Search

The central thesis of this article is that by anchoring bioethics' core conceptual armamentarium in a four-principled theory emphasizing autonomy and treating justice as a principle of allocation, theorists inadvertently biased 20th-century bioethical scholarship against addressing such subjects as ableism, anti-Black racism, classism, and other forms of discrimination, placing them outside of the scope of bioethics research and scholarship. It is also claimed that these scope limitations can be traced to the displacement of the nascent concept of respect for persons-a concept designed to address classist and racist discrimination-with the morally solipsistic concept of autonomy., (© 2023 John Wiley & Sons Ltd.)

Tom Beauchamp and James Childress's revolutionary textbook, Principles of Biomedical Ethics, shaped the field of bioethics in America and around the world. Midway through the Principle's eight editions, however, the authors jettisoned their attempt to justify the four principles of bioethics -autonomy, beneficence, nonmaleficence, justice-in terms of ethical theory, replacing it with the idea that these principles are part of a common morality shared by all rational persons committed to morality, at all times, and in all places. Other commentators contend that their theory has never been empirically confirmed and is unfalsifiable, since counterexamples can be deemed irrational, or as held by those living lives not committed to morality. The thesis of this paper is that common morality theory is the artifact of a category mistake-conflating common areas regulated by moral norms with common norms regulating moral conduct-that accords mid-twentieth century American liberal morality the status of transcultural, transtemporal, eternal moral truths. Such a conception offers bioethicists no tools for analyzing moral change-moral progress, regress, reform, evolution, devolution, or revolution-no theoretical basis for deconstructing structural classicism, racism, and sexism, or for facilitating international cooperation on ethical issues in the context of culturally based moral differences.

Although bioethics societies are developing standards for clinical ethicists and a code of ethics, they have been castigated in this journal as "a moral, if not an ethics, disaster" for not having completed this task. Compared with the development of codes of ethics and educational standards in law and medicine, however, the pace of professionalization in bioethics appears appropriate. Assessed by this metric, none of the charges leveled against bioethics are justified. The specific charges leveled against the American Society for Bioethics and Humanities (ASBH) and its Core Competencies report are analyzed and rejected as artifacts of an ahistoric conception of the stages by which organizations professionalize. For example, the charge that the ASBH should provide definitive criteria for what counts as "medical ethics consultation" antecedent to further progress towards professionalization is assessed by comparing it with the American Medical Association's decades-long struggle to define who can legitimately claim the title "medical doctor." Historically, clarity about who is legitimately a doctor, a lawyer - or a "clinical ethicist"- is a byproduct of, and never antecedent to, the decades-long process by which a field professionalizes. The charges leveled against ASBH thus appear to be a function of impatient, ahistoric perfectionism.

Philosophy textbooks typically treat bioethics as a form of "applied ethics"-i.e., an attempt to apply a moral theory, like utilitarianism, to controversial ethical issues in biology and medicine. Historians, however, can find virtually no cases in which applied philosophical moral theory influenced ethical practice in biology or medicine. In light of the absence of historical evidence, the authors of this paper advance an alternative model of the historical relationship between philosophical ethics and medical ethics, the appropriation model. They offer two historical case studies to illustrate the ways in which physicians have "appropriated" concepts and theory fragments from philosophers, and demonstrate how appropriated moral philosophy profoundly influenced the way medical morality was conceived and practiced.

Standard bioethics textbooks present the field to students and non-experts as a form of "applied ethics." This ahistoric and rationalistic presentation is similar to that used in philosophy of science textbooks until three decades ago. Thomas Kuhn famously critiqued this self-conception of the philosophy of science, persuading the field that it would become deeper, richer, and more philosophical, if it integrated the history of science, especially the history of scientific change, into its self-conception. This essay urges a similar reconceptualization for bioethics, arguing that the analysis of moral change ought to be integral to bioethics (and to ethics generally). It proceeds by suggesting the sterility of the ahistoric, rationalist applied ethics model of bioethics embraced by standard bioethics textbooks. It also suggests the fecundity of alternative conceptions of the bioethics that focus on the history of successful and failed attempts to negotiate moral change, and the history of multifaceted relations between moral philosophy and practical ethics.

Can the bioethical theories that have served American bioethics so well, serve international bioethics as well? In two papers in the previous issue of the Kennedy Institute of Ethics Journal, I contend that the form of principlist fundamentalism endorsed by American bioethicists like Tom Beauchamp and Ruth Macklin will not play on an international stage. Deploying techniques of postmodern scholarship, I argue that principlist fundamentalism justifies neither the condemnation of the Nazi doctors at Nuremberg, nor, as the Report of the Advisory Committee on the Human Radiation Experiments (ACHRE) demonstrates, condemnation of Cold War radiation researchers. Principlist fundamentalism thus appears to be philosophy bankrupt. In this issue of the Journal, Beauchamp and Macklin reject this claim, arguing that I have misread the ACHRE report and misunderstood Nazism. They also argue that the form of post-postmodern negotiated human rights theory that I proffer is adequate only insofar as it is itself really fundamentalist; insofar as I take postmodernism seriously, however, I mire international bioethics in relativism. In this response, I reaffirm my anti-fundamentalism, provide further evidence in support of my reading of the ACHRE report, and defend my post-postmodern version of rights theory. I also develop criteria for a minimally adequate theoretical framework for international bioethics.

