Contemporary Bioethics Research Articles

How is a Theological Bioethics and Medical Ethics Possible: A Study on Background and Foundation of the "Ethic of Personhood"

The core issue in bioethics is how to define humans. Contemporary bioethics is in trouble on many issues because of limitations in principles and methods. Ethics of personhood tries to rethink these issues from a different perspective. The premise of the ethics of personhood is to redefine humans. From the perspective of Christian thought, it introduces the concept of "person" into bioethics and points out that the research object of bioethics is human being as human person. The concept of human person is the basis of the ethics of personhood. Human person possesses both substantiality and relationality. This makes up for the shortcomings of contemporary bioethics that either only value individual interests, or only value collective interests. Although the ethic of personhood is a very good paradigm and framework for studying bioethics, it still faces many fundamental problems in modernity, such as how to be widely accepted.

Principlism, Uncodifiability, and the Problem of Specification.

In this paper I critically examine the implications of the uncodifiability thesis for principlism as a pluralistic and non-absolute generalist ethical theory. In this regard, I begin with a brief overview of W.D. Ross's ethical theory and his focus on general but defeasible prima facie principles before turning to 2) the revival of principlism in contemporary bioethics through the influential work of Tom Beauchamp and James Childress; 3) the widespread adoption of specification as a response to the indeterminacy of abstract general principles and the limitations of balancing and deductive approaches; 4) the challenges raised to fully specified principlism by the uncodifiability thesis and 5) finally offer a defense of the uncodifiability thesis against various critiques that have been raised.

TEODOSIJUS DOBŽANSKI I EVOLUCIJA ČOVEČANSTVA: JEDAN DRUGAČIJI PRISTUP

The text is a plausible presentation and review of the main work of Theodosius Dobzhansky (Theodosius Grigorievich Dobzhansky) - The Evolution of Humanity. He tries to show and prove that Dobzhansky tries, and largely succeeds, in offering a different, dialectical interpretation of the evolution of the human species, i.e. the evolution of humanity. In line with, but also in contrast to, traditional Darwinism, Dobžanski insists on the claim that evolution, primarily biological, is not over, but that it continues, despite human/cultural intervention, namely together with it, which tries to influence and change the directions of previous natural flows and processes. Biology and culture have become interdependent and interfering during the millennial history, thus, man imposes himself as the main and most responsible factor in the fate of the human race and the survival of the human community/species, but also the totality and entirety of planetary biodiversity, as necessary prerequisites for his own survival. In his research on the evolution of humanity, Dobzhansky starts from the inspiring views of some well-known predecessors, such as Pierre Teilhard de Chardin, however, we can argue that Dobžanski influenced many of his contemporaries, including Avram Noam Chomsky, especially when it comes to linguistic research into the genesis and origin of human language and the influence of transformational-generative grammar on the development of the human mind, equally so, human brain. At the same time, we can state that his researches correspond and coincide with the researches and ethical positions of some contemporary bioethicists, culturologists and philosophers of biology, as well as with the positions of many like-minded people and followers.

Supporting Solidarity

Supporting Solidarity

Contemporary Bioethics and the Question of the Beginning of Personhood and Metaphysical Solutions Thereto

This article presents some answers to the question on the moment of the emergence of personhood, particularly answers based in metaphysics. The author points out the disadvantages and advantages of certain statements and analyses the arguments upon which they are based. Conception, implantation of the fetus into the uterine wall, and observation of brain activity are considered to be the probable moments marking the beginning of personhood.

Toward Planetary Health Ethics? Refiguring Bios in Bioethics

In responding to perceived crises—such as the COVID-19 pandemic—in routinized ways, contemporary bioethics can make us prisoners of the proximate. Rather, we need bioethics to recognize and engage with complex configurations of global ecosystem degradation and collapse, thereby showing us paths toward co-inhabiting the planet securely and sustainably. Such a planetary health ethics might draw rewardingly on Indigenous knowledge practices or Indigenous philosophical ecologies. It will require ethicists, with other health professionals, to step up and become public advocates for environmental sustainability. The COVID-19 pandemic should be seen as opening a portal to planetary health ethics or ecologized bioethics.

