitant rise in favorable health outcomes and by the unjustified marked variations among physicians' practice patterns. Proponents contend that altering the reimbursement system to encourage physicians to make choices based upon the best available evidence would be one way to ensure better outcomes per health care dollar spent. Although physician autonomy is most easily justified when decisions are made by appealing to the best available evidence, incentivizing decision-making risks sacrificing physician autonomy to political and social forces if the limitations of evidence-based medicine are not respected. Any reimbursement system designed to encourage physicians to utilize the best available evidence by providing financial incentives must recognize physicians who try to play to the numbers as well as physicians who refuse to follow the best available evidence if doing so would conflict with good medicine or patient preferences. By designing, promulgating, and updating evidence-based clinical practice guidelines, medical specialty societies can limit threats to physician autonomy while improving medical practice.

Educating nurses for their future role in bioethics.

PubMed

Leavitt, F J

1996-03-01

The emerging new multidisciplinary and crosscultural field of bioethics will require sensitive, open-minded professionals to take the lead in hospital ethics, in genetic counselling, and in the teaching of bioethics to students in nursing, medicine and the basic sciences. Nurses with ward experience who return to university to gain an MA or PhD in bioethics are eminently suited for this leadership role, for they may be more likely than physicians to study for a liberal education to supplement their professional knowledge; their first-hand experience in nursing is an antidote to the pointless subtleties into which philosophical ethics so often degenerates. When teaching ethics to nurses one must remember that, while some will simply use this knowledge in their own clinical work, others will go on to be teachers and researchers in bioethics. Their training must therefore be broad and interdisciplinary, including real substantive philosophy (as opposed to philosophical ethics), as well as mystical bioethics, religious law, ethics of genetic counselling, clinical approaches to ethical pseudo problems, research skills, etc.

A Tale of Two Disciplines: Law and Bioethics.

PubMed

Dresser, Rebecca

2017-01-01

Fascination with In re Quinlan, the first high-profile right-to-die case in the United States, led the author to law school. By the time she received her law degree, bioethics was emerging as a field of study, and law and bioethics became her field. The mission of legal education is to teach students to "think like a lawyer," which can be a productive way to approach issues in many fields, including bioethics. Legal education can also teach individuals to respect people whose views on bioethics issues differ from their own. This essay describes three areas in which legal training influenced the author's work in bioethics: treatment decisions, research misconduct, and stem cell research.

Anticipatory Governance: Bioethical Expertise for Human/Animal Chimeras

PubMed Central

Harvey, Alison; Salter, Brian

2012-01-01

The governance demands generated by the use of human/animal chimeras in scientific research offer both a challenge and an opportunity for the development of new forms of anticipatory governance through the novel application of bioethical expertise. Anticipatory governance can be seen to have three stages of development whereby bioethical experts move from a reactive to a proactive stance at the edge of what is scientifically possible. In the process, the ethicists move upstream in their engagement with the science of human-to-animal chimeras. To what extent is the anticipatory coestablishment of the principles and operational rules of governance at this early stage in the development of the human-to-animal research field likely to result in a framework for bioethical decision making that is in support of science? The process of anticipatory governance is characterised by the entwining of the scientific and the philosophical so that judgements against science are also found to be philosophically unfounded, and conversely, those activities that are permissible are deemed so on both scientific and ethical grounds. Through what is presented as an organic process, the emerging bioethical framework for human-to-animal chimera research becomes a legitimating framework within which ‘good’ science can safely progress. Science gives bioethical expertise access to new governance territory; bioethical expertise gives science access to political acceptability. PMID:23576848

The Ethics of Globalizing Bioethics

PubMed Central

Rennie, Stuart; Mupenda, Bavon

2012-01-01

In the last decade, there have been efforts to globalize the field of bioethics, particularly in developing countries, where biomedical and other research is increasingly taking place. We describe and evaluate some key ethical criticisms directed towards these initiatives, and argue that while they may be marked by ethical, practical, and political tensions and pitfalls, they can nevertheless play an important role in stimulating critical bioethics culture in countries vulnerable to exploitation by foreign agencies and/or their own authorities. PMID:25632370

Bioethics: why philosophy is essential for progress.

PubMed

Savulescu, Julian

2015-01-01

It is the JME's 40th anniversary and my 20th anniversary working in the field. I reflect on the nature of bioethics and medical ethics. I argue that both bioethics and medical ethics together have, in many ways, failed as fields. My diagnosis is that better philosophy is needed. I give some examples of the importance of philosophy to bioethics. I focus mostly on the failure of ethics in research and organ transplantation, although I also consider genetic selection, enhancement, cloning, futility, disability and other topics. I do not consider any topic comprehensively or systematically or address the many reasonable objections to my arguments. Rather, I seek to illustrate why philosophical analysis and argument remain as important as ever to progress in bioethics and medical ethics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Bioethics and innovation in pediatric nutrition research.

PubMed

Solomons, Noel W

2010-01-01

Advances in technology and understanding of fundamental human biology allow for an increasingly innovative research agenda in pediatric nutrition. All human research is governed by the norms of bioethics, which are in turn based on four primary principles: free will in participation, freedom from harm, opportunity to benefit, and non-discrimination in access. Legally, if not essentially, juveniles do not have free will to affirm their participation as research subjects. They have an absolute right, in nontherapeutic research, however, to decline. Pivotal in the discussion in nontherapeutic research in healthy children is the tolerance for risky procedures. Complicated situations include: multi-national protocols, choice of developing country sites, the inclusion of placebo treatment arms, analysis of genetic biomarkers, and research for commercial enterprises. The overly stringent interpretation of bioethical principles, as adapted to children, would stifle innovation in research. A relaxed bioethical attitude in pursuit of advancing science, by contrast, could violate essential human rights and expose a population worthy of special protection to undue risk and harm. By following the course of utility, seeking the steepest benefit-to-risk ratios, weighted toward safety and child welfare, the divergent nature of the considerations should be brought into convergence for the sake of continuing innovation. Copyright © 2010 S. Karger AG, Basel.

Bioethics in the public square: reflections on the how.

PubMed

Campbell, Amy Tannery

2012-07-01

As bioethics gains more prominence in public policy debates, it is time to more fully reflect on the following: what is its role in the public square, and what limitations relate to and barriers impede its fulfilment of this role? I contend we should consider the how of bioethics (as a policy influencer) rather than simply focus on the who or what of bioethical enquiry. This is not to suggest considerations of latter categories are not important, only that too little attention has been paid to parallel or resulting policy involvement-involvement that will require specialised skills and knowledge that we can develop with a proactive (vs reactive) stance. Moreover, and equally critically, this how of public policy involvement will require more transparency regarding influences (eg, philosophical, ideological, cultural, socio-political) on what bioethicists bring to the table and what constituency base each represents-a humility as to the scope of one's role. In this vision, bioethics is not one single person or belief system for a policymaker to call to guide or give support to a position; rather, it offers tools-formed and utilised by a diverse disciplinary range of individuals-to help guide ethical analysis of biomedical endeavours, with the goal of infusion and diffusion of ethical enquiry and prioritisation in health policymaking, and greater humility among bioethicists who inform this discussion.

Family Secrets: The Bioethics of Genetic Testing

ERIC Educational Resources Information Center

Markowitz, Dina G.; DuPre, Michael J.; Holt, Susan; Chen, Shaw-Ree; Wischnowski, Michael

2006-01-01

This article discusses "Family Secrets," a problem-based learning (PBL) curriculum module that focuses on the bioethical implications of genetic testing. In high school biology classrooms throughout New York State, students are using "Family Secrets" to learn about DNA testing; Huntington's disease (HD); and the ethical, legal,…

Integrating bioethics into postgraduate medical education: the University of Toronto model.

PubMed

Howard, Frazer; McKneally, Martin F; Levin, Alex V

2010-06-01

Bioethics training is a vital component of postgraduate medical education and required by accreditation organizations in Canada and the United States. Residency program ethics curricula should ensure trainees develop core knowledge, skills, and competencies, and should encourage lifelong learning and teaching of bioethics. Many physician-teachers, however, feel unprepared to teach bioethics and face challenges in developing and implementing specialty-specific bioethics curricula. The authors present, as one model, the innovative strategies employed by the University of Toronto Joint Centre for Bioethics. They postulate that centralized support is a key component to ensure the success of specialty-specific bioethics teaching, to reinforce the importance of ethics in medical training, and to ensure it is not overshadowed by other educational concerns.

An undignified bioethics: there is no method in this madness.

PubMed

De Melo-Martín, Inmaculada

2012-05-01

In a recent article, Alasdair Cochrane argues for the need to have an undignified bioethics. His is not, of course, a call to transform bioethics into an inelegant, pathetic discipline, or one failing to meet appropriate disciplinary standards. His is a call to simply eliminate the concept of human dignity from bioethical discourse. Here I argue that he fails to make his case. I first show that several of the flaws that Cochrane identifies are not flaws of the conceptions of dignity he discusses but rather flaws of his, often problematic, understanding of such conceptions. Second, I argue that Cochrane's case against the concept of human dignity goes too far. I thus show that were one to agree that these are indeed flaws that require that we discard our ethical concepts, then following Cochrane's recommendations would commit us not only to an undignified bioethics, i.e. a bioethics without dignity, but to a bioethics without much ethics at all. © 2010 Blackwell Publishing Ltd.

Community outreach: a focus on bioethics.

PubMed

Mackta, J

2001-01-01

The author suggests that the infusion of bioethics into all aspects of the animal research community's work provides a framework for making decisions. Such deliberations, grounded in ethical theories and principles, can help to reinforce the position that both the research process and the people involved in it are morally sound. Pro-biomedical research groups around the country are therefore investing time and effort in bioethics training.

Assessment of Parent Orientation towards Autonomy vs. Control in Promoting Children's Healthy Eating and Exercise.

PubMed

Chiang, Evelyn S; Padilla, Miguel A

2012-07-01

Self-determination theory has been widely applied to understanding individuals' health-related behaviors such as eating healthy foods and exercising. Different reasons for engagement are associated with varying levels of personal agency or autonomy. Authority figures in the environment can be supportive of autonomy or, in contrast, controlling. Although researchers have assessed individuals' perceptions of the autonomy-support in their environments, studies have not directly examined the authority figures' orientations to autonomy with respect to health contexts. A new scale, Parent Orientations to Health, was created to investigate parent orientation to autonomy and control with respect to healthy eating and exercise in children. One hundred and forty-three parents of elementary school-aged children responded to the scale. Scale validation and reliability results indicate that the scale successfully assessed parent orientation towards autonomy for children in health contexts. Furthermore, parent autonomy orientation varied according to child weight status and the healthiness of the child's diet. Parent orientation towards autonomy can be evaluated through the use of the Parent Orientations to Health scale. In addition, parent autonomy orientation is associated with both the healthiness of the child's diet (as perceived by the parent) and the child's body mass index. © 2012 The Authors. Applied Psychology: Health and Well-Being © 2012 The International Association of Applied Psychology.

A meta-science for a global bioethics and biomedicine.

PubMed

Basser, David S

2017-11-07

As suggested by Shook and Giordano, understanding and therefore addressing the urgent international governance issues around globalizing bio-medical/technology research and applications is limited by the perception of the underlying science. A philosophical methodology is used, based on novel and classical philosophical reflection upon existent literature, clinical wisdoms and narrative theory to discover a meta-science and telos of humankind for the development of a relevant and defendable global biomedical bioethics. In this article, through pondering an integrative systems approach, I propose a biomedical model that may provide Western biomedicine with leadership and interesting insight into the unity beyond the artificial boundaries of its traditional divisions and the limit between physiological and pathological situations (health and disease). A unified biomedicine, as scientific foundation, might then provide the basis for dissolution of similar reflected boundaries within bioethics. A principled and communitarian cosmopolitan bioethics may then be synonymous with a recently proposed principled and communitarian cosmopolitan neuroethics based on a novel objective meta-ethics. In an attempt to help facilitate equal and inclusive participation in inter-, multi-, and transdisciplinary intercultural discourse regarding the aforementioned international governance issues, I offer: (1) a meta-science derived through considering the general behaviour of activity, plasticity and balance in biology and; (2) a novel thought framework to encourage and enhance the ability for self-evaluation, self-criticism, and self-revision aimed at broadening perspective, as well as acknowledging and responding to the strengths and limitations of extant knowledge. Through classical philosophical reflection, I evolve a theory of medicine to discover a telos of humankind which in turn provides an 'internal' moral grounding for a proposed global biomedical bioethics.

Teaching Bioethics

ERIC Educational Resources Information Center

Russo, Michael T.; Sunal, Cynthia Szymanski; Sunal, Dennis W.

2004-01-01

All citizens will make bioethics decisions as a result of today's biotechnology revolution. The decisions made require citizens to find possible acceptable solutions to dilemmas that have become public issues. In this activity, students practice making decisions in ethical dilemmas after evaluating the influences of their own ethical beliefs and…

On the "pendulum" of bioethics.

PubMed

Petrini, C

According to a well-known philosopher, the life of ethics was saved, at the beginning of the 1970s, by medicine. The claim is based on the consideration that the questions then being posed by medicine were actual and dramatic, forcing ethicists and philosophers to abandon their mostly useless abstract speculations. Since the early years of the new century some authors have been harsh in their criticism of bioethics, accusing it not only of not "returning the favour" to medicine but also of seriously hindering medical practice and, above all, research, by subjecting them to unnecessary constraints. Some of the more restrictive and bureaucratic regulations have been relaxed over the years, to the extent that some authors suggest that the bioethics pendulum "is taking a swing to the permissive". There are nonetheless some fundamental principles and values that do not admit of concessions. Provided these are properly guaranteed, it is appropriate to simplify overly rigid regulations (such as those concerning consent to the use of health data) and allow research to achieve potentially useful results.

Effects of constructivist teaching methods on bioethics education for nursing students: a quasi-experimental study.

PubMed

Choe, Kwisoon; Park, Sunghee; Yoo, So Yeon

2014-05-01

In order to help nurses advocate for the patient's human rights and ensure respect for life in clinical situations, it is of utmost importance to improve nursing students' capacity to make ethical decisions. This study compares the effects of two constructivist teaching strategies (action learning and cross-examination debate) on nursing students' recognition of bioethical issues, experience of bioethical issues, and attainment of ethical competence. This study used a quasi-experimental (two-group pretest-posttest) design. A nursing college in South Korea. A total of 93 Korean nursing students participated in the study (46 in the action learning group and 47 in the cross-examination debate group). Participants took a bioethics class employing one or the other of the strategies mentioned, 2h a week for 15 weeks. All participants responded twice to a set of questionnaires, at the beginning of the first session and at the end of the last session. After their bioethics education, the students' recognition of bioethical issues improved for both classes; however, the knowledge of students who had participated in action learning improved more than that of the students in the debate-based class. Students in both groups reported more experience of bioethics and exposure to better-quality instruction in bioethics after their classes than previously. Students in both groups also reported improved ethical competency after this education. Positive effects of action learning and cross-examination debate implemented as teaching strategies on nursing students' understanding of bioethical issues and their ethical competency were identified; these findings will be important in the essential task of teaching bioethics to nursing students in order to foster more ethical decision-making and other ethical behavior. © 2013.

Bioethics training programmes for Africa: evaluating professional and bioethics-related achievements of African trainees after a decade of Fogarty NIH investment

PubMed Central

Kass, Nancy E; Ali, Joseph; Hallez, Kristina

2016-01-01

Objectives Our primary aim was to evaluate the impact of US National Institutes of Health (NIH)-funded bioethics training programmes (Fogarty bioethics training programmes, FBTPs) that trained individuals from Africa over the programme's first 10 years to examine changes between pretraining and post-training in individual achievement and to document any associations between individual, training programme and post-training accomplishments. Design We surveyed trainees from the 10 bioethics programmes funded by NIH Fogarty International Center from 2000 to 2011 that included African trainees. McNemar's and Wilcoxon signed rank-sum tests were used to analyse pre–post levels of general and bioethics-related professional achievement. Likelihood of specific post-training achievement outcomes was measured using logistic regression including demographic, pretraining and intratraining variables. Setting 10 different FBTPs that trained individuals from Africa from 2000 to 2011. Participants Of 253 eligible respondents, 171 completed the survey (response rate 67.6%). Primary outcome measures Pre–post comparisons of professional achievement indicators (eg, serving in leadership roles, teaching, publishing manuscripts); likelihood of specific post-training achievement outcomes. Results Post-training, respondents were significantly more likely to report serving in a leadership role, being an investigator on a research grant, serving on international committees, serving as a mentor, and publishing manuscripts than at pretraining. Post-training, significantly greater numbers of respondents reported bioethics-related achievements including being a bioethics instructor, serving on an Institutional Review Board (IRB), being an investigator on a bioethics grant and publishing bioethics-related manuscripts than pretraining. Controlling for other factors, there were no significant differences by gender in the post-training success of these participants in terms of leadership roles

Development of integrative bioethics in the Mediterranean area of South-East Europe.

PubMed

Kukoč, Mislav

2012-11-01

With regards to its origin, foundation and development, bioethics is a relatively new discipline, scientific and theoretical field, where different and even contradicting definition models and methodological patterns of its formation and application meet. In some philosophical orientations, bioethics is considered to be a sub-discipline of applied ethics as a traditional philosophical discipline. Yet in biomedical and other sciences, bioethics is designated as a specialist scientific discipline, or a sort of a new medical ethics. The concept of integrative bioethics as an interdisciplinary scholarly and pluriperspectivistic area goes beyond such one-sided determinations, both philosophical and scientistic, and intends to integrate the philosophical approach to bioethics with its particular scientific contents, as well as different cultural dimensions and perspectives. This concept of integrative bioethics has gradually developed at philosophical and interdisciplinary conferences and institutions on the "bioethical islands" of the Croatian Mediterranean. In this paper, the author follows the formation, development and prospects of integrative bioethics in the wider region of the Mediterranean and Southeast Europe.

