Bioethics developed as an academic and clinical discipline during the later part of the 20th century due to a variety of factors. Crucial to this development was the increased secularization of American culture as well as the dissolution of medicine as a quasi-guild with its own professional ethics. In the context of this moral vacuum, bioethics came into existence. Its raison d’être was opposition to the alleged paternalism of the medical community and traditional moral frameworks, yet at the same time it set itself up as a source of moral authority with respect to biomedical decision making. Bioethics serves as biopolitics in so far as it attempts to make determinations about how individuals ought to make medical decisions and then attempts to codify that in law. Progressivism and secularism are ultimately the ideology of bioethics.
This volume brings together a set of critical essays on the thought of Professor Doctor H. Tristram Engelhardt Junior, Co-Founding Editor of the Philosophy and Medicine book series. Amongst the founders of bioethics, Professor Engelhardt, Jr. looms large. Many of his books and articles have appeared in multiple languages, including Italian, Romanian, Portuguese, Spanish, and Chinese. The essays in this book focus critically on a wide swath of his work, in the process elucidating, critiquing, and/or commending the rigor and reach of his thought. This volume compasses analyses of many different aspects of Engelhardt's work, including social and political philosophy, biopolitics, the philosophy of medicine, and bioethics. It brings together internationally known scholars to assess key elements of Engelhardt's work.
Several studies have argued that there is a correlation between short stature and negative experiences and characteristics, such as social discrimination, economic disadvantage, health problems (especially for men). The idea that short men have a disadvantage in social interactions and in partner choices is also widespread in popular culture and common knowledge. It is now possible to use recombinant human growth hormone (hGH) to treat children with idiopathic short stature (ISS), namely children who are shorter than average for unknown medical reasons. Critics argue that there is a lack of evidence of both psychological distress caused by short stature and the efficacy of the treatment in increasing children’s well-being. This controversy is reflected in international drug evaluations: while the Food and Drug Administration (FDA) in the US granted marketing authorisation for hGH for children with ISS in 2003, the European Medicines Agency (EMA) refused it in 2007. The research presented here had two aims: first, to identify and analyse the norms, values and assumptions about short stature and the use of hGH treatment for children with ISS, found within sociocultural, philosophical and regulatory discussions of these, and within narrated lived experiences of short stature. Second, to critically and reflectively discuss how these analyses contribute to bioethical debates on the use of hGH treatment for children with ISS. It employs what it calls a critical paediatric bioethics theoretical approach, which deems as important to carefully analyse different reasoning, conceptualisations and arguments around the object of study, through a self-reflective analysis that is also sceptical about other forms of problematisation, and that combines philosophical analyses while being open to social implications and drawing upon empirical methods. The first article proposes a critical understanding of medicalisation as both a concept and a phenomenon, and explores what insights such critical understanding brings to ethical discussions about hGH for ISS. It argues that three main ethical issues concern the medicalisation of short stature: the downplayed role of the qualitative dimension of short stature, the justification of the treatment (as sometimes based on uncritically assumed social beliefs and unrealistic parental expectations), and possible misconduct of stakeholders. The second article examines the arguments for and against granting marketing authorisation of hGH treatment for the indication of ISS presented in selected FDA and EMA documents. It combines argumentative analysis with an approach to policy analysis called ‘what’s the problem represented to be’ and focuses on underlying assumptions and presuppositions about short stature and hGH treatment for ISS. It then discusses these arguments through the relational, experiential and cultural understandings of disability, and argues that the choice about whether to give hGH is not merely a choice based on efficacy and safety, but requires an examination of the values that we transmit by that choice. The third article examines how and why attendance to lived experiences of height is needed in bioethical and biomedical discussions of hGH treatment for children with ISS. It first describes what it defines as the ‘problem-oriented’ approach to the debate about hGH treatment for children with ISS. It then offers a sociophenomenological analysis of whether and, if so, when and how, height matters to the interviewed people in the Netherlands who are shorter than average without any known medical reasons. The sociophenomenological analysis shows the richness of meanings of lived experiences of short stature that cannot be captured by the problem-oriented approach, and suggests complementing clinical practices with narrative approaches. This research contributes to the ethical debate about using hGH for children with ISS, setting a critical gaze onto the social perception of short stature, highlighting some ethical challenges met by stakeholders involved at different levels (such as families, medical professionals and policy makers), and providing new insights into how to address these ethical issues. It is, therefore, of interest to stakeholders, bioethicists and lay people willing to explore alternative ways to address such bioethical dilemmas, and other paediatric interventions that aim to normalise children’s bodily characteristics.
Leading bioethicists from America, Asia and Europe discuss Jahr's visionary concept of an ethics of 'bios', integrating the ethics of land, community, health, and culture in light of global challenges in the 21st century.