Abortion, euthanasia, and the limits of principlism.

Principlism is an ethical framework that has dominated bioethical discourse for the past 50years. There are differing perspectives on its proper scope and limits. In this article, we consider to what extent principlism provides guidance for the abortion and euthanasia debates. We argue that whilst principlism may be considered a useful framework for structuring bioethical discourse, it does not in itself allow for the resolution of these neuralgic policy discussions. Scholars have attempted to use principlism to analyse the ethics and legality of abortion and euthanasia; but such efforts are methodologically problematic. We close with a consideration of the proper scope of principlism in bioethics-a vision that is more modest than the manner in which principlism is often deployed in contemporary academic bioethics and medical education.

Methodological and Discursive Considerations for Islamic Bioethics Research and Writing

The past two decades have witnessed a substantial interest in Islamic bioethics research and writing. As more papers are published and a greater number of conferences are held, it is important to reflect on the concepts and concerns that frame the emerging discourse and its nascent academic literature. Accordingly, this paper begins by reflecting on the term Islamic bioethics and the motivations that spur Islamic bioethical deliberation. In so doing, it calls for paying attention to the normative and methodological implications of uniting the disparate discourses represented by the conjunctive term. To further assist consumers in distinguishing various types of Islamic bioethics research and writing, three general categories of scholarly work—Islamic bioethics, Muslim bioethics, and applied Islamic bioethics—are introduced. Next, the paper outlines several lacunae in the extant academic Islamic bioethics literature that emerge from an incomplete engagement with the foundations, elements, and nature of contemporary bioethics discourse. Finally, in order to advance the field and better engage with contemporary bioethical questions, the paper closes by underscoring the need for Islamic bioethics research and writing to become multidisciplinary and involve multilevel ethical analysis.

Care for the Environment as a Consideration in Bioethics Discourse and Education

This article argues that environmental considerations fall within the scope of medical bioethics, and there are implications specific to medical education. It endorses the need to expand the scope and epistemology of contemporary medical bioethics discourse by including themes related to environmental considerations. Our discussion begins by providing a brief history of environmental bioethics. It then offers a critique of three specific health and environmental issues, namely technology, toxics, and consumption, and discusses how these issues are key to articulating moral considerations of human health and subsequently medicine and its teaching. Lastly, it explores criticisms of including environmental issues into the bioethical debate before providing suggestions of how environmental ethics can be included into the medical curriculum. This article concludes by suggesting theoretical possibilities for environmentally inclusive bioethics, such as reorienting bioethical discussions to its original environmental advocacy and supporting environmental bioethics as a competency in medical education.

"It Gives the Mother the Best Chance for Her Life": U.S. Catholic Health Care and the Treatment of Ectopic Pregnancy.