The preceding article in this issue of the Kennedy Institute of Ethics Journal presents the argument that "moral fundamentalism," the position that international bioethics rests on "basic" or "fundamental" moral prinicples that are universally accepted in all eras and cultures, collapses under a variety of multicultural and postmodern critiques. The present article looks to the contractarian tradition of Hobbes and Locke -- as reinterpreted by David Gauthier, Robert Nozick, and John Rawls -- for an alternative justification for international bioethics. Drawing on the central themes of this tradition, it is argued that international bioethics can be rationally reconstructed as a negotiated moral order that respects culturally and individually defined areas of nonnegotiability. Further, the theory of a negotiated moral order is consistent with traditional ideals about human rights, is flexible enough to absorb the genuine insights of multiculturalism and postmodernism, and yet is strong enough to justify transcultural and transtemporal moral judgments, including the condemnation of the Nazi doctors at Nuremberg. This theory also is consistent with the history of the ethics of human subjects experimentation and offers insights into current controversies such as the controversy over changing the consent rule for experiments in emergency medicine and the controversy over exempting certain clinical trials of inexpensive treatments for preventing the perinatal transmission of AIDS from the ethical standards of the sponsoring country.

The first of two articles analyzing the justifiability of international bioethical codes and of cross-cultural moral judgments reviews "moral fundamentalism," the theory that cross-cultural moral judgments and international bioethical codes are justified by certain "basic" or "fundamental" moral priniciples that are universally accepted in all cultures and eras. Initially propounded by the judges at the 1947 Nuremberg Tribunal, moral fundamentalism has become the received justification of international bioethics, and of cross-temporal and cross-cultural moral judgments. Yet today we are said to live in a multicultural and postmodern world. This article assesses the challenges that multiculturalism and postmodernism pose to fundamentalism and concludes that these challenges render the position philosophically untenable, thereby undermining the received conception of the foundations of international bioethics. The second article, which follows, offers an alternative model -- a model of negotiated moral order -- as a viable justification for international bioethics and for transcultural and transtemporal moral judgments.

The author responds to the article "Were the Pioneer Clinical Ethics Consultants Outsiders? For Them, Was Critical Distance That Critical?" by B. D. White, W. N. Shelton and C. J. Rivais, that was published within the issue. Topics discussed include the history of clinical ethics consultation in the U.S., the reasons why physicians brought philosophers into ethics committees, and the changes in patients' attitudes following the enactment of the 1964 Civil Rights Act.

The article presents the author's view regarding the medical profession known as clinical ethics consultant. Topics discussed include a brief history concerning the evolution of the medical profession in the Western world, the significance of the initiatives proposed by the professional organization American Society for Bioethics and Humanities for the evaluation of the medical profession, and the author's trial application and assessment of the Ethics Consultation Quality Assessment Tool.

This brief essay describes the purpose, the content, and the development, by a group of Hastings Center fellows and a scholar at the Center, of the Hastings Center Bioethics Timeline. The timeline covers the wide range of contemporary events pertaining to the intersection of bioethics with the medical and biological sciences, health care, and health policy, as well as the medical arts and medical humanities. A collaborative effort that documents events in a collaborative field, the timeline is meant to be updated and edited so that it improves over time. [ABSTRACT FROM AUTHOR]

Philosophy textbooks typically treat bioethics as a form of «applied ethics»-i.e., an attempt to apply a moral theory, like utilitarianism, to controversial ethical issues in biology and medicine. Historians, however, can find virtually no cases in which applied philosophical moral theory influenced ethical practice in biology or medicine. In light of the absence of historical evidence, the authors of this paper advance an alternative model of the historical relationship between philosophical ethics and medical ethics, the appropriation model. [ABSTRACT FROM AUTHOR]

In this article, the author analyses the description of bioethics as death and dying being an intrinsic part of life as discussed in the book "On Death and Dying" by Elisabeth Kübler-Ross. Topics include healthcare professionals coping with a terminal prognosis, five stages by which dying patients process and cope with a terminal prognosis such as denial, anger and acceptance, and side-effect of professionalization.

Bioethicists function in an environment in which their peers—healthcare executives, lawyers, nurses, physicians—assert the integrity of their fields through codes of professional ethics. Is it time for bioethics to assert its integrity by developing a code of ethics? Answering in the affirmative, this paper lays out a case by reviewing the historical nature and function of professional codes of ethics. Arguing that professional codes are aggregative enterprises growing in response to a field's historical experiences, it asserts that bioethics now needs to assert its integrity and independence and has already developed a body of formal statements that could be aggregated to create a comprehensive code of ethics for bioethics. A Draft Model Aggregated Code of Ethics for Bioethicists is offered in the hope that analysis and criticism of this draft code will promote further discussion of the nature and content of a code of ethics for bioethicists. [ABSTRACT FROM AUTHOR]

Comments on the study by Tod Chambers on the use of narrative discourse in bioethics which was published in the December 2001 issue of `The American Journal of Bioethics.' Format of cases presented; Role of principles in solving dilemmas.

The article discusses the development of the Code of Ethics for Health Care Ethics Consultatns (HCECs) published by the American Society for Bioethics and Humanities (ASBH). Topics covered include the Clinical Ethics Consultation Affairs (CECA) committee assigned by ASBH to write the code that employed content analysis and involved governmental bodies and institutional review boards for a broader scope of the code. Also mentioned are commitment of members to competency and conflict management.

Comments on the article "A Defense of Unqualified Confidentiality," by Kenneth Kipnis, which appeared in the 2006 issue of "The American Journal of Bioethics." Views on the argument of Kipnis that exceptionless confidentiality is the better policy; Strengths and limitations of the article; Argument against Kipnis's theories.

Presents a reply to comments on the article "A Draft Model Aggregated Code of Ethics for Bioethicists." Application of codes of ethics in the fields of physical sciences, social sciences and in applied fields; Philosophical justification for a bioethics code; Role of bioethicists in providing advice, analysis and scholarship about ethical issues in biomedicine and healthcare.

Provides information on a conference on ethics and epidemic held in March 2004. Sponsors of the conference; Topics covered by conference presentations; Highlights of the event.