AbstractThe Belmont Report continues to be held in high regard, and most bioethical analyses conducted in recent years have presumed that it affects United States federal regulations. However, the assessments of the report’s creators are sharply divided. Understanding the historic reputation of this monumental report is thus crucial. We first recount the historical context surrounding the creation of this report. Subsequently, we review the process involved in developing ethical guidelines and describe the report’s features. Additionally, we analyze the effect of (...) unfolding events on the subsequent creation of federal regulations, especially on gene therapy clinical trials. Moreover, throughout this paper we evaluate the ethical principles outlined in this report and describe how they overlap with the issue of protecting socially vulnerable groups. Based on the analysis, we conclude that the features of the Belmont Report cannot be considered as having affected the basic sections of the federal regulations for ethical reviews that were made uniform in 1981. Nevertheless, regarding the regulations on gene therapy clinical trials—which were at first expected to be applicable to research involving children—in addition to implementing policies regarding the public review of protocols that passed ethical review, this report’s principles are clearly reflected in the key notes that should have been referred to when the report was created. (shrink)

In this article, we first give a normative account of the doctor–patient relationship as: oriented to the good of the patient’s health; motivated by a vocational commitment; and characterized by solidarity and trust. We then look at the difference that Christianity can, and we believe, should, make to that relationship, so understood. In doing so, we consolidate and expand upon some claims we have made in a forthcoming book, Ethics and the Healing Profession (Curlin and Tollefsen, 2021).1.

Clinical ethics consultants (CECs) are not moral authorities. Standardization of CECs’ professional role does not confer upon them moral authority. Certification of particular CECs does not confer upon them moral authority (nor does it reflect such authority). Or, so we will argue. This article offers a distinctly Orthodox Christian response to those who claim that CECs—or any other academically trained bioethicist—retain moral authority (i.e., an authority to know and recommend the right course of action). This article proceeds in three parts. (...) First, we discuss recent movements toward the certification of CECs in the United States, focusing primarily on proposals and programs put forth by the American Society for Humanities and Bioethics (ASBH). Second, we outline two secular reasons to be concerned about the relevant trends toward certification. For one thing, certification is currently being advanced via political dominance, rather than gaining authority by reliance on rigorous philosophical argument or reason. For another, the trends operate on the assumption that there exists a secular, content-full, canonical, morality. There is no such morality. Next, we argue that Orthodox Christians should resist the current trends toward certification of CECs. Specifically, we unpack ways in which the ASBH’s certification program (and those like it) conflict with Orthodox claims about moral authority and the moral life more generally. We conclude that Orthodox Christians should resist the current certification trends. (shrink)

In her important and well-known discussion “On the Moral and Legal Status of Abortion,” Mary Anne Warren regrets that “it is not possible to produce a satisfactory defense of a woman’s right to obtain an abortion without showing that the fetus is not a human being, in the morally relevant sense.” Unlike some more cautious philosophers, Warren thinks that we can definitively demonstrate that the fetus is not a person. In this paper, Warren’s argument is critically examined with a focus (...) especially on the question of the foundation and the boundaries of the moral community. The fundamental thesis of the paper is that Warren’s approach is flawed for at least four reasons: (1) that being a person is not as obviously central to having full moral rights as Warren assumes, (2) that her exclusivism regarding moral status has dubious moral consequences independent of the abortion issue, (3) that it is not clear that a fetus is not a person, even on Warren’s own criteria, and (4) her criteria for personhood are themselves suspect. (shrink)

The widespread practices of data collection by third-party actors pose challenges to children’s and adolescents’ privacy when they navigate digital environments. Given that the informed-consent par...

McCarthy et al.’s proposal gains much of its plausibility by relying on a superficial treatment of justice, human dignity, sin, and the common good within the Christian tradition. Upon closer inspection of what these terms mean within the context of Christianity, it becomes clear that despite using the same phrases (e.g., a commitment to “protecting vulnerable populations,” the goal of “promoting justice,” etc.) contemporary secular bioethical goals are often deeply at odds with goals of Christian bioethics. So, while the authors (...) are right that there is room for dialogue (and even agreement) concerning general moral principles, the process of specification and application of these principles will often be heavily influenced by competing ethical traditions. Such divergent influences will often frustrate cooperative ventures between secular and religious bioethical projects. Thus, when put into action, McCarthy et al.’s proposal will—at best—produce a divided kingdom; one that cannot hope to stand. (shrink)