“It Gives the Mother the Best Chance for Her Life”: U.S. Catholic Health Care and the Treatment of Ectopic Pregnancy Jessica Martucci (bio) It is widely understood that the Catholic Church prohibits abortion.1 Few women today would likely approach a Catholic hospital with the hope of obtaining an elective abortion. That this is so normalized in our society is a reflection of both a long history of Catholic influences in American health care and the Catholic Church’s long-standing position on the matter.2 This association between Catholicism and antiabortion politics dates back to the 1869 proclamation by Pope Pius IX that officially declared abortion at any point in gestation—either its conduct or its procurement—to be an excommunicable offense.3 Yet despite the apparent clarity and consistency of their convictions, the implementation of this position in Catholic health care institutions has never been quite so straightforward. In her prescient 2002 essay, “The Evil of Abortion and the Greater Good of the Faith,” religious studies scholar Kathleen M. Joyce argued that leaders in Catholic medicine had learned to strategically diminish their “condemnation of practices their church deemed evil in the pursuit [End Page 48] of . . . the preservation of a Catholic voice in the American health care system.”4 Here I examine this characterization and perhaps push it even further. As nursing historian Barbra Mann Wall has demonstrated, Catholic medical organizations have a long history of evolving and negotiating to maintain and grow their success.5 In the pages that follow, I discuss how one of the staunchest antiabortion forces in America has grappled with the limits and consequences of a religious ban on procedures that are central to the provision of women’s health care. Through a brief analysis of the case of ectopic pregnancy, I emphasize the historical weight behind what has become a well-known mantra in modern reproductive health activism, as well as the namesake of a proposed bill in the U.S. Senate: “Abortion is Healthcare.”6 From a Fatal Condition to Lifesaving Treatments Sometimes described in the historical medical literature as an “extra-uterine” pregnancy, ectopic pregnancy describes a condition in which a fertilized egg implants somewhere other than in the main cavity of a woman’s uterus and begins to grow. The most common presentation of this is a tubal pregnancy, which occurs in the Fallopian tubes due to preexisting infections, endometrial growth, or a structural abnormality.7 Once implanted, the embryo attempts to form connections with the blood vessels in the tube. The tube wall swells and weakens as the embryo develops, and if left untreated, the tube can burst, causing hemorrhage and death for the embryo and often the mother. The condition is considered so pathological that contemporary bioethicists have suggested we stop referring to it as a “pregnancy” at all.8 The condition was first described in an eleventh-century Arabic medical text, but the development of lifesaving interventions did not emerge until the late 1800s as anatomical knowledge and antiseptic methods improved. Medical data collected by nineteenth-century physicians suggested a 25 percent survival rate without intervention. Those who lived faced a life-time [End Page 49] of complications as a result of the ordeal.9 As early twentieth-century obstetrician Joseph B. DeLee wrote in 1915, “The prognosis as to health is also bad, because the condition leaves peritonitic adhesions, which often result in sterility; if untreated, decomposition and abscess cause hectic fever, invalidism, etc.”10 Given these poor outcomes, it is no wonder that the 1884 report of a successful surgical treatment for ectopic pregnancy by a Scottish gynecologist and surgeon named Robert Lawson Tait caused such a stir in the late nineteenth-century medical world. By 1888, Tait had operated on a total of twenty-eight patients who suffered from a ruptured tubal pregnancy and had lost only one, a feat made only more remarkable at the time by his complete disavowal of germ theory and aseptic and antiseptic techniques.11 The new technique made ectopic pregnancies a treatable condition and saved lives. Between 1876 and the turn of the twentieth century, the documented mortality rate for a ruptured ectopic pregnancy fell from...

Philosophy

Socio-cultural shifts during the 1960s and 1970s included widespread secularization, challenges to authority and tradition, and an emphasis on individual choice. Healthcare and biomedical research advances accompanied these social changes, giving rise to numerous ethical and policy questions. The contemporary bioethics project emerged in this context with (at least) three aims: (1) to offer practical answers to these questions (often) in ways that (2) facilitate or support particular practices or goals (e.g., organ donation or human research) and that (3) appear broadly applicable and legitimately enforceable. Philosophical thinking, which involves investigating and disambiguating concepts and categories, articulating conceptually clear definitions, and mapping arguments to identify premises, detect fallacies, and describe their logical implications, can undermine the practical goals of the bioethics project. This tension between the goals of bioethics and philosophical thinking might help to explain what some scholars see as a disinterest in philosophical thinking in bioethics today.

The Socioeconomic Impacts of Emergent Biotechnology on the Next Human Age

Modern biotechnology has progressed to unforeseeable heights, from genetic engineering to radical life extension. The rapid advent of this technology has enforced upon us a duty to contemplate the ethics surrounding it to inform our decisions. One pressing aspect of contemporary bioethics lies in medical developments that have become widely consumed resources. In modern society, big pharmaceutical companies dominate the healthcare industry, which makes them uniquely positioned to introduce new-age biotechnology as consumer resources. A "big pharma" future exemplified by the emergence of revolutionary new-age biotechnology presents severe ethical concerns. This paper describes potential scenarios where emergent biotechnology becomes a consumer resource as a result of aggressive marketing, indirect coercion, and monopoly of the "big pharma" companies. Chasing higher profitability and benefiting from their monopoly position, big pharmaceutical companies can price new biotechnologies at excessive levels, resulting in new biotechnology proliferating along socioeconomic lines. Such a development threatens to create an elite genetic class and destroy social mobility. In order to mitigate such consequences, this paper proposes a price cap mechanism to improve equal access to emerging biotechnology and promote innovations in breakthrough treatments.

