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The Ethics of Bioethics

Mapping the Moral Landscape

edited by Lisa A. Eckenwiler and Felicia G. Cohn

Publication Year: 2007

Stem cell research. Drug company influence. Abortion. Contraception. Long-term and end-of-life care. Human participants research. Informed consent. The list of ethical issues in science, medicine, and public health is long and continually growing. These complex issues pose a daunting task for professionals in the expanding field of bioethics. But what of the practice of bioethics itself? What issues do ethicists and bioethicists confront in their efforts to facilitate sound moral reasoning and judgment in a variety of venues? Are those immersed in the field capable of making the right decisions? How and why do they face moral challenge—and even compromise—as ethicists? What values should guide them? In The Ethics of Bioethics, Lisa A. Eckenwiler and Felicia G. Cohn tackle these questions head on, bringing together notable medical ethicists and people outside the discipline to discuss common criticisms, the field’s inherent tensions, and efforts to assign values and assess success. Through twenty-five lively essays examining the field’s history and trends, shortcomings and strengths, and the political and policy interplay within the bioethical realm, this comprehensive book begins a much-needed critical and constructive discussion of the moral landscape of bioethics.

Published by: The Johns Hopkins University Press

Contents

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pp. v-vii

List of Contributors

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pp. ix-xi

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Foreword

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pp. xiii-xvi

This collection of essays marks an important milestone in the maturation of bioethics. In 1995 I published a book on the nature of moral consensus called Deciding Together. As should happen when an author is truly grappling with the material, I was surprised by the direction I felt impelled to pursue in the last

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Acknowledgments

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pp. xvii-

This book was inspired by our experiences as two professionals now in the early middle of our careers working in bioethics. One of us is a philosopher by training, working in an academic philosophy department, while the other is grounded in religious studies and based in a university medical center. One...

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Introduction

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pp. xix-xxx

Over the course of four decades, bioethics has come to be recognized as an authoritative field. Indeed, many would argue that the field has come of age. Increasingly, bioethicists are sought after for their expertise—in clinical research and in government, legal, corporate, and community contexts—by universities...

PART I: SITUATING BIOETHICS: WHERE HAVE WE BEEN? WHERE SHOULD WE BE GOING?

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1 Analyzing Pandora’s Box: The History of Bioethics

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pp. 3-23

The definitive history of bioethics has yet to be written. That is not surprising since bioethics in its modern American incarnation is only about fifty years old. But the future historian will have a mountain of source material, for nearly everyone involved in the field has written about some clinical dilemma, legal ruling...

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2 A History of Codes of Ethics for Bioethicists

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pp. 24-40

Bioethicists 1 function in an environment in which most of their peers embrace codes of professional ethics. 2 Some bioethicists challenge this claim on the grounds that bioethics is really an academic discipline and such disciplines do not usually subscribe to codes of ethics (Lantos 2005). Although it is true that...

PART II: BIOETHICS AND THE PROBLEMS OF EXPERTISE

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3 The Tyranny of Expertise

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pp. 43-46

When I was in medical school and first began seeing hospital patients, there was something about the way the patients behaved that embarrassed me. It was an issue of manners. In South Carolina, where I grew up, we still say “ma’am” and “sir” to our elders. It is a sign of respect. I grew up saying “yes ma’am” and...

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4 Trusting Bioethicists

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pp. 47-55

It’s spring of 1972. I’m in the basement of my college library, surer than ever that I want to become a philosopher, so I’m thinking that I should start getting to know the professional literature. A new journal catches my eye. Its cover is bright, for a start, and the title—Philosophy and Public Affairs—is intriguing, too. Maybe...

PART III: CONTRIBUTIONS AND CONFLICTS: POLICY AND POLITICS

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5 Intellectual Capital and Voting Booth Bioethics: A Contemporary Historical Critique

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pp. 59-73

The age that gave birth to bioethics fairly teemed with public intellectuals offering every manner of sometimes incendiary critique of science, medicine, technology, and society (Stevens 2003). Do bioethicists today serve the public as did these intellectual predecessors? Considering the sheer tonnage of paper...

