Reflexivity, or the systematic attempt to include the spokesperson in accounts of the social world, is a magnetic signature and inherent riddle of all modern thinking about knowledge and science. Turning the narrative back upon the narrator may sharpen our critical wits about the `inescapable perspectivity' of human knowledge; but self-referential accounts may also trigger endless loops of meta-theorizing and lose track of the object itself. Negotiating the twin pitfalls of spiralling meta-reflexivity and flat naturalistic accounts, I argue for a (...) reflexive `one step up', which adds one storey to the story. It explores, through critical discussions of the work of Harding and Bourdieu, how reflexivity may promiscuously combine with conflicting objectivist and constructivist epistemologies, and how reflexive accounts invariably appear to run in a circle. This performative circularity, it is argued, does not invalidate the reflexive effort but defines its major strength. Constitutive circularity graces both world-accounts and self-accounts with a radical uncertainty and incompleteness; which implies, among other things, that we must shift part of the burden of reflexive work to our friends, or rather: to our best enemies. (shrink)

Bioethicists’ attraction to principlism is rooted in a Western view of how matters that affect the public ought to be deliberated and decided: their resolution ought to be so structured and constrained that it can be understood and verified even by those at a remove from the circumstances of the problem. That view of deliberation, itself fostered by the Western view of government, has encouraged principlism to spread from its source in human subjects research into other areas of bioethics discourse.

On the usual account of moral reasoning, social science is often seen as able to provide “just the facts,” while philosophy attends to moral values and conceptual clarity and builds formally valid arguments. Yet disciplines are informed by epistemic values—and bioethics might do well to see social scientific practices and their attendant normative understandings about what is humanly important as a significant part of ethics generally.

The authors use the term “principlism” to refer to the practice of using “principles” to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these “principles” do not function as claimed, and that their use is misleading both practically and theoretically. The “principles” are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for (...) consideration when dealing with a moral problem. The “principles” lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory. (shrink)

Contra those bioethicists who think that their cases are based on “real” events and thus not motivated by any particular ethical theory, Chambers explores how case narratives are constructed and thus the extent to which they are driven by particular theories.

OBJECTIVES: To study empirically whether ethical theory (from the mainstream principles-based, virtue-based, and feminist schools) usefully describes the approaches doctors and nurses take in everyday patient care. DESIGN: Ethnographic methods: participant observation and interviews, the transcripts of which were analysed to identify themes in ethical approaches. SETTING: A British old-age psychiatry ward. PARTICIPANTS: The more than 20 doctors and nurses on the ward. RESULTS: Doctors and nurses on the ward differed in their conceptions of the principles of beneficence and respect (...) for patient autonomy. Nurses shared with doctors a commitment to liberal and utilitarian conceptions of these principles, but also placed much greater weight on relationships and character virtues when expressing the same principles. Nurses also emphasised patient autonomy, while doctors were more likely to advocate beneficence, when the two principles conflicted. CONCLUSION: The study indicates that ethical theory can, contrary to the charges of certain critics, be relevant to everyday health care-if it (a) attends to social context and (b) is flexible enough to draw on various schools of theory. (shrink)

Three standard tasks undertaken by applied ethicists engaged in the public policy process are identifying value issues, clarifying concepts and meanings, and analyzing arguments. I urge that these should be expanded to include making specific moral judgments and advocating positions and policies. Three objections to philosophers/ethicists' engagement in the formation of public policy are advanced and evaluated: philosophers necessarily do public policy badly, doing it at all compormises one's integrity as a seeker after truth, and frequently participation is in the (...) service of a repressive status quo that is structured simultaneously to preclude radical change and to co-opt ethicists. finally, however, I argue that those who would be ‘applied ethicists’ cannot avoid all participation in some form of a public policy process; that engagement holds the hope as well for improved ethical theory; that the preferred form of participation is frequently from outside of establishment bodies; and that wherever philosophers do involve themselves in policy formulation, this is best done in the expanded sense urged at the outset. Keywords: applied ethics, moral reasoning, public policy CiteULike Connotea Del.icio.us What's this? (shrink)

This discussion is a critical assessment of the methods employed by some leading writers in the field of bioethics. The author agrees with those in the field who regard its primary or essential method as moral philosophy, but he nevertheless finds a prevalent tendency among bioethical writers merely to apply received moral principles to issues and to avoid penetrating theoretical analysis, even when such analysis is unavoidably required. He explains these deficiencies in terms of the exigencies of interdisciplinary work and (...) the affinity of much early bioethics with policy- or legislatively-oriented "public ethics". The discussion ends with a call for increased theoretical sophistication in this field. Keywords: bioethics, ethics, medical ethics, method CiteULike Connotea Del.icio.us What's this? (shrink)