The religious character of secular arguments supporting euthanasia and what it implies for conscientious practice in medicine.

Contemporary bioethics generally stipulates that public moral deliberation must avoid allowing religious beliefs to influence or justify health policy and law. Secular premises and arguments are assumed to maintain the neutral, common ground required for moral deliberation in the public square of a pluralistic society. However, a careful examination of non-theistic arguments used to justify euthanasia (regarding contested notions of human dignity, individual autonomy, and death as annihilation) reveals a dependence on metaethical and metaphysical beliefs that are not universally accepted in a pluralistic society. Such beliefs function in non-theistic arguments in the same way that foundational beliefs justify moral convictions in religious frameworks of belief. This parallel is apparent when religious belief is defined broadly (a la John Reeder) as 'the search for the good in light of the limits and possibilities of the real.' Seen through this interpretive lens, frameworks comprising Secular foundational commitments function, in ethically relevant respects, like the guiding beliefs found in the comprehensive frameworks of traditional religions. When conscientious practice in healthcare is reconsidered in light of this foundational similarity between the religious and the secular, it is clear that those who object to the foundational beliefs underpinning Secular arguments for euthanasia should not be required to provide, participate in, or refer patients for euthanasia (or other ethically controversial practices similarly dependent on contested frameworks of belief) in pluralistic societies that prize moral freedom as a primary human good.

Virtue Ethics in Medical Practice during the COVID-19 Pandemic

The article aims to reflect the medical virtue ethics as applied to situations related to the COVID-19 pandemic. The method of processing uses deduction, by which the article points out the use of the generally defined cardinal and theological virtues in terms of specific attitudes and concrete situations. The practical output of the article is the usability of these reflections in the prevention and therapy of stress, including burnout syndrome and post-traumatic stress disorder. Stress was a reaction commonly experienced often and in various degrees during the new and unforeseen conditions of the pandemic. The article emphasises the importance of virtue ethics as a part of contemporary bioethics.

Биоэтика сегодня

Five years have passed since the death of the great scientist, the "father" of Russian bioethics Boris Grigoryevich Yudin. A round table held at the Institute of Philosophy of the Russian Academy of Sciences was dedicated to his memory. Memories of B.G.Yudin and the reinterpretation of his ideas in the modern era have become the subject of discussion by leading bioethicists. Science itself has undergone major changes over the years. It is all the more important to "read" the works of Boris Grigorievich in a new way, who not only reflected on contemporary bioethics, but also formulated the main ideas of its future development.

Bioethics and the Contours of Autonomy

AbstractThe principle of respect for autonomy often dominates the bioethical discourse. Yet despite its prominence, the exact contours are not always well defined. Widespread disagreement about the nature of autonomy has led some to conclude that autonomy is hopelessly vague and therefore ought to be abandoned in contemporary bioethics. Despite calls to move beyond it, autonomy remains at the center of bioethical reflection. The challenge, then, if autonomy is to function as a bedrock of contemporary bioethics, is to define more clearly the shape of autonomy, to mark more precisely its conceptual boundaries, and to delineate more carefully how best autonomy is put into practice in medical ethics. In this article, I raise questions about the ways autonomy is used in theory, as well as the ways that it is operationalized in practice.

The concept of vulnerability in aged care: a systematic review of argument-based ethics literature

