Contemporary Bioethics Research Articles

Theologians at the Bedside: On the Role of Theology in Contemporary Bioethical Discourse

Theologians at the Bedside: On the Role of Theology in Contemporary Bioethical Discourse

A dignidade da pessoa humana e o direito à vida do nascituro: fundamentos biológicos, filosóficos e jurídicos

Explicando o sentido da dignidade da pessoa humana e o alcance do direito à vida do nascituro, demonstra por que o aborto voluntário carece de fundamentação racional. Para tanto, no âmbito da interdisciplinaridade, relaciona Biologia, Filosofia e Direito em três partes: (1) considerações biológicas sobre quando e como uma realidade individual humana surge; (2) as dimensões antropológica e ética do ser humano à luz da Filosofia de Tomás de Aquino; e (3) a tutela jurídica dada ao nascituro no Código Penal brasileiro e na ADPF nº 54. Com isso, contribui para a elucidação de um tema complexo da bioética contemporânea.

Anthropomorphism as a methodological problem of animal ethics (in the memory of Sir Patrick Bateson)

Abstract The paper aims to highlight the serious methodological issue of contemporary bioethics (especially topics on the subject of animal ethics). In the discourse on the issue of the pain and suffering of animals and in derived questions, a certain form of anthropomorphism is manifested. Ethical applications of empirical research results that are relevant to humans (or humans as an anatomically and physiologically analogous animal species) are preferred. Subsequently, these extrapolations serve as a criterion for judging the qualitative level of the capabilities of all animals. Serious ethical conclusions are drawn from this reduction.

The Nazi Physicians as Leaders in Eugenics and "Euthanasia": Lessons for Today.

This article, in commemoration of the 70th anniversary of the Doctors' Trial at Nuremberg, reflects on the Nazi eugenics and "euthanasia" programs and their relevance for today. The Nazi doctors used eugenic ideals to justify sterilizations, child and adult "euthanasia," and, ultimately, genocide. Contemporary euthanasia has experienced a progression from voluntary to nonvoluntary and from passive to active killing. Modern eugenics has included both positive and negative selective activities. The 70th anniversary of the Doctors' Trial at Nuremberg provides an important opportunity to reflect on the implications of the Nazi eugenics and "euthanasia" programs for contemporary health law, bioethics, and human rights. In this article, we will examine the role that health practitioners played in the promotion and implementation of State-sponsored eugenics and "euthanasia" in Nazi Germany, followed by an exploration of contemporary parallels and debates in modern bioethics. 1.

The subject and power of bioethics

Summary The present paper argues that late work of Michel Foucault is helpful in understanding contemporary bioethics. Specifically, Foucault's writings on biopower and subjectivity are increasingly relevant as we consider the intersection of public policy and clinical ethics in a socio-political context increasingly structured by the demands of neoliberalism. Although Foucault's earlier work on the clinical gaze has been important to bioethics, that is no longer as important as his later, incomplete research into power and subjectivity. The paper develops this argument in four steps. In the first, I look at a classic phenomenological approach to clinical bioethics by Richard Zaner, starting from which I develop a Foucauldian perspective. In that section, I also offer a basic outline of what I take Foucault's primary theoretical contributions to be by way of an initial explication of the biopower-subjectification nexus. The following two sections of the paper present exemplary applications of Foucauldian theory to two areas at the intersection of public policy and clinical bioethics. The first is the procedure for testing women for the BRCA1/2 mutations, mutations that impose on carriers a significant risk of developing breast and ovarian cancer. A comparison between American and Dutch practices underscores not only the new ways that genetic testing interprets the body, but also the importance of local political and cultural contexts for understanding how the test is presented, administered and managed. The second is a consideration of the intersection of employee wellness programs and wearable technologies. In it, I develop Foucault's thought that subjects in the Christian West have long been encouraged to understand themselves confessionally, offering to authority figures the “truth” about themselves. I then interpret the compulsory use of wearables as a verification strategy for compliance with wellness programs as exemplary of such confessional strategies. The final section ties the discussion back to the clinical encounter as Zaner formulates it as an inherently moral encounter structured by vulnerabilities that matter for understanding the selfhood of patients. Based on the preceding examples, I make the case that American understandings of selfhood are increasingly separated from any sense of publicness and that this structuring of selfhood is of increasing importance in framing and adequately understanding bioethics today.