Which naturalism for bioethics? A defense of moderate (pragmatic) naturalism.

PubMed

Racine, Eric

2008-02-01

There is a growing interest in various forms of naturalism in bioethics, but there is a clear need for further clarification. In an effort to address this situation, I present three epistemological stances: anti-naturalism, strong naturalism, and moderate pragmatic naturalism. I argue that the dominant paradigm within philosophical ethics has been a form of anti-naturalism mainly supported by a strong 'is' and 'ought' distinction. This fundamental epistemological commitment has contributed to the estrangement of academic philosophical ethics from major social problems and explains partially why, in the early 1980s, 'medicine saved the life of ethics'. Rejection of anti-naturalism, however, is often associated with strong forms of naturalism that commit the naturalistic fallacy and threaten to reduce the normative dimensions of ethics to biological imperatives. This move is rightly dismissed as a pitfall since ethics is, in part, a struggle against the course of nature. Rejection of naturalism has drawbacks, however, such as deterring bioethicists from acknowledging the implicit naturalistic epistemological commitments of bioethics. I argue that a moderate pragmatic form of naturalism represents an epistemological position that best embraces the tension of anti-naturalism and strong naturalism: bioethics is neither disconnected from empirical knowledge nor subjugated to it. The discussion is based upon historical writings in philosophy and bioethics.

Autonomy: Life and Being

NASA Astrophysics Data System (ADS)

Williams, Mary-Anne

This paper uses robot experience to explore key concepts of autonomy, life and being. Unfortunately, there are no widely accepted definitions of autonomy, life or being. Using a new cognitive agent architecture we argue that autonomy is a key ingredient for both life and being, and set about exploring autonomy as a concept and a capability. Some schools of thought regard autonomy as the key characteristic that distinguishes a system from an agent; agents are systems with autonomy, but rarely is a definition of autonomy provided. Living entities are autonomous systems, and autonomy is vital to life. Intelligence presupposes autonomy too; what would it mean for a system to be intelligent but not exhibit any form of genuine autonomy. Our philosophical, scientific and legal understanding of autonomy and its implications is immature and as a result progress towards designing, building, managing, exploiting and regulating autonomous systems is retarded. In response we put forward a framework for exploring autonomy as a concept and capability based on a new cognitive architecture. Using this architecture tools and benchmarks can be developed to analyze and study autonomy in its own right as a means to further our understanding of autonomous systems, life and being. This endeavor would lead to important practical benefits for autonomous systems design and help determine the legal status of autonomous systems. It is only with a new enabling understanding of autonomy that the dream of Artificial Intelligence and Artificial Life can be realized. We argue that designing systems with genuine autonomy capabilities can be achieved by focusing on agent experiences of being rather than attempting to encode human experiences as symbolic knowledge and know-how in the artificial agents we build.

Questioning Engelhardt's assumptions in Bioethics and Secular Humanism.

PubMed

Ahmadi Nasab Emran, Shahram

2016-06-01

In Bioethics and Secular Humanism: The Search for a Common Morality, Tristram Engelhardt examines various possibilities of finding common ground for moral discourse among people from different traditions and concludes their futility. In this paper I will argue that many of the assumptions on which Engelhardt bases his conclusion about the impossibility of a content-full secular bioethics are problematic. By starting with the notion of moral strangers, there is no possibility, by definition, for a content-full moral discourse among moral strangers. It means that there is circularity in starting the inquiry with a definition of moral strangers, which implies that they do not share enough moral background or commitment to an authority to allow for reaching a moral agreement, and concluding that content-full morality is impossible among moral strangers. I argue that assuming traditions as solid and immutable structures that insulate people across their boundaries is problematic. Another questionable assumption in Engelhardt's work is the idea that religious and philosophical traditions provide content-full moralities. As the cardinal assumption in Engelhardt's review of the various alternatives for a content-full moral discourse among moral strangers, I analyze his foundationalist account of moral reasoning and knowledge and indicate the possibility of other ways of moral knowledge, besides the foundationalist one. Then, I examine Engelhardt's view concerning the futility of attempts at justifying a content-full secular bioethics, and indicate how the assumptions have shaped Engelhardt's critique of the alternatives for the possibility of content-full secular bioethics.

Empirical research in bioethical journals. A quantitative analysis

PubMed Central

Borry, P; Schotsmans, P; Dierickx, K

2006-01-01

Objectives The objective of this research is to analyse the evolution and nature of published empirical research in the fields of medical ethics and bioethics. Design Retrospective quantitative study of nine peer reviewed journals in the field of bioethics and medical ethics (Bioethics, Cambridge Quarterly of Healthcare Ethics, Hastings Center Report, Journal of Clinical Ethics, Journal of Medical Ethics, Kennedy Institute of Ethics Journal, Nursing Ethics, Christian Bioethics, andTheoretical Medicine and Bioethics). Results In total, 4029 articles published between 1990 and 2003 were retrieved from the journals studied. Over this period, 435 (10.8%) studies used an empirical design. The highest percentage of empirical research articles appeared in Nursing Ethics (n = 145, 39.5%), followed by the Journal of Medical Ethics (n = 128, 16.8%) and the Journal of Clinical Ethics (n = 93, 15.4%). These three journals account for 84.1% of all empirical research in bioethics published in this period. The results of the χ2 test for two independent samples for the entire dataset indicate that the period 1997–2003 presented a higher number of empirical studies (n = 309) than did the period 1990–1996 (n = 126). This increase is statistically significant (χ2 = 49.0264, p<.0001). Most empirical studies employed a quantitative paradigm (64.6%, n = 281). The main topic of research was prolongation of life and euthanasia (n = 68). Conclusions We conclude that the proportion of empirical research in the nine journals increased steadily from 5.4% in 1990 to 15.4% in 2003. It is likely that the importance of empirical methods in medical ethics and bioethics will continue to increase. PMID:16574880

Physicians’ Perceptions of Autonomy across Practice Types: Is Autonomy in Solo Practice a Myth?

PubMed Central

Lin, Katherine Y.

2013-01-01

Physicians in the United States are now less likely to practice in smaller, more traditional, solo practices, and more likely to practice in larger group practices. Though older theory predicts conflict between bureaucracy and professional autonomy, studies have shown that professions in general, and physicians in particular, have adapted to organizational constraints. However, much work remains in clarifying the nature of this relationship and how exactly physicians have adapted to various organizational settings. To this end, the present study examines physicians’ autonomy experiences in different decision types between organization sizes. Specifically, I ask: In what kinds of decisions do doctors perceive autonomous control? How does this vary by organizational size? Using stacked “spell” data constructed from the Community Tracking Study (CTS) Physician Survey (1996–2005) (n=16,519) I examine how physicians’ perceptions of autonomy vary between solo/two physician practices, small group practices with three to ten physicians, and large practices with ten or more physicians, in two kinds of decisions: logistic-based and knowledge-based decisions. Capitalizing on the longitudinal nature of the data I estimate how changes in practice size are associated with perceptions of autonomy, accounting for previous reports of autonomy. I also test whether managed care involvement, practice ownership, and salaried employment help explain part of this relationship. I find that while physicians practicing in larger group practices reported lower levels of autonomy in logistic-based decisions, physicians in solo/two physician practices reported lower levels of autonomy in knowledge-based decisions. Managed care involvement and ownership explain some, but not all, of the associations. These findings suggest that professional adaptation to various organizational settings can lead to varying levels of perceived autonomy across different kinds of decisions. PMID:24444835

Physicians' perceptions of autonomy across practice types: Is autonomy in solo practice a myth?

PubMed

Lin, Katherine Y

2014-01-01

Physicians in the United States are now less likely to practice in smaller, more traditional, solo practices, and more likely to practice in larger group practices. Though older theory predicts conflict between bureaucracy and professional autonomy, studies have shown that professions in general, and physicians in particular, have adapted to organizational constraints. However, much work remains in clarifying the nature of this relationship and how exactly physicians have adapted to various organizational settings. To this end, the present study examines physicians' autonomy experiences in different decision types between organization sizes. Specifically, I ask: In what kinds of decisions do doctors perceive autonomous control? How does this vary by organizational size? Using stacked "spell" data constructed from the Community Tracking Study (CTS) Physician Survey (1996-2005) (n = 16,519) I examine how physicians' perceptions of autonomy vary between solo/two physician practices, small group practices with three to ten physicians, and large practices with ten or more physicians, in two kinds of decisions: logistic-based and knowledge-based decisions. Capitalizing on the longitudinal nature of the data I estimate how changes in practice size are associated with perceptions of autonomy, accounting for previous reports of autonomy. I also test whether managed care involvement, practice ownership, and salaried employment help explain part of this relationship. I find that while physicians practicing in larger group practices reported lower levels of autonomy in logistic-based decisions, physicians in solo/two physician practices reported lower levels of autonomy in knowledge-based decisions. Managed care involvement and ownership explain some, but not all, of the associations. These findings suggest that professional adaptation to various organizational settings can lead to varying levels of perceived autonomy across different kinds of decisions. Copyright © 2013

Human dignity in the Nazi era: implications for contemporary bioethics.

PubMed

O'Mathúna, Dónal P

2006-03-14

The justification for Nazi programs involving involuntary euthanasia, forced sterilisation, eugenics and human experimentation were strongly influenced by views about human dignity. The historical development of these views should be examined today because discussions of human worth and value are integral to medical ethics and bioethics. We should learn lessons from how human dignity came to be so distorted to avoid repetition of similar distortions. Social Darwinism was foremost amongst the philosophies impacting views of human dignity in the decades leading up to Nazi power in Germany. Charles Darwin's evolutionary theory was quickly applied to human beings and social structure. The term 'survival of the fittest' was coined and seen to be applicable to humans. Belief in the inherent dignity of all humans was rejected by social Darwinists. Influential authors of the day proclaimed that an individual's worth and value were to be determined functionally and materialistically. The popularity of such views ideologically prepared German doctors and nurses to accept Nazi social policies promoting survival of only the fittest humans.A historical survey reveals five general presuppositions that strongly impacted medical ethics in the Nazi era. These same five beliefs are being promoted in different ways in contemporary bioethical discourse. Ethical controversies surrounding human embryos revolve around determinations of their moral status. Economic pressures force individuals and societies to examine whether some people's lives are no longer worth living. Human dignity is again being seen as a relative trait found in certain humans, not something inherent. These views strongly impact what is taken to be acceptable within medical ethics. Five beliefs central to social Darwinism will be examined in light of their influence on current discussions in medical ethics and bioethics. Acceptance of these during the Nazi era proved destructive to many humans. Their widespread

Human dignity in the Nazi era: implications for contemporary bioethics

PubMed Central

O'Mathúna, Dónal P

2006-01-01

Background The justification for Nazi programs involving involuntary euthanasia, forced sterilisation, eugenics and human experimentation were strongly influenced by views about human dignity. The historical development of these views should be examined today because discussions of human worth and value are integral to medical ethics and bioethics. We should learn lessons from how human dignity came to be so distorted to avoid repetition of similar distortions. Discussion Social Darwinism was foremost amongst the philosophies impacting views of human dignity in the decades leading up to Nazi power in Germany. Charles Darwin's evolutionary theory was quickly applied to human beings and social structure. The term 'survival of the fittest' was coined and seen to be applicable to humans. Belief in the inherent dignity of all humans was rejected by social Darwinists. Influential authors of the day proclaimed that an individual's worth and value were to be determined functionally and materialistically. The popularity of such views ideologically prepared German doctors and nurses to accept Nazi social policies promoting survival of only the fittest humans. A historical survey reveals five general presuppositions that strongly impacted medical ethics in the Nazi era. These same five beliefs are being promoted in different ways in contemporary bioethical discourse. Ethical controversies surrounding human embryos revolve around determinations of their moral status. Economic pressures force individuals and societies to examine whether some people's lives are no longer worth living. Human dignity is again being seen as a relative trait found in certain humans, not something inherent. These views strongly impact what is taken to be acceptable within medical ethics. Summary Five beliefs central to social Darwinism will be examined in light of their influence on current discussions in medical ethics and bioethics. Acceptance of these during the Nazi era proved destructive to many

[Bioethics and adolescence. Reflections about corporeality, sexuality, health, education].

PubMed

Soldini, Maurizio

2004-01-01

Bioethics plays an important role and has remarkable implications on all those who operate in the field of adolescentology at all levels. The forma mentis and the modus operandi that bioethics offers to each operator and educator will surely bring benefits towards the prevention of illness and the general well-being of adolescents, who will be tomorrow's adults. This paper, which analyses problems related to adolescence, such as corporeity, sexuality, health and education, underlines the need to consider them from a bioethical perspective. Furthermore, among the various bioethical approaches, the importance of the Aristotelian-Thomistic virtues is highlighted and should be preferred when dealing with the overall health, both physical and moral, of everyone and especially of every adolescent.

The French bioethics debate: norms, values and practices.

PubMed

Fournier, Véronique; Spranzi, Marta

2013-02-01

In 1994, France passed bioethics laws regulating assisted reproductive technologies, organ donations and prenatal diagnosis. These laws were based upon a few principles considered as fundamental: the anonymity and gratuity of all donations concerning the elements of the human body, free and informed consent, and the interdiction of all commercial transactions on the human body. These laws have been the object of heated debates which continue to this day. On the basis on a few clinical ethics studies conducted by the Center for clinical ethics at the Cochin Hospital in Paris, the articles presented in this special issues explore several aspects of the bioethics debate, and relate it to the more general question of the complex relationship between norms, practices and values.

The failure of formal rights and equality in the clinic: a critique of bioethics.

PubMed

Atkins, Chloe G K

2005-01-01

For communities which espouse egalitarian principles, the hierarchical nature of care-giving relationships poses an extraordinary challenge. Patients' accounts of their illnesses and of their medical care capture the latent tension which exists between notional, political equality and the need for dependency on care from others. I believe that the power imbalance in doctor-patient relationships has broad implications for liberal democracies. Professional and care-giving relationships almost always consist of an imbalance of knowledge and expertise which no template of egalitarian moralism can suppress. When we seek help or guidance from authority figures, we are at a disadvantage politically even though we may be equal citizens theoretically and legally. Hierarchic relationships persist within democracies. Moreover, they tend to exist within a realm of privacy which is only partially visible from the social realm. In the end, traditional notions of liberal autonomy and egalitarianism do not properly describe or monitor these interactions. Liberal rhetoric (i.e., terms such as equality, rights, consent, etc.) pervades much of bioethical literature and interventions but, this very language tends to mask the persistence of structural hierarchies in the clinic. The doctor-patient relationship forces democratic communities to confront the problem of continuing hierarchic power relations and challenges liberalism to revise its understanding of individual autonomies.

[The Act of Promotion of Personal Autonomy and Long-Term Care. Reflections and recommendations for better development].

PubMed

López Casasnovas, Guillem

2011-12-01

The present article provides a critical analysis of the state of affairs of the care of dependent individuals and proposals for reform of social protection systems for dependency - especially the Act of Promotion of Personal Autonomy and Long-Term Care. The existing form of public coverage is linked to the theory of public finance. Against this background, a series of recommendations are made to achieve the goals of this important component of the welfare state. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

Literature, history and the humanization of bioethics.

PubMed

Emmerich, Nathan

2011-02-01

This paper considers the disciplines of literature and history and the contributions each makes to the discourse of bioethics. In each case I note the pedagogic ends that can be enacted though the appropriate use of the each of these disciplines in the sphere of medical education, particularly in the medical ethics classroom.(1) I then explore the contribution that both these disciplines and their respective methodologies can and do bring to the academic field of bioethics. I conclude with a brief consideration of the relations between literature and history with particular attention to the possibilities for a future bioethics informed by history and literature after the empirical turn. © 2010 Blackwell Publishing Ltd.

Gender, identity, and bioethics.

PubMed

Dietz, Elizabeth A

2016-07-01

Transgender people and issues have come to the forefront of public consciousness over the last year. Caitlyn Jenner' very public transition, heightened media coverage of the murders of transgender women of color, and the panicked passage of North Carolina's "bathroom bill" (House Bill 2), mean that conversations about transgender health and well-being are no longer happening only within small communities. The idea that transgender issues are bioethical issues is not new, but I think that increased public awareness of transgender people and the ways that their health is affected by systems that bioethics already engages with offers an opportunity for scholarship that works to improve transgender health in meaningful ways. © 2016 The Hastings Center.

On nature and bioethics.

PubMed

Peterson, Paul Silas

2010-01-01

The account of nature and humanity's relationship to nature are of central importance for bioethics. The Scientific Revolution was a critical development in the history of this question and many contemporary accounts of nature find their beginnings here. While the innovative approach to nature going out of the seventeenth century was reliant upon accounts of nature from the early modern period, the Middle Ages, late-antiquity and antiquity, it also parted ways with some of the understandings of nature from these epochs. Here I analyze this development and suggests that some of the insights from older understandings of nature may be helpful for bioethics today, even if there can be no simple return to them.

