In today’s pluralistic society, clinical ethics consultation cannot count on a pre-given set of rules and principles to be applied to a specific situation, because such an approach would deny the existence of different and divergent backgrounds by imposing a dogmatic and transcultural morality. Clinical ethics support (CES) needs to overcome this lack of foundations and conjugate the respect for the difference at stake with the necessity to find shared and workable solutions for ethical issues encountered in clinical practice. We (...) argue that a pragmatist approach to CES, based on the philosophical theories of William James, John Dewey, and Charles Sanders Peirce, can help to achieve the goal of reaching practical solutions for moral problems in the context of today’s clinical environment, characterized by ethical pluralism. In this article, we outline a pragmatist theoretical framework for CES. Furthermore, we will show that moral case deliberation, making use of the dilemma method, can be regarded an example of a pragmatist approach to CES. (shrink)

Bioethics has made a compelling case for the role of experience and empirical research in ethics. This may explain why the movement for empirical ethics has such a firm grounding in bioethics. However, the theoretical framework according to which empirical research contributes to ethics—and the specific role it can or should play—remains manifold and unclear. In this paper, we build from pragmatic theory stressing the importance of experience and outcomes in establishing the meaning of ethics concepts. We then propose three (...) methodological steps according to which the meaning of ethics concepts can be refined based on experience and empirical research: function identification, function enrichment, and function testing. These steps are explained and situated within the broader commitment of pragmatic ethics to a perspective of moral growth and human flourishing. We hope that this proposal will give specific direction to the bridging of theoretical and empirical research in ethics and thus support stronger actualization of ethics concepts. (shrink)

In this article we explore the contribution from social anthropology to the medical ethical debates about the use of informed consent in research, based on blood samples and other forms of tissue. The article springs from a project exploring donors’ motivation for providing blood and healthcare data for genetic research to be executed by a Swedish start-up genomics company. This article is not confined to empirical findings, however, as we suggest that anthropology provides reason to reassess the theoretical understanding of (...) autonomy as generally defined by Beauchamp and Childress. Careful consideration of the trust expressed by donors through the act of donation, furthermore, suggests that there is reason to redirect the ethical scrutiny from informed consent to issues concerning institutional arrangements and social responsibility. In particular, we suggest that an anthropological approach could facilitate a reconsideration of the political implications of using informed consent as a regulatory practice in tissue-based research. (shrink)

Many commentators today lament the politicization of bioethics, but some suggest distinguishing among different kinds of politicization. This essay pursues that idea with reference to three traditions of political thought: liberalism, communitarianism, and republicanism. After briefly discussing the concept of politicization itself, the essay examines how each of these political traditions manifests itself in recent bioethics scholarship, focusing on the implications of each tradition for the design of government bioethics councils. The liberal emphasis on the irreducible plurality of values and (...) interests in modern societies, and the communitarian concern with the social dimensions of biotechnology, offer important insights for bioethics councils. The essay finds the most promise in the republican tradition, however, which emphasizes institutional mechanisms that allow bioethics councils to enrich but not dominate public deliberation, while ensuring that government decisions on bioethical issues are publicly accountable and contestable. (shrink)

Public deliberation about health policy in the United States often hinges on two untenable basic assumptions about political legitimacy. The first assumption, common in public debate throughout the United States, is that federal oversight of health care is justified under a federal compact binding all citizens. This assumption is false because the federal compact precludes such oversight. Indeed, the ascendancy of national government (and demise of federalism) over the past 70 years was engineered through the subversion of the federal compact, (...) creating an expansive legitimation gap. The second assumption—that political legitimacy can be established through appeals to expert consensus about fundamental conceptions of justice or human rights—is prevalent among bioethicists. I argue that this assumption is illicit because it hinges on a weak, rationalistic form of majoritarian democracy that conflates public acquiescence with public approval. If the public mission of academic bioethics involves protecting the integrity of public deliberation, then these two basic assumptions should be challenged. (shrink)

This essay contrasts the notions of charity employed by Traditional Christianity and by liberal cosmopolitan bioethics, arguing that: (1) bioethics attempts to reconstruct the notion of charity in a manner that is caustic to the Traditional Christian moral vision, (2) Christians are, on the whole, more charitable than proponents of bioethics' reconstructed view (even given the standards of the latter), and (3) the theistically oriented conception of charity employed by Traditional Christianity cannot be expressed in bioethics' purportedly neutral public vocabulary. (...) The upshot is that, in the name of neutrality and pluralism, liberal cosmopolitan bioethicists seek to impose an impoverished moral vocabulary that reflects liberal cosmopolitan ideology while excluding input from Traditional Christianity and other non-liberal-humanistic moral visions. (shrink)