The intellectual challenge of doing bioethics in South Africa

Contemporary bioethics is a complex and multidisciplinary combination of medicine, philosophy and law, made more difficult because few,if any, bioethicists are masters of all three disciplines. To further complicate matters, each discipline contains specialised subdisciplines and internal debates. Philosophy is used to illustrate this point. Given constraints of expertise on practising bioethicists in South Africa, a few modest proposals are suggested to make bioethics as a discipline more rigorous in its use of medicine, philosophy and law.

Clinical bioethics and core competencies of attributes, attitudes, and behaviors: Foundations in philosophy and literature

Summary Philosophy clearly underwrites so much of contemporary bioethics. For example, the work of John Rawls and Norman Daniels provides a foundation for conversations about justice and health care; Alan Wertheimer's conceptual analyses of coercion and exploitation are invaluable to reproductive ethics; much of research ethics relies upon the tenets of utilitarian moral theory, and the ideas of its critics; and thinking surrounding moral reasoning in bioethics draws upon philosophical work on moral particularism, virtue theory and generalist moral thought. The work of Susan Sherwin and Margaret Little has provided a foundation for feminist work in bioethics. There is an area of current bioethical discussion, though, that does not draw upon existing work in philosophy, where it could benefit from doing so. Currently, there is great interest in questions surrounding both the core competencies for healthcare ethics consultants and the appropriate training for future healthcare ethics consultants. The core competencies are currently broken down into three categories: (1) competencies of skill, (2) competencies of knowledge and (3) competencies relating to attributes, attitudes and behaviors (such as forthrightness, humility and the possession of leadership skills). My paper explores the relation between the third category of competencies and the appropriate training for healthcare ethics consultants. While training as it applies to the first two categories of competencies has been addressed, training as it applies to the third category is somewhat curiously undertreated. There may be some reason for this; for example, in contrast to certain types of knowledge, factual knowledge, attributes, attitudes and behaviors might be very challenging to teach. At any rate, I argue that a foundation on which we can rely for help with this issue – this issue of how future healthcare ethics consultants should be trained when it comes to attributes, attitudes, and behaviors – can be found in philosophical discussion about the relation between philosophy and literature. Specifically, I make use of discussion on the question of the extent to which the study of fine literature belongs within moral philosophy. This work illustrates two useful sets of points: that fine literature demands of its reader a certain moral attention (which bears a connection to the attributes and attitudes identified as core competencies for the healthcare ethics consultant) and that literature cultivates that attention as it demands it. This work provides a foundation from which we can address our question regarding the training of future HCECs and it does so in a variety of ways. For one, such work emphasizes the importance of certain attitudes and attributes to reading the moral world and builds upon them by introducing the notion of moral attention. Further, it provides groundwork for the suggestion that the reading of fine literature can inculcate certain habits of mind that I urge are important (though under-recognized) for work in clinical ethics.