Janet Malek (91–102, 2019) argues that a “clinical ethics consultant’s religious worldview has no place in developing ethical recommendations or communicating about them with patients, surrogates, and clinicians.” She offers five types of arguments in support of this thesis: arguments from consensus, clarity, availability, consistency, and autonomy. This essay shows that there are serious problems for each of Malek’s arguments. None of them is sufficient to motivate her thesis. Thus, if it is true that the religious worldview of clinical ethics (...) consultants should play no role whatsoever in their work as consultants, this claim will need to be defended on some other ground. (shrink)

Jake Greenblum and Ryan K Hubbard argue that physicians, nurses, clinical ethicists and ethics committee members should not cite religious considerations when helping patients (or their proxies) make medical decisions. They provide two arguments for this position: The Public Reason Argument and the Fiduciary Argument. In this essay, I show that the Public Reason Argument fails. Greenblum and Hubbard may provide good reason to think that physicians should not invoke their own religious commitments as reasons for a particular medical decision. (...) But they fail to show that it is wrong for physicians to cite the patient’s own religious commitments as reasons for a particular decision. As such, if Greenblum and Hubbard’s thesis is to survive, the Fiduciary Argument (or some unmentioned argument) will have to do the bulk of the work. (shrink)

The predominant approach of public health experts to cigarette smoking might be described as behaviorist, for it aims to eliminate this behavior without attending to human agency and intention. The requirement that physicians address smoking cessation at every patient visit also constitutes physicians as “managers” who focus narrowly on technical means to achieve predetermined ends. In this paper, I contrast such an approach with the Aristotelian tradition, according to which physician and patient ought to develop the virtue of temperance that (...) would allow the patient to quit smoking. Although this model could potentially mitigate medicine’s behaviorist-managerial tendencies, I follow Aristotle to argue that it requires a moral friendship in which participants share a conception of the human good and pursue that good together. Due to the intractable moral pluralism that characterizes contemporary life, physicians and patients are unlikely to achieve this sort of friendship, making Aristotelian medicine impracticable at present. (shrink)

Medicalization appears to be an issue that is both ubiquitous and unquestionably problematic as it seems to signal at once a social and existential threat. This perception of medicalization, however, is nothing new. Since the first main writings in the 1960s and 1970s, it has consistently been used to describe inappropriate or abusive instances of medical authority. Yet, while this standard approach claims that medicalization is a growing problem, it assumes that there is simply one “medical model” and that the (...) expanding realm of “the medical” can be more or less clearly delineated. Moreover, while intended to establish the reality of this growing threat, this research often requires making arbitrary or unjustified distinctions between different practices. To better clarify the concept of medicalization, I will focus more on capturing the variety of medical practices than on the sociological aspects of medical discourse. In doing so, I will explore the distinction between medicalization and pathologization, a distinction that is often overlooked and that brings with it many conceptual and practical implications. After defining these terms, I will use some examples to show that while pathologizing is closely tied to medicalizing, both can occur independently. I will then further develop this distinction in terms of the different individual and social effects of these practices. (shrink)

The scientific development of 3D bioprinting is rapidly advancing. This innovative technology involves many ethical and regulatory issues, including theoretical, source, transplantation and enhancement, animal welfare, economic, safety and information arguments. 3D bioprinting technology requires an adequate bioethical debate in order to develop regulations in the interest both of public health and the development of research. This paper aims to initiate and promote ethical debate. The authors examine scientific aspects of 3D bioprinting technology and explore related ethical issues, with special (...) regard to the protection of individual rights and transparency of research. In common with all new biotechnologies, 3D bioprinting technology involves both opportunities and risks. Consequently, several scientific and ethical issues need to be addressed. A bioethical debate should be carefully increased through a multidisciplinary approach among experts and also among the public. (shrink)

Allyne L. Smith, Jr.; Personhood: Beginnings and Endings, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 6, Issue 1, 1 January 2000, Pa.