Toward a bioethical framework for antibiotic use, antimicrobial resistance and for empirically designing ethically robust strategies to protect human health: a research protocol

PubMed Central

Martins Pereira, Sandra; de Sá Brandão, Patrícia Joana; Araújo, Joana; Carvalho, Ana Sofia

2017-01-01

Introduction Antimicrobial resistance (AMR) is a challenging global and public health issue, raising bioethical challenges, considerations and strategies. Objectives This research protocol presents a conceptual model leading to formulating an empirically based bioethics framework for antibiotic use, AMR and designing ethically robust strategies to protect human health. Methods Mixed methods research will be used and operationalized into five substudies. The bioethical framework will encompass and integrate two theoretical models: global bioethics and ethical decision-making. Results Being a study protocol, this article reports on planned and ongoing research. Conclusions Based on data collection, future findings and using a comprehensive, integrative, evidence-based approach, a step-by-step bioethical framework will be developed for (i) responsible use of antibiotics in healthcare and (ii) design of strategies to decrease AMR. This will entail the analysis and interpretation of approaches from several bioethical theories, including deontological and consequentialist approaches, and the implications of uncertainty to these approaches. PMID:28459355

The role of philosophy in global bioethics: introducing four trends.

PubMed

Hellsten, Sirkku K

2015-04-01

This article examines the relationship between philosophy and culture in global bioethics. First, it studies what is meant by the term "global" in global bioethics. Second, the author introduces four different types, or recognizable trends, in philosophical inquiry in bioethics today. The main argument is that, in order to make better sense of the complexity of the ethical questions and challenges we face today across the globe, we need to embrace the universal nature of self-critical and analytical philosophical analysis and argumentation, rather than using seemingly philosophical approaches to give unjustified normative emphasis on different cultural approaches to bioethics.

Controlled Autonomy: Novice Principals' Schema for District Control and School Autonomy

ERIC Educational Resources Information Center

Weiner, Jennie M.; Woulfin, Sarah L.

2017-01-01

Purpose: The purpose of this paper is to gain insights into how a group of novice principals, all in schools that deployed principles of autonomy as mechanisms for improvement, conceptualized what the authors label "controlled autonomy"--a condition in which school leaders are expected to both make site-based decisions and be accountable…

Thinking across species--a critical bioethics approach to enhancement.

PubMed

Twine, Richard

2007-01-01

Drawing upon a concept of 'critical bioethics' [7] this paper takes a species-broad approach to the social and ethical aspects of enhancement. Critical Bioethics aims to foreground interdisciplinarity, socio-political dimensions, as well as reflexivity to what becomes bioethical subject matter. This paper focuses upon the latter component and uses the example of animal enhancement as a way to think about both enhancement generally, and bioethics. It constructs several arguments for including animal enhancement as a part of enhancement debates, and considers some connections between human and animal enhancement. The paper concludes in a plea for an 'enhancement' to our critical abilities to examine some of the underlying social, moral and ethical assumptions bound up in varied anticipated 'enhanced' futures.

Why autonomy needs help.

PubMed

Caplan, Arthur L

2014-05-01

Some argue that to be effective in healthcare settings autonomy needs to be strengthened. The author thinks autonomy is fundamentally inadequate in healthcare settings and requires supplementation by experience-based paternalism on the part of doctors and healthcare providers.

Respect for cultural diversity in bioethics. Empirical, conceptual and normative constraints.

PubMed

Bracanovic, Tomislav

2011-08-01

In contemporary debates about the nature of bioethics there is a widespread view that bioethical decision making should involve certain knowledge of and respect for cultural diversity of persons to be affected. The aim of this article is to show that this view is untenable and misleading. It is argued that introducing the idea of respect for cultural diversity into bioethics encounters a series of conceptual and empirical constraints. While acknowledging that cultural diversity is something that decision makers in bioethical contexts should try to understand and, when possible, respect, it is argued that this cultural turn ignores the typically normative role of bioethics and thus threatens to undermine its very foundations.

Living apart together: reflections on bioethics, global inequality and social justice

PubMed Central

Rennie, Stuart; Mupenda, Bavon

2008-01-01

Significant inequalities in health between and within countries have been measured over the past decades. Although these inequalities, as well as attempts to improve sub-standard health, raise profound issues of social justice and the right to health, those working in the field of bioethics have historically tended to devote greater attention to ethical issues raised by new, cutting-edge biotechnologies such as life-support cessation, genomics, stem cell research or face transplantation. This suggests that bioethics research and scholarship may revolve around issues that, while fascinating and important, currently affect only a small minority of the world's population. In this article, we examine the accusation that bioethics is largely dominated by Anglophone and industrialized world interests, and explore what kinds of positive contributions a 'bioethics from below' (as Paul Farmer calls it) can make to the field of bioethics in general. As our guide in this exploration, we make use of some experiences and lessons learned in our collaborative bioethics project in the Democratic Republic of Congo, Building Bioethics Capacity and Justice in Health. We conclude that while there is some evidence of increased attention to bioethical challenges in developing countries, this development should be further cultivated, because it could help expand the horizons of the field and enhance its social relevance wherever it is practiced. PMID:19061520

Living apart together: reflections on bioethics, global inequality and social justice.

PubMed

Rennie, Stuart; Mupenda, Bavon

2008-12-07

Significant inequalities in health between and within countries have been measured over the past decades. Although these inequalities, as well as attempts to improve sub-standard health, raise profound issues of social justice and the right to health, those working in the field of bioethics have historically tended to devote greater attention to ethical issues raised by new, cutting-edge biotechnologies such as life-support cessation, genomics, stem cell research or face transplantation. This suggests that bioethics research and scholarship may revolve around issues that, while fascinating and important, currently affect only a small minority of the world's population. In this article, we examine the accusation that bioethics is largely dominated by Anglophone and industrialized world interests, and explore what kinds of positive contributions a 'bioethics from below' (as Paul Farmer calls it) can make to the field of bioethics in general. As our guide in this exploration, we make use of some experiences and lessons learned in our collaborative bioethics project in the Democratic Republic of Congo, Building Bioethics Capacity and Justice in Health. We conclude that while there is some evidence of increased attention to bioethical challenges in developing countries, this development should be further cultivated, because it could help expand the horizons of the field and enhance its social relevance wherever it is practiced.

[The role of bioethics committees in the systems protecting scientific biomedical research participants in France and in Poland].

PubMed

Czarkowski, Marek; Sieczych, Alicja

2013-08-01

Bioethics committees are along with ethic regulations and rules of law one of three main pillars in the system of protection of scientific biomedical research participants. Although principal directives for bioethics committees are established by international guidelines, detailed regulations may differ in particular states. The aim of this article was to compare two bioethic committees systems: French and Polish one. Historical beginnings of the bioethics committees system in France and in Poland are briefly mentioned, Subsequently, the networks of bioethics committees in both countries are compared. Although the number of bioethics committees (Research Ethic Committees) in both countries is comparable, the procedure of their establishment varies. French committees are based on administrative division of the country and divide on regional and interregional committees. In Poland, bioethics committees are established by medical universities, medical research and development units or regional chambers of physicians and dentists. In France there is no equivalent of Appeal Bioethics Committee, however one could appeal from the negative bioethics committee's opinion. The composition of French bioethics committees is more diverse and half of the members are not related to medical professions. Members of French committees are named on indefinite term by headmaster of Regional Health Agency after having been chosen in competition for the post. In Poland members are called on three-year-term but the rotation of members is not overwhelming since there is no limit of terms for one member. French legal solutions seems more secure for scientific bioethics research participants. For this reason, a detailed research on legislation in other countries is necessary before introducing any new regulations in Polish law.

Chauncey Leake and the development of bioethics in America.

PubMed

Brody, Howard

2014-03-01

Chauncey D. Leake (1896-1978) occupies a unique place in the history of American bioethics. A pharmacologist, he was largely an autodidact in both history and philosophy, and believed that ethics should ideally be taught to medical students by those with philosophical training. After pioneering work on medical ethics during the 1920s, he helped to lay the groundwork for important centers for bioethics and medical humanities at two institutions where he worked, the University of California-San Francisco and the University of Texas Medical Branch-Galveston. Understanding Leake's role in American bioethics requires navigating a number of paradoxes--why he was described respectfully in his time but largely forgotten today; how in the 1920s he could write forward-looking pieces that anticipated many of the themes taken up by bioethics a half-century later, yet played largely a reactionary role when the new bioethics actually arrived; and why he advocated turning to philosophy and philosophers for a proper understanding of ethics, yet appeared often to misunderstand philosophical ethics.

In pursuit of goodness in bioethics: analysis of an exemplary article.

PubMed

Hofmann, Bjørn; Magelssen, Morten

2018-06-15

What is good bioethics? Addressing this question is key for reinforcing and developing the field. In particular, a discussion of potential quality criteria can heighten awareness and contribute to the quality of bioethics publications. Accordingly, the objective of this article is threefold: first, we want to identify a set of criteria for quality in bioethics. Second, we want to illustrate the added value of a novel method: in-depth analysis of a single article with the aim of deriving quality criteria. The third and ultimate goal is to stimulate a broad and vivid debate on goodness in bioethics. An initial literature search reveals a range of diverse quality criteria. In order to expand on the realm of such quality criteria, we perform an in-depth analysis of an article that is acclaimed for being exemplary. The analysis results in eleven specific quality criteria for good bioethics in three categories: argumentative, empirical, and dialectic. Although we do not claim that the identified criteria are universal or absolute, we argue that they are fruitful for fueling a continuous constitutive debate on what is "good bioethics." Identifying, debating, refining, and applying such criteria is an important part of defining and improving bioethics.

Shared Mind: Communication, Decision Making, and Autonomy in Serious Illness

PubMed Central

Epstein, Ronald M.; Street, Richard L.

2011-01-01

In the context of serious illness, individuals usually rely on others to help them think and feel their way through difficult decisions. To help us to understand why, when, and how individuals involve trusted others in sharing information, deliberation, and decision making, we offer the concept of shared mind—ways in which new ideas and perspectives can emerge through the sharing of thoughts, feelings, perceptions, meanings, and intentions among 2 or more people. We consider how shared mind manifests in relationships and organizations in general, building on studies of collaborative cognition, attunement, and sensemaking. Then, we explore how shared mind might be promoted through communication, when appropriate, and the implications of shared mind for decision making and patient autonomy. Next, we consider a continuum of patient-centered approaches to patient-clinician interactions. At one end of the continuum, an interactional approach promotes knowing the patient as a person, tailoring information, constructing preferences, achieving consensus, and promoting relational autonomy. At the other end, a transactional approach focuses on knowledge about the patient, information-as-commodity, negotiation, consent, and individual autonomy. Finally, we propose that autonomy and decision making should consider not only the individual perspectives of patients, their families, and members of the health care team, but also the perspectives that emerge from the interactions among them. By drawing attention to shared mind, clinicians can observe in what ways they can promote it through bidirectional sharing of information and engaging in shared deliberation. PMID:21911765

Shared mind: communication, decision making, and autonomy in serious illness.

PubMed

Epstein, Ronald M; Street, Richard L

2011-01-01

In the context of serious illness, individuals usually rely on others to help them think and feel their way through difficult decisions. To help us to understand why, when, and how individuals involve trusted others in sharing information, deliberation, and decision making, we offer the concept of shared mind-ways in which new ideas and perspectives can emerge through the sharing of thoughts, feelings, perceptions, meanings, and intentions among 2 or more people. We consider how shared mind manifests in relationships and organizations in general, building on studies of collaborative cognition, attunement, and sensemaking. Then, we explore how shared mind might be promoted through communication, when appropriate, and the implications of shared mind for decision making and patient autonomy. Next, we consider a continuum of patient-centered approaches to patient-clinician interactions. At one end of the continuum, an interactional approach promotes knowing the patient as a person, tailoring information, constructing preferences, achieving consensus, and promoting relational autonomy. At the other end, a transactional approach focuses on knowledge about the patient, information-as-commodity, negotiation, consent, and individual autonomy. Finally, we propose that autonomy and decision making should consider not only the individual perspectives of patients, their families, and members of the health care team, but also the perspectives that emerge from the interactions among them. By drawing attention to shared mind, clinicians can observe in what ways they can promote it through bidirectional sharing of information and engaging in shared deliberation.

Postmodern Bioethics through Literature.

ERIC Educational Resources Information Center

Goldstein, Daniel

1994-01-01

Explores a hermeneutical perspective of modern medicine. The author suggests that good medical decision making requires interpretation, and bioethics will be well served by incorporating this interpretive element. (LZ)

An Annotated Bibliography of Teaching Bioethics in the Public Secondary School.

ERIC Educational Resources Information Center

Jennings, Bruce D.

This study was conducted to identify bioethical topics of possible interest for a high school science curriculum, focusing on advantages and disadvantages of bioethical education and emphasizing the procedure to incorporate bioethics instruction into the secondary school science curriculum. Researched material is presented as an annotated…

Guidelines for Teaching Cross-Cultural Clinical Ethics: Critiquing Ideology and Confronting Power in the Service of a Principles-Based Pedagogy.

PubMed

Brunger, Fern

2016-03-01

This paper presents a pedagogical framework for teaching cross-cultural clinical ethics. The approach, offered at the intersection of anthropology and bioethics, is innovative in that it takes on the "social sciences versus bioethics" debate that has been ongoing in North America for three decades. The argument is made that this debate is flawed on both sides and, moreover, that the application of cross-cultural thinking to clinical ethics requires using the tools of the social sciences (such as the critique of the universality of the Euro-American construct of "autonomy") within (rather than in opposition to) a principles-based framework for clinical ethics. This paper introduces the curriculum and provides guidelines for how to teach cross-cultural clinical ethics. The learning points that are introduced emphasize culture in its relation to power and underscore the importance of viewing both biomedicine and bioethics as culturally constructed.

From solidarity to autonomy: towards a redefinition of the parameters of the notion of autonomy.

PubMed

Fainzang, Sylvie

2016-12-01

Starting from examples of concrete situations in France, I show that autonomy and solidarity can coexist only if the parameters of autonomy are redefined. I show on the one hand that in situations where autonomy is encouraged, solidarity nevertheless remains at the foundation of their practices. On the other hand, in situations largely infused with family solidarity, the individual autonomy may be put in danger. Yet, based on my ethnographic observations regarding clinical encounters and medical secrecy, I show that while solidarity may endanger individual autonomy, it does not necessarily endanger autonomy itself. The social practices observable in France reflect the reality of an autonomy that goes beyond the individual, a reality that involves a collective subject and includes solidarity. The opposition between these two values can then be resolved if the content of the notion of autonomy is understood to be dependent on its cultural context of application and on its social use.

Owning Up to Negative Ingroup Traits: How Personal Autonomy Promotes the Integration of Group Identity.

PubMed

Legault, Lisa; Weinstein, Netta; Mitchell, Jahlil; Inzlicht, Michael; Pyke, Kristen; Upal, Afzal

2017-10-01

Our experiences, attributes, and behaviors are diverse, inconsistent, and often negative. Consequently, our capacity to assimilate divergent experiences-particularly negative aspects-is important to the development of a unified self. Whereas this process of integration has received attention at the level of personal identity, it has not been assessed at the level of group identity. We examined the mechanisms involved in integrating positive and negative ingroup identities, as well as related outcomes. In three experiments, participants (N = 332) high and low in autonomy identified either positive or negative aspects of their ingroup and then indicated the extent to which they integrated the attribute. Those high in personal autonomy integrated both positive and negative identities, whereas those low in autonomy acknowledged only positive identities. Study 2 showed that, regardless of identity valence, those high in autonomy felt satisfied and close with their group. Conversely, those low in autonomy felt less close and more dissatisfied with their group after reflecting on negative identities. Finally, reflecting on a negative identity reduced prejudice, but only for those high in autonomy. Owning up to negative group traits is facilitated by autonomy and demonstrates benefits for ingroup and intergroup processes. © 2016 Wiley Periodicals, Inc.

Inter-ethics: towards an interactive and interdependent bioethics.

PubMed

Abma, Tineke A; Baur, Vivianne E; Molewijk, Bert; Widdershoven, Guy A M

2010-06-01

Since its origin bioethics has been a specialized, academic discipline, focussing on moral issues, using a vast set of globalized principles and rational techniques to evaluate and guide healthcare practices. With the emergence of a plural society, the loss of faith in experts and authorities and the decline of overarching grand narratives and shared moralities, a new approach to bioethics is needed. This approach implies a shift from an external critique of practices towards embedded ethics and interactive practice improvement, and from a legal defence of rights towards fostering interdependent practices of responsibility. This article describes these transitions within bioethics in relation to the broader societal and cultural dynamics within Western societies, and traces the implications for the methodologies and changing roles of the bioethicist. The bioethicist we foresee is not just a clever expert but also a relationally sensitive person who engages stakeholders in reciprocal dialogues about their practice of responsibility and helps to integrate various sorts of knowledge (embodied, experiential, visual, and cognitive-scientific). In order to illustrate this new approach, we present a case study. It concerns a project focusing on an innovation in elderly care, based on the participation of various stakeholders, especially older people themselves.

Challenging the Conventional Wisdom: From Philosophy to Bioethics.

PubMed

Miller, Franklin G

2017-01-01

Philosophy is a core discipline that has contributed importantly to bioethics. In this essay, the author traces his trajectory from philosophy to bioethics, oriented around the theme of challenging the conventional wisdom. Three topics are discussed to illustrate this theme: the ethics of randomized trials, determination of death and organ transplantation, and pragmatism as a method of bioethics. In addition, the author offers some general reflections on the relationship between philosophy and bioethics. Philosophy recovers itself when it ceases to be a device for dealing with the problems of philosophers and becomes a method, cultivated by philosophers, for dealing with the problems of men.-John Dewey (1917).

A Compulsory Bioethics Module for a Large Final Year Undergraduate Class

ERIC Educational Resources Information Center

Pearce, Roger S.

2009-01-01

The article describes a compulsory bioethics module delivered to [approximately] 120 biology students in their final year. The main intended learning outcome is that students should be able to analyse and reason about bioethical issues. Interactive lectures explain and illustrate bioethics. Underlying principles and example issues are used to…

How we developed a bioethics theme in an undergraduate medical curriculum.

