WHAT IS BIOETHICS ALL ABOUT? A START Matti Hayry and Tuija Takala. A Start What is bioethics all about? Is it only about medicine, nursing, and healthcare? ...

Medical practitioners have traditionally seen themselves as part of an international community with shared and unifying scientific and ethical goals in the treatment of disease, the promotion of health, and the protection of life. This shared mission is underpinned by explicit acceptance of traditional concepts of medical morality, and by an implied link between individual human rights and the ethics of medical practice long enshrined in a range of World Medical Association (WMA) and other medical codes. These have been powerful (...) instruments exhorting individual practitioners to promote health and to defend universal principles in order to protect their patients and the physician-patient relationship even in the face of authoritarian state coercion and imposed national ideologies and policies. There has been widespread support for this approach and this should be intensified. (shrink)

In this classic work of feminist political thought, Iris Marion Young challenges the prevailing reduction of social justice to distributive justice.

The emergence of global bioethics is connected to a rise of interest in ethics in general (both in academia and in the public sphere), combined with an increasing awareness of the interrelatedness of peoples and their ethical dilemmas, and the recognition that global problems need global solutions. In short, global bioethics has two distinguishing features: first, its global scope, both geographically and conceptually; and second, its focus on justice (communal and individual).

Medical ethics enjoyed a remarkable degree of continuity from the days of Hippocrates until its long-standing traditions began to be supplanted, or at least supplemented, around the middle of the twentieth century. Scientific, technological, and social developments during that time produced rapid changes in the biological sciences and in health care. These developments challenged many prevalent conceptions of the moral obligations of health professionals and society in meeting the needs of the sick and injured .The Anglo-American textbook of Beauchamp and (...) Childress became the referential work for the discipline of `bio-ethics'. The authors are convinced that a long history of ancient, medieval and modern health care reflection remains very disappointing from the perspective of contemporary biomedical ethics: “It shows how inadequately, and with what measure of insularity, problems of truthfulness, privacy, justice, communal responsibility and the like were framed in past centuries ”. They defend the four principles approach to biomedical ethics, an approach which somewhat disparagingly has been called principlism.The influence of their work has been so strong that bio-ethics seemed to become overwhelmed by the importance of their contribution. It even created a large separation between Anglo-American approaches in bio-ethics and the European-Continental approach . In any case, contemporary biomedical ethics incorporates theoretical conflicts of considerable complexity, and the diverse theories make it no easier.The personalist approach to biomedical ethics presents itself as a typical European reaction to the rapid changes in medicine and health care. Some call it, however, a kind of renewal of the old Thomistic approach, whereby the concept of `nature' has been replaced by the more dynamic concept of `person'. In that way personalism has been situated by many observers as a `person' centred natural law tradition which focuses on the rational nature of the human person as the moral norm of nature. This gives the impression that personalism is only a very `static' variant of the natural law approach.I would, however, defend the opinion that personalism offers a very dynamic and creative approach to the complexities of recent developments in biomedicine. In what follows, I will illustrate this by clarifying two basic dimensions of the integration of personalism in biomedical ethics: the personalist approach offers a relational foundation for medicine as a healing profession and it presents an ethical framework for the integration of new developments in medicine. First, however, I would like to situate the importance of this theoretical reflection for medical ethics. (shrink)

We have a reason to use information which is available about such genes in our reproductive decision-making; (3) couples should selec.

Feminist bioethics poses a challenge to bioethics by exposing the masculine marking of its supposedly generic human subject, as well as the fact that the tradition does not view womens rights as human rights. This essay traces the way in which this invisible gendering of the universal renders the other gender invisible and silent. It shows how this attenuation of the human in man is a source of sickness, both cultural and individual. Finally, it suggests several ways in which images (...) drawn from womens experience and womens bodies might contribute to a constructive rethinking of basic ethical concepts. (shrink)

Bioethics has been subject to considerable social criticism in recent years. One criticism that has caused particular discomfort in the bioethics community is that bioethicists, because of the way their work is funded, are involved in profound conflicts of interest that undermine their title to be considered independent moral commentators on developments in biomedicine and biotechnology. This criticism draws its force from the assumption that bioethics is, or ought to be, a type of normative social criticism. Versions of this criticism (...) come from both the political left and right. For instance, such criticisms include allegations that bioethics is inherently socially conservative, that it is inherently “pro-technology”, that it lays spurious claims to moral and social authority and expertise, that its focus on autonomy links it to neoliberal theories of choice, and that it is an ideological mystification of real social relationships and political power. This commentary paper analyses the problem of bioethical conflict of interest, and argues that the types of conflict of interest facing bioethics are inherent to the role of “public intellectual” that bioethicists generally wish to assume. The paper defends this conception of the role of the bioethicist, arguing that bioethicists should be interested and openly so. (shrink)

Some bioethicists are concerned about other bioethicists being paid by corporations. These concerns make sense if you have a particular view about what the most important role of a bioethicist should be. If you believe that a bioethicist should be a moral critic, attempting to expose wrongdoing, then being paid by corporations might compromise this role. It’s plausible to suppose that this can be a role for bioethicists but it’s unreasonable to insist that all bioethicists should be moral critics.

Some bioethicists are concerned about other bioethicists being paid by corporations. These concerns make sense if you have a particular view about what the most important role of a bioethicist should be. If you believe that a bioethicist should be a moral critic, attempting to expose wrongdoing, then being paid by corporations might compromise this role. It’s plausible to suppose that this can be a role for bioethicists but it’s unreasonable to insist that all bioethicists should be moral critics.