Increasingly, the world seems to shrink due to our ever-expanding technological and communication capacities. Correspondingly, our awareness of other cultures increases. This is especially true in the field of bioethics because the technological progress of medicine throughout the world is causing dramatic and challenging intersections with traditionally held values. Think of the use of pregnancy monitoring technologies like ultrasound to abort fetuses of the “wrong” sex in India, the sale of human organs in and between countries, or the disjunction between (...) the haves and the have-nots in South America when it comes to bone marrow transplants, while thousands of other children die for want of fundamental goods and services like clean water, basic inoculations, and food itself. (shrink)

Timothy Murphy argues in his article “In Defense of Irreligious Bioethics” (2012) that the role of religion in normative bioethics should be limited and that a viable means for limiting its role (o...

The development of a code of ethics for a profession can be an indicator of the coherence and stability of a discipline as a unique and singular entity. Since “bioethics”, as a discipline, is not one profession but many, practiced by persons with not one but many varying responsibilities and training, it has been argued that no code of ethics is possible for the discipline(s) of bioethics. I argue that a code of ethics is possible for bioethics by looking at (...) the nature of the various disciplines and noting necessary overlap between them, and deriving the ethics from the nature of the discipline(s) themselves. I show how this can be done by arguing that strict rules about funding and conflict of interest are necessary for bioethicists. (shrink)

Feminist ethics and medical ethics are critical of contemporary moral theory in several similar respects. There is a shared sense of frustration with the level of abstraction and generality that characterizes traditional philosophic work in ethics and a common commitment to including contextual details and allowing room for the personal aspects of relationships in ethical analysis. This paper explores the ways in which context is appealed to in feminist and medical ethics, the sort of details that should be included in (...) the recommended narrative approaches to ethical problems, and the difference it makes to our ethical deliberations if we add an explicitly feminist political analysis to our discussion of context. It is claimed that an analysis of gender is needed for feminist medical ethics and that this requires a certain degree of generality, i.e. a political understanding of context. (shrink)

The principled approach to theory building that has been a conspicuous mark of bioethical theory for the past generation has in recent years fallen under considerable critical scrutiny. Although some critics have confined themselves to reordering the dominant principles, others have rejected a principled approach entirely and turned to alternative paradigms. Prominent among critics are antiprin-ciplists, who want to jettison the principle-based approach altogether and adopt a casuistic model, and communitarians, who favor an eclectic model combining features of both the (...) casuistic model and a modified principled approach. Particularly conspicuous in virtually all such critiques is their challenge to the preeminence of the principle of autonomy. Critical barbs have been aimed not only at theories favoring a hierarchical ordering of moral principles that give first place to autonomy, but also at those that include autonomy among a set of ostensibly coequal principles. Though these critics have performed a valued function by displacing bioethical principles from their Olympian perch beyond actual decision-making contexts, some version of the principle of autonomy may, nonetheless, be well worth defending but for very different reasons than those put forward by its supporters. (shrink)

Christopher Boorse's Bio Statistical Theory (BST) defines health as the absence of disease, and disease as the adverse departure from normal species functioning. This paper presents a two-pronged problem for this account. First I demonstrate that, in order to accurately account for dynamic physiological functions, Boorse's account of normal function needs to be modified to index functions against situations. I then demonstrate that if functions are indexed against situations, the BST can no longer account for diseases that result from specific (...) environmental factors. The BST is impaled on either horn of this dilemma and therefore must be dismissed. (shrink)

Personhood is a foundational concept in ethics, yet defining criteria have been elusive. In this article we summarize attempts to define personhood in psychological and neurological terms and conclude that none manage to be both specific and non-arbitrary. We propose that this is because the concept does not correspond to any real category of objects in the world. Rather, it is the product of an evolved brain system that develops innately and projects itself automatically and irrepressibly onto the world whenever (...) triggered by stimulus features such as a human-like face, body, or contingent patterns of behavior. We review the evidence for the existence of an autonomous person network in the brain and discuss its implications for the field of ethics and for the implicit morality of everyday behavior. (shrink)

How can we definitively determine which biomedical choices are morally correct and which engage in seriously wrongful acts? Depending on whom one asks, one is informed that choices such as abortion, euthanasia, and significant body modification involve real moral harm (either as forms of murder or as denying the goodness of the body that God has provided), or that disallowing such “medical care” violates the basic rights of persons (where abortion, active euthanasia, and body modification are appreciated as positive expressions (...) of personal autonomy). Secular bioethics appears no longer able to appreciate what could possibly be wrong with such activities, provided that the individuals involved consent in some fashion. Indeed, many actions that were once openly and easily recognized as sinful have become so commonplace, as well as politically desirable, as to appear as if they were obviously good. As the authors in this issue of Christian Bioethics explore, fully to appreciate the serious moral issues raised by modern medicine requires a foundational orientation to the Christian God. (shrink)

Sometimes Blumenthal-Barby et al. (2022) discuss the philosopher’s contribution to bioethics as a largely theoretical or apriori one that arrives from out of the blue—like Parfit’s identity theory—...

