American Bioethics Research Articles

Bioethics-CSR Divide

Bioethics-CSR Divide

Fostering Medical Students’ Commitment to Beneficence in Ethics Education

Fostering Medical Students’ Commitment to Beneficence in Ethics Education

Recalibrating Bioethics for the Reality of Interdependence: The Challenge of Collective-Impact Problems.

Bioethics in the twenty-first century is confronting what one might call "collective-impact problems." The ethics guidance and policies that are developed to address these kinds of problems will affect not only individuals but everyone living and future generations too. With many collective-impact problems, all parties will eventually be worse off if there is a failure to develop solutions to head off damage to the shared environment. However, the effects are not felt equally throughout and across societies; some groups are hit far worse. To address collective-impact problems, bioethics needs to recalibrate. Our field, and especially American bioethics, should find a better balance between individual rights and the best interests of the group, develop more robust tools for examining structural inequities that damage people's health and well-being, and study how to engage the public in learning about and shaping ethics guidance for these complex problems.

The Invisibility of the Asian American Identity in North American Bioethics

This Perspective sheds light on the major barriers behind Asian American invisibility in bioethics, such as the inconsistencies in defining a coherent identity in North American society, the systemic mechanisms of invisibility from history to healthcare based on immigration status, and scarcity of bioethics literature about their perspectives. The consequences of Asian American invisibility in bioethics and healthcare practises are also discussed, including a reflection of the interconnected mechanisms between academic bioethical theory and healthcare practises that perpetuate Asian American invisibility. Finally, recommendations are provided to begin a critical reflection of bioethical theory with Asian Americans in mind. This serves as the stepping-stone for future discussions on Asian American bioethics, to highlight a missing perspective in North American race-based activism regarding the equity, diversity, and inclusion of an underrepresented demographic.

A Critique of Principlism

A Critique of Principlism

Complexity and transdisciplinary in medical curricula committed to Latin American bioethics

Resumen Este ensayo muestra, basándose en la bioética, la transformación del currículo de medicina en Brasil del modelo multidisciplinar al modelo inter- o transdisciplinar. Desde una revisión narrativa se discute la teoría de la complejidad y la transdisciplinariedad bajo una analogía de cómo las bioéticas latinoamericanas utilizan esa teoría para comprender la realidad, sentando bases conceptuales para un currículo de medicina que supere una formación fragmentaria. Para las bioéticas del sur global, el pensamiento complejo y la transdisciplinariedad son claves para comprender una realidad no reduccionista, abierta a la construcción de saberes que no se restringen a la explicación biomédica de mundo. Asimismo, para una formación médica con visión amplia de la salud y que valora los determinantes sociales y subjetivos del proceso salud-enfermedad, el currículo debe propiciar la reconexión de saberes. La introducción del pensamiento complejo en el currículo de medicina puede fomentar una enseñanza no reduccionista.

Complexidade e transdisciplinaridade no currículo médico comprometido com bioéticas latino-americanas

Abstract Adopting bioethics as the framework, this essay discusses the transformation of medical curricula in Brazil from a multidisciplinary model to an inter- or transciplinary one. The narrative review method is used to discuss the theory of complexity and transdiciplinarity, establishing an analogous understanding between how Latin American bioethics views use this theory to understand reality, creating conceptual framework of a medical curricula that goes beyond fragmentation in training. Complex thought and transdiciplinarity are fundamental for the bioethics views of the global south to understand a non-reductionist reality, one that is open to constructing knowledge that is not isolated in a biomedical understanding of the world. Likewise, to train physicians with a broader view of health and who value the social and subjective determinant aspects in the health-disease process, the curriculum must provide a rekindling of pieces of knowledge. The introduction of complex though in medical curricula can stimulate non-reductionist teaching.

Complexity and transdisciplinary in medical curricula committed to Latin American bioethics

Resumo Este ensaio aborda, à luz da bioética, a transformação do currículo médico no Brasil de um modelo multidisciplinar para um inter ou transdisciplinar. Em revisão narrativa, discutem-se a teoria da complexidade e a transdisciplinaridade, estabelecendo analogia entre a maneira como bioéticas latino-americanas usufruem dessa teoria para a compreensão da realidade, formulando bases conceituais de um currículo médico que supere a fragmentação na formação. Para as bioéticas do sul global, o pensamento complexo e a transdisciplinaridade são fundamentais para compreender uma realidade não reducionista, aberta à construção de conhecimentos que não se isolem na explicação biomédica do mundo. De maneira semelhante, para a formação de médicos com visão de saúde ampliada, que valorizem os determinantes sociais e subjetivos do processo saúde-doença, o currículo deve proporcionar a religação dos saberes. A introdução do pensamento complexo no currículo médico pode estimular o ensino não reducionista.