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6 Bioethics and Society: From the Ivory Tower to the State House

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pp. 74-82

Controversies in bioethics routinely land in legislatures, before governors and presidents, or in court. The question whether to withdraw artificial nutrition and hydration from Terri Schiavo was an extreme example—it generated statutes by the Florida legislature and by Congress, intervention by Governor Jeb Bush and...

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7 Democratic Ideals and Bioethics Commissions: The Problem of Expertise in an Egalitarian Society

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pp. 83-94

Being a bioethicist is a funny thing. It makes one welcome in polite social conversation in a way that being called a philosopher does not. “Bioethics” immediately suggests some familiar issues to the news-savvy public. Names such as Quinlan, Cruzan, Kevorkian, and Schiavo have each been familiar to many...

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8 The Endarkenment

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pp. 95-107

In March 2005, the Washington Post broke the news that then-chairman Leon Kass and others appointed by George W. Bush to his “President’s Council on Bioethics” (PCB), purportedly acting as private citizens and not as members and sta¤ of the council, had been meeting privately for months to develop and...

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9 Left Bias in Academic Bioethics: Three Dogmas

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pp. 108-117

In what follows, I argue: (1) that there is left bias in academic bioethics, and (2) that academic bioethics’ left bias is a problem that warrants remediation. I use the term left bias to designate systematic favoritism toward political positions and ideas that characterize the “left” in the United States—i.e., the side occupied primarily by Democrats in what amounts to a two-party system...

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10 Bioethics as Politics: A Critical Reassessment

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pp. 118-133

Bioethics is biopolitics, although it is surely not only politics, because it is a medical morality that has been understood in terms of the political agendas it can serve. It is impossible to appreciate the rapid emergence of bioethics at the end of the twentieth century apart from its roles in authorizing health care policy and...

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11 ASBH and Moral Tolerance

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pp. 134-143

I just got off the phone with my colleague Steve Miles. He’s helping me with a poetry compilation on the downside of war. We’re designing the cover. He said, “I’ve got a good picture of a guy with a severed ear I could send you.” And I thought, Hmm . . . Do I want to use the photo of the guy sans ear? Or, instead...

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12 Bioethics as Activism

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pp. 144-157

In recent years, discussions of bioethics and activism have often devolved into debate about whether bioethicists, and especially bioethical organizations (like the American Society for Bioethics and Humanities, ASBH), ought to adopt substantive moral positions on particular issues (Nelson 2001a; Antommaria 2004)...

PART IV: CONTRIBUTIONS AND CONFLICTS: CONSULTATION IN THE CLINIC AND THE CORPORATE WORLD

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13 Ethics on the Inside?

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pp. 161-170

Bioethics has become “an accommodating handmaiden” (Callahan 1996, 3) to the biomedical sciences, and in so doing, has “sold out” (Loewy 2002, 388). So goes the concern, raised by a number (albeit a small one) of passionate voices in the field. It is a very troubling worry, one that merits serious consideration. In this...

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14 Strategic Disclosure Requirements and the Ethics of Bioethics

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pp. 171-180

Although there are historical, conceptual, and economic obstacles that make it difficult to address the ethics of bioethics, the need for such reflection is made more urgent by the growing commercialization of science and academia. Over the last twenty-five years, a number of forces have spurred this...

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15 Ties without Tethers: Bioethics Corporate Relations in the AbioCor Artificial Heart Trial

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pp. 181-190

My objective in this essay is not to argue the broader question whether bioethicists should become involved with corporations or, if so, under what conditions. Rather, I describe one arrangement in which a corporation-bioethics relationship seemed to work well, with minimal opportunities for the kinds of potential...