The nature of the doctor–patient relationship is central to the practice of medicine and thus to bioethics. The American Medical Association (in AMA principles of medical ethics, available at: https://www.ama-assn.org/delivering-care/ethics/patient-physician-relationships, 2016) states, “The practice of medicine, and its embodiment in the clinical encounter between a patient and a physician, is fundamentally a moral activity that arises from the imperative to care for patients and to alleviate suffering.” In this issue of Christian Bioethics, leading scholars consider what relevance (if any) Christianity (...) brings to the relationship between physician and patient: does Christianity make a difference? The contributors consider this question from several different perspectives: the proper model of medicine, the role that the Christian moral tradition can play in medicine in a secular pluralistic society, how a Christian understanding of virtue can inform practices such as perinatal hospice and physician-assisted suicide, and whether or not appeals to Christian values can (or should) ground a physician’s right to conscientious objection. (shrink)

The definitions and conceptualizations of health, and the management of healthcare have been challenged by the current global scenarios (e.g., new diseases, new geographical distribution of diseases, effects of climate change on health, etc.) and by the ongoing scholarship in humanities and science. In this paper we question the mainstream definition of health adopted by the WHO—‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO in Preamble to the constitution of (...) the World Health Organization as adopted by the international health conference, The World Health Organization, 1948)—and its role in providing tools to understand what health is in the contemporary context. More specifically, we argue that this context requires to take into account the role of the environment both in medical theory and in the healthcare practice. To do so, we analyse WHO documents dated 1984 and 1986 which define health as ‘coping with the environment’. We develop the idea of ‘coping with the environment’, by focusing on two cardinal concepts: adaptation in public health and adaptivity in philosophy of biology. We argue that the notions of adaptation and adaptivity can be of major benefit for the characterization of health, and have practical implications. We explore some of these implications by discussing two recent case studies of adaptivity in public health, which can be valuable to further develop adaptive strategies in the current pandemic scenario: community-centred care and microbiologically healthier buildings. (shrink)

“Outsiders” addressing ethical issues in medicine—Strangers at the Bedside —became “bioethicists.” Bioethicists providing research ethics consultation have been described as “stranger...

Empirical research in bioethics has developed rapidly over the past decade, but has largely eschewed the use of technology-driven methodologies. We propose “design bioethics” as an area of conjoined theoretical and methodological innovation in the field, working across bioethics, health sciences and human-centred technological design. We demonstrate the potential of digital tools, particularly purpose-built digital games, to align with theoretical frameworks in bioethics for empirical research, integrating context, narrative and embodiment in moral decision-making. Purpose-built digital tools can engender situated engagement (...) with bioethical questions; can achieve such engagement at scale; and can access groups traditionally under-represented in bioethics research and theory. If developed and used with appropriate rigor, tools motivated by “design bioethics” could offer unique insights into new and familiar normative and empirical issues in the field. (shrink)

The literature on conscientious objection in medicine presents two key problems that remain unresolved: Which conscientious objections in medicine are justified, if it is not feasible for individual medical practitioners to conclusively demonstrate the genuineness or reasonableness of their objections? How does one respect both medical practitioners’ claims of conscience and patients’ interests, without leaving practitioners complicit in perceived or actual wrongdoing? My aim in this paper is to offer a new framework for conscientious objections in medicine, which, by bringing (...) medical professionals’ conscientious objection into the public realm, solves the justification and complicity problems. In particular, I will argue that: an “Uber Conscientious Objection in Medicine Committee” —which includes representatives from the medical community and from other professions, as well as from various religions and from the patient population—should assess various well-known conscientious objections in medicine in terms of public reason and decide which conscientious objections should be permitted, without hearing out individual conscientious objectors; medical practitioners should advertise their conscientious objections, ahead of time, in an online database that would be easily accessible to the public, without being required, in most cases, to refer patients to non-objecting practitioners. (shrink)