BackgroundVulnerability is a key concept in traditional and contemporary bioethics. In the philosophical literature, vulnerability is understood not only to be an ontological condition of humanity, but also to be a consequence of contingent factors. Within bioethics debates, vulnerable populations are defined in relation to compromised capacity to consent, increased susceptibility to harm, and/or exploitation. Although vulnerability has historically been associated with older adults, to date, no comprehensive or systematic work exists on the meaning of their vulnerability. To fill this gap, we analysed the literature on aged care for the meaning, foundations, and uses of vulnerability as an ethical concept.MethodsUsing PRISMA guidelines, we conducted a systematic review of argument-based ethics literature in four major databases: PubMed, Embase®, Web of Science™, and Philosopher’s Index. These covered biomedical, philosophy, bioethical, and anthropological literature. Titles, abstracts, and full texts of identified papers were screened for relevance. The snowball technique and citation tracking were used to identify relevant publications. Data analysis and synthesis followed the preparatory steps of the coding process detailed in the QUAGOL methodology.ResultsThirty-eight publications met our criteria and were included. Publication dates ranged from 1984 to 2020, with 17 publications appearing between 2015 and 2020. Publications originated from all five major continents, as indicated by the affiliation of the first author. Our analyses revealed that the concept of vulnerability could be distinguished in terms of basic human and situational vulnerability. Six dimensions of older adults’ vulnerability were identified: physical; psychological; relational/interpersonal; moral; sociocultural, political, and economic; and existential/spiritual. This analysis suggested three ways to relate to older adults’ vulnerability: understanding older adults’ vulnerability, taking care of vulnerable older adults, and intervening through socio-political-economic measures.ConclusionsThe way in which vulnerability was conceptualised in the included publications overlaps with distinctions used within contemporary bioethics literature. Dimensions of aged care vulnerability map onto defining features of humans, giving weight to the claim that vulnerability represents an inherent characteristic of humans. Vulnerability is mostly a value-laden concept, endowed with positive and negative connotations. Most publications focused on and promoted aged care, strengthening the idea that care is a defining practice of being human.

Engaging Diversity

Engaging Diversity

Disability bioethics and the commitment to equality.

Robert Veatch’s The Foundations of Justice: Why the Retarded and the Rest of Us Have Claims to Equality (1986) delves into deep questions of justice through the case of a child with disabilities. I describe what is basically right about this vision, as well as what is problematic from the standpoint of contemporary disability bioethics. From there, I dive into the notion of vulnerability that is at play in his work. He describes disability as necessarily a condition of weakness, lesser-than existence, and neediness. When disability is viewed in this way as an inherently vulnerable state of being, the essential sociopolitical dimensions of disability receive inadequate attention, which, in turn, makes it impossible to identify injustices correctly. I connect these points to concrete challenges faced by disability communities during the COVID-19 pandemic, which have raised profound questions about the just use of scarce critical care resources. Any case drawn from the pandemic is a very different kind of case than that of the child in Veatch’s book, but a commonality is the question of who should get what limited resources when needs and urgency vary.

Ethical issues and dilemmas in spinal cord injury rehabilitation in the developing world: a mixed-method study.

Mixed-method study (small group discussions and online literature search). Identify the ethical issues and dilemmas faced by rehabilitation professionals involved in the service delivery to the persons with spinal cord injury (SCI) in the low income and lower-middle-income countries (LIC/LMIC) located in Asia. Small group discussions in three biomedical conferences in Dhaka, Bangladesh and Kualalampur, Malaysia. Three small group discussions (30-45 min each) were held during three international conferences in 2019. The conferences brought together experts in the fields of neurology, rehabilitation, neurorehabilitation, and bioethics. A summary of SCI practice points and dilemmas were documented including goals of care, duties of rehabilitation professionals, health care worker-patient relationships, roles, and expectations of family members at different care settings. There is a paucity of literature on this topic. The application of the principles of contemporary bioethics in the pluralistic societies of LIC/LMIC can be challenging. The ethical dilemmas faced by rehabilitation professionals working in LIC/LMIC are diverse and different from those reported from the Western and developed countries. Ethical issues and dilemmas identified were understanding patient autonomy in decision making, lack of insurance for SCI rehabilitation, financial challenges, challenges of providing emerging technology in SCI rehabilitation and SCI rehabilitation during disasters. We have summarized the possible ethical issues and dilemmas which rehabilitation professionals in LIC/LMIC may encounter during delivery of SCI rehabilitation services. We hope it generates a discussion on an often-neglected aspect of SCI care in the LIC/LMIC and helps identify the complexities of ethical dilemmas unique to persons with SCI living in a developing country.