Skip navigation

Bioethics

  • Page 3 of 10
Science, Policy, and Politics

Bioethics has become increasingly politicized over the past decade. Conservative voices dominated the debate at first, but the recent resurgence of progressivism and the application of its fundamental values (social justice, critical optimism, practical problem solving) to bioethical issues have helped correct this ideological imbalance. Progress in Bioethics is the first book to debate the meaning of progressive bioethics and to offer perspectives on the topic both from bioethicists who consider themselves progressive and from bioethicists who do not. It aims to begin a dialogue and to provide a foothold for readers interested in understanding the field.

The chapter authors, leading scholars in the field, discuss the meaning of progressive bioethics, the rise of conservative bioethics, the progressive stance toward biotechnology, the interplay of progressive bioethics and religion, and progressive approaches to such specific policy issues as bioethics commissions, stem cell research, and health-care reform.

Bioconstitutionalism in the Genetic Age
Edited by Sheila Jasanoff

Legal texts have been with us since the dawn of human history. Beginning in 1953, life too became textual. The discovery of the structure of DNA made it possible to represent the basic matter of life with permutations and combinations of four letters of the alphabet, A, T, C, and G. Since then, the biological and legal conceptions of life have been in constant, mutually constitutive interplay--the former focusing on life’s definition, the latter on life’s entitlements. Reframing Rights argues that this period of transformative change in law and the life sciences should be considered “bioconstitutional.”
Reframing Rights explores the evolving relationship of biology, biotechnology, and law through a series of national and cross-national case studies. Sheila Jasanoff maps out the conceptual territory in a substantive editorial introduction, after which the contributors offer “snapshots” of developments at the frontiers of biotechnology and the law. Chapters examine such topics as national cloning and xenotransplant policies; the politics of stem cell research in Britain, Germany, and Italy; DNA profiling and DNA databases in criminal law; clinical trials in India and the United States; the GM crop controversy in Britain; and precautionary policymaking in the European Union. These cases demonstrate changes of constitutional significance in the relations among human bodies, selves, science, and the state.

Autonomy through Psychotherapy

One in six people worldwide will experience depression over the course of a lifetime. Many who seek relief through the healthcare system are treated with antidepressant medication; in the United States, nearly 170 million prescriptions for antidepressants were written in 2005, resulting in more than $12 billion in sales. And yet despite the dominance of antidepressants in the marketplace and the consulting room, another treatment for depression has proven equally effective: psychotherapy--in particular, cognitive behavior therapy (CBT). Antidepressants can lift mood independent of a person’s understanding of symptoms or stressors. By contrast, CBT teaches patients skills for dealing with distressing feelings, negative thoughts, and causal stressors. In The Ethical Treatment of Depression, Paul Biegler argues that the insights patients gain from the therapeutic process promote autonomy. He shows that depression is a disorder in which autonomy is routinely and extensively undermined and that physicians have a moral obligation to promote the autonomy of depressed patients. He concludes that medical practitioners have an ethical imperative to prescribe psychotherapy--CBT in particular--for depression. To make his case, Biegler draws on a wide philosophical literature relevant to autonomy and the emotions and makes a comprehensive survey of the latest research findings from the psychological sciences. Forcefully argued, densely researched, and engagingly written, the book issues a challenge to physicians who believe their duty of care to depressed patients is discharged by merely writing prescriptions for antidepressants.

An Institutional Compromise

Physicians in the United States who refuse to perform a variety of legally permissible medical services because of their own moral objections are often protected by "conscience clauses." These laws, on the books in nearly every state since the legalization of abortion by Roe v. Wade, shield physicians and other health professionals from such potential consequences of refusal as liability and dismissal. While some praise conscience clauses as protecting important freedoms, opponents, concerned with patient access to care, argue that professional refusals should be tolerated only when they are based on valid medical grounds. In Conflicts of Conscience in Health Care, Holly Fernandez Lynch finds a way around the polarizing rhetoric associated with this issue by proposing a compromise that protects both a patient’s access to care and a physician’s ability to refuse. This focus on compromise is crucial, as new uses of medical technology expand the controversy beyond abortion and contraception to reach an increasing number of doctors and patients.

Lynch argues that doctor-patient matching on the basis of personal moral values would eliminate, or at least minimize, many conflicts of conscience and suggests that state licensing boards facilitate this goal. Licensing boards would be responsible for balancing the interests of doctors and patients by ensuring a sufficient number of willing physicians such that no physician's refusal leaves a patient entirely without access to desired medical services. This proposed solution, Lynch argues, accommodates patients' freedoms while leaving important room in the profession for individuals who find some of the capabilities of medical technology to be ethically objectionable.