In only four decades, bioethics has transformed from a fledgling field into a complex, rapidly expanding, multidisciplinary field of inquiry and practice. Its influence can be found not only in our intellectual and biomedical institutions, but also in almost every facet of our social, cultural, and political life. This volume maps the remarkable development of bioethics in American culture, uncovering the important historical factors that brought it into existence, analyzing its cultural, philosophical, and professional dimensions, and surveying its potential future trajectories. Bringing together a collection of original essays by seminal figures in the fields of medical ethics and bioethics, it addresses such questions as the following: - Are there precise moments, events, socio-political conditions, legal cases, and/or works of scholarship to which we can trace the emergence of bioethics as a field of inquiry in the United States? - What is the relationship between the historico-causal factors that gave birth to bioethics and the factors that sustain and encourage its continued development today? - Is it possible and/or useful to view the history of bioethics in discrete periods with well-defined boundaries? - If so, are there discernible forces that reveal why transitions occurred when they did? What are the key concepts that ultimately frame the field and how have they evolved and developed over time? - Is the field of bioethics in a period of transformation into biopolitics? Contributors include George Annas, Howard Brody, Eric J. Cassell, H. Tristram Engelhardt Jr., Edmund L. Erde, John Collins Harvey, Albert R. Jonsen, Loretta M. Kopelman, Laurence B. McCullough, Edmund D. Pellegrino, Warren T. Reich, Carson Strong, Robert M. Veatch, and Richard M. Zaner.
Before curing was a possibility, medicine was devoted to the relief of suffering. Attention to the relief of suffering often takes a back seat in modern biomedicine. This book seeks to place suffering at the center of biomedical attention, examining suffering in its biological, psychological, clinical, religious, and ethical dimensions.
Advances in our understanding of the brain and rapid advances in the medical practice of neurology are creating questions and concerns from an ethical and legal perspective. Ethical and Legal Issues in Neurology provides a detailed review of various general aspects of neuroethics, and contains chapters dealing with a vast array of specific issues such as the role of religion, the ethics of invasive neuroscience research, and the impact of potential misconduct in neurologic practice. The book focuses particular attention on problems related to palliative care, euthanasia, dementia, and neurogenetic disorders, and concludes with examinations of consciousness, personal identity, and the definition of death. This volume focuses on practices not only in North America but also in Europe and the developing world. It is a useful resource for all neuroscience and neurology professionals, researchers, students, scholars, practicing clinical neurologists, mental health professionals, and psychiatrists. - A comprehensive introduction and reference on neuroethics - Includes coverage of how best to understand the ethics and legal aspects of dementia, palliative care, euthanasia and neurogenetic disorders - Brings clarity to issues regarding ethics and legal responsibilities in the age of rapidly evolving brain science and related clinical practice
This book argues that legal theory provides a jumping-off point for the study of controversial topics related to the work of Practicing Healthcare Ethicists (PHEs). Healthcare ethics consultation has had a place in healthcare for many decades yet the nature of the work is not well understood by many of its critics as well as its defenders. PHEs have been described as compromised and ineffectual, politicised and undemocratic, and their promise to offer sound advice has been deemed irredeemably incoherent in the context of value pluralism. Legal theorists have long attended to the relationship between law and morality, and the supposed tension between democracy and the role of an expert judiciary. An appreciation that these debates are not unique to the practice of healthcare ethics can help PHEs to engage critics with a renewed confidence and some fresh approaches to perennial, and hitherto unproductive, arguments. This book will be of great interest to practicing healthcare ethicists, as well as those who rely upon their services (healthcare professionals and healthcare leaders, patients, and their families) as well as academics working in the broader field of bioethics.
Perhaps no other field of medicine illustrates the ethical dilemmas occasioned by the explosion of technology more than neurology. Many dilemmas which at first appear to be ethical, however, are actually biotechnical, informational, or interpersonal in nature. For those which are, indeed, ethical, a review of existing information and acquisition of additional data can often serve to identify the proper response. When the optimal course of action remains unclear, the comprehensive, structured approach described in this chapter is both philosophically rigorous and clinically relevant. It takes into account a variety of critical considerations – including rights, duties, consequences, virtues, and similar cases – while utilizing both inductive and deductive methods. The end result is the “least bad” of available options, or, at the very least, a practical response which preserves future options and avoids crucial mistakes.
The moral theology of Hans G. Ulrich is presented here in English for the first time. These collected essays represent the culmination of a lifetime of reflection on Christian living from this German theologian in conversation with Luther, Bonhoeffer, and contemporary philosophers and theologians. Ulrich's ethics affirm the lively presence of the living work of God in orienting the daily life of Christians. This presence enables members of the Church to live as creatures trusting in God's promises, bearing witness in political and economic spheres, and trusting in life as a gift in response to bioethical issues. Ulrich's fresh take on living out of the promise of God yields further guidance on issues in international relations, economics, parenting, disability, and more.