Kant, autonomy and bioethics

Summary The concept of autonomy has played a pivotal role in bioethics discourse since the 1970s. Yet, prior to the emergence of bioethics, autonomy had received scant mention in twentieth-century philosophy and was conspicuous by its absence from discussions of healthcare. The term was not even mentioned in the 1967 edition of the Encyclopedia of philosophy . The emergence of bioethics in the early 1970s coincided with increased attention across the western world to civil and human rights; with the rise of this new discipline the liberal emphasis on individual rights was recast in terms of respect for patient autonomy. Although its legal appeal was based on the ease with which autonomy was operationalized in the doctrine of informed consent, the power of the concept of autonomy lay in what it symbolized: the right of an individual to resist coercion or compulsion in the context of a relationship of power. Most commentators in the field of bioethics are familiar with autonomy as one of the four principles of biomedical ethics laid down by Beauchamp and Childress in their canonical text, The principles of biomedical ethics (1979) . ‘Principlism’ is a mid-level theoretical tool, which has had broad appeal in facilitating analysis of ethical dilemmas in biomedicine, grasped in the abstract as conflicts between two or more of the four principles. Yet the principle of autonomy, which has had such an extraordinary influence in contemporary bioethics bears only, passing resemblance to the concept of autonomy, which emerged in early modern philosophy. Although the bioethical redrawing of autonomy owes a large debt both to the philosophical tradition and to the social upheavals of the twentieth century, the relationship between contemporary interpretations of the concept of autonomy in bioethics and its historical origins is rarely examined. The purpose of this paper is to trace the evolution of the concept of autonomy from its emergence in modern moral theory to contemporary debates about its relevance for bioethical analysis. The roots of the principle of autonomy can be traced back to the political theory of ancient Greece. Originally used to describe the capacity of the Greek polis or city-state to govern itself, the concept of autonomy received its first modern expression – and its first application to the individual – in the moral theory of Immanuel Kant. For Kant, autonomy stood for the ideal of free will: a human will be driven to action, not by appetite or desire, but by identification with a ‘higher’ or rational self. At the heart of Kant's ethics is the close association of moral action with human rationality; for Kant, autonomous action – action which is deliberately and self-consciously motivated by moral reasons – is the quintessential expression of human rationality. Although the moral universalism Kant sought to defend is no longer philosophically tenable, his insights about many of the core features of autonomous action remained influential until well into the twentieth century. This paper falls into four parts: in the first section I will explore the contextual factors which influenced the emergence of autonomy as a principle appropriate for bioethical analysis. From there, I will examine the hugely influential definition of autonomy put forward by Beauchamp and Childress in the Principles of biomedical ethics and trace the philosophical foundations of this concept. I will then provide a brief account of the concept of autonomy so central to Kant's moral theory and I will conclude by examining recent accounts of personal autonomy in contemporary philosophy with the aim of arriving at a richer understanding of autonomy, which can perhaps be of greater service to bioethics.

Finitude, Freedom and Biomedicine: An Engagement with Gilbert Meilaender’s Bioethics

A fundamental theme in Gilbert Meilaender’s work on bioethical issues is the relationship between the ethical claims of finitude (that is, the biological necessity that characterizes human beings as finite creatures) and of freedom (that is, the capacity of human beings to transcend biological necessity). This article identifies two ways in which Meilaender articulates this relationship (one Niebuhrian, the other Augustinian) and proposes a third (Barthian) way which avoids the limitations of the first two ways while serving Meilaender’s purpose, which is to redress what he sees as an imbalance in favor of the claims of freedom over those of finitude in contemporary biomedicine and bioethics. The article ends by suggesting that Meilaender’s purpose would be best served by avoiding tensions between finitude and freedom as the third way does.

ЭВОЛЮЦИЯ ПРЕДСТАВЛЕНИЙ О ДОСТОИНСТВЕ В ИСТОРИИ ЭТИЧЕСКОЙ МЫСЛИ

The article is devoted to the evolution of the concept of dignity in ethical and philosophical thought. On the basis of the etymology of the word, the author reveals the basic definition of dignity as a measure of the correspondence of a person’s behavior to his or her position in society and the approving reaction of the others to such behavior. This definition is corrected in the analysis of the views of Aristotle, the Stoics, Cicero, Thomas Aquinas, J. Manetti, J. Pico della Mirandola, T. Hobbes, J.-J. Rousseau, I. Kant, and others. It is shown that in the course of historical development (under the influence of philosophy and religion) the hierarchical understanding of dignity was gradually replaced by the universalist one. Analyzing the notions of dignity as a theoretical foundation of the human rights system and disputes about dignity in contemporary bioethics, the author concludes that dignity is an important personal and social value, which potential in solving complex ethical dilemmas of present time, despite the frequent use of this word in public discourse, is not yet fully realized.

BeyondThe Anticipatory Corpse—Future Perspectives for Bioethics

This essay explores the two main objectives of Bishop's book, which he analyzes in the context of the care for the dying: (1) the medical metaphysics underlying medical science and (2) biopolitics as governance of the human body. This essay discusses Bishop's claims in view of newer developments in medicine, especially the turn to the construction of life, and confronts the concept of the patient's sovereignty with an alternative model of vulnerable agency. In order to overcome the impasses of contemporary bioethics, the essay argues that practical reason requires a two-fold ethics: first, it must develop a new hermeneutics of illness and disease, and second, in order to protect the individuals in the process of dying, moral claims concerning death must be based on the concept of human rights.