PubMed

Ghias, Kulsoom; Ali, Syeda Kauser; Khan, Kausar S; Khan, Robyna; Khan, Murad M; Farooqui, Arshi; Nayani, Parvez

2011-01-01

The 5-year undergraduate medical curriculum at Aga Khan University integrates basic sciences with clinical and community health sciences. Multimodal strategies of teaching and learning, with an emphasis on problem-based learning, are utilized to equip students with knowledge, skills, behaviours, attitudes and values necessary for a high-calibre medical graduate. Bioethics teaching was introduced in the medical curriculum in 1988 and has since undergone several changes. In 2009, a multidisciplinary voluntary group began review of undergraduate bioethics teaching and invested over 350 man-hours in curricular revision. This involved formulating terminal objectives, delineating specific objectives and identifying instructional methodologies and assessment strategies appropriate for the contents of each objective. Innovative strategies were specially devised to work within the time constraints of the existing medical curriculum and importantly, to increase student interest and engagement. The new bioethics curriculum is designed to be comprehensive and robust, and strives to develop graduates who, in addition to being technically skilled and competent, are well-versed in the history and philosophy of ethics and bioethics and are ethical in their thinking and practice, especially in the context of a developing country like Pakistan where health indicators are among the worst in the region, and clinical practices are not effectively regulated to ensure quality of care.

What feminism can do for bioethics.

PubMed

Purdy, L M

2001-01-01

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

Moral experience: a framework for bioethics research.

PubMed

Hunt, Matthew R; Carnevale, Franco A

2011-11-01

Theoretical and empirical research in bioethics frequently focuses on ethical dilemmas or problems. This paper draws on anthropological and phenomenological sources to develop an alternative framework for bioethical enquiry that allows examination of a broader range of how the moral is experienced in the everyday lives of individuals and groups. Our account of moral experience is subjective and hermeneutic. We define moral experience as "Encompassing a person's sense that values that he or she deem important are being realised or thwarted in everyday life. This includes a person's interpretations of a lived encounter, or a set of lived encounters, that fall on spectrums of right-wrong, good-bad or just-unjust". In our conceptualisation, moral experience is not limited to situations that are heavily freighted with ethically-troubling ramifications or are sources of debate and disagreement. Important aspects of moral experience are played out in mundane and everyday settings. Moral experience provides a research framework, the scope of which extends beyond the evaluation of ethical dilemmas, processes of moral justification and decision-making, and moral distress. This broad research focus is consistent with views expressed by commentators within and beyond bioethics who have called for deeper and more sustained attention in bioethics scholarship to a wider set of concerns, experiences and issues that better captures what is ethically at stake for individuals and communities. In this paper we present our conceptualisation of moral experience, articulate its epistemological and ontological foundations and discuss opportunities for empirical bioethics research using this framework.

Normative foundations of technology transfer and transnational benefit principles in the UNESCO Universal Declaration on Bioethics and Human Rights.

PubMed

Faunce, Thomas Alured; Nasu, Hitoshi

2009-06-01

The United Nations Scientific, Education, and Cultural Organization Universal Declaration on Bioethics and Human Rights (UDBHR) expresses in its title and substance a controversial linkage of two normative systems: international human rights law and bioethics. The UDBHR has the status of what is known as a "nonbinding" declaration under public international law. The UDBHR's foundation within bioethics (and association, e.g., with virtue-based or principlist bioethical theories) is more problematic. Nonetheless, the UDBHR contains socially important principles of technology transfer and transnational benefit (articles 14, 15, and 21). This paper is one of the first to explore how the disciplines of bioethics and international human rights law may interact in the UDBHR to advance the policy relevance and health impact of such principles. It investigates their normative ancestry in the UDBHR, as well as relevant conceptual differences between bioethics and public international law in this respect, and how these may be relevant to their conceptual evolution and application.

A degree in bioethics: an "introspective" analysis from Pakistan.

PubMed

Jafarey, Aamir M

2014-04-01

The success of degree-level bioethics programmes, a recent development across the world, is generally evaluated on the basis of their quantifiable impact; for instance, the number of publications graduates produce. The author conducted a study of Pakistani graduates who had pursued a higher qualification in bioethics, and on the basis of the respondents' written and verbal narratives, this paper presents an analysis of their perceptions of the internal impact of bioethics degree programmes. Using these narratives, the paper also analyses the reactions of their colleagues to their new qualification.The respondents reported significant changes in their thinking and actions following their education in bioethics. They exhibited more empathy towards their patients and research subjects, and became better "listeners~ They also reported changes in practices,the most significant being the discontinuation of the linkages they had established with pharmaceutical firms to seek support,because of concerns related to conflict of interest. Although some respondents believed that their new qualification was generally welcomed by their colleagues, who considered them aesthetics resources, others reported that their colleagues harboured unreasonable and impractical expectations from them, and that these were impossible to fulfil. They also got the feeling of being ostracized and regarded as "ethics watchdogs~ Whereas the internalisation of bioethics is an encouraging finding in this cohort, the mixed reception that bioethics and those involved in it received indicates a Jack of understanding of the field and is a source of concern.

Bioethics and "Rightness".

PubMed

Frank, Arthur W

2017-03-01

If bioethics seeks to affect what people do and don't do as they respond to the practical issues that confront them, then it is useful to take seriously people's sense of rightness. Rightness emerges from the fabric of a life-including the economy of its geography, the events of its times, its popular culture-to be what the sociologist Pierre Bourdieu calls a predisposition. It is the product of a way of life and presupposes continuing to live that way. Rightness is local and communal, holding in relationship those who share the same predisposing sense of how to experience. Rightness is an embodied way of evaluating what is known to matter and choosing among possible responses. Bioethics spends considerable time on what people should do and on the arguments that support recommended actions. It might spend more time on what shapes people's sense of the rightness of what they feel called to do. © 2017 The Hastings Center.

[Autonomy and dementia Part II: autonomy and representation: a possible combination?].

PubMed

Rigaux, Natalie

2011-06-01

This paper, based on a critical review of the medico-social literature, questions the representation of patients with dementia in relation to the autonomy perspectives presented in a previous article. In the canonical perspective of autonomy (defined as a rational decision-making by a stand alone self), the surrogate is the spokeperson of the subject's wills when he was competent because he knows these wills through advance directives or assuming them via substituted judgment. Best patient's interest is then depreciated because it is focused on the present incompetent self. In the relational perspective, where autonomy is constructed through a dialogue with others, the surrogate is the present interlocutor, making the decisions with the patient and care-givers in a way varying with the disease process. He represents the subject with dementia as he was before the disease but also as he has become. Therefore, there is a continuum between autonomy and representation. Autonomy and well being are both the surrogate aims. The relational perspective allows care continuity of patients with dementia even when considered as incompetent. It offers a more balanced perspective on the patient autonomy since it is embedded in all others, and opens a richer view on what good life is, untill the end of dementia.

The features of a "Mediterranean" Bioethics.

PubMed

Leone, Salvino

2012-11-01

Even if somebody considers inappropriate any geographic adjective for Bioethics, nevertheless we think that there are some specific features of "Mediterranean" Bioethics that could distinguish it from a "Northern-European and Northern-American" one. First of all we must consider that medical ethics was born and grew in Mediterranean area. First by the thought of great Greek philosophers as Aristotle (that analyse what ethics is), then by Hippocrates, the "father" of medical ethics. The ethical pattern of Aristotle was based on "virtues" and their practice. In this perspective we can already note a strong difference with actual North-European or American principialist ethics. But a second consideration concerns the role that great Mediterranean religions (Judaism, Christianity and Islam) had in the construction of the ethical thought especially on the matter of life and its respect. So, in our pluralistic and multicultural society is absolutely necessary to rescue an approach that considers both "lungs" of ethical thought (Mediterranean and Northern one) and highlights the role that Mediterranean Ethics still has in this way.

MEDICAL SCIENCE, RESEARCH AND HIGHER EDUCATION IN AZERBAIJAN FROM BIOETHICAL DEVELOPMENTS PERSPECTIVE

PubMed Central

VUGAR, MAMMADOV; KERIM, MUNIR; LALA, JAFAROVA

2017-01-01

Azerbaijan is a modern, rapidly developing democratic country at the crossroads of Europe and Asia. The country is currently harmonizing its national legislation with international norms, and reforming its national scientific and medical. Higher standards of medical research and education will enhance public health and protect human rights to life and health that are specified in Azerbaijan Constitution. In order to raise its medical research and education to international standards, Azerbaijani scientists and authorities are studying the experience of other countries and taking measures to implement international standards and norms in the country’s national legislation. Cooperation with the WHO, UNESCO and other international and foreign organizations, both on regional and global level is creating steps to achieve this goal. These steps include, for example, creation of the Azerbaijan unit of the UNESCO Chair in Bioethics and teaching bioethics based on UNESCO’s Bioethics Core Curriculum. Another step is providing research fellowship for young Azerbaijani professionals to study at leading medical research and educational centers around the world including Harvard Medical School and Boston Children’s Hospital in the USA, and Koc University in Turkey. A complementary step is the development of local bioethical research, including its legal, ethical and scientific foundations. Adherence to ethical principles in different spheres of life is currently one of the most challenging social and professional issues, especially, this is true with the development of new medical technologies in recent decades and the development of new ethical and legal standards, issues involving different areas of health and medicine and their relation to human rights. Bioethics in Azerbaijan is developing as an important field that deals with universal moral principles within the context of both national laws and the UNESCO Universal Declaration on Bioethics and Human Rights. PMID

Intention, autonomy, and brain events.

PubMed

Gillett, Grant

2009-07-01

Informed consent is the practical expression of the doctrine of autonomy. But the very idea of autonomy and conscious free choice is undercut by the view that human beings react as their unconscious brain centres dictate, depending on factors that may or may not be under rational control and reflection. This worry is, however, based on a faulty model of human autonomy and consciousness and needs close neurophilosophical scrutiny. A critique of the ethics implied by the model takes us towards a 'care of the self' view of autonomy and the subject's attunement to the truth as the crux of reasoning rather than the inner mental/neural state views of autonomy and human choice on offer at present.

Bioethics and multiculturalism: nuancing the discussion.

PubMed

Durante, Chris

2018-02-01

In his recent analysis of multiculturalism, Tom Beauchamp has argued that those who implement multicultural reasoning in their arguments against common morality theories, such as his own, have failed to understand that multiculturalism is neither a form of moral pluralism nor ethical relativism but is rather a universalistic moral theory in its own right. Beauchamp's position is indeed on the right track in that multiculturalists do not consider themselves ethical relativists. Yet, Beauchamp tends to miss the mark when he argues that multiculturalism is in effect a school of thought that endorses a form of moral universalism that is akin to his own vision of a common morality. As a supporter of multiculturalism, I would like to discuss some aspects of Beauchamp's comments on multiculturalism and clarify what a multicultural account of public bioethics might look like. Ultimately, multiculturalism is purported as a means of managing diversity in the public arena and should not be thought of as endorsing either a version of moral relativism or a universal morality. By simultaneously refraining from the promotion of a comprehensive common moral system while it attempts to avoid a collapse into relativism, multiculturalism can serve as the ethico-political framework in which diverse moralities can be managed and in which opportunities for ethical dialogue, debate and deliberation on the prospects of common bioethical norms are made possible. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The psychology of autonomy.

PubMed

2016-05-01

In May 2016, right around the time that this issue of the Hastings Center Report should be published, The Hastings Center is holding a conference in New York City titled "Bioethics Meets Moral Psychology." The goal of the conference is to consider the lessons that bioethicists should learn from the raft of literature now accumulating on how the mental processes of perception, emotion, and thinking affect things that bioethicists care about, from the education of health care professionals to the conflicts that arise in clinical care, the "culture wars" over bioethical policy issues, the status of different cultures' value systems, and the very understanding of the values that are foundational in moral thinking. The articles in this issue simply provide more evidence that bioethics is meeting moral psychology. © 2016 The Hastings Center.

The Psychobiology of Aggression and Violence: Bioethical Implications

ERIC Educational Resources Information Center

Diaz, Jose Luis

2010-01-01

Bioethics is concerned with the moral aspects of biology and medicine. The bioethical relevance of aggression and violence is clear, as very different moral and legal responsibilities may apply depending on whether aggression and violence are forms of behaviour that are innate or acquired, deliberate or automatic or not, or understandable and…

The journalist's role in bioethics.

PubMed

Rosenfeld, A

1999-04-01

In the late 1950s and early 1960s, emerging advances in the biomedical sciences raised insufficiently noticed ethical issues, prompting science reporters to serve as a sort of Early Warning System. As awareness of bioethical issues increased rapidly everywhere, and bioethics itself arrived as a recognized discipline, the need for this early-warning press role has clearly diminished. A secondary but important role for the science journalist is that of investigative reporter/whistleblower, as in the Tuskegee syphilis trials and the government's secret plutonium experiments. Because the general public gets most of its information from the popular media, ways are suggested for journalists and bioethicists to work together.

Diagnosis and treatment for vulvar cancer for indigenous women from East Arnhem Land, Northern Territory: bioethical reflections.

PubMed

McGrath, Pam; Rawson, Nicole; Adidi, Leonora

2015-06-01

This paper explores the bioethical issues associated with the diagnosis and treatment of vulvar cancer for Indigenous women in East Arnhem Land, Northern Territory, Australia. Based on a qualitative study of a vulvar cancer cluster of Indigenous women, the article highlights four main topics of bioethical concern drawn from the findings: informed consent, removal of body parts, pain management, and issues at the interface of Indigenous and Western health care. The article seeks to make a contribution towards Indigenous health and bioethics and bring to light areas of further research.

Merging arts and bioethics: An interdisciplinary experiment in cultural and scientific mediation.

PubMed

Couture, Vincent; Bélisle-Pipon, Jean-Christophe; Cloutier, Marianne; Barnabé, Catherine

2017-10-01

How to engage the public in a reflection on the most pressing ethical issues of our time? What if part of the solution lies in adopting an interdisciplinary and collaborative strategy to shed light on critical issues in bioethics? An example is Art + Bioéthique, an innovative project that brought together bioethicists, art historians and artists with the aim of expressing bioethics through arts in order to convey the "sensitive" aspect of many health ethics issues. The aim of this project was threefold: 1) to identify and characterize mechanisms for the meeting of arts and bioethics; 2) to experiment with and co-construct a dialogue between arts and bioethics; and 3) to initiate a public discussion on bioethical issues through the blending of arts and bioethics. In connection with an exhibition held in March 2016 at the Espace Projet, a non-profit art space in Montréal (Canada), the project developed a platform that combined artworks, essays and cultural & scientific mediation activities related to the work of six duos of young bioethics researchers and emerging artists. Each duo worked on a variety of issues, such as the social inclusion of disabled people, the challenges of practical applications of nanomedicine and regenerative medicine, and a holistic approach to contemporary diseases. This project, which succeeded in stimulating an interdisciplinary dialogue and collaboration between bioethics and arts, is an example of an innovative approach to knowledge transfer that can move bioethics reflection into the public space. © 2017 John Wiley & Sons Ltd.

Bioethics as several kinds of writing.

PubMed

Nelson, J L

1999-04-01

Three different models are described of the relationship of bioethics to the press. The first two are familiar: bioethicists often are interviewed by journalists seeking background and short quotes to insert in a story; alternately, bioethicists sometimes themselves act as journalists of a sort, writing op-eds, articles or even longer works designed for wide readership. These models share the notion that bioethicists can provide information and ideas that increase the quality of people's thinking on moral matters. They share also a common difficulty: do the constraints the media impose on bioethical discourse keep bioethicists from deepening public reflection, and if not, how can those constraints be most effectively kept from distorting what bioethicists wish to say? The third model reverses--in part--the presupposition that bioethics bestows moral sophistication on a public naive about ethical issues, holding rather that matters run both ways; bioethicists stand to learn a great deal from their interactions with various publics and the media that serve them. On this view, the constraints imposed by media conventions constitute opportunities for new and potentially important forms of bioethical writing. Various concerns generated by the first two models are surveyed. It is concluded that while none of the difficulties constitute knock-down arguments against these forms of collaborating with the press, the worries are problematic enough to provide some support for considering the less familiar third approach. Further reason for taking the third model seriously draws on moral theoretic considerations.

Does ethical theory have a future in bioethics?

PubMed

Beauchamp, Tom L

2004-01-01

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

Autonomy in chimpanzees.

PubMed

Beauchamp, Tom L; Wobber, Victoria

2014-04-01

Literature on the mental capacities and cognitive mechanisms of the great apes has been silent about whether they can act autonomously. This paper provides a philosophical theory of autonomy supported by psychological studies of the cognitive mechanisms that underlie chimpanzee behavior to argue that chimpanzees can act autonomously even though their psychological mechanisms differ from those of humans. Chimpanzees satisfy the two basic conditions of autonomy: (1) liberty (the absence of controlling influences) and (2) agency (self-initiated intentional action), each of which is specified here in terms of conditions of understanding, intention, and self-control. In this account, chimpanzees make knowledge-based choices reflecting a richly information-based and socially sophisticated understanding of the world. Finally, two major theories of autonomy (Kantian theory and two-level theory) are rejected as too narrow to adequately address these issues, necessitating the modifications made in the present approach.

