Practice Of Bioethics Research Articles

A Good Death

This narrative symposium examines the relationship of bioethics practice to personal experiences of illness. A call for stories was developed by Tod Chambers, the symposium editor, and editorial staff and was sent to several commonly used bioethics listservs and posted on the Narrative Inquiry in Bioethics website. The call asked authors to relate a personal story of being ill or caring for a person who is ill, and to describe how this affected how they think about bioethical questions and the practice of medicine. Eighteen individuals were invited to submit full stories based on review of their proposals. Twelve stories are published in this symposium, and six supplemental stories are published online only through Project MUSE. Authors explore themes of vulnerability, suffering, communication, voluntariness, cultural barriers, and flaws in local healthcare systems through stories about their own illnesses or about caring for children, partners, parents and grandparents. Commentary articles by Arthur Frank, Bradley Lewis, and Carol Taylor follow the collection of personal narratives.

Reflections on Two Decades of Bioethics: Where We Have Been and Where We Are Going

The American Journal of Bioethics (AJOB) emerged at a time when bioethics, though still a young discipline, was described by some as at a critical crossroads.1 Commentators noted that bioethics began as a scholarly, reflective, academic enterprise but was increasingly focused on providing practical services to institutions and clients, and worried whether the field could productively and coherently accommodate both bioethics scholars and practitioners.2 Ten years later, bioethics remains a field comprised of some who are primarily scholars, some who are primarily practitioners, and some who are scholar-practitioner hybrids. Bioethics scholarship rests on a foundation of moral philosophy, but also incorporates law, policy studies, empirical studies, analysis of government or international guidelines, standards of practice, case studies, and more. As for most, my perspective of where the field has been and where it is going is colored by my own experiences. My background education is both practice based (nursing) and conceptual (philosophy) – and I consider it a privilege to be a ‘hybrid’ bioethicist- involved in both bioethics practice and bioethics scholarship. For this essay, I chose to discuss 4 short cases to reflect on bioethics over the last decade and speculate about the next decade. Although based on my own experiences, each case has been embellished for clarity and effect. My future scenarios are deliberately optimistic, yet of course, they are simply guesses, an exercise inspired by “Choose your own adventure,” a popular children’s book series that allows the reader to create the story ending.3 It is conceivable, however, that my future predictions are too optimistic and due to constricting resources or shifting societal priorities or values, the growth and influence of bioethics will lose speed. It is also possible that with increasing numbers of certificate, masters, and doctoral programs in bioethics, the future bioethicist will be much more specialized than today; there will be distinct career paths for scholars and practitioners and policy wonks, and ultimately fewer hybrids. Losing some of the rich diversity of perspectives that comes with bioethicists trained in different disciplines would be unfortunate. At the same time, specialization and focused expertise has the advantages of allowing bioethicists to engage and integrate in complex areas of science, health care, and policy. Now for the cases:

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

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.

Barbara Maier and Warren A. Shibles: The philosophy and practice of medicine and bioethics: A naturalistic-humanistic approach

Barbara Maier and Warren A. Shibles: The philosophy and practice of medicine and bioethics: A naturalistic-humanistic approach

Neuropsychoanalytic Bioethics

This article lays the foundation for a neuropsychoanalytic approach to bioethics. This approach bases bioethical research and practice on a psychoanalytic conception of subjectivity. According to such a conception, the individual is characterized by intra- and intersubjective conflict, much of which occurs outside of consciousness. The goal of psychoanalysis is to bring these unconscious conflicts into awareness, thus freeing the individual to make richer and more fulfilling decisions. I argue that there is robust neuroscientific evidence supporting this model of subjectivity, as well as fundamental psychoanalytic concepts such as conflict, transference, and compromise; neuroscientific evidence also explains, as well as confirms, the efficacy of dynamic psychotherapy in reconfiguring existing neural networks. As a result, a neurologically sound bioethics must take psychoanalysis seriously. Basing bioethics on this neuropsychoanalytic foundation will require changes to key bioethical concepts and will reorient the field toward the goal of promoting—as opposed to protecting—autonomy. These changes will produce a bioethics that is more theoretically consistent and practically effective.

From ancient consolation and negative care to modern empathy and the neurosciences

A historical understanding of the virtue of consolation, as contrasted to empathy, compassion, or sympathy, is developed. Recent findings from neuroscience are presented which support and affirm this understanding. These findings are related to palliative care and its current practice in bioethics.