Health Equity, History, and a New Presidential Bioethics Commission: Lessons from the "Lost" Reports.

Convening a national bioethics commission has historically been one of the most powerful bioethical legacies a US presidential administration can undertake. The Biden Administration has not yet created such a commission; here we argue that centering health equity and healthcare access would provide a vital framework for a new commission’s legacy. Moreover, we demonstrate two crucial historical episodes when American presidents appointed commissions to examine the practical and ethical implications of these very issues. We turn first to the 1952 President’s Commission report on “Building America’s Health,” a lofty vision of universal healthcare access stymied by both political conflict and unaddressed problems of racism in the era’s legislation. Its rich yet incomplete account of American health inequities serves as a valuable forerunner to questions of justice in bioethics. We then explore the President’s Commission’s 1983 report “Securing Access to Healthcare: A Report on the Ethical Implications of Differences in the Availability of Health Services.” This report took up the mantle of equity in healthcare access, again with mixed results. Only by understanding the checkered history of these overlooked, practically “lost” reports can a new era in American bioethics successfully re-center the goal of equitable health for all.

Shared Principles? German Responses to American Bioethics Since the 1970s

Since its inception in the late 1960s and early 1970s, the academic discipline of bioethics has profoundly shaped the professional and public assessments of biomedicine. A universalistic approach preferred by American bioethicists and challenges posed by modern biomedicine created a transatlantic moment for ethical theories and practices. This article will discuss the transfer of bioethical knowledge from the United States to (West) Germany and highlight its immediate reception, its slow adaptation, and its belated implementation at universities, in society, and in the medical profession. Examples from academia, policy and law will provide a narrative focus for explaining the peculiar relationship between institutional ambitions, universalistic theoretical claims, and local professional routines and adjustments. In particular, the article contrasts a general openness towards ethical concepts and practices with the comparably reluctance in adopting American bioethics as it was perceived in Germany, which effectively delayed the implementation of ethics in German medicine for decades. The German responses to American bioethics provide a topical example for boundary work on an international level.

Theological Bioethics and Public Health from the Margins

This essay examines the development of a liberation bioethics in Latin America with its focus on public health equity from the experience and knowledge of those who are at the margins, the poor and historically oppressed groups. An encounter between bioethics and liberation theology contributed to form a Latin American bioethics marked by a double aspect: bioethical scholarly focus on public health equity and social activism for universal healthcare coverage. Liberation theology has a role in this bioethics oriented to public health, and Pope Francis offers a new contribution for this perspective at the same time that he brings it to a global discussion. Considering the exchange between liberation theology and bioethics and Francis’s insights, this essay offers a new perspective grounded in the Brazilian experiment and the Catholic social tradition to dialogue with US bioethical accounts by challenging the Western epistemological framework of bioethical studies in the Global North.

Patient privacy and autonomy: a comparative analysis of cases of ethical dilemmas in China and the United States

BackgroundRespect for patients’ autonomy is usually considered to be an important ethical principle in Western countries; privacy is one of the implications of such respect. Healthcare professionals frequently encounter ethical dilemmas during their practice. The past few decades have seen an increased use of courts to resolve intractable ethical dilemmas across both the developed and the developing world. However, Chinese and American bioethics differ largely due to the influence of Chinese Confucianism and Western religions, respectively, and there is a dearth of comparative studies that explore cases of ethical dilemmas between China and the United States.MethodsThis paper discusses four typical cases with significant social impact. First, it compares two cases concerning patient privacy: the “Shihezi University Hospital Case”, in which a patient was used as a clinical teaching object without her permission, and the “New York-Presbyterian Hospital Case”, in which the hospital allowed the filming of a patient’s treatment without his consent. Second, it compares two cases regarding patient autonomy and potentially life-saving medical procedures: the “Case of Ms. L”, concerning a cohabitant’s refusal to sign a consent form for a pregnant woman’s caesarean, and the “Case of Mrs. V”, concerning a hospital’s insistence upon a blood transfusion for a dissenting patient. This paper introduces the supporting and opposing views for each case and discusses their social impact. It then compares and analyses the differences between China and the United States from cultural and legislative perspectives.ConclusionsEthical dilemmas have often occurred in China due to the late development of bioethics. However, the presence of bioethics earlier in the US than in China has not spared the US of ethical dilemmas. This paper highlights lessons and inspiration from the cases for healthcare professionals and introduces readers to the role and weight of privacy and autonomy in China and in the US from the perspectives of different cultures, religions and laws.