Straipsnyje analizuojamos bioetikoje vyraujančio pagarbos asmens autonomijai principo prielaidos. Remiantis antropologų L. Dumont’o ir C. Geertzo darbais parodoma, kaip pagarbos asmens autonomijai principas yra susijęs su vakarietiška, krikščioniška, individualistine asmens samprata bei iš to plaukiančiu racionalumo reikšmės įtvirtinimu informuoto sutikimo koncepte. Taip pat ginama idėja, kad būtina atsižvelgti į rūpesčio etikos, pabrėžiančios emocijų svarbą moralėje ir paremtos reliacinio asmens prielaida, pasiūlytas įžvalgas. Straipsnyje parodoma, kaip rūpesčio etikoje pasiūlyti normatyviniai rūpesčio idealai gali būti pritaikomi bioetiniame kontekste – konceptualizuojant rūpestį medicinos sferoje (...) galima pritaikyti Bourdieu pasiūlytą habitus konceptą ir išryškinti ne tik tarpasmeninių santykių svarbą moraliniam vystymuisi, bet ir įvairias sociokultūrines bei istorines įtakas, lemiančias tam tikrus mūsų elgsenos modelius. (shrink)

Transhumanism is a “technoprogressive” socio-political and intellectual movement that advocates for the use of technology in order to transform the human organism radically, with the ultimate goal of becoming “posthuman.” To this end, transhumanists focus on and encourage the use of new and emerging technologies, such as genetic engineering and brain-machine interfaces. In support of their vision for humanity, and as a way of reassuring those “bioconservatives” who may balk at the radical nature of that vision, transhumanists claim common ground (...) with a number of esteemed thinkers and traditions, from the ancient philosophy of Plato and Aristotle to the postmodern philosophy of Nietzsche. It is crucially important to give proper scholarly attention to transhumanism now, not only because of its recent and ongoing rise as a cultural and political force, but because of the imminence of major breakthroughs in the kinds of technologies that transhumanism focuses on. Thus, the articles in this issue of The Journal of Medicine and Philosophy are either explicitly about transhumanism or are on topics, such as the ethics of germline engineering and criteria for personhood, that are directly relevant to the debate between transhumanists and bioconservatives. (shrink)

In many ways, we live in propitious times for gay and lesbian people. In 1996, the Supreme Court struck down Colorado law prohibiting any kind of protected status based on sexual orientation. In 2003, the Supreme Court held that states may not criminalize sexual conduct between consenting adults of the same sex in private, so long as no money changes hands. In 2010, the Congress repealed the “Don't Ask, Don't Tell” policy that excluded openly gay men and lesbians from military (...) service. In 2013, the Supreme Court struck down key elements of the Defense of Marriage Act that prohibited any federal recognition of same‐sex marriage. Most states do not allow same‐sex marriage, but more and more states are joining the fold. Likewise, most U.S. states do not forbid discrimination based on sexual orientation, but the number that does is increasing. Arguably, no other social minority has made as much legal progress in so short a time. Despite these advances, the story of gay and lesbian people and the law is not yet finished, and the meaning of homosexuality for bioethics is still being written too. Concerns about gay and lesbian people remain important to bioethics in key domains, especially in seeing to the conferral of optimal health care benefits and in sorting through the priorities and social effects of research. Progress in these domains still involves lifting certain burdens of medical and social misjudgments about same‐sex attraction. (shrink)

This article sets out the moral failure of single-tier basic healthcare. Single-tier basic healthcare has been advocated on the grounds that the provision of healthcare should be divorced from ability to pay and unequal access to basic healthcare is morally intolerable. However, single-tier basic healthcare encounters a host of catastrophic moral failings. Given the fact of human pluralism it is impossible to objectively define “basic” healthcare. Attempts to provide single-tier healthcare therefore become political processes in which interest groups compete for (...) control of scarce resources with the most privileged possessing an inherent advantage. The focus on outputs in arguments for single-tier provision neglects the question of justice between individuals when some people provide resources for others without reciprocal benefits. The principle that only healthcare that can be provided to everyone should be provided at all leads to a leveling-down problem in which advocates of single-tier provision must prefer a situation where some individuals are made worse-off without any individual being made better-off compared to plausible multi-tier alternatives. Contemporary single-tier systems require the exclusion of noncitizens, meaning that their universalism is a myth. In the light of these pathologies, it is judged that multi-tier healthcare is morally required. (shrink)