The Philosophy and Practice of Medicine and Bioethics: A Naturalistic/Humanistic Approach

The Philosophy and Practice of Medicine and Bioethics: A Naturalistic/Humanistic Approach

Considering virtue: public health and clinical ethics

As bioethicists increasingly turn their attention to the profession of public health, many candidate frameworks have been proposed, often with an eye toward articulating the values and foundational concepts that distinguish this practice from curative clinical medicine. First, I will argue that while these suggestions for a distinct ethics of public health are promising, they arise from problems within contemporary bioethics that must be taken into account. Without such cognizance of the impetus for public health ethics, we risk developing a set of ethical resources meant exclusively for public health professionals, thereby neglecting implications for curative medical ethics and the practice of bioethics more broadly. Second, I will present reasons for thinking some of the critiques of dominant contemporary bioethics can be met by a virtue ethics approach. I present a virtue ethics response to criticisms that concern (1) increased rigor in bioethics discourse; (2) the ability of normative theory to accommodate context; and (3) explicit attention to the nature of ethical conflict. I conclude that a virtue ethics approach is a viable avenue for further inquiry, one that leads us away from developing ethics of public health in a vacuum and has the potential for overcoming certain pitfalls of contemporary bioethics discourse.

Vorsprung durch Technik: On Biotechnology, Bioethics, and Its Beneficiaries

Bioethics as a distinctive field is undergoing a critical turn. It may be a quiet revolution, but a growing body of scholarship illustrates a perceived need for a rethink of the scope of the field and the approaches and priorities that have carried bioethicists through many heady years of success. Few areas of bioethical practice have been left unexamined, ranging from questions as to the sustainability of the discipline in its current form to the “expertise” of its practitioners; the legitimacy of bioethics in the realms of policymaking; its relationship to philosophy; the purchase of empirical and interdisciplinary method; the relationship of bioethics to the real world; bioethical understandings of the concept of “health” (and methods of attainment); its agenda, priorities, and inclusiveness right up to what might be the overarching question: “What is bioethics all about?” Unsurprisingly, these questions elicit varied responses. Scholars from various disciplines have critiqued fundamental tenets of the “ethics” business, albeit as claims of its “conservatism,” “corruption,” and its questionable “usefulness” suggest, not always with a charitable or constructive eye. But quite crucially and often overlooked, bioethicsitselfhas not shied away from the question as to what bioethics is and what it should become; increasingly apparent is that this kind of self-conscious and reflexive theorizing is regarded as a key priority for taking contemporary ethics forward.

Ethics and adolescent care: an international perspective

This update reviews the concepts underlying ethical issues in various contexts and countries, highlighting the evolution in the use of the core values underpinning the field and practice of bioethics as applied to healthcare. It stresses the specific position of the adolescent as being a unique individual searching for autonomy and, most of the time, being competent to make decisions regarding the adolescent's own health. It briefly outlines the principles of a 'deliberative' approach in which the practitioner, while keeping in mind the legal context of the country where the practitioner is working, assesses to what extent the adolescent can be considered as competent, and then discusses with the adolescent the medical and psychosocial aspects of the various actions to be taken in a situation, as well as the basic ethical values linked with each of the various options available. The deliberation can involve relevant stakeholders, provided the issues concerning confidentiality have been fully discussed with the adolescent. This process forces the practitioner, the adolescent patient and those who care for the adolescent patient to look outside their usual frameworks and make a decision that is in the best interest of the young person, and is informed by various ethical values.

The Ethics of Bioethics

Stem cell research. Drug company influence. Abortion. Contraception. Long-term and end-of-life care. Human participants research. Informed consent. The list of ethical issues in science, medicine, and public health is long and continually growing. These complex issues pose a daunting task for professionals in the expanding field of bioethics. But what of the practice of bioethics itself? What issues do ethicists and bioethicists confront in their efforts to facilitate sound moral reasoning and judgment in a variety of venues? Are those immersed in the field capable of making the right decisions? How and why do they face moral challenge-and even compromise-as ethicists? What values should guide them? In The Ethics of Bioethics, Lisa A. Eckenwiler and Felicia G. Cohn tackle these questions head on, bringing together notable medical ethicists and people outside the discipline to discuss common criticisms, the field's inherent tensions, and efforts to assign values and assess success. Through twenty-five lively essays examining the field's history and trends, shortcomings and strengths, and the political and policy interplay within the bioethical realm, this comprehensive book begins a much-needed critical and constructive discussion of the moral landscape of bioethics.

