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Bioethics In Social Context

Barry Hoffmaster

Publication Year: 2001

The problems of bioethics are embedded in people's lives and social worlds. They are shaped by individual biographies and relationships, by the ethos and institutions of health care, by economic and political pressures, by media depictions, and by the assumptions, beliefs, and values that permeate cultures and times. Yet these forces are largely ignored by a professional bioethics that concentrates on the theoretical justification of decisions.

The original essays in this volume use qualitative research methods to expose the multiple contexts within which the problems of bioethics arise, are defined and debated, and ultimately resolved. In a provocative concluding essay, one contributor asks his fellow ethnographers to reflect on the ethical problems of ethnography.

Published by: Temple University Press

Contents

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pp. v-vi

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Acknowledgments

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pp. vii-

The chapters in this volume are the culmination of three meetings of the Humanizing Bioethics research group that were held in London, Ontario. We are very grateful to the Social Sciences and Humanities Research Council of Canada for supporting this project and making this book possible (grant 806-93-0051). ...

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Introduction

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pp. 1-11

Bioethics has been preoccupied with making judgments about troublesome moral problems and justifying those judgments, with doing what has been aptly called “quandary ethics.”1 Following the lead of philosophical ethics, justification is regarded as a matter of providing “good reasons” for judgments, and that, in turn, is taken to require an appeal to moral rules or principles or to moral theories. Bioethics, in this view, is situated in rationality and generality. ...

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1. Clinical Narratives and Ethical Dilemmas in Geriatrics

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pp. 12-38

By now the critique of traditional bioethics, based on tenets of Western philosophical rationalist thought (Marshall 1992), is well known in the medical social sciences. Clinicians and others have commented on the remoteness or ineffectiveness of moral theory for actual problem solving (Anspach 1993; Hoffmaster 1992, 1994; Smith and Churchill 1986). Social scientists have noted the lack of attention to culture, ethnicity, and economics in North American bioethics and the primacy it grants individualism and self-determination as these notions have emerged in the Western...

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2. Situated Ethics, Culture, and the Brain Death “ Problem” in Japan

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pp. 39-68

Anthropologists are trained to be inherently skeptical of generalizations—to be alert to boundaries, margins, and differences. Most, but not all, of us are “splitters” in Tambiah’s idiom (1990); that is, we seek to relativize information by situating it in context. Moreover, to the majority of anthropologists, contextualization intuitively means the situation of knowledge in “cultural” context. ...

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3 Constructing Moral Boundaries: Public Discourse on Human Experimentation in Twentieth-Century America

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pp. 69-89

During the 1960s and 1970s, the treatment of human subjects in clinical research became an identified public problem. Medical journals published commentaries criticizing researchers for moral laxity. Newspapers carried stories of investigatory abuse. Congress convened hearings on questionable experimental practices, including exposing subjects to great risk without the possibility of benefit, drawing subjects from vulnerable—often institutionalized—groups, and failing to secure informed consent. ...

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4. Media Images, Genetics, and Culture: Potential Impacts of Reporting Scientific Findings on Bioethics

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pp. 90-111

Bioethical issues generally are conceived of as arising within doctor-patient encounters and relating to matters such as the provision of medical information, decisions about treatment protocols, and the scientific investigation of treatment options. The vision of bioethics has focused largely on decision making, autonomy, and consent in treatment and research contexts. In this chapter, I want to broaden the scope of bioethics to include aspects of the social context that typically are not considered as “bioethical” concerns. ...

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5. Emotions in Medical and Moral Life

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pp. 112-136

Both medical life and moral life evoke deep emotions. Merely contemplating a hospital conjures emotion-laden images: the grief of families of dying patients; the joy of new parents; the fear of patients hearing a diagnosis of cancer; the pride of a surgeon describing a technical feat; and the guilt of a medical student experiencing the first death of a patient. Moral life, too, evokes emotionally charged imagery: the vehemence of Dr. Jack Kevorkian as well as that of his opponents; the anger of demonstrators outside an abortion clinic...

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6. A Contextual Approach to Clinical Ethics Consultation

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pp. 137-152

Clinical ethics consultation has become increasingly prevalent in biomedical settings in the last decade. A recent consensus statement (Fletcher and Siegler 1996:125) defined ethics consultation as “a service provided by an individual consultant, team, or committee to address the ethical issues involved in a specific clinical case.” The primary goal of ethics consultation is to improve patient care by helping patients, their families, and health care providers to identify, analyze, and resolve ethical problems that occur in the course of medical treatment.1...

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7. Family Values and Resistance to Genetic Testing

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pp. 153-179

We are currently in the midst of a historic shift in the conceptualization of health and illness. Increasingly health and illness are being viewed through “the prism of heritability” (Duster 1990:2). The seductiveness of this perspective is reflected in the proliferation of terms such as “geneticization,” “the genetic revolution” (Elmer-DeWitt 1994; Kitcher 1996), and “genomania” (Hubbard 1995:13). Lippman (1991:19) defined “geneticization” as “the process by which interventions employing genetic technologies are adopted to manage problems of health.” ...

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8. Ethics Committees and Social Change: Plus

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pp. 180-198

One of the most fertile sites for contextual analysis of health care ethics is located at its core—the operation of the institutional ethics committee (IEC). IECs have been contextual entities from their inception. They are the result of powerful social forces, and they represent both a response to social change and an attempt to foster further change. ...

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9. Irony, Ethnography, and Informed Consent

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pp. 199-220

Much of this volume is an argument for and demonstration of two interrelated propositions: Bioethical analysis can be made sharper if more attention is paid to the context of medical decision making, and ethnography is the ideal method for accomplishing this. Intellectual completeness and honesty—not to mention the self-reflexive dimension of ethnographic work itself—require that attention to the ethnography of medical ethics be matched by a reciprocal analysis of the ethics of ethnography. ...

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Afterword

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pp. 221-227

Many of the chapters in this volume employ qualitative research methods. Indeed, the use of such methods, ethnography in particular, seems to be central to creating the kind of contextual approach to bioethics that this volume seeks (see Conrad 1994; Hoffmaster 1992; Jennings 1990). That view has become almost commonplace, for as Fox and DeVries have observed, “Among sociologists working in the field of bioethics, it is taken for granted that the method par excellence of conducting socially and culturally cognizant and sensitive bioethical research is ethnography” (1998:273). ...

About the Contributors

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pp. 229-230

Index

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pp. 231-234


E-ISBN-13: 9781439901168

Publication Year: 2001