As lifestyle diseases put a heavy burden on health care expenditures, voices are raised and win in sound to hold people responsible for their unhealthy lifestyle. Most of the arguments in favour of responsibility are backward-looking. In this article, we describe the distributional consequences of these backward-looking measures and show that they are very harsh on those who regret a past unhealthy lifestyle. We demonstrate that it is possible to take policy measures which respect individual responsibility but which are at (...) the same time able to grant fresh starts to individuals who regret their past unhealthy lifestyle (which is an application of Fleurbaey (2005)). This ‘forgiving’ policy is confronted with a moral hazard problem, however. In general the regulator does not observe whether individuals really regret their past choices or they just pretend to have changed preferences in order to enjoy the compensatory measures for regretful people. In this article, we argue that the health setting offers interesting opportunities to move beyond this moral hazard problem and offer a solution through the use of redistributive instruments that are conditional on lifestyle changes. (shrink)

The development of nursing ethics as a field of inquiry has largely relied on theories of medical ethics that use autonomy, beneficence, and/or justice as foundational ethical principles. Such theories espouse a masculine approach to moral decision-making and ethical analysis. This paper challenges the presumption of medical ethics and its associated system of moral justification as an appropriate model for nursing ethics. It argues that the value foundations of nursing ethics are located within the existential phenomenon of human caring within (...) the nurse/patient relationship instead of in models of patient good or rights-based notions of autonomy as articulated in prominent theories of medical ethics. Models of caring are analyzed and a moral-point-of-view (MPV) theory with caring as a fundamental value is proposed for the development of a theory of nursing ethics. This type of theory is supportive to feminist medical ethics because it focuses on the subscription to, and not merely the acceptance of, a particular view of morality. (shrink)

Traditional Chinese culture, Confucianism, in particular, has a non-individualist conception of what it is to be human. It conceives of people fundamentally as members of social groups—specifically, the family, the clan, the political community and the state—not as atomic individuals as perceived in modern society. The communist ideology since the middle of the last century also emphasizes the significance of ‘the common good’ of the state which describes a specific ‘good’ that is shared and beneficial for all (or most) members (...) of a given community. Nevertheless, marketization and decentralization in China today have significantly challenged the notion of a state-oriented community that directly impacts China's healthcare system, beginning with the dismantling of the rural collectives and state-owned enterprises as part of the reform and opening process. This article will address healthcare challenges in China today, examining the conceptual/ethical issues raised by public healthcare, and contending that public health concerns should go beyond the dichotomy between individualism and collectivism. The article will argue that the family-oriented model of Confucianism offers an alternative way to look at what constitute a community and common goods. The Confucian approach to ethics is relevant to healthcare today. For example, it will be much easier to find a shared idea of common good in terms of complicated issues like healthcare; it would make sense to give a larger role to families via family savings accounts, and not have everything determined by the government. (shrink)

(2005). Between Morality and Repentance: Recapturing “Sin” for Bioethics. Christian Bioethics: Vol. 11, No. 2, pp. 93-132.

The current manner of practicing chaplaincy in health care is one which prizes the multi-faith chaplain. When one asks multi-faith chaplain, “To whom are you beholden?” they will respond, “The patient.” This is evident in the way that chaplaincy is currently practiced and taught, which prizes the use of psychology over recourse to theology. Chaplaincy’s recourse to practices whose aims are directed toward the efficient rather than the eternal challenges its original telos. This paper looks at this question by blending (...) a Catholic and Engelhardtian approach to conclude that chaplains should recognize that they are beholden to God, rather than to patients’ autonomy. (shrink)

La justicia sanitaria ha sido entendida, tradicionalmente, apenas como la aplicación del modelo distributivo de la justicia social al campo de la salud. El objetivo del presente artículo consiste en analizar, a partir del enfoque de Iris Young sobre las “políticas de la diferencia”, otras nociones de justicia sanitaria, contenidas en las demandas de diferentes movimientos sociales de Argentina. En función del análisis mencionado, ha sido posible identificar cuatro nociones que, si bien presuponen aspectos vinculados con la distribución de recursos, (...) están, sin embargo, lejos de reducirse al modelo distributivo de la justicia. (shrink)