Beware Dichotomies and Grand Abstractions: Attending to Particularity and Practice in Empirical Bioethics

Beware Dichotomies and Grand Abstractions: Attending to Particularity and Practice in Empirical Bioethics

Religion, Bioethics and Nursing Practice

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.

A systemic view of family health

A systemic view of family health

Can Bioethics Be Global and Local, or Must It Be Both?

This article contributes to ethnography of bioethical practices in a developing nation by examining how doctors perceive and use them in Mexico. We ask whether principle-based bioethics can transplant to a developing nation. An analysis reveals the bioethical approaches in different hospital settings, the local nature of bioethical understanding, and a universal requirement for ethical distribution of health care. After an overview of U.S. bioethics development and of Mexican biomedical institutions, the article presents field research done on bioethical conceptualizations and practices in two Mexican government hospitals. An analysis of the bioethical dilemmas physicians face and the approaches taken within the society in different institutional venues uncovers the local character of bioethics and the universal bioethical needs, and the intersection between micro and macro processes in hospital health care. While local conditions must guide a physician's day-to-day ethical practices, a global bioethics is needed to address universal problems experienced in economically developing nations.

Bioethics and Deliberative Democracy: Five Warnings from Hobbes

Thomas Hobbes is one of the most ardent and thoroughgoing opponents of participatory democracy among Western political philosophers. Though Hobbes's alternative to participatory democracy-assent by subjects to rule by an absolute sovereign-no longer constitutes a viable political alternative for Westerners, his critique of participatory democracy is a potentially valuable source of insight about its liabilities. This essay elaborates five theses from Hobbes that stand as cogent warnings to those who embrace participatory democracy, especially those (such as most bioethicists) advocating for deliberative democracy based on a rational consensus model. In light of these warnings, the author suggests an alternative, modus vivendi approach to deliberative democracy that would radically alter the current practice of bioethics.

THE BIRTH OF THE EMPIRICAL TURN IN BIOETHICS

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.

Doctor-Family-Patient Relationship: The Chinese Paradigm of Informed Consent

Bioethics is a subject far removed from the Chinese, even from many Chinese medical students and medical professionals. In-depth interviews with eighteen physicians, patients, and family members provided a deeper understanding of bioethical practices in contemporary China, especially with regard to the doctor-patient relationship (DPR) and informed consent. The Chinese model of doctor-family-patient relationship (DFPR), instead of DPR, is taken to reflect Chinese Confucian cultural commitments. An examination of the history of Chinese culture and the profession of medicine in China is used to disclose the deep roots of these commitments. The author predicts that the DFPR model will further develop in China but that it will maintain its Chinese character.

Bioetyka. Jej historia i sposoby ujmowania

Bioethics is a new scientific branch created over 30 years ago, connecting natural sciences (biology, medicine) with the science of morals in human conduct. (ethics). Bioethics started to grow in the area of ecology, therefore primarily it appeared as a discipline of environmental protection and preservation of the ecosystem (environmental ethics). Later the matter of dispute became limited to problems related to human health and its promotion (medical ethics). However, these problems are closely related to plant preservation and animal life protection. The practice in bioethics is faced with difficulties related to the interdisciplinary character of this branch and axiological pluralism of the modern world. In consequence, in the area of bioethics most important become human being respect and human rights as touchstones universally accepted in social life practice and international law. A favorable fact is that the European Union has recognized and accepted these values as its own cultural identity constituents.

House of healing, house of disrespect: a Kantian perspective on disrespectful behaviour among hospital workers.

Respect toward patients is one of the most fundamental and central tenets guiding both modern bioethical practice and the everyday behaviour of all healthcare professionals. However, similar courtesy and respect is often breached in day-to-day interactions between hospital workers. Many examples are relatively minor, while egregious examples such as gender discrimination and physical abuse do occur. The more egregious transgressions may be handled by formal processes, even legal proceedings. However, the innumerable smaller examples of disrespectful behaviour are ubiquitous and insidious in their erosion of a productive collaborative approach to patient care and other aspects of functioning within the institution. The authors briefly summarize some of the pertinent literature on this subject and analyze the problem of disrespect in the hospital with special focus on the issue as seen from the perspective of the moral philosophy of Immanuel Kant. Some simple recommendations for improving disrespectful behaviour amongst hospital workers are offered.