An Introduction with Readings
Edited by Martha J. Farah

Neuroscience increasingly allows us to explain, predict, and even control aspects of human behavior. The ethical issues that arise from these developments extend beyond the boundaries of conventional bioethics into philosophy of mind, psychology, theology, public policy, and the law. This broader set of concerns is the subject matter of neuroethics. In this book, leading neuroscientist Martha Farah introduces the reader to the key issues of neuroethics, placing them in scientific and cultural context and presenting a carefully chosen set of essays, articles, and excerpts from longer works that explore specific problems in neuroethics from the perspectives of a diverse set of authors. Included are writings by such leading scientists, philosophers, and legal scholars as Carl Elliot, Joshua Greene, Steven Hyman, Peter Kramer, and Elizabeth Phelps. Topics include the ethical dilemmas of cognitive enhancement; issues of personality, memory and identity; the ability of brain imaging to both persuade and reveal; the legal implications of neuroscience; and the many ways in which neuroscience challenges our conception of what it means to be a person.

Neuroethics is an essential guide to the most intellectually challenging and socially significant issues at the interface of neuroscience and society. Farah's clear writing and well-chosen readings will be appreciated by scientist and humanist alike, and the inclusion of questions for discussion in each section enhances the book's appeal for classroom use.

Contributors: Zenab Amin, Ofek Bar-Ilan, Richard G. Boire, Philip Campbell, Turhan Canli, Jonathan Cohen, Robert Cook-Degan, Lawrence H. Diller, Carl Elliot, Martha J. Farah, Rod Flower, Kenneth R. Foster, Howard Gardner, Michael Gazzaniga, Jeremy R. Gray, Henry Greely, Joshua Greene, John Harris, Andrea S. Heberlein, Steven E. Hyman, Judy Iles, Eric Kandel, Ronald C. Kessler, Patricia King, Adam J. Kolber, Peter D. Kramer, Daniel D. Langleben, Steven Laureys, Stephen J. Morse, Nancey Murphy, Eric Parens, Sidney Perkowitz, Elizabeth A. Phelps, President's Council on Bioethics, Eric Racine, Barbara Sahakian, Laura A. Thomas, Paul M. Thompson, Stacey A. Tovino, Paul Root Wolpe

Improving Treatment and Understanding of the Mind-Brain

Today the measurable health burden of neurological and mental health disorders matches or even surpasses any other cluster of health conditions. At the same time, the clinical applications of recent advances in neuroscience are hardly straightforward. In Pragmatic Neuroethics, Eric Racine argues that the emerging field of neuroethics offers a way to integrate such specialties as neurology, psychiatry, and neurosurgery with the humanities and social sciences, neuroscience research, and related healthcare professions, with the goal of tackling key ethical challenges and improving patient care. Racine provides a survey of the often diverging perspectives within neuroethics, offers a theoretical framework supported by empirical data, and discusses the neuroethical implications of such issues as media coverage of neuroscience innovation and the importance of public concerns and lay opinion; nonmedical use of pharmaceuticals for performance enhancement; and the discord between intuitive notions about consciousness and behavior and the scientific understanding of them.

Racine proposes a pragmatic neuroethics that combines pluralistic approaches, bottom-up research perspectives, and a focus on practical issues (in contrast to other more theoretical and single-discipline approaches to the field). [He discusses ethical issues related to powerful neuroscience insights into the mechanisms underlying moral reasoning, cooperative behavior, and such emotional processes as empathy.] In addition, he outlines a pragmatic framework for neuroethics, based on the philosophy of emergentism, which identifies conditions for the meaningful contribution of neuroscience to ethics, and sketches new directions and strategies for meeting future challenges for neuroscience and society.

Basic Bioethics series

In this book, Norman Cantor analyzes the legal and moral status of people with profound mental disabilities—those with extreme cognitive impairments that prevent their exercise of medical self-determination. He proposes a legal and moral framework for surrogate medical decision making on their behalf. The issues Cantor explores will be of interest to professionals in law, medicine, psychology, philosophy, and ethics, as well as to parents, guardians, and health care providers who face perplexing issues in the context of surrogate medical decision making.

The profoundly mentally disabled are thought by some moral philosophers to lack the minimum cognitive ability for personhood. Countering this position, Cantor advances both theoretical and practical arguments for according them full legal and moral status . He also argues that the concept of intrinsic human dignity should have an integral role in shaping the bounds of surrogate decision making. Thus, he claims, while profoundly mentally disabled persons are not entitled to make their own medical decisions, respect for intrinsic human dignity dictates their right to have a conscientious surrogate make medical decisions on their behalf. Cantor discusses the criteria that bind such surrogates. He asserts, contrary to popular wisdom, that the best interests of the disabled person are not always the determinative standard: the interests of family or others can sometimes be considered. Surrogates may even, consistent with the intrinsic human dignity standard, sometimes authorize tissue donation or participation in nontherapeutic medical research by profoundly disabled persons. Intrinsic human dignity limits the occasions for such decisions and dictates close attention to the preferences and feelings of the profoundly disabled persons themselves. Cantor also analyzes the underlying philosophical rationale that makes these decision-making criteria consistent with law and morals.