Are we witnessing the swan song of neoliberalism?

Dr José Ramón Acosta-Sariego is full professor of basic and preclinical scienc-es at the Medical University of Havana's Victoria de Girón Institute, where he also chairs the Scientifi c Research Ethics Committee. He serves as vice-chair of the Board of Directors of UNESCO's Latin American and Caribbean Bioethics Net-work (REDBioética) and in 2020, UNES-CO's Director-General appointed him to its 36-member International Bioethics Committee. Dr Acosta-Sariego has been academic coordinator for the bioethics master's degree program at the Univer-sity of Havana since its inception in 2006, is president of the Neuroethics Chapter of the Cuban Neurosciences Society and is a member of the Cuban National Bioeth-ics Committee.

“The edge of harm and help”: ethical considerations in the care of transgender youth with complex family situations

Health-care providers frequently face clinical ethical dilemmas when working with transgender youth who require hormone therapy but lack parental support for this intervention. Through semi-structured interviews and grounded theory analysis, we explored ethical and clinical decision-making processes of health-care providers, as well as the health care experiences of trans youth with family discordance. We analyzed responses in relation to North American bioethics principles, best interests standard, and the harm principle, exploring issues of autonomy, evidence, and anti-trans bias. We propose an ethically acceptable clinical approach termed parallel process hormone therapy initiation to address the needs of transgender youth with complex family situations.

Building a Concept of Health -Focusing on the Debate between Christopher Boorse and Lennart Nordenfelt over Health-

‘Health’ has been mainly defined as ‘absence of disease’, even though it implies that one’s life is in a good state when one’s physical and mental status is sound. However, in order to view health in more comprehensive perspectives, including the issues of distribution of sources or quality of life, then there have been debates between the narrow definition of health as ‘absence of disease’ and a broader definition of it as ‘the base of quality of life’ in the Western world. These debates are significant in medicine for the scope of health and treatment as well as healthcare policies. Moreover, with the reality that better quality of life is highly expected and the importance of policies to realize it is being empathized, it is necessary to understand health more elaborately. Accordingly, this article aims to suggest an exquisite understanding of health through debates over the core concept of health. Therefore, after reviewing the naturalistic concept of health as ‘absence of disease’ by American bioethics theorist Christopher Boorse, and the normativist concept of health affecting human life significantly by Swedish philosopher Lennart Nordefelt, a layered concept of health that synthesizes both theories will be possible.

Uma visão holística das práticas em saúde mental amparadas na bioética latino-americana

Estes apontamentos têm por escopo investigar as práticas em saúde mental na perspectiva da bioética latino-americana que desponta como a visão mais adequada do contexto e das profundas diferenças do Sul em relação ao mundo, e a partir de uma visão holística. Buscou-se primeiramente situar a saúde mental, traçando um sucinto panorama, passando-se, no segundo momento, a abordar a bioética latino-americana. Posteriormente, realizou-se o levantamento bibliográfico pertinente a respeito da visão holística, a fim de caminhar, no último momento, para as ponderações a respeito das práticas em saúde mental e da necessidade de mudança de paradigma. O método de abordagem utilizado foi o indutivo pelo qual as particularidades encontradas nos universos observados foram utilizadas para a construção da compilação. A técnica de pesquisa utilizada foi a bibliográfica, com especial atenção às normas e literatura necessárias à elucidação das variáveis envolvidas. Ao longo da escrita fixou-se o entendimento de que a medicina adotou o paradigma cartesiano no cuidado da saúde mental, enxergando o corpo como uma máquina e a saúde como o funcionamento perfeito dessa máquina, enquanto que o cuidado desejável em saúde mental deve ser compreendido como uma ação social inclusiva que contrarie os modelos assistenciais em saúde mental. Concluiu-se que uma mudança de paradigma se mostra necessária para atingir a atenção integral em cuidados com saúde mental que seja capaz de promover a dignidade humana através da humanização do tratamento e da reinserção desses pacientes em sociedade, na esteira ecológica em que se integram enquanto ser e não máquinas.