This paper discusses a dispute concerning the ethics of research on preventing the perinatal transmission of HIV in developing nations. Critics of this research argue that it is unethical because it denies a proven treatment to placebo‐control groups. Since studies conducted in developed nations would not deny this treatment to subjects, the critics maintain that these experiments manifest a double standard for ethical research and that a single standard of ethics should apply to all research on human subjects. Proponents of (...) the research, however, argue that these charges fail to understand the ethical complexities of research in developing nations, and that study designs can vary according to the social, economic, and scientific conditions of research. This essay explores some of the ethical issues raised by this controversial case in order to shed some light on the deeper, meta‐ethical questions. The paper argues that standards of ethical research on human subjects are universal but not absolute: there are some general ethical principles that apply to all cases of human subjects research but the application of these principles must take into account factors inherent in particular situations. (shrink)

This article seeks to establish that the social sciences have an important contribution to make to the study of ethics. The discussion is framed around three questions: (i) what theoretical work can the social sciences contribute to the understanding of ethics? (ii) what empirical work can the social sciences contribute to the understanding of ethics? And (iii) how does this theoretical and empirical work combine, to enhance the understanding of how ethics, as a field of analysis and debate, is socially (...) constituted and situated? Through these questions the argument goes beyond the now commonly cited objection to the over‐simplistic division between normative and descriptive ethics (that assigns the social sciences the ‘handmaiden’ role of simply providing the ‘facts’). In extending this argument, this article seeks to establish, more firmly and in more detail, that: (a) the social sciences have a longstanding theoretical interest analysing the role that a concern with ethics plays in explanations of social change, social organisation and social action; (b) the explanations that are based on the empirical investigations conducted by social scientists exemplify the interplay of epistemological and methodological analyses so that our understanding of particular substantive issues is extended beyond the conventional questions raised by ethicists, and (c) through this combination of theoretical and empirical work, social scientists go beyond the specific ethical questions of particular practices to enquire further into the social processes that lie behind the very designation of certain matters as being ‘ethical issues’. (shrink)

This paper illustrates a role that bioethics should play in developing and criticizing protocols for breast cancer genetic screening. It demonstrates how a critical bioethics, using approaches and reflecting concerns of contemporary philosophy of science and science studies, may critically interrogate the normative and conceptual schemes within which ethical considerations about such screening protocols are framed. By exploring various factors that influence the development of such protocols, including politics, cultural norms, and conceptions of disease, this paper and the critical bioethics' (...) approach it endorses illuminate and critically assess some of the competing worldviews informing protocol development. One of the frequently neglected worldviews in traditional bioethics' treatment of protocols concerning breast care is constituted by women's own views of their breasts and breast cancer, both within the technologically-oriented social practice of American medicine and in light of the social construction of their breasted experience in American society. This paper attempts to redress and critically assess this neglect on the part of traditional bioethics. Finally, in contrast to traditional bioethics, critical bioethics critically interrogates its own normative and conceptual commitments. In this final capacity, a critical bioethics' approach makes a valuable contribution to the evolution of bioethics. (shrink)

This paper identifies four major forms of scholarship in bioethics: empirical research, the articulation of mid-level principles of bioethics, the relating of these principles to fundamental moral theories, and discussions of the bioethical implications of legal principles and health delivery policies. It develops a reflective equilibrium approach to the relation between these four forms of scholarship. It then presents, in light of this approach, criteria for quality research in each of these forms of scholarship in bioethics. Keywords: quality of scholarship, (...) reflective equilibria in bioethics, research in bioethics CiteULike Connotea Del.icio.us What's this? (shrink)

Bioethics represents a dramatic revision of the centuries-old professional ethics that governed the behavior of physicians and their relationships with patients. This venerable ethics code was challenged in the years after World War II by the remarkable advances in the biomedical sciences and medicine that raised questions about the definition of death, the use of life-support systems, organ transplantation, and reproductive interventions. In response, philosophers and theologians, lawyers and social scientists joined together with physicians and scientists to rethink and revise (...) the old standards. Governments established commissions to recommend policies. Courts heard arguments and legislatures passed laws. This book is the first broad history of the growing field of bioethics. Covering the period 1947-1987, it examines the origin and evolution of the debates over human experimentation, genetic engineering, organ transplantation, termination of life-sustaining treatment, and new reproductive technologies. It assesses the contributions of philosophy, theology, law and the social sciences to the expanding discourse of bioethics. Written by one of the field's founders, The Birth of Bioethics is based on extensive archival research into sources that are difficult to obtain and on interviews with many of the leading figures in the moral debates in medicine. A very readable and comprehensive account of the evolution of bioethics, this book stresses the history of ideas but does not neglect the social and cultural context and the people involved. It will serve the information needs of philosophers, ethicists, social historians, and everyone interested in the origins of some of today's most hotly debated issues. (shrink)

Bioethics is now taken seriously. Is there a danger of its being taken in or taken over? Might it be influenced in other ways, less visible and less easily avoided? As private corporations and bioethicists build relationships with each other, bioethicists must ask themselves about the opportunities, the constraints, and the subtle shifts in attitude and focus that such ties might create.