Kwestie bioetyczne w encyklice „Laudato si’” papieża Franciszka

Artykuł podejmuje refleksję nad wątkami bioetycznymi zawartymi w ostatniej encyklice papieża. W punkcie pierwszym analizuje modele filozoficzne we współczesnej bioetyce, szczególnie rozpowszechnione w ostatnich latach, takie jak: scjentyzm, utylitaryzm, model absolutnej autonomii i personalizm. W punkcie tym ukazano również ocenę tych sposobów filozofowania dokonaną przez papieża Franciszka i jego wniosek, że jedynie model personalistyczny jest adekwatny do właściwego rozwiązania kwestii ekologicznej i bioetycznej.W punkcie drugim opisane są trzy modele ekologiczne: model antropocentryczny, biocentryczny i partnerski. Ukazana jest także refleksja Franciszka w tej kwestii: relacja człowieka do przyrody powinna mieć charakter partnerski i uwzględniać fakt odpowiedzialności człowieka przed Bogiem za działania wobec przyrody. Człowiek powinien być nie władcą tego świata, lecz sługą mającym na celu dobro stworzeń i winien szanować nadane przez Boga prawa.W trzeciej części omówiono kazusy bioetyczne poruszone w encyklice Laudato si’. Dotyczą one początków życia człowieka (status embrionu ludzkiego, aborcja), przemocy wobec dzieci, godności osoby cierpiącej i starszej oraz bioetyki ekologicznej (zadawanie cierpień zwierzętom i żywność GMO).

Si Zubiri pudiera discutir con la bioética actual: inteligencia y neurociencia

Philosophers are products of their time. Their standpoints, themes and perspectives are a result of a historical time, a knowledge and a prevailing paradigm throughout their epoch. Zubiri is a good example of a philosopher who wants to be in touch with the science and knowledge of his time, but is an author from the XX century. Contemporary bioethics includes a profusion of themes that undoubtedly would have fascinated Zubiri, in as far as they relate to a reflection on the human condition itself. Specifically, the development of neurosciences is challenging to thought, and is producing a correlative development of so-called neuroethics. From this new scenario, this paper deals with those ideas that Zubiri would have discussed in the context of contemporary neuroethics.

Patient Autonomy in Talmudic Context: The Patient's "I Must Eat" on Yom Kippur in the Light of Contemporary Bioethics.

In contemporary bioethics, the autonomy of the patient has assumed considerable importance. Progressing from a more limited notion of informed consent, shared decision making calls upon patients to voice the desires and preferences of their authentic self, engaging in choice among alternatives as a way to exercise deeply held values. One influential opinion in Jewish bioethics holds that Jewish law, in contradistinction to secular bioethics, limits the patient's exercise of autonomy only in those instances in which treatment choices are sensitive to preferences. Here, we analyze a discussion in the Mishna, a foundational text of rabbinic Judaism, regarding patient autonomy in the setting of religiously mandated fasting, and commentaries in the Babylonian and Palestinian Talmuds, finding both a more expansive notion of such autonomy and a potential metaphysical grounding for it in the importance of patient self-knowledge.

Aboriginal Health Care and Bioethics: A Reflection on the Teaching of the Seven Grandfathers

Contemporary bioethics recognizes the importance of the culture in shaping ethical issues, yet in practice, a process for ethical analysis and decision making is rarely adjusted to the culture and ethnicity of involved parties. This is of a particular concern in a health care system that is caring for a growing Aboriginal population. We raise the possibility of constructing a bioethics grounded in traditional Aboriginal knowledge. As an example of an element of traditional knowledge that contains strong ethical guidance, we present the story of the Gifts of the Seven Grandfathers. We note a resemblance of this Ojibway teaching to virtue ethics in European traditions, but we suggest that there are also important differences in how these two traditions are currently presented. We hope that further engagement with a variety of indigenous moral teachings and traditions could improve health care involving Aboriginal patients and communities, and enrich the discipline of bioethics.

Emergence of a Discipline? Growth in U.S. Postsecondary Bioethics Degrees.