There are numerous ways in which “the particular”—particular individuals, particular ideologies, values, beliefs, and perspectives—are sometimes overlooked, ignored, or even driven out of the healthcare profession. In many such cases, this is bad for patients, practitioners, and the profession. Hence, we should seek to find a place for the particular in health care. Specific topics that I examine in this essay include distribution of health care based on the particular needs of patients, the importance of protecting physicians’ right to conscientious (...) objection, the value in tolerating a plurality of moral and medical perspectives within the field, and more. Ultimately, as the imagery in the essay’s title suggests, I argue that if one cares about the “well-being” of the medical profession, then one should seek to avoid destroying the many diverse and particular entities that constitute it. (shrink)

Several commentators have tried to ground legal prohibitions of kidney sales in some form of Kant’s moral arguments against such sales. This paper reconsiders this approach to justifying laws and policies in light of Kant’s approach to law in his political philosophy. The author argues that Kant’s political philosophy requires that kidney sales be legally permitted, although contracts for such sales must remain unenforceable. The author further argues that Kant’s approach to laws, such as those governing kidney distribution, was formed (...) in part by considering and rejecting an assumption frequently employed in the bioethics literature, namely, that legal duties can be grounded directly in moral duties. The author explains some of Kant’s reasons for rejecting this assumption and concludes that arguments pertaining to the legality of kidney sales developed on the basis of Kant’s moral philosophy should no longer be considered tenable. (shrink)

H. Tristram Engelhardt, Jr.; Bioethics after the Enlightenment, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 8, Issue 3, 1 January 20.

This essay focuses on the challenge European states have imposed on themselves, namely, to provide state-of-the-art health care equally to all and for less than market price. Continued endorsement of that challenge in these states hinges on their character as media democracies: the public is moved by a supposed morally warranted expectation that all should receive adequate health care at no significant personal cost. The structural and economic constraints that hamper such forms of healthcare delivery result in systems that are (...) financially inefficient and fail to provide the quality of treatment patients are led to expect. This essay examines the tension between secular moral claims to social solidarity and the actual limits of accessibility to healthcare services. Its critical focus addresses both the difficulties that result from politicians invoking high moral ideals while framing their decisions around short-term political advantage, and the transformation of the Enlightenment’s secular aspirations into a political ideology that distorts such moral ideals. This essay concludes that the commitments to very particular notions of equality and human dignity, which frame contemporary Europe’s provision of publicly subsidized health care, have given rise to a governance that is morally incoherent and unsustainable. This failure of public health care in Europe can thus be read as one more belated manifestation of the epistemological and moral failure of the Enlightenment’s secularizing project, a failure which should invite contemporary Europeans to honestly face the moral challenge of postmodernity. (shrink)

There is all over the world a sort of fever affecting all the research fields related, closely or somewhat loosely,with human health issues. Some of them – cloning, therapeutic cloning, stem cell therapy, human enhancement, etc. – arise fierce and controversial public debates. At the same time, a concern can be felt worldwide that tomorrow’s medicine might well become more and more « dual », the advanced health devices threatening to become the privilege of a small whealthy minority, or at (...) least excluding the vast majority of the poor and the low middle class. Furthermore, there are even greater disparities between wealthy and poor nations in access to health care and in the level of protection available to members of the latter’s population in a medical context. The theme of rationing health care has been ongoingly gaining in prevalence over the two to three last decades in the public debates, causing many to express worries about the ability of our health system to provide both efficiency and justice in health care. But, among all the new health care devices, are there not some which could be efficient both in terms of improvement of the management of patients’ health and of a just allocation of care ? Besides, not only emerge concerns linked with the development of new technologies in health care, but also in connection with the impact of social-political transformations onto the medical relationship : what are in this context the doctor-patient relationship in regard to autonomy and gender ? Should we be free to use or not to use these new technologies ? Might not the « quest for perfection » develop into a duty of perfection ? And, with the improvement of the therapeutic power to prolong human life, are we to think of assisted suicide as the future of death ? These are some of the issues that this conference wants to adress from an ethical perspective and with rigour. To enrich our discussions also medical and life science praticioners willing to reflect ethically on moral questions of health issues in their professional life and politicians faced with ethical decisions in the domain of health are welcome to participate. (shrink)