Bridging the Science/Humanism Divide

Psychiatry today is torn by opposing sensibilities. Is it primarily a science of brain functioning or primarily an art of understanding the human mind in its social and cultural context? Competing conceptions of mental illness as amenable to scientific explanation or as deeply complex and beyond the reach of empirical study have left the field conceptually divided between science and humanism. In Healing Psychiatry David Brendel takes a novel approach to this stubborn problem. Drawing on the classical American pragmatism of Charles Sanders Peirce, William James, and John Dewey, as well as contemporary work of pragmatic bioethicists, Brendel proposes a "clinical pragmatism" that synthesizes scientific and humanistic approaches to mental health care. Psychiatry, he argues, must integrate scientific and humanistic models by emphasizing the practical, pluralistic, participatory, and provisional aspects of clinical diagnosis and treatment. Psychiatrists need to have the skill and flexibility to use scientific and humanistic approaches in a collaborative, open-ended clinical process; they must recognize the complexity of human suffering even as they strive for scientific rigor. This is the only way, he writes, that psychiatry can heal its conceptual rift and the emotional wounds of its patients.Healing Psychiatry explores these issues from both clinical and theoretical standpoints and uses case histories to support its basic argument. Brendel calls for an open-minded and flexible yet scientifically informed approach to understanding, diagnosing, and treating mental disorders. And he considers the future of psychiatry, applying the principles of clinical pragmatism to a broad range of ethical concerns in psychiatric training and research.

Moral and Social Implications of Creating Life in the Laboratory

Teams of scientists around the world are racing to create protocells--microscopic, self-organizing entities that spontaneously assemble from simple organic and inorganic materials. The creation of fully autonomous protocells--a technology that can, for all intents and purposes, be considered literally alive--is only a matter of time. This book examines the pressing social and ethical issues raised by the creation of life in the laboratory. Protocells might offer great medical and social benefits and vast new economic opportunities, but they also pose potential risks and threaten cultural and moral norms against tampering with nature and “playing God.” The Ethics of Protocells offers a variety of perspectives on these concerns. After a brief survey of current protocell research (including the much-publicized “top-down” strategy of J. Craig Venter and Hamilton Smith, for which they have received multimillion dollar financing from the U.S. Department of Energy), the chapters treat risk, uncertainty, and precaution; lessons from recent history and related technologies; and ethics in a future society with protocells. The discussions range from new considerations of the precautionary principle and the role of professional ethicists to explorations of what can be learned from society’s experience with other biotechnologies and the open-source software movement.

Contributors: Mark A. Bedau, Gaymon Bennett, Giovanni Boniolo, Carl Cranor, Bill Durodié, Mickey Gjerris, Brigitte Hantsche-Tangen, Christine Hauskeller, Andrew Hessel, Brian Johnson, George Khushf, Emily C. Parke, Alain Pottage, Paul Rabinow, Per Sandin, Joachim Schummer, Mark Triant, Laurie Zoloth

Bioethical dilemmas--including those over genetic screening, compulsory vaccination, and abortion--have been the subject of ongoing debates in the media, among the public, and in professional and academic communities. But the paramount bioethical issue in an age of digital technology and new media, Joanna Zylinska argues, is the transformation of the very notion of life. In this provocative book, Zylinska examines many of the ethical challenges that technology poses to the allegedly sacrosanct idea of the human. In doing so, she goes beyond the traditional understanding of bioethics as a matter for moral philosophy and medicine to propose a new “ethics of life” rooted in the relationship between the human and the nonhuman (both animals and machines) that new technology prompts us to develop. After a detailed discussion of the classical theoretical perspectives on bioethics, Zylinska describes three cases of “bioethics in action,” through which the concepts of “the human,” “animal,” and “life” are being redefined: the reconfiguration of bodily identity by plastic surgery in a TV makeover show; the reduction of the body to two-dimensional genetic code; and the use of biological material in such examples of “bioart” as Eduardo Kac’s infamous fluorescent green bunny. Zylinska addresses ethics from the interdisciplinary perspective of media and cultural studies, drawing on the writings of thinkers from Agamben and Foucault to Haraway and Hayles. Taking theoretical inspiration in particular from the philosophy of alterity as developed by Jacques Derrida, Emmanuel Levinas, and Bernard Stiegler, Zylinska makes the case for a new nonsystemic, nonhierarchical bioethics that encompasses the kinship of humans, animals, and machines.

  • Page 3 of 10