Autonomy for Constellation

NASA Technical Reports Server (NTRS)

Truszkowski, Walt; Szczur, Martha R. (Technical Monitor)

2000-01-01

The newer types of space systems, which are planned for the future, are placing challenging demands for newer autonomy concepts and techniques. Motivating these challenges are resource constraints. Even though onboard computing power will surely increase in the coming years, the resource constraints associated with space-based processes will continue to be a major factor that needs to be considered when dealing with, for example, agent-based spacecraft autonomy. To realize "economical intelligence", i.e., constrained computational intelligence that can reside within a process under severe resource constraints (time, power, space, etc.), is a major goal for such space systems as the Nanosat constellations. To begin to address the new challenges, we are developing approaches to constellation autonomy with constraints in mind. Within the Agent Concepts Testbed (ACT) at the Goddard Space Flight Center we are currently developing a Nanosat-related prototype for the first of the two-step program.

Questioning scrutiny: bioethics, sexuality, and gender identity.

PubMed

Wahlert, Lance; Fiester, Autumn

2012-09-01

The clinic is a loaded space for LGBTQI persons. Historically a site of pathology and culturally a site of stigma, the contemporary clinic for queer patient populations and their loved ones is an ethically fraught space. This paper, which introduces the featured articles of this special issue of the Journal of Bioethical Inquiry on "Bioethics, Sexuality, and Gender Identity," begins by offering an analysis of scrutiny itself. How do we scrutinize? When is it apt for us to scrutinize? And what are the benefits and perils of clinical and bioethical scrutiny? Bearing in mind these questions, the second half of this paper introduces the feature articles in this special issue in response to such forms of scrutiny. How, why, when, and in what ways to sensitively scrutinize LGBTQI persons in the clinic are the aims of this piece.

Autonomy-based arguments against physician-assisted suicide and euthanasia: a critique.

PubMed

Sjöstrand, Manne; Helgesson, Gert; Eriksson, Stefan; Juth, Niklas

2013-05-01

Respect for autonomy is typically considered a key reason for allowing physician assisted suicide and euthanasia. However, several recent papers have claimed this to be grounded in a misconception of the normative relevance of autonomy. It has been argued that autonomy is properly conceived of as a value, and that this makes assisted suicide as well as euthanasia wrong, since they destroy the autonomy of the patient. This paper evaluates this line of reasoning by investigating the conception of valuable autonomy. Starting off from the current debate in end-of-life care, two different interpretations of how autonomy is valuable is discussed. According to one interpretation, autonomy is a personal prudential value, which may provide a reason why euthanasia and assisted suicide might be against a patient's best interests. According to a second interpretation, inspired by Kantian ethics, being autonomous is unconditionally valuable, which may imply a duty to preserve autonomy. We argue that both lines of reasoning have limitations when it comes to situations relevant for end-of life care. It is concluded that neither way of reasoning can be used to show that assisted suicide or euthanasia always is impermissible.

Autonomy and the principle of respect for autonomy.

PubMed

Gillon, R

1985-06-15

Autonomy is defined as the capacity to think, decide, and act freely and independently on the basis of such thought and decisions. Three types of autonomy are distinguished: autonomy of thought, which embraces the wide range of human intellectual activities called "thinking for oneself"; autonomy of will, or the capacity to decide to do things on the basis of one's deliberations; and autonomy of action, the absence of which is illustrated by the situation of a patient whose voluntary muscles are paralyzed by curariform drugs and who thus cannot tell the surgeon that the anesthetist has forgotten the nitrous oxide. Autonomy is viewed as a prerequisite for all the virtues, rather than as a virtue in its own right. The arguments of Immanuel Kant and John Stuart Mill concerning the principle of respect for autonomy are summarized as exemplars respectively of the deontological and utilitarian philosophical approaches.

Becoming partners, retaining autonomy: ethical considerations on the development of precision medicine.

PubMed

Blasimme, Alessandro; Vayena, Effy

2016-11-04

Precision medicine promises to develop diagnoses and treatments that take individual variability into account. According to most specialists, turning this promise into reality will require adapting the established framework of clinical research ethics, and paying more attention to participants' attitudes towards sharing genotypic, phenotypic, lifestyle data and health records, and ultimately to their desire to be engaged as active partners in medical research.Notions such as participation, engagement and partnership have been introduced in bioethics debates concerning genetics and large-scale biobanking to broaden the focus of discussion beyond individual choice and individuals' moral interests. The uptake of those concepts in precision medicine is to be welcomed. However, as data and medical information from research participants in precision medicine cohorts will be collected on an individual basis, translating a participatory approach in this emerging area may prove cumbersome. Therefore, drawing on Joseph Raz's perfectionism, we propose a principle of respect for autonomous agents that, we reckon, can address many of the concerns driving recent scholarship on partnership and public participation, while avoiding some of the limitations these concept have in the context of precision medicine. Our approach offers a normative clarification to how becoming partners in precision is compatible with retaining autonomy.Realigning the value of autonomy with ideals of direct engagement, we show, can provide adequate normative orientation to precision medicine; it can do justice to the idea of moral pluralism by stressing the value of moral self-determination: and, finally, it can reconcile the notion of autonomy with other more communitarian values such as participation and solidarity.

The Adaptation of a School-Based Health Promotion Programme for Youth with Intellectual and Developmental Disabilities: A Community-Engaged Research Process

ERIC Educational Resources Information Center

Hubbard, Kristie L.; Bandini, Linda G.; Folta, Sara C.; Wansink, Brian; Must, Aviva

2014-01-01

Background: Evidenced-based health promotion programmes for youth with intellectual and developmental disabilities (I/DD) are notably absent. Barriers include a lack of understanding of how to adapt existing evidence-based programmes to their needs, maximize inclusion and support mutual goals of health and autonomy. Methods: We undertook a…

Critical Realism and Empirical Bioethics: A Methodological Exposition.

PubMed

McKeown, Alex

2017-09-01

This paper shows how critical realism can be used to integrate empirical data and philosophical analysis within 'empirical bioethics'. The term empirical bioethics, whilst appearing oxymoronic, simply refers to an interdisciplinary approach to the resolution of practical ethical issues within the biological and life sciences, integrating social scientific, empirical data with philosophical analysis. It seeks to achieve a balanced form of ethical deliberation that is both logically rigorous and sensitive to context, to generate normative conclusions that are practically applicable to the problem, challenge, or dilemma. Since it incorporates both philosophical and social scientific components, empirical bioethics is a field that is consistent with the use of critical realism as a research methodology. The integration of philosophical and social scientific approaches to ethics has been beset with difficulties, not least because of the irreducibly normative, rather than descriptive, nature of ethical analysis and the contested relation between fact and value. However, given that facts about states of affairs inform potential courses of action and their consequences, there is a need to overcome these difficulties and successfully integrate data with theory. Previous approaches have been formulated to overcome obstacles in combining philosophical and social scientific perspectives in bioethical analysis; however each has shortcomings. As a mature interdisciplinary approach critical realism is well suited to empirical bioethics, although it has hitherto not been widely used. Here I show how it can be applied to this kind of research and explain how it represents an improvement on previous approaches.

Moral philosophy in bioethics. Etsi ethos non daretur?

PubMed

Pessina, Adriano

2013-01-01

In this paper I intend to put forward some criticism of the purely procedural model of bioethics, which, in fact, leads to delegating to biopolitics and biolaw the finding of a purely pragmatic solution to the issues for which bioethics was "invented" over forty years ago. This delegating takes place after the transition from the thesis, dear to modernity, whereby in ethics reasoning should avoid any discussion regarding its foundation or ultimate justification (Etsi Deus non daretur) to the contemporary affirmation of a substantial ethical agnosticism, which, in the name of the incommensurability of morals, should construct procedures as if no sole substantial moral were possible (Etsi ethos non daretur) and act as a guarantor of ethical pluralism. These theses will be discussed and an attempt will be made to demonstrate why it is necessary to establish a link between true and good, and how this is possible only by referring to ontology. The conclusion points to the need to propose bioethics explicitly in terms of content that satisfies the presumed axiological neutrality of procedural bioethics, which however, turns out to be theoretically weak and practically unable to protect the ethical pluralism for which it would like to be the guarantor. The conclusion is that only by referring to ontology can bioethics, which is a fully fledged form of moral philosophy, act as a guarantor of pluralism within the truth and oppose the authoritarian tendencies concealed under the liberal guise of ethical agnosticism.

How bioethics principles can aid design of electronic health records to accommodate patient granular control.

PubMed

Meslin, Eric M; Schwartz, Peter H

2015-01-01

Ethics should guide the design of electronic health records (EHR), and recognized principles of bioethics can play an important role. This approach was recently adopted by a team of informaticists who are designing and testing a system where patients exert granular control over who views their personal health information. While this method of building ethics in from the start of the design process has significant benefits, questions remain about how useful the application of bioethics principles can be in this process, especially when principles conflict. For instance, while the ethical principle of respect for autonomy supports a robust system of granular control, the principles of beneficence and nonmaleficence counsel restraint due to the danger of patients being harmed by restrictions on provider access to data. Conflict between principles has long been recognized by ethicists and has even motivated attacks on approaches that state and apply principles. In this paper, we show how using ethical principles can help in the design of EHRs by first explaining how ethical principles can and should be used generally, and then by discussing how attention to details in specific cases can show that the tension between principles is not as bad as it initially appeared. We conclude by suggesting ways in which the application of these (and other) principles can add value to the ongoing discussion of patient involvement in their health care. This is a new approach to linking principles to informatics design that we expect will stimulate further interest.

The evolving idea of social responsibility in bioethics: a welcome trend.

PubMed

Ahola-Launonen, Johanna

2015-04-01

This article discusses the notion of social responsibility for personal health and well-being in bioethics. Although social responsibility is an intrinsic aspect of bioethics, and its role is increasingly recognized in certain areas, it can still be claimed that bioethics in general is committed to an individualistic theoretical framework that disregards the social context in which decisions, health, and well-being are situated. The philosophical premises of this framework regard individuals as rational decisionmakers who can be held accountable for their health conditions and who should be the primary objects of intervention in attempts to reduce lifestyle-associated chronic diseases. There are, however, social determinants of health that challenge this conclusion. Because their impact can be controlled, to a certain extent, by social and public policy decisions, their existence shows the inadequacy of the purely individualistic approach. I suggest, accordingly, that bioethics would benefit, both academically and societally, from a more social perspective. Bioethical studies that acknowledge, from the start, the social determinants of health would be more amenable to constructive multi- and interdisciplinarity, and a more balanced account of responsibility would further the contribution of sound bioethical work to sensible public policies.

Elucidating Bioethics with Undergraduates.

ERIC Educational Resources Information Center

Hoskins, Betty B.; Shannon, Thomas A.

1977-01-01

Discusses the importance of developing bioethics programs for undergraduate students. Two aspects are considered: (1) current areas of concern and sources of bibliographic information; and (2) problems encountered in undergraduate projects. A list of references is provided. (HM)

[Bioethics today: Heidegger’s questions].

PubMed

Figueroa, Gustavo

2011-10-01

Bioethics was born not only as an aftermath of medical technological advance but also from underlying philosophical conceptions about man, that determine scientific research. Analyzing occidental ethics, Heidegger showed that animalism was the only human dimension considered and thereby the domain of measurable objectiveness. He postulated that the essence of human existence as being-in-the-world is ethical and revealed through an original consciousness. Unlike moral conscience, original conscience calls to authenticity, to hear his constitutive nihilism as a "Being-referred-to-death". The founding ground of bioethics may be to listen to this primary being-guilty prior to the derived guilts, e.g. faults, deficiencies and shortcomings of specific daily actions.

[Bioethical arguments in Joseph Ratzinger's thinking].

PubMed

Martínez-Carbonell López, Alfonso

2014-01-01

In the dense theological thought of Joseph Ratzinger before his election as pope, we find fundamental contributions to contemporary bioethics. Starting from the assumption of the close relationship between faith and science he incorporates a necessary theological dimension in the bioethical dialogue that illuminates and clarifies the answers to the real questions raised in bioethical actions. On the one hand, there is the question of the origin of man that is understood as God's creation as opposed to a purely biological origin to which a modern pseudoscientific stance wants to confine it. On the other hand, there is the question about man's identity, which is understood as the image of God, from which stems the inviolable dignity and sacredness of human life, overcoming scientistic materialism. Finally, we find the question of how to treat the ″other″, even the embryo, as a result of its lofty dignity, analyzing the ethical and legal consequences that exude from their nature and are summarized in the duty to protect and respect the other which the law should protect against the abuse of those who are stronger.

The transformation of (bio)ethics expertise in a world of ethical pluralism.

PubMed

Kovács, József

2010-12-01

Today, bioethics experts have an increasing role in public life. However, the question arises: what does bioethics expertise really mean? Can there be such a thing in our globalised world characterised by ethical pluralism? I will argue that bioethics as a discipline represents the transformation of ethics expertise from a hard to a soft form of it. Bioethics was born as a reaction to the growing awareness of ethical pluralism, and it denied the hard form of normative-prescriptive ethics expertise (the ability to determine what is the right course of action for others), particularly in its medical ethics form. In contrast, the traditional medical ethics model, and pre-modern societies in general, believed in hard normative ethics expertise. From this followed the characteristic paternalism of traditional medical practice: if physicians were experts in moral matters as well, if they knew what the right course of action to choose was, then they had a right to benevolently force this course of action on their patients. The remnants of this doctrine, although rarely stated explicitly, still can often be seen in clinical practice. The whole bioethics movement can be seen as a radical denial of the doctrine of physician's hard expertise in moral matters. Bioethics, however, represents a type of soft ethics expertise (mainly value sensitivity). Hence follows the seeming paradox of bioethics expertise: bioethics is both a denial of ethics expertise (in its hard form) as well as a type of (soft) ethics expertise.

Disconnections between Teacher Expectations and Student Confidence in Bioethics

ERIC Educational Resources Information Center

Hanegan, Nikki L.; Price, Laura; Peterson, Jeremy

2008-01-01

This study examines how student practice of scientific argumentation using socioscientific bioethics issues affects both teacher expectations of students' general performance and student confidence in their own work. When teachers use bioethical issues in the classroom students can gain not only biology content knowledge but also important…

A Conceptual Model for the Translation of Bioethics Research and Scholarship.

PubMed

Mathews, Debra J H; Hester, D Micah; Kahn, Jeffrey; McGuire, Amy; McKinney, Ross; Meador, Keith; Philpott-Jones, Sean; Youngner, Stuart; Wilfond, Benjamin S

2016-09-01

While the bioethics literature demonstrates that the field has spent substantial time and thought over the last four decades on the goals, methods, and desired outcomes for service and training in bioethics, there has been less progress defining the nature and goals of bioethics research and scholarship. This gap makes it difficult both to describe the breadth and depth of these areas of bioethics and, importantly, to gauge their success. However, the gap also presents us with an opportunity to define this scope of work for ourselves and to help shape the broader conversation about the impact of academic research. Because of growing constraints on academic funding, researchers and scholars in many fields are being asked to demonstrate and also forecast the value and impact of their work. To do that, and also to satisfy ourselves that our work has meaningful effect, we must understand how our work can motivate change and how that change can be meaningfully measured. In a field as diverse as bioethics, the pathways to and metrics of change will likewise be diverse. It is therefore critical that any assessment of the impact of bioethics research and scholarship be informed by an understanding of the nature of the work, its goals, and how those goals can and ought to be furthered. In this paper, we propose a conceptual model that connects individual bioethics projects to the broader goals of scholarship, describing the translation of research and scholarly output into changes in thinking, practice, and policy. One of the key implications of the model is that impact in bioethics is generally the result of a collection of projects rather than of any single piece of research or scholarship. Our goal is to lay the groundwork for a thoroughgoing conversation about bioethics research and scholarship that will advance and shape the important conversation about their impact. © 2016 The Hastings Center.

Institutional Autonomy Revisited: Autonomy Justified and Accounted

ERIC Educational Resources Information Center

Moses, Ingrid

2007-01-01

Australian universities have enjoyed large-scale autonomy. In a society that increasingly regards university education from an instrumentalist point of view, universities' anxious safeguarding of their autonomy is widely seen as an attempt to evade accountability. Yet there has been an acceptance that a corollary to autonomy is accountability.…

Is there a Mediterranean bioethics?

PubMed

Mallia, Pierre

2012-11-01

Is there a special Mediterranean approach to Bioethics and if so what are the roots of this approach? And why not a Bosphorus, or a 'lake Michigan' bioethics? The answer to such a question depends on the focus one takes on defining 'Mediterranean'? On the one hand one can refer to the Mediterranean region which includes the surrounding coasts, having Europe on its northern coast line, northern Africa on its southern coast line (and these will include the north and South West coasts), and in the Eastern region countries which border with Middle-Eastern countries. This approach is the approach currently being taken by European Parliamentarians when they speak about the Mediterranean, namely including countries like France, Italy and Libya. On the other hand there is the look upon the Mediterranean as 'Southern Europe'; this is a more 'traditional' way on how westerners view the Mediterranean. This common approach is often recognized when, for example, we speak of 'Mediterranean diet', or, 'Mediterranean Temperament'. It would include Eastern countries like Greece and Cyprus. This article focuses on these two approaches to Mediterranean ethics after discussing issues pertaining to the region which are important to define in this context. It then analyses the need for having a Mediterranean approach to bioethical issues.

Bioethics for human geneticists: models for reasoning and methods for teaching.

PubMed Central

Parker, L. S.