AbstractTeaching competency in bioethics has been a concern of the field since its start. In 1976, The Hastings Center published the first report on the teaching of contemporary bioethics. Graduate programs culminating in an MA or PhD were not needed at the time, concluded the report. “In the future, however,” the report speculated, “the development and/or changing social priorities may at some point allow, or even require, the creation of new academic structures for graduate education in bioethics.” Although that future might be upon us, the creation of a terminal degree in bioethics has its detractors. Scholars have debated whether bioethics is a discipline with its own methods and theoretical grounding, a multidisciplinary field bringing various professional perspectives to bear on particular types of problems, a set of problem‐solving skills to resolve moral disagreements, or something else entirely. Whether or not efforts to develop the methods and theory of bioethics have matured to the point that it is now a discipline in the strictest sense, new bioethics training programs have appeared at all postsecondary levels. In this essay, we examine the number and types of U.S. programs and degrees in this growing field.

Dignity reevaluated: A theological examination of human dignity and the role of the Church in bioethics and end-of-life care.

Predominant among the terminological ambiguities that plague contemporary bioethics is confusion attending the meaning of the term "human dignity," particularly as it applies to so-called end-of-life discussions. This study surveys current trends in treatment of the concept of dignity, examining relevant thinkers who see dignity as redundant or as capability-dependent. These inadequate views are contrasted with an attitude, based theologically in Mark 5, that understands human dignity to represent an absolute characteristic that is donated graciously to all bearers of imago Dei. Human dignity must thus be affirmed as inviolable and independent of autonomy, rationality, or capability. A specific task of the Christian Church is to faithfully recognize and proclaim this dignity. This investigation is particularly relevant in the face of contemporary discussions regarding euthanasia and physician-assisted death. Lay Summary: Much of the polarization within the contemporary bioethical discussion proceeds out of confusion regarding how we ought to define the terms of the debate. If we may take the existing debates regarding euthanasia and physician-assisted death as an example, we may understand the vital need for a sensible definition of the term that stands at the heart of the arguments of both sides of the debate: "human dignity." As such, this study seeks to define dignity in a logical, theological, deeply personal, and highly practical fashion, and to outline the critical role of the Church within such an understanding. Sometimes, when I walk into the room, he ignores me. Sometimes he thinks I am someone else. Most often he is asleep, subjugated by drugs designed to prevent agitation, although "agitation" is the sterilized hospital word for what I would call unbridled panic, total disorientation. The night he had the stroke, they had to tie him to the bed just to keep him in the hospital. And they wouldn't let me see him because he had been calling my name. Very dramatic, but most of his suffering, and our grief, is not dramatic. It is just the mundane process of one man slowly fading, becoming, every day, more of a stranger to himself and to those he loves.

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

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.

Beyond the Sterility of a Distinct African Bioethics: Addressing the Conceptual Bioethics Lag in Africa.

In the current debate on the future of bioethics in Africa, several authors have argued for a distinct communitarian African bioethics that can counter the dominancy of Western atomistic principlism in contemporary bioethics. In this article I examine this rather contentious argument and evaluate its validity and viability. Firstly, I trace the contextual origins of contemporary bioethics and highlight the rise and dominance of principlism. I particularly note that principlism was premised on a content-thin notion of the common morality that is in need of enrichment. I also contend that bioethics is essentially two-dimensional, being both conceptual and empirical, and indicate the lag in Africa with regard to conceptual bioethics. I then appeal for authentic engagement by 1) African health care professionals, 2) African health care training institutions, 3) Africa's bioethics development partners, and 4) African bioethicists and philosophers, towards addressing this critical lag. I underline the need to maintain the essential universality of bioethics as a discipline. I particularly argue against the pursuit of a distinct African bioethics, as it appears to be rooted in sterile African ethno-philosophy. Rather, African bioethicists and philosophers would do well to elucidate the universalisability of insights from traditional African thought, for the benefit of bioethics as a whole. Thus we must engage beyond the sterility of a distinct African bioethics - authentically reflecting on the essentially universal contemporary bioethical concerns - to effectively articulate a viable trajectory for bioethics in Africa.

The End of the HIPAA Privacy Rule? Currents in Contemporary Bioethics.

The HIPAA Privacy Rule is notoriously weak because of its incomplete coverage, numerous exclusions and exemptions, and limited rights for individuals. The three areas in which it provides the most protection are fundraising, marketing, and research. Provisions of the 21st Century Cures Act, pending in Congress, and the Notice of Proposed Rulemaking to amend the federal research regulations (Common Rule), awaiting final regulatory action, would weaken the privacy protections for research. If these measures are adopted, the HIPAA Privacy Rule would have so little value that it might not be worth the aggravation and burden.