PART V: DEFFINING VALUES AND OBLIGATIONS

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16 Of Courage, Honor, and Integrity

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pp. 193-204

I have, for some time, written about the importance of character for the work of health care ethics consultation in the clinical setting (e.g., Baylis 1989, 1994, 1999, 2004; Baylis and Brody 2003; Webster and Baylis 2000). In these writings I have asked and answered the questions: “What kind of person should the health...

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17 I Want You: Notes toward a Theory of Hospitality

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pp. 205-219

Here we all are, in the room of bioethics, or rather in “the field” of bioethics, for that word describes—or rather reveals—the linguistic echo of a particular sort of relationship among us, in which the human work had to do with land, borders, property, and the harvest or the failure of the crop. Taking a careful, word-by-word...

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18 Learning to Listen: Second-Order Moral Perception and the Work of Bioethics

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pp. 220-228

Bioethics is a practice, in Alasdair MacIntyre’s sense of the word: a complex social activity that changes through time and has its own internal goals and excellences (MacIntyre 1981). I have argued elsewhere that a central, defining goal of our field is encouraging moral development in ourselves and in those we serve...

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19 Global Health Inequalities and Bioethics

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pp. 229-240

What moral issues belong at the heart of bioethics rather than on the periphery of the field? Although priority setting and resource allocation in medicine and health care are important topics for bioethicists, few publications in bioethics explicitly address what priorities ethicists should have when crafting research...

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20 White Normativity in U.S. Bioethics: A Call and Method for More Pluralist and Democratic Standards and Policies

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pp. 241-259

When reflecting on the cultural practices of academics, we cannot separate questions about knowledge construction from questions about standpoints based on ethnicity, class, gender, sexual orientation, physical abilities or disabilities, religion, nation, and/or academic discipline. In bioethics, however, we have not...

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21 Mentoring in Bioethics: Possibilities and Problems

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pp. 260-269

While delaying the preparation of this essay on mentoring in bioethics—and wondering why, in a moment of weakness, I had blithely agreed to write it—I had opportunities to interact with several former graduate students, as well as a few former teachers, and these interactions reminded me just how much I have...

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22 Obligations to Fellow and Future Bioethicists: Publication

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pp. 270-277

Ludwig Wittgenstein once likened doing philosophy to swimming under water— there is an almost irresistible temptation to come up for air. Many bioethicists, I dare say, feel the same way about writing for publication. We’re tempted to surface when we stare for an hour or so at that blank first page, when the...

PART VI: ASSESSING BIOETHICS AND BIOETHICISTS

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23 The Virtue of Attacking the Bioethicist

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pp. 281-287

Recently I was working on an essay in which I wanted to examine the criticism raised against bioethics by Renée Fox and Judith Swazey. In an article titled “Medical Morality Is Not Bioethics” (1984), these two sociologists of medicine describe their fieldwork experience in China and compare it to H. Tristram Engelhardt’s...

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24 Social Moral Epistemology and the Role of Bioethicists

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pp. 288-296

As a species of practical ethics, bioethics aims not just at achieving a better understanding of ethical problems, but at understanding ethical problems in ways that contribute to morally better actions and policies. Given that the ultimate aim of bioethics is practical, those who claim the title of bioethicist ought to think hard...

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25 The Glass House: Assessing Bioethics

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pp. 297-309

Bioethics is a relatively young field that is principally concerned with moral reflection upon and reform of practices associated with medicine and biomedical science. Despite its youth, it seems to have acquired quite a reputation. Significantly, bioethics is often viewed as more willing to critically examine others than...

Index

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pp. 311-320


E-ISBN-13: 9780801892264
E-ISBN-10: 0801892260
Print-ISBN-13: 9780801886126
Print-ISBN-10: 0801886120

Page Count: 352
Publication Year: 2007

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Subject Headings

  • Bioethics.
  • Professional ethics.
  • Medical ethics.
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