1994-01-01

The ethical issues raised by the Human Genome Project (HGP) and by human genetics in general are not entirely novel. In fact, the ethical issues surrounding genetic research and the provision of genetic services fit into the evolution of bioethics, a field of inquiry which has its roots in concerns of the 1970s, concerns about the dignity and self-determination of individuals and about the development of medical technologies. Although bioethics has been largely occupied with patient-centered concerns, attention is currently shifting toward socially oriented issues, such as the justice of the existing health-care system. Genetic counseling has already incorporated many of the lessons of early bioethics and, as a profession, adheres to a consultand-centered ethic which reflects the values incorporated into the doctrine of informed consent, which is a cornerstone of bioethics. The mandate of the Ethical, Legal, and Social Implications Program of the HGP--to anticipate ethical problems arising from advances in genetics and to educate the public about genetics--reflects not only the nonpaternalistic approach of early bioethics but also bioethics' increasing attention to the ethical import of systemic and institutional factors, as well as an anticipatory and preventive approach to dealing with ethical concerns. Because bioethics has so much to contribute to current consideration of ethical issues in human genetics, it is important to provide training in ethics to those working in the field. Guidelines for using a case-oriented approach are suggested. PMID:8279464

The Best Interest Standard: Same Name but Different Roles in Pediatric Bioethics and Child Rights Frameworks.

PubMed

Ross, Lainie Friedman; Swota, Alissa Hurwitz

2017-01-01

This article explores the intersection of pediatric bioethics and child rights by examining the best interest standard as it operates within the pediatric bioethics framework in the United States and the child rights framework based on the UN 1989 Convention on the Rights of the Child (CRC). While the "best interest of the child" standard is central to both pediatric bioethics and the child rights community, it operates only as a guidance principle, and not as an intervention principle, in decision-making within U.S. pediatric bioethics, whereas it operates as both a guidance and intervention principle in the child rights community. The differences in how the best interest standard is operationalized lead to different roles for the family, the state, and the minor in decision-making processes and outcomes. We examine the recent case of Charlie Gard to illustrate some of these differences.

Bioethics of life programs: taking seriously moral pluralism in clinical settings.

PubMed

Niebroj, Leslaw

2010-11-04

In the more and more globalized world, the experience of moral pluralism (often related to, or based upon, religious pluralism) has become a common issue which ethical importance is undeniable. Potential conflicts between patients' and therapeutic teams' moral views and between moral beliefs of the particular member of this team are being resolved in the light of bioethical theories, among which principlism remains the mainstream approach to biomedical ethics. The question arises, however, whether this approach, in itself, as being strictly bound to the specific and distinct American philosophical tradition, is to be considered the tool for so called ?moral imperialism'. Also architectures of principlism, in particular by elaborating the concept of common morality, defend the applicability of their theory to the pluralistic settings, it should be emphasized that the idea that some norms and standards of moral character are shared by all morally serious people in every culture has attracted criticism both from empirical as well as theoretical backgrounds. This paper aims at reconsidering principlism so that it would be more suitable for resolving moral dilemma in ethically pluralistic clinical settings. Lakatos' sophisticated methodological falsification is used into two different ways: (1) to construct a concept of 'life programs' and (2) to confront a newly elaborated ethical theory with principlism. The reflection is limited to the norms related to the key issue in clinical ethics, i.e., respecting the patient's autonomy. The concepts of common morality and particular moralities are interpreted (in the light of Lakatos' philosophy of sciences) as "hard core" and "protective belt" of life programs, respectively. Accepting diversity of research programs, Lakatos maintains the idea of the objectivity of truth. Analogously, the plurality of life programs does not put into question the objectivity of moral values. The plurality of moral norms not only respects the

Bioethics of life programs: Taking seriously moral pluralism in clinical settings

PubMed Central

2010-01-01

Background In the more and more globalized world, the experience of moral pluralism (often related to, or based upon, religious pluralism) has become a common issue which ethical importance is undeniable. Potential conflicts between patients' and therapeutic teams' moral views and between moral beliefs of the particular member of this team are being resolved in the light of bioethical theories, among which principlism remains the mainstream approach to biomedical ethics. The question arises, however, whether this approach, in itself, as being strictly bound to the specific and distinct American philosophical tradition, is to be considered the tool for so called 'moral imperialism'. Also architectures of principlism, in particular by elaborating the concept of common morality, defend the applicability of their theory to the pluralistic settings, it should be emphasized that the idea that some norms and standards of moral character are shared by all morally serious people in every culture has attracted criticism both from empirical as well as theoretical backgrounds. Objective This paper aims at reconsidering principlism so that it would be more suitable for resolving moral dilemma in ethically pluralistic clinical settings. Methods Lakatos' sophisticated methodological falsification is used into two different ways: (1) to construct a concept of 'life programs' and (2) to confront a newly elaborated ethical theory with principlism. The reflection is limited to the norms related to the key issue in clinical ethics, i.e., respecting the patient's autonomy. Results The concepts of common morality and particular moralities are interpreted (in the light of Lakatos' philosophy of sciences) as 'hard core' and 'protective belt' of life programs, respectively. Accepting diversity of research programs, Lakatos maintains the idea of the objectivity of truth. Analogously, the plurality of life programs does not put into question the objectivity of moral values. The plurality of

Establishing a framework for a physician assistant/bioethics dual degree program.

PubMed

Carr, Mark F; Bergman, Brett A

2014-01-01

: Numerous medical schools currently offer a master of arts (MA) in bioethics dual degree for physicians. A degree in bioethics enhances the care physicians provide to patients and prepares physicians to serve on ethics committees and consult services. Additionally, they may work on institutional and public policy issues related to ethics. Several physician assistant (PA) programs currently offer a master of public health (MPH) dual degree for PAs. A degree in public health prepares PAs for leadership roles in meeting community health needs. With the success of PA/MPH dual degree programs, we argue here that a PA/bioethics dual degree would be another opportunity to advance the PA profession and consider how such a program might be implemented. The article includes the individual perspectives of the authors, one of whom completed a graduate-level certificate in bioethics concurrently with his 2-year PA program, while the other served as a bioethics program director.

Patient autonomy preferences among hypertensive outpatients in a primary care setting in Japan.

PubMed

Nomura, Kyoko; Ohno, Maiko; Fujinuma, Yasuki; Ishikawa, Hirono

2007-01-01

To investigate autonomy preferences and the factors to promote active patient participation in a primary care setting in Japan. Ninety-two hypertensive outpatients who consecutively visited a Japanese hospital between January and May of 2005 in Tokyo, Japan. This cross-sectional study was conducted by using a self-administered questionnaire. The main outcome measures were patient preferences for autonomy (i.e., decision-making and information-seeking preferences), measured by the Autonomy Preference Index (API). The variables studied were patient sociodemographic characteristics, physician characteristics based on patient preference (i.e., ability to communicate, extent of clinical experience, qualifications, educational background, gender, and age), and the Multidimensional Health Locus of Control. On the API scale from 0 to 100, the patients had an intermediate desire for decision-making (median: 51) and a greater desire for information (median: 95). A multivariate regression model indicated that decision-making preference increased when patients were woman and decreased as physician age increased, and information-seeking preference was positively associated with good communication skills, more extensive clinical experience, physicians of middle age, and patient beliefs that they were responsible for their own health, and was negatively associated with a preference for man physicians. Physicians may need to understand that patient autonomy preferences pertain to physician age and gender, physician communication ability and extent of clinical experience, and patient beliefs about self-responsibility toward health, and could use the information to promote reliable patient-physician relationships.

[On bioethics].

PubMed

Wolniewicz, B

2001-01-01

The so-called "bioethics", fashionable today, is mostly sophistry to obscure the fact that human embryos are human beings. This holds already for the human zygote, as it embodies a complete and individualized human "entelechy": a human being in its early stage of life. Therefore experimenting on human embryos resembles closely the dealings of the infamous dr Mengele. Possibly the new biology will force upon mankind deep religious and political divisions never known before.

Patient autonomy in home care: Nurses' relational practices of responsibility.

PubMed

Jacobs, Gaby

2018-01-01

Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers in home care, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. To explore how nurses in home care deal with the transformation towards fostering patient autonomy and self-care. Research design and context: A case study was conducted in a professional development course ('learning circle') for home care nurses, including participant observations and focus groups. The theoretical notion of 'relational agency' and the moral concept of 'practices of responsibility' were used to conduct a narrative analysis on the nurses' stories about autonomy. Eight nurses, two coaches and two university lecturers who participated in the learning circle. Ethical considerations: Informed consent was sought at the start of the course and again, at specific moments during the course of the learning circle. Three main themes were found that expressed the moral demands experienced and negotiated by the nurses: adapting to the person, activating patients' strengths and collaboration with patients and informal caregivers. On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on healthcare budget savings. This is manifested in the ambiguities the nurses face in fostering patient autonomy in their daily home care practice. To support nurses, critical thinking, moral sensitivity and trans-professional working should be part of their professional development. The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together.

An innovative approach to teaching bioethics in management of healthcare.

PubMed

Aleksandrova-Yankulovska, Silviya

2016-03-01

Bioethical courses were introduced in the curricula in medical universities in Bulgaria in 1990s. In the beginning, the courses were mainly theoretical, and systematic case analyses and discussions of movies were introduced later on. The benefits of using films to teach ethics have been previously analyzed in the literature; however, to our knowledge such studies in Bulgaria are yet lacking. The aim of this study was to survey the opinions of students and analyze the results from the application of movies in bioethics teaching in a medical university in the north of Bulgaria. A survey was carried out among 92 students in the management of healthcare. Two movies were used, and separate protocols for film discussion were developed. The study was conducted anonymously and with students' free informed consent. The students distinguished in total 21 different dilemmas and concepts in the first movie. The ethical dilemmas were classified into five groups: general ethical issues, deontological issues, special ethical issues, principles of bioethics, and theories of ethics. The second movie focused students' attention on the issues of death and dying. In total, 18 elements of palliative care were described by the students. The range of different categories was a positive indicator of an increased ethical sensitivity. The students evaluated the movies' discussions as a generally positive educational approach. They perceived the experience as contributing to their better understanding of bioethical issues. The innovative approach was well accepted by the students. The introduction of movies in the courses of bioethics had the potential to provide vivid illustrations of bioethical issues and to contribute to the exploration of specific theses and arguments. The presentation and discussion should be preceded by accumulation of theoretical knowledge. The future of effective bioethics education lays in the interactive involvement of students. © The Author(s) 2014.

All in the family: law, medicine and bioethics.

PubMed

Parker, Malcolm

2008-02-01

In this first Bioethical Issues column the author outlines some of the distinctions and congruities between ethics and law, and between bioethics and medical law. The evidence for connections is obvious and wide-ranging, appearing within health and medical education, the academic literature, statute and case law, professional guidelines and the activities of professional associations, the history of legal practice and philosophical inquiry, and the emergence of human rights theory and applications. The interpenetration of morals and law is examined first by briefly tracing the development of natural law and legal positivism. These links are then developed through a number of examples which are the subjects of both bioethical and legal interest: decision-making capacity, what constitutes good medical practice in the advance care planning context, sex selection, embryo experimentation and posthumous conception. These topics illustrate some of the explicit and some of the less obvious ways in which moral considerations and medical law interact, and suggest that biolaw can involve inconsistencies and even obfuscation which, while difficult to avoid in plural societies, are appropriate areas for examination. In the final section the author argues that bioethics and medical law share some important logical features, including a prescriptivist, principled structure, which is subject to the related requirements of specification and universalisability. Again, medico-legal illustrations are used to support this proposal, which also constitutes a suitable topic for critique. Future columns will provide the opportunity for those who care about the issues of bioethics and medical law to share their thoughts and those of their colleagues.

An intercultural nursing perspective on autonomy.

PubMed

Hanssen, Ingrid

2004-01-01

This article is based on an empirical study regarding ethical challenges in intercultural nursing. The focus is on autonomy and disclosure. Autonomy is a human capacity that has become an important ethical principle in nursing. Although the relationship between autonomy and patients' possibly harmful choices is discussed, the focus is on 'forced' autonomy. Nurses seem to equate respect with autonomy; it seems to be hard to cope with the fact that there are patients who voluntarily undergo treatment but who actively participate neither in the treatment offered nor in making choices regarding that treatment. Nurses' demand for patients to be autonomous may in some cases jeopardize the respect, integrity and human worth that the ethical principle of autonomy is meant to ensure. Even though respect for a person's autonomy is also respect for the person, one's respect for the person in question should not depend on his or her capacity or aptitude to act autonomously. Is autonomy necessarily a universal ethical principle? This article negates this question and, through the issues of culture, individualism versus collectivism, first- and second-order autonomy, communication and the use of family interpreters, and respect, an attempt is made to explain why.

Resident Autonomy in the Operating Room: How Faculty Assess Real-time Entrustability.

PubMed

Chen, Xiaodong Phoenix; Sullivan, Amy M; Smink, Douglas S; Alseidi, Adnan; Bengtson, Joan M; Kwakye, Gifty; Dalrymple, John L

2018-02-20

This study aimed to identify the empirical processes and evidence that expert surgical teachers use to determine whether to take over certain steps or entrust the resident with autonomy to proceed during an operation. Assessing real-time entrustability is inherent in attending surgeons' determinations of residents' intraoperative autonomy in the operating room. To promote residents' autonomy, it is necessary to understand how attending surgeons evaluate residents' performance and support opportunities for independent practice based on the assessment of their entrustability. We conducted qualitative semi-structured interviews with 43 expert surgical teachers from 21 institutions across 4 regions of the United States, using purposeful and snowball sampling. Participants represented a range of program types, program size, and clinical expertise. We applied the Framework Method of content analysis to iteratively analyze interview transcripts and identify emergent themes. We identified a 3-phase process used by most expert surgical teachers in determining whether to take over intraoperatively or entrust the resident to proceed, including 1) monitoring performance and "red flags," 2) assessing entrustability, and 3) granting autonomy. Factors associated with individual surgeons (eg, level of comfort, experience, leadership role) and the context (eg, patient safety, case, and time) influenced expert surgical teachers' determinations of entrustability and residents' final autonomy. Expert surgical teachers' 3-phase process of decisions on take-over provides a potential framework that may help surgeons identify appropriate opportunities to develop residents' progressive autonomy by engaging the resident in the determination of entrustability before deciding to take over.

The Philosophical Basis of Bioethics.

PubMed

Horn, Peter

2015-09-01

In this article, I consider in what sense bioethics is philosophical. Philosophy includes both analysis and synthesis. Analysis focuses on central concepts in a domain, for example, informed consent, death, medical futility, and health. It is argued that analysis should avoid oversimplification. The synthesis or synoptic dimension prompts people to explain how their views have logical assumptions and implications. In addition to the conceptual elements are the evaluative and empirical dimensions. Among its functions, philosophy can be a form of prophylaxis--helping people avoid some commonly accepted questionable theories. Generally, recent philosophy has steered away from algorithms and deductivist approaches to ethical justification. In bioethics, philosophy works in partnership with a range of other disciplines, including pediatrics and neurology. Copyright © 2015 Elsevier Inc. All rights reserved.

77 FR 61608 - Public Meeting of the Presidential Commission for the Study of Bioethical Issues

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-10

[email protected]bioethics.gov . Additional information may be obtained at www.bioethics.gov . SUPPLEMENTARY... also be webcast at www.bioethics.gov . Under authority of Executive Order 13521, dated November 24... access to the webcast, will be available at www.bioethics.gov . The Commission welcomes input from anyone...

Cognitive Enhancement and Beyond: Recommendations from the Bioethics Commission.

PubMed

Allen, Anita L; Strand, Nicolle K

2015-10-01

Media outlets are reporting that cognitive enhancement is reaching epidemic levels, but evidence is lacking and ethical questions remain. The US Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has examined the issue, and we lay out the commission's findings and their relevance for the scientific community. Published by Elsevier Ltd.

Education research: a case-based bioethics curriculum for neurology residents.

PubMed

Tolchin, Benjamin; Willey, Joshua Z; Prager, Kenneth

2015-03-31

In 2012, the American Academy of Neurology (AAN) updated and expanded its ethics curriculum into Practical Ethics in Clinical Neurology, a case-based ethics curriculum for neurologists. We piloted a case-based bioethics curriculum for neurology residents using the framework and topics recommended by the AAN, matched to clinical cases drawn from Columbia's neurologic services. Our primary outcome was residents' ability to analyze and manage ethically complex cases as measured on precurriculum and postcurriculum multiple-choice quizzes. Secondary outcomes included precurriculum and postcurriculum self-assessed comfort in discussing and managing ethically complex cases, as well as attendance at ethics discussion sessions as compared to attendance at other didactic sessions. Resident performance on quizzes improved from 75.8% to 86.7% (p = 0.02). Comfort in discussing ethically complex cases improved from 6.4 to 7.4 on a 10-point scale (p = 0.03). Comfort in managing such cases trended toward improvement but did not reach statistical significance. Attendance was significantly better at ethics discussions (73.5%) than at other didactic sessions (61.7%, p = 0.04). Our formal case-based ethics curriculum for neurology residents, based on core topics drawn from the AAN's published curricula, was successfully piloted. Our study showed a statistically significant improvement in residents' ability to analyze and manage ethically complex cases as measured by multiple-choice tests and self-assessments. © 2015 American Academy of Neurology.

Bioethics: Research, Action and Ethics

ERIC Educational Resources Information Center

Castleman, Nancy

1974-01-01

Alerts science teachers to ethical and social issues as well as research findings associated with recent developments in biomedicine. Also provides a brief list of suggested readings on bioethical issues. (PEB)

What is Christian about Christian bioethics?