The Principles of Biomedical Ethics by Tom L Beauchamp and James F Childress which is now in its fourth edition has had a great influence on the development of bioethics through its exposition of a theory based on the four principles: respect for autonomy; non-maleficence; beneficence, and justice (1). The theory is developed as a common-morality theory, and the present paper attempts to show how this approach, starting from American common-morality, leads to an underdevelopment of beneficence and justice, and that (...) the methods offered for specification and balancing of principles are inadequate. (shrink)

This paper argues that a precautionary approach to scientific progress of the sort advocated by Walter Glannon with respect to life-extending therapies involves both incoherence and irresolvable paradox. This paper demonstrates the incoherence of the precautionary approach in many circumstances and argues that with respect to life-extending therapies we have at present no persuasive reasons for a moratorium on such research.

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 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)

Research into the mechanisms of aging has suggested the possibility of extending the human life span. But there may be evolutionary biological reasons for senescence and the limits of the cell cycle that explain the infirmities of aging and the eventual demise of all human organisms. Genetic manipulation of the mechanisms of aging could over many generations alter the course of natural selection and shift the majority of deleterious mutations in humans from later to earlier stages of life. This could (...) harm people in the distant future by making them more susceptible to premature disease and mortality. Thus there are biological and moral reasons to carefully consider the implications of exploiting this technology on a broad scale to extend the lives of people in the present and near future. (shrink)

It is striking that some arguments in the bioethical literature seem implausible, counterintuitive, and even ridiculous when reported to competent moral agents. When examined, these arguments bear uncanny resemblances to the discourse of patients with debilitating mental disorders. I examine the kinds of irrationality involved, and discuss the fact that such irrationality is worrying in a discipline that purports to serve as a guide for real‐life practical reasoning. I offer some thoughts about correctives that we might use to temper some (...) of the odd opinions that bedevil our subject in the name of ethical analysis. It seems that one ought to be suspicious of neatly rational arguments that produce counterintuitive conclusions, but the alternative seems to be that we explore new constructions of old problems in Bioethics such that our discussion of them does justice to what we regard as of fundamental significance to our lives together as human beings. (shrink)

Increasingly, medicine is used to remodel, revise, and revamp as much as to heal and mend. It is tempting to say that people make merely personal choices about these new uses. But such choices have implications for everybody, and they ought to be made cautiously, slowly, and in a way that opens them to discussion.

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

Bioethics has been subject to considerable social criticism in recent years. One criticism that has caused particular discomfort in the bioethics community is that bioethicists, because of the way their work is funded, are involved in profound conflicts of interest that undermine their title to be considered independent moral commentators on developments in biomedicine and biotechnology. This criticism draws its force from the assumption that bioethics is, or ought to be, a type of normative social criticism. Versions of this criticism (...) come from both the political left and right. For instance, such criticisms include allegations that bioethics is inherently socially conservative, that it is inherently “pro-technology”, that it lays spurious claims to moral and social authority and expertise, that its focus on autonomy links it to neoliberal theories of choice, and that it is an ideological mystification of real social relationships and political power. This commentary paper analyses the problem of bioethical conflict of interest, and argues that the types of conflict of interest facing bioethics are inherent to the role of “public intellectual” that bioethicists generally wish to assume. The paper defends this conception of the role of the bioethicist, arguing that bioethicists should be interested and openly so. (shrink)

Principle-based formulations of bioethical theory have recently come under increasing scrutiny, particularly insofar as they give prominence to personal autonomy. This essay critiques the dominant conceptualization of autonomy and urges an alternative formulation freed from the individualistic assumptions that pervade the prevailing framework. Drawing on feminist perspectives, I discuss the need for a vision of patient autonomy that joins relational experiences to individuality and acknowledges the influence of patterns of power and authority on the exercise of patient agency. Deficiencies in (...) the current models of science and social relations guiding medical practice are analyzed, particularly (1) the tendency to disregard the patients self-knowledge and (2) failure to recognize limitations on the generalizability of medical knowledge. Models of social relations such as mothering and friendship are explored to advance a conception of autonomy better suited to the practical activities of medicine. In conclusion, I consider how acknowledgement of the specificity and complexity of social relations can contribute to reconfiguration of other principles comprising the standard framework of bioethics, particularly beneficence, justice, and equality. (shrink)

Two of the most important political movements of the late twentieth century are those of environmentalism and feminism. In this book, Val Plumwood argues that feminist theory has an important opportunity to make a major contribution to the debates in political ecology and environmental philosophy. _Feminism and the Mastery of Nature_ explains the relation between ecofeminism, or ecological feminism, and other feminist theories including radical green theories such as deep ecology. Val Plumwood provides a philosophically informed account of the relation (...) of women and nature, and shows how relating male domination to the domination of nature is important and yet remains a dilemma for women. (shrink)

Controversies about abortion and women's reproductive technologies often seem to reflect personal experience, religious commitment, or emotional response. Laura M. Purdy believes, however, that coherent ethical principles are implicit in these controversies and that feminist bioethics can help clarify the conflicts of interest which often figure in human reproduction. As she defines the underlying issues, Purdy emphasizes the importance of taking women's interests fully into account. Reproducing Persons first explores the rights and duties connected with conception and pregnancy. Purdy asks (...) whether conceiving a child or taking a pregnancy to term can ever be morally wrong. She challenges the thinking of those who feel the prospect of disability or serious genetic disease should not constrain conception or justify abortion. The essays next look at abortion from a variety of angles. One contends that killing fetuses is not murder; others emphasize the moral importance of access to abortion. Purdy considers the conflicting interests of women and men regarding abortion, and argues against requiring a husband's consent. The book concludes with a consideration of new reproductive technologies and arrangements, including the controversial issue of surrogacy, or contract pregnancy. Throughout, Purdy combines traditional utilitarianism with some of the most powerful insights of contemporary feminist ethics. Her provocative essays create guidelines for approaching new topics and inspire fresh thinking about old ones. (shrink)