Perspectivas para una bioética latinoamericana

There is an intense discussion if whether we must talk about a Latin American bioethics or about bioethics in Latin America. This is an issue we must reflect about, acknowledging the need for a further analyses and debate towards a definition of its characteristics and its epistemological fundaments. Several bioethicists in the region and other places have made contributions to characterize a Latin American bioethical discipline.Realidad: Revista de Ciencias Sociales y Humanidades No. 119, 2009: 105-113

Towards a transformation in the pharmacist care paradigm: A scoping study

Introducción: En un artículo publicado por Hepler, se menciona que la atención farmacéutica constituye un cambio en el paradigma de la profesión, afirmación que es necesario aclarar, ya que, aparentemente, este concepto no se utiliza desde la filosofía o las ciencias sociales. Metodología: Se realizó un estudio de alcance a partir de revisiones sistemáticas de literatura y metanálisis publicadas en MEDLINE, EMBASE yLILACS, en las que se estudió el papel del farmacéutico en los diferentes contextos de atención de la salud. No se restringió por el idioma o fecha de publicación. Resultados:El proceso de selección identificó 86 revisiones publicadas entre 1998 y 2014, de las cuales el 84,9% son revisiones sistemáticas. Se estudiaron todos los ámbitos deatención en el 23,3%, comunitario 22,1% y ambulatorio 22,1%. Según el título, el 65% se refiere al papel del farmacéutico, el 21% con atención farmacéutica u otros términos relacionados y el 14% con los servicios de farmacia clínica. No se evidenciauniformidad en los conceptos de atención farmacéutica ni problemas relacionados con medicamentos. Conclusiones: Es necesario construir el objeto de conocimientode las actividades de atención farmacéutica a partir de un paradigma que permita otra comprensión de las intervenciones farmacéuticas, construir valores en la relaciónpaciente-farmacéutico apoyada en la bioética latinoamericana y una metodología de investigación que trascienda los hallazgos de los estudios realizados desde la epidemiología clásica.

The epigenetic effects of assisted reproductive technologies: ethical considerations.

The use of assisted reproductive technologies (ART) has increased significantly, allowing many coping with infertility to conceive. However, an emerging body of evidence suggests that ART could carry epigenetic risks for those conceived through the use of these technologies. In accordance with the Developmental Origins of Health and Disease hypothesis, ART could increase the risk of developing late-onset diseases through epigenetic mechanisms, as superovulation, fertilization methods and embryo culture could impair the embryo's epigenetic reprogramming. Such epigenetic risks raise ethical issues for all stakeholders: prospective parents and children, health professionals and society. This paper focuses on ethical issues raised by the consideration of these risks when using ART. We apply two key ethical principles of North American bioethics (respect for autonomy and non-maleficence) and suggest that an ethical tension may emerge from conflicting duties to promote the reproductive autonomy of prospective parents on one hand, and to minimize risks to prospective children on the other. We argue that this tension is inherent to the entire enterprise of ART and thus cannot be addressed by individual clinicians in individual cases. We also consider the implications of the 'non-identity problem' in this context. We call for additional research that would allow a more robust evidence base for policy. We also call upon professional societies to provide clinicians with guidelines and educational resources to facilitate the communication of epigenetic risks associated with ART to patients, taking into consideration the challenges of communicating risk information whose validity is still uncertain.

Bioética latino-americana: contorno intangible de la realidad del continente

This brief essay proposes to reflect on what could be Latin American bioethics, speculating about possible identity characteristics and operational limits of the idea of what constitutes Latin America, outlined conceptually by geographical, historical and cultural aspects. This attempt does not assume the task of defining exactly or definitively what Latin American bioethics is, but rather limits itself to the purpose of causing controversy in order to stimulate reflection on this topic to assess its usefulness.