PubMed

Waters, Brent

2005-12-01

What is Christian about Christian bioethics? The short answer to this question is that the Incarnation should shape the form and content of Christian bioethics. In explicating this answer it is argued that contemporary medicine is unwittingly embracing and implementing the transhumanist dream of transforming humans into posthumans. Contemporary medicine does not admit that there are any limits in principle to the extent to which it should intervene to improve the quality of human life. This largely inarticulate, yet ambitious, agenda is derived first in late modernity's failed, but nonetheless ongoing, attempt to transform necessity into goodness, and second the loss of any viable concept of eternity, thereby stripping temporal existence of any normative significance. In short, medicine has become the vanguard of a profane attempt to save humankind by extracting data from flesh. In response, it is contended that an alternative Christian bioethics must be shaped by the Incarnation, the Word made flesh. This assertion does not entitle Christians to oppose the posthuman trajectory of contemporary medicine on the basis of any natural or biological essentialism. Rather, it is an evangelical witness to the grace of Christ's redemption instead of the work of self-transformation. It is Christ alone who thereby makes the vulnerability and mortality of finitude a gift and blessing. Specifically, it is maintained that the chasm separating necessity and goodness cannot be filled but only bridged through the suffering entailed in Christ's cross, and through Christ's resurrection eternity becomes the standard against which the temporal lives of human creatures are properly formed and measured. Consequently, Christian bioethics should help us become conformed to Christ rather than enabling self-transformation.

The psychobiology of aggression and violence: bioethical implications.

PubMed

Díaz, José Luis

2010-01-01

Bioethics is concerned with the moral aspects of biology and medicine. The bioethical relevance of aggression and violence is clear, as very different moral and legal responsibilities may apply depending on whether aggression and violence are forms of behaviour that are innate or acquired, deliberate or automatic or not, or understandable and justifiable based on causes. Biological research and natural science theories are a basic ingredient for reflections, arguments and decisions on such matters. This study presents the problem of the causes of aggressive behaviour, the evolutionary understanding and definition of aggressive behaviour, the biological basis for this behaviour and the link between emotions and aggression. A growing body of evidence suggests that innate factors of behaviour (be they genetic or neurobiological) do not by themselves define behaviour and nor do acquired factors such as learning, cultural norms or worldviews. Both types of factor interact from the outset to shape a development process that mutually interacts to define beliefs or behaviour.

Solidarity in contemporary bioethics--towards a new approach.

PubMed

Prainsack, Barbara; Buyx, Alena

2012-09-01

This paper, which is based on an extensive analysis of the literature, gives a brief overview of the main ways in which solidarity has been employed in bioethical writings in the last two decades. As the vagueness of the term has been one of the main targets of critique, we propose a new approach to defining solidarity, identifying it primarily as a practice enacted at the interpersonal, communal, and contractual/legal levels. Our three-tier model of solidarity can also help to explain the way in which crises of solidarity can occur, notably when formal solidaristic arrangements continue to exist despite 'lower tiers' of solidarity practices at inter-personal and communal levels having 'broken away'. We hope that this contribution to the growing debate on the potential for the value of solidarity to help tackle issues in bioethics and beyond, will stimulate further discussion involving both conceptual and empirically informed perspectives. © 2012 Blackwell Publishing Ltd.

Bioethics education for practicing nurses in Taiwan: Confucian-Western clash.

PubMed

Yang, Wan-Ping; Chen, Ching-Huey; Chao, Co-Shi Chantal; Lai, Wei-Shu

2010-07-01

To understand the gaps between current bioethics education and the requirements of practicing nurses, a semistructured questionnaire was used to invite the directors of nursing departments at all 82 teaching hospitals in Taiwan to participate in this survey. The response rate was 64.6%. Through content analysis we obtained information about previous bioethical training, required themes and content, recommended teaching strategies, and difficulties with education and its application. The results suggest that Taiwanese nursing personnel need to be instilled with both self-cultivation of morality and mental cultivation to acquire nursing virtues and the right attitudes toward bioethical issues. Good communication skills to prevent damage to the harmonious relationships between patients, their families and medical team members, policies that support the provision of systematic formal knowledge of ethics, small group training, and clarification of values were also shown to be important in bioethics education.

Social-psychological principles of community-based conservation and conservancy motivation: attaining goals within an autonomy-supportive environment.

PubMed

Decaro, Daniel; Stokes, Michael

2008-12-01

Community-based natural resource conservation programs in developing nations face many implementation challenges underpinned by social-psychological mechanisms. One challenge is garnering local support in an economically and socially sustainable fashion despite economic hardship and historical alienation from local resources. Unfortunately, conservationists' limited understanding of the social-psychological mechanisms underlying participatory conservation impedes the search for appropriate solutions. We address this issue by revealing key underlying social-psychological mechanisms of participatory conservation. Different administrative designs create social atmospheres that differentially affect endorsement of conservation goals. Certain forms of endorsement may be less effective motivators and less economically and socially sustainable than others. From a literature review we found that conservation initiatives endorsed primarily for nonautonomous instrumental reasons, such as to avoid economic fines or to secure economic rewards, are less motivating than those endorsed for autonomous reasons, such as for the opportunity for personal expression and growth. We suggest that successful participatory programs promote autonomous endorsement of conservation through an administrative framework of autonomy support-free and open democratic participation in management, substantive recognition and inclusion of local stakeholder identity, and respectful, noncoercive social interaction. This framework of the autonomy-supportive environment (self-determination theory) has important implications for future research into program design and incentive-based conservation and identifies a testable social-psychological theory of conservancy motivation.

Teaching Bioethics at Historically Black Colleges and Universities (HBCUs).

PubMed

Solberg, Lauren B; Freund Taylor, Carol

2015-05-01

This article describes a two-pronged, pilot bioethics education program implemented at a historically Black college/university to determine the interest in bioethics education and begin increasing the program's visibility. The pilot program included a Train-the-Trainer (TtT) component for selected faculty members and a simultaneously-running film- and-speaker series for the entire campus.

Should Bioethics Be Taught?

ERIC Educational Resources Information Center

Kieffer, George H.

1980-01-01

Examined is the issue concerning teaching bioethics. Differing points of view are discussed. The author concludes that moral and ethical reasoning should be incorporated into the public school curriculum, using morally laden issues that have grown out of advances in biological knowledge and biomedical technology. (CS)

[From environmental ethics to environmental bioethics: antecedents, trajectories, and perspectives].

PubMed

Fischer, Marta Luciane; Cunha, Thiago; Renk, Valquiria; Sganzerla, Anor; Santos, Juliana Zacarkin Dos

2017-01-01

The relationship between humans and the environment became an ethical problem in the twentieth century, when accelerated economic and scientific development was accompanied by profound alterations in global ecological systems. In response, environmental ethics called for limits in the dichotomous relationship between man and nature. In 1970, Van Potter proposed bioethics as the interdisciplinary study of "human survival." Subsequently, the discipline focused on clinical and hospital conflicts. Environmental bioethics is analyzed in this article as a theoretical perspective that has historically drawn on Van Potter's approach to bioethics, marked by the interpersonal, socioeconomic, and political dimensions of environmental ethical dilemmas.

Genetic and attachment influences on adolescents' regulation of autonomy and aggressiveness.

PubMed

Zimmermann, Peter; Mohr, Cornelia; Spangler, Gottfried

2009-11-01

Adolescence is a time when intense emotions are elicited within the parent-adolescent relationship, often when autonomy subjectively is endangered. As emotion dysregulation is one of the risk processes for the development of psychopathology, adolescence may be perceived as a highly sensitive period for maladjustment. Inter-individual differences in emotionality and emotion regulation have been shown to be influenced or moderated by molecular genetic differences in the serotonin transporter gene (5-HTT) and by attachment patterns. We investigated whether both the 5-HTT and attachment are associated with emotionality and emotion regulation in an observed adolescent-mother interaction and the personality traits aggressiveness and anxiety in adolescence. Ninety-one adolescents at age 12 were observed in interaction with their mothers during a standardized emotion-eliciting social task to assess emotionality and emotion regulation in relation to autonomy. Adolescents' aggressiveness and anxiety were assessed by mother report. Concurrent attachment quality was determined by an attachment interview. DNA samples were collected in order to assess the 5-HTTLPR, a repeat polymorphism in the promoter region of the serotonin transporter gene. While the short allele of the serotonin transporter gene was associated with a higher overall rate of autonomy behaviors, attachment security was related to more agreeable and less hostile autonomy. A significant interaction revealed a moderating effect of attachment security. Carriers of the short version of the 5-HTTLPR showed more agreeable autonomy when they had a secure attachment behavior strategy but showed more hostile autonomy when they were insecurely attached. Carriers of the short version of the 5-HTTLPR and insecurely attached adolescents were rated as more aggressive. The study suggests a gene-attachment interaction in adolescents where the adolescent's attachment status moderates a genetically based higher negative

[Media, cloning, and bioethics].

PubMed

Costa, S I; Diniz, D

2000-01-01

This article was based on an analysis of three hundred articles from mainstream Brazilian periodicals over a period of eighteen months, beginning with the announcement of the Dolly case in February 1997. There were two main objectives: to outline the moral constants in the press associated with the possibility of cloning human beings and to identify some of the moral assumptions concerning scientific research with non-human animals that were published carelessly by the media. The authors conclude that there was a haphazard spread of fear concerning the cloning of human beings rather than an ethical debate on the issue, and that there is a serious gap between bioethical reflections and the Brazilian media.

Fostering Autonomy through Syllabus Design: A Step-by-Step Guide for Success

ERIC Educational Resources Information Center

Ramírez Espinosa, Alexánder

2016-01-01

Promoting learner autonomy is relevant in the field of applied linguistics due to the multiple benefits it brings to the process of learning a new language. However, despite the vast array of research on how to foster autonomy in the language classroom, it is difficult to find step-by-step processes to design syllabi and curricula focused on the…

[Bioethical language in the law and jurisprudence about bioethical problems].

PubMed

Corral García, Eduardo

2013-01-01

The impact is analyzed that on the Spanish Law relative to questions bioethics--as the Law on artificial reproduction, the Law of biomedical investigation, and the Law on sexual and reproductive health--can have the conception of human embryo enunciated by the Court of Justice of the European Union in his judgment of October 18, 2011, considering it to be any ovum fertilized with independence of the degree of reached development.

CURRENT PERSPECTIVES OF POTTER'S GLOBAL BIOETHICS AS A BRIDGE BETWEEN CLINICAL (PERSONALIZED) AND PUBLIC HEALTH ETHICS.

PubMed

Turina, Iva Sorta-Bilajac; Brkljacić, Morana; Grgas-Bile, Cecilija; Gajski, Domagoj; Racz, Aleksandar; Cengić, Tomislav

2015-12-01

In the context of modern scientific and technological developments in biomedicine and health care, and the potential consequences of their application on humans and the environment, Potter's global bioethics concept resurfaces. By actualizing Potter's original thoughts on individual bioethical issues, the universality of two of his books, which today represent the backbone of the world bioethical literature, "Bioethics--Bridge to the Future" and "Global Bioethics: Building on the Leopold Legacy", is emphasized. Potter's global bioethics today can legitimately be viewed as a bridge between clinical personalized ethics on the one hand and ethics of public health on the other.

Theological discourse and the postmodern condition: the case of bioethics.

PubMed

Dell'Oro, Roberto

2002-01-01

Bioethics reflects--like many other disciplines--the cultural fragmentation and the complexity of what has come to be known as the postmodern condition. The case of bioethics is particularly acute because of its epistemological indeterminacy and the moral pluralism characterizing postliberal societies. A provisional solution to this situation is the retrieval of a neo-Kantian version of ethical formalism in which concern for a consensus on rules replaces universal dialogue on moral content. The article analyzes the possible consequences of this solution with reference to theological ethics. In particular, the reduction of ethical rationality to a function of political regulation on the one hand, and the implicit legitimization of ethical relativism on the other, push any theological contribution to bioethics to the margins. The central methodological issue for the articulation of theological discourse in bioethics is how to avoid the pitfall of privatism while creating the conditions for ethical dialogue across different traditions.

A theory of international bioethics: multiculturalism, postmodernism, and the bankruptcy of fundamentalism.

PubMed

Baker, Robert

1998-09-01

The first of two articles analyzing the justifiability of international bioethical codes and of cross-cultural moral judgments reviews "moral fundamentalism," the theory that cross-cultural moral judgments and international bioethical codes are justified by certain "basic" or "fundamental" moral priniciples that are universally accepted in all cultures and eras. Initially propounded by the judges at the 1947 Nuremberg Tribunal, moral fundamentalism has become the received justification of international bioethics, and of cross-temporal and cross-cultural moral judgments. Yet today we are said to live in a multicultural and postmodern world. This article assesses the challenges that multiculturalism and postmodernism pose to fundamentalism and concludes that these challenges render the position philosophically untenable, thereby undermining the received conception of the foundations of international bioethics. The second article, which follows, offers an alternative model -- a model of negotiated moral order -- as a viable justification for international bioethics and for transcultural and transtemporal moral judgments.

Bioethics and anti-bioethics in light of Nazi medicine: what must we remember?

PubMed

Wikler, D; Barondess, J

1993-03-01

Only recently have historians explored in depth the role of the medical profession in Nazi Germany. Several recent works reveal that physicians joined the Nazi party in disproportionate numbers and lent both their efforts and their authority to Nazi eugenic and racist programs. While the crimes of the physician Mengele and a few others are well known, recent research points to a much broader involvement by the profession, even in its everyday clinical work. Analogous activities existed in the German legal and industrial communities; disruption of the medical ethic thus sprang from the broader social contexts of Nazi Germany. The new United States Holocaust Memorial Museum, now opening on the Mall in Washington, D.C., will have an opportunity to educate the public about both the great crimes at Auschwitz and other camps, and the gradual but thorough degradation of ethics in the German medical profession. From this presentation, contemporary bioethics can ponder the proper use of the Nazi analogy in bioethical debate.

Do Some People Need Autonomy More Than Others? Implicit Dispositions Toward Autonomy Moderate the Effects of Felt Autonomy on Well-Being.

PubMed

Schüler, Julia; Sheldon, Kennon M; Prentice, Mike; Halusic, Marc

2016-02-01

The present studies examined whether implicit or explicit autonomy dispositions moderate the relationship between felt autonomy and well-being. Study 1 (N = 187 undergraduate students) presents an initial test of the moderator hypothesis by predicting flow experience from the interaction of autonomy need satisfaction and autonomy dispositions. Study 2 (N = 127 physically inactive persons) used vignettes involving an autonomy (un)supportive coach to test a moderated mediation model in which perceived coach autonomy support leads to well-being through basic need satisfaction. Again, the effects of need satisfaction on well-being were hypothesized to be moderated by an implicit autonomy disposition. Study 1 showed that individuals with a strong implicit autonomy (but not power or achievement) motive disposition derived more flow experience from felt autonomy than individuals with a weak implicit autonomy disposition. Study 2 revealed that perceived autonomy support from sports coaches, which we experimentally induced with a vignette method, leads to autonomy satisfaction, leading in turn to positive effects on well-being. This indirect effect held at high and average but not low implicit autonomy disposition. The results indicate that the degree to which people benefit from autonomy need satisfaction depends on their implicit disposition toward autonomy. © 2014 Wiley Periodicals, Inc.

Compilation of a casebook on bioethics and the Holocaust as a platform for bioethics education.

PubMed

Chelouche, Tessa

2013-03-01

The Holocaust arose, in part, because of a profound and pervasive breakdown of medical professional ethics. This history is complex and powerfully instructive. The value judgments and moral actions of the Nazi doctors can inform current debate and practices and also prevent the use of inaccurate analogies in current bioethical debates. Under the auspices of the International Center for Health, Law and Ethics at Haifa University, we are in the process of publishing a casebook on bioethical topics, using personal cases from the Third Reich and the Holocaust. The casebook will provide a platform for deep reflection and discourse on historical ethical issues and their relevance for today. This teaching tool can also inspire healthcare professionals and students to practice with greater compassion, knowledge, tolerance, respect and justice on behalf of their patients.

Autonomy, Paternalism, and Justice: Ethical Priorities in Public Health

PubMed Central

Buchanan, David R.

2008-01-01

With attention to the field of public health ethics growing, significant time has been devoted to identifying a sound ethical justification for paternalistic interventions that override individual autonomy to prevent people from adopting unhealthy behaviors. Efforts focused on specifying the conditions that warrant paternalism, however, are largely misplaced. On empirical and ethical grounds, public health should seek instead to expand individual autonomy to improve population health. To promote autonomy, the field should redirect current efforts toward clarifying principles of justice. Although public health’s most highly visible stance is associated with an egalitarian conception of “social justice,” it is imperative that public health professionals address gaping divisions in public understandings of justice. I present recommendations for initiating this process. PMID:18048780

Translational research-the need of a new bioethics approach.

PubMed

Hostiuc, Sorin; Moldoveanu, Alin; Dascălu, Maria-Iuliana; Unnthorsson, Runar; Jóhannesson, Ómar I; Marcus, Ioan

2016-01-15

Translational research tries to apply findings from basic science to enhance human health and well-being. Many phases of the translational research may include non-medical tasks (information technology, engineering, nanotechnology, biochemistry, animal research, economy, sociology, psychology, politics, and so on). Using common bioethics principles to these areas might sometimes be not feasible, or even impossible. However, the whole process must respect some fundamental, moral principles. The purpose of this paper is to argument the need for a different approach to the morality in translational bioethics, and to suggest some directions that might be followed when constructing such a bioethics. We will show that a new approach is needed and present a few ethical issues that are specific to the translational research.

Educating for Well-Being and Autonomy

ERIC Educational Resources Information Center

Cuypers, Stefaan E.; Haji, Ishtiyaque

2008-01-01

Liberals champion the view that promoting autonomy--seeing to it that our children develop into individuals who are self-governing in the conduct of their lives--is a vital aim of education, though one generally accredited as being subsidiary to well-being. Our prime goal in this article is to provide a partial validation of this liberal ideal…

Interdisciplinary debate in the teaching-learning process on bioethics: academic health experiences.