It has been a pleasure to read these papers and to contemplate their importance for what I believe to be a useful and provocative prism though which to view the field of bioethics: the nature of moral consensus. In my own most extended contribution to this literature, DecidingTogether, I did not attempt to prescribe so much as to understand the role of moral consensus in the practice of bioethics. At the end of the book, I expressed the hope that it (...) might help trigger an examination of bioethics and moral consensus. Though a few others shared my interest at that time (in particular Tris Engelhardt, for whose early encouragement I remain deeply grateful), with this set of stimulating papers the conversation has finally begun in earnest. (shrink)

This paper is a reaction to an article by John Arras published earlier in this journal. In this article Arras argues that “freestanding pragmatism” has little new to offer to bioethics. We respond to some of Arras' arguments and conclude that, although he overstates his case at certain points, his critique is, broadly speaking, correct. We then introduce and discuss an alternative approach to pragmatist ethics, one which puts to work the ideas and insights of pragmatism conceived as a broad (...) philosophical movement, without lapsing into a canon dependent approach. The approach we propose exhibits a number of characteristics that differ from Arras'saccount of freestanding pragmatism and offers something new to bioethics. (shrink)

A distinction is made between two models of ethics committees. According to the Mirror Model, ethics committees ought to reflect the values of society. The Critical Model says committees are to critically examine these standards rather than merely reflect them. It is argued that the Critical Model should be accepted because a society's ethical standards can be mistaken and a society that has Critical rather than merely Mirror ethics committees is more likely to have such mistakes revealed. Some implications of (...) the Critical Model are discussed. (shrink)

The World Anti-Doping Agency was created in 1999 with the goal of making elite competitive sports free of doping practices. Since then, it has grown into a powerful organization that oversees national anti-doping institutions and a majority of international sports federations. Anti-doping regulations means that the use of performance enhancement drugs or methods is prohibited in elite sports competition, and athletes who do not comply are sanctioned through a ban from competition and loss of titles and prizes link to them. (...) The recent discovery of a systematic doping scheme in Russia has shown that the regulations currently in place have failed to offer the 'clean' environment promised to athletes and the public. While there is an understandable call to reform WADA's practices to further the anti-doping fight, I suggest that the purpose of WADA itself should also be reconsidered. In taking a step back from the current controversy and urge for stricter regulations, this thesis will first ask if performance enhancement in sports should really be understood as unethical and undesirable. Favouring a interdisciplinary approach to this problematic, I will take a look at the scholarly debate on doping and critically analyze arguments from both positions including theoretical ideas on doping itself and practical concerns about WADA's current measures to prevent doping. This overview, while it does provide an unequivocal answer about the ethicality of doping, will show a wide range of counterarguments to the prevailing anti-doping stance, and raise numerous concerns about the current system. In doing so, it indicates the need for a larger, inclusive of all stakeholders, deliberation on the anti-doping position, a position which remains so far mostly uncontested outside of academia. In the second part of my thesis, this rejection of a by-default anti stance to doping in sports will then lead me to explore whether there is a more suited alternative to dealing with issue of doping in elite sports than the current zero tolerance approach. Finally, I conclude that a harm reduction approach provides a suitable answer to both moral concerns and issues of feasibility, even though it may be difficult to incorporate into WADA given the number of stakeholders involved. Still, the identification of this alternative, conjointly with the Russian scandal, serves to justify why there should be further deliberation about WADA and the anti-doping movement that goes beyond accepting the status quo and the Agency's idealist notion of achieving completely doping-free sports. (shrink)

The contribution of healthcare ethics committee (HEC) members to HECs is fundamental. However, little is known about how HEC members view clinical ethics. We report results from a qualitative study of the moral psychology of HEC members. We found that contrary to the existing Kohlberg-based studies, HEC members hold a pragmatic non-expert view of clinical ethics based mainly on respect for persons and a commitment to the patient’s good. In general, HEC members hold deflationary views regarding moral theory. Ethical principles (...) are not abstract foundations but the expression of moral commitments to patients that pre-exist awareness of moral theory. Emotions and proximity to patient sufferance fundamentally shape the views of HEC members on clinical ethics. Further work at the intersection of clinical ethics and qualitative research could bring to the foreground lay perspectives on moral problems that may differ from bioethics expert views. (shrink)