PubMed

Campos Daniel, Jéssica; Dias Reis Pessalacia, Juliana; Leite de Andrade, Ana Flávia

2016-06-01

The study aimed to understand the health of student experiences to participate in interdisciplinary discussions in bioethics and know the contributions of interdisciplinary methodological resource for the teaching-learning process at graduation. Descriptive study of qualitative approach in a public higher education institution of Divinópolis, Minas Gerais, Brazil. Three categories of analysis were identified: ''active methodologies in the training of a professional critic,'' ''interdisciplinary debate as facilitator reflection of bioethics'' and ''feelings and attitudes caused by the interdisciplinary debate.'' Discussion. There was a lack of approach of bioethical contents in the health curriculum, and the adoption of active methodologies provides a better reflection in bioethics, but that requires changing paradigms of teachers and educational institutions.

Capturing Requirements for Autonomous Spacecraft with Autonomy Requirements Engineering

NASA Astrophysics Data System (ADS)

Vassev, Emil; Hinchey, Mike

2014-08-01

The Autonomy Requirements Engineering (ARE) approach has been developed by Lero - the Irish Software Engineering Research Center within the mandate of a joint project with ESA, the European Space Agency. The approach is intended to help engineers develop missions for unmanned exploration, often with limited or no human control. Such robotics space missions rely on the most recent advances in automation and robotic technologies where autonomy and autonomic computing principles drive the design and implementation of unmanned spacecraft [1]. To tackle the integration and promotion of autonomy in software-intensive systems, ARE combines generic autonomy requirements (GAR) with goal-oriented requirements engineering (GORE). Using this approach, software engineers can determine what autonomic features to develop for a particular system (e.g., a space mission) as well as what artifacts that process might generate (e.g., goals models, requirements specification, etc.). The inputs required by this approach are the mission goals and the domain-specific GAR reflecting specifics of the mission class (e.g., interplanetary missions).

Eli Lilly and Company's bioethics framework for human biomedical research.

PubMed

Van Campen, Luann E; Therasse, Donald G; Klopfenstein, Mitchell; Levine, Robert J

2015-11-01

Current ethics and good clinical practice guidelines address various aspects of pharmaceutical research and development, but do not comprehensively address the bioethical responsibilities of sponsors. To fill this void, in 2010 Eli Lilly and Company developed and implemented a Bioethics Framework for Human Biomedical Research to guide ethical decisions. (See our companion article that describes how the framework was developed and implemented and provides a critique of its usefulness and limitations.) This paper presents the actual framework that serves as a company resource for employee education and bioethics deliberations. The framework consists of four basic ethical principles and 13 essential elements for ethical human biomedical research and resides within the context of our company's mission, vision and values. For each component of the framework, we provide a high-level overview followed by a detailed description with cross-references to relevant well regarded guidance documents. The principles and guidance described should be familiar to those acquainted with research ethics. Therefore the novelty of the framework lies not in the foundational concepts presented as much as the attempt to specify and compile a sponsor's bioethical responsibilities to multiple stakeholders into one resource. When such a framework is employed, it can serve as a bioethical foundation to inform decisions and actions throughout clinical planning, trial design, study implementation and closeout, as well as to inform company positions on bioethical issues. The framework is, therefore, a useful tool for translating ethical aspirations into action - to help ensure pharmaceutical human biomedical research is conducted in a manner that aligns with consensus ethics principles, as well as a sponsor's core values.

The Aims of Sex Education: Demoting Autonomy and Promoting Mutuality

ERIC Educational Resources Information Center

McAvoy, Paula

2013-01-01

In this essay, Paula McAvoy critiques a commonly held view that teaching young people to be good choice makers should be a central aim of sex education. Specifically, she argues against David Archard's recommendation that sex educators ought to focus on the development of autonomy and teaching young people that "choice should be accorded…

The value and pitfalls of speculation about science and technology in bioethics: the case of cognitive enhancement.

PubMed

Racine, Eric; Martin Rubio, Tristana; Chandler, Jennifer; Forlini, Cynthia; Lucke, Jayne

2014-08-01

In the debate on the ethics of the non-medical use of pharmaceuticals for cognitive performance enhancement in healthy individuals there is a clear division between those who view "cognitive enhancement" as ethically unproblematic and those who see such practices as fraught with ethical problems. Yet another, more subtle issue, relates to the relevance and quality of the contribution of scholarly bioethics to this debate. More specifically, how have various forms of speculation, anticipatory ethics, and methods to predict scientific trends and societal responses augmented or diminished this contribution? In this paper, we use the discussion of the ethics of cognitive enhancement to explore the positive and negative contribution of speculation in bioethics scholarship. First, we review and discuss how speculation has relied on different sets of assumptions regarding the non-medical use of stimulants, namely: (1) terminology and framing; (2) scientific aspects such as efficacy and safety; (3) estimates of prevalence and consequent normalization; and (4) the need for normative reflection and regulatory guidelines. Second, three methodological guideposts are proposed to alleviate some of the pitfalls of speculation: (1) acknowledge assumptions more explicitly and identify the value attributed to assumptions; (2) validate assumptions with interdisciplinary literature; and (3) adopt a broad perspective to promote more comprehensive reflection. We conclude that, through the examination of the controversy about cognitive enhancement, we can employ these methodological guideposts to enhance the value of contributions from bioethics and minimize potential epistemic and practical pitfalls in this case and perhaps in other areas of bioethical debate.

Maternal Household Decision-Making Autonomy and Adolescent Education in Honduras.

PubMed

Hendrick, C Emily; Marteleto, Leticia

2017-06-01

Maternal decision-making autonomy has been linked to positive outcomes for children's health and well-being early in life in low- and middle-income countries throughout the world. However, there is a dearth of research examining if and how maternal autonomy continues to influence children's outcomes into adolescence and whether it impacts other domains of children's lives beyond health, such as their education. The goal of this study was to determine whether high maternal decision-making was associated with school enrollment for secondary school-aged youth in Honduras. Further, we aimed to assess whether the relationships between maternal autonomy and school enrollment varied by adolescents' environmental contexts and individual characteristics such as gender. Our analytical sample included 6,579 adolescents ages 12-16 living with their mothers from the Honduran Demographic and Health Survey (DHS) 2011-12. We used stepwise logistic regression models to investigate the association between maternal household decision-making autonomy and adolescents' school enrollment. Our findings suggest that adolescents, especially girls, benefit from their mothers' high decision-making autonomy. Findings suggest that maternal decision-making autonomy promotes adolescents' school enrollment above and beyond other maternal, household, and regional influences.

Maternal Household Decision-Making Autonomy and Adolescent Education in Honduras

PubMed Central

Hendrick, C. Emily; Marteleto, Leticia

2017-01-01

Maternal decision-making autonomy has been linked to positive outcomes for children’s health and well-being early in life in low- and middle-income countries throughout the world. However, there is a dearth of research examining if and how maternal autonomy continues to influence children’s outcomes into adolescence and whether it impacts other domains of children’s lives beyond health, such as their education. The goal of this study was to determine whether high maternal decision-making was associated with school enrollment for secondary school-aged youth in Honduras. Further, we aimed to assess whether the relationships between maternal autonomy and school enrollment varied by adolescents’ environmental contexts and individual characteristics such as gender. Our analytical sample included 6,579 adolescents ages 12–16 living with their mothers from the Honduran Demographic and Health Survey (DHS) 2011–12. We used stepwise logistic regression models to investigate the association between maternal household decision-making autonomy and adolescents’ school enrollment. Our findings suggest that adolescents, especially girls, benefit from their mothers’ high decision-making autonomy. Findings suggest that maternal decision-making autonomy promotes adolescents’ school enrollment above and beyond other maternal, household, and regional influences. PMID:29075048

Autonomy and Religious Education: Lessons from a Six-Year Evaluation of an Educational Reform in an Israeli School Network

ERIC Educational Resources Information Center

Paul-Binyamin, Ilana; Gindi, Shahar

2017-01-01

This study investigated the tension that exists between promoting an educational agenda and practising an educational approach which emphasises autonomy within the framework of religious education. Our main thesis is that every educational deed contains a dialectical tension between endorsing an educational agenda and the promotion of autonomy.…

[Bioethics and the French speaking world: an answer to globalization].

PubMed

Byk, Christian

2009-01-01

Are we able, today, to take a step closer to bringing together the French speaking world and bioethics by realizing that their association could provide a profound view of the current evolution of our world characterized by what is referred to as globalization? Could we be even more ambitious and register the specificity of the rapport between the French speaking world and bioethics confronted with this global phenomenon of deconstruction/reconstruction of the planetary order by setting as its path a dynamic balance, which is an integral part of the use of the French language and cultural diversity, a central point in a truly pluridisciplinary and pluralist bioethics?

Bioethics in Denmark. Moving from first- to second-order analysis?

PubMed

Nielsen, Morten Ebbe Juul; Andersen, Martin Marchman

2014-07-01

This article examines two current debates in Denmark--assisted suicide and the prioritization of health resources--and proposes that such controversial bioethical issues call for distinct philosophical analyses: first-order examinations, or an applied philosophy approach, and second-order examinations, what might be called a political philosophical approach. The authors argue that although first-order examination plays an important role in teasing out different moral points of view, in contemporary democratic societies, few, if any, bioethical questions can be resolved satisfactorily by means of first-order analyses alone, and that bioethics needs to engage more closely with second-order enquiries and the question of legitimacy in general.

The IAB Congress 2016: Is there justice in the bioethics world?

PubMed

Gopichandran, Vijayaprasad

2017-01-01

This comment contains the reflections of a first-time participant in the 13th International Association of Bioethics Congress (IAB 2016), held from June 14 to 17, 2016, in Edinburgh. At the outset, I would like to make a couple of clarifications. First, the opinions expressed here are my personal reflections and second, I am a physician and public health practitioner by profession and my interest is bioethics. I reflect on the justice implications of the IAB 2016 from the perspective of the challenge of maintaining inclusivity in a multidisciplinary bioethics world.

Restoring trust through bioethics education?

PubMed

Salerno, Judith A

2008-06-01

Ethically conducted research involving human participants is a cornerstone of the academic medical research establishment. However, there is public mistrust of clinical research and, as a result, low participation rates in research studies among minorities and in communities where health disparities are glaring. Specific initiatives have been undertaken by the National Institutes of Health (NIH) to restore public confidence in biomedical research and to ensure that research is conducted ethically and responsibly. The T15 program, instituted in 1997, made awards beginning in 1998 to institutions for up to three years to develop, conduct, and evaluate short-term courses on ethical issues in research. A companion solicitation (K01 program) targeted the career development of independent investigators in applied research ethics through mentored scientist development awards in research ethics. Both programs emphasized ethical research involving human participants and outreach to minority scientists. The author asks how the success of these programs should be gauged, especially in light of new--and often unforeseen--ethical challenges that are likely to confront the research community. Participation in some T15 programs indicates that few researchers and practitioners perceived the need to increase their proficiency in analyzing the ethical dimensions of their work. To improve participation and, ultimately, ethical approaches to human participants research, the NIH should foster appreciation for the centrality of bioethics in the biomedical research enterprise. The author calls on the NIH to provide leadership for bioethics by further developing a national agenda for bioethics training and research.

Autonomy-supportive, Web-based lifestyle modification for cardiometabolic risk in postmenopausal women: Randomized trial.

PubMed

Kim, Hye-Ryoung; Kim, Hee-Seung

2017-12-01

The management of cardiometabolic risk factors, such as abdominal obesity, dyslipidemia, hypertension, and hyperglycemia, is essential for the health of postmenopausal women. In this study, we identified the effects of autonomy-supportive, Web-based lifestyle modification for the management cardiometabolic risk of postmenopausal women, and assessed the mediation effect of intrinsic motivation. This study was a randomized trial involving 71 postmenopausal Korean women. For the intervention group, we provided the Web-based autonomy supports for 12 weeks; however, for the control group, individual consultations on healthy lifestyle was conducted at the first meeting. In the intervention group, cardiometabolic risks ameliorated as follows: waist circumference and waist-to-height ratio decreased by 3.9 cm and 0.03 cm, respectively; triglycerides decreased by 8.5 mg/dl; triglycerides-to-high-density-lipoprotein cholesterol ratio decreased by 0.21; systolic blood pressure decreased by 3.3 mmHg, and the visceral adiposity index decreased. Among the subdomain of intrinsic motivation, perceived competence, effort/importance, and perceived choice showed an association with waist circumference changes. Web-based autonomy supports can be effective in implementation and maintenance, and the amelioration of cardiometabolic risk in postmenopausal women. © 2017 John Wiley & Sons Australia, Ltd.

Religion, bioethics and nursing practice.

PubMed

Fowler, Marsha D

2009-07-01

This article calls nursing to engage in the study of religions and identifies six considerations that arise in religious studies and the ways in which religious faith is expressed. It argues that whole-person care cannot be realized, neither can there be a complete understanding of bioethics theory and decision making, without a rigorous understanding of religious-ethical systems. Because religious traditions differ in their cosmology, ontology, epistemology, aesthetic, and ethical methods, and because religious subtraditions interact with specific cultures, each religion and subtradition has something distinctive to offer to ethical discourse. A brief example is drawn from Native American religions, specifically their view of ;speech' and ;words'. Although the example is particular to an American context, it is intended to demonstrate a more general principle that an understanding of religion per se can yield new insights for bioethics.

Abstracting event-based control models for high autonomy systems

NASA Technical Reports Server (NTRS)

Luh, Cheng-Jye; Zeigler, Bernard P.

1993-01-01

A high autonomy system needs many models on which to base control, management, design, and other interventions. These models differ in level of abstraction and in formalism. Concepts and tools are needed to organize the models into a coherent whole. The paper deals with the abstraction processes for systematic derivation of related models for use in event-based control. The multifaceted modeling methodology is briefly reviewed. The morphism concepts needed for application to model abstraction are described. A theory for supporting the construction of DEVS models needed for event-based control is then presented. An implemented morphism on the basis of this theory is also described.

Iranian EFL Teachers' Practices and Learner Autonomy: Do Gender, Educational Degree, and Experience Matter?

ERIC Educational Resources Information Center

Nasri, Najmeh; Vahid Dastjerdy, Hossein; Eslami Rasekh, Abbass; Amirian, Zahra

2017-01-01

Owing to the importance of learner autonomy (LA) and considering the prominent role of teachers in this respect, the present study investigated: (1) Iranian English as a foreign language teachers' practices for promoting high school students' autonomy, (2) possible differences among teachers' practices with different educational degrees, levels of…

Volitional Trust, Autonomy Satisfaction, and Engagement at Work.

PubMed

Heyns, Marita; Rothmann, Sebastiaan

2018-02-01

This study tested a structural model that identifies the nature of relationships between trust, autonomy satisfaction, and personal engagement at work. A cross-sectional survey design with a convenience sample ( n = 252) was used. The Behavioral Trust Inventory, Work-Related Basic Need Satisfaction Scale, and Work Engagement Scale were administered. While reliance-based trust did not have a significant influence on engagement, disclosure-based trust in a focal leader was found to predict satisfaction of autonomy needs and employee engagement. Mediation analyses revealed that satisfaction of the need for autonomy facilitates the influence of trust on work outcomes. More specifically, disclosure (a dimension of trust) impacted engagement via autonomy satisfaction. Overall, the model explained 44% of total variance in engagement, to which the variables proportionately contributed as follows: autonomy satisfaction = 79.58%, disclosure = 18.22%, and reliance = 2.20%. The findings provide possible directions for how leaders can leverage trust to facilitate autonomy support and higher levels of engagement.

In defence of academic freedom: bioethics journals under siege.

PubMed

Schüklenk, Udo

2013-05-01

This article analyses, from a bioethics journal editor's perspective, the threats to academic freedom and freedom of expression that academic bioethicists and academic bioethics journals are subjected to by political activists applying pressure from outside of the academy. I defend bioethicists' academic freedom to reach and defend conclusions many find offensive and 'wrong'. However, I also support the view that academics arguing controversial matters such as, for instance, the moral legitimacy of infanticide should take clear responsibility for the views they defend and should not try to hide behind analytical philosophers' rationales such as wanting to test an argument for the sake of testing an argument. This article proposes that bioethics journals establish higher-quality requirements and more stringent mechanisms of peer review than usual for iconoclastic articles.

Ethics of surrogacy: a comparative study of Western secular and islamic bioethics.

PubMed

Islam, Sharmin; Nordin, Rusli Bin; Bin Shamsuddin, Ab Rani; Mohd Nor, Hanapi Bin; Al-Mahmood, Abu Kholdun

2012-01-01

The comparative approach regarding the ethics of surrogacy from the Western secular and Islamic bioethical view reveals both commensurable and incommensurable relationship. Both are eager to achieve the welfare of the mother, child and society as a whole but the approaches are not always the same. Islamic bioethics is straightforward in prohibiting surrogacy by highlighting the lineage problem and also other social chaos and anarchy. Western secular bioethics is relative and mostly follows a utilitarian approach.

Ethics of Surrogacy: A Comparative Study of Western Secular and Islamic Bioethics

PubMed Central

Islam, Sharmin; Nordin, Rusli Bin; Bin Shamsuddin, Ab Rani; Mohd Nor, Hanapi Bin; Al-Mahmood, Abu Kholdun

2012-01-01

The comparative approach regarding the ethics of surrogacy from the Western secular and Islamic bioethical view reveals both commensurable and incommensurable relationship. Both are eager to achieve the welfare of the mother, child and society as a whole but the approaches are not always the same. Islamic bioethics is straightforward in prohibiting surrogacy by highlighting the lineage problem and also other social chaos and anarchy. Western secular bioethics is relative and mostly follows a utilitarian approach. PMID:23864994

When Opportunity Knocks Twice: Dual Living Kidney Donation, Autonomy and the Public Interest.

PubMed